3.5. Schizophrenia
MOST OF US spontaneously slip back into something approaching the actual bicameral mind at some part of our lives. For some of us, it is only a few episodes of thought deprivation or hearing voices. But for others of us, with overactive dopamine systems, or lacking an enzyme to easily break down the biochemical products of continued stress into excretable form, it is a much more harrowing experience — if it can be called an experience at all. We hear voices of impelling importance that criticize us and tell us what to do. At the same time, we seem to lose the boundaries of ourselves. Time crumbles. We behave without knowing it. Our mental space begins to vanish. We panic, and yet the panic is not happening to us. There is no us. It is not that we have nowhere to turn; we have nowhere. And in that nowhere, we are somehow automatons, unknowing what we do, being manipulated by others or by our voices in strange and frightening ways in a place we come to recognize as a hospital with a diagnosis we are told is schizophrenia. In reality, we have relapsed into the bicameral mind.
At least that is a provocative if oversimplified and exaggerated way of introducing an hypothesis that has been obvious in earlier parts of this essay. For it has been quite apparent that the views presented here suggest a new conception for that most common and resistant of mental illnesses, schizophrenia. This suggestion is that, like the phenomena discussed in the preceding chapters, schizophrenia, at least in part, is a vestige of bicamerality, a partial relapse to the bicameral mind. The present chapter is a discussion of this possibility.
The Evidence in History
Let us begin with a glance, a mere side-glance, at the earliest history of this disease. If our hypothesis is correct, there should first of all be no evidence of individuals set apart as insane prior to the breakdown of the bicameral mind. And this is true, even though it makes an extremely weak case, since the evidence is so indirect. But in the sculptures, literature, murals, and other artifacts of the great bicameral civilizations, there is never any depiction or mention of a kind of behavior which marked an individual out as different from others in the way in which insanity does. Idiocy, yes, but madness, no.1 There is, for example, no idea of insanity in the Iliad.2 I am emphasizing individuals set apart from others as ill, because, according to our theory, we could say that before the second millennium B.C., everyone was schizophrenic.
Secondly, we should expect on the basis of the above hypothesis that when insanity is first referred to in the conscious period, it is referred to in definitely bicameral terms. And this makes a much stronger case. In the Phaedrus, Plato calls insanity “a divine gift, and the source of the chiefest blessings granted to men.”3 And this passage preludes one of the most beautiful and soaring passages in all the Dialogues in which four types of insanity are distinguished: prophetic madness due to Apollo, ritual madness due to Dionysus, the poetic madness “of those who are possessed by the Muses, which taking hold of the delicate and virgin soul, and there inspiring frenzy, awaken lyrical and all other numbers, ” and, finally, erotic madness due to Eros and Aphrodite. Even the word for prophetic, mantike, and the word for psychotically mad, manike, were for the young Plato the same word, the letter t being for him “only a modern and tasteless insertion. “4 The point I am trying to make here is that there is no doubt whatever of the early association of forms of what we call schizophrenia with the phenomena that we have come to call bicameral.
This correspondence is also brought out in another ancient Greek word for insanity, paranoia, which, coming from para + nous, literally meant having another mind alongside one’s own, descriptive both of the hallucinatory state of schizophrenia and of what we have described as the bicameral mind. This, of course, has nothing whatever to do with the modern and etymologically incorrect usage of this term, with its quite different meaning of persecutory delusions, which is of nineteenth-century origin. Paranoia, as the ancient general term for insanity, lasted along with the other vestiges of bicamerality described in the previous chapter, and then linguistically died with them about the second century A.D.
But even in Plato’s own time, a time of war, famine, and plague, the four divine insanities were gradually shifting into the realm of the wise man’s poetry and the plain man’s superstition. The sickness aspect of schizophrenia comes to the fore. In later dialogues, the elderly Plato is more skeptical, referring to what we call schizophrenia as a perpetual dreaming in which some men believe “that they are gods, and others that they can fly,”5 in which case the family of those so afflicted should keep them at home under penalty of a fine.6
The insane are now to be shunned. Even in the exotic farces of Aristophanes, stones are thrown at them to keep them away.
What we now call schizophrenia, then, begins in human history as a relationship to the divine, and only around 400 B.C. comes to be regarded as the incapacitating illness we know today. This development is difficult to understand apart from the theory of a change in mentality which this essay is about.
The Difficulties of the Problem
Before looking at its contemporary symptoms from the same point of view, I would make a few preliminary observations of a very general sort. As anyone knows who has worked in the literature on the subject, there is today a rather vague panorama of dispute as to what schizophrenia is, whether it is one disease or many, or the final common path of multiple etiologies, whether there exist two basic patterns variously called process and reactive, or acute and chronic, or quick-onset and slow-onset schizophrenia. The reason for this disagreement and its vagueness is because research in the area is as obstinate a tangle of control difficulties as can be found anywhere. How may we study schizophrenia and at the same time eliminate the effects of hospitalization, of drugs, of prior therapy, of cultural expectancy, of various learned reactions to bizarre experiences, or of differences in obtaining accurate data about the situational crises of patients who, through the trauma of hospitalization, find it frightening to communicate?
It is beyond my effort here to sort out a way through these difficulties to any definitive position. Rather I intend to step around them with some simplicities on which there is wide agreement. These are, that there does exist a syndrome that can be called schizophrenia, that at least in the florid state it is easily recognized in the clinic, and that it is found in all civilized societies the world over.7 Moreover, for the truth of this chapter, it is not really important whether I am speaking of all patients with this diagnosis.8 Nor of the illness as it first appears, or as it develops subsequent to hospitalization. My thesis is something less, that some of the fundamental, most characteristic, and most commonly observed symptoms of florid unmedicated schizophrenia are uniquely consistent with the description I have given on previous pages of the bicameral mind.
These symptoms are primarily the presence of auditory hallucinations as described in I:4, and the deterioration of consciousness as defined in I:2, namely the loss of the analog the erosion of mind-space, and an inability to narratize. Let us look at these symptoms in turn.
Hallucinations
Again, hallucinations. And what I shall say here is merely adjunctory to my earlier discussion.
If we confine ourselves to florid unmedicated schizophrenics, we can state that hallucinations are absent only in exceptional cases. Usually they predominate, crowding in persistently and massively, making the patient appear confused, particularly when they are changing rapidly. In very acute cases, visual hallucinations accompany the voices. But in more ordinary cases, the patient hears a voice or many voices, a saint or a devil, a band of men under his window who want to catch him, burn him, behead him. They lie in wait for him, threaten to enter through the walls, climb up and hide under his bed or above him in the ventilators. And then there are other voices who want to help him. Sometimes God is a protector, at other times one of the persecutors. At the persecuting voices, the patients may flee, defend themselves, or attack. With helpful consoling hallucinations, the patient may listen intently, enjoy them like a festivity, even weeping at hearing the voices of heaven. Some patients may go through all sorts of hallucinated experiences while lying under the blankets in their beds, while others climb around, talk loudly or softly to their voices, making all kinds of incomprehensible gestures and motions. Even during conversation or reading, patients may be constantly answering their hallucinations softly or whispering asides to their voices every few seconds.
Now one of the most interesting and important aspects of all this in respect to the parallel with the bicameral mind is the following: auditory hallucinations in general are not even slightly under the control of the individual himself, but they are extremely susceptible to even the most innocuous suggestion from the total social circumstances of which the individual is a part. In other words, such schizophrenic symptoms are influenced by a collective cognitive imperative just as in the case of hypnosis.
A recent study demonstrates this very clearly.9 Forty-five hallucinating male patients were divided into three groups. One group wore on their belts a small box with a lever which when pressed administered a shock. They were instructed to thus shock themselves whenever they began to hear voices. A second group wore similar boxes, were given similar instructions, but pressing the lever did not give the patient a shock. A third group were given similar interviews and evaluation, but had no boxes. The boxes, incidentally, contained counters which recorded the number of lever presses, the frequency ranging from 19 to 2362 times over the fortnight of the experiment. But the important thing is that all three groups were casually led to expect that the frequency of hallucinations might diminish.
It was of course predicted on the basis of learning theory that the shocked group alone would improve. But alas for learning theory, all three groups heard significantly fewer voices. In some cases the voices vanished completely. And no group was superior to another in this respect, showing clearly the huge role of expectation and belief in this aspect of mental organization.
A further observation is a related one, that hallucinations are dependent on the teachings and expectations of childhood — as we have postulated was true in bicameral times. In contemporary cultures where an orthodox excessive personal relationship to God is a part of the child’s education, individuals that become schizophrenic tend to hear strict religious hallucinations more than others.
On the British island of Tortola in the West Indies, for example, children are taught that God literally controls each detail of their life. The name of the Deity is invoked in threats and punishment. Churchgoing is the major social activity. When the natives of this island require any psychiatric care whatever, they invariably describe experiences of hearing commands from God and Jesus, feelings of burning in hell or hallucinations of loud praying and hymn-singing, or sometimes a combination of prayer and profanity.10
When the auditory hallucinations of schizophrenia have no particular religious basis they are still playing essentially the same role as I have suggested was true for the bicameral mind, that of initiating and guiding the patient’s behavior. Occasionally the voices are recognized as authorities even within the hospital. One woman heard voices that were mainly beneficial which she believed were created by the Public Health Service to provide psychotherapy. Would that psychotherapy could always be so easily accomplished! They constantly gave her advice, including, incidentally, not to tell the psychiatrist that she heard voices. They advised her on difficult pronunciations, or gave her hints on sewing and cooking. As she described it,
When I am making a cake, she gets too impatient with me. I try to figure it out all by myself. I am trying to make a clothspin apron and she is right there with me trying to tell me what to do.11