Abstract
The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. Identity perception in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human (i.e., real, external) voice perception, and shapes the emotional (distress) and behavioral (help-seeking) response to the experience. Yet, the phenomenological assessment of voice identity is often limited, for example to the gender of the voice, and has failed to take advantage of recent models and evidence on human voice perception. In this paper we aim to synthesize the literature on identity in real and hallucinated voices and begin by providing a comprehensive overview of the features used to judge voice identity in healthy individuals and in people with schizophrenia. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. Next we provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. Our studies used diverse methods, assessing recognition and binding of words and voices in memory as well as multidimensional scaling of voice dissimilarity judgments. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. In contrast, these voice processing abilities appear to be generally intact in non-clinical hallucinators. The review highlights some important avenues for future research and treatment of AVH associated with a need for care, and suggests some novel insights into other symptoms of psychosis.
Highlights
Auditory hallucinations usually involve hearing voices that noone else can hear (Bentall, 2003)
These studies highlight the importance of voice identity in distinguishing clinical and non-clinical hallucinations, and raise the possibility that the perception of voice identity in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human voice perception
An obvious question arises, namely: do the differences in phenomenology of AVH in clinical and non-clinical voice hearers result from differences in the underlying mechanisms of human voice perception? we provide a summary and critique of several recent studies which have examined the ability to process real, external voices in clinical and non-clinical hallucinators
Summary
Voices to reckon with: perceptions of voice identity in clinical and non-clinical voice hearers. The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. We provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. These voice processing abilities appear to be generally intact in non-clinical hallucinators.
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