Stop, Look, Listen ...

One of the leading cognitive models of auditory verbal hallucinations (AVHs) proposessuch experiences result from a disturbance in the process by which inner speech isattributed to the self. Research in this area has, however, proceeded in the absence ofthorough cognitive and phenomenological investigations of the nature of inner speech,against which AVHs are implicitly or explicitly defined. In this paper we begin byintroducing philosophical phenomenology and highlighting its relevance to AVHs, beforebriefly examining the evolving literature on the relation between inner experiences andAVHs. 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 nuancedpicture of both inner experience and AVHs than either could on its own. A criticalexamination is undertaken of the leading model of AVHs derived from phenomenologicalphilosophy, the ipseity disturbance model. From this we suggest issues that future workin this vein will need to consider, and examine how interdisciplinary methodologies maycontribute to advances in our understanding of AVHs. Detailed suggestions are made forthe direction and methodology of future work into AVHs, which we suggest should beundertaken in a context where phenomenology and physiology are both necessary, butneither sufficient.
Keywords: hallucination, phenomenology, psychosis, schizophrenia, interdisciplinary
INTRODUCTION
The experience of hearing a voice in the absence of an appro-priate external stimulus, formally termed an auditory verbalhallucination (AVH), is found in people with a range of psy-chiatric diagnoses, including schizophrenia, bipolar disorder,post-traumatic stress disorder, as well as in non-psychiatric pop-ulations (Larøi et al., 2012). In attempting to understand thecauses of AVHs, researchers have explored the experience atmultiple levels, including the neurological, cognitive, and soci-ological (McCarthy-Jones, 2012). Yet all these levels of explana-tion must take into account the findings of phenomenologicalstudies of AVHs. A detailed knowledge of the phenomenology of AVHs is necessary, firstly, in order to ensure that mod-els are explaining what voice-hearers are actually experiencingand, secondly, in order to obtain clues as to what may beunderpinning the experience of AVHs (McCarthy-Jones et al.,2012).Consistent with this proposal, Garcia-Montes et al. (2012)have argued that research should give people diagnosed withpsychosis a “turn to speak,” i.e., that it should take aphenomenological approach, involving in-depth questioning of peopleabouttheirsubjective experiences, withquestionsthatsus-pend or “bracket” presuppositions about the phenomena underinvestigation, including its normality or abnormality, and itscauses (Stanghellini and Lysaker, 2007). Garcia-Montes et al.also suggest that giving people “increased importance in defin-ing their experience may assist in fine-tuning concepts used by the cognitive tradition, usually taken from research in basic psy-chology... and extrapolated without further ado to the field of schizophrenia.” They note that this could lead to cognitive psy-chology “leaving behind its tendency to reduce symptoms orclinical phenomena to premade concepts.” Such an approach hasthe potential to interrogate some unexamined assumptions in thestudy of AVHs, even if they are eventually found to be innocent.For example, many models in the cognitive psychology paradigmassume that AVHs are altered forms of normal cognitive pro-cesses (such as inner speech or memory), and often uncritically recruit such concepts into their explanatory models. However,it is possible that AVHs may be a distinct experience, withoutroots in these normal cognitive processes, and thus requiring
Frontiers in Human Neuroscience www.frontiersin.org
 April 2013 | Volume 7 | Article 127