[Psychopathological study on "hallucination of soliloquy" in a case of schizophrenia]

We present what appears to be the first reported case of schizophrenia with hallucinatory soliloquy. An appropriate name for this symptom might be "hallucination of soliloquy." A thirty-year-old man had been laboring under delusions of persecution and auditory hallucinations in the form of being blamed by others after changing his job at the age of twenty-eight. He consulted our hospital because of unintentional "soliloquy." He complained that he had been maltreated in his new work place and that this stress made him talk to himself. The contents of his "soliloquies" were nonsensical; for example, he would grumble about his colleagues or the plot of a teleplay that he had seen the previous day. During his "soliloquies" he had the vivid sensation of both speaking and hearing his own voice, but the episodes actually lacked vocalization. As a result of therapy, the patient's disorder gradually shifted from "soliloquy" to "silent soliloquy," then to "breathing hard," before finally disappearing. We are aware of a similar symptom, "delusion of soliloquy" (Y. Kasahara et al.), in which the patient believes that he unintentionally spoke to himself and that everyone learned his secrets through his soliloquy. In comparison, our "hallucination of soliloquy" is unique in that it is an abnormal experience of both speaking and hearing. From the viewpoint of traditional symptomatology, "hallucination of soliloquy" is composed of auditory hallucinations, which are experiences of hearing, and psychomotor hallucinations, which are experiences of speaking. In other words, it is a simultaneous experience of both thought resonance and "hallucination verbale psychomotrice" (J. Séglas) or "Halluzination des Muskelsinns" (A. Cramer) of the speech apparatus. However the overall concept of "hallucination of soliloquy" deviates from both thought resonance and "hallucination verbale psychomotrice" or "Halluzination des Muskelsinns." For a different point of view, we refer to L.S. Vygotsky's studies on inner speech. A comparison of "hallucination of soliloquy" with inner speech suggests that "hallucination of soliloquy" is "inner speech which is converted into outer speech" or "egocentric speech without vocalization." S. Kato notes that two patterns are found in the schizophrenic discourse, mirroring discourse and deviant discourse, which are named after mirroring and deviant characters concerning the ordinary linguistic code. The former simulates the ordinary linguistic code. In mirroring discourse, the patient almost literally imitates and repeats customary discourse such as an authority's speech or television. The latter is characterized by deviation from human actuality or the existing linguistic code and is represented by delusions, neologisms, and incoherent speeches. It has been suggested that mirroring discourse has moments of return to actuality, while in deviant discourse the patient remains entirely in the delusional world. It is said that discourse is realized in the deviant mode in the case of ordinary auditory hallucinations. In the case of "hallucination of soliloquy," the discourse occurs in the patient's own mind and is spoken through his own mouth, in short, it is realized in mirroring mode. We conclude that "hallucination of soliloquy" has the characteristic of mirroring discourse, which is realized in mirroring mode. We suggest that "hallucination of soliloquy" is schizophrenic auditory hallucination that has self-healing moments.