The Phenomenological Diversity of Hallucinations: Some theoretical and clinical implications

Abstract

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.

Listening to Schneiderian Voices: A Novel Phenomenological Analysis

“…In clinical populations, specific characteristics of AVHs have not been found to be specific to particular diagnoses (70,71). The consequent de-emphasis on diagnosis and greater attention to the dimensional differences and their clinical impact further underscore the importance of engaging with the complexities of first person accounts.…”

Hallucinations from a Cognitive Perspective

“…5 Our goal in this review is to contrast the restricted set of experimental conditions that have been utilized in source-monitoring studies of hallucinations with the diversity of their documented phenomenology. What follows is a (non-exhaustive) summary of that phenomenology, with a focus on the distinction between origin and source.…”

Carving versus Stitching: The Concept of Psychic Function and the Continuity/Discontinuity Debate

“…Quite understandably, schemas (‘I hear voices', ‘I know I'm in danger') are too often taken as faithful renderings of pathological experiences (perception went wrong, thought went wrong). Once we have defined ‘hallucination' as ‘perception but without an object to be perceived', it is only natural to understand hallucinations in terms of the psychology and physiology of perception [10]. Thus, a putative family of phenomena is neatly arranged in a line going from perception to illusion to hallucination or to dissociative/depressive/schizophrenic hallucinations.…”

“…Some research groups consider auditory verbal hallucinations (AVHs) a heterogeneous group of phenomena which includes commanding/commenting voices (usually associated with troubles in inner speech), ‘replay' voices (with memories), ‘own thoughts' voices (which share commonalities with inner speech and with memories), and non-verbal auditory hallucinations [11]. There have been others who have tried to make clear the relations between first-rank hallucinations and other kinds of ‘voices' [12], establish the role of culture in modelling hallucinations or study the differences between alcohol/epilepsy/schizophrenia-related voices [10,12]. In short, they all break a ‘perceptual' category into related but different experiential pieces.…”

“…The phenomena gathered under the umbrella term ‘auditory hallucinations' and screened for by usual questionnaires range from single words, music or noises to constantly commanding or commenting voices. Even if we focus on AVHs, commonalities between AVHs in different clinical syndromes [10] such as epilepsy, alcohol abuse, posttraumatic stress disorder, schizophrenia, and bipolar disorder go along with clinically relevant differences, and if we look into the symptom itself, some characteristics so far considered essential in descriptive definitions (volume, intensity, location, control) may be considered accessory, even misleading, as they have blurred the different experiential realms behind AVHs [5]. …”