From Thoughts to Voices: Understanding the Development of Auditory Hallucinations in Schizophrenia

Abstract

Drawing upon core phenomenological contributions of the last decades, the present paper provides an integrated description of the development of auditory hallucinations in schizophrenia. Specifically, these contributions are (i) the transitional sequences of development of psychotic symptoms of schizophrenia as envisioned by Klosterkötter and rooted in the basic symptoms approach, (ii) Conrad’s Gestalt-analysis of developing psychosis, and (iii) Sass and Parnas’ self-disturbance approach. Klosterkötter’s contribution provides a general descriptive psychopathological approach to the transitional sequence of the development of auditory hallucinations. The key concepts in Conrad’s proposal (such as trema, apophany, anastrophy, Reflexionskrampf [hyperreflexivity] and transparence) are discussed, as their role is central as driving forces of the process from non-psychotic symptoms to overt hallucinations. Finally, Parnas and Sass link psychiatry to philosophy and psychology, and provide an in-depth and thorough description of these phenomena in their work on schizophrenia as a disorder of consciousness and self-experience (disturbed ipseity) with hyper-reflexivity and diminished self-affection as key aspects.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Blankenburg, W. 1971. Der Verlust der natürlichen Selbstverständlichkeit: Ein Beitrag zur Psychopathologie symptomarmer Schizophrenien. Stuttgart: Ferdinand Enke Verlag.

    Google Scholar 

  2. Bleuer, E. 1952. Dementia Praecox or the group of schizophrenias.

  3. Conrad, K. 1958. Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Georg Thieme Verlag. Stuttgart, Germany.

  4. Gross, G., G. Huber, J. Klosterkötter, and M. Linz. 1987. BSABS Bonner Skala für die Beurteilung von Basissymptomen. Manual, Kommentar, Dokumentationsbogen.. Berlin: Springer.

    Google Scholar 

  5. Gross, G., G. Huber, J. Klosterkötter, and M. Linz. 2008. BSABS - Bonn Scale for the Assessment of Basic Symptoms: 1st english edition: Manual, commentary, references, index, documentation sheet (Berichte aus der Medizin). Aachen: Shaker Verlag.

    Google Scholar 

  6. Jaspers, K. 1913. Allgemeine Psychopathologie. Ein Leitfaden für Studierende, Ärzte und Psychologen. Berlin Springer Verlag. Translated from the German 7th edition by Hoenig J and Hamilton MW in 1959.

  7. Klosterkötter, J. 1992. The meaning of basic symptoms for the development of schizophrenic psychoses. Neurology Psychiatry and Brain Research 1: 30–41.

    Google Scholar 

  8. Klosterkötter, J., M. Hellmich, E.M. Steinmeyer, and F. Schultze-Lutter. 2001. Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry 58: 158–164.

    Article  Google Scholar 

  9. Larøi, F., S. de Haan, S. Jones, and A. Raballo. 2010. Auditory verbal hallucinations: Dialoguing between the cognitive sciences and phenomenology. Phenomenology and the Cognitive Sciences 9: 225–240.

    Article  Google Scholar 

  10. McCarthy-Jones, S., J. Krueger, F. Larøi, M.R. Broome, and C. Fernyhough. 2013. Stop, look and listen: The need for philosophical phenomenological perspectives on auditory verbal hallucinations. Frontiers in Human Neuroscience 7: 127.

    Article  Google Scholar 

  11. Møller, P., and R. Husby. 2000. The initial prodrome in schizophrenia: Searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin 26: 217–232.

    Article  Google Scholar 

  12. Mundt, C. 2005. Anomalous self-experience: A plea for phenomenology. Psychopathology 38: 231–235.

    Article  Google Scholar 

  13. Parnas, J., and P. Handest. 2003. Phenomenology of anomalous self-experience in early schizophrenia. Comprehensive Psychiatry 44: 121–134.

    Article  Google Scholar 

  14. Parnas, J., and L.A. Sass. 2002. Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry & Psychology 8: 101–120.

    Article  Google Scholar 

  15. Parnas, J., P. Møller, T. Kircher, J. Thalbitzer, L. Jansson, P. Handest, and D. Zahavi. 2005. EASE-scale (Examination of Anomalous Self-Experience). Psychopathology 38: 236–258.

    Article  Google Scholar 

  16. Parnas, J., A. Raballo, P. Handest, L. Jansson, A. Vollmer-Larsen, and D. Saebye. 2011. Self-experience in the early phases of schizophrenia: 5-year follow-up of the Copenhagen Prodromal Study. World Psychiatry 10: 200–204.

    Article  Google Scholar 

  17. Parnas, J., L.A. Sass, and D. Zahavi. 2012. Rediscovering psychopathology: The epistemology and phenomenology of the psychiatric object. Schizophrenia Bulletin 39: 270–277.

    Article  Google Scholar 

  18. Raballo, A., and F. Larøi. 2011. Murmurs of thought: Phenomenology of hallucinatory consciousness in impending psychosis. Psychosis 3: 163–166.

    Article  Google Scholar 

  19. Sass, L. A. 1992. Madness and Modernism: Insanity in light of modern art, literature, and thought, New York, Basic Books.

  20. Sass, L.A., and J. Parnas. 2003. Schizophrenia, consciousness, and self. Schizophrenia Bulletin 29: 427–444.

  21. Sass, L., J. Parnas, and D. Zahavi. 2011. Philosophy, Psychiatry, & Psychology, 1: 1–23.

  22. Schultze-Lutter, F. 2009. Subjective symptoms of schizophrenia in research and the clinic: The basic symptom concept. Schizophrenia Bulletin 35: 5–8.

    Article  Google Scholar 

  23. Schultze-Lutter, F., J. Addington, S. Ruhrmann, and J. Klosterkötter. 2007. The Schizophrenia Proneness Instrument – Adult version (SPI-A). Rome: Giovanni Fioriti Editore s.r.l.

    Google Scholar 

  24. Schultze-Lutter, F., S. Ruhrmann, J. Berning, W. Maier, and J. Klosterkötter. 2010. Basic symptoms and ultrahigh risk criteria: Symptom development in the initial prodromal state. Schizophrenia Bulletin 36: 182191.

    Article  Google Scholar 

  25. Stanghellini, G., and M. Ballerini. 2004. Autism: Disembodied existence. Philosophy, Psychiatry& Psychology 11: 259–268.

    Article  Google Scholar 

  26. Wiggins, O.P., and M.A. Schwartz. 2007. Schizophrenia: a phenomenological-anthropological approach. In International perspectives in philosophy and psychiatry, Reconceiving schizophrenia, ed. M.C. Chung, K.W.M. Fulford, and G. Graham, 113–127. Oxford: Oxford University Press.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Peter Handest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Handest, P., Klimpke, C., Raballo, A. et al. From Thoughts to Voices: Understanding the Development of Auditory Hallucinations in Schizophrenia. Rev.Phil.Psych. 7, 595–610 (2016). https://doi.org/10.1007/s13164-015-0286-8

Download citation

Keywords

  • Schizophrenia
  • Auditory Hallucination
  • Mental Content
  • Psychotic Experience
  • Prodromal Phase