What voices can do with words: pragmatics of verbal hallucinations

Abstract

Background. In this paper we consider verbal hallucinations as inner speech with pragmatics. The specific pragmatic properties of verbal hallucinations investigated included the number of voices, the characteristics that individuate the voices, the sequential characteristics of the dialogues between voice hearers and their voices, the dialogical positioning of voices hearers, voices and other individuals, and how the voices influence voice hearers' activities.

Methods. These properties were examined in structured interviews with 28 individuals, 14 of whom had a diagnosis of schizophrenia, while 14 were students who did not use psychiatric services.

Results. The analysis showed that voices were most frequently individuated with reference to individuals significant to voice hearers. The talk with voices was typically mundane and related to voice hearers' on-going activities, as is the case for ordinary inner speech. The voices were typically orientated towards the voice hearer, without direct access to each other or to other people. Contrary to received wisdom, the voices typically did not impel actions of voice hearers, rather they influenced voice hearers' decisions on how to act. This was so irrespective of the diagnostic status of informants. Finally, we have found some differences between the voices of informants with, and without, schizophrenia. These concerned the alignment of voices, the type of action required by a voice and the degree of dialogical engagement between voices and voice hearers.

Conclusions. We conclude that verbal hallucinations can be fruitfully considered to be a genus of inner speech. Pragmatics can be used as a framework to distinguish verbal hallucinations in different populations.