Hearing voices – the histories, causes and meanings of auditory verbal hallucinations (original) (raw)
Related papers
Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations
2014
Despite the recent proliferation of scientiic, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucina- tory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowl- edge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate method- ologies to analyze a wider range of irst-person accounts of AVH at 3 contextual levels: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are signiicant potential beneits for voice hearers, clinicians, and researchers. These include (1) informing the development and reinement of subtypes of hallucinations within and across diagnostic categories; (2) “front-loading” research in cognitive neuroscience; and (3) suggesting new possibilities for therapeutic inter- vention. In conclusion, we argue that an interdisciplin- ary approach to the phenomenology of AVH can nourish the ethical core of scientiic enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences.
Auditory verbal hallucinations as dialogical experiences
The purpose of this study is to offer a model in which auditory verbal hallucinations (AVHs) can be conceptualized as dialogical experiences. This model is of interest in that it integrates several different perspectives (phenomenological, cognitive, social, and evolutionary) and the findings of empirical research on the subject. Hallucinations are understood as the product of a state of consciousness in which the self is dissociated into different positions or perspectives. After reviewing the most relevant results of psychological research, dialogical self theory is proposed as the theoretical framework for understanding hallucinatory experiences. It is argued that the voices possess a series of characteristics, pragmatic properties, relationships with the voices similar to their social surroundings, and more dissociative experiences in people who experience voices than in those who do not, with which they may be considered a dialogical experience. Finally, a model attempting to integrate psychological research on AVHs within the framework of dialogical self theory is presented.
Beyond the sensory: the phenomenology of "hearing voices"
Objective: Research concerning the subjective sensory qualities of auditory hallucinations (AH) in people diagnosed with schizophrenia is scarce. Our goal was to investigate the “auditoriness” of AH and their overlap with symptoms grounded in alterations of thought rather than perception. Method: We undertook a detailed analysis of phenomenological interviews with 80 schizophrenia-spectrum voice-hearers. Results: We coded the dominant voice patterns of our subjects and found that only a minority (17.5%) reported a dominant pattern of AH which were experi- enced as literally auditory. Of dominant AH patterns, 11.3% were instead described as only quasi- or partially auditory, 28.8% as involving a combination of distinctly auditory and thought-like voices, and 15% as unambiguously thought-like. In addition, 5% reported exclusively simple, short-duration AH (e.g. hearing a single word), 12.5% the misperception of actual speech or sounds, and 10% predominantly multisensory voices. We also found substantial overlap between voices and symptoms traditionally considered abnormalities of thought rather than sensation. Conclusion: We believe these findings challenge common assumptions about AH in people diagnosed with schizophrenia, draw attention to potentially impor- tant but under-recognized characteristics of voices, and suggest a need for greater recognition of the heterogeneity of voices and the potential clinical as well as theoretical risks of conceptual over-simplification.
One of the leading cognitive models of auditory verbal hallucinations (AVHs) proposes such experiences result from a disturbance in the process by which inner speech is attributed to the self. Research in this area has, however, proceeded in the absence of thorough cognitive and phenomenological investigations of the nature of inner speech, against which AVHs are implicitly or explicitly defined. In this paper we begin by introducing philosophical phenomenology and highlighting its relevance to AVHs, before briefly examining the evolving literature on the relation between inner experiences and AVHs. We then argue for the need for philosophical phenomenology (Phenomenology) and the traditional empirical methods of psychology for studying inner experience (phenomenology) to mutually inform each other to provide a richer and more nuanced picture of both inner experience and AVHs than either could on its own. A critical examination is undertaken of the leading model of AVHs derived from phenomenological philosophy, the ipseity disturbance model. From this we suggest issues that future work in this vein will need to consider, and examine how interdisciplinary methodologies may contribute to advances in our understanding of AVHs. Detailed suggestions are made for the direction and methodology of future work into AVHs, which we suggest should be undertaken in a context where phenomenology and physiology are both necessary, but neither sufficient.
Auditory verbal hallucinations: Dialoguing between the cognitive sciences and phenomenology
Phenomenology and the …, 2010
Auditory verbal hallucinations (AVHs) are a highly complex and rich phenomena, and this has a number of important clinical, theoretical and methodological implications. However, until recently, this fact has not always been incorporated into the experimental designs and theoretical paradigms used by researchers within the cognitive sciences. In this paper, we will briefly outline two recent examples of phenomenologically informed approaches to the study of AVHs taken from a cognitive science perspective. In the first example, based on Larøi and Woodward (Harv Rev Psychiatry 15:109–117, 2007), it is argued that reality monitoring studies examining the cognitive underpinnings of hallucinations have not reflected the phenomenological complexity of AVHs in their experimental designs and theoretical framework. The second example, based on Jones (Schizophr Bull, in press, 2010), involves a critical examination of the phenomenology of AVHs in the context of two other prominent cognitive models: inner speech and intrusions from memory. It will be shown that, for both examples, the integration of a phenomenological analysis provides important improvements both on a methodological, theoretical and clinical level. This will be followed by insights and critiques from philosophy and clinical psychiatry—both of which offer a phenomenological alternative to the empiricist–rationalist conceptualisation of AVHs inherent to the cognitive sciences approach. Finally, the paper will conclude with ideas as to how the cognitive sciences may integrate these latter perspectives into their methodological and theoretical programmes.
Auditory Verbal Hallucinations and their Phenomenological Context
Oxford Handbook of Phenomenological Psychopathology, 2019
Auditory verbal hallucinations (hereafter, AVHs) are frequently associated with schizophrenia diagnoses but also occur in several other psychiatric conditions, as well as in the non-clinical population. In order to investigate how they are caused and how they might be treated (if they require treatment), it is essential to get the phenomenology right. Otherwise, there is a risk of failing to distinguish different experiences that need to be explained in different ways or even seeking to explain the wrong thing entirely, a point that applies equally to treatment. This is not to suggest that we need rely exclusively on phenomenological research in order to pin down the nature of AVHs. We can also draw on non-phenomenological findings in order to corroborate, clarify, or challenge phenomenological claims. For example, suppose it is assumed that AVHs are much like veridical auditory experiences, but it then turns out that patterns of brain activity associated with audition are entirely absent. In such a scenario, non-phenomenological findings would prompt us to a reconsider the phenomenology. However, where AVHs are concerned, one might think that the required phenomenological work is easily done. The term ‘auditory verbal hallucination’ already says it all: a hallucination is an experience that resembles perception in one or another sensory modality, but which occurs in the absence of an appropriate external stimulus. By implication, an auditory verbal hallucination is an experience of hearing someone speak, which occurs in the absence of a speaker. Such definitions are commonplace in the literature. For example: "Voices are defined as a sensory perception that has a compelling sense of reality, but which occurs without external stimulation of the sensory organ." (Hayward, Berry and Ashton, 2011, p.1314) "Auditory hallucinations (AHs) are auditory experiences that occur in the absence of a corresponding external stimulation and which resemble a veridical perception." (Waters et al., 2012, p.683) "Auditory verbal hallucinations (AVHs) are a sensory experience that takes place in the absence of any external stimulation whilst in a fully conscious state." (de Leede-Smith and Barkus, 2013, p.1) This understanding is consistent with the (remarkably cursory) description of AVHs supplied by DSM-5: “Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts” (American Psychiatric Association, 2013, p.87). The only further qualification offered here is that cases where someone is falling asleep or waking up should be excluded. But again, it might seem that the relevant experiences are easy enough to comprehend: they are just like hearing someone speak. If that is right, then cursory definitions and descriptions are unproblematic. It is obvious what the relevant phenomenology consists of and so the phenomenological preliminaries can be dispensed with quickly. This chapter will show that matters are considerably more complicated. The kinds of experience routinely labeled as ‘AVHs’ are diverse, and many of them are not at all like hearing someone speak. Furthermore, in the context of severe psychiatric illness, AVHs are generally not circumscribed perceptual anomalies. They are embedded in much wider-ranging phenomenological disturbances, of a kind that are difficult to describe. It is debatable whether and to what extent these disturbances correspond to established diagnostic categories. Hence, if AVH experiences are to be adequately characterized and differentiated, in-depth phenomenological research is needed, of a kind that is able to acknowledge, describe, and distinguish profound disturbances in the overall structure or form of experience. Current phenomenological psychopathology acknowledges that AVHs are often unlike mundane perceptual experience and that they arise within the context of more encompassing experiential changes. Nevertheless, it offers what is at best an incomplete account, one that is questionable in several respects.