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Voices carry

The message and mystery of auditory hallucinations, from Moses to modern times

Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination
By Daniel B. Smith
Penguin, 254 pp., $24.95

Imagine that you are sitting on a bench in an MBTA station, waiting for a train. Next to you is an older man, staring into the distance with a glazed look in his eyes. Every few minutes his lips move in silent speech. Then, his trance seems to break, and he turns to you. "I hear voices in my head," he says, "that tell me what to do. "

Chances are you will politely nod, sidle to the end of the bench, and scan the platform for another place to sit. Your reaction likely mixes pity with anxiety, because auditory hallucinations signal psychosis, and you're saddened and unnerved encountering a person unable to distinguish between reality and illusion.

The man in the subway station fades from your mind until you next attend your house of prayer, whether it be a church, synagogue, or mosque. And as the priest or rabbi or imam delivers his sermon, he refers to sacred texts that recount how Moses spoke with God at the burning bush, or how Ignatius Loyola and Martin Luther listened to the divine call, or how Mohammed was instructed by Allah to write down the suras of the Koran. As a person of faith, you venerate those who heard God's voice and translated it into wisdom for the world.

Suppose you are not a religious person but a secular humanist, committed to living an ethical and self-aware life. Then Socrates would be one of your guides. He formulated his philosophy through dialogue with the Athenians around him. But, it turns out, Socrates also regularly turned inward, listening to an inner voice that he termed his "daimonion." Rather than consult the sanctioned oracle at Delphi, he strictly obeyed the unique voice in his head.

Daniel B. Smith, in the articulate, engaging, and deeply researched "Muses, Madmen, and Prophets," wrestles with what it means to hear voices. Saint, scholar, or schizophrenic -- why do we assign differing values and valences to individuals who hear voices, and to what their voices say?

Smith's interest in auditory hallucinations stems from a jarring discovery made during his youth: Both his father and grandfather heard voices. He learned about his grandfather's case when, as a teenager, he assisted him in preparing a rambling memoir of his life. His grandfather was living in a benign equilibrium with his voices; he called upon them to make key business decisions, and to assist him in keeping or discarding cards when he played gin (alas, the voices proved of no benefit at the race track). Smith's father had a very different relationship with his voices. They capriciously intruded into his life, demanding, for example, that he move a glass from one side of the table to another, or that he choose a particular token to insert into a subway turnstile. The burden of these voices ultimately crushed him, and he required care in a psychiatric facility. Although he recovered, the voices never left him, and to his dying day he listened to them with a deep sense of shame.

Smith himself has never heard a voice. He describes his attempt to experience voice-hearing: Walkman plugged in, he plays a disc that purports to reproduce the authentic sounds and speech heard by people like the man in the MBTA station. Smith cruises around lower Manhattan, but the experiment fails. He cannot open himself fully to the voices.

Contrary to popular notions, auditory hallucinations are not rare. One study of 375 healthy volunteers, cited in the book, revealed that 57 percent had, at times, thought they heard strangers say their name; 39 percent heard their thoughts aloud; 11 percent regularly heard distinct voices; and 5 percent engaged in conversation with their voices. "The surveys seem to be telling us . . . that auditory hallucinations are not limited to the mentally ill," Smith concludes. "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."

Smith's fluid prose brings to life hearers of both harsh and soft voices in different cultures and historical periods -- not only Socrates and the prophets, but also Joan of Arc and Daniel Paul Schreber, a prominent 19th-century German judge who sued to leave a state asylum. More recently, auditory hallucinations have entered the battleground of identity politics; while most in the psychiatric community view it as diagnostic of pathology, others, especially those who hear voices, celebrate it as an integral part of their community. Marius Romme, a professor of social psychiatry at the University of Limburg in the Netherlands, appeared on a popular Dutch talk show with Patsy Hage, a 30-year-old woman who heard voices. Hage had been diagnosed as schizophrenic, did not benefit from medication, and only found comfort in the knowledge that voice-hearing was common in the ancient world. Hundreds of people called in to the show, many claiming that they were able to listen to their voices without difficulty or distress. This spawned the "Hearing Voices Movement," and its leaders, Romme and a colleague, the journalist Sandra Escher, ultimately rejected the view that persistent voice- hearing was a certain sign of psychosis. Hallucinators, Romme said, "are like homosexuals in the 1950s -- in need of liberation, not cure."

Smith adds his voice to the debate by addressing the cultural resonance of the word "hallucination." "It is, rather, the practical and often immeasurable effects of language: the soft tyranny of offering a single pathological term for an experience that, both historically and in the present, reaches into more varied and . . . exalted forms of human consciousness than is typically assumed." The story of voice- hearing is marked by triumphs of Western philosophy, religion, and literature, and tragedies of lives shackled by a hectoring hallucination. Even those who sharply differ with Smith will appreciate the truth that we have all been profoundly shaped by those who heard voices.

Jerome Groopman, MD, is a professor at Harvard Medical School and Beth Israel Deaconess Medical Center. A staff writer for The New Yorker, he is the author of "How Doctors Think."