Dissociation, Trauma, and the Role of Lived Experience: Toward a New Conceptualization of Voice Hearing Eleanor Longden Bradford and Airedale Early Intervention in Psychosis Service, Bradford, England Anna Madill and Mitch G. Waterman University of Leeds Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self– other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed. Keywords: auditory hallucinations, psychosis, dissociation, trauma Voice hearing (VH) is a singular human experience that is referred to in many ways: auditory or verbal hallucinations, splin- ter psyches, locutions, and language magic being four examples (Watkins, 2008). 1 For some it may be a fleeting and dispassionate event, yet in others inspire such profound and fundamental changes in their social, emotional, and cultural experience as to possess the equivalent “primitive immediacy” of a genuine sensory incident (Bell, Raballo, & Larøi, 2010, p. 378). The phenomenon has been described and understood in a myriad of ways: as psychic or paranormal, as spiritual or devotional, 2 as psychiatric incident, and even as psychologically normal and natural. From the elevat- ing and inspirational to the malevolent and persecutory, VH has been portrayed as a source of comfort, instruction, and guidance or as a critical, commanding presence that threatens, terrorizes, and attacks. VH experiences have been documented throughout human history, and the number of reported voice hearers is striking: from Socrates and Joan of Arc (Leudar & Thomas, 2000) to Carl Jung, Mahatma Gandhi (Watkins, 2008), and Virginia Woolf (D. B. Smith, 2007). Jaynes (1976) has even argued that VH is an evolutionary adaptation that played an essential role in the origins of human consciousness. For the purposes of this review, VH will be defined according to the following parameters: (a) a percept-like experience in the absence of appropriate stimulus, which manifests as (b) a human vocalization, which is experienced in (c) a conscious state and is (d) not induced by organic or state-dependent circumstances (see Bentall, 1990; Slade & Bentall, 1988). According to Liester (1996, 1998), VH anchors a continuum with other mental events, with “inner speech,” 3 or the “inner voice” (“true” perceptions associ- 1 Although auditory and/or verbal hallucinations are favored terminol- ogy in professional literature, the term voice hearing is deemed more neutral and subjective (James, 2001; Romme & Escher, 1993, 2000) and, as such, is preferred here. 2 Whether VH may represent an authentic spiritual event in certain instances is beyond the scope of this article. As noted by Moskowitz and Corstens (2007), “Adequate means to distinguish such experiences from [those] better explained by psychological (dissociative) mechanisms re- main to be established” (pp. 58 –59). 3 Inner speech is an ambiguous term that has been defined in an assortment of ways, including “the overlapping region of thought and speech” (S. R. Jones & Fernyhough, 2007, p. 148), “thinking in words” (McGuire et al., 1995, p. 596), verbal thought (Vygotsky, 1934/1987), and simply “speech without sound” (de Guerrero, 2005, p. 22). This article was published Online First November 14, 2011. Eleanor Longden, Bradford and Airedale Early Intervention in Psychosis Service, Bradford, England; Anna Madill and Mitch Waterman, Institute of Psychological Sciences, University of Leeds, Leeds, England. The article is based on a predoctoral dissertation by Eleanor Longden supervised by Anna Madill, with additional guidance and input from Mitch Waterman. We wish to thank Allan House and Dirk Corstens for their helpful comments on an early version of this article. Correspondence concerning this article should be addressed to Eleanor Longden, who is now at Institute of Psychological Sciences, University of Leeds, Leeds LS2 9LT, England. E-mail: eleanorlongden@gmail.com Psychological Bulletin © 2011 American Psychological Association 2012, Vol. 138, No. 1, 28 –76 0033-2909/11/$12.00 DOI: 10.1037/a0025995 28