Table Of ContentReal Hallucinations
Philosophical Psychopathology
Jennifer Radden and Jeff Poland, editors
Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World, Mat-
thew Ratcliffe (2017)
Extraordinary Science: Responding to the Current Crisis in Psychiatric Research, Jeffrey
Poland and Şerife Tekin, editors (2017)
Disturbed Consciousness: New Essays on Psychopathology and Theories of Consciousness,
Rocco J. Gennaro, editor (2015)
Being Amoral: Psychopathy and Moral Incapacity, Thomas Schramme, editor (2014)
A Metaphysics of Psychopathology, Peter Zachar (2014)
Classifying Psychopathology: Mental Kinds and Natural Kinds, Harold Kincaid and Jac-
queline Sullivan, editors (2014)
The Ethical Treatment of Depression: Autonomy through Psychotherapy, Paul Biegler (2011)
Addiction and Responsibility, Jeffrey Poland and George Graham, editors (2011)
Real Hallucinations
Psychiatric Illness, Intentionality, and the Interpersonal World
Matthew Ratcliffe
The MIT Press
Cambridge, Massachusetts
London, England
© 2017 Massachusetts Institute of Technology
All rights reserved. No part of this book may be reproduced in any form by any
electronic or mechanical means (including photocopying, recording, or information
storage and retrieval) without permission in writing from the publisher.
This book was set in ITC Stone Serif by Jen Jackowitz. Printed and bound in the
United States of America.
Library of Congress Cataloging-in-Publication Data
Names: Ratcliffe, Matthew, 1973-, author.
Title: Real hallucinations : psychiatric illness, intentionality, and the
interpersonal world / Matthew Ratcliffe.
Other titles: Philosophical psychopathology.
Description: Cambridge, MA : The MIT Press, [2017] | Series: Philosophical
psychopathology | Includes bibliographical references and index.
Identifiers: LCCN 2017003353 | ISBN 9780262036719 (hardcover : alk. paper)
Subjects: | MESH: Hallucinations--psychology | Delusions--psychology |
Perception | Interpersonal Relations | Philosophy
Classification: LCC RC512 | NLM WM 204 | DDC 616.89--dc23 LC record available
at https://lccn.loc.gov/2017003353
10 9 8 7 6 5 4 3 2 1
Contents
Acknowledgments vii
1 Introduction 1
2 Schizophrenia and Selfhood 13
2.1 Minimal Self 14
2.2 Modalities of Intentionality 18
2.3 Other People 29
2.4 The Appearance of Hallucination 36
3 Thought Insertion Clarified 43
3.1 The Sense of Perceiving 44
3.2 Two Interpretations of Thought Insertion 49
3.3 Verbal Hallucinations and Inserted Thoughts 51
3.4 An Unfamiliar Kind of Intentionality 62
3.5 Agency and Ownership 66
4 Voices of Anxiety 71
4.1 Anxiety 72
4.2 Anticipation 75
4.3 Alienated Content 83
4.4 Hypervigilance 96
4.5 Voices in Context 102
5 Trauma and Trust 107
5.1 Delusional Atmosphere 108
5.2 Trauma 113
5.3 Projects and Narratives 116
5.4 Trust 118
5.5 Habitual Certainty 122
vi
6 Intentionality and Interpersonal Experience 139
6.1 The Interpersonal Regulation of Experience 140
6.2 Ways of Believing 151
6.3 Becoming Unhinged 154
6.4 The Anticipation of Memory 160
6.5 Intentionality and Time 164
6.6 Schizophrenia and Trauma 170
6.7 Renee Revisited 181
6.8 Phenomenology Meets Predictive Coding 185
7 Varieties of Hallucination 191
7.1 Orthodox Hallucinations 192
7.2 Horizonal Hallucinations 194
7.3 Benevolent Voices 200
7.4 Relating to the Dead 204
8 Metaphilosophical Conclusion 223
Notes 237
References 257
Index 279
Acknowledgments
The argument of this book follows a winding path through various topics
and disciplines. Lots of people helped me to navigate it and to arrive at
what I hope is a cohesive, persuasive philosophical position. For helpful
conversation and correspondence, I am grateful to Anna Bortolan, Mat-
thew Broome, Havi Carel, Jonathan Cole, Charles Fernyhough, Thomas
Fuchs, Shaun Gallagher, Philip Gerrans, Emily Hughes, Daniel Hutto, Lau-
rence Kirmayer, Joel Krueger, Martin Kusch, Sophie Loidolt, Graham Parkes,
Mark Ruddell, Louis Sass, Tasia Scrutton, Jan Slaby, Benedict Smith, Achim
Stephan, Mark Wynn, Dan Zahavi, and many others. Thanks, in particular,
to Owen Earnshaw, Jennifer Radden, and Sam Wilkinson. It was through
supervising Owen’s highly original PhD thesis at Durham University that I
A c k n o w l e d g m e n t s
began to appreciate the relevance of trust and its fragility to an understand-
ing of psychiatric illness (Earnshaw 2011; available at http://etheses.dur
.ac.uk/3225/). Sam and I have had many long conversations about the top-
ics of this book, which led to two coauthored papers. And it was a privilege
to be able to share ideas with Jennifer while she was a Visiting Professor
A c k n o w l e d g m e n t s
at the University of Vienna in 2016. It is also thanks to her earlier advice
and encouragement that I sought to publish this book as part of the MIT
Press Philosophical Psychopathology series. I am grateful to members of
my “phenomenological psychopathology and philosophy of psychiatry”
research group at the University of Vienna for all their feedback and sup-
port, especially Maike Cram, Marie Dahle, Christoph Durt, Line Ingerslev,
Oliver Lukitsch, and Philipp Schmidt. Thanks, as well, to all those students
who participated so actively in my Phenomenology and Psychiatry courses
at Vienna and offered numerous insightful comments.
Material from the book was presented at events hosted by the Free Uni-
versity of Berlin, King’s College London, and the Universities of Aalborg,
viii Acknowledgments
Amsterdam, Durham, Edinburgh, Essex, Graz, Guelph, Groningen, Leeds,
Memphis, McGill, Ryerson, Vienna, Warwick, and Wesleyan. I thank all
these audiences for comments, suggestions, and criticisms. At MIT Press,
Philip Laughlin has been an absolute pleasure to work with. I am also grate-
ful to four referees who read my book proposal and two referees who read
the entire manuscript, all of whom provided very helpful and encouraging
comments.
This book incorporates, in substantially revised form, material from
some previously published articles and chapters:
“The Integrity of Intentionality: Sketch for a Phenomenological Study.” In
Phenomenology for the Twenty-First Century, ed. J. A. Simmons and J. E.
Hackett, 207–230. Basingstoke: Palgrave Macmillan, 2016.
“Selfhood, Schizophrenia, and the Interpersonal Regulation of Experience.”
In Embodiment, Enaction, and Culture: Investigating the Constitution of the
Shared World, ed. C. Durt, T. Fuchs, and C. Tewes, 149–171. Cambridge,
MA: MIT Press, 2017.
“How Anxiety Induces Verbal Hallucinations” (coauthored with Sam
Wilkinson). Consciousness and Cognition 39 (2016): 48–58.*
“Thought Insertion Clarified” (Coauthored with Sam Wilkinson). Journal of
Consciousness Studies 22, nos. 11–12 (2015): 246–269.*
“Relating to the Dead: Social Cognition and the Phenomenology of Grief.”
In The Phenomenology of Sociality: Discovering the “We,” ed. D. Moran
and T. Szanto, 202–215. London: Routledge, 2016.*
“What Is a Sense of Foreshortened Future? A Phenomenological Study of
Trauma, Trust, and Time” (coauthored with Mark Ruddell and Benedict
Smith). Frontiers in Psychology 5, (art. 1026 (2014): 1–11.*
In those cases where permission to reuse material was required, I am grateful
to the publishers for granting it. Where material is adapted from coauthored
publications, it is taken exclusively from my contributions to those pieces,
and with the consent of my coauthors. Four of the above papers (marked
with an asterisk) were written as part of the Wellcome Trust–funded project,
“Hearing the Voice” (grant no. WT098455), and I am grateful to the trust
for its support. At several points in my discussion, I draw on a questionnaire
study, which I conducted in collaboration with some project-colleagues:
Angela Woods, Ben Alderson-Day, Felicity Callard, Charles Fernyhough,
and Nev Jones. This study was closely modeled on earlier work that I had
Acknowledgments ix
done with another group, for the AHRC- and DFG-funded project “Emo-
tional Experience in Depression” (see Ratcliffe 2015, chap. 1, for details).
I thank Benedict Smith, who played a major role in designing the original
study, for allowing us to adapt and use material.
I am very grateful to those who completed the voices questionnaire,
many of whom described their experiences in considerable detail. I would
also like to thank all those people who have approached me informally, in
writing or in person, in order to describe and discuss their experiences of
psychiatric illness. Without exception, their testimonies have been infor-
mative and, indeed, inspiring.
