In Real Hallucinations, Matthew Ratcliffe offers a philosophical examination of the structure of human experience, its vulnerability to disruption, and how it is shaped by relations with other people. He focuses on the seemingly simple question of how we manage to distinguish among our experiences of perceiving, remembering, imagining, and thinking. To answer this question, he first develops a detailed analysis of auditory verbal hallucinations (usually defined as hearing a voice in the absence of a speaker) and thought insertion (somehow experiencing one's own thoughts as someone else's). He shows how thought insertion and many of those experiences labeled as "hallucinations” consist of disturbances in a person's sense of being in one type of intentional state rather than another.

Ratcliffe goes on to argue that such experiences occur against a backdrop of less pronounced but wider-ranging alterations in the structure of intentionality. In so doing, he considers forms of experience associated with trauma, schizophrenia, and profound grief.

The overall position arrived at is that experience has an essentially temporal structure, involving patterns of anticipation and fulfillment that are specific to types of intentional states and serve to distinguish them phenomenologically. Disturbances of this structure can lead to various kinds of anomalous experience. Importantly, anticipation-fulfillment patterns are sustained, regulated, and disrupted by interpersonal experience and interaction. It follows that the integrity of human experience, including the most basic sense of self, is inseparable from how we relate to other people and to the social world as a whole.