An essay and short film about an artist learning to “co-live” with a distressing voice in her head has renewed public interest in non‑pathologizing, skill‑based approaches to voice‑hearing and in community, creative and peer‑led ways of reducing distress. The story — which foregrounds acceptance, art and practical coping rather than immediate removal of the symptom — echoes a growing body of research showing that many people who hear voices do not need inpatient care and that interventions focused on living with voices (rather than only eliminating them) can reduce harm and improve quality of life. The implications for Thailand are immediate: with mental‑health attendance rising, patchy access outside cities, and strong family and Buddhist cultural resources, Thai services can adapt low‑cost, culturally sensitive support that helps people co‑exist with voices while expanding clinical safety nets and research into what works locally (Aeon video and essay).
The topic matters to Thai readers because hearing voices is not as rare as most people assume, and responses that respect a person’s experience can reduce stigma and demand on acute services. Epidemiological work in Europe finds lifetime voice‑hearing in roughly 5–10% of people, with most voice‑hearers never seeking professional help and many reporting neutral or even positive relationships with their voices. A national Norwegian survey estimated a lifetime prevalence of auditory verbal hallucinations of about 7.3%, and noted that roughly 84% of people with voice‑hearing had not sought professional help; those who did seek help tended to experience more negative content, greater anxiety and depression, and were more likely to try resisting the voices rather than “doing nothing” or accepting them (Kråkvik et al., 2015). These patterns are globally relevant because they show voice‑hearing sits on a continuum from benign to clinically urgent, and responses should be tailored accordingly (Kråkvik et al., 2015).
Recent clinical research offers a mixed but maturing evidence base for therapeutic approaches that reduce distress without insisting on eradication of voices. Acceptance and Commitment Therapy (ACT) — which teaches people to notice and accept difficult thoughts and sensations while pursuing a meaningful life — has been trialed in psychosis and voice‑hearing. A systematic review and meta‑analysis of randomized trials concluded that evidence for ACT reducing core psychotic symptoms is limited and that trials to date are small and at risk of bias; the authors warned that safety reporting was inadequate and advised caution when implementing ACT as a front‑line clinical treatment for psychotic symptomatology (Brown et al., 2021). At the same time, some subgroup and rehospitalization analyses suggest ACT or group formats may reduce relapse risk for some patients, which points to a potential role as an adjunctive coping strategy rather than a guaranteed cure (Brown et al., 2021).
These scientific caveats matter when translating creative first‑person stories — such as the artist’s — into public policy. Personal narratives are powerful and can point to useful strategies (art, peer support, mindfulness, values work) but they do not replace randomized evidence of safety and efficacy. The ACT review’s caution — “there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology” — highlights the need for careful adaptation, monitoring for harms, and rigorous local research before large‑scale rollout (Brown et al., 2021).
Beyond ACT, a broader movement known as the Hearing Voices approach or Hearing Voices Network (HVN) advocates listening to people who hear voices, reducing stigma, and offering peer support groups that help voice‑hearers develop their own coping strategies and meanings. The Hearing Voices Network runs groups, training and resources that treat voice‑hearing as an understandable human experience rather than a single clinical emergency; many participants report less distress and greater agency after peer‑group engagement (Hearing Voices Network resources). For clinicians and families, the practical message from peer work is clear: ask what the voice says, what it means to the person, and which strategies reduce suffering — rather than jumping straight to a diagnostic label.
Creative practice — including art — is also emerging as an adjunctive tool for people who hear voices. Trials of art therapy in psychosis have produced mixed results: some studies find small benefits for negative symptoms and wellbeing, while larger trials have struggled to show strong effects on core positive symptoms. Recent reviews point to art and expressive therapies being acceptable and meaningful to many service users, though the evidence for symptom reduction remains limited and quality of trials varies (Cochrane‑style and systematic reviews of art therapy for psychosis; art therapy review 2022). For an artist learning to “co‑live” with a voice, art can be both a method of dialogue with the voice and a way to externalize suffering so it can be negotiated; such approaches fit comfortably with Thai cultural strengths of creative household and community rituals.
Thailand faces an acute set of local challenges and opportunities in mental health. A recent national study of facility attendances between 2015 and 2023 showed rising contacts for anxiety, depression and schizophrenia, regional clustering of diagnoses, and clear service gaps outside urban centers (spatiotemporal analysis of Thai mental‑health attendances, 2015–2023). The Department of Mental Health and the National Health Security Office have expanded hotlines and integrated mental‑health pathways into the Universal Coverage Scheme, but access remains uneven and stigma still limits help‑seeking in many provinces (Thailand mental‑health services integration and hotline details).
Putting the artist’s experience next to Thai realities suggests several practical lessons. First, a sizeable fraction of people who hear voices will benefit from non‑medical, community‑based supports. The Norwegian survey found that individuals who did not seek help most often used “doing nothing” or acceptance as a coping strategy and tended to experience voices as neutral or positive; by contrast those who sought help reported more distressing, negative voices and more active resistance strategies (Kråkvik et al., 2015). For Thailand, this argues for tiered responses: community and peer supports for non‑distressing voice‑hearers, and clinical treatment pathways for those whose voices are commanding, traumatic, or associated with self‑harm risk.
Second, Thai cultural and religious resources can be assets in compassionate care. Buddhist teachings that emphasize mindful awareness, non‑attachment, and compassion resonate strongly with acceptance‑oriented therapies and may make culturally adapted ACT‑style methods more intuitive for some people. Family‑centred care — a strong value in Thai society — can be mobilized to provide non‑stigmatising daily support, supervised by trained community mental‑health workers. Community rituals or supervised creative groups in temples, community centres or schools could provide safe spaces for people to externalize and transform voice experiences while preserving dignity.
Third, creative therapies and arts‑based programs deserve investment as low‑risk, high‑value adjuncts. They are acceptable to many voice‑hearers and can foster skills, social connection and meaning. However, Thai policymakers should not treat art or ACT as substitutes for clinical care where needed; rather they should be funded as complementary services, ideally embedded in community mental‑health teams that can monitor safety and refer higher‑risk cases to specialist services (art therapy and mixed evidence; art therapy for schizophrenia review).
Fourth, peer‑led Hearing Voices groups can be a low‑cost, scalable intervention to reduce isolation and stigma. The Hearing Voices Network model trains volunteers with lived experience to run listening groups and share coping strategies; international evidence is mainly qualitative but consistently positive about reduced shame and increased self‑management (Hearing Voices Network resources). Thailand could pilot HVN‑style groups, especially in provinces with mental‑health service gaps identified by the spatiotemporal analysis, partnering local community health officers and village health volunteers to reach hill‑tribe and border communities where access is weakest (Thai spatiotemporal needs map).
Expert perspectives underline both promise and caution. The lead systematic review of ACT for psychosis warns that trials are small, heterogeneous and often underpowered, concluding “there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology” and calling for larger, better‑reported trials with harms monitoring (Brown et al., 2021). At the same time, epidemiological studies emphasise that most voice‑hearing is non‑clinical and that coping styles differ; the Norwegian study observed that people who did not seek help were more likely to accept voices and report neutral or positive content (Kråkvik et al., 2015). Clinicians and policymakers should therefore adopt a balanced view: support acceptance‑oriented, peer and creative options for many voice‑hearers, but maintain robust clinical pathways and research for those with severe distress or risk.
What might this look like in practice in Thailand? First, expand community‑level, peer‑facilitated Hearing Voices groups in a handful of provinces chosen for need (for example, areas flagged as high‑need in the north and northeast by the 2015–2023 spatial analysis) and measure outcomes such as distress, social participation and service use. Second, pilot culturally adapted arts‑in‑mental‑health programs co‑designed with local artists and community leaders; run these inside existing community mental‑health units or temple‑based social programmes. Third, train primary‑care and community mental‑health staff in a “listen‑first, assess‑risk, support‑choices” approach so that non‑distressing voice‑hearing is not automatically medicalised and so that high‑risk cases are rapidly escalated. Fourth, integrate monitoring and research into all pilots: register trials, collect harms data, and publish results so Thai practice adds to global evidence rather than repeating low‑quality small studies (Brown et al., 2021).
Families, schools and temples can play constructive roles now. Families should be encouraged to ask supportive, non‑judgmental questions: What does the voice say? How does it affect daily life? What helps? Schools and universities can run anti‑stigma workshops that include lived‑experience testimony and creative activities; temples and local Buddhist leaders can host mindful listening circles that emphasize compassion and agency, not moral blame. These culturally rooted forums can reduce shame and encourage early help‑seeking where it is needed.
For clinicians and health administrators the priorities are straightforward. Strengthen crisis‑response capacity (hotlines, rapid outpatient teams and safe inpatient care for those with high risk), while rapidly scaling low‑intensity, peer and arts‑based community supports for the many who hear voices but are not in immediate danger. Ensure any psychological intervention — whether ACT, CBT for psychosis, or art therapy — is implemented with pre‑registration, clear outcome plans, and active monitoring for adverse events so Thailand avoids repeating the methodological problems flagged in the ACT literature (Brown et al., 2021).
There are obstacles. Stigma, workforce shortages, and uneven provincial resources mean some areas will need creative delivery models such as mobile outreach, tele‑health, and partnerships with NGOs and temple networks. Funding should be pragmatic: small pilots with measured outcomes can be far more informative than large, unmonitored programmes. Importantly, Thai research funders and universities can prioritise well‑designed, multicentre trials of culturally adapted interventions so that policy rests on high‑quality local evidence.
In sum, the artist’s decision to “co‑live” with a voice may be an instructive example for many in Thailand: acceptance, creative dialogue and peer support can reduce suffering for some people who hear voices. But individual stories should guide — not replace — careful clinical judgment and research. Thai services can take practical steps now: expand peer‑led groups, embed arts and mindfulness into community mental‑health, train primary‑care staff in assessment and supportive response, and commit to rigorous evaluation. Doing so will honour Thai cultural strengths of compassion and community while protecting those with the most urgent clinical needs (Kråkvik et al., 2015; Brown et al., 2021; Thailand mental‑health attendance mapping).
Practical recommendations for Thai readers and local services:
- If you or a family member hears a voice that is not distressing, consider local peer‑support groups or arts activities before assuming psychiatric diagnosis; ask “what helps?” rather than “what’s wrong?”.
- Where voices are threatening, commanding, or tied to self‑harm or severe mood symptoms, seek rapid clinical assessment (hotlines and community mental‑health units can triage risk).
- Community leaders and temples can host listening and arts groups that teach basic acceptance and coping skills while connecting people to clinical care when needed.
- Health managers should pilot Hearing Voices groups and arts programs in high‑need provinces identified by national data, and insist on pre‑registered evaluation and harms monitoring.
- Researchers and funders should prioritise methodologically sound, culturally adapted trials and transparent reporting so Thailand contributes robust evidence rather than small, underpowered studies (Brown et al., 2021).
The artist’s story of learning to “co‑live” with a voice is not a simple prescription for every person who hears voices. It does, however, put a humane choice on the table: for many people, relief comes from learning skills and finding community, from making art, and from clinicians who will listen first and escalate care only when it is needed. Thailand is well placed to combine its community networks, Buddhist practices, and growing mental‑health infrastructure to offer compassionate, evidence‑driven support that helps people live better lives — whether their voices go away or remain as part of who they are.