“we argue that the most important factor in auditory verbal hallucinations in schizophrenia spectrum psychoses is a loss of first-person authority, and that a perceptual quality is not required for it to be this kind of hallucination.”
# Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual? (in The Lancet, 14 Apr 2024)
I think there’s something there but I also think it’s a somewhat incomplete way to tackle it. I think we can agree that how impactful the disperception and cognitive symptoms are on executive function is a key aspect of the severity of psychosis and not the nature and quality of the disperception itself although there is generally a relationship between the two within the same person and especially the same psychotic episode the same doesn’t hold true across multiple people and, to a lesser extent, different episodes, especially if different medications are involved.
I think however that the framing of the affected executive function as a loss of first person authority is a relatively unnecessary and uncommon one although it definitely marks an extreme in severity, unlike how clear the perception of a voice may be.
In fact I would put forth that not only the perceptual quality isn’t required, the loss of first person authority isn’t necessary either, but the alteration of its ability to carry out its functions and assessments is what is actually relevant to this kind of disperception, whether that causes a direct loss of control or not is ultimately more consequential in how impactful the narration of the episode is than in how out of character the behaviour becomes as a result.
Personally the more I assess my own psychosis the more I see its core nature as a distortion of realization and personalization that follows very meaningful patterns, generally highly influenced by recency bias. In that sense the quality of the disperception isn’t relevant because the magnitude of the affected realization is what actually informs the severity on that side of the coin, and I think wanting to go towards the loss of first person authority is an attempt to link the extreme on distorted realization to the extreme on distorted personalization, but while connected they aren’t so linked that you can assess the severity of one through the severity of the other, as seems to be the proposed formalization here.
[double posting because apparently I used the edit function too much and I’ve been put on a 14h ban from it]
Accepting such a view would put at a disadvantage in recognition of severity all those whose symptomatology is informed disproportionately by their impeached realization while having comparatively less of an impact on the personalization side of things since their narration of events would be perceived as significantly less severe going by these standards which put a lot of emphasis on first person authority and less so on executive function more generally, which I find unnecessary because the severity of a loss of first person authority is self-evident and easy to convey in speech while the effects of a similarly severe affliction on realization are much harder to convey, especially when the perceptual component isn’t keeping up with the underlying affliction due to the fact that people who haven’t experienced altered realization in some fashion have no effing clue what you are talking about nor how pervasive and crucial to our functioning as human beings it actually is.