There’s been a drive recently to de-pathologise the experience of “hearing voices”. The message from recent surveys is that it’s not just people with a diagnosis of schizophrenia who hear voices in their heads, many people considered mentally well do to. This revelation may have a welcome de-stigmatising effect in terms of how people think about some of the symptoms associated with a diagnosis of schizophrenia, but a new study published in Psychosis asks us to hang on a minute – to say that one “hears voices” can mean different things to different people. You might assume that “hears voices” means that a person has an hallucinated auditory experience just like someone is talking to them. But what about hearing an inner voice that is experienced like an out-of-control thought rather than an external voice? Or a heard voice that’s not like either a thought or an external voice?
The inner voice/out of control thought makes quite a lot of sense based on my admittedly infrequent experiences.
Since I started having pseudohallucinations I always thought that it might not be a reason for a sz diagnosis, although it wasn’t the reason.
This seems consistent with a recent book that I read chapters of on hallucinations. The qualitative analyses in that book suggest that the different modes of thought (or intentionality) that are ordinarily stable and clearly separated can become unstable, blurred, or perhaps fluid would be an apt description.
The idea is that with phenomena as hallucination and intrusive thoughts, it may not be as straightforward as a patient mistaking two well-defined modes of thought for another. Thus, that often it would not quite be appropriate to say that an act of imagination is mistaken for one of perception, resulting in a hallucination.
Instead, or so the analyses seemed to reveal, the very distinction between imagination and perception, (but also other modes such recollection) may be what is at stake such that intermediate modes and hybrid forms of thought become possible. Which could account for the great variety of expressions people use to report their experiences.
Something similar could be said about delusions, that sometimes may have very much perception-like qualities, rather than exhibiting clear and only belief-like features. Considering that this research shows intrusive thoughts and auditory hallucinations may not be clearly distinguishable, while the former is considered a delusion and the latter an anomalous perception, this makes a lot of sense to me.