Clara S. Humpston

Auditory verbal hallucinations in persons with and without a need for care

Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.

Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), 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: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include (1) informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; (2) “front-loading” research in cognitive neuroscience; and (3) 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.

Perplexity and Meaning: Toward a Phenomenological “Core” of Psychotic Experiences

The experiences of people with psychotic disorders such as schizophrenia have long been considered “incomprehensible.”1 However, more recently the incomprehensibility of psychosis has been brought into doubt by more phenomenologically oriented researchers who view psychosis not only as the result of aberrant neurobiology but also as a disorder of self-awareness and experience.2,3 To propose the idea that psychosis has no biochemical or genetic bearing is extremely naive to say the least, if not outright dangerous. Nevertheless, to negate the phenomenological perspective is also counterproductive. Phenomenology may well lie at the “core” of psychotic experiences just like any other human experience; in this article, I aim to use some of the available evidence of phenomenological research in psychosis, taking into account first-person perspectives as important factors, in order to put forward this argument.

Deficits in reality and internal source monitoring of actions are associated with the positive dimension of schizotypy

People with schizophrenia have deficits in retrieving the source of memory information. Research has focused on two types of judgements: reality monitoring (discriminating internally-generated stimuli from external information) and internal source monitoring (distinguishing two different internal sources). The aim of the current study was to assess the relation between schizotypy and both types of source memory in healthy volunteers. One hundred and two participants completed two source memory tasks: one involved the completion of well-known word pairs (e.g. Fish and? ) and the other was an action based task (e.g. nod your head). At test participants needed to indicate whether the act had been performed or imagined by themselves, performed by the experimenter, or was new. The positive dimension of schizotypy was positively correlated with errors in internal source monitoring i.e. confusing participant performed and imagined acts. Furthermore, the same dimension of schizotypy was also positively associated with reality monitoring errors i.e. confusing participant performed/imagined with experimenter performed items. However, these relationships were not found in the word pair task. Our findings suggest that there might be overlap in the processes required to retrieve source information from memory, particularly for actions, and the occurrence of unusual experiences in healthy volunteers.

The paradoxical self: Awareness, solipsism and first-rank symptoms in schizophrenia

Abstract Schizophrenia as a pathology of self-awareness has attracted much attention from philosophical theorists and empirical scientists alike. I view schizophrenia as a basic self-disturbance leading to a lifeworld of solipsism adopted by the sufferer and explain how this adoption takes place, which then manifests in ways such as first-rank psychotic symptoms. I then discuss the relationships between these symptoms, not as isolated mental events, but as end-products of a loss of agency and ownership, and argue that symptoms like thought insertion and other ego-boundary disorders are by nature a multitude of paradoxes created by a fragmented awareness. I argue that such fragmentation does not always require or lead to a delusional elaboration as the definitive feature of its phenomenology, and present reasons for the role of the first-person pronoun as a mere metaphor used to represent the patient’s bizarre experiences where sensory perception and thinking processes converge. Further, I discuss the initial benefits of adopting a solipsistic stance and how despite being a maladaptive strategy, it nevertheless acts as a protective barrier for the integrity of one’s self. Lastly, I offer some suggestions for clinical practice, emphasizing the importance of understanding the patient’s suffering in any therapeutic alliance.

Evidence of absence: no relationship between behaviourally measured prediction error response and schizotypy

ABSTRACT Introduction: The predictive processing framework has attracted much interest in the field of schizophrenia research in recent years, with an increasing number of studies also carried out in healthy individuals with nonclinical psychosis-like experiences. The current research adopted a continuum approach to psychosis and aimed to investigate different types of prediction error responses in relation to psychometrically defined schizotypy. Methods: One hundred and two healthy volunteers underwent a battery of behavioural tasks including (a) a force-matching task, (b) a Kamin blocking task, and (c) a reversal learning task together with three questionnaires measuring domains of schizotypy from different approaches. Results: Neither frequentist nor Bayesian statistical methods supported the notion that alterations in prediction error responses were related to schizotypal traits in any of the three tasks. Conclusions: These null results suggest that deficits in predictive processing associated with clinical states of psychosis are not always present in healthy individuals with schizotypal traits.

The measure of madness: philosophy of mind, cognitive neuroscience, and delusional thought [Book Review]

Professor Philip Gerrans has written extensively on a wide range of topics in neuroscience, psychopathology and philosophy, ranging from neurodevelopmental disorders to the formation of delusion to morality and emotion. Gerrans is an excellent example of how not being confined to a singular model of explanation can broaden one’s horizon with the added benefit of being able to view a research question from multiple angles when sustaining focus. The Measure of Madness is one of his most recent publications and so far the only one in book form; as its title suggests, in this book Gerrans offers an integrative model of delusion formation drawing from various disciplines such as cognitive neuroscience, phenomenology and even neurochemistry. Perhaps, most importantly, Gerrans challenges (successfully, in my opinion) the doxastic account of delusions as empirical beliefs and provides an alternative theory of delusions as “default thoughts”. Each chapter of the book focuses on a key aspect of Gerrans’ argument in support of the non-doxastic account, building towards a compelling new model of explanation which is very well-written throughout. The Introduction opens with a clinical case study of delusions of misidentification after brain injury; to Gerrans, this particular type of delusion amongst others provides an example of thinking process which, despite possessing many belief-like qualities (and thus may “automatically” qualify as beliefs to many theorists), can all be held in a person’s psychological space without necessarily being believed. This of course is directly at odds with the doxastic framework where delusional thoughts are treated and explained as empirical beliefs, which is a highly influential model that is adopted by current diagnostic manuals. Gerrans clearly spells out his argument and offers a different theoretical definition of delusion from the very beginning: