Evaluation of inner-outer space distinction and verbal hallucinations in schizophrenia

Introduction. Verbal hallucinations could result from attributing one's own inner speech to another. Inner speech is usually experienced in inner space, whereas hallucinations are often experienced in outer space. To clarify this paradox, we investigated schizophrenia patients' ability to distinguish between speech experienced in inner space, and speech experienced in outer space. Methods. 32 schizophrenia patients and 26 matched healthy controls underwent a two-stage experiment. First, they read sentences aloud or silently. Afterwards, they were required to distinguish between the sentences read aloud (experienced in outer space), the sentences read silently (experienced in inner space), and new sentences not previously read (no space coding). The sentences were in the first, second, or third person in equal proportions. Linear mixed models were used to investigate the effects of group, sentence location, pronoun, and hallucinations status. Results. Schizophrenia patients were similar to controls in recognition capacity of sentences without space coding. They exhibited both inner-outer and outer-inner space confusion (they confused silently read sentences for sentences read aloud, and vice versa). Patients who experienced hallucinations inside their head were more likely to have outer-inner space bias. Conclusions. For speech generated by one's own brain, schizophrenia patients have bidirectional failure of inner-outer space distinction (inner-outer and outer-inner space biases); this might explain why hallucinations (abnormal inner speech) could be experienced in outer space. Furthermore, the direction of inner-outer space indistinction could determine the spatial location of the experienced hallucinations (inside or outside the head).