Oliver Sacks - Hallucinations

It is clear that attitudes to hearing voices are critically important. One can be tortured by voices, as Daniel Smith’s father was, or accepting and easygoing, like his grandfather. Behind these personal attitudes are the attitudes of society, attitudes which have differed profoundly in different times and places.

Hearing voices occurs in every culture and has often been accorded great importance — the gods of Greek myth often spoke to mortals, and the gods of the great monotheistic traditions, too. Voices have been significant in this regard, perhaps more so than visions, for voices, language, can convey an explicit message or command as images alone cannot.

Until the eighteenth century, voices — like visions — were ascribed to supernatural agencies: gods or demons, angels or djinns. No doubt there was sometimes an overlap between such voices and those of psychosis or hysteria, but for the most part, voices were not regarded as pathological; if they stayed inconspicuous and private, they were simply accepted as part of human nature, part of the way it was with some people.

Around the middle of the eighteenth century, a new secular philosophy started to gain ground with the philosophers and scientists of the Enlightenment, and hallucinatory visions and voices came to be seen as having a physiological basis in the overactivity of certain centers in the brain.

But the romantic idea of “inspiration” still held, too — the artist, especially the writer, was seen or saw himself as the transcriber, the amanuensis, of a Voice, and sometimes had to wait years (as Rilke did) for the Voice to speak. 20 20 Judith Weissman, in her book Of Two Minds: Poets Who Hear Voices , presents strong evidence, drawn especially from what poets themselves have said, that many of them, from Homer to Yeats, have been inspired by true auditory vocal hallucinations, not just metaphorical voices.

Talking to oneself is basic to human beings, for we are a linguistic species; the great Russian psychologist Lev Vygotsky thought that “inner speech” was a prerequisite of all voluntary activity. I talk to myself, as many of us do, for much of the day — admonishing myself (“You fool! Where did you leave your glasses?”), encouraging myself (“You can do it!”), complaining (“Why is that car in my lane?”), and, more rarely, congratulating myself (“It’s done!”). Those voices are not externalized; I would never mistake them for the voice of God, or anyone else.

But when I was in danger once, trying to descend a mountain with a badly injured leg, I heard an inner voice that was wholly unlike my normal babble of inner speech. I had a great struggle crossing a stream with a buckled and dislocating knee. The effort left me stunned, motionless for a couple of minutes, and then a delicious languor came over me, and I thought to myself, Why not rest here? A nap maybe? This was immediately countered by a strong, clear, commanding voice, which said, “You can’t rest here — you can’t rest anywhere. You’ve got to go on. Find a pace you can keep up and go on steadily.” This good voice, this Life voice, braced and resolved me. I stopped trembling and did not falter again.

Joe Simpson, climbing in the Andes, also had a catastrophic accident, falling off an ice ledge and ending up in a deep crevasse with a broken leg. He struggled to survive, as he recounted in Touching the Void — and a voice was crucial in encouraging and directing him:

There was silence, and snow, and a clear sky empty of life, and me, sitting there, taking it all in, accepting what I must try to achieve. There were no dark forces acting against me. A voice in my head told me that this was true, cutting through the jumble in my mind with its coldly rational sound.

It was as if there were two minds within me arguing the toss. The voice was clean and sharp and commanding. It was always right, and I listened to it when it spoke and acted on its decisions. The other mind rambled out a disconnected series of images, and memories and hopes, which I attended to in a daydream state as I set about obeying the orders of the voice . I had to get to the glacier.… The voice told me exactly how to go about it, and I obeyed while my other mind jumped abstractly from one idea to another.… The voice , and the watch, urged me into motion whenever the heat from the glacier halted me in a drowsy exhausted daze. It was three o’clock — only three and a half hours of daylight left. I kept moving but soon realized that I was making ponderously slow headway. It didn’t seem to concern me that I was moving like a snail. So long as I obeyed the voice , then I would be all right.

Such voices may occur with anyone in situations of extreme threat or danger. Freud heard voices on two such occasions, as he mentioned in his book On Aphasia:

I remember having twice been in danger of my life, and each time the awareness of the danger occurred to me quite suddenly. On both occasions I felt “this was the end,” and while otherwise my inner language proceeded with only indistinct sound images and slight lip movements, in these situations of danger I heard the words as if somebody was shouting them into my ear, and at the same time I saw them as if they were printed on a piece of paper floating in the air.

The threat to life may also come from within, and although we cannot know how many attempts at suicide have been prevented by a voice, I suspect this is not uncommon. My friend Liz, following the collapse of a love affair, found herself heartbroken and despondent. About to swallow a handful of sleeping tablets and wash them down with a tumbler of whiskey, she was startled to hear a voice say, “No. You don’t want to do that,” and then “Remember that what you are feeling now you will not be feeling later.” The voice seemed to come from the outside; it was a man’s voice, though whose she did not know. She said, faintly, “Who said that?” There was no answer, but a “granular” figure (as she put it) materialized in the chair opposite her — a young man in eighteenth-century dress who glimmered for a few seconds and then disappeared. A feeling of immense relief and joy came over her. Although Liz knew that the voice must have come from the deepest part of herself, she speaks of it, playfully, as her “guardian angel.”

Various explanations have been offered for why people hear voices, and different ones may apply in different circumstances. It seems likely, for example, that the predominantly hostile or persecuting voices of psychosis have a very different basis from the hearing of one’s own name called in an empty house; and that this again is different in origin from the voices which come in emergencies or desperate situations.

Auditory hallucinations may be associated with abnormal activation of the primary auditory cortex; this is a subject which needs much more investigation not only in those with psychosis but in the population at large — the vast majority of studies so far have examined only auditory hallucinations in psychiatric patients.

Some researchers have proposed that auditory hallucinations result from a failure to recognize internally generated speech as one’s own (or perhaps it stems from a cross-activation with the auditory areas so that what most of us experience as our own thoughts becomes “voiced”).

Perhaps there is some sort of physiological barrier or inhibition that normally prevents most of us from “hearing” such inner voices as external. Perhaps that barrier is somehow breached or undeveloped in those who do hear constant voices. Perhaps, however, one should invert the question — and ask why most of us do not hear voices. Julian Jaynes, in his influential 1976 book, The Origin of Consciousness in the Breakdown of the Bicameral Mind , speculated that, not so long ago, all humans heard voices — generated internally, from the right hemisphere of the brain, but perceived (by the left hemisphere) as if external, and taken as direct communications from the gods. Sometime around 1000 B.C., Jaynes proposed, with the rise of modern consciousness, the voices became internalized and recognized as our own. 21 21 Jaynes thought that there might be a reversion to “bicamerality” in schizophrenia and some other conditions. Some psychiatrists (such as Nasrallah, 1985) favor this idea or, at the least, the idea that the hallucinatory voices in schizophrenia emanate from the right side of the brain but are not recognized as one’s own, and are thus perceived as alien.