![]() ![]() This covers a family of models that share a core idea: a defect in a system whose role is to monitor internal episodes as self-generated. One of the prevailing standard models of AVH invokes self- (or source-) monitoring (see Figure Figure1). Finally, by “hallucination” we take a simple view: in AVH, these involve internal (auditory) representations that a verbalized sound occurs when there is no such sound. ![]() Admittedly, categorizing a patient’s experience as auditory or thought can be difficult, but we should first aim to explain the clear cases, those with clear auditory phenomenology. Just as cognitive scientists distinguish between perception and thought in normal experience, we should where possible distinguish between auditory hallucination and thought phenomena (e.g., thought insertion). While there is little controversy that AVH involves language (emphasis on “verbal”) we restrict our attention to auditory experiences, namely where AVH is phenomenally like hearing a voice. Yet even among non-clinical populations, the concepts we use to categorize experiences may be quite fuzzy and imprecise ( 3). What is AVH? It is important to be rigorous in identifying what we are trying to explain, especially since clinical diagnosis of schizophrenia depends on patients’ reports of the phenomenology of their experience. Logical and Conceptual Issues Regarding Mechanisms of AVH ![]() Conceptual and logical analysis, however, will play an important role in aiding empirical work. Still, both models we consider might hold, and this requires further empirical investigation. We believe that there are in fact significant limitations to the account that have largely gone unnoticed. ![]() Self-monitoring accounts have provided much impetus to current theorizing about AVH, but one salient aspect of our discussion is to raise questions as to whether such accounts, as currently formulated, can adequately explain AVH. Rather, we believe that it remains an open question what mechanisms underlie AVH in schizophrenia, and that by drawing clear contrasts between alternative models, we can identify experimental directions to explain what causes AVH. The aim of this paper is not to provide a comprehensive literature review on AVH as there have been recent reviews ( 1, 2). In one sense, self-monitoring accounts emphasize “top-down” control mechanisms spontaneous activity accounts emphasize “bottom-up” sensory mechanisms. On the former, a monitoring mechanism tracks whether internal episodes such as inner speech are self- or externally generated while on the latter, spontaneous auditory activity is the primary basis of AVH. We shall contrast two proposed mechanisms of auditory verbal hallucinations (AVH): (a) the family of self-monitoring accounts and (b) a less discussed spontaneous activity account. Accordingly, we suggest a set of experimental strategies to dissect the underlying mechanisms of AVH in light of the two competing models. Our theoretical overview leads to new questions and issues regarding the explanation of AVH as a subjective phenomenon and its neural basis. We identify a set of challenges for the self-monitoring account and argue that the spontaneous activation account has much in favor of it and should be the default account. In this paper, we provide such a theoretical discussion of the two models, drawing strong contrasts between them. Accordingly, a discussion that systematically contrasts the two models of AVH can generate sharper questions that will lead to new avenues of investigation. Science is often aided by putting theories in competition. A more neglected alternative is an account focusing on defects in auditory processing, namely a spontaneous activation account of auditory activity underlying AVH. Recent work on the mechanisms underlying auditory verbal hallucination (AVH) has been heavily informed by self-monitoring accounts that postulate defects in an internal monitoring mechanism as the basis of AVH. ![]()
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