8 Nor of just such patients. There is a growing movement in psychiatry to distinguish diagnostic categories by the drugs specific to them, the schizophrenias by the phenothiazines and manic-depression by lithium. If this is correct, many patients formerly diagnosed as having paranoid schizophrenia are really manic-depressive since they respond only to lithium. In the manic phase, almost half of such patients have hallucinations.
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a band of men under his window who want to catch him, burn him, behead him. They lie in wait for him, threaten to enter through the walls, climb up and hide under his bed or above him in the ventilators. And then there are other voices who want to help him. Sometimes God is a protector, at other times one of the persecutors. At the persecuting voices, the patients may flee, defend themselves, or attack. With helpful consoling hallucinations, the patient may listen intently, enjoy them like a festivity, even weeping at hearing the voices of heaven. Some patients may go through all sorts of hallucinated experiences while lying under the blankets in their beds, while others climb around, talk loudly or softly to their voices, making all kinds of incomprehensible gestures and motions. Even during conversation or reading, patients may be constantly answering their hallucinations softly or whispering asides to their voices every few seconds.
Now one of the most interesting and important aspects of all this in respect to the parallel with the bicameral mind is the following: auditory hallucinations in general are not even slightly under the control of the individual himself, but they are extremely susceptible to even the most innocuous suggestion from the total social circumstances of which the individual is a part. In other words, such schizophrenic symptoms are influenced by a collective cognitive imperative just as in the case of hypnosis.
A recent study demonstrates this very clearly.9 Forty-five hallucinating male patients were divided into three groups. One group wore on their belts a small box with a lever which when pressed administered a shock. They were instructed to thus shock themselves whenever they began to hear voices. A second group wore similar boxes, were given similar instructions, but
®9 Arthur H. Weingaertner, “Self-administered aversive stimulation with hallucinating hospitalized schizophrenics,” Journal of Consulting and Clinical Psychology, 1971, 36: 422-429-
410 Vestiges of the Bicameral Mind in the Modern World pressing the lever did not give the patient a shock. A third group were given similar interviews and evaluation, but had no boxes.
The boxes, incidentally, contained counters which recorded the number of lever presses, the frequency ranging from 19 to 2362
times over the fortnight of the experiment. But the important thing is that all three groups were casually led to expect that the frequency of hallucinations might diminish.
It was of course predicted on the basis of learning theory that the shocked group alone would improve. But alas for learning theory, all three groups heard significantly fewer voices. In some cases the voices vanished completely. And no group was superior to another in this respect, showing clearly the huge role of expectation and belief in this aspect of mental organization.
A further observation is a related one, that hallucinations are dependent on the teachings and expectations of childhood — as we have postulated was true in bicameral times. In contemporary cultures where an orthodox excessive personal relationship to God is a part of the child’s education, individuals that become schizophrenic tend to hear strict religious hallucinations more than others.
On the British island of Tortola in the West Indies, for example, children are taught that God literally controls each detail of their life. The name of the Deity is invoked in threats and punishment. Churchgoing is the major social activity. When the natives of this island require any psychiatric care whatever, they invariably describe experiences of hearing commands from God and Jesus, feelings of burning in hell or hallucinations of loud praying and hymn-singing, or sometimes a combination of prayer and profanity.10
When the auditory hallucinations of schizophrenia have no particular religious basis they are still playing essentially the 10 Edwin A. Weinstein, “Aspects of Hallucinations,” Hallucinations, L. J. West, ed. (New York: Grune and Stratton, 1962), pp. 233-238.
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same role as I have suggested was true for the bicameral mind, that of initiating and guiding the patient’s behavior. Occasionally the voices are recognized as authorities even within the hospital.
One woman heard voices that were mainly beneficial which she believed were created by the Public Health Service to provide psychotherapy. Would that psychotherapy could always be so easily accomplished! They constantly gave her advice, including, incidentally, not to tell the psychiatrist that she heard voices.
They advised her on difficult pronunciations, or gave her hints on sewing and cooking. As she described it,
W h e n I am making a cake, she gets too impatient with me.
I try to figure it out all by myself. I am trying to make a clothspin apron and she is right there with me trying to tell me what to do.11
Some psychiatric investigators, particularly of a psychoanalytic persuasion, wish to infer by the associations the patient uses that the voices can “in all instances . . . be traced to persons who were formerly significant in the patients’ lives, especially their parents.”12 It is supposed that because such figures if recognized would produce anxiety, they are therefore unconsciously distorted and disguised by the patients. But why should that be so? It is more parsimonious to think that it is the patient’s experiences with his parents (or other loved authorities) that become the core around which the hallucinated voice is structured, even as I have suggested was the case with the gods in the bicameral era.
I do not mean that parents do not figure in hallucinations.
They often do, particularly in younger patients. But otherwise, the voice-figures of schizophrenia are not parents in disguise; they are authority figures created by the nervous system out of the patient’s admonitory experience and his cultural expecta-II A. H. Modell, “Hallucinations in schizophrenic patients and their relation to psychic structure,” in West, pp. 166-1735 the quotation is from p. 169.
12 Modell, in West, p. 168.
412 Vestiges of the Bicameral Mind in the Modern World tions, his parents of course being an important part of that admonitory experience.
One of the most interesting problems in hallucinations is their relation to conscious thought. If schizophrenia is partly a return to the bicameral mind, and if this is antithetical to ordinary consciousness (which it need not be in all cases), one might expect hallucinations to be the replacement of ‘thoughts.’
In some patients at least, this is how hallucinations first appear. Sometimes, the voices seem to begin as thoughts which then transform themselves into vague whispers, which then gradually become louder and more authoritative. In other cases, patients feel the beginning of voices “as if their thoughts were dividing.” In mild cases, the voices may even be under the control of conscious attention as are ‘thoughts.’ As one nondeluded patient described it:
Here I have been in this ward for two years and a half and almost every day and every hour of the day I hear voices about me, sometimes sounding from the wind, sometimes from foot-steps, sometimes rattling dishes, from the rustling trees, or from the wheels of passing trains and vehicles. I hear the voices only if I attend to them, but hear them I do. T h e voices are words that tell me one story or another, just as if they were not thoughts in my head, but were recounting past deeds — yet only when I think of them. T h e whole day through they keep on telling truly my daily history of head and heart.13