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Supporting Evidence: New Research
Supporting Jaynes' Bicameral Mind Theory

Auditory and Visual Hallucinations in Normal (Non-Psychotic) Adults

Supporting Evidence > Auditory and Visual Hallucinations in Normal (Non-Psychotic) Adults

In his theory, Julian Jaynes describes the role hallucinations played in an earlier mentality, prior to the development of subjective consciousness. He predicted that hallucinations were more common in the normal population than was known at the time, and this has been confirmed in literally hundreds of studies over the past three decades. Below is a small sample of research supporting this aspect of Jaynes's theory.

Examining the Continuum Model of Auditory Hallucinations: A Review of Cognitive Mechanisms
Badcock, Johanna C. and Kenneth Hugdahl. Hallucinations, 2012, Part 3, 317-328.
Faced with mounting evidence that auditory hallucinations occur both in health and in psychosis, the continuum model of psychotic symptoms has become the "accepted dogma." Despite the dominant influence of this model, careful phenomenological comparison suggests both similarities and differences between nonpsychotic and psychotic "voice hearers." Wider recognition of the differences, as well as similarities, of "voice hearing" and auditory hallucinations in healthy and psychotic individuals, respectively, should encourage clinicians to conduct more detailed assessments of phenomenology and cognition in patients presenting with "voices" and develop more targeted (i.e., individualized) pharmacological and/or psychosocial interventions as necessary.

Visual Hallucinations and Sensory Delusions in the Elderly
Berrios, G. E., and P. Brook. British Journal of Psychiatry, June 1984, 144, 662–664.
One hundred and fifty successive referrals to a psychogeriatrician were assessed for visual hallucinations. Forty-four (29.33 per cent) patients reported visual perceptual disturbances. No differences between hallucinators and non-hallucinators were found in terms of sex, age, length of illness, underlying psychiatric diagnosis or cognitive score. There was a significant correlation between presence of hallucinations and eye pathology (less than .001) and delusions (less than .001). The phenomenological characteristics of the visual hallucinations are analyzed. The "picture" sign is described in 7 patients and the Charles Bonnet syndrome in two. The significance of these findings is discussed.

Visions For All: People who Report Vivid Religious Experiences May Hold Clues to Nonpsychotic Hallucinations
Bower, Bruce. Science News, April 2012, 181 (7): 22–25.

Hallucinatory Experiences in Extreme-Altitude Climbers
Brugger, Peter, Marianne Regard, Theodor Landis, and Oswald Oelz. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, Jan. 1999, 12 (1): 67–71.
This study attempted a systematic investigation of incidence, type, and circumstances of anomalous perceptual experiences in a highly specialized group of healthy subjects, extreme-altitude climbers. BACKGROUND: There is anecdotal evidence for a high incidence of anomalous perceptual experiences during mountain climbing at high altitudes. METHOD: In a structured interview, we asked eight world-class climbers, each of whom has reached altitudes above 8500 m without supplementary oxygen, about hallucinatory experiences during mountain climbing at various altitudes. A comprehensive neuropsychological, electroencephalographic, and magnetic resonance imaging evaluation was performed within a week of the interview (8). RESULTS: All but one subject reported somesthetic illusions (distortions of body scheme) as well as visual and auditory pseudohallucinations (in this order of frequency of occurrence). A disproportionately large number of experiences above 6000 m as compared to below 6000 m were reported (relative to the total time spent at these different altitudes). Solo climbing and (in the case of somesthetic illusions) life-threatening danger were identified as probable triggers for anomalous perceptual experiences. No relationship between the number of reported experiences and neuropsychological impairment was found. Abnormalities in electroencephalographic (3 climbers) and magnetic resonance imaging (2 climbers) findings were likewise unrelated to the frequency of reported hallucinatory experiences. CONCLUSIONS: The results confirm earlier anecdotal evidence for a considerable incidence of hallucinatory experiences during climbing at high altitudes. Apart from hypoxia, social deprivation and acute stress seem to play a role in the genesis of these experiences.

Visual and Auditory Hallucinations in A Psychologically Normal Woman
Chedru, F., F. Feldman, A. Ameri, J. Sales, and M. Roth. Lancet, Sept. 28 1996, 348 (9031):896.

The Origins of Voices: Links Between Life History and Voice Hearing in a Survey of 100 Cases
Corstens, Dirk and Eleanor Longden. Psychosis: Psychological, Social and Integrative Approaches, Special Issue: Voices in a Positive Light, 2013, 5 (3).
A data synthesis is presented from 100 clinical cases, 80% with a diagnosis of schizophrenia or other psychotic disorder, in which Romme and Escher's "construct" method was used to formulate voice-hearing content and characteristics in relation to life events. Across the sample, most participants heard between two and five voices and the average duration of voice hearing was 18 years. At least one adverse childhood experience was reported by 89% of the sample, including family conflict, neglect, physical/sexual/emotional maltreatment, and bullying. In addition, a broad range of acute, precipitating stressors were associated with the onset of voice hearing itself in both childhood and adulthood. In 94% of cases, it was possible to clearly formulate the underlying emotional conflicts embodied by the voices (e.g., low self-worth, anger, shame and guilt). Representations for voice identity (e.g., disowned aspects of self, a family member, a past abuser) were formulated in 78% of cases. It is proposed that many individuals hear voices that make psychological sense in the context of life events, and that this information can be clinically applied in ways that serve personal recovery.

Auditory and Visual Hallucinations in University Students
Feelgood, S. R. and A. J. Rantzen. Personality and Individual Differences, 1994, 17 (2): 293-296.
One-hundred and thirty-six univeristy students were administered the Launay-Slade Hallucination Scale (LSHS). Low and high scorers then completed a visual and an auditory task that utilized non-hypnotic suggestion and ambiguous stimuli. The high LSHS group reported a significantly greater number of meaningful visual and auditory experiences in response to the ambiguous stimulation. It is argued that these phenomena are hallucinations and demonstrate the possibility of researching hallucinations in non-psychotic populations in a laboratory setting.

Hallucinatory Experiences at High Altitude
Garrido, Eduardo, Casimiro Javierre, Josep L. Ventura, and Ramon Segura. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, April 2000, 13 (2): 148–148.

Auditory Hallucinations Following Near-Death Experiences
Greyson, B. and M.B. Liester. Journal of Humanistic Psychology, 2004, 44: 320-336.
Among persons who reported having had near-death experiences, 80% also reported subsequent auditory hallucinations. Experiencers’ attitudes toward these hallucinations were over-whelmingly positive, as contrasted with the overwhelmingly negative attitudes of patients with schizophrenia toward their auditory hallucinations. Auditory hallucinations not related to disease processes are common and may be highly valued by those who hear them.

Hallucinations Following the Loss of a Spouse: Common and Normal Events Among the Elderly
Grimby, Agneta. Journal of Clinical Geropsychology, 1998, 4 (1): 65-74.
In a widowhood intervention study of elderly Swedish citizens, ratings of grief reactions showed a high proportion of postbereavement hallucinations and illusions. Most common was the feeling that the deceased was present (illusion). Claiming to speak to, and to hear and see the dead spouse (hallucinations) was rather common. Very few had tactile hallucinations. Former marital harmony, loneliness, and severe crying are related to the incidence of hallucinations/illusions. Subjects had a dualistic attitude to the phenomena, as they were considered ridiculous sensations, but a pleasant and comforting rendezvous with the lost beloved one.

Hallucinatory Experiences in Non-clinical Populations
Hill, Katy and David E.J. Linden. In Renaud Jardi, et al (eds.) The Neuroscience of Hallucinations (Springer, 2013, 21-41).
It is now widely recognised that some people hear voices in the absence of distress or a need for psychiatric care. Although there have been reports of such individuals throughout history, until relatively recently there was little empirical research on this population. The consensus from interview and questionnaire-based research is that non-clinical voice-hearers hear voices that are more positive in content, less frequent, less disruptive, and less distressing. Influenced by cognitive models of psychosis, the literature has focused on the appraisals that voice-hearers make of their voices, to the exclusion of other variables such as content. There is growing evidence that clinical voice-hearers have more negative beliefs about their voices and that these are influenced by their more negative beliefs about people in general, formed in the context of negative life experiences. Initial fMRI data suggests that non-clinical voices are underpinned by similar neural mechanisms as clinical voices but as yet it is unclear from these studies why they are experienced so differently. The current chapter reviews these findings and suggest avenues for future research.

A Study of Manifestations of Hallucinations in a Non-Psychiatric Population of Caribbean Descent
Izquierdo, A. M. Dissertation Abstracts International: Section B: The Sciences & Engineering, Dec. 2000, 61(5-B): 2764.

Commentary Hallucination in the Elderly: Three Case Reports
Kobayashi, T., S. Kato, T. Osawa, and K. Shioda. Psychogeriatrics, September 2004, 4 (3): 96-101(6).
Three elderly females with commentary hallucinations are presented. Here, the term ‘commentary hallucination’ is used as a comprehensive term describing a condition where the subject hears voices that comment on, command, or describe the subject's actions or behavior. According to the DSM-IV, the three cases presented here met the criteria for a psychotic disorder not otherwise specified, a schizoaffective disorder, and schizophrenia, respectively. All three cases showed no evidence of abnormalities when examined using neuroimaging techniques but might have had some senile brain changes that were under the threshold of the neuroimaging studies. Although the commentary hallucinations in the three patients were not distinctively different from the hallucinations that are characteristic of schizophrenia, the subjects were able to keep some distance from the hallucinations; in other words, the hallucinations were not ego-invasive. The commentary hallucinations in the present patients might be explained as resulting from exhaustion caused by stressful life events, subtle senile organic brain changes, and a subsequent decline in psychological tension. These hallucinations may have originated from the pathological appearance of a background-inner speech accompanying the patients’ behavior.

The Characteristic Features of Auditory Verbal Hallucinations in Clinical and Nonclinical Groups: State-of-the-Art Overview and Future Directions
Larři, Frank, Iris E. Sommer, Jan Dirk Blom, Charles Fernyhough, Dominic H. ffytche, Kenneth Hugdahl, Louise C. Johns, Simon McCarthy-Jones, Antonio Preti, Andrea Raballo, Christina W. Slotema, Massoud Stephane, and Flavie Waters. Schizophrenia Bulletin, 2012.
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson's disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.

A Study of Hallucinations in Normal Subjects
McCreery, C. and G. Claridge. Personality and Individual Differences, 1996, 21 (5): 739-747.
A group of 20 subjects who reported previously experiencing at least one ‘out-of-the-body’ experience (OBE) and a group of 20 matched controls attempted to induce OBEs in the laboratory under conditions of mild sensory limitation and physical relaxation. As predicted, the OBErs were more prone than controls to report hallucinations and involuntary imagery in this situation. The reporting of anomalous perceptual experiences was also positively correlated with scores on schizotypy scales, which measure the incidence of ‘positive’ symptomatology at a sub-clinical level. The results are interpreted in terms of a model of the 'happy schizotype'—a relatively well-adjusted person who is functional despite, and in some cases even because of, his or her anomalous perceptual experiences.

Auditory Hallucinations: Psychotic Symptom or Dissociative Experience?
Moskowitz, Andrew and Dirk Corstens. Journal of Psychological Trauma, January 2008, 6 (2 & 3): 35-63.
While auditory hallucinations are considered a core psychotic symptom, central to the diagnosis of schizophrenia, it has long been recognized that persons who are not psychotic may also hear voices. There is an entrenched clinical belief that distinctions can be made between these groups, typically, on the basis of the perceived location or the 'third-person' perspective of the voices. While it is generally believed that such characteristics of voices have significant clinical implications, and are important in the differential diagnosis between dissociative and psychotic disorders, there is no research evidence in support of this. Voices heard by persons diagnosed schizophrenic appear to be indistinguishable, on the basis of their experienced characteristics, from voices heard by persons with dissociative disorders or by persons with no mental disorder at all. On this and other bases outlined in this article, we argue that hearing voices should be considered a dissociative experience, which under some conditions may have pathological consequences. In other words, we believe that, while voices may occur in the context of a psychotic disorder, they should not be considered a psychotic symptom.

Psychotic Symptoms Psychotic Symptoms in an Urban General Medicine Practice
Olfson, M., R. Lewis-Fernandez, M. Weissman, A. Feder, M. Gamerof, D. Pilowsky, and M. Fuentes. American Journal of Psychiatry, August 2002, 159: 1412-1419.
OBJECTIVE: The authors’ goals were to estimate the prevalence of psychotic symptoms among adults attending an urban general medical practice that serves a low-income population and to describe the mental health, social and occupational functioning, and mental health treatment of these patients. METHOD: Data were drawn from a recent study of adult primary care patients (N=1,005) in a large, urban, university-affiliated general medicine practice. During a medical visit, patients completed the psychotic disorders section of the Mini International Neuropsychiatric Interview, the Primary Care Evaluation of Mental Disorders, a drug use disorders screen, the Sheehan Disability Scale, and a questionnaire that probed demographic characteristics, health status, and mental health treatment. RESULTS: Two hundred ten (20.9%) patients reported one or more psychotic symptoms, most commonly auditory hallucinations. There was an inverse correlation between family income and the prevalence of psychotic symptoms and a positive association between prevalence and Hispanic ethnicity. Compared with patients without psychotic symptoms, patients with psychotic symptoms were significantly more likely to have major depression (42.4% versus 12.6%), panic disorder (24.8% versus 4.0%), generalized anxiety disorder (38.6% versus 8.4%), and alcohol use disorder (12.9% versus 5.0%). They were also more likely to report current suicidal ideation (20.0% versus 3.5%), recent work loss (55.0% versus 35.6%), and marital distress (28.6% versus 13.0%). Approximately one-half of the patients with psychotic symptoms (47.6%) had taken a prescribed psychotropic medication during the last month. CONCLUSIONS: Psychotic symptoms were highly prevalent in this primary care practice. These patients were at risk for several common mental disorders and often reported impaired work and social functioning. Future research should clarify the extent to which psychotic symptom reports among Hispanic patients are affected by culturally patterned idioms of distress. Clinicians who work in primary care practices that serve low-income patient populations should routinely inquire about psychotic symptoms.

Hallucinations in A Normal Population: Imagery and Personality Influences
Rodrigo, A.M.L., M.M.P. Pineiro, P.C.M. Suarez, M.I. Caro, and S.L. Giraldez. Psychology in Spain, 1997, 1 (1): 10-16.
The present study was designed to gather data related to the continuum hypothesis of hallucinations. According to this hypothesis, hallucinations can be considered to be one end of a continuum of normal conscious experience that include vivid imagery, daydreams, and thoughts. Subjects were 222 college students who anonymously completed the Hallucination Questionnaire (Barrett and Etheridge, 1994), the Betts QMI Vividness of Imagery Scale (Richardson, 1969), and Millon’s Clinical Multiaxial Inventory (MCMI-II) (Millon, 1983). The results suggest that hallucinators have more vivid imagery and higher scores on most Millon’s Inventory scales compared to non-hallucinators. Nevertheless, a normal distribution of the hallucinatory experiences was not found, which casts doubt on their dimensional nature.

Coping with Hearing Voices: An Emancipatory Approach
Romme, M.A.J., A. Honig, E.O. Noorthoorn, and A.D.M.A.C. Escher. British Journal of Psychiatry, 1992, 161: 99-103.
A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

Hearing Voices
Romme, M. and S. Escher. Schizophrenia Bulletin, 1989, 15: 209-216.
An experiment is described in which people with auditory hallucinations were brought into contact with each other. On an evening television talk show, a patient — diagnosed several times as having schizophrenia — talked about her voices. Four hundred and fifty people who also were hearing voices reacted to the program by telephone. A questionnaire was sent to those who responded to the television program in order to get more information about their way of coping with the vocies. From those who filled out the questionnaire, 20 people were selected who explained their experiences in a clear way. A meeting for people hearing voices was organized, and the 20 persons were invited to become the speakers. In this article the experiences described by the participants are reported as well as the many ways in which they coped with these experiences.

The Voice-Hearer
Woods, Angela. Journal of Mental Health, 2013, 22(3): 263-270.
For 25 years, the international Hearing Voices Movement and the UK Hearing Voices Network have campaigned to improve the lives of people who hear voices. In doing so, they have introduced a new term into the mental health lexicon: "the voice-hearer." This article offers a "thick description" of the figure of "the voice-hearer." A selection of prominent texts (life narratives, research papers, videos and blogs), the majority produced by people active in the Hearing Voices or consumer/survivor/ex-patient movements, were analysed from an interdisciplinary medical humanities perspective. "The voice-hearer" (i) asserts voice-hearing as a meaningful experience, (ii) challenges psychiatric authority and (iii) builds identity through sharing life narrative. While technically accurate, the definition of "the voice-hearer" as simply "a person who has experienced voice-hearing or auditory verbal hallucinations" fails to acknowledge that this is a complex, politically resonant and value-laden identity. The figure of "the voice-hearer" comes into being through a specific set of narrative practices as an "expert by experience" who challenges the authority and diagnostic categories of mainstream psychiatry, especially the category of "schizophrenia."