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Schizophrenia Bulletin 2003 29(3):445-457;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Auditory Hallucinations, Source Monitoring, and the Belief That "Voices" Are Real

Michael Garrett, M.D. and Raul Silva, M.D.
Vice Chairman of Psychiatry and Clinical Associate Professor of Psychiatry, State University of New York Downstate Medical Center Brooklyn, NY
Deputy Director, Division of Child and Adolescent Psychiatry, New York University Medical Center/Bellevue Hospital Center, and Clinical Associate Professor of Psychiatry, New York University Medical Center New York, NY

Send reprint requests to Dr. M. Garrett, Department of Psychiatry, Box 1203, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203-2098; e-mail: michael.garrett{at}downstate.edu

The term source monitoring refers to a variety of cognitive processes individuals use to determine whether an experience originated within the self or came from an external source. A belief that auditory hallucinations are real entities independent of the self may be considered an error in source monitoring. The Source Monitoring Framework (SMF) is the most developed and empirically validated model of how ordinary individuals judge whether an event was self-generated or occurred in the outside world. This study of 41 acute inpatients is a first attempt to apply the SMF to autobiographical reports of auditory hallucinations in a clinical setting. Consistent with the SMF, results suggest that similarities between "voices" and real speakers may offer a partial explanation of why patients believe the voices are real. While the SMF provides a useful conceptual background for examining the phenomenology of these voices, the types of source monitoring errors typically encountered in normal individuals do not fully account for this belief as it occurs in psychotic individuals.

Keywords: Auditory hallucinations / reality monitoring / source monitoring / reality testing / delusion / insight / psychosis


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