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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
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.
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.
Billon, A. 2013. Does consciousness entail subjectivity? The puzzle of thought insertion. Philos Psychol 26(2): 291–314.
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.
Bortolotti, L., and M.R. Broome. 2012. Affective dimensions of the phenomenon of double bookkeeping in delusions. Emot Rev 4(2): 187–191.
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.
Campbell, J. 1999. Schizophrenia, the space of reasons, and thinking as a motor process. The Monist, 609–625.
Campbell, J. 2002. The ownership of thoughts. Philos Psychiatry Psychol 9(1): 35–39.
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.
Chapman, R.K. 2002. First person account: Eliminating delusions. Schizophr Bull 28(3): 545–553.
Coliva, A. 2002. Thought insertion and immunity to error through misidentification. Philos Psychiatry Psychol 9(1): 27–34.
David, A.S. 1994. Thought echo reflects the activity of the phonological loop. Br J Clin Psychol 33: 81–83.
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.
Frith, C.D. 1992. The cognitive neuropsychology of schizophrenia. Hove: Psychology Press.
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.
Garrett, M., and R. Silva. 2003. Auditory hallucinations, source monitoring, and the belief that “voices” are real. Schizophr Bull 29(3): 445–457.
Gerrans, P. 2013. Delusional attitudes and default thinking. Mind Lang 28(1): 83–102.
Gerrans, P. 2014. Measure of Madness: Philosophy of Mind, Cognitive Neuroscience, and Delusional Thought. Cambridge: MIT Press.
Gibbs, P.J. 2000. Thought insertion and the inseparability thesis. Philos Psychiatry Psychol 7(3): 195–202.
Greenblat, L. 2000. First person account: Understanding health as a continuum. Schizophr Bull 26(1): 243–245.
Heinimaa, M. 2002. Incomprehensibility: The role of the concept in DSM-IV definition of schizophrenic delusions. Med Health Care Philos 5(3): 291–295.
Hoerl, C. 2001. On thought insertion. Philos Psychiatry Psychol 8(2): 189–200.
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.
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.
Jones, S.R., and C. Fernyhough. 2007. Thought as action: Inner speech, self-monitoring, and auditory verbal hallucinations. Conscious Cogn 16(2): 391–399.
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.
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.
Maher, B.A. 2006. The relationship between delusions and hallucinations. Curr Psychiatry Rep 8(3): 179–183.
Martin, J.R., and E. Pacherie. 2013. Out of nowhere: Thought insertion, ownership and context-integration. Conscious Cogn 22(1): 111–122.
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.
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.
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.
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.
Miller, L.J. 1996. Qualitative changes in hallucinations. Am J Psychiatr 153: 265–267.
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.
Mueser, K.T., A.S. Bellack, and E.U. Brady. 1990. Hallucinations in schizophrenia. Acta Psychiatr Scand 82(1): 26–29.
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.
Nayani, T.H., and A.S. David. 1996. The auditory hallucination: A phenomenological survey. Psychol Med 26(01): 177–189.
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.
Nordgaard, J., S.M. Arnfred, P. Handest, and J. Parnas. 2008. The diagnostic status of first-rank symptoms. Schizophr Bull 34(1): 137–154.
Payne, R. 2012. Night’s end. Schizophr Bull 38(5): 899–901.
Ruocchio, P.J. 1989. First person account: Fighting the fight-the schizophrenic’s nightmare. Schizophr Bull 15(1): 163–166.
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.
Sass, L.A. 2004. Some reflections on the (analytic) philosophical approach to delusion. Philos Psychiatry Psychol 11(1): 71–80.
Sass, L.A., and J. Parnas. 2003. Schizophrenia, consciousness, and the self. Schizophr Bull 29(3): 427–444.
Seeger, M. 2013. Commentary on Martin & Pacherie. Out of nowhere: Thought insertion, ownership and context-integration. Conscious Cogn 22(1): 261–263.
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.
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.
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.
Sousa, P., and L. Swiney. 2013. Thought insertion: Abnormal sense of thought agency or thought endorsement? Phenomenol Cogn Sci 12(4): 637–654.
Stainsby, J. 1992. First person account: Schizophrenia: Some issues. Schizophr Bull 18(3): 543–546.
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.
Stephens, G.L., and G. Graham. 2000. When self-consciousness breaks: Alien voices and inserted thoughts. Massachusetts: The MIT Press.
Timlett, A. 2013. Controlling bizarre delusions. Schizophr Bull 39(2): 244–246.
Urfer, A. 2001. Phenomenology and psychopathology of schizophrenia: The views of Eugene Minkowski. Philos Psychiatry Psychol 8(4): 279–289.
Wagner, P.S. 1996. First person account: A voice from another closet. Schizophr Bull 22(2): 399–401.
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.
Waters, F. & Jardri, R. 2014. Auditory hallucinations: debunking the myth of language supremacy. Schizophrenia Bulletin, sbu166.
Waters, F.A., and J.C. Badcock. 2010. First-rank symptoms in schizophrenia: Reexamining mechanisms of self-recognition. Schizophr Bull 36(3): 510–517.
About this article
Cite this article
Humpston, C.S., Broome, M.R. The Spectra of Soundless Voices and Audible Thoughts: Towards an Integrative Model of Auditory Verbal Hallucinations and Thought Insertion. Rev.Phil.Psych. 7, 611–629 (2016). https://doi.org/10.1007/s13164-015-0232-9
- Phonological Loop
- Psychotic Experience
- Think Insertion
- Verbal Thought