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Humpston CS, Woodward TS. Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual? Lancet Psychiatry 2024; 11:658-664. [PMID: 38631367 DOI: 10.1016/s2215-0366(24)00061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
In much contemporary psychiatric training and practice, there is a strong emphasis on the audible or perceptual quality and externality of auditory verbal hallucinations in clinical assessments. A typical question during clinical assessment is asking whether the voices that a person hears sound identical to the way the clinician's voice is heard. In this Personal View, we argue that the most important factor in auditory verbal hallucinations in schizophrenia spectrum psychoses is a loss of first-person authority, and that a perceptual quality is not required for it to be this kind of hallucination. We draw on evidence from cognitive neuroscience showing that the activation of brain networks retrieved during capture of auditory verbal hallucinations that were experienced when a patient was in a functional MRI scanner does not match activation of networks retrieved during auditory perception. We propose that, despite early writings by Esquirol and Schneider that defined auditory verbal hallucinations as beliefs in perception rather than true perception, cognitive neuroscience, psychiatric training and practice, and patients adopting clinical vocabulary have been strongly influenced by the progression of the diagnostic criteria for schizophrenia, which increasingly place emphasis on language, such as the "full force" of a true perception. We hold that this change has resulted in an unhelpful top-down influence on the field, imposing perceptual qualities on auditory verbal hallucinations, and leading to misunderstandings and inaccuracies in clinical practice and patients' self-reports, and misinterpretations in cognitive neuroscience. We encourage a revision of the definition of auditory verbal hallucinations to move away from the necessity for auditory perception, and towards beliefs in perception due to the loss of first-person authority.
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Affiliation(s)
- Clara S Humpston
- Department of Psychology, University of York, York, UK; School of Psychology, University of Birmingham, Birmingham, UK.
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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2
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Broome MR. Phenomenology, delusions and justice. World Psychiatry 2024; 23:239-240. [PMID: 38727068 PMCID: PMC11083906 DOI: 10.1002/wps.21202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Affiliation(s)
- Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK
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3
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Rosen C, Harrow M, Humpston C, Tong L, Jobe TH, Harrow H. 'An experience of meaning': A 20-year prospective analysis of delusional realities in schizophrenia and affective psychoses. Front Psychiatry 2022; 13:940124. [PMID: 35990079 PMCID: PMC9388349 DOI: 10.3389/fpsyt.2022.940124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Delusions are transdiagnostic and heterogeneous phenomena with varying degrees of intensity, stability, and dimensional attributes where the boundaries between everyday beliefs and delusional beliefs can be experienced as clearly demarcated, fuzzy, or indistinguishable. This highlights the difficulty in defining delusional realities. All individuals in the current study were evaluated at index and at least one of six subsequential follow-ups over 20 years in the Chicago Longitudinal Study. We assessed 16 distinct delusions categorized as thought or thematic delusions. We also examined the probability of recurrence and the relationships between delusions and hallucinations, depression, anxiety, and negative symptoms. The sample consisted of 262 individuals with schizophrenia vs. affective psychosis. Thought delusions were significantly different between groups at all follow-up evaluations except the 20-year timepoint. Thematic delusions were more common than thought delusions and show a significant decreasing pattern. In general, delusional content varied over time. Referential, persecutory, and thought dissemination delusions show the highest probability of recurrence. Hallucinations were the strongest indicator for thought, thematic, and overall delusions. The formation and maintenance of delusions were conceptualized as a multimodal construct consisting of sensory, perceptual, emotional, social, and somatic embodiment of an "experience of meanings". Given the significant associations between delusions and hallucinations, future work incorporating participatory research is needed to better define and align subjective and objective perspectives. Our research also points to the need for future clinical interventions that specifically evaluate and target the coexistence and entanglement of delusions and hallucinations.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Clara Humpston
- Department of Psychology, University of York, York, United Kingdom
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Liping Tong
- Advocate Aurora Health, Downers Grove, IL, United States
| | - Thomas H. Jobe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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Rappe S, Wilkinson S. Counterfactual cognition and psychosis: adding complexity to predictive processing accounts. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2054789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sofiia Rappe
- Faculty of Philosophy, Ludwig-Maximilians-Universität München, München, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, München, Germany
| | - Sam Wilkinson
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, Exeter, UK
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López-Silva P, Cavieres Á, Humpston C. The phenomenology of auditory verbal hallucinations in schizophrenia and the challenge from pseudohallucinations. Front Psychiatry 2022; 13:826654. [PMID: 36051554 PMCID: PMC9424625 DOI: 10.3389/fpsyt.2022.826654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
In trying to make sense of the extensive phenomenological variation of first-personal reports on auditory verbal hallucinations, the concept of pseudohallucination is originally introduced to designate any hallucinatory-like phenomena not exhibiting some of the paradigmatic features of "genuine" hallucinations. After its introduction, Karl Jaspers locates the notion of pseudohallucinations into the auditory domain, appealing to a distinction between hallucinatory voices heard within the subjective inner space (pseudohallucination) and voices heard in the outer external space (real hallucinations) with differences in their sensory richness. Jaspers' characterization of the term has been the target of a number of phenomenological, conceptual and empirically-based criticisms. From this latter point of view, it has been claimed that the concept cannot capture distinct phenomena at the neurobiological level. Over the last years, the notion of pseudohallucination seems to be falling into disuse as no major diagnostic system seems to refer to it. In this paper, we propose that even if the concept of pseudohallucination is not helpful to differentiate distinct phenomena at the neurobiological level, the inner/outer distinction highlighted by Jaspers' characterization of the term still remains an open explanatory challenge for dominant theories about the neurocognitive origin of auditory verbal hallucinations. We call this, "the challenge from pseudohallucinations". After exploring this issue in detail, we propose some phenomenological, conceptual, and empirical paths for future research that might help to build up a more contextualized and dynamic view of auditory verbal hallucinatory phenomena.
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Affiliation(s)
- Pablo López-Silva
- School of Psychology, Faculty of Social Sciences, Universidad de Valparaíso, Valparaíso, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Álvaro Cavieres
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Clara Humpston
- School of Psychology, University of York, York, United Kingdom.,School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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Shiel L, Demjén Z, Bell V. Illusory social agents within and beyond voices: A computational linguistics analysis of the experience of psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:349-363. [PMID: 34541680 PMCID: PMC9290020 DOI: 10.1111/bjc.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/17/2021] [Indexed: 11/27/2022]
Abstract
Objectives Psychosis has a strong social component and often involves the experience of being affected by ‘illusory social agents’. However, this experience remains under‐characterized, particularly for social agents in delusions and non‐vocal hallucinations. One useful approach is a form of computational linguistics called corpus linguistics that studies texts to identify patterns of meaning encoded in both the semantics and linguistic structure of the text. Methods Twenty people living with psychosis were recruited from community and inpatient services. They participated in open‐ended interviews on their experiences of social agents in psychosis and completed a measure of psychotic symptoms. Corpus linguistics analysis was used to identify key phenomenological features of vocal and non‐vocal social agents in psychosis. Results Social agents i) are represented with varying levels of richness in participants’ experiences, ii) are attributed with different kinds of identities including physical characteristics and names, iii) are perceived to have internal states and motivations that are different from those of the participants, and iv) interact with participants in various ways including through communicative speech acts, affecting participants’ bodies, and moving through space. These representations were equally rich for agents associated with hallucinated voices and those associated with non‐vocal hallucinations and delusions. Conclusions We show that the experience of illusory social agents is a rich and complex social experience reflecting many aspects of genuine social interaction and is not solely present in auditory hallucinations, but also in delusions and non‐vocal hallucinations. Practitioner Points The experience of being affected by illusory social agents in psychosis extends beyond hallucinated voices. They are a rich and complex social experience reflecting many aspects of genuine social interaction. These are also likely to be a source of significant distress and disability.
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Affiliation(s)
- Lisha Shiel
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Zsófia Demjén
- UCL Centre for Applied Linguistics, University College London, UK
| | - Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,South London and Maudsley NHS Foundation Trust, UK
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Möller TJ, Georgie YK, Schillaci G, Voss M, Hafner VV, Kaltwasser L. Computational models of the "active self" and its disturbances in schizophrenia. Conscious Cogn 2021; 93:103155. [PMID: 34130210 DOI: 10.1016/j.concog.2021.103155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
The notion that self-disorders are at the root of the emergence of schizophrenia rather than a symptom of the disease, is getting more traction in the cognitive sciences. This is in line with philosophical approaches that consider an enactive self, constituted through action and interaction with the environment. We thereby analyze different definitions of the self and evaluate various computational theories lending to these ideas. Bayesian and predictive processing are promising approaches for computational modeling of the "active self". We evaluate their implementation and challenges in computational psychiatry and cognitive developmental robotics. We describe how and why embodied robotic systems provide a valuable tool in psychiatry to assess, validate, and simulate mechanisms of self-disorders. Specifically, mechanisms involving sensorimotor learning, prediction, and self-other distinction, can be assessed with artificial agents. This link can provide essential insights to the formation of the self and new avenues in the treatment of psychiatric disorders.
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Affiliation(s)
- Tim Julian Möller
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Yasmin Kim Georgie
- Department of Computer Science, Humboldt-Universität zu Berlin, Germany.
| | - Guido Schillaci
- The BioRobotics Institute and Dept. of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Martin Voss
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine and St. Hedwig Hospital, Berlin, Germany.
| | | | - Laura Kaltwasser
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
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Houlders JW, Bortolotti L, Broome MR. Threats to epistemic agency in young people with unusual experiences and beliefs. SYNTHESE 2021; 199:7689-7704. [PMID: 34970007 PMCID: PMC8668839 DOI: 10.1007/s11229-021-03133-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/19/2021] [Indexed: 05/05/2023]
Abstract
A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users' sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people's contributions as epistemic agents in the clinical encounter.
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Affiliation(s)
- Joseph W. Houlders
- Department of Philosophy, University of Birmingham, 32 Pritchatts Road, Edgbaston, Birmingham, B15 2TT United Kingdom
| | - Lisa Bortolotti
- Department of Philosophy, University of Birmingham, 32 Pritchatts Road, Edgbaston, Birmingham, B15 2TT United Kingdom
| | - Matthew R. Broome
- Institute for Mental Health, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham, B15 2TT United Kingdom
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Wilson P, Humpston C, Nathan R. Innovations in the psychopathology of schizophrenia: a primer for busy clinicians. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSignificant developments in schizophrenia psychopathology are ready to be incorporated into clinical practice. These advances allow a way forward through the well-described challenges experienced with current diagnostic and psychopathological frameworks. This article discusses approaches that will enable clinicians to access a wider and richer spectrum of patient experience; describes process-based models of schizophrenia in the domains of both the brain and the mind; and considers how different levels of analysis might be linked via the predictive processing framework. Multiple levels of analysis provide different targets for varying modalities of treatment – dopamine blockade at the molecular level, psychological therapy at the level of the mind, and social interventions at the personal level. Psychiatry needs to align itself closer to neuroscientific research. It should move from a symptom-based understanding to a model based on process. That is – after having asked about a patient's symptoms and experience clinicians need to introduce steps involving a consideration of what might be the brain and mind processes underlying the experience.
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Humpston CS, Broome MR. Thinking, believing, and hallucinating self in schizophrenia. Lancet Psychiatry 2020; 7:638-646. [PMID: 32105619 DOI: 10.1016/s2215-0366(20)30007-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 01/01/2023]
Abstract
In this Personal View, we discuss the history and concept of self-disturbance in relation to the pathophysiology and subjective experience of schizophrenia in terms of three approaches: the perceptual anomalies approach of the early Heidelberg School of Psychiatry, the ipseity model, and the predictive coding framework. Despite the importance of these approaches, there has been a notable absence of efforts to compare them and consider how they might be integrated. This Personal View compares the three approaches and offers suggestions as to how they might work together, which represents a novel position. We view self-disturbances as transformations of self that form the inseparable background against which psychotic symptoms emerge. Integrating computational psychiatric approaches with those used by phenomenologists in the first two listed approaches, we argue that delusions and hallucinations are inferences produced under extraordinary conditions and are both statistically and experientially as real for patients as other mental events. Such inferences still approximate Bayes-optimality, given the personal, neurobiological, and environmental circumstances, and might be the only ones available to minimise prediction error. The added contribution we hope to make focuses on how the dialogue between neuroscience and phenomenology might improve clinical practice. We hope this Personal View will act as a timely primer and bridging point for the different approaches of computational psychiatry and phenomenological psychopathology for interested clinicians.
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Affiliation(s)
- Clara S Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
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Abstract
Auditory verbal hallucinations (AVHs) are considered as hallmark symptoms of psychosis, more specifically of schizophrenia. A substantial body of evidence indicates that AVHs can be attributed to a disorganization of overall speech capacity in psychotic subjects. AVHs are associated with activation of cortical areas of the brain that are related to speech production and perception; "voices" in deaf patients seem to be about the message rather than the sound of it; the content of AVHs is often related to that of delusional ideas; the internal or external location of AVHs makes little diagnostic difference; AVHs are often related to the patient's subvocal speech, having identical content with that, and they have been theorized as a misattribution of inner speech (i.e., the patient's own thoughts) to external sources. The aforementioned evidence comes close to certain long-standing insights mainly of the French psychiatric (de Clérambault) and psychoanalytical (Lacan) school, according to which, 1) the outside world is perceived through normal language function, 2) a language disorder is central to schizophrenic phenomena, and 3) AVHs represent a fragmentation and autonomization of speech (thought) function in schizophrenic patients (de Clérambault: "hallucinations think"). Today, several authors agree that 1) operationalized definitions have led to an oversimplification of psychopathology, and 2) a more theoretically informed understanding and an integration of different levels of explanation of psychotic phenomena is needed. Thus, psychotic AVHs should be investigated beyond their narrow classification as disordered perceptions, in the wider context of formal thought disorder and disordered language capacity.
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Humpston CS, Adams RA, Benrimoh D, Broome MR, Corlett PR, Gerrans P, Horga G, Parr T, Pienkos E, Powers AR, Raballo A, Rosen C, Linden DEJ. From Computation to the First-Person: Auditory-Verbal Hallucinations and Delusions of Thought Interference in Schizophrenia-Spectrum Psychoses. Schizophr Bull 2019; 45:S56-S66. [PMID: 30715542 PMCID: PMC6357975 DOI: 10.1093/schbul/sby073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Schizophrenia-spectrum psychoses are highly complex and heterogeneous disorders that necessitate multiple lines of scientific inquiry and levels of explanation. In recent years, both computational and phenomenological approaches to the understanding of mental illness have received much interest, and significant progress has been made in both fields. However, there has been relatively little progress bridging investigations in these seemingly disparate fields. In this conceptual review and collaborative project from the 4th Meeting of the International Consortium on Hallucination Research, we aim to facilitate the beginning of such dialogue between fields and put forward the argument that computational psychiatry and phenomenology can in fact inform each other, rather than being viewed as isolated or even incompatible approaches. We begin with an overview of phenomenological observations on the interrelationships between auditory-verbal hallucinations (AVH) and delusional thoughts in general, before moving on to review several theoretical frameworks and empirical findings in the computational modeling of AVH. We then relate the computational models to the phenomenological accounts, with a special focus on AVH and delusions that involve the senses of agency and ownership of thought (delusions of thought interference). Finally, we offer some tentative directions for future research, emphasizing the importance of a mutual understanding between separate lines of inquiry.
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Affiliation(s)
- Clara S Humpston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom,School of Psychology, Cardiff University, Cardiff, United Kingdom,To whom correspondence should be addressed;Department of Psychological Medicine (PO72), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, LondonSE5 8AF, United Kingdom; tel: +44 (0) 20 7848 0088, fax: +44 (0) 20 7848 0298, e-mail:
| | - Rick A Adams
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Benrimoh
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom,Department of Psychiatry,Medical Sciences Division, University of Oxford, Oxford, United Kingdom,Faculty of Philosophy, Humanities Division, University of Oxford, Oxford, United Kingdom
| | | | - Philip Gerrans
- Department of Philosophy, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Thomas Parr
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom
| | - Elizabeth Pienkos
- Graduate Institute of ProfessionalPsychology, University of Hartford, West Hartford, CT
| | | | - Andrea Raballo
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - David E J Linden
- School of Psychology, Cardiff University, Cardiff, United Kingdom,Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
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14
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Jones N, Luhrmann TM. Beyond the sensory: Findings from an in-depth analysis of the phenomenology of “auditory hallucinations” in schizophrenia. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2015. [DOI: 10.1080/17522439.2015.1100670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Badcock JC. A Neuropsychological Approach to Auditory Verbal Hallucinations and Thought Insertion - Grounded in Normal Voice Perception. ACTA ACUST UNITED AC 2015; 7:631-652. [PMID: 27617046 PMCID: PMC4995233 DOI: 10.1007/s13164-015-0270-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A neuropsychological perspective on auditory verbal hallucinations (AVH) links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream (APS) framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH – such as thought insertion (TI). In this paper, I propose that an APS framework offers a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, 6009 Western Australia
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