Some people plagued by voices are grateful for drugs to silence them.
But hundreds of members of a group called Hearing Voices prefer to listen and communicate with their voices.
"At first I thought it was a support group. But it's much more far-reaching," said Jan, 43, a member of the Oxford chapter. "It's helping to validate those who hear voices and get across their point of view. It's giving people who hear voices a voice."
Jan and about five other people meet two evenings a month at the office of Dr. Gordon Claridge, a professor of psychology at Oxford University and an authority on schizophrenia. Claridge is the host for meetings run by the group itself.
Although many people with schizophrenia have auditory hallucinations, not all voice-hearers are schizophrenic, Claridge said. Schizophrenia is a diagnosis based on several symptoms that can include paranoia, distorted sense of reality and blunted emotions.
Many members of this burgeoning European organization hear voices but have no other symptoms of mental illness.
Hearing Voices was launched six years ago in Maastricht, the Netherlands, by Dr. Marius Romme, a psychiatrist, and one of his patients whose voices could not be stopped with drugs.
Neuroleptics, the drugs to treat auditory hallucinations, do not work in about a third of sufferers, Romme said. Others do not like the drugs because of the side effects, which can include tardive dyskinesia, a potentially irreversible syndrome of involuntary, jerky movements.
Some voice-hearers, like Sarah Bell who runs the meetings of the Oxford group, stopped taking drugs because they "stopped the voices but they also stopped my thinking altogether."
The patient who co-founded Hearing Voices tried to cope with her voices but she felt isolated and at times suicidal, according to Romme.
"I thought she should talk to other people who hear voices, but most of my patients couldn't cope. So we went on television to see if there were other people who heard voices and could cope," Romme said during a visit to London to promote the English translation of his book "Accepting Voices."
About 450 voice-hearers contacted Romme after the TV show, including 150 people who said they had never sought help.
"I was shocked," said Romme. "We met ordinary people who hear voices from time to time. That's what struck me because as a psychiatrist I'm educated that hearing voices is not healthy."
Indeed, centuries ago people who heard voices were not considered mad. They were venerated as messengers of God, glorified as mystics or feared for possessing evil forces.
In this century, Sigmund Freud tried to find hidden sexual meanings in voices.
Today, people who hear voices are thought to have a physiological brain disturbance, perhaps a chemical defect or faulty electric discharge. Though studies suggest a biological basis, scientists do not know precisely how chemicals or electric disturbances trigger voices.
Romme is not debunking modern theories. Nor is he crusading against drugs or psychotherapy. But he faults modern medicine for too often providing drugs without therapy.
"This kind of treatment allows no room for identification with the voices, which is the essential first step toward effective coping," said Romme.
Romme said the vast majority of people who hear voices are occasionally plagued by commands to commit violent acts. Voice-hearing members teach each other to listen but not to obey during those rare occurrences.
"At first people think if they don't obey the voices, things will get more troublesome," said Romme. "But then they realize when they don't obey, nothing happens, and it makes them more secure."
Most participants stay in touch by telephone every day or two between the twice-monthly meetings to offer emotional support or get members to a hospital for emergency medical attention. Hearing Voices does not oppose drugs for dire circumstances or for those who want them to ease anxiety.
Romme said few members suffer from paranoid schizophrenia, one form of schizophrenia in which patients are tormented constantly with voices telling them to kill.
"Paranoid people don't easily attend groups, because they are paranoid," said Romme.
But even for these very ill people Romme recommends a combination of medicine and continuous therapy.
"You can't just rely on medication because they can always stop taking medicine. You are much safer talking about it," said Romme.
Dr. John Strauss, a professor of psychiatry at Yale University, attended one of the Hearing Voices conferences in Maastricht and found it "really impressive."
"I think it's extremely important for people to learn how to deal with their voices, partly because they are so frightening . . . ," Strauss said.
Romme believes the way a person interprets the voices offers clues to the psyche. It's important to find out the age, sex and messages of the voices, he said.
In "Accepting Voices," Romme and his co-author, Sandra Escher, discuss a variety of coping strategies. Some patients believe they have otherworldly powers, hearing voices from God. Others believe they are telepathic, picking up brain waves from other people.
Hearing Voices takes no position, but supports any tactic that helps patients get through the day.
Bell, a research scientist with a degree in physics from Oxford University, believes she hears other people's thoughts.
Jan said she doesn't dwell on the cause of her voices, but tries to befriend them.
"It's the most intimate relationship you can have with someone, to know they can see you in the loo (toilet), to comment on what you're actually doing. At first they were doing all the talking, but now I feel we've entered a more two-way conversation.
"I even went through a phase when we got really close, and I loved them and wouldn't want to get rid of them," said Jan.
The ultimate goal of the organization, said Romme, is to remove the stigma attached to hearing voices.
Since its creation in 1987, Hearing Voices has grown to include 1,000 members in the Netherlands, more than 300 in England, a few groups in Austria, one chapter in Berlin and one in Italy.