Stop, look, listen: the need for philosophical phenomenological perspectives on auditory verbal hallucinations

Simon Mccarthy-Jones,Frank Larøi,Joel Krueger,Matthew Broome,Charles Fernyhough

doi:10.3389/fnhum.2013.00127

Abstract

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.

Highlights

The experience of hearing a voice in the absence of an appropriate external stimulus, formally termed an auditory verbal hallucination (AVH), is found in people with a range of psychiatric diagnoses, including schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as in non-psychiatric populations (Larøi et al, 2012)
accounts of AVHs drawn from phenomenological philosophy may be valuable
that this is then mapped onto the actual phenomenology of AVHs

Summary

INTRODUCTION

The experience of hearing a voice in the absence of an appropriate external stimulus, formally termed an auditory verbal hallucination (AVH), is found in people with a range of psychiatric diagnoses, including schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as in non-psychiatric populations (Larøi et al, 2012). Philosophical phenomenology is a systematic investigation of subjectivity, a consideration of experience from the first-person perspective of the “I” (Moran, 2000; Sokolowski, 2000) This first-person emphasis involves an analysis of basic structures of consciousness such as intentionality, self-awareness, temporality, embodiment, spatiality, agency, and intersubjectivity. Some argue (e.g., Merleau-Ponty, 1962), that there can be no truly presuppositionless seeing, no “total” epoché, and that, just like cognitive psychology, philosophical phenomenology has its own set of concepts that influence the aspects of AVHs that are attended to, such as the embodiment of the experience or its temporal or spatial character Such insights have been gained via phenomenological reflection on the nature of experience. AVHs “represent the perfectly normal phenomena of ordinary human experience— which, are radically transformed because of being lived in the abnormal condition of hyper-reflexive awareness and diminished self-affection” (p. 433)

LIMITATIONS

CONCLUSIONS AND EMPIRICAL PRIORITIES