اندیشه عمل: گفتار درونی، خودنظارتی و توهم شنوایی کلامی

Passivity experiences in schizophrenia are thought to be due to a failure in a neurocognitive action self-monitoring system (NASS). Drawing on the assumption that inner speech is a form of action, a recent model of auditory verbal hallucinations (AVHs) has proposed that AVHs can be explained by a failure in the NASS. In this article, we offer an alternative application of the NASS to AVHs, with separate mechanisms creating the emotion of self-as-agent and other-as-agent. We defend the assumption that inner speech can be considered as a form of action, and show how a number of previous criticisms of applying the NASS to AVHs can be refuted. This is achieved in part through taking a Vygotskian developmental perspective on inner speech. It is suggested that more research into the nature and development of inner speech is needed to further our understanding of AVHs.

The phenomenon of auditory verbal hallucinations (AVHs), where individuals report hearing speech in the absence of any external stimulation, continues to puzzle psychiatrists and psychologists. Schneider (1959) classified AVHs as a first-rank symptom of schizophrenia, reflecting the approximately 60–74% of those with schizophrenia who report experiencing them (Slade and Bentall, 1988 and Wing et al., 1974). However, a movement has developed away from understanding AVHs as necessarily signifying pathology, and towards an acceptance that voice-hearing can be a part of normal experience (Johns & van Os, 2001). Furthermore, there do not seem to be radical differences in the structure and functions of AVHs between voice-hearers with a diagnosis of schizophrenia and those without (Leudar, Thomas, McNally, & Glinski, 1997). Whether in a clinical or non-clinical sample, one of the fundamental characteristics of AVHs is their alien quality. In this article, we take a new look at the question of how it is possible that a self-generated cognition may come to be experienced as produced and performed by an agent other than the self.