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. (shrink)

Recent work on the mechanisms underlying auditory verbal hallucination (AVH) has been heavily informed by self-monitoring accounts that postulate defects in an internal monitoring mechanism as the basis of AVH. A more neglected alternative is an account focusing on defects in auditory processing, namely a spontaneous activation account of auditory activity underlying AVH. Science is often aided by putting theories in competition. Accordingly, a discussion that systematically contrasts the two models of AVH can generate sharper questions (...) that will lead to new avenues of investigation. In this paper, we provide such a theoretical discussion of the two models, drawing strong contrasts between them. We identify a set of challenges for the self-monitoring account and argue that the spontaneous activation account has much in favor of it and should be the default account. Our theoretical overview leads to new questions and issues regarding the explanation of AVH as a subjective phenomenon and its neural basis. Accordingly, we suggest a set of experimental strategies to dissect the underlying mechanisms of AVH in light of the two competing models. (shrink)

About 75% of subjects diagnosed with schizophrenia experience auditory-verbal hallucination and report "hearing voices" that are not actually present. One notable feature of AVH is that it seems involuntary and not directly in the subject's control. With regard to content, these represented voices make utterances, typically commands and evaluations, and either are directed to the patient or speak about her in the third person. Voices may echo the subject's thoughts or comment on the subject's behavior and, in some (...) cases, the voices seem to carry on conversations or even argue. Subjects often experience the voices as having pitch, timbre, and intensity, and as having a... (shrink)

Two challenges that face popular self-monitoring theories (SMTs) of auditory verbal hallucination (AVH) are that they cannot account for the auditory phenomenology of AVHs and that they cannot account for their variety. In this paper I show that both challenges can be met by adopting a predictive processing framework (PPF), and by viewing AVHs as arising from abnormalities in predictive processing. I show how, within the PPF, both the auditory phenomenology of AVHs, and three subtypes of (...) AVH, can be accounted for. (shrink)

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. (shrink)

Auditory verbal hallucinations form an essential criterial feature in the schizophrenia definition in the Diagnostic and Statistical Manual of Mental Disorders -IV and International Classification of Diseases -10. In both classificatory systems, the presence of a hallucinatory voice that continuously comments the patient’s behavior or thoughts, or the presence of several voices that discuss the patient with each other, is a sufficient criterion to diagnose schizophrenia. The DSM-IV defines a hallucination as “a sensory perception that has the..

Do self‐monitoring accounts, a dominant account of the positive symptoms of schizophrenia, explain auditory verbal hallucination? In this essay, I argue that the account fails to answer crucial questions any explanation of auditory verbal hallucination must address. Where the account provides a plausible answer, I make the case for an alternative explanation: auditory verbal hallucination is not the result of a failed control mechanism, namely failed self‐monitoring, but, rather, of the persistent automaticity of (...) class='Hi'>auditory experience of a voice. My argument emphasizes the importance of careful examination of phenomenology as providing substantive constraints on causal models of the positive symptoms in schizophrenia. (shrink)

The phenomenology of auditory verbal hallucinations occurring in hypnagogic and hypnopompic states has received little attention. In a sample of healthy participants, 108 participants reported H&H AVHs and answered subsequent questions on their phenomenology. AVHs in the H&H state were found to be more likely to only feature the occasional clear word than to be clear, to be more likely to be one-off voices than to be recurrent voices, to be more likely to be voices of people (...) known to the individual than unknown persons, to be more likely to talk directly to the person rather than not, and to only rarely give commands, ask questions, or to result in an interactive conversation. Their phenomenology was similar to normative AVHs in wakefulness in that the voice-hearer was usually the target of the voice, and the voice was more likely to be of a recognized person. However, H&H AVHs differed from AVHs in wakefulness in that commands and questions were rare, and there was typically no dialogical engagement with the voice. We conclude by proposing that two distinct types of H&H AVHs may exist, based on an analysis of the phenomenology of the experience, and suggest avenues for future research. (shrink)

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations, the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person (...) accounts of AVH at 3 contextual levels: cultural, social, and historical; experiential; and biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; “front-loading” research in cognitive neuroscience; and suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. (shrink)

A neuropsychological perspective on auditory verbal hallucinations 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 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. 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. (shrink)

Current models of auditory verbal hallucinations tend to focus on the mechanisms underlying their occurrence, but often fail to address the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking why, given that there are AVHs, they have the properties that they have. One such property, which has been largely overlooked and which we will focus on here, is why the voices are often experienced (...) as coming from agents, and often specific, individualised agents. In this article, we argue not only that the representation of agents is important in accurately describing many cases of AVH, but also that deeper reflection on what is involved in the representation of agents has potentially vital consequences for our aetiological understanding of AVH, namely, for understanding how and why AVHs come about. (shrink)

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. (shrink)

Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations, and thought insertion 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. (shrink)

Several theories propose that one of the core functions of inner speech (IS) is to support subjects in the completion of cognitively effortful tasks, especially those involving executive functions (EF). In this paper we focus on two populations who notoriously encounter difficulties in performing EF tasks, namely, people diagnosed with schizophrenia who experience auditory verbal hallucinations (Sz-AVH) and people within the Autism Spectrum Conditions (ASC). We focus on these two populations because they represent two different ways in (...) which IS can fail to help in EF tasks, which can be illustrative for other mental conditions. First, we review the main components of EF (Section 1). Then we explain the functions that IS is taken to perform in the domain of EF (Section 2) and review the evidence concerning problems about EF in the two populations of our study: Sz-AVH (Section 3) and ASC (Section 4). After this we further detail our account about what a properly functioning IS can do for both populations and how different IS profiles may impact EF performance: in the case of Sz-AVH, the uncontrolled and intrusive character of IS negatively affects EF performance, whereas in ASC, EF is not sufficiently supported by IS, given the tendency in this population to present a diminished use of IS (Section 5). We finally briefly discuss Attention Deficit/Hyperactivity Disorder (ADHD) and Developmental Language Disorders (DLD). (shrink)

Both in research on Auditory Verbal Hallucinations (AVHs) and in their clinical assessment, it is common to distinguish between voices that are experienced as ‘inner’ (or ‘internal’, ‘inside the head’, ‘inside the mind’,...) and voices that are experienced as ‘outer’ (‘external’, ‘outside the head’, ‘outside the mind’,...). This inner/outer-contrast is treated not only as an important phenomenological variable of AVHs, it is also often seen as having diagnostic value. In this article, we argue that the distinction between (...) ‘inner’ and ‘outer’ voices is ambiguous between different readings, and that lack of disambiguation in this regard has led to flaws in assessment tools, diagnostic debates and empirical studies. Such flaws, we argue furthermore, are often linked to misreadings of inner/outer-terminology in relevant 19th and early twentieth century work on AVHs, in particular, in connection with Kandinsky’s and Jaspers’s distinction between hallucinations and pseudo-hallucinations. (shrink)

A theory which has had significant influence seeks to explain auditory verbal hallucinations as utterances in inner speech which are not properly monitored and are consequently misattributed to some external source. This paper argues for a distinction between inner speech and imagined speech, on the basis that inner speech is a type of actual speech. The paper argues that AVHs are more likely instances of imagined speech, rather that inner speech, which are not properly monitored : 86–107, (...) 2012), Cho and Wu and Cho and Wu, although they prefer a quite different explanation of AVHs). (shrink)

Passivity experiences in schizophrenia are thought to be due to a failure in a neurocognitive action self-monitoring system . Drawing on the assumption that inner speech is a form of action, a recent model of auditory verbal hallucinations has proposed that AVHs can be explained by a failure in the NASS. In this article, we offer an alternative application of the NASS to AVHs, with separate mechanisms creating the emotion of self-as-agent and other-as-agent. We defend the assumption (...) that inner speech can be considered as a form of action, and show how a number of previous criticisms of applying the NASS to AVHs can be refuted. This is achieved in part through taking a Vygotskian developmental perspective on inner speech. It is suggested that more research into the nature and development of inner speech is needed to further our understanding of AVHs. (shrink)

A common but overlooked form of explanation in psychiatry is what I label ‘empathetic explanation’. Empathetic explanations invoke empathetic variables, which, in addition to providing an explanation of the target phenomenon, also afford an empathetic understanding of it. Focusing on the case of auditory verbal hallucination (AVH), I argue that empathetic explanation fails to provide an adequate account of the phenomenon, perniciously shapes empirical research, and confuses empathetic understanding with scientific understanding. I close by providing a general condition (...) on the legitimate application of empathetic explanation. (shrink)

We present one of the first quantitative studies on auditory verbal experiences and auditory verbal agency voices or characters”) in healthy participants across states of consciousness. Tools of quantitative linguistic analysis were used to measure participants’ implicit knowledge of auditory verbal experiences and auditory verbal agencies, displayed in mentation reports from four different states. Analysis was conducted on a total of 569 mentation reports from rapid eye movement sleep, non-REM sleep, sleep onset, (...) and waking. Physiology was controlled with the nightcap sleep–wake mentation monitoring system. Sleep-onset hallucinations, traditionally at the focus of scientific attention on auditory verbal hallucinations, showed the lowest degree of VE and VA, whereas REM sleep showed the highest degrees. Degrees of different linguistic-pragmatic aspects of VE and VA likewise depend on the physiological states. The quantity and pragmatics of VE and VA are a function of the physiologically distinct state of consciousness in which they are conceived. (shrink)

A Correction to this paper has been published: https://doi.org/10.1007/s13164-021-00536-7.

We respond to Moseley and Wilkinson's defense of inner speech models of AVH.

To some it is a shallow platitude that inner speech always has an auditory-phonological component. To others, it is an empirical hypothesis with accumulating support. To yet others it is a false dogma. In this chapter, I defend the claim that inner speech always has an auditory-phonological component, confining the claim to adults with ordinary speech and hearing. It is one thing, I emphasize, to assert that inner speech often, or even typically, has an auditory-phonological component—quite another (...) to propose that it always does. When forced to argue for the stronger point, we stand to make a number of interesting discoveries about inner speech itself, and about our means for discriminating it from other psycholinguistic phenomena. Establishing the stronger conclusion also provides new leverage on debates concerning how we should conceive of, diagnose, and explain auditory verbal hallucinations and “inserted thoughts” in schizophrenia. (shrink)

In Real Hallucinations, Matthew Ratcliffe offers a philosophical examination of the structure of human experience, its vulnerability to disruption, and how it is shaped by relations with other people. He focuses on the seemingly simple question of how we manage to distinguish among our experiences of perceiving, remembering, imagining, and thinking. To answer this question, he first develops a detailed analysis of auditory verbal hallucinations (usually defined as hearing a voice in the absence of a speaker) (...) and thought insertion (somehow experiencing one's own thoughts as someone else's). He shows how thought insertion and many of those experiences labeled as "hallucinations" consist of disturbances in a person's senseof being in one type of intentional state rather than another. Ratcliffe goes on to argue that such experiences occur against a backdrop of less pronounced but wider-ranging alterations in the structure of intentionality. In so doing, he considers forms of experience associated with trauma, schizophrenia, and profound grief. The overall position arrived at is that experience has an essentially temporal structure, involving patterns of anticipation and fulfillment that are specific to types of intentional states and serve to distinguish them phenomenologically. Disturbances of this structure can lead to various kinds of anomalous experience. Importantly, anticipation-fulfillment patterns are sustained, regulated, and disrupted by interpersonal experience and interaction. It follows that the integrity of human experience, including the most basic sense of self, is inseparable from how we relate to other people and to the social world as a whole. (shrink)

Many philosophers and psychologists have sought to explain experiences of auditory verbal hallucinations and “inserted thoughts” in schizophrenia in terms of a failure on the part of patients to appropriately monitor their own inner speech. These self-monitoring accounts have recently been challenged by some who argue that AVHs are better explained in terms of the spontaneous activation of auditory-verbal representations. This paper defends two kinds of self-monitoring approach against the spontaneous activation account. The defense requires (...) first making some important clarifications concerning what is at issue in the dispute between the two forms of theory. A popular but problematic self-monitoring theory is then contrasted with two more plausible conceptions of what the relevant self-monitoring deficits involve. The first appeals to deficits in the neural mechanisms that normally filter or attenuate sensory signals that are the result of one’s own actions. The second, less familiar, form of self-monitoring approach draws an important analogy between Wernicke’s aphasia and AVHs in schizophrenia. This style of self-monitoring theory pursues possible connections among AVHs, inserted thoughts, and the disorganized speech characteristic formal thought disorder. (shrink)

Inner speech travels under many aliases: the inner voice, verbal thought, thinking in words, internal verbalization, “talking in your head,” the “little voice in the head,” and so on. It is both a familiar element of first-person experience and a psychological phenomenon whose complex cognitive components and distributed neural bases are increasingly well understood. There is evidence that inner speech plays a variety of cognitive roles, from enabling abstract thought, to supporting metacognition, memory, and executive function. One active area (...) of controversy concerns the relation of inner speech to auditory verbal hallucinations in schizophrenia, with a common proposal being that sufferers of AVH misidentify their own inner speech as being generated by someone else. Recently, researchers have used artificial intelligence to translate the neural and neuromuscular signatures of inner speech into corresponding outer speech signals, laying the groundwork for a variety of new applications and interventions. (shrink)

Wegner’s argument on the illusory nature of conscious will, as developed in The Illusion of Conscious Will (2002) and other publications, has had major impact. Based on empirical data, he develops a theory of apparent mental causation in order to explain the occurrence of the illusion of conscious will. Part of the evidence for his argument is derived from a specific interpretation of the phenomenon of auditory verbal hallucinations as they may occur in schizophrenia. The aim of (...) this paper is to evaluate the validity of the evidence on auditory verbal hallucinations as employed by Wegner. I conclude that auditory hallucinations do not provide solid evidence for Wegner’s theory. Moreover, the phenomena in schizophrenia provide, in fact, an argument against part of Wegner’s theory of apparent mental causation. (shrink)

Transcranial magnetic stimulation, EEG, and behavioral studies by our group implicate spurious activation of speech perception neurocircuitry in the genesis of auditory hallucinations in schizophrenia. The neurobiological basis of these abnormalities remains uncertain, however. We review our ongoing studies, which suggest that altered cortical coupling underlies speech processing in schizophrenia and is expressed via disrupted gamma resonances and impaired corollary discharge function of self-generated verbal thought.

This dissertation explores the phenomenon of inner speech. It takes the form of an introduction, which introduces the phenomenon; three long, largely independent chapters; a conclusion; and an appendix. -/- The first chapter deliberates between two possible theories as to the nature of inner speech. One of these theories is that inner speech is a kind of actual speech, just as much as external speech is a kind of actual speech. When we engage in inner speech, we are actually speaking, (...) but we are doing so silently. The other theory holds that inner speech is a kind of imagined speech. When we produce inner speech, we are imagining performing the action of speaking. The chapter argues for the theory that inner speech is a kind of actual speech. -/- The second chapter argues against a theory which holds that inner speech is dialogic. On this theory, a subject represents different perspectives in inner speech and a dialogue can take place in the same sense in which a dialogue can take place between different individuals in external speech. The chapter borrows some important material from the philosophy of language to show that this position, though it might have some intuitive appeal, is ultimately implausible. -/- The third chapter is concerned with the question whether inner speech can be a source of knowledge of our own beliefs. It shows that the view that inner speech can be such a source is subject to an adapted version of a problem from the epistemology of testimony: roughly, what justification do we have for believing that we believe what we say in inner speech? It makes use of some material from the recent debate about cognitive phenomenology to develop a version of the view which is not subject to this problem. It then provides some initial discussion of the merits of this view. -/- The appendix takes up a more practical issue regarding inner speech. There is a theory that auditory verbal hallucinations – i.e. experiences of voice-hearing – take place when someone produces an utterance in inner speech but loses track of the fact that they have produced the utterance. Accordingly, they have an experience as of something being said and, not realising that they are the source of the experience, postulate some external cause, i.e. someone else speaking. The appendix develops an alternative account which has been suggested in the literature, at times drawing upon earlier work in the dissertation. (shrink)

Voices are a complex and rich acoustic signal processed in an extensive cortical brain network. Specialized regions within this network support voice perception and production and may be differentially affected in pathological voice processing. For example, the experience of hallucinating voices has been linked to hyperactivity in temporal and extra-temporal voice areas, possibly extending into regions associated with vocalization. Predominant self-monitoring hypotheses ascribe a primary role of voice production regions to auditory verbal hallucinations. Alternative postulations view a (...) generalized perceptual salience bias as causal to AVH. These theories are not mutually exclusive as both ascribe the emergence and phenomenology of AVH to unbalanced top-down and bottom-up signal processing. The focus of the current study was to investigate the neurocognitive mechanisms underlying predisposition brain states for emergent hallucinations, detached from the effects of inner speech. Using the temporal voice area localizer task, we explored putative hypersalient responses to passively presented sounds in relation to hallucination proneness. Furthermore, to avoid confounds commonly found in in clinical samples, we employed the Launay-Slade Hallucination Scale for the quantification of HP levels in healthy people across an experiential continuum spanning the general population. We report increased activation in the right posterior superior temporal gyrus during the perception of voice features that positively correlates with increased HP scores. In line with prior results, we propose that this right-lateralized pSTG activation might indicate early hypersensitivity to acoustic features coding speaker identity that extends beyond own voice production to perception in healthy participants prone to experience AVH. (shrink)

Against claims that cognitive science of religion undercuts belief in God, many defenders of theistic belief have invoked the Religious Reasons Reply: science cannot undercut belief in God if one has good independent reasons to believe. However, it is unclear whether this response helps salvage the god beliefs of most people. This paper considers four questions: (1) What reasons do Christians have for believing in God? (2) What kinds of beliefs about God can the reasons support? (3) Are the reasons (...) rationalizations? (4) Can cognitive science undercut the reasons? Many Christians invoke everyday religious experiences (EREs)—such as experiences of divine presence, guidance, and communication—as reasons to believe. Unlike another popular reason to believe in God (the appearance of design and beauty in nature), EREs can support beliefs about a relational God who is present to me, who guides my life, and who speaks to me. EREs are not rationalizations since they seem to cause and sustain such beliefs. Nonetheless, EREs like experiences of hearing God speak are problematic reasons to believe. ‘Soft’ voice-hearing experiences are easily undercut. ‘Hard’ experiences of an external, audible voice are probably underpinned by similar cognitive processes as audio-verbal hallucinations. (shrink)

Much of what we say is never said aloud. It occurs only silently, as inner speech. We chastise, congratulate, joke and cajole, all without making a sound. This distinctively human ability to create public language in the privacy of our own minds is no less remarkable for its familiarity. And yet, until recently, inner speech remained at the periphery of philosophical and psychological theorizing. This essay collection, from an interdisciplinary group of leading philosophers, psychologists, and neuroscientists, displays the rapidly growing (...) interest among researchers in the puzzles surrounding the nature and cognitive role of the inner voice. Questions explored include: the aids and obstacles inner speech presents to self-knowledge; the complex relation it bears to overt speech production and perception; the means by which inner speech can be identified and empirically assessed; its role in generating auditory verbal hallucinations; and its relationship to conceptual thought itself. (shrink)

Many mental phenomena involve thinking about people who do not exist. Imagined characters appear in planning, dreams, fantasizing, imaginary companions, bereavement hallucinations, auditory verbal hallucinations, and as characters created in fictional narratives by authors. Sometimes these imagined persons are felt to be completely under our control, as when one fantasizes about having a great time at a party. Other times, characters feel as though they are outside of our conscious control. Dream characters, for example, are experienced (...) by dreamers as autonomous entities, and often do things that frighten and surprise dreamers. Some imagined persons, such as characters in fiction, start off under conscious control of the author, but over time, can appear to gain an illusion of independent agency. I propose an explanation for different autonomy attributions: characters are by default non-autonomous, unless their personalities are well-practiced. Characters become autonomous because modeling their thinking has become automatized, like many other well-practiced activities. (shrink)

The phenomenon of 'hearing voices,' often viewed as a symptom of schizophrenia, is commonly called, in the scientific and clinical literature, 'auditory-verbal hallucination.' However, reports of hearing soundless voices, voices that are not auditory, which go as far back as Tuttle and Kraepelin and appear in phenomenological interviews and questionnaires are relatively common. What are we to make of such reports?One option is to dismiss these claims: one cannot hear soundless voices. This dismissal could be due to (...) a combination of the following seemingly reasonable claims, each sufficient to consign the notion of 'hearing soundless voices' to the status... (shrink)

In this introduction we present the orthodox account of auditory verbal hallucinations, a number of worries for this account, and some potential responses open to its proponents. With some problems still remaining, we then introduce the problems presented by the phenomenon of thought insertion, in particular the question of how different it is supposed to be from AVHs. We then mention two ways in which theorists have adopted different approaches to voices and thoughts in psychosis, and then (...) present the motivation and composition of this special issue. (shrink)

In the last few years, avatars have been increasingly used in treating persistent persecutory auditory verbal hallucinations. The digital representation (an avatar) of persecutory hallucinations is voiced by the therapist and engages the patient in a dialogue, progressively conceding its power and, hence, reducing the stress experienced by the patient. Such attempts at integrating digital representations and cognitive behavior therapy raise a range of philosophical questions, which this chapter tackles along two trajectories. From an epistemological standpoint, (...) we inquire what notion of mental disorder can underlie the use of avatar therapy, and how our understanding of psychiatric diseases can be affected by the implementation of such a therapy. Relatedly, from an ethical standpoint, we reflect on some of the controversial issues posed by such therapeutic strategies. Discussing selected epistemological and ethical aspects stemming from the latest relevant literature both in philosophy and in psychiatry, the chapter aims to provide a tentative evaluation of trade-offs between the promises of and the limits to this therapeutic option. (shrink)

There has recently been emphasis put on providing two-factor accounts of monothematic delusions. Such accounts would explain (1) whether a delusional hypothesis (e.g. someone else is inserting thoughts into my mind) can be understood as a prima facie reasonable response to an experience and (2) why such a delusional hypothesis is believed and maintained given its implausibility and evidence against it. I argue that if we are to avoid obfuscating the cognitive mechanisms involved in monothematic delusion formation we should split (...) the first factor (1 above) into two factors: how abnormal experience can give rise to a delusional ‘proto-hypothesis’ and how a ‘proto-hypothesis’ in consort with normal experiences and background information, can be developed into a delusional hypothesis. In particular I will argue that a schizophrenic is faced with the unusual requirement of having to identify an introspectively accessible thought as one's own, and that this requirement of identification is the central experiential abnormality of thought insertion, auditory verbal hallucination, and alien control (i.e. passivity symptoms). Additionally, I will consider non-experiential factors which are required for the formation of a delusional hypothesis. (shrink)

Differentiating self from other has been investigated at the neural level, and its incorporation into the model proposed Hurley is necessary for the model to be complete. With an emphasis on the feed-forward model in layer 2, we examine the role that self and other disruptions, including auditory verbal hallucinations (AVHs), may have in expanding the model proposed by Hurley.

The first commentary that we discuss is the quite critical one by Thomas and Long-den. The pertinent question is if the authors’ criticism hits the mark or if it is simply off the mark? We will let the reader decide. In the following, we address some of the most important problems in their commentary. First, Thomas and Longden seem to conflate the concept of pathogenesis with that of etiology. We have presented a phenomenological account of the pathogenesis of some (...) class='Hi'>auditory verbal hallucinations in schizophrenia —an account based on empirical data.. (shrink)

We welcome Cho and Wu’s suggestion that the study of auditory verbal hallucinations could be improved by contrasting and testing more explanatory models. However, we have some worries both about their criticisms of inner speech-based self-monitoring models and whether their proposed spontaneous activation model is explanatory.

An examination of verbal hallucinations and thought insertion as examples of "alienated self-consciousness.".

Abstract: How it is that one's own thoughts can seem to be someone else's? After noting some common missteps of other approaches to this puzzle, I develop a novel cognitive solution, drawing on and critiquing theories that understand inserted thoughts and auditory verbal hallucinations in schizophrenia as stemming from mismatches between predicted and actual sensory feedback. Considerable attention is paid to forging links between the first-person phenomenology of thought insertion and the posits (e.g. efference copy, corollary discharge) (...) of current cognitive theories. I show how deficits in the subconscious mechanisms regulating inner speech may lead to a 'fractured phenomenology' responsible for schizophrenic patients' reports of inserted thoughts and auditory verbal hallucinations. Supporting work on virtual environments is discussed, and lessons concerning the fixity of delusional belief are drawn. (shrink)