How doctors learn not to listen

John Goldie is a retired GP and medical educator

My introduction to Julian Jaynes’ theory of the “bicameral mind”¹—the idea that ancient humans experienced thoughts as external voices—came while reading Iain McGilchrist’s The Master and His Emissary.² Both argue that consciousness and reason are shaped by history and culture, and not fixed traits. Jaynes suggested that the social upheaval of the Bronze Age collapse forced humans to internalise once external voices, giving rise to modern consciousness. I would later realise that this perspective has implications for how doctors are trained to listen—or not listen—to their patients.

Michel Foucault described the birth of the “medical gaze”³—a shift in the late 18th century from attending to the whole person to scrutinising the internal mechanics of the body. McGilchrist’s metaphor of left‑hemisphere dominance echoes this shift.² Madness was transformed from something spoken with into something spoken about. Voices that once carried moral or spiritual meaning became symptoms to be categorised. Reason was enthroned, and medicine appointed itself its guardian. These historical changes are not merely academic; they shape how doctors interact today.

None of this is taught explicitly. It is absorbed through the hidden curriculum—the informal lessons of ward rounds, corridor conversations, and the quiet approval of seniors. Students learn that ambiguity is risky, uncertainty should be resolved, and experience must be rendered legible through diagnosis. They learn to apply the gaze, filtering out the “noise” of life to find the signal of disease. A patient’s story becomes something to be translated, corrected, or contained.

In a routine surgery, an elderly man attends for a medication review. Near the end, almost as an afterthought, he mentions that since his wife died he sometimes hears her voice in the early morning, reminding him to put the kettle on. He laughs softly, calling it “probably just my imagination.” The GP pauses, aware of the templates waiting to be completed and the next patient already late. There is a moment of uncertainty—whether to record hallucinations, screen for psychosis, or gently redirect. Instead, the GP reassures him that grief takes many forms, offers condolence, and moves on. The voice is neither explored nor documented. Later, the GP wonders whether something important was missed—or whether, by refusing to apply the medical gaze, the man’s experience was quietly protected.

In Western psychiatry, hearing voices is typically framed as pathology. Yet population studies suggest that up to one in ten people hear voices at some point, many without distress or psychiatric illness.⁴ Voices are common during bereavement, trauma, or the liminal states of waking. Neuroimaging shows activity in auditory and language‑processing regions during these experiences, but biology alone does not determine meaning.

The Hearing Voices Movement challenges the assumption that voices must be silenced. Across cultures, voice‑hearing is interpreted in radically different ways—as ancestral guidance, spiritual presence, or creative intuition. Luhrmann and colleagues showed how cultural context shapes the interpretation and emotional impact of voice‑hearing experiences.⁵ Even within Western history, figures such as Freud or Jung did not experience their internal dialogues solely as symptoms. What varies is not just the experience, but the story told about it.

When medicine insists on a single explanatory frame, something human is lost. The clinician’s role narrows from interpreter to gatekeeper; listening becomes secondary to categorisation—a consequence of a system under duress. For students, professional identity is shaped accordingly: to be a good doctor is to be decisive, rational, and untroubled by ambiguity. Voices, like other forms of human difference, are tidied away.

This is not an argument against diagnosis. Many who hear distressing voices benefit from medication and structured care. We must also remain alert to early‑onset psychosis or organic disease. Rather, it is an argument against allowing one model of reason to monopolise meaning. When all voices are reduced to pathology, we risk mistaking cultural habit for clinical necessity.

If medicine is to remain humane, it must make room for pluralism.⁶ Exposure to cross‑cultural psychiatry, narrative medicine, and the lived experience of voice‑hearers could broaden what students understand as “normal.” It could soften the rigid boundary between reason and madness that has shaped medical identity since the Enlightenment. In McGilchrist’s metaphor, balance between the hemispheres needs to be restored.

Jaynes may have been wrong about the timeline of consciousness, but he was right to insist that consciousness—and medicine with it—is a cultural achievement, not a given. Perhaps the real task is to learn to listen not just for disease, but for meaning.

References

1. Jaynes J. The Origin of Consciousness in the Breakdown of the Bicameral Mind. Boston: Houghton Mifflin. 1986.
2. McGilchrist I. The Master and His Emissary: The Divided Brain and the Making of the Western World. Yale University Press. 2019.
3. Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception. London: Routledge. 2003.
4. Ynnesdal Haugen LS. Towards validating invalidated knowledge: a discourse analysis of first-hand accounts of hearing voices. BMC Psychol. 2024 Oct 2;12(1):527.
5. Luhrmann TM, Padmavati R, Tharoor H, Osei A. Differences in voice-hearing experiences across cultures: A study of schizophrenia patients in the USA, India, and Ghana. British Journal of Psychiatry. 2015;206(1):41-44.
6. Leach H, Kelly J, Parry S. Compassion‑informed approaches for coping with hearing voices: literature review and narrative synthesis. Psychosis. 2024;16(3):325–335

Featured photo by Cherry Laithang on Unsplash