Hallucinations in Psychotics
It is of course in the distress of schizophrenia that auditory hallucinations similar to bicameral voices are most common and best studied. This is now a difficult matter. At a suspicion of hallucinations, distressed psychotics are given some kind of chemotherapy such as Thorazine, which specifically eliminates hallucinations. This procedure is at least questionable, and may be done not for the patient, but for the hospital which wishes to 2 Henry Sidgewick et al., "Report on the census of hallucinations," Proceedings of the Society for Psychical Research, 1894, 34: 25-394.
3 An example of what not to do may be found in D. J. West, "A mass-observation questionnaire on hallucinations," Journal of the Society for Psychical Research, 1948, 34:187-196.
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eliminate this rival control over the patient. But it has never been shown that hallucinating patients are more intractable than others. Indeed, as judged by other patients, hallucinating schizophrenics are more friendly, less defensive, more likable, and have more positive expectancies toward others in the hospital than nonhallucinating patients.4 And it is possible that even when the effect is apparently negative, hallucinated voices may be helpful to the healing process.
At any rate, since the advent of chemotherapy the incidence of hallucinatory patients is much less than it once was. Recent studies have revealed a wide variation among different hospitals, ranging from 50 percent of psychotics in the Boston City Hospital, to 30 percent in a hospital in Oregon5 and even lower in hospitals with long-term patients under considerable sedation.
Thus, in what follows, I am leaning more heavily on some of the older literature in the psychoses, such as Bleuler's great classic, Dementia Praecox, in which the hallucinatory aspect of schizophrenia in particular is more clearly seen.6 This is important if we are to have an idea of the nature and range of the bicameral voices heard in the early civilizations.
The Character of the Voices
The voices in schizophrenia take any and every relationship to the individual. They converse, threaten, curse, criticize, consult, often in short sentences. They admonish, console, mock, command, or sometimes simply announce everything that's happen-4 P. M. Lewinsohn, "Characteristics of patients with hallucinations," Journal of Clinical Psychology, 1968, 24: 423.
5 P. E. Nathan, H. F. Simpson, and M. M. Audberg, "A systems analytic model of diagnosis II. The diagnostic validity of abnormal perceptual behavior," Journal of Clinical Psychology, 1969, 25: 115-136.
6 Eugen Bleuler, Dementia Praecox or The Group of Schizophrenias, Joseph Zinkin, trans. (New York: International Universities Press, 1950). Other sources for the sections to follow include my own observations and interviews with patients, works footnoted on subsequent pages, various chapters in L. J. West, and miscellaneous case reports.
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ing. They yell, whine, sneer, and vary from the slightest whisper to a thunderous shout. Often the voices take on some special peculiarity, such as speaking very slowly, scanning, rhyming, or in rhythms, or even in foreign languages. There may be one particular voice, more often a few voices, and occasionally many.
As in bicameral civilizations, they are recognized as gods, angels, devils, enemies, or a particular person or relative. Or occasionally they are ascribed to some kind of apparatus reminiscent of the statuary which we will see was important in this regard in bicameral kingdoms.
Sometimes the voices bring patients to despair, commanding them to do something and then viciously reproaching them after the command is carried out. Sometimes they are a dialogue, as of two people discussing the patient. Sometimes the roles of pro and con are taken over by the voices of different people. The voice of his daughter tells a patient: " H e is going to be burnt alive!" While his mother's voice says: " H e will not be burnt!"7
In other instances, there are several voices gabbling all at once, so that the patient cannot follow them.
Their Locality and Function
In some cases, particularly the most serious, the voices are not localized. But usually they are. They call from one side or another, from the rear, from above and below 3 only rarely do they come from directly in front of the patient. They may seem to come from walls, from the cellar and the roof, from heaven and from hell, near or far, from parts of the body or parts of the clothing. And sometimes, as one patient put it, "they assume the nature of all those objects through which they speak — whether they speak out of walls, or from ventilators, or in the woods and fields."8 In some patients there is a tendency to associate the good consoling voices with the upper right, while bad voices 7 Bleuler, p. 97f.
8 T. Hennell, The Witnesses (London: Davis, 1938), p. 182.
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come from below and to the left. In rare instances, the voices seem to the patient to come from his own mouth, sometimes feeling like foreign bodies bulging up in his mouth. Sometimes the voices are hypostasized in bizarre ways. One patient claimed that a voice was perched above each of his ears, one of which was a little larger than the other, which is reminiscent of the ka' s and the way they were depicted in the statues of the pharaohs of ancient Egypt, as we shall see in a subsequent chapter.
Very often the voices criticize a patient's thoughts and actions.
Sometimes they forbid him to do what he was just thinking of doing. And sometimes this occurs even before the patient is aware of his intention. One intelligent paranoid who came from the Swiss canton of Thurgau harbored hostile feelings toward his personal attendant. As the latter stepped into his room, the voice said in its most reproachful tone before the patient had done anything, "There you have it! A Thurgauer beats up a perfectly decent private attendant!"9
Of immense importance here is the fact that the nervous system of a patient makes simple perceptual judgments of which the patient's 'self' is not aware. And these, as above, may then be transposed into voices that seem prophetic. A janitor coming down a hall may make a slight noise of which the patient is not conscious. But the patient hears his hallucinated voice cry out,
"Now someone is coming down the hall with a bucket of water."
Then the door opens, and the prophecy is fulfilled. Credence in the prophetic character of the voices, just as perhaps in bicameral times, is thus built up and sustained. The patient then follows his voices alone and is defenseless against them. Or else, if the voices are not clear, he waits, catatonic and mute, to be shaped by them or, alternatively, by the voices and hands of his attendants.
Usually the severity of schizophrenia oscillates during hospitalization and often the voices come and go with the undulations of the illness. Sometimes they occur only when the patients are 9 Bleuler, p. 98.
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doing certain things, or only in certain environments. And in many patients, before the present-day chemotherapy, there was no single waking moment free from them. When the illness is most severe, the voices are loudest and come from outside; when least severe, voices often tend to be internal whispers; and when internally localized, their auditory qualities are sometimes vague.
A patient might say, "They are not at all real voices but merely reproductions of the voices of dead relatives." Particularly intelligent patients in mild forms of the illness are often not sure whether they are actually hearing the voices or whether they are only compelled to think them, like "audible thoughts," or "sound-less voices," or "hallucinations of meanings."