Free Hallucinations by Oliver Sacks

other treatments, and careful history taking, looking at the whole life of the patient, had largely been replaced by the use of DSM criteria to make snap diagnoses.
    E ugen Bleuler, who directed the huge Burghölzli asylum near Zurich from 1898 to 1927, paid close and sympathetic attention to the many hundreds of schizophrenic people under his care. He recognized that the “voices” his patients heard, however outlandish they might seem, were closely associated with their mental states and delusions. The voices, he wrote, embodied “all their strivings and fears … their entire transformedrelationship to the external world … above all … [to] the pathological or hostile powers” that beset them. He described these in vivid detail in his great 1911 monograph,
Dementia Praecox; or, The Group of Schizophrenias:
    The voices not only speak to the patient, but they pass electricity through the body, beat him, paralyse him, take his thoughts away. They are often hypostasized as people, or in other very bizarre ways. For example, a patient claims that a “voice” is perched above each of his ears. One voice is a little larger than the other but both are about the size of a walnut, and they consist of nothing but a large ugly mouth.
    Threats or curses form the main and most common content of the “voices.” Day and night they come from everywhere, from the walls, from above and below, from the cellar and the roof, from heaven and from hell, from near and far.… When the patient is eating, he hears a voice saying, “Each mouthful is stolen.” If he drops something, he hears, “If only your foot had been chopped off.”
    The voices are often very contradictory. At one time they may be against the patient … then they may contradict themselves.… The roles of pro and con are often taken over by voices of different people.… The voice of a daughter tells a patient: “He is going to be burned alive,” while his mother’s voice says, “He will not be burned.” Besides their persecutors the patients often hear the voice of some protector.
    The voices are often localized in the body.… A polyp may be the occasion for localizing the voices in the nose. An intestinal disturbance brings them into connection with the abdomen.… In cases of sexual complexes, the penis, the urine in the bladder, or the nose utter obscene words.… A reallyor imaginarily gravid patient will hear her child or children speaking inside her womb.…
    Inanimate objects may speak. The lemonade speaks, the patient’s name is heard to be coming from a glass of milk. The furniture speaks to him.
    Bleuler wrote, “Almost every schizophrenic who is hospitalized hears ‘voices.’ ” But he emphasized that the reverse did not hold—that hearing voices did not necessarily denote schizophrenia. In the popular imagination, though, hallucinatory voices are almost synonymous with schizophrenia—a great misconception, for most people who do hear voices are not schizophrenic.
    M any people report hearing voices which are not particularly directed at them, as Nancy C. wrote:
    I hallucinate conversations on a regular basis, often as I am falling asleep at night. It seems to me that these conversations are real and are actually taking place between real people, at the very time I’m hearing them, but are occurring somewhere else. I hear couples arguing, all kinds of things. They are not voices I can identify, they are not people I know. I feel like I’m a radio, tuned into someone else’s world. (Though always an American-English-speaking world.) I can’t think of any way to regard these experiences except as hallucinations. I am never a participant; I am never addressed. I am just listening in.
    “Hallucinations in the sane” were well recognized in the nineteenth century, and with the rise of neurology, peoplesought to understand more clearly what caused them. In England in the 1880s, the Society for Psychical Research was founded to