Getting better acquainted with Auditory Voice Hallucinations (AVHs): A need for clinical and social change

The phenomenon of hearing voices (AVHs) is very much a subject of current scientific interest, both clinically1 and socially. For a long time, auditory hallucinations—perceiving sounds without external stimuli (David, 2004)—were considered an obvious sign of schizophrenic or psychotic psychopathology (Goodwin et al., 1971; Larøi et al., 2012), but these days such an association is no longer taken for granted. Various recent studies in the areas of psychology, psychiatry, and neuroscience have brought a renewal of interest in AVHs. First of all, the move beyond Kraepelinian logic (van Os, 2009; Fusar-Poli et al., 2014) has led us to see AVHs as a phenomenon in their own right, and not just a characteristic of schizophrenia (Fernyhough, 2004). Furthermore, a number of studies in imaging techniques have allowed us to study the phenomenon live, as it occurs, collecting various new data (Shergill et al., 2000). On the other hand, psychological studies with attempts at modeling, have boosted the idea that AVHs are linked to the linguistic and verbal qualities of the subject, thus reducing the association between voice hallucinations and signs of pathology (Johns and van Os, 2001; Pearson et al., 2001; Stanghellini and Cutting, 2003). Other researchers have theorized that hearing voices is a different manifestation of self-awareness (Salvini and Bottini, 2011; Salvini and Quarato, 2011). Even DSM-5 has modified the importance it attaches to hallucinations, in fact although the 4th edition diagnosed “schizophrenia” simply on the basis of the symptom “hallucinations,” in the new edition hallucinations on their own are not considered a sufficient symptom to diagnose the specter of schizophrenia” (American Psychiatric Association, 2013). Many of those suffering from this condition are not under treatment and are not diagnosable in psychopathological terms, which asks ever more questions of health professionals (Iudici, 2015), and which brings with it the risk that the phenomenon of hearing voices may be considered pathological because of a lack of understanding of the problem. One direct implication of this risk concerns non-psychotic and non-schizophrenic hearers of voices who are afraid of being considered mad or disturbed, who very often live in fear for years without talking about it with anyone, although realizing that hearing voices causes no general maladjustment in their lives (Andrew et al., 2008). In the long term this can lead to feelings of alarm in some of them, and when such situations result in a visit to a clinic or a psychiatrist, there are often “suffering and conflicted confessions” about such experiences, especially by people who have never had psychiatric experience (Iudici and Gagliardo Corsi, 2017). These people consequently do not have appropriate information to help them understand their experiences (Faccio et al., 2013). This fact raises further doubts about the direct juxtaposition of auditory hallucinations and diagnoses of mental disturbance, and consequently our interest is in sensitizing clinicians to a broader interpretation of the phenomenon than the traditional view, highlighting the importance of considering more perspectives.