Phenomenology Of Hallucinations Research Articles

The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review.

Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes. A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples. Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Māori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services. These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.

Cross-cultural Differences in Hallucinations: A Comparison Between Middle Eastern and European Community-Based Samples.

While literature indicates that culture modulates phenomenological characteristics of hallucinations in schizophrenia-spectrum disorders, little is known about the extent culture modulates these characteristics in nonclinical samples. We compared lifetime prevalence, age of onset, and phenomenology of hallucinations as assessed with the Questionnaire for Psychotic Experiences between samples of nonclinical participants used from the Netherlands (N = 2999) and Qatar (N = 2999). While participant recruitment differed between the 2 countries, the samples were relatively equal in terms of demographic factors. Our findings indicate that the lifetime prevalence of tactile and olfactory hallucinations are the same across countries. However, the prevalence of auditory hallucinations (AH) and visual hallucinations (VH) were twice as high in the Dutch sample. The reported age of onset for auditory and tactile hallucinations was younger for the Dutch sample. Findings from the measurement invariance supported cross-cultural comparisons with exception for duration, distress, and insight. Qatar's and Dutch participants reported similar valence and extent of interaction with AH and VH. However, compared to those in the Netherlands, participants from Qatar reported significantly more impact on daily functioning and a higher prevalence of receiving commands from hallucinations in the past week. While AH and VH were more often reported in the Dutch sample, participants in Qatar generally had higher mean factor scores for past week AH and VH than in the Netherlands. The phenomenology of hallucinations in the Qatar sample was of greater clinical relevance, with potentially important implications for early screening and prevention.

The role of religiosity types in the phenomenology of hallucinations: A large cross-sectional community-based study in a predominantly Muslim society

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

Comparison of the Phenomenology of Hallucination and Delusion Characteristics in People Diagnosed With Borderline Personality Disorder and Schizophrenia.

Hallucinations and delusions in borderline personality disorder (BPD) are understudied. The authors explore the phenomenology of multisensory hallucinations and delusions in individuals with BPD and compare them to those in individuals with schizophrenia spectrum disorders (SSD). Clinical psychopathology was also explored. Eighty-nine adults participated and were categorized into four groups: BPD with voices, BPD without voices, SSD with high BPD traits, and SSD with low BPD traits. Among individuals with BPD, 81% reported visual and tactile hallucinations, 75% reported olfactory hallucinations, and 94% experienced delusions. When comparing BPD with and without voices, there were no significant differences in nonpsychotic psychopathology. Slight differences were found when hallucinations in BPD were compared with hallucinations in SSD, but overall the experiences were similar across diagnoses. The BPD group also reported significantly higher rates of paranoia/suspiciousness and delusions of guilt than the SSD group. Multisensory hallucinations and delusions occur in BPD and should be explored when treating people with BPD.

Occurrence and phenomenology of hallucinations in the general population: A large online survey

Although epidemiological studies report that hallucinations occur in 6–15% of the general population, little is known about their phenomenology. To overcome this paucity, this study investigates the phenomenological characteristics of hallucinations in the general population, by using a nationally promoted online survey to assess hallucination phenomenology in four sensory modalities, through a self-report version of the Questionnaire for Psychotic Experiences (QPE), in 10,448 participants (aged 14–88 years). The phenomenology of hallucinations was assessed if hallucinations reportedly occurred in the past month. In the past month, auditory hallucinations were reported most frequently (29.5%), followed by visual (21.5%), tactile (19.9%), and olfactory hallucinations (17.3%); hallucinations in two or more modalities were reported by 47.6%. Substantial numbers of participants rated their hallucinations as severe, due to negative content (16.0–31.6%), previous bothersome experiences (14.8–20.2%), ensuing distress (10.5–16.8%), and/or ensuing disfunctioning (12.7–17.3%). Decreased insight was found in 10.2–11.4%. Hypnagogia was reported by 9.0–10.6%, and bereavement hallucinations by 2.8%. Despite a low prevalence of delusions (7.0%), these phenomena were significantly associated with recent hallucinations, observed in up to 13.4% of the participants with hallucinations during the past week (p < 0.001). Our results indicate a wide variety of the phenomenology of hallucinations in the general population and support the existence of a phenomenological continuum.

Fragmented sleep relates to hallucinations across perceptual modalities in the general population

Although previous studies reported a link between sleep problems and the occurrence of hallucinations, more detailed information is needed to translate this association into clinical practice. This study investigates sleep quality and its relation to prevalence, type, content, and phenomenology of hallucinations, using an online survey in a large population sample (n = 10,299). Based on community-based cluster analysis, four groups could be distinguished that differed in terms of sleep quality. Our results confirm previous studies in showing that poor sleep is associated with the occurrence of hallucinations, and extend previous results on a number of aspects. First, we show that particularly fragmented sleep relates to the occurrence of hallucinations. Second, we show that this is the case for hallucinations across the auditory, visual, olfactory, and tactile domains. Third, our results show that fragmented sleep not only relates to the occurrence, but also to the content, frequency, duration, and associated distress of hallucinations. Finally, compared to poor sleep, good sleep quality is associated with hallucinations that are less negative and disruptive. We conclude that sleep hygiene measures could have a large positive impact on individuals whose fragmented sleep underlies the occurrence of bothersome hallucinations.

The phenomenology of auditory verbal hallucinations in emotionally unstable personality disorder and post-traumatic stress disorder.

To explore the phenomenology of auditory verbal hallucinations (AVHs) in a clinical sample of young people who have a 'non-psychotic' diagnosis. Ten participants aged 17-31 years with presentation of emotionally unstable personality disorder or post-traumatic stress disorder and frequent AVHs were recruited and participated in a qualitative study exploring their subjective experience of hearing voices. Photo-elicitation and ethnographic diaries were used to stimulate discussion in an otherwise unstructured walking interview. 'Non-psychotic' voices comprised auditory qualities such as volume and clarity. Participants commonly personified their voices, viewing them as distinct characters with which they could interact and form relationships. There appeared to be an intimate and unstable relationship between participant and voice, whereby voices changed according to the participants' mood, insecurities, distress and circumstance. Equally, participants reacted to provocation by the voice, leading to changes in mood and circumstance through emotional and physical disturbances. In contrast to our previous qualitative work in psychosis, voice hearing was not experienced with a sense of imposition or control. This phenomenological research yielded in-depth and novel accounts of 'non-psychotic' voices which were intimately linked to emotional experience. In contrast to standard reports of voices in disorders such as schizophrenia, participants described a complex and bi-directional relationship with their voices. Many other features were in common with voice hearing in psychosis. Knowledge of the phenomenology of hallucinations in non-psychotic disorders has the potential to inform future more successful management strategies. This report gives preliminary evidence for future research.

Hallucinations after Cardiac Surgery: A Prospective Observational Study.

Background and Objective: Hallucinations after cardiac surgery can be a burden, but their prevalence and phenomenology have not been studied well. Risk factors for postoperative hallucinations, as well as their relation to delirium are unclear. We aimed to study the prevalence and phenomenology of hallucinations after cardiac surgery, and to study the association between hallucinations and delirium in this population. Materials and Methods: We used the Questionnaire for Psychotic Experiences to detect hallucinations in cardiac surgery patients and a control group of cardiology outpatients. We assessed postoperative delirium with validated instruments. Risk factors for postoperative hallucinations and the association between hallucinations and delirium were analysed using logistic regression. Results: We included 201 cardiac surgery patients and 99 cardiology outpatient controls. Forty-four cardiac surgery patients (21.9%) experienced postoperative hallucinations in the first four postoperative days. This was significantly higher compared to cardiology outpatient controls (n = 4, 4.1%, p < 0.001). Visual hallucinations were the most common type of hallucinations in cardiac surgery patients, and less common in outpatient controls. Cardiac surgery patients who experienced hallucinations were more likely to also have delirium (10/44, 22.7%) compared to patients without postoperative hallucinations (16/157, 10.2% p = 0.03). However, the majority of patients with postoperative hallucinations (34/44, 77.3%) did not develop delirium. Conclusion: After cardiac surgery, hallucinations occurred more frequently than in outpatient controls. Hallucinations after cardiac surgery were most often visual in character. Although postoperative hallucinations were associated with delirium, most patients with hallucinations did not develop delirium.

The Questionnaire for Psychotic Experiences: An Examination of the Validity and Reliability

Psychotic experiences are prevalent across a wide variety of psychiatric, neurological, and medical conditions. Yet current assessments are often designed for one disorder, or are limited in their examination of phenomenological features; this has hindered transdiagnostic research. This article describes an examination of the validity and reliability of the English version of a new assessment, the Questionnaire for Psychotic Experiences (QPE). This study aimed to use the QPE to examine hallucinations and delusions across a number of different conditions, and to ensure that the QPE had acceptable psychometric properties. An International Consortium on Hallucination Research working group, along with consumer groups, developed the 50-item QPE to assess the presence, severity, and phenomenology of hallucinations and delusions. Participants in the study who reported psychotic experiences included those with schizophrenia, schizoaffective disorder, bipolar affective disorder, and major depressive disorder, and those without a need for care (ie, nonclinical participants). There were 173 participants in total. Convergent and discriminant validity were assessed. Reliability was examined in terms of stability, equivalence, and internal consistency. The data confirmed that the QPE had good psychometric properties and could be put forward as an accepted measure of the transdiagnostic evaluation of psychotic experiences. Further validation is recommended with neurological and medical populations. Given its validity and reliability, comprehensive evaluation of psychotic phenomena, and relatively quick administration time, we propose that the QPE is a valuable instrument for both clinical and research settings.

Classification of Disjunctivism about the Phenomenology of Visual Experience

This paper proposes a classificatory framework for disjunctivism about the phenomenology of visual perceptual experience. Disjunctivism of this sort is typically divided into positive and negative disjunctivism. This distinction successfully reflects the disagreement amongst disjunctivists regarding the explanatory status of the introspective indiscriminability of veridical perception and hallucination. However, it is unsatisfactory in two respects. First, it cannot accommodate eliminativism about the phenomenology of hallucination. Second, the class of positive disjunctivism is too coarse-grained to provide an informative overview of the current dialectical landscape. Given this, I propose a classificatory framework which preserves the positive-negative distinction, but which also includes the distinction between eliminativism and non-eliminativism, as well as a distinction between two subclasses of positive disjunctivism. In describing each class in detail, I specify who takes up each position in the existing literature, and demonstrate that this classificatory framework can disambiguate some existing disjunctivist views.

Representacionalismo, disyuntivismo y el problema de la alucinación

Representationalists claim that there is a common metaphysical factor of a representational type that characterizes both perceptions and hallucinations and that we cannot discriminate introspectively from them. Disjunctivists reject this idea and claim that perceptions are essentially relations to objects in the physical world, while hallucinations only seem to be. The Disjunctivist needs then to face the challenge of giving a proper characterization of the nature and phenomenology of hallucinations, without appealing to the existence of primitive mental properties that could explanatorily screen off the relational structure of perceptions. Only in this way it is possible to avoid the commitment to a metaphysical common factor. I will argue that the so-called negative epistemic strategy is suitable to meet this demand only if we supplement it with an empirically supported account — probably of a metacognitive kind — regarding the possibility of indiscriminability between hallucinations and perceptions and of the fact that we subjectively experience hallucinations as if they were relations to objects in the physical world. Keywords: Disjunctivism, indiscriminability, hallucinations.

Studying hallucinations within the NIMH RDoC framework.

We explore how hallucinations might be studied within the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) framework, which asks investigators to step back from diagnoses based on symptoms and focus on basic dimensions of functioning. We start with a description of the objectives of the RDoC project and its domains and constructs. Because the RDoC initiative asks investigators to study phenomena across the wellness spectrum and different diagnoses, we address whether hallucinations experienced in nonclinical populations are the same as those experienced by people with psychotic diagnoses, and whether hallucinations studied in one clinical group can inform our understanding of the same phenomenon in another. We then discuss the phenomenology of hallucinations and how different RDoC domains might be relevant to their study. We end with a discussion of various challenges and potential next steps to advance the application of the RDoC approach to this area of research.

Books by John Cutting

Books by John Cutting

Ontological Minimalism about Phenomenology

I develop a view of the common factor between subjectively indistinguishable perceptions and hallucinations that avoids analyzing experiences as involving awareness relations to abstract entities, sense‐data, or any other peculiar entities. The main thesis is that hallucinating subjects employ concepts (or analogous nonconceptual structures), namely the very same concepts that in a subjectively indistinguishable perception are employed as a consequence of being related to external, mind‐independent objects or property‐instances. These concepts and nonconceptual structures are identified with modes of presentation types. Since a hallucinating subject is not related to any such objects or property‐instances, the concepts she employs remain empty. I argue that the phenomenology of hallucinations and perceptions can be identified with employing concepts and analogous nonconceptual structures. By doing so, I defend an ontologically minimalist view of the phenomenology of experience that (1) vindicates Aristotelianism about types and (2) amounts to a naturalized view of the phenomenology of experience.

Re-expanding the phenomenology of hallucinations: lessons from sixteenth-century Spain

The paradigm within which hallucinations are studied, and the explanatory frameworks employed, may bias the phenomenological analysis of these experiences. After introducing the new term, hallucination, this paper undertook an inter-disciplinary study of the phenomenology of hallucinations identified by the sixteenth-century theologians, St John of the Cross and St Teresa of Avila. It was examined whether the phenomenological properties they highlighted are identified and addressed by contemporary psychological research. Many of these properties were indeed found to be acknowledged and studied by contemporary research in psychiatric patients, as well as in healthy individuals during hypnagogia, near-death experiences and at times of stress. However, many experiences, such as “internal voices,” “soundless voices,” and “voices that save,” were found to be neglected by contemporary research, as was the potential for hallucinations to communicate novel/original information. Finally, it was examined how these phenomenological insights may be “front-loaded” into future experimental designs.

Hallucinations in Adolescent Inpatients with Post-Traumatic Stress Disorder and Schizophrenia: Similarities and Differences

This study compares the phenomenology of hallucinations in a series of hospitalized adolescents diagnosed with post-traumatic stress disorder (PTSD) and schizophrenia. Subjects admitted to a tertiary adolescent inpatient unit were screened for hallucinations. Those reporting hallucinations were asked standardized questions relating to these experiences. Hallucinations in subjects with a primary diagnosis of schizophrenia or PTSD were compared. Hallucinations in both schizophrenia and PTSD have similar form and content. Frequent, vivid, realistic, external hallucinations occurred in both disorders. Hallucinations in PTSD were usually derogatory and related to self-harm, but not direct reflections of traumatic events. Patients with PTSD reported greater emotional distress, self-harm and suicidal ideation than those with schizophrenia. This case series suggests that the phenomenology of hallucinations in adolescents with schizophrenia and PTSD is similar.

Hallucinations in Adolescents With Post-Traumatic Stress Disorder and Psychotic Disorder

The aim of the study was to compare the phenomenology of hallucinations in hospitalized adolescents diagnosed with post-traumatic stress disorder (PTSD) and psychotic disorder. Diagnoses were ascertained in 66 adolescents consecutively admitted to an acute adolescent unit in Australia. Hallucinations were examined to compare their phenomenology in PTSD with psychotic disorder. On most measures, hallucinations did not differ significantly in form or content between those adolescents with PTSD and those with psychotic disorder. In a minority of patients with PTSD, the hallucinations reflected a previous traumatic experience. Hallucinations were found to be unreliable in distinguishing adolescent inpatients with PTSD from those with psychotic disorder.

An Atypical Presentation of Visual Hallucinatory Experiences Following Prolonged Blindness*

We report a patient with long-standing blindness experiencing both simple and complex visual hallucinations secondary to a cortical arteriovenous malformation (AVM). The hallucinations were located in the right visual field corresponding to the contra-lateral site of cortical damage. This case contributes to our understanding of neurophysiological mechanisms underlying visual hallucinations and ongoing research investigating the phenomenology of hallucinations with respect to the cause and localization of neural damage.

The Phenomenological Diversity of Hallucinations: Some theoretical and clinical implications

Hallucinations are complex psychopathological phenomena. Nevertheless, this has not always been clear in the scientific literature, until recently. In the following paper, the phenomenology of hallucinations will be (briefly) described. Then, ways in which examining phenomenological characteristics of hallucinations may have theoretical and clinical implications, will be presented. Assessment tools that examine phenomenological aspects of hallucinations will also briefly be presented. In particular, it will be argued that previous theoretical accounts of hallucinations that exclusively propose an externalising bias have not integrated the full phenomenological diversity of hallucinations. In addition, it will be maintained that taking into account the phenomenological diversity of hallucinations has a number of clinical implications, such as providing the patient with important information, improving patient-clinician relations, helping individualise treatment, opening up new therapeutic avenues, and providing information concerning changes in the patient's mental and emotional condition.

Dissolution and enchantment on Erwin Straus' phenomenology of obsession

The author presents Erwin Straus’ psychopathology of phoby and obsession (with reference to his texts On Obsession, Phenomenology of Hallucinations, and Vom Sinn der Sinne), bringing to light the implications concerning the role of language and gesture in the consistution (and the crisis) of the experiences of subjectivity and objectivity.