In many patients this appears as the symptom called Command Automatism. The patient obeys any and every suggestion and command coming from the outside. He is incapable of not obeying authoritative short orders, even when otherwise negativ-istic. Such orders must deal with simple activities and cannot apply to a long complicated task. The well-known waxy flexibil-ity of catatonics may fall under this heading; the patient is really obeying the physician by remaining in any position in which he is placed. While not all such phenomena are, of course, characteristic of what we have called the bicameral mind, the underlying principle is. An interesting hypothesis would be that patients with such Command Automatism are those in whom auditory hallucinations are absent, and the external voice of the physician is taking its place.
Consistent with such an hypothesis is the symptom known as echolalia. When no hallucinations are present, the patient repeats back the speech, cries, or expressions of others. But when hallucinations are present, this becomes hallucinatory echolalia, where the patient must repeat out loud all that his voices say to him, rather than those of his environmental surroundings. Hallucinatory echolalia is, I suggest, essentially the same mental organization that we have seen in the prophets of the Old Testament, as well as the aoidoi of the Homeric poems.
S C H I Z O P H R E N I A
425
Body Image Boundary Disturbance
It is possible that the erosion of the analog ‘I’ and its mind-space also results in what is called Boundary Loss in Rorschach studies of schizophrenia. This is a score for the proportion of images seen in the ink blots that have poorly defined, fuzzy, or inexistent boundaries or edges. Most interesting from our point of view here is that this measure is strongly correlated with the presence of vivid hallucinatory experiences. A patient high in Boundary Loss often describes it as a feeling of disintegration.
W h e n I am melting I have no hands, I go into a doorway in order not to be trampled on. Everything is flying away from me. In the doorway I can gather together the pieces of my body. It is as if something is thrown in me, bursts me asunder.
W h y do I divide myself in different pieces? I feel that I am without poise, that my personality is melting and that my ego disappears and that I do not exist anymore. Everything pulls me apart . . . T h e skin is the only possible means of keeping the different pieces together. There is no connection between the different parts of my body . . ,32
In one study on Boundary Loss, the Rorschach was given to 80
schizophrenic patients. Boundary definiteness scores were significantly lower than in the group of normals and neurotics matched for age and socio-economic status. Such patients would commonly see in the ink blots mutilated bodies, animal or human.33 This mirrors the breaking up of the analog self, or the metaphor picture that we have of ourselves in consciousness. In another study of 604 patients in Worcester State Hospital, it was specifically found that Boundary Loss, including, we may presume, the loss of the analog ‘I’, is a factor in the development of hallucinations. Patients who had more hallucinations were those 32 P. Schilder, The Image and Appearance of the Human Body (London: Kegan Paul, Trench, Trubner, and Co., 1935), p. 159.
33 S. Fisher and S. E. Cleveland, “The Role of Body Image in Psychosomatic Symptom Choice,” Psychological Monographs, 1955, 69, No. 17, whole no. 402.
426 Vestiges of the Bicameral Mind in the Modern World who were less successful in establishing “boundaries between the self and the world.”34
Along the same line of thought, chronic schizophrenic patients are sometimes unable to identify themselves in a photograph, or may misidentify themselves, whether they are photographed individually or in a group.
The Advantages of Schizophrenia
A curious heading, certainly, for how can we say there are advantages of so terrifying an illness? But I mean such advantages in the light of all human history. Very clearly, there is a genetic inherited basis to the biochemistry underlying this radically different reaction to stress. And a question that must be asked of such a genetic disposition to something occurring so early in our reproductive years is, what biological advantage did it once have?
Why, in the slang of the evolutionist, was it selected for? And at what period long, long ago, since such genetic disposition is present all over the world?
The answer, of course, is one of the themes I have stated so often before in this essay. The selective advantage of such genes was the bicameral mind evolved by natural and human selection over the millennia of our early civilizations. The genes involved, whether causing what to conscious men is an enzyme deficiency or other, are the genes that were in the background of the prophets and the ‘sons of the nabiim’ and bicameral man before them.
Another advantage of schizophrenia, perhaps evolutionary, is tirelessness. While a few schizophrenics complain of generalized fatigue, particularly in the early stages of the illness, most patients do not. In fact, they show less fatigue than normal persons and are capable of tremendous feats of endurance. They are not fatigued by examinations lasting many hours. They may move about day and night, or work endlessly without any sign of being tired. Catatonics may hold an awkward position for days that the 34 L. Phillips and M. S. Rabinovitch, Journal of Abnormal and Social Psychology, 1958, 57: 181.
S C H I Z O P H R E N I A
427
reader could not hold for more than a few minutes. This suggests that much fatigue is a product of the subjective conscious mind, and that bicameral man, building the pyramids of Egypt, the ziggurats of Sumer, or the gigantic temples at Teotihuacan with only hand labor, could do so far more easily than could conscious self-reflective men.
A further thing that schizophrenics do ‘better’ than the rest of us — although it certainly is no advantage in our abstractly complicated world — is simple sensory perception. They are more alert to visual stimuli, as might be expected if we think of them as not having to strain such stimuli through a buffer of consciousness. This is seen in their ability to block E E G alpha waves more quickly than normal persons following an abrupt stimulus, and to recognize projected visual scenes coming into focus considerably better than the normal.35 Indeed, schizophrenics are almost drowning in sensory data. Unable to narratize or conciliate, they see every tree and never the forest. They seem to have a more immediate and absolute involvement with their physical environment, a greater in-the-world-ness. Such an interpretation, at least, could be put on the fact that schizophrenics fitted with prism glasses that deform visual perception learn to adjust more easily than the rest of us, since they do not overcompensate as much.36
The Neurology of Schizophrenia
If schizophrenia is in part a relapse to the bicameral mind, and if our earlier analyses have any merit, then we should find some kind of neurological changes that are consistent with the neurological model suggested in I.5. There I proposed that the halluci-35 See R. L. Cromwell and J. M. Held, “Alpha blocking latency and reaction time in schizophrenics and normals,” Perceptual and Motor Skills, 1969, 29: 195-201; E. Ebner and B. Ritzier, “Perceptual recognition in chronic and acute schizophrenics,”
Journal of Consulting and Clinical Psychology, 1969, 33: 200-206.
36 See E. Ebner, V. Broekma, and B. Ritzier, “Adaptation to awkward visual proprioceptive input in normals and schizophrenics,” Archives of General Psychiatry, 1971, 24: 367-371-