In The Lancet Psychiatry last week, Dr. Todd Woodward alongside Dr. Clara S. Humpston published an article noting that, despite early writings on hallucinations and recent evidence from cognitive neuroscience, psychiatric training and clinical vocabulary around hallucinations continues to be strongly influenced by emphasis on language such as the requirement for “full force” of a true perception.
As Dr. Woodward explains, “We hold that this has led to misunderstandings and inaccuracies in clinical practice, and misinterpretations in cognitive neuroscience. We propose a revision of the definition of auditory verbal hallucinations, to move away from the necessity for auditory perception, because auditory verbal hallucinations are more than some perceptual abnormalities of the mind, they are experienced by the entirety of one’s being, not just heard.”
He adds, “We recommend that medical students and trainee clinicians pay increased attention to the phenomenological nuances and complexities of anomalous thought and perception in clients/patients who have (or are at risk of) a schizophrenia-spectrum condition. For example, instead of ‘ Do you hear voices?’ clinicians could instead ask ‘Have your thoughts felt alien, as if they do not belong to you?’ or ‘Are your thoughts so loud that you can almost hear them?’ If any answers are positive, it is imperative to check in with the client/patient by following up with an open-ended question such as ‘Can you tell me more about these experiences?’. If the voices that those so-called mad people hear were not so distinctive or audible, or if the voices were just like the thoughts that everyone can have from time to time, then the clearly drawn demarcation lines between pathological and normal would suddenly become not so clear and the mad would not be so far removed from the normal. If emphasis on the perceptual quality of auditory verbal hallucinations were released, and if auditory verbal hallucinations would be considered as a type of belief rather than as exotic perception, then the discussion with the client/patient might be changed—from a simple response to a query about voices, to a different way of understanding the client/patient’s perception-like thoughts, involving checking in with the silenced selves behind the voices.”