Understanding Child Development

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Children can hear voices for many reasons.

These reasons can include trauma, dissociation, psychosis, normal development, and complex family dynamics.

Why do children hear voices? I have written or spoken on this topic many times. I have done so as an academic researcher, as a program director of a first episode psychosis program, and now as a psychiatrist and psychoanalyst in private practice. I am definitely experiencing an un-learning.

When I go over my talks or writings from my time as a researcher, I realize that I took great confidence from the data I presented. When I gave the talk as a clinician, actually seeing young people who experienced voices, I felt a niggling sense that there was more to the story—I didn’t understand all the reasons my patients heard voices. I hadn’t yet been exposed to a vocabulary for their experiences. Now in private practice, I have the luxury to spend more time with people than just 20-minute medication management appointments, and with the added insights of analytic training, I am more open to the richness of the voice-hearing experience, and that niggling sense I had a few years ago has blossomed into a full awareness; the more I learn, the less I know.

So I will talk about some data, a number of clinical examples, and my own conjectures. But in the end, I really don’t know very much with certainty, except this: Children hear voices for all sorts of complex reasons.

First, a story. Anna’s mom contacted me because her school had put her on a medical leave until she got evaluated by a psychiatrist. She had reported hearing voices and seeing a ghost that told her to do things. I saw Anna once. What I saw was a 10-year-old girl who was off-the-charts smart, the kind of genius that sets children too far apart to adapt to others. The world is not designed for people, especially children, who are so outside of the normal range of IQ.

Anna was so bright that the IQ difference between her........

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