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Letter to the Editor: Auditory-verbal hallucinations and ordinary verbal thought

Published online by Cambridge University Press:  10 October 2008

FRANK LARØI
Affiliation:
Cognitive Psychopathology Unit, University of Liège, Boulevard du Rectorat (B33), 4000 Liège, (Email: [email protected]) Belgium
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Abstract

Type
Correspondence
Copyright
Copyright © 2008 Cambridge University Press

While the discussion concerning advantages and disadvantages of the single-symptom approach compared to other approaches, such as the syndrome/diagnosis approach, is far from resolvedFootnote *, I agree with Mojtabai & Reider's (Reference Mojtabai and Rieder1998) conclusion that each approach has different aims and answers different questions and therefore, in my opinion, can be viewed as complementary. In the spirit of methodological pluralism – both approaches deserve to be, as it were, in each researcher's ‘toolbox’.

In particular, hallucinations have frequently been examined within a single-symptom approach (for a review see Aleman & Larøi, Reference Aleman and Larøi2008)Footnote . There has, furthermore, been a noteworthy recent interest in a ‘phenomenological’ approachFootnote , both within psychopathology research in general (cf. Owen & Harland, Reference Owen and Harland2007) and for hallucinations in particular (cf. Larøi, Reference Larøi2006; Larøi & Woodward, Reference Larøi and Woodward2007). That is, for example, researchers are using the phenomenological characteristics of hallucinations to either test the validity of previous findings and/or models, and/or have employed a refined phenomenological analysis of the experience or symptom in question in order to guide future research. The study by Hoffman and colleagues (Reference Hoffman, Varanko, Gilmore and Mishara2008) is an excellent example of the merits of adopting both a single-symptom and a phenomenological approach.

Hoffman et al. (Reference Hoffman, Varanko, Gilmore and Mishara2008) ask the question: ‘Are schizophrenia patients with auditory-verbal hallucinations (AVHs) able to differentiate between own thoughts and voices and if so, how do they do so?’ The results showed that 80% of patients were able to differentiate AVHs from their usual verbal thoughts either ‘most of the time’ or ‘always’. A similar finding was reported in a recent study (Moritz & Larøi, Reference Moritz and Larøi2008) where a large majority of schizophrenia patients expressed being able to distinguish real from hallucinated voices. Although the results from Hoffman et al. (Reference Hoffman, Varanko, Gilmore and Mishara2008) are not entirely clear-cut and seem to suggest considerable individual variability, the results additionally revealed that three characteristics were particularly important in differentiating voices from thoughts: verbal content, degree of control and the non-self ‘sound’ of the speaking voice.

However, after having read the article, two issues popped into mind. Do the findings have clinical implications? It would have been interesting to match the theoretical reflections with reflections regarding the extent to which the findings might have a clinical impact. Briefly, how do we get patients to gradually come to terms with the fact that their voices are, in reality, internal mental events (i.e. thoughts)? Perhaps it would be fruitful to mention to voice-hearers that thoughts may take a verbal form, are also involuntary or unintended, and may also lead individuals to feel as if they do not belong to oneself. Another issue is that future studies will inevitably need to better elucidate the developmental or dynamic nature of the genesis of hallucinations. To begin with, hallucinations are, ultimately, internal mental events. These internal mental events evolve over time through a complex interaction of cognitive, emotional, biological and socio-cultural mechanisms and factors. They are, as it were, transformed into something else – for some individuals, this transformation results in a voice. Regrettably, we continue to predominantly (although the climate has changed in the past years) study hallucinations when they are fully ‘developed’ (e.g. hallucinations present in chronic schizophrenia patients). It will be an important future approach to consider when and how internal mental events, such as ordinary everyday thoughts, are transformed into voices. This calls for a developmental approach to hallucinations – yet another approach that researchers will need to include in their toolbox.

Declaration of Interest

None.

Footnotes

* See Persons (Reference Persons1986) and Costello (Reference Costello1992) for a discussion of the advantages of the single-symptom approach, a critical review of the single-symptom approach by Mojtabai & Reider (Reference Mojtabai and Rieder1998), and a reply to this by Bentall (Reference Bentall2003).

Although please note that other symptoms, and most notably (persecutory) delusions, have also attracted researchers' attention. On the other hand, the dominance of positive psychotic symptoms (i.e. hallucinations and delusions) within the single-symptom approach has perhaps been to the detriment of studying other symptoms, such as negative symptoms. Perhaps future research will even out this discrepancy.

This revival did not come out of the blue. Certain researchers have for a long time advocated a phenomenological analysis of psychopathological states and experiences (cf. Parnas & Bovet, Reference Parnas and Bovet1995; Parnas & Zahavi, Reference Parnas, Zahavi, Maj, Gaebel, López-Ibor and Sartorius2002).

References

Aleman, A, Larøi, F (2008). Hallucinations: The Science of Idiosyncratic Perception. American Psychological Association: Washington, DC.CrossRefGoogle Scholar
Bentall, RP (2003). Madness Explained: Psychosis and Human Nature. Penguin: London.Google Scholar
Costello, CG (1992). Research on symptoms versus research on syndromes: arguments in favour of allocating more research time to the study of symptoms. British Journal of Psychiatry 160, 304308.CrossRefGoogle Scholar
Hoffman, RE, Varanko, M, Gilmore, J, Mishara, AL (2008). Experiential features used by patients with schizophrenia to differentiate ‘voices’ from ordinary verbal thought. Psychological Medicine 38, 11671176.CrossRefGoogle ScholarPubMed
Larøi, F (2006). The phenomenological diversity of hallucinations: some theoretical and clinical implications. Psychologica Belgica 46, 163183.CrossRefGoogle Scholar
Larøi, F, Woodward, T (2007). Hallucinations from a cognitive perspective. Harvard Review of Psychiatry 15, 109117.CrossRefGoogle ScholarPubMed
Mojtabai, R, Rieder, RO (1998). Limitations of the symptom-oriented approach to psychiatric research. British Journal of Psychiatry 173, 198202.CrossRefGoogle ScholarPubMed
Moritz, S, Larøi, F (2008). Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts. Schizophrenia Research 102, 96107.CrossRefGoogle ScholarPubMed
Owen, G, Harland, R (2007). Theme issue on phenomenology and psychiatry for the 21st century. Taking phenomenology seriously. Schizophrenia Bulletin 33, 105107.CrossRefGoogle ScholarPubMed
Parnas, J, Bovet, P (1995). Research in psychopathology: epistemological issues. Comprehensive Psychiatry 36, 167181.CrossRefGoogle Scholar
Parnas, J, Zahavi, D (2002). The role of phenomenology in psychiatric classification and diagnosis. In Psychiatric Diagnosis and Classification (ed. Maj, M., Gaebel, W., López-Ibor, J. J. and Sartorius, N.), pp. 137162. John Wiley & Sons: Chichester.CrossRefGoogle Scholar
Persons, JB (1986). The advantages of studying psychological phenomena rather than psychiatric diagnoses. American Psychologist 41, 12521260.CrossRefGoogle ScholarPubMed