Cultural-Historical Approach to the Exploration of Auditory Hallucinations: Reorganization of Dialogical Inner Speech and Voice

Research Significance. Contemporary science demonstrates increasing interest in the psychological understanding of auditory hallucinations as a transdiagnostic phenomenon. The significance of this research lies in the necessity to transcend the traditional perspective that views voices solely as symptoms of psychosis and to develop a comprehensive psychological framework. Reconceptualizing the mechanisms of hallucinatory experiences has become one of the paramount tasks in clinical psychology, considering their established links to traumatic experiences, social anxiety, and shame. Of particular importance is the development of a new understanding of the dissociative nature of voices through the lens of the cultural-historical approach, which opens avenues for creating non-stigmatizing and effective psychological interventions aimed at reorganizing inner speech and relationships with social positions embodied in «voices» that carry autobiographical significance. Purpose. This article introduces a psychological conceptualization of auditory hallucinations based on L.S. Vygotsky's cultural-historical approach, the relating approach, the theory of the dialogical self, and the cognitive model of psychosis. Results. Departing from the traditional perspective that views voices as perceptual anomalies specific to psychosis, the paper presents a scientific view of hallucinations as transdiagnostic phenomena associated with a loss of agency. These voices are contextualized within autobiographical narratives and adverse psychosocia experiences and observed in non-clinical populations. The discussion includes the integration of Vygotsky's theory and C. Fernyhough's concept of «re-expanded inner speech» to elucidate the voices mechanisms. Social interactions, as they are mediated through language, evolve into private and subsequently inner speech. Throughout development, these dialogical patterns become increasingly internalized and private. Under conditions of stress, inner speech can re-expand and become externalized, perceived as voices. A de-pathologizing framework for understanding voices (as proposed by M. Romme and S. Escher) and E. Longden's insights into hallucinations as dissociative phenomena enhance this conceptualization, offering non-stigmatizing pathways for psychological intervention. The paper underscores the importance of the sociocultural context and the significant role of social emotions in the genesis of hallucinations. Conclusion. This refined understanding shapes contemporary goals in psychological interventions, such as «Talking with Voices», AVATAR therapy, and Relating Therapy. These interventions aim to reorganize patterns of alienated dialogue with self-positions, develop assertive response skills, and achieve integration with the voices.

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