The Pathogenesis of Auditory Verbal Hallucinations in Schizophrenia: A Clinical–Phenomenological Account

Although hallucinations are among the most studied psychiatric symptoms, their pathogenesis remains largely unknown and their experiential complexities are rarely accounted for. In schizophrenia, auditory verbal hallucinations are by far the most frequently reported type of hallucination. In this study, we explore verbal hallucinations in schizophrenia and we argue that these are best understood not as abnormal perceptions, but as cognitive phenomena arising from a partial dissolution of certain structures of self-consciousness. Consistent with recent empirical and conceptual studies in phenomenological psychiatry, we claim that specific alterations of self-awareness tend to precede the emergence of verbal hallucinations in schizophrenia. We illustrate these altered states of self-awareness in three detailed case vignettes of hallucinating schizophrenia spectrum patients. We propose a clinical–phenomenological account of the pathogenesis of verbal hallucinations in schizophrenia, suggesting that pathological changes in the experience of space and morbid objectification of inner speech may lead to crystalized verbal hallucinations.