Book Reviews - Spring 2007

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From the divinely inspired to the pathological, a history of auditory hallucination

By Richard Restak

March 1, 2007


 

Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination by Daniel B. Smith, Penguin, $24.95

Describing the composition of his epic poem Milton, William Blake wrote to one of his patrons: “I have written this poem from immediate Dictation twelve or sometimes twenty or thirty lines at a time without Premeditation & even against my will.” Today such comments make most of us uncomfortable since we’re accustomed to equating the experience of hearing voices with mental illness or instability. But, as pointed out by New York-based journalist and author Daniel B. Smith in this well-written and deeply personal view of auditory hallucinations, such assumptions are exaggerated.

Research extending from the late 19th century until the present reveals that about 3 percent of the general population experience a vivid auditory hallucination at one time or another during their lives. In one survey 57 percent of respondents drawn from the general population answered yes to “Sometimes I have thought I heard people say my name . . . like in a store when you walk past someone you don’t know.”

Certainly voice-hearing was not considered exceptional in earlier eras. Throughout history men and women of genius and inspiration (Socrates, Christ, Mohammed, Joan of Arc, Ignatius Loyola, Joseph Smith, among others) have freely admitted to hearing voices. And although interpretations have varied about the origin and meaning of the voices, such visionary experiences weren’t labeled as indisputably pathological until the flourishing of psychiatry in the 19th century, especially with the introduction in 1838 of the word hallucination by the French psychiatrist Jean-Etienne-Dominique Esquirol. “In hallucinations everything goes on in the brain. Visionaries, and those in a state of ecstasy, are hallucinated,” wrote Esquirol.

Dating from the acceptance of Esquirol’s definition and extending to our own day, a person admits to hearing voices at his or her peril. “The language packed its own internal logic,” writes Smith. “With one linguistic swoop, Esqui­rol had diagnosed not only his patients but the entirety of Western culture.”

But this equation of voice-hearing with mental illness strikes Smith as simplistic. “Voice-hearing is strange, but by degree, not by kind.” Smith’s credentials for claiming this include not only a thorough familiarity with the literature on auditory hallucinations but, in addition, his childhood and early adult experience with his father, a successful attorney who lived a normal life despite regularly experiencing and fighting auditory hallucinations.

“My father assumed from the start that his voices were the sign of illness, and he wanted them as much as one might want a tumor in the brain,” Smith writes. Since he experienced the voices as “a malignant force,” Smith’s father became “embarrassed, dismissive or irate” whenever someone referred to them. “His shame about his voices was complete and impenetrable.”

Although Smith has never heard voices, he has investigated the phenomenon with sufficient thoroughness to make the convincing case that consigning all auditory hallucinations to the pathological “often fails to take into account the inevitable work of meaning making that occurs when an individual begins to have unusual experiences.”

Smith explores this meaning making in short engrossing chapters that include his own unsuccessful attempts to experience voices while floating in a sensory deprivation tank; his attendance at a meeting of the Hearing Voices Network, a loosely knit group of people working toward reducing ignorance and anxiety about the experience of hearing voices; interviews with a psychiatric patient, “Richard,” who believes that he can hear the voice of God; and detailed descriptions of famous voice-hearers such as Socrates, Daniel Paul Schreber (the subject of Sigmund Freud’s book The Schreber Case), and Joan of Arc.

As Smith points out, Joan of Arc is particularly difficult to understand apart from the voices that convinced her at age 17 that she could lead the French Armagnacs to victory over the English. Unable to read or write and lacking any military training, she nonetheless convinced the dauphin Charles of France to provide her with a royal sanction and an army. But before agreeing, Charles appointed a wily interrogator to grill Joan over a three-week period about her voices and her motives. During this ordeal she proved herself far subtler than would be expected from a wild-eyed visionary or a psychotic. When the interrogator demanded “a sign to show that we should believe in you,” Joan presciently responded: “In God’s name, I have not come to Poitiers to make signs. But lead me to Orléans and I will show you the signs I was sent to make.” True to her assertion, in May 1429 she rallied the French forces and drove the English troops from their fortifications surrounding Orléans.

Scholars have debated over the ensuing five centuries about the source of Joan’s “voices.” George Bernard Shaw didn’t consider her insane but a “visualizer” who “saw imaginary saints just as some other people see imaginary drawings and landscapes with numbers dotted about them, and are thereby able to perform feats of memory and arithmetic im­pos­sible to non-visualizers.” In his play Saint Joan Shaw further downplays the divine origin of the voices and depicts Joan telling a resentful archbishop that he should trust in her voices “even if they are the echoes of my own commonsense.” Nor have recent interpreters looked more kindly on Joan’s claim that she was responding to heavenly directives. Novelist Mary Gordon, in a 2000 biography, rues that “as historical character, model, or exemplum, Joan would be far more palatable to the post-Enlightenment appetite if she hadn’t claimed to hear voices.”

Yet, Smith suggests, the proper response to Joan’s voices is to interpret them in light of beliefs held at the time rather than to apply the psychiatrically grounded prejudices of our own age. “She heard voices; they told her what to do; she obeyed. This obedience is the essence of Joan and the engine of both her success and her demise.” As with Joan of Arc, explanations about the origin and meaning of the voices heard by other historical figures are best formulated, claims Smith, by taking into account the beliefs about faith, consciousness, and inspiration that were popular at the time.

“All eras subject voice-hearing to a test. . . . In our time the test is psychiatric: are voices healthy or pathological? In Joan’s time the question was theological: do the voices come from God or from the Devil?” Such dichot­omies, though, aren’t necessarily incompatible, as psychologist-philosopher William James pointed out: “If there were such a thing as inspiration from another realm, it might well be that the neurotic temperament would furnish the chief condition of the requisite receptivity.” The challenge—one that I frequently face in my professional role as a neurologist—is to distinguish those voices that are the products of madness from the voices that may result from inspiration, divine or otherwise.

Smith suggests that, in addition to the association of voices with insanity, our culture finds voice-hearing so threatening and foreign because as “modernists” we’re rendered acutely anxious by the absence of any sense of conscious control over the voices and their messages. “When an individual hears a voice, he is at that moment not the agent of his own thoughts but the vessel for them.” It is this abrogation of control, Smith maintains, that is among our greatest fears.

Toward the end of this enlightening book, Smith whimsically inquires what attitude “the illustrious voice-hearers of the past” would take toward the antipsychotic medications that are now routinely administered to those who reveal to others that they hear voices. He doubts that Moses would have dismissed Yahweh’s demands as an example of his dopa­mine system playing tricks on him. As for Joan of Arc and William Blake, he assumes that they “would have tossed them aside.”


Richard Restak is a neurologist and neuro­psychiatrist, and the author of 20 books about the brain, including Mind: The Big Questions and The Playful Brain.


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