Stanghellini Giovanni, Cutting John
Department of Mental Health, University of Florence, Florence, Italy.
Psychopathology. 2003 May-Jun;36(3):120-8. doi: 10.1159/000071256.
Auditory verbal hallucinations (AVHs) are usually defined as perceptions of speech that occur in the absence of any appropriate external stimulus. This definition, we argue, is false. We maintain that AVHs are disorders of self-consciousness that are best understood as the becoming conscious of inner dialogue. Normally, subconscious interior conversations are experienced as a sense of partnership between distinct parts: we feel these parts as distinct, but also integrated and collaborating with each other in decision-making and in self-representation. AVHs attest to a breakdown in this process of interior conversation: the feeling of unity in duality falls apart, and the dialectic partnership on which self-representation is grounded shatters into a mere dichotomy. There is a fracture in self-consciousness. If ipseity (i.e. the prereflective modality of self-awareness, the self-feeling of one's own self in which the one who feels and what is felt is but one thing) is lacking, the sense of unity weakens, and the sense of duality increases. This crisis of ipseity is accompanied by an increase of reflexivity (i.e. the process through which I take a part of myself as a focal object of awareness). Hyperreflexivity contributes to the objectification of the sense of duality and to the loss of the sense of 'myness' of inner speech. In schizophrenics, inner dialogue becomes anomalously manifest. Whereas in normal conditions, inner dialogue is the medium for self-representation, AVHs arise through its morbid objectification: inner speech comes to the foreground in the concrete fashion of alien 'voices'.
听幻觉（AVHs）通常被定义为在没有任何适当外部刺激的情况下出现的言语感知。我们认为，这个定义是错误的。我们坚持认为，听幻觉是自我意识障碍，最好理解为对内心对话的觉知。通常情况下，潜意识的内心对话被体验为不同部分之间的伙伴关系：我们感觉这些部分是不同的，但在决策和自我呈现中又相互整合与协作。听幻觉证明了这种内心对话过程的崩溃：二元统一的感觉瓦解，自我呈现所基于的辩证伙伴关系破碎成仅仅是一种二分法。自我意识出现了裂痕。如果缺乏自我性（即自我意识的前反思模式，自我对自身的感觉，其中感受者和被感受者是同一事物），统一感就会减弱，二元感就会增强。这种自我性危机伴随着反思性的增加（即我将自己的一部分作为意识焦点对象的过程）。过度反思导致二元感的客观化以及内心言语“我的”感觉的丧失。在精神分裂症患者中，内心对话异常显现。在正常情况下，内心对话是自我呈现的媒介，而听幻觉则通过其病态的客观化而产生：内心言语以陌生“声音”的具体形式凸显出来。
