Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations, and thought insertion to a lesser degree; however, their mechanisms and relationships between each other remain largely elusive. Here we attempt to establish a integrative model drawing from the phenomenology of both AVHs and TI and argue that they in fact can be seen as ‘spectra’ of experiences with varying degrees of agency and ownership, with ‘silent and internal own thoughts’ on one extreme and ‘fully (...) external and clearly audible voices’ in the absence of a speaker on the other. We believe a spectral model will add emphasis to the continuity of experience and help to better understand how one type of psychotic symptom may interact with another, and put forward the argument that the experience of TI itself is not sufficient to classify as a delusion. In addition we aim to discuss some of the conceptual issues surrounding AVHs and TI with first-person accounts and current philosophical and neuropsychological theories in mind. We propose that the mechanisms behind AVHs and TI are more complex than source-monitoring deficits; indeed, to understand such phenomena one must appreciate that their very ‘existence’ and ‘reality’ as experienced by the individual have much deeper implications and meaning, both philosophically and clinically. (shrink)

Drawing upon core phenomenological contributions of the last decades, the present paper provides an integrated description of the development of auditory hallucinations in schizophrenia. Specifically, these contributions are the transitional sequences of development of psychotic symptoms of schizophrenia as envisioned by Klosterkötter and rooted in the basic symptoms approach, Conrad’s Gestalt-analysis of developing psychosis, and Sass and Parnas’ self-disturbance approach. Klosterkötter’s contribution provides a general descriptive psychopathological approach to the transitional sequence of the development of auditory hallucinations. The key concepts (...) in Conrad’s proposal are discussed, as their role is central as driving forces of the process from non-psychotic symptoms to overt hallucinations. Finally, Parnas and Sass link psychiatry to philosophy and psychology, and provide an in-depth and thorough description of these phenomena in their work on schizophrenia as a disorder of consciousness and self-experience with hyper-reflexivity and diminished self-affection as key aspects. (shrink)

This paper will philosophically extend Julian Leff’s Avatar therapy paradigm (AT) for voice-like hallucinations that was initially proposed for treatment-resistant Schizophrenia patients into the realm of gesture-enhanced embodied cognition and Virtual Reality (VR), entitled g+TA (gesture-enhanced Avatar Therapy). I propose an philosophy of technology approach of embodied rhetorics of triadic kinetic “actions” in the sense of Charles Sanders Peirce that transforms the voice hallucination incorporated by an avatar- and that can confront acousmatic voice-like hallucinations with a method of gesture synchronization (...) and dyssynchronization and gestural refusal of interaction that the player with the Avatar can resist in full embodiment. This paper therefore introduces a gesture-enhanced, extended version of Cybertherapy with Avatars that tackle multimodal bodily experience of voice-like hallucinations beyond mere visual or auditory stimulation. This is put forward theoretically in a 4E-cognition approach that expands Avatar Therapy with gestures into VR. (shrink)

Despite a recent surge in publications on Tourette Syndrome, we still lack substantial insight into first-personal aspects of “what it is like” to live with this condition. This is despite the fact that developments in phenomenological psychiatry have demonstrated the scientific and clinical importance of understanding subjective experience in a range of other neuropsychiatric conditions. We argue that it is time for Tourette Syndrome research to tap into the sophisticated frameworks developed in the philosophical tradition of phenomenology for describing experience (...) in a way that integrates discrete symptoms into an overarching experiential framework concerning the self, the body, and its modes of experience. Following a historical introduction that contextualises the pertinence of phenomenology to psychopathology, we distinguish this approach from the existing, psychologically oriented studies on TS that are also qualitative. We then outline gaps and opportunities for future research, including the sorts of questions that might be utilised in phenomenological interviews and why they are of potential benefit to research programs in philosophy, psychology, and neuroscience. In conclusion we address some of the broader implications for phenomenology of the body and philosophy of action. (shrink)

The papers included in the thesis, and summarized in this covering document, were selected, in discussion with my supervisor, Dr. Roessler, from papers I have published in the philosophy of psychiatry. In parallel to this philosophical work, I have worked clinically as a psychiatrist and academically as a research psychiatrist. My clinical work has largely been working with Early Intervention Services, both in South London and in Coventry and Warwickshire, and this work has been acting as a psychiatrist in clinical (...) teams who work with young people who may either be at risk of developing a psychotic illness, or are in the earliest stages of such an illness. My empirical work has been in the same clinical group and has used functional neuroimaging and cognitive neuropsychology to characterize those at risk of psychosis and to chart the onset of psychosis and the formation of delusions. As required by the university guidelines, a full list of publications, both empirical and philosophical, is detailed in appendix 1. The papers included in the thesis hence parallel many of these clinical and empirical interests: papers 2 and 4, in particular, examine the role neuroimaging may play in studying delusions and relate the prodromal phase of psychosis to both the neurodevelopmental and continuum models of psychosis. Paper 3 is one of two papers written with Lisa Bortolotti drawing on Richard Moran’s work and examining delusions. Paper 1 is perhaps the paper least connected to my empirical and clinical work as has a wider focus and tries to examine what mental illnesses are and to begin to describe a position Lisa Bortolotti and I later expanded on and referred to as ‘psychological realism’, with Paper 2 being a case example of this account being applied to a particular area of psychopathology, namely delusions. The papers form a progression with Paper 1 outlining a general conception of mental disorder, Paper 2 being a case study of this approach specifically in the area of delusion. Paper 3 takes the example of thought insertion and develops ideas from Paper 2 that reason giving is a crucial feature that helps highlight what is pathological about certain experiences. Paper 4 brings together the philosophical concerns regarding a wholly neuroscientific conception of psychopathology, and how this is of clinical and scientific relevance when we use psychopathology to demarcate the various stages of psychotic experience and illness. (shrink)

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations, the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH (...) at 3 contextual levels: cultural, social, and historical; experiential; and biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; “front-loading” research in cognitive neuroscience; and suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. (shrink)