‘‘Hearing voices’’ in schizophrenia: Who’s voices are they?

What is it about?

Auditory hallucinations represent a particularly rich and varied phenomenology. They involve the perception of a large array of sounds, which, when involving voices, are referred to as auditory verbal hallucinations. I propose that auditory hallucinations are in fact on a continuum beginning with acousma (Greek ?jotr- la-audible)-separate sounds: noise, ringing, shouts, shots, music, raps, and phonemes (the smallest contrastive unit in the sound system of a language) and ending with words, sentences, which are the audible expressions of thought disorders (such as over- valued ideas), e.g. the ability to control one’s thought processes.

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Why is it important?

Hearing voices is not a disturbance of perception but rather of thought – or ‘‘pseudo-perception’’. The manner in which patients report hearing voices allows confirmation of the degree of cooperation (or dissimulation). For example, reporting on the voice of an unfamiliar woman by a male patient can indicate dissimulation.In terms of research, it can be assumed that owing to the relationship of the phenomenon of hearing voices to thought, it is difficult to expect that with the currently available tools (such as fMRI, PET, SPECT) it will be possible to identify the brain areas definitively involved in the creation of the voices. Voices and thinking are in the same brain area. Thought is more damaged because of the lack of functioning of the brain areas and structures responsible for supervising thinking processes. The differences that can be found using fMRI, PET SPECT will be minimal if at all, because the brain areas are the same – thus new methods must be sought for identifying the difference in brain function between those that supervise thinking and those lacking capacity to supervise thinking and therefore create hallucinations. (the greater the impairment the less the capacity to differentiate thought from speech).

Perspectives