Tuesday 9 September 2014

The Representation of Agents in Auditory Verbal Hallucinations

Sam Wilkinson
In this post, I will sketch some ideas from a paper that I have been working on with Vaughan Bell.

Current aetiological models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlying their occurrence, but often fail to address more fine-grained aspects of the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking, given that there are AVHs, why they have the properties that they have. One such property, which has been somewhat overlooked, is why the voices are often experienced as coming from (or being the voices of) agents, and often specific agents.

One reason why this has been overlooked (more by theorists than by clinicians) is perhaps the – explicit or implicit – view that, if we can account for the auditory experience, then the agency will follow. Thus Cho and Wu (2013, p.2) claim that ‘it is simple to explain why the patient misattributes the event to another person: that is what it sounds like’. According to such a view, I hear the voice of, e.g., my stepfather because my auditory experience has the properties that resemble those of my stepfather’s voice.

Of course, one problem with this is that, even if this is an accurate account, we need to explain why the experience has those properties and not others. If, instead, we see that what needs explaining is why it is the stepfather who is represented, and not some other agent, then we can potentially provide illuminating explanations in terms of the stepfather’s role in the subject’s life. Of course, these only form a relatively small subset (e.g. 4 out of 24 in Fowler et al. 2006) of AVHs, but I mean this as an illustration of how, if you change your explanatory focus, your explanations start to look very different. If you move the focus away from auditory properties, to the properties of the agent represented, whether it’s a specific individual from the subject’s past, a richly represented imaginary tormentor or friend, or just a particular type of agent, then the explanatory payoffs could be great.

Why might this shift in focus, away from the auditory, be warranted? There are a number of reasons for this, but here I mention just two.

The first is that some voice-hearers describe an experience of ‘soundless voices’. For example, one participant in a recent study told us: “It’s hard to describe how I could ‘hear’ a voice that wasn’t auditory; but the words used and the emotions they contained were completely clear, distinct and unmistakeable, maybe even more so than if I had heard them aurally”. This is in keeping with Chris Frith’s claim that AVHs can involve ‘an experience of receiving a communication without any sensory component’ (1992, p.73).

The second is that ‘voices’ are also ‘heard’ by congenitally deaf people. Jo Atkinson, a researcher in London, has done very important work correcting the ‘audio-centrism’ of mainstream clinical perspectives (Atkinson 2006). She has shown that deaf voice-hearers experience vague visual imagery like being addressed in sign-language, or of disembodied lips. But they do not, as was previously thought, have auditory experiences at all.

A wealth of literature in evolutionary and developmental psychology, as well as in cognitive anthropology, points towards the representation of agency as something that is “trip-wired” (Gurthrie 1980; Barrett 2000), developmentally early and potentially innate (Bates et al. 1975; Butterworth and Grover 1988; Morton and Johnson 1991), and can plausibly enter into the very content of an experience (Johnson 2003). In other words humans can experience “illusions of agency”, even if they don’t go on to believe that agency is present.

Perhaps we should start viewing AVHs as primarily communicative experiences from agents, which happen to often be auditory or reported as auditory, rather than seeing them as primarily auditory experiences that happen to have communicative and agentive aspects.


  1. Very interesting as it opens many avenues.

    What is the proportion of reported 'soundless voices' that were attributes to supernatural agents?

  2. Thanks for your comment, Nath! (And sorry for the delay in responding!)

    There is some data, much of it conflicting, on the percentage of voices that are soundless (and often, there are no questionnaire items for "soundless", and it gets subsumed under "soft" cf. McCarthy-Jones et al. 2013). There is also some data on how many hallucinations have "religious or supernatural content" (which is importantly different from whether they are from a supernatural agent). However, as far as I know, there is no data on voices that are both soundless, and attributed to supernatural agents. This would be very interesting indeed.

    Do you think that a soundless voice is more likely to be attributed to a supernatural agent?

  3. It's only a guess, but I wouldn't be surprised if soundless voices were more likely attributed to supernatural agents. Since the hallucination doesn't come from the surrounding nor attributed to one's own brain, it would be 'logical' to attributed to 'another dimension', assuming that the subject already indoctrinated in believing in supernatural agents.

    Many numinous experiences, from testimonies I've seen on the web, seem to be fairly similar to those 'soundless voices'. Maybe it is what some people describe as having a 'divine revelation'.

    Thank you for replying.

    Best wishes.

  4. Reminds me of some discussions I have of how people visualise (I'm not up to date on the actual literature).

    For many I think visualisation is actually not a fully 'visual' experience. When we try to bring a person to mind, I suspect we are actually activating the brain network that links to a much more holistic representation.. a 'felt sense' as much any anything else. This sense may no longer be linked to any one sensorial modality, but be something that only exists in the brain. A network state no longer exactly decomposable into senses.

    Thus yes, from that perspective, I support the idea that voices are more than 'auditory', and of course, in the congenitally deaf, not auditory at all. It's not uncommon in my experience for those with auditory hallucinations to also report a separate feeling of a person's 'presence' (and indeed not uncommon in the general population' and especially the recently bereaved).

    I'm not sure however I'd be fully happy with describing AHs as 'Agents' though. There are a number of reasons for this:

    1. It implies agency. AHs don't have agency. They are also often quite repetitive and boring (in terms of semantic content, not emotion)
    2. Many people who experience AHs, also experience delusional ideation, bringing discussion of agents into this might not be that helpful. I'm uncomfortable even when we start talking about 'voices' as if they are real voices. In therapy, I often try to help people move to the position where they ca view their voices as an experience generated by their brain (often with reference to the brain's dreaming abilities).

    (can you make your comments box bigger, it's hard to see what one has written to see if it makes sense - can only see 4 lines - safari, Mac ).

  5. Am enjoying reading your blog, thanks all for writing.

    Shifting away from auditory description of these voices sounds like a good idea. For me an AH was more like when you remember a person speaking to you. You don't 'hear' them speak in your memory, you sort of 'think' them speak.

    I also found the concept of agency was very important, for me at least, to be able to recover my thought processes after they were disrupted by the experience. I chose to view everything I 'saw' or 'heard' as a real hallucinatory message from an Agent that does not exist yet and tests me with untruth about reality. There is only one agent that can appear as any agent I could imagine, including myself.

    I came to the conclusion that an Agent that asks us to believe that an untruth about reality could account for all the people who choose to believe that delusions exist. What we call a delusion occurs when an Agent asks a person to believe an untruth about reality.

    For example, the Agent might ask you to believe that some other person who claims to have superpowers is delusional. If you choose to believe that the person is delusional, you would be deceived by the Agent. If you choose to believe that the other person has superpowers, without first testing their claim, you would be deceived by the other person, not the Agent.

    How can I get someone to learn my beliefs well enough to provide me with counter-evidence?

  6. Genetics, telepathy, religiues, demons, permanent brain damage, gift, privileged, adaptation to the religion gives comfort, voices of humans brains or others creatures Living in earth, the brain as a machine communications radio used to develop you for the better, deception is possible by the external ideas if the subject is not religiues, those voices are very dangerous for humans without the exact knowledge.

  7. I twice heard the voice of my dead father saying my name with a questioning inflection. I answered once, even as I knew he was dead. Years earlier. when My father was still alive, the electricity failed and I was oversleeping when, clear as a bell, my dead mother called in my head: Donald, you get up out of that bed this instant. I'm sure that was dredged from my memories word for word from an actual speech by my mother. The mechanism by which that was employed at that moment, for a necessary task, has continued to mystify.


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