Hearing voices: more common than you might think

I remember being woken up from one of my daily naps by the familiar melody of the ice cream van that comes round our estate every day in summer. True, it was slightly odd that I could hear it so vividly despite wearing ear plugs; nevertheless I leaped out of bed, grabbed my purse and ran outside. Imagine my disappointment when I realized that there was no ice cream van in sight!

Voices can be loud and clear, or barely distinguishable from thoughts.  Image courtesy of stockimages at FreeDigitalPhotos.net
Voices can be loud and clear, or barely distinguishable from thoughts.
Image courtesy of stockimages at FreeDigitalPhotos.net

Auditory hallucinations are more common that we might think, and they do not only happen to people with mental health problems. The example I described above is a form of hypnopompic hallucinations, i.e. those experienced upon awakening from sleep, and familiar to just over 12% of the population (Ohayon et al., 1996).

Let’s take a moment though to consider what we mean by a ‘hallucination’. The word itself comes from the Latin ‘allucinari’ meaning ‘to wander in the mind’, ‘to dream’ (Choong et al., 2007). It is a perception that occurs in the absence of an external stimulus, when we are fully or partially awake, and is not to be confused with an illusion, which is a misperception of a real stimulus. Hallucinations are one of the cardinal symptoms of schizophrenia; indeed, 70% of people with this illness hear voices. However, they are not the only ones. In some studies 10% of men and 15% of women in the general population described hearing voices at some point in their lives (Tien, 1991). It is not uncommon to experience hallucinations when we are drifting off to sleep (hypnagogic) or  when we are waking up (hypnopompic). Hearing voices might affect us even more after we lose a loved one; nearly half of recent widows and widowers hear the voice of their dead spouse (Carlsson and Nilsson, 2007).

What is it then that people hear? Hallucinations could be fragments of memories or stream of consciousness, often related to worries, and are more likely to occur in times of stress or tiredness.  The voices could be loud and clear, as if someone in the room has just spoken, or they could be barely distinguishable from our thoughts.

“I hear a mixture of men and women, but no children. They usually tell me to do things, but not dangerous things. Like they’ll tell me to take out the garbage or check the lock on the window or call someone. Sometimes they comment on what I’m doing and whether I’m doing a good job or what I could be doing better.” (Woods et al., 2015).

Since hallucinations affecting healthy people have a similar form to those that torment patients with schizophrenia, scientists think that they are on the continuum of normal perception. Where, then, is the line between ‘normal’ and ‘psychotic’ hallucinations and if we hear voices, does it mean we are at risk of a mental illness? Hallucinations that lead to, or are part of a disorder tend to be more negative and intrusive, and are associated with more anxiety and depression. For example, a healthy person might find spiritual or religious explanation for their voices and is more likely to ‘go along’ with them, whereas a person with psychosis is more likely to think that the voice belongs to a real person and try to resist it. The distress that the voices can cause might create a vicious cycle, where the more the individual fears and tries to avoid the voices, the more intrusive and frightening they become.

Voices in mental illness tend to be more negative and associated with more depression.  Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
Voices in mental illness tend to be more negative and associated with more depression.
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

“Starting when I was about 20 years old, I heard the voices of demons screaming at me, telling me that I was damned, that God hated me, and that I was going to hell… The voices were so frightening and disruptive that much of the time I was unable to focus or concentrate on anything else.”

The physiological underpinnings of hallucinations are not clear. We know that hearing sounds and voices that are not there activates the auditory cortex in a similar way  to ‘real’ auditory stimuli. The content of hallucinations are probably best understood in the context of the individual’s life, personality and experiences. A simple melody produced by the auditory cortex in response to your craving for ice cream is harmless enough. Similarly, hearing the voice of a dead loved one might be comforting; their voice is imprinted on your brain – no wonder it can be reproduced when you long to hear it. Perhaps the derisive commentary is your internal critic that harnessed the auditory cortex to torment you? One thing is certain: whilst voices can be very distressing and coping with them often requires professional help, they are not always dangerous or a sign of mental illness.

Post by: Jadwiga Nazimek


Carlsson, M. E. & Nilsson, I. M. (2007) Bereaved spouses’ adjustment after the patients’ death in palliative care. Palliative and Supportive Care, 5, 397-404.

Choong, C., Hunter, M. D. & Woodruff, P. W. (2007) Auditory hallucinations in those populations that do not suffer from schizophrenia. Current Psychiatry Reports, 9, 206-12.

Johns, L., Kompus, K., Connell, M. et al. (2014) Auditory Verbal Hallucinations in Persons With and Without a Need for Care. Schizophrenia Bulletin 40 (4): 255-264


Nayani, T. H. & David, A. S. (1996) The Auditory Hallucination: a Phenomenological Survey. Psychological Medicine, 26, 179-192.

Ohayon, M. M., Priest, R. G., Caulet, M. & Guilleminault, C. (1996) Hypnagogic and hypnopompic hallucinations: pathological phenomena? British Journal of Psychiatry, 169, 459-67.

Tien, A. Y. (1991) Distributions of hallucinations in the population. Social Psychiatry and Psychiatric Epidemiology, 26, 287-92.

Woods, A., Jones, N., Alderson-Day, B., Callard, F., fernyhough, C. (2015) Experiences of         hearing voices: analysis of a novel phenomenological survey. The Lancet. Psychiatry http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900006-1/fulltext

Scientist Syndrome? Check your Symptoms now!

Becoming a scientist is a process that reminds me of the saying, “you can’t see the wood for the trees.” If that’s not immediately obvious, stick with me, you may find that this applies to you too…

When you’re studying or conducting research in the Sciences you’re so busy staring at your data (the trees), that you overlook your development as a person and a scientist (the wood).

Screen Shot 2015-05-21 at 12.29.54When I started out studying triple sciences at A-Level and secretly hating science, I couldn’t even make the simplest chemistry experiment work. I was in fact so bad that I made myself a comical ‘dunce’ hat to wear in class. And don’t get me started on Physics! My favourite subject was Psychology, which I later pursued at degree level; and although my theoretical knowledge was good, my technical ability, logical reasoning, and practical skills were average at best. The weight of these limitations was a constant burden throughout my career, until mounting evidence suggested what I could not believe to be true… I had somehow unwittingly shed my shackles of ineptitude and become what can only be known as… A Scientist.

There’s no absolute test to see if you have unwittingly become a Scientist. I rather like to imagine it as “Scientist Syndrome” – diagnosed by the observation of a cluster of symptoms. And it’s not an easy syndrome to live with. You can use the following symptom checker to see if you too, have become a scientist.

1) Data Rage: Any reporting of data annoys you.

Do you find that you have to question any basic reporting of data in the media? Are you left with remaining questions regarding the validity of said data; plagued with intrusive thoughts after such an ordeal? Then you may have Data Rage…

Whilst watching BBC News one morning, I learned about the crisis UK milk producers are suffering regarding the price of milk. It sounded quite the dire situation – the price that supermarkets pay for milk has fallen year on year, meaning that some farms can no longer afford to carry on. Terrible news! The reporter went on to present a bar graph of the price of milk by year to make his point. “Great idea”, I thought. But no, this was an epic fail that, for me, completely undermined the story. At a glance I could already see that at least one of the bars was not smaller than its predecessor, suggesting that the price of milk did not fall that year. What’s more disturbing – I had grave concerns that the price of milk from year to year was not significantly different – i.e. it didn’t look to me as if the difference in price was large enough to say for sure that the price was really falling year by year rather than just fluctuating in the normal way prices tend to. To know this I wanted to see the standard error of milk prices for each year. But, to my horror, no standard error was presented. How could the BBC make such an oversight?! Breakfast ruined.

2) Matlabitis: inflammation of the matlab gland.

If you are regularly caught extolling the benefits of MATLAB to your poor uneducated Excel-using friends, then you may just be suffering from a bad case of ‘Matlabitis’. For those (un?)lucky enough not to know what Matlab is – it’s a life-changing ‘high level’ programing language, which is great for management and analysis of large data sets and, which includes a number of useful toolboxes for specialist analysis (like SPM (Statistical Parametric Mapping) for neuroimaging research). With matlab the world is your oyster! And, it’s exactly this kind of thinking that is symptomatic of Matlabitis.

When I started my PhD I did a lot of my data management in Microsoft Excel – nothing wrong with that, but it wasn’t easy. For example, in a complex data set you may have many columns of data (let’s say relating some demographic information and questionnaire responses). So far, so good. But what if you want to look at a subset of these data, like only data from males? “Use the Sort function” I hear you cry? Indeed! But what if you want to look at a subsection within a subsection; or what if there are more than two conditions that specify the data of interest (males, over 30 years old, living in South Manchester, who have a disability)? I found this tedious and difficult in Excel, however, in matlab I can write a simple function that loops through each row and selects only the data that satisfy my conditions. If I want to, I can then save it as a new variable (organised like a spreadsheet), and manipulate (organise) it to display however I wish. It’s like a dream, I’m telling you! It’s when you start using matlab outside of work that you should worry…

3) Scientist Syndrome Sleep Disturbances.

Screen Shot 2015-05-21 at 12.30.07Do you wake up in a cold sweat, wondering whether the analysis you left running overnight has finished? Have you had dreams about your research? Are your night-times plagues by nightmares of mislabelled graphs, insignificant t-tests and negative reviewer’s comments? If so, you may be suffering from Scientist Syndrome sleep disturbances.

You spend so many hours of your life at work that when you leave for home you need a peaceful, work-free environment. However, if you haven’t properly decompressed from the day, you can inadvertently bring you work home with you. This can lead to troubles falling asleep, early waking, and night terrors. One time when I was deep in programming (writing a code – in matlab of course – that would present my experiment on a computer screen) I seriously had a nightmare that I could only talk in ‘for’ / ‘if’ loops and logical statements. I know it’s a common joke that scientists might as well talk in binary code, but this was no joke, it was terrifying!

4) Science-related sight difficulties: You see ANOVAs everywhere.

Like many syndromes, Science Syndrome can adversely affect our senses and our cognitions – the way we think. If you’ve found yourself looking at simple objects of beauty in a new and slightly odd way, or you’ve started interpreting art as science, this may be a sign that you have Science-related sight difficulties.

During my Masters studies, I think I over-indulged in statistics a little, until one day I had a temporary breakdown. I was at band practice with my housemate (we called ourselves The Gamma Band, which should have been an early warning sign of the syndrome) guitar in hand, vocal chords warmed. And then it hit me. The guitar was like a very large ANOVA (a statistical analysis of variance). ANOVAs test the statistical relationship between a number of factors, which can have many levels. In this case the factors were: Strings (with 6 levels, one per string); and Frets (with 19 levels, one per fret). The combination of these levels and factors create distinctly different sounds, and therefore I reasoned that this demonstrated a significant ANOVA. When I explained this to my housemate, she was not enthused. We never spoke of the guitar ANOVA again…

5) SNR hypersensitivity: You explain everything as Signal to Noise Ratio (SNR).

Screen Shot 2015-05-21 at 12.30.15Have you started seeing your environment differently? Maybe your perception of the environment (what you actually see) is the same, but the way you interpret and navigate it is different? If this sounds like you, you may be suffering from SNR hyperactivity.

I noticed this myself last week when driving through drizzly Manchester. Although well-known for its downpours, on this particular day the rain was happily rather light. I was driving home from the office, listening to XFMs daily feature “that’s good innit” when I had my own “that’s good innit” moment. I found the optimal windscreen wiper setting for the weather conditions. I’m ashamed to say that not only did this realisation accompany a rather long inner monologue which hinged upon scientific concepts but, that I also felt utterly delighted. I reasoned to myself that the size and frequency of the rain drops, along with the velocity of my car had created a deficit in the usual signal to noise ratio of driving. The proportion of signal – in this case, the visual information my eyes could detect about the road, the position of other cars etc. – was lower than the proportion of noise – in this case, the disruption to my visual perception caused by rain on the windscreen making things look blurry. Fortunately this disaster was averted by choosing the correct windscreen wiper speed, which weighed the SNR (signal to noise ratio) in favour of the signal by eradicating enough noise (rain) to drive safely. As Clint Boon of XFM would say – “that’s good innit!”

If you have been affected by any of the issues raised in this article, you should “get help now”; or to use my (newly) native tongue: “01100111 01100101 01110100 00100000 01101000 01100101 01101100 01110000 00100000 01101110 01101111 01110111”.(binary code taken from http://www.unit-conversion.info/texttools/convert-text-to-binary/).

Post by: Gemma Barnacle

Dementia: hanging on

“I am, along with many others, scrabbling to stay ahead long enough to be there when the Cure comes along’ said Terry Pratchett when donating to research on Alzheimer’s disease (AD). The writer had been suffering from a rare form of dementia, which starts at an unusually young age (he was diagnosed at the age of 59).

Social interactions are very important for the wellbeing of people with dementia. Image courtesy of graur razvan ionut at FreeDigitalPhotos.net
Social interactions are very important for the wellbeing of people with dementia.
Image courtesy of graur razvan ionut at FreeDigitalPhotos.net

Why is the number of people with dementia increasing? The simple answer is: because we live longer. Some older people experience hardly any changes in their memory with age; many may become more forgetful and think more slowly, but otherwise their mind will remain intact. Age, however, is the greatest risk factor for dementia, an illness that affects 850 000 people in UK and gradually destroys our ability to remember, think, interact with others, live independently and look after ourselves.

Alzheimer’s disease, similar to the early-onset illness that affected Terry Pratchett, is the main culprit in dementia. It is responsible for 60–70% of cases and manifests in the brain as accumulations of sticky protein, which form plaques in the brain. The protein, called beta amyloid, kills the nerve cells and causes the brain to shrink. On the other hand, in vascular dementia (VaD) – the second most common killer – symptoms are caused by problems with blood vessels in the brain. Doctors diagnose the type of dementia on the basis of the pattern of symptoms and the brain images, which show them the areas of damage.

Accumulations of beta-amyloid protein is thought to be the main culprit in death of neurons in AD. Image courtesy of National Institute on Aging, via Wikimedia Commons
Accumulations of beta-amyloid protein is thought to be the main culprit in death of neurons in AD. Image courtesy of National Institute on Aging, via Wikimedia Commons

At the moment there is no cure for dementia. Some medications, if taken early, help to slow down the progress of AD. Medicine can also help with problems that accompany the illness, such as anxiety, agitation and depression. Finding a cure for dementia is, therefore, the great challenge for today’s research. So how far have scientists got when it comes to tackling it?

One of the questions that researchers are looking into is: why and how exactly do the sticky proteins accumulate in the brain? Here, Down syndrome has shed some light on the events in the brain. People with Down syndrome have an additional copy of chromosome 21. Apart from having some level of intellectual disability, they also suffer from increased risk of AD. By the age 65, 75% of individuals with Down syndrome have symptoms of dementia. It seems that the extra copy of chromosome 21 might be responsible for reduced level of a protein called sorting nexin 27 (SNX27). SNX27 lowers the level of beta amyloid by curbing the activity of an enzyme (gamma secretase) which produces the sticky protein.

Beta-amyloid is a sticky protein that forms plaques in the brain. Image courtesy of National Institute on Aging, via Wikimedia Commons
Beta-amyloid is a sticky protein that forms plaques in the brain. Image courtesy of National Institute on Aging, via Wikimedia Commons

Whilst gamma – and beta – secretases increase the production of beta amyloid, their sister alpha secretase, an enzyme called ADAM10, has the opposite effect. It blocks the growth of the sticky protein, whilst protecting the nerve cells. Scientists have discovered that a drug for psoriasis (skin problem) increases the activity of ADAM10 in brains of people affected by AD. However, before this medication can be used to treat AD, it has to be tested in extensive and lengthy clinical trials.

Other areas of science are focusing on the influence of diet and lifestyle on the risk of dementia. Researchers have found that older people who have a deficiency of vitamin D (the sunshine vitamin) are more likely to develop dementia. The greater the deficiency, the greater the likelihood of the illness: the risk for those with low levels of vitamin D was 53% higher, and for those with severe deficiency was 125% higher. This could be because vitamin D is not just a building block for our bones, it contributes to clearing the amyloid plaques in the brain and protecting the neurons. Lack of vitamin D can also cause problems with blood vessels, thus increasing the risk of vascular dementia.

Exercise reduces the risk of dementia. Image courtesy of Sura Nualpradid at FreeDigitalPhotos.net
Exercise reduces the risk of dementia. Image courtesy of Sura Nualpradid at FreeDigitalPhotos.net

Finally, some scientists investigating whether exercise can help us keep our brains healthy. Exercise fanatics will welcome the news that even if we carry a gene in which may predispose us to AD, a decent amount of exercise can protect our brains to some extent from shrinkage. ‘Decent’ in this study was equivalent to jogging, walking or swimming for at least 30 minutes a day, as well as playing sports, e.g. tennis, for at least an hour, but also – and this is good news for those of us who do a lot of housework – 45 minutes a day of fairly intense chores.

No ground-breaking news on the dementia front yet then. However, while we wait for scientists to find the cure, we can certainly look after ourselves and if nothing else, give ourselves a better chance of keeping dementia at bay with healthy lifestyle, good diet and exercise.

Post by: Jadwiga Nazimek



Littlejohns, T.J., Henley, W.E., Lang, I.A. and Annweiler, C. (2014) Vitamin D and the risk of dementia and Alzheimer disease. Neurology 2:920-928.

Flier, W.M. and Scheltens (2005) Epidemiology and risk factors of dementia. Journal of Neurology, Neurosurgery and Psychiatry 76:(Suppl V):v2–v7. doi: 10.1136/jnnp.2005.082867

Smith, J.C., Nielson, K.A., Woodard, J.L. et al. (2014) Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease. Frontiers in Aging Neuroscience 6:1-7

Endres, K., Fahrenholz, F., Lotz, J.  et al. (2014) Increased CSF APPs-a levels in patients with Alzheimer disease treated with acitretin. Neurology 83: 1930-1935.

Wang X., Huang, T., Hong, W., and Xu, H. (2014) SortingNexin 27 Regulates Aβ Production through Modulating γ-Secretase Activity. Cell Reports 9: 1023–1033

The unsung story of amusia

image03We’ve all seen those contestants on shows like ‘X Factor’ or ‘Britain’s got Talent’ who are adamant they can sing, when the evidence unfortunately suggests differently. We ask ourselves how it is they can’t tell or we leap to the conclusion that it must be a set up. And, while I admit this may sometimes be the case, bear in mind there could also be a medical diagnosis to explain the situation. These individuals may have a condition known as amusia.

More colloquially called “tone deafness”, approximately 4% of the population suffer from amusia. This differs from the self-diagnosed 15–17% who believe they have the condition but are just poor singers – the difference being that poor singers are aware of their difficulty while true amusics are not. Amusics also tend to find music unpleasant to listen to, leading them to try to avoid situations in which they may be exposed – a rather difficult feat given the popularity and prevalence of music in modern society. Amusia can be congenital (i.e. the individual is born with the condition) or acquired (as the result of a brain injury or stroke). While amusia may seem less debilitating than other potentially socially isolating conditions such as dyslexia or dyspraxia, it can also cause an individual a great deal of stress, lead to social stigma and may affect an individual’s ability to process and learn tonal languages (e.g. Mandarin or Thai).

The term amusia was coined back in 1888 by a doctor called August Knoblauch, following the first diagnosis of the condition 10 years earlier. Nowadays, amusia is diagnosed by a set of six tests, collectively known as The Montreal Battery of Evaluation of Amusia (MBEA), which examine an individual’s musical ability for contour, scale, pitch interval, rhythm, meter and musical memory.

As yet, there is no consensus on the neurological causes for amusia but, a key feature apparent in those with the condition seems to be a deficit in fine-grained pitch discrimination (i.e. an individual’s ability to process a small change in pitch, such as a tone or semi-tone). Based on a number of studies which imaged the brains of amusics and non-amusics, two areas of the brain known to be involved in processing music appear to be affected in amusia – the auditory cortex (AC; especially the right AC) and the inferior frontal gyrus (IFG). These studies found a difference in cortical thickness of the AC and IFG, as well as a reduction in brain activity in the IFG of amusic subjects compared to matched controls. Amusics also showed reduced connectivity from the AC to the IFG (via a group of fibres called the arcuate fasciculus) which correlated with the degree of tone deafness of the individual, offering further evidence for the involvement of these areas in the condition.

Screen Shot 2015-05-03 at 21.22.18

Whether someone with amusia can be “rehabilitated” or trained to improve their ability to process tone and to sing in tune is also up for debate. One small study in 2012 which provided five amusics with a 7-week course held by a professional singing teacher reported that four of the five subjects showed improved MBEA scores at the end of the study. However, whether the improvements were significant enough to warrant the time and resource invested into this study has been questioned.

It’s no secret that the term tone deafness is overused. But the condition, amusia, is a long-standing medical diagnosis which can have a significant effect on an individual’s social and educational life. Despite ongoing debate, the areas of the brain involved in music processing (the AC and IFG) differ both physically and in terms of activity in amusics compared with non-amusics. So next time X Factor hosts a “not so musically gifted individual”, I for one will hold my cynicism and consider a more medical reason before assuming it’s a set up.

Post by: Megan Barrett