Gedankenlautwerden

   Also known as Gedankenhören. Both German expressions translate into English as thought-echo, thought echoing, thoughts-out-loud, thought audition, or audible thinking, and into French as écho de la pensée. All of these terms refer to a * verbal auditory hallucination (VAH) echoing the contents of the * hallucinator's conscious thoughts. The term Gedankenlautwerden was coined by the German psychiatrist August Cramer (1860-1912). In 1889, Cramer designated this symptom as "the patients' sensation that all their thoughts are spoken within their chest, or that these are repeated and cried out loudly, or that these resonate within some accidental rustling sound in the external world." Although Cramer introduced the notion of Gedankenlautwerden, and also provided the first systematic study of the phenomenon, he acknowledged that it had been referred to by many authors before him. The Russian psychiatrist Victor Kandinsky (1849-1889), for example, had discussed it at length in his 1885 work on *sensory deceptions, and in 1889, the year of Cramer's publication on the subject, the German psychiatrist Emil Kraepelin (1856-1926) devoted attention to it in the third edition of his textbook under the heading Doppeldenken. With hindsight, it would seem that the Gedankenlautwerden phenomenon was conceptualized by many authors, including Cramer himself, in a much broader sense than is customary today. For example, the sensation of thoughts spoken aloud in one's chest, included in Cramer's description, shows a significant overlap with the notion of *extracampine hallucination introduced in 1903. The sensation of one's thoughts resonating "within some accidental rustling sound in the external world", also referred to by Cramer, has since 1908 been designated as * indirect Gedankenlautwerden. The concept's lack of uniformity was noted as far back as 1900 by the German neurologist Carl Wernicke (1848-1904), who felt that "the 'Gedankenlautwerden' symptom should be understood as narrowly as possible, and in the sense that the thoughts, which are recognized by the patient as being his or her own, sound aloud at certain occasions, such as when the patient is reading or writing. Unfortunately Cramer himself, as well as all of his followers, conceived the symptom so broadly that it completely lost its original value as an elementary symptom." Today the variant of Gedankenlautwerden in which reading is accompanied by an audible echo of the words read is known as *echo of reading. Thus it would seem that even Wer-nicke's definition of Gedankenlautwerden can be criticized as being too broad. As to the phenomenon's mediation, Cramer attributes Gedankenlautwerden to a duplex action of the cerebral hemispheres. The German psychiatrist Hubert Grashey (1839-1914), by contrast, attributes it to an aberrant excitation of the cerebral sensory cortex, concomitant with regular thinking (i.e. as a *reperception phenomenon). The Swiss physiologist Johann Ignaz Hoppe (1811-1891) suggests that it may stem either from secondary peripheral excitation (i.e. of the auditory nerve) or from *subvocalization. Avariant or special case of Gedankenlautwerden is the hallucination in * braille. Phenomenologically, Gedankenlautwerden shows a certain similarity to * palinacusis, a phenomenon characterized by the echoing or perseverance of auditory stimuli derivative of the external environment. Although the two phenomena are generally considered different symptoms, both have been described in the context oftemporal lobe epilepsy.

   References

   Cramer, A. (1889). Die Hallucinationen im Muskelsinn bei Geisteskranken und ihre klinische Bedeutung. Eine Beitrag zur Kenntniss der Paranoia. Freiburg: Akademische Verlagsbuchhandlung von J.C.B. Mohr.

   Critchley, M. (1939). Visual and auditory hallucinations. British Medical Journal, 2, 634-639.

   Goldstein, K. (1908). Zur Theorie der Hallucina-tionen. Studien über normale und pathologische Wahrnehmung. Archiv für Psychiatrie und Nervenkrankheiten, 44, 1036-1106.

   Grashey, H. (1893). Ueber Hallucinationen. Münchener medizinische Wochenschrift, 40, 153-155 und 174-176.

   Wernicke, C. (1900). Grundriss der Psychiatrie. Leipzig: Verlag von Georg Thieme.