The Perceptual Characteristics of Voice-Hallucinations in Deaf People: Insights into the Nature of Subvocal Thought and Sensory Feedback Loops - PMC

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Schizophr Bull<br>. 2006 Mar 1;32(4):701–708. doi: 10.1093/schbul/sbj063

The Perceptual Characteristics of Voice-Hallucinations in Deaf People: Insights into the Nature of Subvocal Thought and Sensory Feedback Loops

Joanna R Atkinson<br>Joanna R Atkinson

2Deafness, Cognition, and Language Centre, University College of London

Find articles by Joanna R Atkinson

2,1

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2Deafness, Cognition, and Language Centre, University College of London

1To whom correspondence should be addressed; e-mail: joatko@googlemail.com.

Issue date 2006 Oct.

© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

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PMCID: PMC2632268  PMID: 16510696

Abstract

The study of voice-hallucinations in deaf individuals, who exploit the visuomotor rather than auditory modality for communication, provides rare insight into the relationship between sensory experience and how “voices” are perceived. Relatively little is known about the perceptual characteristics of voice-hallucinations in congenitally deaf people who use lip-reading or sign language as their preferred means of communication. The existing literature on hallucinations in deaf people is reviewed, alongside consideration of how such phenomena may fit into explanatory subvocal articulation hypotheses proposed for auditory verbal hallucinations in hearing people. It is suggested that a failure in subvocal articulation processes may account for voice-hallucinations in both hearing and deaf people but that the distinct way in which hallucinations are experienced may be due to differences in a sensory feedback component, which is influenced by both auditory deprivation and language modality. This article highlights how the study of deaf people may inform wider understanding of auditory verbal hallucinations and subvocal processes generally.

Keywords: deafness, auditory verbal hallucinations, psychosis, subvocal articulation, British sign language (BSL), sensory feedback loop

Introduction

The study of how voice-hallucinations are uniquely experienced among deaf people, who cannot hear speech but use lip-reading or sign language as their primary means of communication, provides an exciting opportunity to reflect on the nature of auditory verbal hallucinations (AVH) generally. In particular, it allows a unique test of one of the major theories of AVH, the subvocal articulation hypothesis. This theory suggests that auditory voice-hallucinations result from the misattribution of inner speech to an external locus of control.1,2 It posits that the form of the hallucination mirrors subvocal thought processes, which in hearing individuals are predominantly speech-based. Deaf people form a highly individuated population in terms of their experience with language and sensory input. One consequence is that the considerably greater diversity in the ways that language and subvocal thought processes develop in deaf individuals may be reflected in how they perceive voice-hallucinations. The subvocal thought hypothesis would predict that the perceptual characteristics of an individual's experiences of voice-hallucinations may map onto their own experiences, with spoken or signed languages, of total deafness or of hearing sound either before they became deaf or through the use of residual hearing and hearing aids. Thus, it would be plausible that true auditory hallucinations would be confined to deaf people who at some point in their lives had heard speech.3 Research to date has been preoccupied with the question of whether the “voices” described by people born profoundly deaf are truly auditory in nature, as well as documenting the alternative perceptual forms that voice-hallucinations may take in deaf individuals. In the first part of this article, the existing literature is outlined, and methodological shortcomings are evaluated. The discussion then moves on to consider the adequacy of subvocal articulation models in accounting for “voice” phenomena in deaf...