Hearing Things: When Auditory Hallucinations Take Over the Mind

One leading neuroscientist explains that we’re all capable of hallucinations—and that, to better understand the brain, these weird experiences are worth listening to.

| January 2013

Hallucinations don’t belong wholly to the insane. Much more commonly, they are linked to sensory deprivation, intoxication, illness, or injury. In Hallucinations (Knopf, 2012), Oliver Sacks weaves together stories of his patients, of his own mind-altering experiences and of his lifelong fascination with hallucinations. The book examines perceived reality and illuminates what “seeing things” or “hearing things” tells us about the organization and structure of our brains, how “visions” have influenced every culture’s folklore and art, and why the potential for hallucination is present in us all. In this excerpt from chapter four, “Hearing Things,” Sacks dives into the fascinating realm of auditory hallucinations, from the malicious and psychotic to the puzzling constant private concert of “earworms”—non-existent music that just won’t go away. 

In 1973 the journal Science published an article that caused an immediate furor. It was entitled "On Being Sane in Insane Places," and it described how, as an experiment, eight "pseudopatients" with no history of mental illness presented themselves at a variety of hospitals across the United States. Their single complaint was that they "heard voices." They told hospital staff that they could not really make out what the voices said but that they heard the words "empty," "hollow," and "thud." Apart from this fabrication, they behaved normally and recounted their own (normal) past experiences and medical histories. Nonetheless, all of them were diagnosed as schizophrenic (except one, who was diagnosed with "manic-depressive psychosis"), hospitalized for up to two months, and prescribed antipsychotic medications (which they did not swallow). Once admitted to the mental wards, they continued to speak and behave normally; they reported to the medical staff that their hallucinated voices had disappeared and that they felt fine. They even kept notes on their experiment, quite openly (this was registered in the nursing notes for one pseudopatient as "writing behavior"), but none of the pseudopatients were identified as such by the staff.

This experiment, designed by David Rosenhan, a Stanford psychologist (and himself a pseudopatient), emphasized, among other things, that the single symptom of "hearing voices" could suffice for an immediate, categorical diagnosis of schizophrenia even in the absence of any other symptoms or abnormalities of behavior. Psychiatry, and society in general, had been subverted by the almost axiomatic belief that "hearing voices" spelled madness and never occurred except in the context of severe mental disturbance.

This belief is a fairly recent one, as the careful and humane reservations of early researchers on schizophrenia made clear. But by the 1970s, antipsychotic drugs and tranquilizers had begun to replace 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.

Eugen 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 transformed relationship 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.