Abstract
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.
Highlights
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’ and voices that are experienced as ‘outer’ (‘external’, ‘outside the head’, ‘outside the mind’, ...)
The development of numerous assessment tools for AVHs since the 1970s—including both questionnaires for self-report and rating scales for structured and semi-structured interviews—was an immediate response to the need for more reliable diagnostic tools, especially for schizophrenia, that was perceived in that period
Given the pivotal role of AVH assessment tools both for clinical purposes and for the collection of data that serve as basis for empirical research on the phenomenology, epidemiology, explanation, treatment and other aspects of voice-hearing, the ambiguities that we have identified are bound to have damaging consequences both in clinical contexts and in research
Summary
In his 1885 monograph on hallucinations and related phenomena, Kandinsky distinguishes genuine hallucinations from phenomena that he calls ‘proper pseudo-hallucinations’,4 or ‘pseudo-hallucinations’ for short, on the ground that the former, but not the latter, possess a feature that he calls ‘character of objectivity’ (e.g., 1885, 30; sometimes, he speaks of ‘character of reality’, e.g., 1885, 30, and of the hallucination being ‘palpable’ [leibhaftig], 1885, 1355). In virtue of their ‘character of objectivity’, perceptions and hallucinations make it seem to the subject that what they represent is real Kandinsky explains that the term ‘inner voice’ is due to the fact that in pseudo-hallucinations, “patients know from immediate feeling that the source of voices lies in their own inner nature [in ihrem eigenen innern Wesen]” (1885, 82)—i.e. such voices are experienced as mind-dependent, as originating and located ‘in the subject’s mind’, and they are innerEXP This latter passage and Kandinsky’s term ‘character of objectivity’ suggest that the precise variant of ‘inner/outerEXP’ that Kandinsky employs is ‘inner/outerEXP-1’ (absence/presence of a sense of mindindependent reality). This latter passage and Kandinsky’s term ‘character of objectivity’ suggest that the precise variant of ‘inner/outerEXP’ that Kandinsky employs is ‘inner/outerEXP-1’ (absence/presence of a sense of mindindependent reality). (Notice that Kandinsky’s pseudo-hallucinations are characterized by full sensory detail and stability (1885, 29–30), so they are not innerEXP-2.)
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