Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations, and thought insertion to a lesser degree; however, their mechanisms and relationships between each other remain largely elusive. Here we attempt to establish a integrative model drawing from the phenomenology of both AVHs and TI and argue that they in fact can be seen as ‘spectra’ of experiences with varying degrees of agency and ownership, with ‘silent and internal own thoughts’ on one extreme and (...) ‘fully external and clearly audible voices’ in the absence of a speaker on the other. We believe a spectral model will add emphasis to the continuity of experience and help to better understand how one type of psychotic symptom may interact with another, and put forward the argument that the experience of TI itself is not sufficient to classify as a delusion. In addition we aim to discuss some of the conceptual issues surrounding AVHs and TI with first-person accounts and current philosophical and neuropsychological theories in mind. We propose that the mechanisms behind AVHs and TI are more complex than source-monitoring deficits; indeed, to understand such phenomena one must appreciate that their very ‘existence’ and ‘reality’ as experienced by the individual have much deeper implications and meaning, both philosophically and clinically. (shrink)

On a widely held view, episodes of inner speech provide at least one way in which we become conscious of our thoughts. However, it can be argued, on the one hand, that consciousness of thoughts in virtue of inner speech presupposes interpretation of the simulated speech. On the other hand, the need for such self-interpretation seems to clash with distinctive first-personal characteristics that we would normally ascribe to consciousness of one’s own thoughts: a special reliability; a lack (...) of conscious ambiguity and incomprehensibility; and a sense of causal agency. I try to resolve this puzzle by proposing an account for the requisite self-interpretation of inner speech in terms of Bayesian probabilistic inference. Drawing on “perceptual loop” accounts of speech control, I argue that such interpretive probabilistic inferences are used for the control of inner speech, and that as a consequence of this function, they are biased toward the correct interpretations. I conclude by showing how this model can explain the first-personal characteristics of consciousness of one’s own thoughts. In the case of the sense of causal agency, the resulting explanation yields novel accounts for “audible thoughts” and thought insertion. (shrink)

On a widely held view, episodes of inner speech provide at least one way in which we become conscious of our thoughts. However, it can be argued, on the one hand, that consciousness of thoughts in virtue of inner speech presupposes interpretation of the simulated speech. On the other hand, the need for such self-interpretation seems to clash with distinctive first-personal characteristics that we would normally ascribe to consciousness of one’s own thoughts: a special reliability; a lack (...) of conscious ambiguity and incomprehensibility; and a sense of causal agency. I try to resolve this puzzle by proposing an account for the requisite self-interpretation of inner speech in terms of Bayesian probabilistic inference. Drawing on “perceptual loop” accounts of speech control, I argue that such interpretive probabilistic inferences are used for the control of inner speech, and that as a consequence of this function, they are biased toward the correct interpretations. I conclude by showing how this model can explain the first-personal characteristics of consciousness of one’s own thoughts. In the case of the sense of causal agency, the resulting explanation yields novel accounts for “audible thoughts” and thought insertion. (shrink)