Voices of Reason, Voices of Insanity

Studies of Verbal Hallucinations

Ivan Leudar, Philip Thomas

• Publisher: Routledge
• Year: 2005
• Print ISBN: 9780415147866
• eBook ISBN: 9781134754281
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Records of people experiencing verbal hallucinations or 'hearing voices' can be found throughout history. Voices of Reason, Voices of Insanity examines almost 2,800 years of these reports including Socrates, Schreber and Pierre Janet's "Marcelle", to provide a clear understanding of the experience and how it may have changed over the millenia. Through six cases of historical and contemporary voice hearers, Leudar and Thomas demonstrate how the experience has metamorphosed from being a sign of virtue to a sign of insanity, signalling such illnesses as schizophrenia or dissociation.

They argue that the experience is interpreted by the voice hearer according to social categories conveyed through language, and is therefore best studied as a matter of language use. Controversially, they conclude that 'hearing voices' is an ordinary human experience which is unfortunately either mystified or pathologised.

Voices of Reason, Voices of Insanity offers a fresh perspective on this enigmatic experience and will be of interest to students, researchers and clinicians alike.

1

The daemon of Socrates

Socrates is not usually seen as a religious visionary. Some would say that he is the father of logic and rationality, and he certainly seems to be the epitome of ‘sanity, shrewdness, physical robustness, and moral integrity’ (Myers, 1903). It does come as a surprise to those who know him just by this general reputation that he let himself be guided by ‘a voice’, to which he occasionally referred as ‘the daemon’, as did others in his time and since. The daemon has been of considerable interest to philosophers for well over 2,000 years; alienists and psychiatrists have become interested more recently. Plato mentioned the phenomenon in several of his dialogues (for instance, in Apology, Crito, Euthydemus, Phaedrus, Theaetetus) as well as in The Republic. Xenophon wrote about it in his Conversations of Socrates, and Plutarch dedicated a whole monograph, ‘On the sign of Socrates’, to the matter. In fact, allowing himself to be guided by a daemon was one of the charges levelled against Socrates at his trial—the daemon was not a god recognised in Athens. The daemon probably cost Socrates his life: it ‘stopped’ him from defending himself in his trial and from escaping once he was sentenced to death. Thus the daemon is a well-documented phenomenon which is important in understanding Socrates (Nares, 1782; Voltaire, 1773/1994; Nietzsche, 1872/1991). We are interested in both Socrates and his daemon.

In the nineteenth century, the daemon became ‘a hallucination’ and Socrates was declared insane on its account by practitioners of ‘retrospective medicine’ (Lelut, 1836; Brunet, 1863; James, 1995). He was in good company; the other prominent figures who have fallen from greatness by a stroke of diagnosis included Pythagoras, Mohammed, Merlin, Joan of Arc, Luther, Loyola and Pascal. Nietzsche wrote the following:

The Socrates’ Daimonion likewise is perhaps a disease of the ear, which he explains in accordance with his prevailing moral thinking, but other than how it would be explained today. It is no different with madness and ravings of prophets and oracular priests: it is always the degree of knowledge.

(Nietzsche, 1878/1994, p. 126; emphasis in original)

In this chapter we shall first summarise the early French conception of ‘hallucination’. We will then summarise what is known about the daemon of Socrates and finally consider whether it fits this concept of hallucination.

On the history of the concept of hallucination

We cannot assume that the concept of hallucination used in nineteenth-century France was exactly the same as ours; let us therefore briefly consider that concept and then return to Socrates. You may have thought that the concept of ‘hallucination’ is an ancient one but it is almost accepted wisdom in current psychiatry that the concept was formulated by Esquirol in the early nineteenth century. According to James (1995), Esquirol (1838, 1845) coined a single generic term ‘hallucination’ for ‘visions’ and ‘ecstasies’, and distinguished hallucinations from illusions. Esquirol wrote: ‘The activity of the brain is so intense, that the visionary or the hallucinator gives a body and substance to images reproduced by memory, without the senses intervening’ (Esquirol, 1838, translated by James, 1995, pp. 84–85).

According to James, there were actually words ‘hallucination’ and ‘hallucinate’ in Latin but these meant ‘to confabulate’ and ‘to ramble’ without specifically perceptual connotations.¹ (This meaning is still noted in the Shorter Oxford English Dictionary.) Esquirol’s description of somebody who ‘hallucinates’ was as follows: ‘A man…who has the inward conviction of a presently perceived sensation at a moment when no external object capable of arousing this sensation is within the field of his senses, is in a state of hallucination. He is a visionary’ (Esquirol, 1838, translated by James, 1995, p. 70). So, as Esquirol saw it, hallucinations were sensations without appropriate external objects (why Esquirol added the word ‘perceived’ is unclear), and the ‘visionary’ and the ‘hallucinator’ were one and the same person.

The term ‘hallucination’ was not accepted without an argument and with exactly the meaning Esquirol gave it. The controversy ensued over which experiences the term should apply to (the extension of ‘hallucination’), as well as over what the correct theory of hallucinations might be.

One recurrent problem discussed by psychiatrists was whether hallucinations can coexist with reason. Many argued that they cannot and that hallucinations are, by themselves, indisputable signs of madness. This means that if Socrates experienced hallucinations he was insane, as were the other ‘visionaries’. James (1995) reports that Pinel (1818) thought that Socrates was subject to catalepsy. We shall see that his daemon often stopped Socrates in his tracks, but whether one should consider his contemplation ‘catalepsy’ is debatable. Lelut, in the now famous Du demon de Socrat, argued that Socrates was a victim of hallucinations. He wrote in the first edition of this monograph: ‘Hallucination evolves from melancholia and it is a clearest characteristic of madness’ (Lelut, 1836, cited in James, 1995). Lelut’s definition of hallucinations would not be out of place in a psychiatry textbook today: hallucinations were ‘internal perceptions wrongly attributed to the action of external objects’ and ‘spontaneous transformations of thought into sensations’. Compare this to more recent definitions:

A sensory perception without external stimulation of the relevant sensory organ.

(APA, 1994)

Any percept-like experience which (a) occurs in the absence of an appropriate stimulus, (b) has a full force or impact of the corresponding actual (real) perception and (c) is not amenable to direct or voluntary control by the experiencer.

(Slade and Bentall, 1988, p. 23)

Simply stated, the susceptible patient claims to ‘hear’ the speech in the absence of the actual speaker.

(Hoffman, 1986, p. 503)

According to Lelut, ‘Hallucinations were inherently pathological, and an indisputable sign of madness.’ Socrates suffered from auditory hallucinations; only mad people so suffer, ergo he was mad (James, 1995, p. 92).

For Maury (1855) there was no difference between visionaries, ecstatics and madmen of his time. He argued that the apparent rationality of visionaries’ hallucinations was beside the point—rational hallucinations were still essentially hallucinations, just like those of the inmates of contemporary French asylums. Maury held that these ‘great figures’ ‘believed in their hallucinations as if they were facts’, and the hallucinations motivated their actions. Thus the great projects of Socrates, Mohammed and Joan of Arc to which they attended with such single-mindedness were motivated by hallucinations and insanity.

The French Société Médico-Psychologique met to discuss hallucinations twice in the autumn of 1855 and Brierre de Boismont compiled a report on these two meetings (Brierre de Boismont, 1856). The speaker on the first occasion was Baillarger, on the second Castelnau. Baillarger started by summarising the positions of his contemporaries Buchez and Peisse. Buchez held that we are endowed with physiological faculties of internal vision and internal audition, which can be much more developed in musicians and painters. Their internal visions and auditory images are prepared and voluntary. In pathological conditions, however, the internal images are spontaneous and involuntary. In other words, the difference between artistic and insane hallucinations was drawn in terms of control over the hallucinatory experiences or the lack of it. According to Baillarger, Peisse shared this same view of hallucinations but added that the insane hallucinators do not distinguish their spontaneous and involuntary internal perceptions from normal perceptions (of external objects), while the artists do. We are thus told that psychotic hallucinations are false sensations while ‘ordinary’ hallucinations are not. What is pertinent to us here is simply the attempt to distinguish hallucinations in gifted individuals and in the insane, and that this distinction was formulated in terms of control of the experience and error. It is not absolutely clear to us, however, whether the relevant experiences of artists were really meant to remain conceptualised as ‘hallucination’. In general, concept definition has to be distinguished from concept application. Concept definitions regulate which concepts can in general apply to an object, but they do not determine which of the concepts will actually be applied to the object. So even if some experiences of creative individuals are very much like hallucinations in the insane, a psychiatrist does not have to call them by that name. To return to mid-nineteenth-century France, it is not clear whether real hallucinations had to be spontaneous, not under direct control of the will and mistaken for true perceptions. Or was it sufficient to have perceptual experiences without external objects to hallucinate?

Baillarger also considered the view that hallucinations are no more than internal images preserved by memory and reproduced with a great vividness and confused with perceptions. Not all of those involved in the debate believed that hallucinators necessarily confuse internal perceptions (or conceptions, or sensory memories) with perceptions of external objects; Baillanger did not. He contested the view of Garnier, according to whom hallucinations were conceptions which the ill person confused with perceptions. In Baillanger’s view this error was not necessary—the hallucinating person need not be duped by his hallucinations even as they are taking place; he need not believe in their ‘objective’ reality. All we need to do to demonstrate this, Baillarger said, is to turn to fantastic images which precede sleep. One knows perfectly well that they are not real, yet they are hallucinations. The error of confusing two different kinds of experience is, according to Baillanger, not an essential element of hallucinations. In fact we shall see in Chapter 9 that contemporary voice hearers rarely confuse hearing voices with hearing other people speak, and that they follow simple reality-testing procedures to establish the status of their experiences.

Thus the arguments about hallucinations were threefold. The first problem concerned the nature of hallucinatory experiences: are they inner perceptions, conceptions experienced as perceptions, or vivid sensory memories? The second problem concerned whether hallucinations necessarily involve mistaking internally generated experiences for perceptions. Either the visions of artists are not hallucinations or the reality confusion is not a necessary aspect of the meaning of ‘hallucination’. This is important, since as we shall see, reality confusion nowadays distinguishes true hallucinations from pseudo-hallucinations. The third problem was, do hallucinations and madness go hand in hand?

The paper at the second session of the debate was presented by Castelnau. He and Baillarger agreed that hallucinations are always a pathological phenomenon. But Castelnau quoted the following view of Baillarger: ‘But even if a hallucination is always a pathological phenomenon, it is not always a sign of madness; a peasant in Brittany is not a madman even though he believes that a Virgin appeared to him and spoke to him’ (Brierre de Boismont, 1856, p. 140, our translation).

Partitioning the concept of abnormal is an interesting way of complicating the argument. Hallucinations are always a ‘pathological phenomenon’, but they need not indicate insanity. Presumably ‘pathology’ meant everyday pathology, mistakes anyone could make. Taken this way, clearly not all psychological ‘pathology’ indicates insanity.

Brierre de Boismont resisted the idea that hallucinations should become uniquely tied to madness. According to James (1995), he did not deny that visionaries were hallucinators, but argued that their hallucinations were compatible with reason and were a result of their time in history. Brierre de Boismont’s (1862) book Des hallucinations was republished three times and two extensive articles based on it were published in Annales Médico-Psychologiques. The book is now extremely difficult to obtain so we shall base our analysis here on the articles. Brierre de Boismont (1861a, 1861b) compared hallucinations of insane and sane individuals (‘individus aliénés’ versus ‘individus raisonnables’). He also considered the hallucinations of Joan of Arc and in ‘monomanies tristes’. His aim was to ‘neatly distinguish pathological hallucinations from the physiological hallucinations’ (Brierre de Boismont, 1861b, p. 511). We need to note that both were hallucinations—Brierre de Boismont was not attempting to deny that hallucinations of artists and religious visionaries were hallucinations. For instance, he wrote the following about Joan of Arc:

The voices, the visions, the sensations of touch and smell of Jeanne d’Arc were true hallucinations, in essence identical with those of the insane.

This identity is similar to that between fixed ideas in men of genius and the fools.

(Brierre de Boismont, 1861b, p. 537, our translation)

But he organised hallucinations into two kinds according to their incidental properties of hallucinatory experiences (i.e. those not in the definition of ‘hallucination’). First, physiological hallucinations were compatible with reason, but pathological ones were not:

But even though their manifestations are the same in the two cases, their character, their logic, their course, their ending establish sharp differences between them.

Physiological hallucination is constantly in touch with the dominant thought, the mother idea, the ideal; it is an echo, an adjunct, a stimulant which decides the success. Whatever its duration, it has the same force at the start and at the end, and it does not trouble the reason.

Pathological hallucination, on the other hand, has its origins in diverse causes and mostly false ones; it is almost always associated with delirious conceptions. It invokes most erroneous and contradictory motives. Almost always it is impregnated with childish terrors, or is based on ridiculous exaggerations. It presents remarkable transformations. After time, it causes confusion of ideas and enfeeblement of reason.

These two [kinds of] hallucination have their starting point in mental representations, which exist in all the men, but their different character depends on whether the reason is intact or troubled.

(Ibid., pp. 537–538, our translation)

The second important property of Brierre de Boismont’s ‘physiological hallucinations’ was that they could be voluntary:

Without returning to the theory of mental representation and to the identity of sensation, conception and of hallucination, we have the feats of Talma, Goethe, and of Balzac and of many other persons who had hallucinations at will.

(Ibid., p. 534, our translation)

So hallucinations were not in themselves signs of madness any more than are thinking and remembering, even though some people can have bizarre and false memories and some people think delusional thoughts. The madness of some hallucinations was in their involuntariness, delirious content, its falsity, childish terror of the hallucinator; in other words, nothing specific to hallucinating. Brierre de Boismont implied that hallucinations are an ordinary mental function, which can indicate impairment of reason like any other, as did Taime (1878).

The problem for Brierre de Boismont was that it is not difficult to argue that every hallucination is based on an error. We have already seen, however, that this position was not completely accepted by Baillarger—his subjects could have experiences without external object...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Contents
• Acknowledgements
• Introduction
• 1 The daemon of Socrates
• 2 The gods of Achilles
• 3 The souls of Daniel Paul Schreber
• 4 Pierre Janet on verbal hallucinations: the case of Marcelle
• 5 Pragmatists on self
• 6 Verbal hallucinations in contemporary psychiatry
• 7 Working with voices
• 8 The frenzy of Anthony Smith: hearing voices in British national newspapers
• 9 Voice-talk
• 10 Conclusion
• Notes
• Bibliography
• Index