The intrasubjectivity of self, voices and delusions: A phenomenological analysis

Abstract

To advance the area of phenomenology of voices and their interrelatedness to forms of delusions this study investigated the prevalence and interrelatedness of co-occurring auditory verbal hallucinations (AVHs) and delusions. Additionally we explored the characterization of distinct sub-categories/clusters of AVHs and delusions. Ninety-two participants experiencing psychosis were administered standardized clinical measures. We found a significant diagnostic difference with increased prevalence of co-occurring AVHs and delusions within the schizophrenia group compared to the bipolar with psychosis group. Regardless of diagnosis, there was a significant positive correlation between AVHs and delusions of reference, persecution, control, thought insertion, thought withdrawal and thought broadcasting. However, no significant relationship was found between AVHs and grandiose, somatic, religious, guilty or jealousy-themed delusions. Cluster analysis yielded two distinct cluster groups. Cluster One: Voices and Thought Delusions, and Cluster Two: Voices and Thematic Delusions. Cluster One participants showed elevated disorganized, cognitive and depressive symptoms, but not negative symptoms or excitement. This study underscores the need for expanded clinical and phenomenological research into the intersection of AVHs and delusions, including work that seeks to deconstruct conventional divisions between ostensible symptoms of perception’ (hallucinations) and belief’ (delusions).

Listening to Schneiderian Voices: A Novel Phenomenological Analysis

“…Historically, the phenomenology of AVHs was a major focus of early psychopathology research (8,40,41,42,43). More recent contributions building on this foundational work have begun to differentiate potential AVH subtypes, with renewed emphasis on their phenomenological nuances and complexities (4,44,45,46). Our findings contribute to this growing body of work by further elucidating phenomenological differences and overlap between individuals with voices conversing (VC) and individuals with voices commenting but not conversing (VNC).…”

“…It has been hypothesized that this core disturbance of basic self is a contributing factor in the pathogenesis in psychosis (55). Regardless of a progressive symptom development or a non-temporal-specific disorder of self, Schneiderian voices are often intertwined with delusions (46,53,60,61). In further unpacking the interrelatedness of voices and delusions, recent research has shown a distinction between AVHs and thought delusions and AVHs and thematic delusions (62).…”

“…Regardless of a progressive symptom development or a non-temporal-specific disorder of self, Schneiderian voices are often intertwined with delusions (46,53,60,61). In further unpacking the interrelatedness of voices and delusions, recent research has shown a distinction between AVHs and thought delusions and AVHs and thematic delusions (62). This formulation suggests that AVHs and thought delusions reflect an alteration of self and internal/external boundaries, and that AVHs with thematic delusions reflect exaggerated processes of social internalization or externalization (62).…”

“…In further unpacking the interrelatedness of voices and delusions, recent research has shown a distinction between AVHs and thought delusions and AVHs and thematic delusions (62). This formulation suggests that AVHs and thought delusions reflect an alteration of self and internal/external boundaries, and that AVHs with thematic delusions reflect exaggerated processes of social internalization or externalization (62). Building on this research, our study specifically targeting Schniederian voices further contributes to the phenomenological understanding of voices as distinct characterological entities that are a complex multisensory experience that can include auditory; tactile “could feel his body on top of mine” and “voices are crawling in my scalp”; visual “I picture my voices in my head”; and olfactory, “I can smell them” that typically intercept with delusional content.…”

The paradoxical self: Awareness, solipsism and first-rank symptoms in schizophrenia

“…By the process of telling there is inevitably an experiential gap; by the act of transforming experience into words there must be a more second-order awareness, rather than accurately reflecting the raw "material" of experience. Qualitative researchers have indeed found support in first-person reports of the phenomenology of AVH that a large proportion of all AVH is not sensory (at least as defined in a physiological sense) at all (Jones & Luhrmann, 2016;Jones & Shattell, 2016;Rosen et al, 2016).…”