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Post subject: Speech perception and some symptoms of schizophrenia.http://www.lingforum.com/forum/viewtopic.php?t=512" SCHIZOPHRENIA " (an integration disorder) - the price we pay for language?
I find it very challenging to live with something which has a negative impact on my life without understanding and this is an ongoing attempt to understand an illness most people know very little about. Approximately one percent of the world's population (almost 70 million people!) are at some point in their lives just like me right now (several voices are commenting on what I write and think) forced to somehow cope with what they experience due to what can best be described as an integration disorder which depend on both environmental and genetic factors. My attempts to understand started off several years ago as some kind of metacognitive approach to understand some of what I with this illness experience which now also (to me at least...) seems to enable a better understanding of speech perception. (What can we learn from experiences like these? Some of what I write in my attempts to understand can maybe at the best make people think because I often find it very hard to understand what scientists like Crow, Grossberg, Ford, Frith, Hunter and Hoffman write and have a tendency or need to fill in these gaps when the only comprehensible source of information, reliable or not, seems to be my experience. However the gap between how I understand some of what I with this illness experience and what some of these scientists write has been narrowed down and I do think that at least some of what I write now is worth reading. I focus a lot on how an already stigmatized experience can be connected to some of what characterize an even more stigmatized illness, but most people who hear auditory hallucinations do not meet the diagnostic criteria for schizophrenia! I do appreciate that the administrator of a forum like this allows me to post what I in time hope to understand better and need to apologize for all the changes I make in my attempts to improve some of what I write. This is no doubt a very interesting subject to explore, but I fully understand how hard it must be to respond to a post like this and interpret the very few responses I get as kindness from people who like me want to understand this better. All the sources I use in my attempts to understand this better are included together with what I quote in the end of this letter. )
Information about symptoms and DSM-IV diagnostic criteria for schizophrenia
Characteristic symptoms (DMS-VI): 1.) delusions 2.) hallucinations 3.) disorganized speech (e.g., frequent derailment or incoherence) 4.) grossly disorganized or catatonic behaviour 5.) negative symptoms, i.e., affective flattening, alogia, or avolition
Diagnostic criteria (DMS-VI): Two (or more) symptoms, “…each present for a significant portion of time during a 1-month period (or less if successfully treated)… …Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other…” Social/occupational dysfunction and the possibility to exclude something else are also taken in consideration!
Source: Mental Health: A Report of the Surgeon General, Table 4-6. DSM-IV diagnostic criteria for schizophrenia http://www.surgeongeneral.gov/library/m ... l#table4_6
Diagnosis (DMS-VI): 1.) Paranoid Type 2.) Catatonic Type 3.) Disorganized Type 4.) Undifferentiated Type 5.) Residual Type
Source: Counselling Resource http://counsellingresource.com/distress ... renia.html
The following quotations on schizophrenia are from Mental Health: A Report of the Surgeon General, Table 4-7. Postitive and negative symptoms of schizophrenia http://www.surgeongeneral.gov/library/m ... l#table4_7
Positive Symptoms of Schizophrenia
Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning and/or misinterpretations of perceptions or experiences. Delusions of being followed or watched are common, as are beliefs that comments, radio or TV programs, etc., are directing special messages directly to him/her.
Hallucinations are distortions or exaggerations of perception in any of the senses, although auditory hallucinations (“hearing voices” within, distinct from one’s own thoughts) are the most common, followed by visual hallucinations.
Disorganized speech/thinking, also described as “thought disorder” or “loosening of associations,” is a key aspect of schizophrenia. Disorganized thinking is usually assessed primarily based on the person’s speech. Therefore, tangential, loosely associated, or incoherent speech severe enough to substantially impair effective communication is used as an indicator of thought disorder by the DSM-IV.
Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in activities in daily living), unpredictable agitation or silliness, social disinhibition, or behaviors that are bizarre to onlookers. Their purposelessness distinguishes them from unusual behavior prompted by delusional beliefs.
Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures, or aimless excess motor activity.
Other symptoms sometimes present in schizophrenia but not often enough to be definitional alone include affect inappropriate to the situation or stimuli, unusual motor behavior (pacing, rocking), depersonalization, derealization, and somatic preoccupations.
Negative Symptoms of Schizophrenia
Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and body language.
Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as laconic, empty replies to questions.
Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest.
Professor Tim Crow ( http://en.wikipedia.org/wiki/Tim_Crow
) proposes that the human capacity for language can cause an integration disorder like this as far as I can understand because a deviation in the rate of nonverbal and verbal development cause the human capacity for language to be less lateralized. I do - a lot in my attempts to understand some of what Tim Crow and other scientists write, but this illness could very well be the price we pay for language.
The alien voices I often hear in response to non-verbal environmental sounds such as traffic noise, background chatter or the pitch and timbre of a single distorted maybe distant voice are no doubt just like when I hear and with awareness control my inner voice verbal thoughts heard out loud. To sometimes lose the ability to control what you are doing when you are forced to divide your attention between two similar tasks is a well known experience many people share and to be forced to divide your attention between what you are able to attend when you are trying to hear a certain voice (listening) and the inner voice you intend to produce with an internal gesture (covert speech) may due to a similarity result in that you lose the ability to control covert speech. (The internal gestures you intend to produce when you expect to access a verbal message in response to what you are able to hear more objectively must as far as I can understand like the gestures you intend to produce during overt speech determine what you expect to hear (Quote 1) and what you are able to attend with a top-down sensory expectation like this (Quote 1 and 9) will, when you are trying to hear the voice you intend to produce, automatically correspond to some features matching the sensory consequence you intend to produce.) Verbal thoughts like these are heard in integration with all features matching a corresponding top-down sensory expectation (what you expect to hear when you expect to hear the inner voice you intend to produce) and will in response to certain sounds include non-verbal acoustic features which characterize what you are able to hear more objectively. (The attention you devote to a competing task (what you are able to attend when you are trying to hear the voice you intend to produce) can when you divide your attention between two tasks due to a similarity (what you are able to attend when you are trying to hear the voice you intend to produce will automatically correspond to some features matching the sensory consequence you intend to produce) more or less suppress the ability to control covert speech and to more or less, depending on how well a corresponding top-down sensory expectation matches bottom-up sensory signals, lack the ability to consciously control covert speech with regards to a certain goal is to more or less lack the ability to inhibit a verbal response. This ought to result in a tendency to produce a rather equivalent inner voice in response to what you are able to hear more objectively and to be able to hear the sensory consequence of covert speech in integration with all features matching a corresponding top-down sensory expectation can no doubt generate the perception of a voice "that retain certain acoustic features that where present in the original signal". Quote 16) Some people are able to hear verbal illusions like these (referred to as functional auditory hallucinations) in response to the pitch and timbre of a distorted maybe distant voice impossible to hear more objectively and this must no doubt be the most insidious symptom a person can experience. I succeeded to simulate the circumstances needed to induce functional auditory hallucinations like these in one of my attempts to understand this better. This was done with the help of a soundfile with a lot of white noise used to mask distant voices talking in the background. An objective perception was hereby prevented, but I could still hear them talk and in real life you only need to hear a couple of words to start and fuel false beliefs. It is sometimes hard to tell, but I do think that the ability to hear whatever you expect to hear in response to non-verbal features which characterize a certain voice early on had a negative impact on my life (Quote 17) and wonder if the result of stimulus (non-verbal) - stimulus (verbal) contingencies (classical conditioning) when you with a short delay are able to restore what is or at least subjectively seems to be a verbal message can have such a profound effect that some people eventually develop a mental illness.
Quote 16: "In schizophrenia, functional hallucinations are defined as those that occur when a patient simultaneously receives a real stimulus in the perceptual field concerned (e.g., hallucinated voices heard simultaneously with and specific to the real sound of running water)... ...Another hallucinated voice occurred simultaneously with actual speech uttered by television announcers. The semantic content was the same as that of the "engine voice," but the "television voice" sounded human, exactly like the real voice of the television announcer who was speaking at the same time. For example, the "television voice" was described as sounding like an adult woman with a northern British accent and "serious" emotional prosody... In this Patient, we observed a direct relationship between the timbre, prosody, and pitch of real environmental sounds and simultaneously perceived auditory hallucinations. Evidence from functional neuroimaging supports a general hypothesis that auditory hallucinations can arise because of abnormal activation in the auditory cortex. This case - a further hypothesis: normal activation in the auditory system, which corresponds to neural encoding of natural-sound object and location characteristics, may be misinterpreted, leading to the false perception of functional auditory hallucinations that retain certain acoustic features that where present in the original signal..." Source: Letter to the Editor, Characteristics of Functional Auditory Hallucinations by Michael D. Hunter, M.R.C.Psych., and Peter W.R. Woodruff, Ph.D., M.R.C.P., M.R.c.Psych. Sheffield, U.K. Am J Psychiatry 161:923, May 2004 http://ajp.psychiatryonline.org/cgi/con ... /161/5/923
Quote 17: "...A tendency to extract spurious, message-like meaning from meaningless noise was assessed as a risk factor leading to shizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms..." Source: Extracting spurious messages from noise and risk of schizophrenia-spectrum disorders in a prodromal population" written in British journal of psychiatry (2007), 191, 355-356. by Ralph E. Hoffman and colleagues. (Their findings can as far as I can understand be used in support of the opinion that functional auditory hallucinations early on in the development of an integration disorder like schizophrenia often are a part of what you experience.) http://bjp.rcpsych.org/cgi/content/full/191/4/355
Excessive attentional focus on all features matching a top-down sensory expectation can substantially increase the subjective loudness of what you are able to select (peripheral features not otherwise brought to awareness) when you are trying to hear a certain voice and this will as far as I can understand determine the subjective loudness of the voice you are able to hear in integration with all features matching a top-down sensory expectation. To first excessively pay attention to and then with a short delay interpret all features matching a top-down sensory expectation may result in abnormal (internal) activation of primary auditory cortex (Quote 11), but what I write in my attempts to understand functional auditory hallucinations as the origin of an integration disorder like this will like our ability to restore and better distinguish a verbal message naturally be more concerned with normal (external) activation of primary auditory cortex. (The voice you hear in integration with all features matching a top-down sensory expectation will in response to certain sounds include acoustic features which characterize what you are able to hear more objectively and an ability to sometimes be able to reveal a verbal illusion by locating the source of some environmental sounds can like when you are able to block all features matching a top-down sensory expectation make it very easy to understand that you are able to interpret external stimuli. However to block what I hear with my fingers can only give a temporary relief from the voices I hear and I am also like expected able to hear my own thoughts in the tinnitus sounds I hear (become more aware of) during silence. Most people will probably find it very hard to understand that you are able to hear a voice when you interpret what normally is unattended and bellow awareness, but it is well known that a short or long term memory of a tone can enable the perception of the same tone at a lower volume than otherwise would have been possible (Hemisfärernas musik, s.53, Jan Fagius) and Treisman´s attenuation model which can be used to understand the cocktail party effect claim that "paying attention to a message means increasing its subjective loudness". The ability to take nonverbal features matching what you expect to hear out of their peripheral existence will make it possible to reveal a verbal illusion and to be able to reveal a verbal illusion in response to un-patterned noise above a certain threshold, but totally lack the ability to reveal a verbal illusion in response to un-patterned noise of a much lower volume may result in a tendency to expect to hear a verbal message in response un-patterned noise bellow a certain threshold. To expect to hear a verbal message in response to un-patterned noise bellow a certain threshold can motivate an operant behaviour (the internal gestures we produce during covert speech) which without an act of will can generate the alien voices people are able to hear in integration with all features matching (and previously selected with) a corresponding top-down sensory expectation. Ford and colleagues - that patients with auditory hallucinations may have excessive attentional focus toward internally generated events and because of this overinterpret the kind of internal noise (spontaneous sensory activity) people normally ignore. Quote 11-12)
Quote 11: “…Recent advances in the neurosciences provide clues to why patients report an auditory experience in the absence of any perceptual input. Spontaneous activity in the early sensory cortices may in fact form the basis for the original signal. Early neuronal computation systems are known to interpret this activity and engage in decision-making processes to determine whether a percept has been detected. A brain system that is abnormally tuned in to internal acoustic experiences may therefore report an auditory perception in the absence of any external sound. Ford and colleagues recently - that patients with auditory hallucinations may have excessive attentional focus toward internally generated events—the brains of persons who have auditory hallucinations may therefore be overinterpreting spontaneous sensory activity that is largely ignored in healthy brains…” (She writes about auditory hallucinations in Psychiatric Illness, but it is very important to remember that some people who hear voices do well and can use their voice hearing experience to enrich their lives.) Source: Auditory Hallucinations in Psychiatric Illness from the march 2010 issue of Psychiatric Times by Flavie Waters http://www.psychiatrictimes.com/cme/dis ... 68/1534546
Quote 12: "…Although "voices" are the anticipated sensory experience, it appears that even primary auditory cortex is "turned on" and "tuned in" to process internal acoustic information at the cost of processing external sounds…" Source: Schizophrenia Bulletin 2009 Jan;35(1):58-66, Tuning in to the voices: A Multisite fMRI Study of Auditory by Judith M. Ford and colleagues http://schizophreniabulletin.oxfordjour ... l.pdf+html
Classical conditioning is according to Stephen Grossberg "...far more subtle and relevant to complex human cognitive-emotional behavior than one might first realize..." (Quote 26) and I´m trying to understand if the result of stimulus (non-verbal) - stimulus (verbal) contingencies (classical conditioning) when you with a short delay are able to restore what is or at least subjectively seems to be a verbal message can have such a profound effect that some people eventually develop a mental illness. Classical conditioning (also referred to as pavlovian or respondent conditioning) can be the result of stimulus (non-verbal) - stimulus (verbal) contingencies like these and may trigger the need to access a verbal message (what you learn to expect) in response to non-verbal stimuli while operant conditioning is the result of response - stimulus (the sensory consequence of an internal gesture can be heard in integration with all features matching a corresponding top-down sensory expectation) contingencies and what you learn to do to satisfy the need to access a verbal message. In other words to frequently restore a verbal message in response to more ambiguous sounds may result in a tendency to expect to hear a verbal message in response to non-verbal environmental sounds and to expect to access a verbal message in response to non-verbal environmental sounds can motivate a verbal response which makes it possible to interpret what other people mostly ignore. (Read quote 21 and 31)
Quote 21: "...Respondent conditioning is the result of stimulus-stimulus contingencies, while operant conditioning is the result of response-stimulus contingencies that affect operant behaviour. There are, however certain stimulus-stimulus contingencies that affect operant behaviour. Theoretically speaking, stimulus-stimulus effects on operant conditioning may be regarded as resulting from respondent conditioning interacting with operant conditioning..." (p. 103) "...Before concluding this discussion of the distinction between respondent and operant conditioning, it is important to note that pure instances of either are rare. Most learned behaviour consists of both..." (p. 40) "…Some stimuli, such as food and water, are reinforcers due to phylogeny (i.e., the evolutionary history of the species). These stimuli are called primary reinforcers. Other stimuli can become reinforcers due to events that occur in the history of an individual. Typically, these reinforcers have been paired with existing reinforcers. For example, if a tone regularly precedes food, the tone will become a reinforcer – that is, it can be used to operantly condition an arbitrary response such as a lever press. A conditioned reinforcer is a stimulus that has become a reinforcer by being paired with a reinforcer. Conditioned reinforcement expands the range of stimuli that can become reinforcers. The evolutionary significance of conditioned reinforcement is that responding to produce a stimulus that has occurred in close temporal association with a primary reinforcer is likely to bring the animal closer to the primary reinforcer. Natural selection would favour this because primary reinforcers usually benefit the animal or its reproductivity…" (p. 36) Source: The science of learning by Joseph Pear (available in google books)
Quote 31: ”…Pavlovian conditioning is largely responsible for our motivation to respond in any situation. Operant conditioning, on the other hand, is what we learn to do to satisfy these motivational states. Source: Organisational Behaviour Modification by Jonathan Gabbai on June 14, 2001 http://gabbai.com/management/organisati ... dification