"Seeing voices": fused visual/auditory verbal hallucinations reported by three persons with schizophrenia-spectrum disorder.
OBJECTIVE
The neurocognitive basis of verbal/auditory hallucinations remains uncertain. A leading hypothesis is that these hallucinations correspond to ordinary inner speech mislabeled as non-self. However, some studies suggest pathogenic activation of receptive language neurocircuitry as the cause. A form of visualized verbal hallucinations not previously reported in the literature is described that may shed light on this controversy.


METHODS
Review of three cases.


RESULTS
Two patients described visual hallucinations of speech-like lip and mouth movements fused with simultaneous auditory verbal hallucinations superimposed on perceptions of faces of actual persons in their immediate environment. A third patient described similar experiences incorporated into visual hallucinations of human figures who also exhibited finger and hand movements corresponding to American Sign Language.


CONCLUSIONS
These fused, multimodal verbal hallucinations seem unlikely to be due to inner speech mislabeled as non-self, and instead suggest top-down re-shaping of activation in visual processing brain centers by pathogenically active receptive language neurocircuitry.
Hoffman
R E
RE
Department of Psychiatry, Yale University School of Medicine, Yale-New Haven Psychiatric Hospital, 184 Liberty Street LV108, New Haven, CT 06519, USA. Ralph.hoffman@yale.edu
Varanko
M
M
D000328:Adult; D005260:Female; D006212:Hallucinations / Q000150:complications*; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000150:complications* / Q000503:physiopathology; D012813:Sign Language; D013067:Speech Perception; D013702:Temporal Lobe / Q000503:physiopathology; D014796:Visual Perception