Thomas, Neil; (2001) Auditory hallucinations in schizophrenia: An interpersonal analysis. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

In schizophrenia, auditory hallucinations usually take the form of heard speech or 'voices'. It appears that patients frequently interpret this experience in terms of a separate entity interacting with them, and will sometimes actively engage with their voices as if they were real people. This suggests that patients may have meaningful interpersonal relationships with the voices they hear. There also appear to be varied individual differences in how patients react to hallucination, emotionally and behaviourally, and it seems that the meaning that patients attach to their hallucinatory experience may mediate this. It is possible that the nature of the interpersonal relationships that patients have with their voices can be used to conceptualise these individual differences. The interpersonal aspects of hallucinatory experience were examined by applying a model of interpersonal relating, termed the Structural Analysis of Social Behaviour (SASB; Benjamin, 1974), to patients perceptions of their voices and their responses to them. 35 participants with auditory hallucinations and a diagnosis of schizophrenia or schizoaffective disorder completed a self-report measure of their relationships with their voices based on the SASB model. Results suggested that at least the majority of participants were able to see their hallucinatory experience in coherent interpersonal terms. The interpersonal ratings which participants made conformed to a similar structure to that found in everyday interpersonal relationships, with almost all aspects of interpersonal relating appearing applicable within the voice-patient relationship. The main way in which interpersonal perceptions of voices differed between participants was in terms of the degree of affiliation versus hostility their voices were perceived to express towards them. This reliably predicted both how the participant responded to their voices, and how distressing they found them. It was also found that participants with depressive symptoms tended to see their voices as more controlling. These findings suggest that patients have an interpersonal understanding of their voices that organises their day-to-day experience of hallucination. Possible origins of this are discussed with suggestions for future research.

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