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 $B!H (Ba divine gift, and the source of the chiefest blessings granted to men. $B!I (B3 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 $B!H (Bof 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, $B!I (B 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 $B!H (Bonly a modern and tasteless insertion. $B!I (B4 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 $B!G (Bs 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 $B!G (Bs own time, a time of war, famine, and plague, the four divine insanities were gradually shifting into the realm of the wise man $B!G (Bs poetry and the plain man $B!G (Bs 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 $B!H (Bthat they are gods, and others that they can fly, $B!I (B5 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 $B!G (Bs 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 $B!G (Bs 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 

Some psychiatric investigators, particularly of a psychoanalytic persuasion, wish to infer by the associations the patient uses that the voices can $B!H (Bin all instances .. . be traced to persons who were formerly significant in the patients $B!G (B lives, especially their parents. $B!I (B12 It is supposed that because such figures if recognized would produce anxiety, they are therefore unconsciously distorted and disguised by the patients. But why should that be so? It is more parsimonious to think that it is the patient $B!G (Bs experiences with his parents (or other loved authorities) that become the core around which the hallucinated voice is structured, even as I have suggested was the case with the gods in the bicameral era.

I do not mean that parents do not figure in hallucinations. They often do, particularly in younger patients. But otherwise, the voice-figures of schizophrenia are not parents in disguise; they are authority figures created by the nervous system out of the patient $B!G (Bs admonitory experience and his cultural expectations, his parents of course being an important part of that admonitory experience.

One of the most interesting problems in hallucinations is their relation to conscious thought. If schizophrenia is partly a return to the bicameral mind, and if this is antithetical to ordinary consciousness (which it need not be in all cases), one might expect hallucinations to be the replacement of $B!F (Bthoughts. $B!G (B 

In some patients at least, this is how hallucinations first appear. Sometimes, the voices seem to begin as thoughts which then transform themselves into vague whispers, which then gradually become louder and more authoritative. In other cases, patients feel the beginning of voices $B!H (Bas if their thoughts were dividing. $B!I (B In mild cases, the voices may even be under the control of conscious attention as are $B!F (Bthoughts. $B!G (B As one nondeluded patient described it: 

Here I have been in this ward for two years and a half and almost every day and every hour of the day I hear voices about me, sometimes sounding from the wind, sometimes from footsteps, sometimes rattling dishes, from the rustling trees, or from the wheels of passing trains and vehicles. I hear the voices only if I attend to them, but hear them I do. The voices are words that tell me one story or another, just as if they were not thoughts in my head, but were recounting past deeds ? yet only when I think of them. The whole day through they keep on telling truly my daily history of head and heart.13 

Hallucinations often seem to have access to more memories and knowledge than the patient himself ? even as did the gods of antiquity. It is not uncommon to hear patients at certain stages of their illness complain that the voices express their thoughts before they have a chance to think them themselves. This process of having one $B!G (Bs thoughts anticipated and expressed aloud to one is called in the clinical literature Gedankenlautwerden and is approaching closely the bicameral mind. Some say they never get a chance to think for themselves; it is always done for them and the thought is given to them. As they try to read, the voices read in advance to them. Trying to speak, they hear their thoughts spoken in advance to them. Another patient told his physician that: $B!H (BThinking hurts him, for he can not think for himself. Whenever he begins to think, all his thoughts are dictated to him. He is at pains to change the train of thought, but again his thinking is done for him .. . In church he not infrequently hears a voice singing, anticipating what the choir sings . . . If he walks down the street and sees, say, a sign, the voice reads out to him whatever is on it . . . If he sees an acquaintance in the distance, the voice calls out to him, $B!F (BLook, there goes so and so, $B!G (B usually before he begins to think of the person. Occasionally, though he has not the least intention of noticing passersby, the voice compels him to attend to them by its remarks about them. $B!I (B14

It is the very central and unique place of these auditory hallucinations in the syndrome of many schizophrenics which it is important to consider. Why are they present? And why is $B!H (Bhearing voices $B!I (B universal throughout all cultures, unless there is some usually suppressed structure of the brain which is activated in the stress of this illness? 

And why do these hallucinations of schizophrenics so often have a dramatic authority, particularly religious? I find that the only notion which provides even a working hypothesis about this matter is that of the bicameral mind, that the neurological structure responsible for these hallucinations is neurologically bound to substrates for religious feelings, and this is because the source of religion and of gods themselves is in the bicameral mind. 

Religious hallucinations are particularly common in the so-called twilight states, which are a kind of waking dream in many patients, varying in time from a few minutes to a few years, six months $B!G (B duration being quite common. Invariably such states are characterized by religious visions, posturing, ceremony, and worship, a patient living with hallucinations just as in the bicameral state, except that the environment itself may be hallucinated and the hospital surroundings blotted out. The patient may be in contact with the saints in heaven. Or he may recognize doctors or nurses around him for what they are, but believe that they will prove to be gods or angels in disguise. Such patients may even cry with joy at talking directly with the inhabitants of heaven, may continually cross themselves as they converse with the divine voices or even with the stars, calling to them out of the night.

Often the paranoid, after a lengthy period of difficulties in getting on with people, may begin the schizophrenic aspect of his illness with an hallucinated religious experience in which an angel, Christ, or God speaks to the patient bicamerally, showing him some new way.15 He becomes convinced therefore of his own special relationship to the powers of the universe, and the pathological self-reference of all the occurrences around him then becomes elaborated into delusional ideas which may be pursued for years without the patient $B!G (Bs being able to discuss it. 

Particularly illustrative of the tendency toward religious hallucinations is the famous case of Schreber, a brilliant German jurist around the close of the nineteenth century.16 His own extremely literate retrospective account of his hallucinations while ill with schizophrenia is remarkable from the point of view of their similarity to the relationships of ancient men to their gods. His disease began with a severe anxiety attack during which he hallucinated a crackling in the walls of his house. Then one night, the cracklings suddenly became voices which he immediately recognized as divine communications and $B!H (Bwhich since then have spoken to me incessantly. $B!I (B The voices were continuous $B!H (Bfor a period of seven years, except during sleep, and would persist undeterred even when I was speaking with other people. $B!I (B17 He saw rays of light like $B!H (Blong-drawn-out filaments approaching my head from some vast distant spot on the horizon .. . Or from the sun or other distant stars that do not come towards me in a straight line, but in a kind of circle or parabola. $B!I (B18 And these were the carriers of the divine voices, and could form into the physical beings of gods themselves.

As his illness progressed, it is of particular interest how the divine voices soon organized themselves into a hierarchy of upper and lower gods, as may be supposed to have occurred in bicameral times. And then, streaming down their rays from the gods, the voices seemed to be trying to $B!H (Bsuffocate me and eventually to rob me of my reason. $B!I (B They were committing $B!H (Bsoul-murder, $B!H (B and were progressively $B!H (Bunmanning $B!I (B him, that is, taking away his own initiative or eroding his analog Later in his illness, during more conscious periods, he narratized this into the delusion of being bodily turned into a woman. Freud, I think, overemphasized this particular narratization in his famous analysis of these memoirs, making the entire illness the result of repressed homosexuality that was erupting from the unconscious.19 But such an interpretation, while possibly related to the original etiology of the stress that began the illness, is not very powerful in explaining the case as a whole. 

Now, can we have the temerity to draw a parallel with such phenomena of mental illness and the organization of gods in antiquity? That Schreber also had voice-visions of $B!H (Blittle men $B!I (B is suggestive of the figurines found in so many early civilizations. And the fact that, as he slowly recuperated, the tempo of speech of his gods slowed down and then degenerated into an indistinct hissing20 is reminiscent of how idols sounded to the Incas after the conquest.

A further suggestive parallel is the fact that the sun as the world $B!G (Bs brightest light takes on a particular significance in many unmedicated patients, as it did in the theocracies of bicameral civilizations. Schreber, for example, after hearing his $B!H (Bupper God (Ormuzd) $B!I (B for some time, finally saw him as $B!H (Bthe sun . . . surrounded by a silver sea of rays . . . 21 And a more contemporary patient wrote: 

The sun came to have an extraordinary effect on me. It seemed to be charged with all power; not merely to symbolize God but actually to be God. Phrases like: $B!H (BLight of the World, $B!I (B $B!H (BThe Sun of Righteousness that Setteth Nevermore, $B!I (B etc., ran through my head without ceasing, and the mere sight of the sun was sufficient greatly to intensify this manic excitement under which I was laboring. I was impelled to address the sun as a personal god, and to evolve from it a ritual sun worship.22

In no sense am I thinking here that there is innate sun-worship or innate gods in the nervous system that are released under the mental reorganization of psychosis. The reasons that hallucinations take the particular form they do lie partly in the physical nature of the world, but mostly in education and a familiarity with gods and religious history.   

But I do mean to suggest

  1.  that there are in the brain aptic structures for the very existence of such hallucinations,
  2. that these structures develop in civilized societies such that they determine the general religious quality and authority of such hallucinated voices, and perhaps organize them into hierarchies, 
  3. that the paradigms behind these aptic structures were evolved into the brain by natural and human selection during the early civilizing of mankind, and 
  4. are released from their normal inhibition by abnormal biochemistry in many cases of schizophrenia and particularized into experience. 

There is a great deal more to say about these very real phenomena of hallucination in schizophrenia. And the need for more research here cannot be overstressed. We would like to know the life history of hallucinations and how this relates to the life history of the patient $B!G (Bs illness, of this hardly anything is known. We would like to know more of how the particular hallucinatory experiences relate to the individuals upbringing. Why do some patients have benevolent voices, while others have voices so relentlessly persecuting that they flee or defend themselves or attack someone or something in an attempt to end them? And why do still others have voices so ecstatically religious and inspiring that the patient enjoys them like a festivity? And what are the language characteristics of the voices? Do they use the same syntax and lexicon as the patient $B!G (Bs own speech? Or are they more patterned as we might expect from III.3? All these are problems that can be resolved empirically. When they are, they may indeed give us more insight into the bicameral beginnings of civilization. 

The Erosion of the Analog $B!F (BI $B!G (B

Of what transcending importance is this analog we have of ourselves in our metaphored mind-space, the very thing with which we narratize out solutions to problems of personal action, and see where we are going, and who we are! And when in schizophrenia it begins to diminish, and the space in which it exists begins to collapse, how terrifying the experience must be!

Florid schizophrenic patients all have this symptom in some degree:

When I am ill I lose the sense of where I am. I feel $B!F (BI $B!G (B can sit in the chair, and yet my body is hurtling out and somersaulting about 3 feet in front of me.  |

It is really very hard to keep conversations with others because I can $B!G (Bt be sure if others are really talking or not and if I am really talking back.23

Gradually I can no longer distinguish how much of myself is in me, and how much is already in others. I am a conglomeration, a monstrosity, modeled anew each day.24 

My ability to think and decide and will to do, is torn apart by itself. Finally, it is thrown out where it mingles with every other part of the day and judges what it has left behind. Instead of wishing to do things, they are done by something that seems mechanical and frightening .. . the feeling that should dwell within a person is outside longing to come back and yet having taken with it the power to return.26 

Many are the ways in which this loss of ego is described by patients who are able to describe it at all. Another patient has to sit still for hours at a time $B!H (Bin order to find her thoughts again. $B!I (B Another feels as if $B!H (Bhe died away. $B!I (B Schreber, as we have seen, talked of $B!H (Bsoul-murder. $B!I (B One very intelligent patient needs hours of strenuous effort $B!H (Bto find her own ego for a few brief moments. $B!I (B Or the self feels it is being absorbed by all that is around it by cosmic powers, forces of evil or of good, or by God himself. Indeed, the very term schizophrenia was coined by Bleuler to point to this central experience as the identifying mark of schizophrenia. It is the feeling of $B!F (Blosing one $B!G (Bs mind’, of the self $B!F (Bbreaking off $B!G (B until it ceases to exist or seems to be unconnected with action or life in the usual way, resulting in many of the more obvious descriptive symptoms, such as $B!H (Black of affect $B!I (B or abulia.

Another way in which this erosion of the analog $B!F (BI $B!G (B shows itself is in the relative inability of schizophrenics to draw a person. It is, of course, a somewhat tenuous assumption to say that when we draw a person on paper, that drawing is dependent upon an intact metaphor of the self that we have called the analog $B!F (BI $B!G (B But so consistent has this result been that it has become what is called the Draw-A-Person Test (DAP), now routinely administered as an indicator of schizophrenia.26 Not all schizophrenic patients find such drawings difficult. But when they do, it is extremely diagnostic. They leave out obvious anatomical parts, like hands or eyes; they use blurred and unconnected lines; sexuality is often undifferentiated; the figure itself is often distorted and befuddled. 

But the generalization that this inability to draw a person is a reflecting of the erosion of the analog $B!F (BI $B!G (B should be taken with some circumspection. It has been found that older people sometimes show the same fragmented and primitive drawings as do these schizophrenics, and it should also be noticed that there is a considerable inconsistency with this result and the hypothesis being examined in this chapter. We have stated in an earlier chapter that the analog $B!F (BI $B!G (B came into being toward the end of the second millennium B.C. If the ability to draw a person is dependent upon the drawer having an analog $B!F (BI $B!G (B, then we would expect no coherent pictures of humans before that time. And this most definitely is not the case. It is obvious that there are ways of explaining this discrepancy, but I prefer to simply record the anomaly at this time.

We should not leave this discussion of the erosion of the analog $B!F (BI $B!G (B without mentioning the tremendous anxiety in our own culture that accompanies it, and the attempt, sometimes successful, sometimes unsuccessful, to arrest this terrifying fading-off of that most important part of our interior selves, the almost sacramental center of conscious decision. In fact, much of the behavior that has nothing to do with any reversion to a bicameral mind can be construed as an effort to combat this loss of the analog $B!F (BI $B!G (B. 

Sometimes, for example, there is what is called the $B!H (BI am $B!I (B symptom. The patient in trying to keep some control over his behavior repeats over and over to himself $B!H (BI am, $B!I (B or $B!H (BI am the one present in everything, $B!I (B or $B!H (BI am the mind, not the body. $B!I (B Another patient may use only single words like $B!H (Bstrength $B!I (B or $B!H (Blife $B!I (B to try to anchor himself against the dissolution of his consciousness.27 

The Dissolution of Mind-Space 

A schizophrenic not only begins to lose his $B!F (BI $B!G (B but also his mindspace, the pure paraphrand that we have of the world and its objects that is made to seem like a space when we introspect. To the patient it feels like losing his thoughts, or $B!H (Bthought deprivation, $B!I (B a phrase which elicits immediate recognition from the schizophrenic. The effect of this is so bound up with the erosion of the analog $B!F (BI $B!G (B as to be inseparable from it. Patients cannot easily think of themselves in the places that they are in and so they are unable to utilize information to prepare in advance for things that may happen to them.

One way this can be experimentally observed is in reactiontime studies. All schizophrenics of every type are much less capable than normally conscious people when they attempt to respond to stimuli presented to them at intervals of varying lengths. The schizophrenic, lacking an intact analog $B!F (BI $B!G (B and a mind-space in which to picture himself doing something, is unable to $B!H (Bget ready $B!I (B to respond, and, once responding, is unable to vary the response as the task demands.28 A patient who has been sorting blocks on the basis of form may be unable to shift to sorting them for color when instructed to sort in a different way. 

Similarly, the loss of the analog $B!F (BI $B!G (B and its mind-space results in the loss of as-if behaviors. Because he cannot imagine in the usual conscious way, he cannot play-act, or engage in make-believe actions, or speak of make-believe events. He cannot, for example, pretend to drink water out of a glass if there is no water in it. Or asked what he would do if he were the doctor, he might reply that he is not a doctor. Or if an unmarried patient is asked what he would do if he were married, he might answer that he is not married. And hence his difficulty with the as-if behavior of hypnosis, as I mentioned at the end of the previous chapter. 

Another way the dissolving of mind-space shows itself is in the disorientation in respect to time so common in the schizophrenic. We can only be conscious of time as we can arrange it into a spatial succession, and the diminishing of mind-space in schizophrenia makes this difficult or impossible. For example, patients may complain that $B!H (Btime has stopped, $B!I (B or that everything seems to be $B!H (Bslowed down $B!I (B or $B!H (Bsuspended, $B!I (B or more simply that they have $B!H (Btrouble with time. $B!I (B As one former patient remembered it after he was well:

For a long time no days seemed to me like a day and no night seemed like a night. But this in particular has no shape in my memory. I used to tell time by my meals, but as I believed we were served sets of meals in each real day ? about half a dozen sets of breakfast, lunch, tea, and dinner in each twelve hours ? this was not much help.28

On the face of it, this may seem inconsistent with the hypothesis that schizophrenia is a partial relapse to the bicameral mind. For bicameral man certainly knew the hours of the day and the seasons of the year. But this knowing was, I suggest, a very different knowing from the narratization in a spatially successive time which we who are conscious are constantly doing. Bicameral man had behavioral knowing, responding to the cues for rising and sleeping, for planting and harvesting, cues so important that they were worshiped, as at Stonehenge, and were probably hallucinogenic in themselves. For someone coming from a culture where attention to such cues has been superseded by a different sense of time, the loss of that spatial successiveness leaves the patient in a relatively timeless world. It is interesting in this connection that when it is suggested to normal hypnotic subjects that time does not exist, a schizophrenic form reaction results.30

The Failure of Narratization

With the erosion of the analog and its mind-space, narratization becomes impossible. It is as if all that was narratized in the normal state shatters into associations subordinated to some general thing perhaps, but unrelated to any unifying conceptive purpose or goal, as occurs in normal narratization. Logical reasons cannot be given for behaviors, and verbal answers to questions do not originate in any interior mind-space, but in simple associations or in the external circumstances of a conversation. The whole idea that a person can explain himself, something which in the bicameral era was distinctly the function of gods, can no longer occur.

With the loss of the analog $B!F (BI $B!G (B, its mind-space, and the ability to narratize, behavior is either responding to hallucinated directions, or continues on by habit. The remnant of the self feels like a commanded automaton, as if someone else were moving the body about. Even without hallucinated orders, a patient may have the feeling of being commanded in ways in which he must obey. He may shake hands normally with a visitor, but, asked about this, reply, $B!H (BI don $B!G (Bt do it, the hand proffers itself. $B!I (B Or a patient may feel that somebody else is moving his tongue in speech, particularly as in coprolalia, when scatalogical or obscene words are substituted for others. Even in early stages of schizophrenia, the patient feels memories, music, or emotions, either pleasant or unpleasant, which seem to be forced upon him from some alien source, and, therefore, over which $B!F (Bhe $B!F (B has no control. This symptom is extremely common and diagnostic. And these alien influences often then develop into the full-blown hallucinations I have discussed earlier.

According to Bleuler, $B!H (Bconscious feelings rarely accompany the automatisms which are psychic manifestations split off from the personality. The patients can dance and laugh without feeling happy; can commit murder without hating; do away with themselves without being disappointed with life . . . the patients realize that they are not their own masters. $B!I (B31

Many patients simply allow such automatisms to take place. Others, still able to narratize marginally, invent protective devices against such foreign control of their actions. Negativism itself, even, I think, in neurotics, is such. One of Bleuler $B!G (Bs patients, for example, who was inwardly driven to sing, managed to get hold of a small block of wood which he would cram into his mouth in order to stop his mouth from singing. At present we do not know whether such automatisms and inner commands are always the result of articulate voices directing the patient in his actions, as a relapse to the bicameral mind would suggest. It may indeed be impossible to know, since the split-off fragment of the personality that is still responding to the physician may have suppressed the bicameral commands which are being $B!F (Bheard $B!G (B by other parts of the nervous system.

In many patients this appears as the symptom called Command Automatism. The patient obeys any and every suggestion and command coming from the outside. He is incapable of not obeying authoritative short orders, even when otherwise negativistic. Such orders must deal with simple activities and cannot apply to a long complicated task. The well-known waxy flexibility of catatonics may fall under this heading; the patient is really obeying the physician by remaining in any position in which he is placed. While not all such phenomena are, of course, characteristic of what we have called the bicameral mind, the underlying principle is. An interesting hypothesis would be that patients with such Command Automatism are those in whom auditory hallucinations are absent, and the external voice of the physician is taking its place. 

Consistent with such an hypothesis is the symptom known as echolalia. When no hallucinations are present, the patient repeats back the speech, cries, or expressions of others. But when hallucinations are present, this becomes hallucinatory echolalia, where the patient must repeat out loud all that his voices say to him, rather than those of his environmental surroundings. Hallucinatory echolalia is, I suggest, essentially the same mental organization that we have seen in the prophets of the Old Testament, as well as the aoidoi of the Homeric poems.

Body Image Boundary Disturbance

It is possible that the erosion of the analog $B!F (BI $B!G (B and its mindspace also results in what is called Boundary Loss in Rorschach studies of schizophrenia. This is a score for the proportion of images seen in the ink blots that have poorly defined, fuzzy, or inexistent boundaries or edges. Most interesting from our point of view here is that this measure is strongly correlated with the presence of vivid hallucinatory experiences. A patient high in Boundary Loss often describes it as a feeling of disintegration.

When I am melting I have no hands, I go into a doorway in order not to be trampled on. Everything is flying away from me. In the doorway I can gather together the pieces of my body. It is as if something is thrown in me, bursts me asunder. W h y do I divide myself in different pieces? I feel that I am without poise, that my personality is melting and that my ego disappears and that I do not exist anymore. Everything pulls me apart . . . Th e skin is the only possible means of keeping the different pieces together. There is no connection between the different parts of my body . . . 32 

In one study on Boundary Loss, the Rorschach was given to 80 schizophrenic patients. Boundary definiteness scores were significantly lower than in the group of normals and neurotics matched for age and socio-economic status. Such patients would commonly see in the ink blots mutilated bodies, animal or human.33 This mirrors the breaking up of the analog self, or the metaphor picture that we have of ourselves in consciousness. In another study of 604 patients in Worcester State Hospital, it was specifically found that Boundary Loss, including, we may presume, the loss of the analog $B!F (BI $B!G (B, is a factor in the development of hallucinations. Patients who had more hallucinations were those who were less successful in establishing $B!H (Bboundaries between the self and the world. $B!I (B34

Along the same line of thought, chronic schizophrenic patients are sometimes unable to identify themselves in a photograph, or may misidentify themselves, whether they are photographed individually or in a group.

The Advantages of Schizophrenia

A curious heading, certainly, for how can we say there are advantages of so terrifying an illness? But I mean such advantages in the light of all human history. Very clearly, there is a genetic inherited basis to the biochemistry underlying this radically different reaction to stress. And a question that must be asked of such a genetic disposition to something occurring so early in our reproductive years is, what biological advantage did it once have? Why, in the slang of the evolutionist, was it selected for? And at what period long, long ago, since such genetic disposition is present all over the world? 

The answer, of course, is one of the themes I have stated so often before in this essay. The selective advantage of such genes was the bicameral mind evolved by natural and human selection over the millennia of our early civilizations. The genes involved, whether causing what to conscious men is an enzyme deficiency or other, are the genes that were in the background of the prophets and the $B!F (Bsons of the nabiim $B!G (B and bicameral man before them.

Another advantage of schizophrenia, perhaps evolutionary, is tirelessness. While a few schizophrenics complain of generalized fatigue, particularly in the early stages of the illness, most patients do not. In fact, they show less fatigue than normal persons and are capable of tremendous feats of endurance. They are not fatigued by examinations lasting many hours. They may move about day and night, or work endlessly without any sign of being tired. Catatonics may hold an awkward position for days that the reader could not hold for more than a few minutes. This suggests that much fatigue is a product of the subjective conscious mind, and that bicameral man, building the pyramids of Egypt, the ziggurats of Sumer, or the gigantic temples at Teotihuacan with only hand labor, could do so far more easily than could conscious self-reflective men.

A further thing that schizophrenics do $B!F (Bbetter $B!G (B than the rest of us ? although it certainly is no advantage in our abstractly complicated world ? is simple sensory perception. They are more alert to visual stimuli, as might be expected if we think of them as not having to strain such stimuli through a buffer of consciousness. This is seen in their ability to block EEG alpha waves more quickly than normal persons following an abrupt stimulus, and to recognize projected visual scenes coming into focus considerably better than the normal.35 Indeed, schizophrenics are almost drowning in sensory data. Unable to narratize or conciliate, they see every tree and never the forest. They seem to have a more immediate and absolute involvement with their physical environment, a greater in-the-world-ness. Such an interpretation, at least, could be put on the fact that schizophrenics fitted with prism glasses that deform visual perception learn to adjust more easily than the rest of us, since they do not overcompensate as much.36

The Neurology of Schizophrenia

If schizophrenia is in part a relapse to the bicameral mind, and if our earlier analyses have any merit, then we should find some kind of neurological changes that are consistent with the neurological model suggested in I.5. There I proposed that the hallucinated voices of the bicameral mind were amalgams of stored admonitory experiences that were somehow organized in the right temporal lobe and conveyed to the left or dominant hemisphere over the anterior commissures and perhaps the corpus callosum.

Further, I have suggested that the advent of consciousness necessitated an inhibition of these auditory hallucinations originating in the right temporal cortex. But what precisely this means in a neuro-anatomical sense is far from clear. We definitely know that there are specific areas of the brain that are inhibitory to others, that the brain in a very general way is always in a kind of complicated tension (or balance) between excitation and inhibition, and also that inhibition can occur in a number of different ways. One way is an inhibition of an area in one hemisphere by excitation of an area in the other. The frontal eye fields, for example, are mutually inhibitory, such that stimulation of the frontal eye field on one hemisphere inhibits the other.37 And we may suppose that some proportion of the fibers of the corpus callosum which connects the frontal eye fields are inhibitory themselves, or else excite inhibitory centers on the opposite hemisphere. In behavior, this means that looking in any direction is programmed as the vector resultant of the opposing excitation of the two frontal eye fields.38 And this mutual inhibition of the hemispheres can be presumed to operate in various other bilateral functions.

But to generalize this reciprocal inhibition to asymmetrical unilateral functions is a more daring matter. Can we suppose, for example, that some mental process on the left hemisphere is paired in reciprocal inhibition with some different function on the right, so that some of the so-called higher mental processes could be the resultants of the two opposing hemispheres?

At any rate, the first step in bringing some credence to these ideas about the relationship of schizophrenia to the bicameral mind and its neurological model is to look for some kind of laterality differences in schizophrenics. Do such patients have different right-hemispheric activity from the rest of us? Research on this hypothesis is only beginning, but the following very recent studies are at least suggestive:

  • In most of us, the total EEG over a long time period shows slightly greater activity in the dominant left hemisphere than in the right hemisphere. But the reverse tends to occur in schizophrenia: slightly more activity in the right.39  
  • This increased right hemisphere activity in schizophrenia is much more pronounced after several minutes of sensory deprivation, the same condition that causes hallucinations in normal persons.
  • If we arrange our EEG machine so that we can tell which hemisphere is more active every few seconds, we find that in most of us this measure switches back and forth between the hemispheres about once a minute. But in those schizophrenics so far tested, the switching occurs only about every four minutes, an astonishing lag. This may be part of the explanation of the $B!H (Bsegmental set $B!I (B I have previously referred to, that schizophrenics tend to $B!H (Bget stuck $B!I (B on one hemisphere or the other and so cannot shift from one mode of information processing to another as fast as the rest of us. Hence their confusion and often illogical speech and behavior in interaction with us, who switch back and forth at a faster rate.40
  • It is possible that the explanation of this slower switching in schizophrenia is anatomical. A series of autopsies of long-term schizophrenics have, surprisingly, shown that the corpus callosum which connects the two hemispheres is 1 mm. thicker than in normal brains. This is a statistically reliable result. Such a difference may mean more mutual inhibition of the hemispheres in schizophrenics.41 The anterior commissures in this study were not measured.
  • If our theory is true, any extensive dysfunction of the left temporal cortex due to disease, circulatory changes, or stressinduced alteration of its neurochemistry should release the right temporal cortex from its normal inhibitory control. When temporal lobe epilepsy is caused by a lesion on the left temporal lobe (or on both the left and right), thus (presumably) releasing the right from its normal inhibition, a full 90 percent of the patients develop paranoid schizophrenia with massive auditory hallucinations. When the lesion is on the right temporal lobe alone, fewer than 10 percent develop such symptoms. In fact this latter group tend to develop a manic-depressive psychosis.42 

These findings need to be confirmed and explored further. But together they indicate without doubt and for the first time significant laterality effects in schizophrenia. And the direction of these effects can be interpreted as partial evidence that schizophrenia may be related to an earlier organization of the human brain which I have called the bicameral mind. 

In Conclusion 

Schizophrenia is one of our most morally prominent problems of research, such the agony of heart that it spreads both in those afflicted and in those who love them. Recent decades have watched with gratitude a strong and accelerating improvement in the way this illness is treated. But this has come about not under the banners of new and sometimes flamboyant theories such as mine, but rather in the down-to-earth practical aspects of day-today therapy.  

Indeed, theories of schizophrenia ? and they are legion ? because they have too often been the hobbyhorses of competing perspectives, have largely defeated themselves. Each discipline construes the findings of others as secondary to the factors in its own area. The socio-environmental researcher sees the schizophrenic as the product of a stressful environment. The biochemist insists that the stressful environment has its effect only because of an abnormal biochemistry in the patient. Those who speak in terms of information processing say that a deficit in this area leads directly to stress and counterstress defenses. The defense-mechanism psychologist views the impaired information processing as a self-motivated withdrawal from contact with reality. The geneticist makes hereditary interpretations from family history data. While others might develop interpretations about the role of schizophrenogenic parental influence from the same data. And so on. As one critic has expressed it, $B!H (BLike riding the merry-go-round, one chooses his horse. One can make believe his horse leads the rest. Then when a particular ride is finished, one must step off only to observe that the horse has really gone nowhere.43

It is thus with some presumption that I add yet one more loading to this heavy roster. But I have felt impelled to do so, if only out of responsibility in completing and clarifying the suggestiveness of earlier parts of this book. For schizophrenia, whether one illness or many, is in its florid stage practically defined by certain characteristics which we have stated earlier were the salient characteristics of the bicameral mind. The presence of auditory hallucinations, their often religious and always authoritative quality, the dissolution of the ego or analog and of the mind-space in which it once could narratize out what to do and where it was in time and action, these are the large resemblances.

But there are great differences as well. If there is any truth to this hypothesis, the relapse is only partial. The learnings that make up a subjective consciousness are powerful and never totally suppressed. And thus the terror and the fury, the agony and the despair. The anxiety attendant upon so cataclysmic a change, the dissonance with the habitual structure of interpersonal relations, and the lack of cultural support and definition for the voices, making them inadequate guides for everyday living, the need to defend against a broken dam of environmental sensory stimulation that is flooding all before it ? produce a social withdrawal that is a far different thing from the behavior of the absolutely social individual of bicameral societies. The conscious man is constantly using his introspection to find $B!F (Bhimself $B!G (B and to know where he is, relevant to his purposes and situation. And without this source of security, deprived of narratization, living with hallucinations that are unacceptable and denied as unreal by those around him, the florid schizophrenic is in an opposite world to that of the god-owned laborers of Marduk or of the idols of Ur.

The modern schizophrenic is an individual in search of such a culture. But he retains usually some part of the subjective consciousness that struggles against this more primitive mental organization, that tries to establish some kind of control in the middle of a mental organization in which the hallucination ought to do the controlling. In effect, he is a mind bared to his environment, waiting on gods in a godless world.