The Self, Agency and Spatial Externalizations of Inner Verbal Thoughts, and Auditory Verbal Hallucinations.

Massoud Stephane

doi:10.3389/fpsyt.2019.00668

Abstract

Aim: Auditory Verbal Hallucinations (AVH) are experienced as the “voices” of others (O-AVH) or self (S-AVH) in internal space/inside the head (IS-AVH) or external space (ES-AVH), and are considered to result from agency and spatial externalizations of inner speech. Both types of externalizations are conflated, and the relationship between these externalizations and AVH experiences is unclear. In this paper, I investigate the relationship between cognitive agency and spatial externalizations and between these externalizations and the types of AVH experience. Method: Twenty-five patients with history of AVH and 24 matched healthy controls performed agency and spatial distinction tasks: distinction between self-generated (read) (S) sentences and other-generated (O) sentences, and between sentences read silently (experienced in internal space, IS) and sentences read aloud (experienced in external space, ES). Regression analyses between misattribution biases (S-O vs. IS-ES, and O-S vs. ES-IS) were obtained. t tests were used to compare misattribution biases between AVH subtypes (S-AVH vs. O-AVH, and IS-AVH vs. ES-AVH). Results: Regressions suggest that agency distinction is independent from spatial distinction in both groups. O-AVH and S-AVH subgroups differed only with respect to S-O bias, and IS-AVH and ES-AVH subgroups differed only with respect to IS-ES bias. Conclusion: These results suggest that agency and spatial externalizations of inner speech are independent at phenomenological and cognitive and levels; and that these externalizations are co-related across levels. I discuss the implications of these findings in the wider context of research on AVH and on the experience of self.

Highlights

Auditory Verbal Hallucinations (AVH), i.e. auditory perceptions of speech without corresponding external object [1] are symptoms of many psychiatric and medical illnesses [2]
Hallucinations were evaluated using the computerized binary Scale of Auditory Speech Hallucinations [31] to identify phenomenological subtypes of AVH based on the S, O, internal space (IS), and external space (ES) experiences of the “voices.” Patients were evaluated with the Brief Psychiatric Rating Scale (BPRS) [32], the Scale for the Assessment of Negative Symptoms (SANS) [33], and the Scale for the Assessment of Positive Symptoms (SAPS) [34]
There were no significant differences in age, personal level of education, or mean parental level of education

Summary

Introduction

Auditory Verbal Hallucinations (AVH), i.e. auditory perceptions of speech without corresponding external object [1] are symptoms of many psychiatric and medical illnesses [2]. While the mechanisms of AVH remain elusive, research consistently implicated disordered language processes [5] and, in particular, disorders of generation of inner speech (inner verbal thoughts) [6]. Subjects with AVH report hearing the “voices” of others and often experience these “voices” in external space— hereafter, phenomenological agency and spatial externalizations, respectively [7, 8]. From the perspective of inner speech generation disorder, these aspects of AVH experiences point to agency and spatial externalizations of inner verbal thoughts at a cognitive level. Neuropsychiatric research has shown evidence for both types of externalizations [9, 10]

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Discussion

Conclusion