‘…it is in the brain that everything takes place…It is in the brain that the poppy is red, that the apple is odorous, that the skylark sings.’
Oscar Wilde, De Profundis
Richie lived at the lip of ordinary existence and would often slip as if through an invisible door into a parallel, paranoid universe. It was a world in which he had served as a bodyguard to Princess Diana and where, in the course of his duties he had uncovered a terrible secret. Consequently he was now being pursued by agents of the royal family. I asked him what the secret was. He closed one eye and zoomed in with the other, or so it felt. Diana, he said, had given birth to conjoined twins. They were joined at the head and there was no possibility of separation. She had been advised, then urged, and then ordered, to terminate the pregnancy, but had refused, saying she would love and care for the children come what may. They deserved nothing less and she was a good, loving person. Everyone knew that. But when it came to it she couldn’t stomach the horrible reality and her husband had them despatched. ‘You think I’m fucked up,’ said Richie. The words came out as smoke.
There were voices, too, which he located inches above and to the right of his head. ‘About there,’ he said, circling the empty space with his cigarette. (And what parallel universe were we in to be smoking on a hospital ward?). For the most part it was a semi-coherent mumbling which didn’t trouble him too much, but sometimes they came through with loud and abusive clarity. He was a worthless piece of shit. He was going to die. They’d get him sooner or later.
You couldn’t challenge the Diana story. It was unarguably true for Richie, and interrogation only made him angry. But the voices were another matter. He agreed there was something wrong and he was ready with a neurological explanation. Part of his brain had become functionally detached from the rest (this was the work of the secret agents) and was now semi-autonomous, issuing statements and streams of thought that sometimes mingled with the main flow and sometimes just gurgled alongside. ‘I’m neurologically possessed,’ he said.
Richie was a bright, articulate young man with a degree in physics and a diagnosis of schizophrenia. With his voices and his bizarre, deluded beliefs he was not difficult to label, but how can we begin to comprehendhis state of mind?
The quest to uncover the causes of schizophrenia has failed in part because researchers have too often set themselves the hopeless task of accounting for the whole smorgasbord of schizophrenic symptoms. The problem is that the standardised diagnostic criteria for schizophrenia are rather convoluted. There are duration criteria, varying according to the system you are using, and exclusion clauses to take account of mood, drugs and brain disorder. So-called negative symptoms, like loss of will and emotional flattening, are set alongside positive symptoms, such as delusions and hallucinations. The latter are generally considered the most characteristic features of the condition and, down the centuries, have been taken as the mark of true madness. But one can be diagnosed schizophrenic on the basis of symptom patterns which include neither hallucinations nor delusions. Two individuals might display quite distinct constellations of signs and symptoms and yet both be labelled schizophrenic and, at the same time, one of them might have symptoms in common with a third person who has a quite different diagnosis. Unless you are bound by the dogma of the Diagnostic and Statistical Manual, you might reach the reasonable conclusion that the process of diagnosing schizophrenia is not merely convoluted but also to a certain degree arbitrary.
An alternative approach, favoured by cognitive neuroscientists, is to try to explain specific symptoms rather than complex syndromes on the grounds that different symptoms are likely to be generated by somewhat different neuropsychological mechanisms. Auditory hallucinations, for example, have been linked to sub-vocal speech. We all have an ‘inner voice’, a subterranean babbling brook of formed and half-formed words, verbal ghosts, echoes and intimations. We use it in a conscious, deliberate fashion to hold information in short-term memory as we perform mental arithmetic or take notes at a lecture. Less deliberately, half-consciously, the inner voice circles and corrals our thoughts, memories and perceptions moment by moment, serving as the connective tissue of experience and helping maintain the narrative of who we are. There’s a continuum of inner speech that goes from silence via barely audible sub-vocalisations, through to whispers and voiced speech. The amplified sub-vocalisations and whispers of schizophrenic patients have been shown to reflect the content of their hallucinations, raising speculation that ‘hearing voices’ is simply a misperception of inner speech. The major challenge in pursuing this line of research is to find ways of studying a phenomenon which, in most cases, cannot be recorded directly. The inner voice is usually silent. Brain-imaging studies have given some support to the inner speech hypothesis, revealing that auditory hallucinations trigger patterns of activity typically associated with the perception and production of speech. But a key question remains. What is it that causes the person to disown their inner speech and to perceive it as having an external, alien origin?
Ordinarily we claim ownership of thoughts and feelings even when they are beyond our control. You might be overwhelmed by emotion, tormented by loathsome, intrusive ideas and beset by irresistible urges, but however unwanted they may be they are still your thoughts, feelings and impulses. This takes us to the roots of consciousness because a sense of ownership is intrinsic to all experience. As Frege put it: ‘An experience is impossible without an experient. The inner world presupposes the person whose inner world it is.’ Furthermore, ownership of experience is exclusive. The fenced, private property of consciousness is what, ultimately, separates you from me. We can imagine one another’s experiences and we can simulate them through empathy and other ‘mind-reading’ mechanisms of the social brain, but we can’t inhabit them. As individual selves we are, at the level of conscious experience, hermetically partitioned. We are all, ultimately, solitary.
In the years since my encounter with Richie, I have often reflected on his unsettling pronouncement that he was neurologically possessed, with its striking juxtaposition of science and the supernatural. ‘Possession’ invokes medieval images of demons and dark forces. It doesn’t figure in the lexicon of modern psychiatry, and nor should it. Still, I thought the way he used the term captured something of the essence of psychosis, the sense of invasion and yielding of control, the dispossession of thoughts and actions: the merger of selfand not self. For most of us the solitariness of private consciousness is also sanctuary, a space in which thoughts and actions, desirable or undesirable, are securely one’s own. Richie’s inner sanctum of consciousness had been violated. The words and thoughts in his head were not exclusively his. It must have felt like possession and, at the neurological level, perhaps in a sense it was.
Imagine that your head is full not of brain stuff or even thoughts but little glass beads, all colours of the rainbow. They flow in streams. Before joining a stream each bead passes through a bead-sorter and is embossed with either the letter ‘I’ or the letter ‘E’. Sometimes a stream will consist mostly of ‘I’ beads, sometimes mostly ‘E’, and often a there will be a mix of the two. The beads represent consciousness. The ‘E’ beads are thoughts and images stimulated by events in the external environment; the ‘I’ beads are thoughts and images generated internally by the endogenous neural activity of the brain. They are all very similar in size and shape having gone through the same manufacturing process (in the neural workshops of the brain), but are clearly marked so there is no difficulty telling them apart. Since, generally, we readily distinguish self-generated experiences (close your eyes and imagine your hand) and sense-generated ones (look at your hand) the brain must have mechanisms equivalent to the imaginary bead-sorter. And indeed it does. ‘Corollary discharge’, a basic physiological mechanism for labelling movements as self-generated, has been understood for over a century. Consider the difference between internally-generated eye and head movements where the visual world remains stable, and the destabilising effect of externally prodding the eye. The motor system is constructed in such a way that internally-generated command signals to the muscles (in this case of the eye) are copied to other areas of the brain where sensory processing is adjusted in line with the anticipated effects of the movement, thus imposing perceptual stability upon rapidly shifting patterns of sensory input. This so-called ‘efference copy’ effectively labels the eye-movements as being internally generated. When it is absent, as with a prod to the eye, the world jerks about and the stimulus is readily discerned as external. It seems there may be similar mechanisms involved in the labelling of higher-order cognitive functions, including speech and language. A malfunction here could well account for the misattribution of inner speech to an external source. It would take a bold step to explain complex delusions like Richie’s Diana story in similar terms but it’s conceivable that neuronal confusions of internal and external might also apply in the realms of memory and self-generated fantasy.
Hallucinations are often troublesome, sometimes terrifying, and they are generally taken to signify mental illness, but it’s worth reflecting that voice-hearing might also be considered a part of normal experience. From the time that hallucinations were first clinically defined by Esquirol in the middle of the nineteenth century, there has been debate over their pathological status. Around 1 in 50 people admit to hearing voices from time to time and the bereaved are especially prone. A friend who recently lost his wife to cancer tells me she often speaks to him. Sometimes they’re words of comfort, at other times she makes him laugh as she did in life. He has no belief in the supernatural. The voice, he thinks, is testament to a relationship so long and loving that one mind has braided with another in the circuits of a single brain.
I too have heard voices, just a handful of times, and fleetingly. After a sleepless overnight flight from London to New York I stepped off the plane straight into a long day of work and an evening of social events. It was the early hours of the following day before I finally made it back to my hotel room. I fell instantly into a deep sleep, and then into a lucid dream in which I was holding my baby son, who was wrapped in a multi-coloured silk scarf. I could smell his skin. The colours and textures of the scarf were hyper-real. I was wide-awake by six (eleven according to my body clock) and the room was filling with a grey light. The first voice, just to my right, put a question: Is that it? The response came from the left: Probably. There was a rush of fear, not because I thought there were intruders in the room, but because I knew for sure I was alone. The voices resembled a typical schizophrenic hallucination in some ways. They sounded real and ‘out there’ rather than inside my head, but in other respects they were not typical of psychosis. There was a simple question and response; four bland words which did not address me directly or give a running commentary. The experience would qualify as a ‘hypnopompic’ hallucination, which is a false perception on awakening, so can be safely filed away as ‘normal’. I was still terrified. It was more than the sense of losing control. My visual (and olfactory) ‘hallucination’ of baby and scarf was beyond my control but it was joyful rather than fearful. It was more to do with the deep strangeness of the feeling, however illusory, that there were other articulate beings cohabiting my head. It did not amount to ‘neurological possession’ in Richie’s terms, but certainly there was a passing sense of having been invaded.
That was five years ago and it didn’t happen again until, oddly enough, the early hours of this very morning (Saturday 30th June 2012). As with the New York experience, today’s episode followed a period of sleep deprivation and was associated with a sequence of vivid dreams: being on a broad, stone bridge in dense fog with horsemen looming fast from the gloom; a large band of cyclists pedalling furiously and singing in beautiful harmony; a motorcyclist crashing fatally into a bridge buttress; the interior of a building with white stairways and corridors blocked by white walls; a male voice calling unintelligibly from somewhere in the building. Then I’m in bed with a young, anonymous, woman. We lie in silence for a while, close together, half-clothed, and then without a word she leaves, at which point I’m woken by what sounds like the chiming of a clock, but there’s no clock in the room. As I lie awake trying to figure out if it was a real sound or a dream sound there’s another signal, something like a mobile phone alert. But my phone is switched off. Then I hear a voice, which sounds like mine. Hello? it says, in a tentative, enquiring sort of way, as if to say, Hello, anybody there?
I’m not at all afraid this time and I want to know what else the voice has to say. Perhaps it’s my Socratic daimonion trying to get through! Socrates, one of the founders of Western philosophy, the advocate of critical self-analysis whose method of reasoning through rigorous argument has helped shape the character of the modern mind, was a voice-hearer. His friend Xenophon recollects him saying, ‘a divine voice comes to me and communicates what I must do’. In Plato’s account, Socrates says that his daimonion ‘always dissuades me from what I am proposing to do, and never urges me on’. In other words it intervenes when he is about to make a bad decision. He considered it a form of ‘divine madness’, a gift from the gods akin to the gifts of poetry and love. In this he foreshadows Shakespeare: ‘The lunatic, the lover and the poet / Are of imagination all compact’. As it happens there’s been something on my mind this past couple of days, an emotional matter, with a straightforward binary choice to be made; I must take one of two paths. I’m still at the crossroads pondering but my daimonion perhaps already knows what’s for the best. Yet Hello? is all I get.
I am struck by the imagery of these dreams (and dreams, surely, are a prime example of internally-generated imagery being interpreted as external; a universal, nightly dose of psychosis). Putting Freudian interpretations to one side, and considering, literally, the architecture of the dream, the bridge and the labyrinthine white building suggest nothing so much as the architecture of the brain. It’s a journey, via the corpus callosum, from one hemisphere to the other! Perhaps, in line with Richie’s theory, a part of my brain, somewhere down those white corridors and stairways, was functionally detached from the rest.
Is that it? Probably.
Paul Broks is an English neuropsychologist and science writer. His books include Into the Silent Land and The Darker the Night, The Brighter the Stars.