Self, Voices and Embodiment: A Phenomenological Analysis

Research Article

J Schizophr Res. 2015;2(1): 1008.

Self, Voices and Embodiment: A Phenomenological Analysis

Rosen C1*, Jones N2, Chase KA1, Grossman LS3, Gin H1 and Sharma RP1,4

1University of Illinois at Chicago, The Psychiatric Institute, Department of Psychiatry, USA.

2Stanford University, Department of Anthropology, 450 Serra Mall, Stanford, USA

3University of Illinois at Chicago, Neuropsychiatric Institute, Department of Psychiatry, USA

4Jesse Brown Veterans Affairs Medical Center, USA

*Corresponding author: Rosen C, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor, Suite 489, Chicago, Illinois, 60612

Received: February 23, 2015; Accepted: April 21, 2015; Published: April 23, 2015


Objective: The primary aim of this study was to examine first-person phenomenological descriptions of the relationship between the self and Auditory Verbal Hallucinations (AVHs). Complex AVHs are frequently described as entities with clear interpersonal characteristics. Strikingly, investigations of firstperson (subjective) descriptions of the phenomenology of the relationship are virtually absent from the literature.

Method: Twenty participants with psychosis and actively experiencing AVHs were recruited from the University of Illinois at Chicago. A mixed-methods design involving qualitative and quantitative components was utilized. Following a priority-sequence model of complementarity, quantitative analyses were used to test elements of emergent qualitative themes.

Results: The qualitative analysis identified three foundational constructs in the relationship between self and voices: ‘understanding of origin,’ ‘distinct interpersonal identities,’ and ‘locus of control.’ Quantitative analyses further supported identified links of these constructs. Subjects experienced their AVHs as having identities distinct from self and actively engaged with their AVHs experienced a greater sense of autonomy and control over AVHs.

Discussion: Given the clinical importance of AVHs and emerging strategies targeting the relationship between the hearer and voices, our findings highlight the importance of these relational constructs in improvement and innovation of clinical interventions. Our analyses also underscore the value of detailed voice assessments such as those provided by the Maastricht Interview are needed in the evaluation process. Subjects narratives shows that the relational phenomena between hearer and AVH(s) is dynamic, and can be influenced and changed through the hearers’ engagement, conversation, and negotiation with their voices.

Keywords: Auditory Verbal Hallucinations; Psychosis; Phenomenology


Auditory Verbal Hallucinations (AVHs) are transdiagnostic symptoms present in psychotic disorders that exist along a continuum within psychiatric and non-psychiatric populations [1,2]. AVHs are predominantly sensory experiences that occur in the absence of external stimuli [3] and are typically attributed to an external source [4,5]. AVHs are often described as frightening experiences that can lead to high levels of distress, social isolation, and functional disability [6,7]. An estimated 25%-50% of patients experience persistent AVHs despite pharmacological treatment.

Current diagnostic protocols revolve around categorical syndromes characterized by abnormalities of expression and behavior and have consistently failed to capture the complexity of particular symptoms, including AVHs. Characteristics such as longitudinal change and phenomenological range are frequently ignored. [8-12] In contrast, historically, substantial attention was paid to the phenomenological nuances of particular symptom domains [13-15]. Schneider classified AVHs as First Rank Symptoms (FRS), pathognomonic of schizophrenia, but recent research has shown that FRS is transdiagnostic. AVHs are among the most experientially complex transdiagnostic symptoms; thus research identifying subcategories that cut across diagnostic boundaries has significant translational and nosological implications [16,17]. Further study of phenomenological variations of AVHs also promises to lay a strong foundation for development of innovative phenomenologicallytailored interventions.

Phenomenologically, variation in AVHs is substantial. AVHs may be experienced as ego-syntonic or ego-dystonic, part of or external to self, and may involve voices that command, comment, insult, or affirm. Complex AVHs are frequently experienced as identities with clear interpersonal characteristics. Patients often interact with their AVHs and have described these relationships as very similar to relationships with other people [18-21]. Voice-hearers may attribute AVHs to a Higher Power, spirits, deceased family members, or messages generated by radio, television, or social media. AVHs also vary in terms of frequency, duration, location, number, form of address, content, acoustic quality, and linguistic complexity [22].

Strikingly, systematic investigation of first-person descriptions of the relational phenomenology of AVHs have been virtually absent from the literature [9,1,17]. The primary aim of this study was to explore and unpack the relationship between subjects and their voices.



Twenty participants with psychosis who were actively experiencing AVHs were recruited from the University of Illinois at Chicago. Exclusion criteria included: substance dependence, seizure disorders, and neurological conditions. The study was approved by the IRB and signed consent was obtained prior to initiation of study procedures.

Consensus diagnoses were determined by the clinical and research team using the Structured Clinical Interview for DSM-IV, and available collateral information. Of the total sample (n=20), 85% (17/20) were diagnosed with schizophrenia and 15% (3/20) with bipolar disorder with psychosis. Eighty-five percent were African- American (17/20), and 65% (13/20) were female. Mean age was 41, mean age of onset of psychotic symptoms was 24, and duration of illness mean score was 20 years. Mean number of previous psychiatric hospitalizations was 5, ranging from 0 to 12. All subjects were receiving psychiatric services at the time of the evaluation and were prescribed either typical or atypical antipsychotic medications. See Table 1 for a detailed description of the demographic information for the full sample (n=20) and the qualitative sample (n=14). There were six subjects who did not participate in the tape-recorded interview.

Citation: Rosen C, Jones N, Chase KA, Grossman LS, Gin H and Sharma RP. Self, Voices and Embodiment: A Phenomenological Analysis. J Schizophr Res. 2015;2(1): 1008. ISSN:2471-0148