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PRELUDE

THE PATHOLOGICAL ASSUMPTION

Indeed, if every inspiration that comes to one with such commanding urgency that it is heard as a voice is to be condemned out of hand by the learned qualification of a morbid symptom…who would not rather stand with Joan of Arc and Socrates on the side of the mad than with the faculty of the Sorbonne on that of the sane?

—JOHAN HUIZINGA, “Bernard Shaw’s Saint”

In the summer of 1995, when I was seventeen years old, my oldest brother and I self-published a memoir that my grandfather had written over the course of his retirement in West Palm Beach. The job wasn’t supposed to be ours. My father had promised to type up and edit the manuscript himself, but for some reason it had sat on his desk for months, untouched. Then June brought him cheap, convenient labor. He delegated the task, we agreed, and for a week of afternoons my brother manned the computer in my father’s small home office as I sat on the carpet and dictated from a thin stack of loose-leaf paper, scrawled over with barely legible script and topped by a cover page that read: The Smith Family Chronicles.

The title was misleading. My grandfather’s book was neither chronological nor particularly familial. Rather, it was a loosely packed grab bag of memories, anecdotes, poems, complaints, and prayers, set down with little concern for artfulness, context, or even grammar. Most of the material wasn’t even fresh, in fact, but consisted of chestnuts that my grandfather had fed his children and grandchildren for years and that he had now reheated for the purpose of posterity or vanity or both. Veterans of these tales, my brother and I therefore performed our duties in a state of skeptical admiration. We were exasperated by my grandfather’s literary effort, but we were charmed by it as well.

My father had a less charitable reaction to the Chronicles. He did not read the book until a week later, when we presented him with the first copy—a slim volume, velo-bound, that we printed at a copy shop where my brother worked that summer and routinely stole products and services—and when he did he encountered a chapter that, although we had not noted its importance, struck him with the force of a deep and disturbing revelation. As a rule, my father was not quick to show emotion, but this chapter caused him to balloon with rage. He railed at a great injustice that had been done to him. He fumed and festered over time wasted and anguish unnecessarily endured. Finally, he flew to Florida and demanded an explanation.

No one knows precisely what was said at that meeting. Both of the participants are dead, and in life neither talked about it. But we do have the chapter that sparked the discussion. It is a modest section in a modest book—330 words long, rambling, and betraying not the slightest hint of its own importance. Its title is “Voices.”

Voices

I have always heard them, but it took some time for me to recognize that they had a significance. Mostly they appeared when there was a decision-making problem. You had to listen very carefully or you missed it. More often than not you did miss it. When after a decision was made, incorrectly, I would think back in retrospect and recall that a voice in my head told me the proper thing to do. Misinterpretation is the key word. Listening to the voice and interpreting the correct choice in what you’re thinking becomes a habit and in time, your awareness can almost always help you decide an issue. This is not tried and true.

With exams, true or false, multiple choice questions, I was 80% correct. I became good at this. Even when choosing wrong, I know it was my fault for not listening carefully. In my business ventures, if there was a problem, or a decision to be made, I almost always listened carefully and decided correctly.

I tried this with betting at the racetrack. It didn’t work. My mind got clouded with voices telling me that this horse could win or maybe this one is ready to win. In the end, I lost more times than I won. Do you think a higher power was trying to tell me something?

Mother and I have a regular gin game with friends from the mountains who now live here in Century Village. We take turns on alternate Fridays playing in one another’s homes. I point out this phenomenon. When it is my turn to discard a card from my hand, invariably, an inner voice will tell me that he needs the card. I have proven this, time and time again, by holding back the voice card discard, but later throwing it, he always picks up and needs this card. I have almost lost all of this awareness. Patience and fortitude are not attributes of the elderly (I am not!!).

The ordinary reader of this chapter likely wouldn’t think much more than that my grandfather was describing an unusually strong sense of intuition. My father, however, wasn’t an ordinary reader. At the time he read the Chronicles, he was forty-nine years old, and for more than three decades he had heard unseen voices telling him what to do. These voices weren’t elaborate, and they weren’t disturbing in content. They issued simple commands. They instructed him, for instance, to move a glass from one side of the table to the other or to use a specific token in a specific subway turnstile. Yet in listening to them and obeying them, his interior life had early become, by all reports, unendurable. The voices had first begun to make their demands when he was thirteen, and since that time he had attended to them in anguish.

He had also attended to them in silence. For twenty-five years my father told no one about his voices, not even his wife, with whom he had three children. He feared that if they were exposed, he would be deemed insane. In the end, this silence undid itself. In 1983, overstrained by his voices and overtaxed by the effort required to conceal them, my father succumbed to a nervous breakdown. Frightened and tired, he at last revealed his voices to my mother and checked himself into the psychiatric ward of a nearby university hospital, where he was diagnosed with “major depression with psychotic features”—a sort of catchall, able to contain both his despair and the experiences that, to my mind, caused it. He stayed for two weeks and returned home to a family that was on the brink of dissolution and a career that seemed over; in his absence, his law firm had dismissed him on the grounds of mental unfitness.

In the years that followed, my father’s fears did not come true. My mother didn’t leave him, his mental stability quickly returned, and in time he regained his professional footing. But the Chronicles made him feel that his long struggle might have been avoided. This is not hard to understand. For years he had writhed in shame. He had been terrorized by the thought of what might happen if he revealed his voices and, perhaps, by the knowledge of what might happen if he did not. And for all that time my grandfather had not only been hearing voices as well, he had been doing so without angst or confusion, using them for, of all things, picking horses at the track and beating retirees at gin rummy. My father felt that he had been denied his salvation.

Fifteen years on, it’s hard to say whether my father was right, whether he might have lived a less tortured life had he known about my grandfather’s voices earlier. All that can be said for sure is that, without knowing about them, my father experienced his voices as a malignant force. Though they weren’t cruel, they caused him profound distress. Though they didn’t try to harm him or others, he thought of them as dangerous, insidious enemies. Though they don’t seem to have been harsh, he considered them pathological: undesirable, unnatural, injurious. 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.

Or less so, since a tumor can be excised. My father’s voices could not. Though he learned to live his life well enough in their presence, they never stopped talking. And he never truly began. When someone mentioned his voices, he would grow embarrassed, dismissive, or irate. It was obvious to those of us in the know—a club containing only the immediate members of his family—that his shame was complete and impenetrable. So we learned not to ask. Until his death of cancer, in 1998, we allowed my father’s voices to remain in the one place where he felt they were safe: the silent, hidden recesses of his mind.

 

In April 2002, on the front page of its Metro section, the Boston Globe published a photograph of a police officer standing in court holding an AK-47 assault rifle with a wooden handle, a banana clip, and an evidence tag dangling from its trigger guard. The gun had been used two years earlier by a man named Michael McDermott to kill seven people at a technology consulting firm in Wakefield, Massachusetts. McDermott, a diagnosed schizophrenic, claimed he had committed the crime under the orders of Saint Michael the Archangel, who had descended from heaven and ordered him to assassinate Hitler and six of his generals. A smaller photograph, printed below the article, showed McDermott entering the courtroom in prison blues. He looks intimidating and wild. His hair shoots out from his head like a lion’s mane. His face is obscured by a thick, matted beard. Addressing the jury, his lawyer explained, “He has his hair like that because it keeps the voices down.”¹

When people are asked for their first impression of the words hearing voices, this is typically the kind of story that comes to mind. It is the kind of story that displays with memorable force the heights to which madness can ascend, the kind of story that shows what can happen when a human being becomes unmoored from reality and the ability to reason. In McDermott’s world, nothing seems to be stable—not time, not thought, not emotion, not perception. He appears almost as the embodiment of madness. And because we cannot hear them or know their intentions, because we don’t know what they are telling him, his voices seem to be madness’s most frightening representatives.

This impression is extreme, but it’s not completely incorrect. Hearing voices—what the clinical literature refers to as “auditory hallucinations,” or, more precisely, “verbal auditory hallucinations”—is indeed one of the prototypical symptoms of schizophrenia, and schizophrenia is the gravest mental illness in the psychiatric pantheon. According to experts, as many as 75 percent of people with schizophrenia hear voices.² It is a myth that these individuals pose an inherent threat to others; researchers have found no direct link between auditory hallucinations per se and physical aggression, though people who hear voices that order them to commit acts of violence (a relatively minuscule group) do on occasion obey.³ It is not a myth, however, that voices pose a threat to the hearer. The overwhelming majority of schizophrenics who hear voices describe the experience as being always or almost always negative. For quite a few patients, voices are the very worst of the disease’s symptoms—what one woman has described as a “constant state of mental rape.”⁴ Schizophrenic voices can take any number of horrible forms. They can issue commands, echo the patient’s thoughts, provide a running commentary on everyday actions, or berate, curse, and insult the hearer. Often they chatter all day, making it impossible for a person to think or work or carry on a conversation. The experience can be so unremitting and demoralizing that patients are frequently driven to acts of desperation. As many as one-third of people with schizophrenia attempt suicide. As many as one-fifth hear voices that command them to do so.⁵

Yet what is rarely realized or openly expressed is that voices are not exclusive to schizophrenia. Obscured by the dramatic stories that make it into the news, and by our own concern about the horrors of psychosis, is the fact that auditory hallucinations are able to take a number of different forms and are associated with a number of different conditions. Even within psychiatry this is true. Approximately 20 percent of patients suffering from mania and 10 percent of patients suffering from depression hear voices.⁶ Psychological trauma is also closely related to the phenomenon. Combat veterans diagnosed with post-traumatic stress disorder report high rates of voice-hearing. So do women who have been sexually abused—more than 40 percent, according to one study.⁷ Voices can even come in the very throes of trauma. The civil rights activist James Cameron, the only one of three men to survive a 1930 lynch mob, heard a voice as he was about to be hanged. “Take this boy back,” the voice said to Cameron, who had been falsely charged with killing a white man and raping the man’s girlfriend. “He doesn’t have anything to do with any shooting or raping.”⁸ No one else heard it.

Auditory hallucinations are also known to occur as the result of nonpsychiatric, “organic” conditions. Doctors in Hawaii recently treated a man who began to suffer from voices soon after he had surgery to remove a blood clot from his brain. One day while his wife was driving him in her car, he heard a “deep male voice” telling him to grab the steering wheel and crash the car. Later, he heard vampires telling him to bite her. (“Cover your neck!” he warned.)⁹ Voices can be a symptom of brain tumor, Parkinson’s disease, migraine headaches, hyperthyroidism, temporal lobe epilepsy, Alzheimer’s disease, and various types of delirium. Recreational drugs such as LSD, psychedelic mushrooms, ecstasy, and cocaine sometimes cause voices, but the phenomenon is more commonly associated with alcohol. Either during or after a binge, chronic alcoholics can experience auditory hallucinations that closely mirror schizophrenic voices; for years clinicians have had trouble telling the two apart.¹⁰

What is even less commonly realized is that auditory hallucinations extend to people who are not suffering from any pathology at all—that is, people hear voices without any distress or impairment in functioning. Sometimes people even enjoy the experience. One of the most widely cited examples of this was reported in 1971 by a Welsh doctor named Dewi Rees. Rees questioned three hundred patients who had recently lost a spouse and found that 13 percent had heard the voice of their dead husband or wife, and 10 percent had actually held a conversation with the deceased. Of this group of “grief hallucinators,” as they are sometimes called, the vast majority, 80 percent, reported that they had found the experience pleasurable. Apparently the hallucination helped smooth the process of mourning.¹¹

The idea that auditory hallucinations can occur in people who are free of mental and physical illness is not a new one. For decades researchers have conducted large-scale epidemiological surveys into the matter, though intermittently. One of the more famous efforts of this kind was conducted in the late nineteenth century by the Society for Psychical Research, a British organization that investigates paranormal phenomena such as clairvoyance and out-of-body experiences. Under the direction of the philosopher Henry Sidgwick, the society questioned 17,000 adult men and women as to whether they had ever heard a voice when no one was around to speak. (The American psychologist and philosopher William James was one of the interviewers.) Excluding those respondents who seemed either physically or mentally unstable, the researchers concluded that 3.3 percent of the population had experienced a vivid auditory hallucination at one time or another in their lives. A small but not insignificant number, 159, heard voices on multiple occasions.¹²

The society’s findings are not the most reliable according to today’s scientific standards: The researchers had an obvious stake in proving the veracity of unusual experiences, the interview data wasn’t carefully verified, and the sample collected didn’t reflect the makeup of the general population. In light of these facts, Allen Tien, a psychiatrist at Johns Hopkins University, reproduced the study in 1991. Analyzing data gathered from more than 18,500 people as part of a landmark effort by the National Institute of Mental Health, Tien drew several notable conclusions. First, the overall incidence of auditory hallucinations had remained remarkably stable over the course of almost a century. The demographics, however, had shifted somewhat. In Sidgwick’s day, the people most likely to hear voices were in their twenties; in Tien’s, voice-hearing spiked in the middle-aged and the elderly. Finally, and most notable, two-thirds of those who reported hearing voices today felt no distress as a result of the experience and had no plans to seek professional help.¹³

Tien’s work has been hailed as the most comprehensive survey of hallucinations in the general population conducted so far. But in light of a smaller-scale study published eight years earlier by the psychologists Thomas Posey and Mary Losch, of Murray State University in Kentucky, his findings weren’t particularly surprising. Intrigued by the idea that, as they put it, “normals hear voices,” Posey and Losch devised a list of fourteen quotations illustrating a broad range of examples of auditory hallucinations, some of which were particularly characteristic of schizophrenia, and asked 375 healthy volunteers to state whether they had ever experienced something similar. (The psychologists were careful to emphasize that what they were studying was not voices heard in the head, like thoughts, but heard aloud, “as if someone had spoken.”) The results of Posey and Losch’s study have been widely reported in the scientific literature. Fifty-seven percent of the sample 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”; 39 percent to “I hear my thoughts aloud”; 11 percent to “When I am driving in my car…I hear my own voice from the backseat”; and 5 percent to “Almost every morning while I do my housework, I have a pleasant conversation with my dead grandmother.”¹⁴

What are all these surveys telling us? They could be telling us, of course, that the researchers didn’t adequately determine the mental status of their respondents. Perhaps those who stated that they heard voices were in fact mentally ill and were living undetected in the community. Not everyone who suffers from a psychiatric condition is under psychiatric care, after all. But given the diligence of most of the researchers involved, the scientific safeguards through which much of the data passed, and the relatively high numbers that were uncovered, this seems unlikely. The surveys seem to be telling us, rather, that auditory hallucinations are not limited to the mentally ill. They seem to be telling us that for many years we have been paying attention only to the harshest voices that make their way to our ears, and forgetting the softer ones that lie underneath.

 

In 1961, the novelist and essayist Aldous Huxley—a man well known in his day as a champion of unusual experiences—made the following remarks to an international gathering of psychologists:

[We] now live in a period when people don’t like to talk about these experiences. If you have these experiences, you keep your mouth shut for fear of being told to go to a psychoanalyst. In the past, when [they] were regarded as creditable, people talked about them. They did run, of course, a considerable risk because most [of these experiences] in the past were regarded as being inspired by the devil, but if you had the luck to convince your fellows that [your experiences] were divine, then you achieved a great deal of credit. But now…the case has altered and people don’t like talking about these things.¹⁵

The subject of Huxley’s speech, obscured here in brackets, was “visionary experiences”—those mysterious apprehensions of a “luminous other world” beyond our own that mystics and saints have been striving to attain and explain for centuries. But with the exception of the reference to psychoanalysis, which has since fallen out of favor in therapeutic circles, his summary applies perfectly to the history of voice-hearing as well. For hundreds of years, hearing a voice that no one else did was regarded as a creditable phenomenon. As the distinguished medical historian German Berrios has put it, “Experiences redolent of hallucinations…were in earlier times culturally integrated and semantically pregnant, i.e., their content was believed to carry a message for the individual or the world.”¹⁶

Today, this quality of meaningfulness is conspicuously absent from our understanding of voice-hearing. The experience now draws its meaning from medical psychiatry, the discipline that conducts the lion’s share of the research into the phenomenon, and to medical psychiatry voice-hearing technically has no meaning. What matters most to the contemporary clinician is the experience’s form—what grammatical tense and “person” it speaks in, whether it seems to occur in external or psychological space, whether it speaks continuously or intermittently. This information is the key to making a correct diagnosis, and to prescribing the most effective treatment. Discussions of meaning are commonly thought to distract from this work.

To be sure, psychiatry’s attitude toward voice-hearing saves lives: The vast majority of patients who take psychiatric medications for auditory hallucinations experience a reduction in the symptom, and sometimes the drugs silence the voices altogether.¹⁷ The problem is that psychiatry’s attitude resonates far beyond the clinic. Tanya Luhrmann, an anthropologist at the University of Chicago, has put this problem poetically. “Psychiatric knowledge,” she writes, “seeps into popular culture like the dye from a red shirt in hot water.”¹⁸ In regard to voices, the knowledge that has seeped into the culture the deepest is the perspective that they are by definition incapable of carrying a meaning that is useful to the hearer. In traditional psychiatry, voice-hearing is little more than a neurochemical glitch, to which the only proper response is medical, pharmaceutical treatment.

Historically, this viewpoint is quite new and represents a profound interpretive shift. The written record of Western history stretches back more than 2,500 years, and from the beginning voice-hearing was plainly apparent and positively valued. Indeed, the phenomenon is associated with some of the fundamental texts and figures of Western culture. For instance, the ancient Greek epic the Iliad—composed around 750 BCE and one of the oldest examples of European literature—is rife with voices. The characters who inhabit the tale, the legendary heroes of the Trojan War, are constantly being spoken to by the gods of the Greek pantheon, who urge them into battle, devise their strategies, and cause them to quarrel. In ancient Greece, voice-hearing is also central to the workings of the oracles emanating from shrines, those holy sites that dotted the mainland and that drew individuals and states in search of counsel from the gods. Even the great philosopher Socrates heard a daimonion, or “divine thing.” Like my grandfather’s voice, Socrates’ voice offered him simple guidance in regard to everyday tasks.

In the history of monotheistic religion, voice-hearing is even more formative than it was in ancient Greece—literally so. The god of the ancient Hebrews is a god who speaks almost without pause. The book of Genesis proclaims, “In the beginning…God said, ‘Let there be light,’” and from that moment forward Yahweh’s voice becomes the motive force behind the history of the Jews. It is the divine voice that sets monotheism on its way when it orders Abraham to leave his home and make a “great nation.” It is the divine voice that orders Abraham to sacrifice his son Isaac and then stays his hand before committing the crime, that repeats the blessing of fruitfulness and renown to Isaac and to Jacob, and that leads Moses through the desert and delivers to him the laws of Israel. And it is the divine voice that speaks to all the biblical prophets—from Isaiah to Malachi—and compels them, not without trouble, to carry the divine message to their countrymen.

The divine voice speaks less forcefully but more profoundly in the history of Christianity. John the Baptist receives a heavenly call in the Gospels in the same way as his prophetic predecessors. But in Christian theology, Jesus Christ doesn’t hear the word of God—he is the word of God. In this paradoxical way, voice-hearing was made talismanic to Christianity. “Faith cometh by hearing,” Saint Paul declared, and ever since, the devout have obeyed in droves. The Church fathers Saint Augustine and Saint Thomas Aquinas both heard voices. So did the mystics Hildegard of Bingen and Teresa of Ávila, the schismatic Martin Luther, the Quaker George Fox, the preacher and author John Bunyan, and the poets John Milton and William Blake. The divine voice runs like a steady trail through Christian history.

And then, it seems, the trail runs cold. Sometime late in human history, after centuries of chattering, the unseen voice seems to have stopped speaking in its old ways. Precisely why this happened is a matter of some complexity. Psychiatry did not rise up one day and slay the ancient voice like a mythical dragon. Rationality did not up and murder irrationality. But somewhere around the eighteenth century, the culture’s way of thinking and talking about unusual experiences altered markedly. What was once revelation and inspiration became symptom and pathology. What was piety and poetry became science and sanity. In public discourse, voice-hearing became a force of harm and an experience to eradicate.

This alteration was hardly an unmitigated success. Traditions as ancient and foundational as the unseen voice are impossible to extinguish. Our religious and literary heritage perennially validates them. What is more, the sheer multiplicity of human life acts as a natural barrier against the dominance of any single interpretation of human experience. The old meanings persist. But they are harder to hear. In many cases, they have quieted or disguised their voices or retreated to more distant precincts. To find them and listen to what they have to say, you have to clear your ears of the new assumptions.