Review of Philosophy and Psychology

, Volume 7, Issue 3, pp 611–629 | Cite as

The Spectra of Soundless Voices and Audible Thoughts: Towards an Integrative Model of Auditory Verbal Hallucinations and Thought Insertion

Article

Abstract

Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations (AVHs), and thought insertion (TI) to a lesser degree; however, their mechanisms and relationships between each other remain largely elusive. Here we attempt to establish a integrative model drawing from the phenomenology of both AVHs and TI and argue that they in fact can be seen as ‘spectra’ of experiences with varying degrees of agency and ownership, with ‘silent and internal own thoughts’ on one extreme and ‘fully external and clearly audible voices’ in the absence of a speaker on the other. We believe a spectral model will add emphasis to the continuity of experience and help to better understand how one type of psychotic symptom may interact with another, and put forward the argument that the experience of TI itself is not sufficient to classify as a delusion. In addition we aim to discuss some of the conceptual issues surrounding AVHs and TI with first-person accounts and current philosophical and neuropsychological theories in mind. We propose that the mechanisms behind AVHs and TI are more complex than source-monitoring deficits; indeed, to understand such phenomena one must appreciate that their very ‘existence’ and ‘reality’ as experienced by the individual have much deeper implications and meaning, both philosophically and clinically.

References

  1. Atkinson, J.R. 2006. The perceptual characteristics of voice-hallucinations in deaf people: insights into the nature of subvocal thought and sensory feedback loops. Schizophr Bull 32(4): 701–708.CrossRefGoogle Scholar
  2. Atkinson, J.R., K. Gleeson, J. Cromwell, and S. O'Rourke. 2007. Exploring the perceptual characteristics of voice-hallucinations in deaf people. Cogn Neuropsychiatry 12(4): 339–361.CrossRefGoogle Scholar
  3. Billon, A. 2013. Does consciousness entail subjectivity? The puzzle of thought insertion. Philos Psychol 26(2): 291–314.CrossRefGoogle Scholar
  4. Bortolotti, L., and M. Broome. 2009. A role for ownership and authorship in the analysis of thought insertion. Phenomenol Cogn Sci 8(2): 205–224.CrossRefGoogle Scholar
  5. Bortolotti, L., and M.R. Broome. 2012. Affective dimensions of the phenomenon of double bookkeeping in delusions. Emot Rev 4(2): 187–191.CrossRefGoogle Scholar
  6. Breier, A., and P.H. Berg. 1999. The psychosis of schizophrenia: Prevalence, response to atypical antipsychotics, and prediction of outcome. Biol Psychiatry 46(3): 361–364.CrossRefGoogle Scholar
  7. Campbell, J. 1999. Schizophrenia, the space of reasons, and thinking as a motor process. The Monist, 609–625.Google Scholar
  8. Campbell, J. 2002. The ownership of thoughts. Philos Psychiatry Psychol 9(1): 35–39.CrossRefGoogle Scholar
  9. Cermolacce, M., J. Naudin, and J. Parnas. 2007. The “minimal self” in psychopathology: Re-examining the self-disorders in the schizophrenia spectrum. Conscious Cogn 16(3): 703–714.CrossRefGoogle Scholar
  10. Chapman, R.K. 2002. First person account: Eliminating delusions. Schizophr Bull 28(3): 545–553.CrossRefGoogle Scholar
  11. Coliva, A. 2002. Thought insertion and immunity to error through misidentification. Philos Psychiatry Psychol 9(1): 27–34.CrossRefGoogle Scholar
  12. David, A.S. 1994. Thought echo reflects the activity of the phonological loop. Br J Clin Psychol 33: 81–83.CrossRefGoogle Scholar
  13. Fletcher, P.C., and C.D. Frith. 2009. Perceiving is believing: A Bayesian approach to explaining the positive symptoms of schizophrenia. Nat Rev Neurosci 10(1): 48–58.Google Scholar
  14. Frith, C.D. 1992. The cognitive neuropsychology of schizophrenia. Hove: Psychology Press.Google Scholar
  15. Gallagher, S. 2014. Relations Between Agency and Ownership in the Case of Schizophrenic Thought Insertion and Delusions of Control. Review of Philosophy and Psychology, 1–15.Google Scholar
  16. Garrett, M., and R. Silva. 2003. Auditory hallucinations, source monitoring, and the belief that “voices” are real. Schizophr Bull 29(3): 445–457.CrossRefGoogle Scholar
  17. Gerrans, P. 2013. Delusional attitudes and default thinking. Mind Lang 28(1): 83–102.CrossRefGoogle Scholar
  18. Gerrans, P. 2014. Measure of Madness: Philosophy of Mind, Cognitive Neuroscience, and Delusional Thought. Cambridge: MIT Press.CrossRefGoogle Scholar
  19. Gibbs, P.J. 2000. Thought insertion and the inseparability thesis. Philos Psychiatry Psychol 7(3): 195–202.Google Scholar
  20. Greenblat, L. 2000. First person account: Understanding health as a continuum. Schizophr Bull 26(1): 243–245.CrossRefGoogle Scholar
  21. Heinimaa, M. 2002. Incomprehensibility: The role of the concept in DSM-IV definition of schizophrenic delusions. Med Health Care Philos 5(3): 291–295.CrossRefGoogle Scholar
  22. Hoerl, C. 2001. On thought insertion. Philos Psychiatry Psychol 8(2): 189–200.CrossRefGoogle Scholar
  23. Hoffman, R.E., M. Varanko, J. Gilmore, and A.L. Mishara. 2008. Experiential features used by patients with schizophrenia to differentiate ‘voices’ from ordinary verbal thought. Psychol Med 38(08): 1167–1176.CrossRefGoogle Scholar
  24. Jones, S.R. 2010. Do we need multiple models of auditory verbal hallucinations? Examining the phenomenological fit of cognitive and neurological models. Schizophr Bull 36(3): 566–575.CrossRefGoogle Scholar
  25. Jones, S.R., and C. Fernyhough. 2007. Thought as action: Inner speech, self-monitoring, and auditory verbal hallucinations. Conscious Cogn 16(2): 391–399.CrossRefGoogle Scholar
  26. Kapur, S. 2003. Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatr 160(1): 13–23.CrossRefGoogle Scholar
  27. Lindenmayer, M.D., and A. Khan. 2006. Psychopathology. In Textbook of Schizophrenia, ed. J.A. Lieberman, T.S. Stroup, and D.O. Perkins, 187–222. Arlington: American Psychiatric Publishing, Inc.Google Scholar
  28. Maher, B.A. 2006. The relationship between delusions and hallucinations. Curr Psychiatry Rep 8(3): 179–183.CrossRefGoogle Scholar
  29. Martin, J.R., and E. Pacherie. 2013. Out of nowhere: Thought insertion, ownership and context-integration. Conscious Cogn 22(1): 111–122.CrossRefGoogle Scholar
  30. Marvel, C.L., and J.E. Desmond. 2012. From storage to manipulation: How the neural correlates of verbal working memory reflect varying demands on inner speech. Brain Lang 120(1): 42–51.CrossRefGoogle Scholar
  31. McCarthy-Jones, S., Krueger, J., Larøi, F., Broome, M., & Fernyhough, C. 2013. Stop, look, listen: the need for philosophical phenomenological perspectives on auditory verbal hallucinations. Frontiers in Human Neuroscience, 7.Google Scholar
  32. McCarthy-Jones, S., T. Trauer, A. Mackinnon, E. Sims, N. Thomas, and D.L. Copolov. 2014. A new phenomenological survey of auditory hallucinations: Evidence for subtypes and implications for theory and practice. Schizophr Bull 40(1): 231–235.CrossRefGoogle Scholar
  33. McGuire, P.K., D.A. Silbersweig, R.M. Murray, A.S. David, R.S.J. Frackowiak, and C.D. Frith. 1996. Functional anatomy of inner speech and auditory verbal imagery. Psychol Med 26(01): 29–38.CrossRefGoogle Scholar
  34. Miller, L.J. 1996. Qualitative changes in hallucinations. Am J Psychiatr 153: 265–267.CrossRefGoogle Scholar
  35. Moritz, S., and F. Larøi. 2008. Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts. Schizophr Res 102(1): 96–107.CrossRefGoogle Scholar
  36. Mueser, K.T., A.S. Bellack, and E.U. Brady. 1990. Hallucinations in schizophrenia. Acta Psychiatr Scand 82(1): 26–29.CrossRefGoogle Scholar
  37. Mullins, S., and S.A. Spence. 2003. Re-examining thought insertion: Semi-structured literature review and conceptual analysis. Br J Psychiatry 182(4): 293–298.CrossRefGoogle Scholar
  38. Nayani, T.H., and A.S. David. 1996. The auditory hallucination: A phenomenological survey. Psychol Med 26(01): 177–189.CrossRefGoogle Scholar
  39. Nelson, B., T.J. Whitford, S. Lavoie, and L.A. Sass. 2014. What are the neurocognitive correlates of basic self-disturbance in schizophrenia?: Integrating phenomenology and neurocognition. Part 1 (Source monitoring deficits). Schizophr Res 152(1): 12–19.CrossRefGoogle Scholar
  40. Nordgaard, J., S.M. Arnfred, P. Handest, and J. Parnas. 2008. The diagnostic status of first-rank symptoms. Schizophr Bull 34(1): 137–154.CrossRefGoogle Scholar
  41. Payne, R. 2012. Night’s end. Schizophr Bull 38(5): 899–901.CrossRefGoogle Scholar
  42. Ruocchio, P.J. 1989. First person account: Fighting the fight-the schizophrenic’s nightmare. Schizophr Bull 15(1): 163–166.CrossRefGoogle Scholar
  43. Saavedra, J., M. Cubero, and P. Crawford. 2009. Incomprehensibility in the narratives of individuals with a diagnosis of schizophrenia. Qual Health Res 19(11): 1548–1558.CrossRefGoogle Scholar
  44. Sass, L.A. 2004. Some reflections on the (analytic) philosophical approach to delusion. Philos Psychiatry Psychol 11(1): 71–80.CrossRefGoogle Scholar
  45. Sass, L.A., and J. Parnas. 2003. Schizophrenia, consciousness, and the self. Schizophr Bull 29(3): 427–444.CrossRefGoogle Scholar
  46. Seeger, M. 2013. Commentary on Martin & Pacherie. Out of nowhere: Thought insertion, ownership and context-integration. Conscious Cogn 22(1): 261–263.CrossRefGoogle Scholar
  47. Shinn, A.K., S. Heckers, and D. Öngür. 2013. The special treatment of first rank auditory hallucinations and bizarre delusions in the diagnosis of schizophrenia. Schizophr Res 146(1): 17–21.CrossRefGoogle Scholar
  48. Smailes, D., E. Meins, and C. Fernyhough. 2014. The impact of negative affect on reality discrimination. J Behav Ther Exp Psychiatry 45(3): 389–395.CrossRefGoogle Scholar
  49. Sommer, I.E., J.P. Selten, K.M. Diederen, and J.D. Blom. 2010. Dissecting auditory verbal hallucinations into two components: Audibility (Gedankenlautwerden) and alienation (thought insertion). Psychopathology 43(2): 137–140.CrossRefGoogle Scholar
  50. Sousa, P., and L. Swiney. 2013. Thought insertion: Abnormal sense of thought agency or thought endorsement? Phenomenol Cogn Sci 12(4): 637–654.CrossRefGoogle Scholar
  51. Stainsby, J. 1992. First person account: Schizophrenia: Some issues. Schizophr Bull 18(3): 543–546.CrossRefGoogle Scholar
  52. Stephens, G.L., and G. Graham. 1994. Self-consciousness, mental agency, and the clinical psychopathology of thought insertion. Philos Psychiatry Psychol 1(1): 1–10.CrossRefGoogle Scholar
  53. Stephens, G.L., and G. Graham. 2000. When self-consciousness breaks: Alien voices and inserted thoughts. Massachusetts: The MIT Press.Google Scholar
  54. Timlett, A. 2013. Controlling bizarre delusions. Schizophr Bull 39(2): 244–246.CrossRefGoogle Scholar
  55. Urfer, A. 2001. Phenomenology and psychopathology of schizophrenia: The views of Eugene Minkowski. Philos Psychiatry Psychol 8(4): 279–289.CrossRefGoogle Scholar
  56. Wagner, P.S. 1996. First person account: A voice from another closet. Schizophr Bull 22(2): 399–401.CrossRefGoogle Scholar
  57. Wang, L., P.D. Metzak, and T.S. Woodward. 2011. Aberrant connectivity during self-other source monitoring in schizophrenia. Schizophr Res 125(2): 136–142.CrossRefGoogle Scholar
  58. Waters, F. & Jardri, R. 2014. Auditory hallucinations: debunking the myth of language supremacy. Schizophrenia Bulletin, sbu166.Google Scholar
  59. Waters, F.A., and J.C. Badcock. 2010. First-rank symptoms in schizophrenia: Reexamining mechanisms of self-recognition. Schizophr Bull 36(3): 510–517.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.School of PsychologyCardiff UniversityCardiffUK
  2. 2.Department of PsychiatryUniversity of OxfordOxfordUK

Personalised recommendations