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Hearing voices
6/12/15

And in the brain?

A remarkable fact: functional magnetic resonance imaging (fMRI) of the brain has revealed that during a hallucination, the area associated with the sensory channels involved (visual, auditory, olfactory, etc.) is activated in the cortex, whereas, by definition, there is no perception there. In addition, the Broca and Wernicke areas, which are essential for language, play a part in auditory verbal hallucinations. ʺHowever, there is a nuance here because these activation patterns (auditory areas ‘switched on’ during an auditory hallucination, etc.) aren’t present in all patientsʺ, says Frank Larøi. Furthermore, this type of data doesn’t explain several essential aspects of the experience, such as the negative content of the auditory verbal hallucinations in psychotic patients.

Other regions of the brain are involved in hallucinatory experiences, but they are difficult to map. In particular, the frontal regions, among others, may be involved in  ʺreality monitoringʺ. In addition, the activation of one of the small networks in the hippocampus has been revealed in auditory verbal hallucinations. Furthermore, according to Flavie Waters, from the University of Western Australia, hallucinations partly depend upon an inappropriate mnesic mechanism. ʺIn her opinion, they could be linked to memories that surface owing to inhibition deficits together with deficits in contextual memory, which is related to elements of the context (place, temporal organisation, etc.) in which a piece of information was acquiredʺ, Frank Larøi further explains.

Support groups  

Traditionally, in psychiatry, hearing voices is considered a sign of psychosis. The solution? To prescribe neuroleptic drugs, which can essentially help schizophrenic patients to control the so-called positive symptoms of their illness, such as hallucinations and delusions. ʺHowever, it is believed that despite these drugs, 30 to 60 % of patients continue to have difficulty managing their symptomsʺ, Frank Larøi specifies. In fact, antipsychotics aren’t specifically directed at auditory verbal hallucinations. Hence, they aren’t really appropriate for dealing with the difficulties related to these symptoms.

In some cases, the voices aren’t a problem and the hearers even seek them out. This is also the case among a proportion of psychotic patients, as revealed in a study carried out in 1993 by Laura Miller from the University of Illinois. Not only did 52 % of the patients interviewed consider that their hallucinations had an adaptive function, but, even more surprising, 20 % of them didn’t want to take a drug that might protect them against their hallucinations. According to Jonathan Burnay, a clinical psychologist and doctoral student at ULg under the direction of Frank Larøi, the pathological aspect is more the fact of not knowing how to manage the voices, i.e. how to prevent them from being intrusive and not respond to their demands, rather than the fact of hearing them and even believing that they are real, that they are the voice of God, an angel or someone who has died, etc., as is the case in the majority of people concerned.

That’s why, on the basis of the work he undertook at the end of the 1970s, Dutch psychiatrist Marius Romme succeeded in shaking off the shackles of mental illness and assimilate these voices as an experience that can be managed. entendre voixOf course, they may ʺtake hold ofʺ psychotic patients, insult them, threaten to kill them, push them to carry out extreme acts, but, when approached from a non-medical perspective (though often as a complement to treatment with neuroleptic drugs, and even psychotherapy), they appear easier to control. This led to the creation of small support groups in Holland some 20 years ago, attended by both clinical and non-clinical voice hearers. The initiative then spread to many other countries, including France and French-speaking Belgium quite recently, in the last 20 months. Two groups were set up in Brussels, followed by one in Namur and one in Liège. The four entities are part of the association REV-Belgium - Réseau belge des entendeurs de voix - based on its French counterpart REV-France.

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