The ontology and epistemology of symptoms: The case of auditory verbal hallucinations in schizophrenia

We present a phenomenological account of auditory verbal hallucinations (AVH) in schizophrenia. We examine the mode of articulation of AVH, their spatial and temporal characteristics, and their relation to self-alienation, reflecting an emergence of otherness (alterity) in the midst of the patient’s self. This process of self-alienation is associated with the emergence of a different reality, a new ontological framework, which obeys other rules of causality and time. Patient becomes psychotic not because they cannot distinguish AVH from mundane perception, but because they are in touch with an alternative form of reality. A characteristic feature of schizophrenia is the coexistence of these incompatible realities. AVH are radically different from perception, and associated delusions stem from a breakthrough to another ontological framework. Thus, the current definition of AVH seems incorrect: The symptom is ontologically complex, involving first- and second-person dimensions, relations to the structure of consciousness, and other psychopathological phenomena.