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      Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations

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          Abstract

          That trauma can play a significant role in the onset and maintenance of voice-hearing is one of the most striking and important developments in the recent study of psychosis. Yet the finding that trauma increases the risk for hallucination and for psychosis is quite different from the claim that trauma is necessary for either to occur. Trauma is often but not always associated with voice-hearing in populations with psychosis; voice-hearing is sometimes associated with willful training and cultivation in nonclinical populations. This article uses ethnographic data among other data to explore the possibility of multiple pathways to voice-hearing for clinical and nonclinical individuals whose voices are not due to known etiological factors such as drugs, sensory deprivation, epilepsy, and so forth. We suggest that trauma sometimes plays a major role in hallucinations, sometimes a minor role, and sometimes no role at all. Our work also finds seemingly distinct phenomenological patterns for voice-hearing, which may reflect the different salience of trauma for those who hear voices.

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          Most cited references66

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          Dynamic predictions: oscillations and synchrony in top-down processing.

          Classical theories of sensory processing view the brain as a passive, stimulus-driven device. By contrast, more recent approaches emphasize the constructive nature of perception, viewing it as an active and highly selective process. Indeed, there is ample evidence that the processing of stimuli is controlled by top-down influences that strongly shape the intrinsic dynamics of thalamocortical networks and constantly create predictions about forthcoming sensory events. We discuss recent experiments indicating that such predictions might be embodied in the temporal structure of both stimulus-evoked and ongoing activity, and that synchronous oscillations are particularly important in this process. Coherence among subthreshold membrane potential fluctuations could be exploited to express selective functional relationships during states of expectancy or attention, and these dynamic patterns could allow the grouping and selection of distributed neuronal responses for further processing.
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            The environment and schizophrenia.

            Psychotic syndromes can be understood as disorders of adaptation to social context. Although heritability is often emphasized, onset is associated with environmental factors such as early life adversity, growing up in an urban environment, minority group position and cannabis use, suggesting that exposure may have an impact on the developing 'social' brain during sensitive periods. Therefore heritability, as an index of genetic influence, may be of limited explanatory power unless viewed in the context of interaction with social effects. Longitudinal research is needed to uncover gene-environment interplay that determines how expression of vulnerability in the general population may give rise to more severe psychopathology.
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              Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications.

              To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications. Relevant studies and previous review papers were identified via computer literature searches. Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect. Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.
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                Author and article information

                Journal
                Schizophr Bull
                Schizophr Bull
                schbul
                Schizophrenia Bulletin
                Oxford University Press (US )
                0586-7614
                1745-1701
                February 2019
                01 February 2019
                01 February 2019
                : 45
                : Suppl 1 , Hallucinations Research: Into the Future, and Beyond
                : S24-S31
                Affiliations
                [1 ]Department of Anthropology, Stanford University, Stanford, CA
                [2 ]Department of Psychology, Durham University, Durham, UK
                [3 ]Division of Psychiatry, University College London, London, UK
                [4 ]Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
                [5 ]Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT
                [6 ]Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
                [7 ]Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL
                [8 ]Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
                [9 ]Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
                [10 ]School of Psychology, University of Central Lancashire, Preston, UK
                [11 ]Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
                [12 ]King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
                [13 ]Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Foundation Trust (SLaM), London, England, UK
                [14 ]School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
                [15 ]Clinical Research Centre, Graylands Health Campus, North Metropolitan Health Service, Mental Health, Nedlands, Western Australia, Australia
                Author notes
                To whom correspondence should be addressed; Department of Anthropology, Stanford University, Building 50, Stanford, CA 94305, USA; tel.: 650-723-3421, fax: 650-725-0605, e-mail: luhrmann@ 123456stanford.edu
                Article
                sby110
                10.1093/schbul/sby110
                6357973
                30715545
                00c25dce-ea5a-4619-8417-31290d6f0aa3
                © The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 8
                Funding
                Funded by: John Templeton Foundation 10.13039/100000925
                Categories
                Supplement Articles

                Neurology
                hallucination,trauma,psychosis,healthy voice-hearers,spiritual practices
                Neurology
                hallucination, trauma, psychosis, healthy voice-hearers, spiritual practices

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