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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
THE phenomena of so-called “double thinking” are extremely interesting from our point of view. The patient hears his own thoughts uttered aloud. He has the hallucination of his thoughts uttered when engaged in writing or in reading, though loud reading may check the hallucinatory voices. These hallucinatory voices may be of an imitative character and simply repeat what is spoken or read by the patient; or they may be of an anticipatory character and utter the patient's thoughts before he himself utters them.
The usual explanation of such cases is found in the theory of the so-called “overcharged centers.” Where the voices follow and repeat the patient's words and phrases, it is assumed that the auditory centers are highly irritable and overcharged so that stimulations from other centers bring about a discharge into the “ideational” auditory centers and auditory hallucinations result. In the case of reading, for instance, the visual image of the word awakens also an auditory image, but when the auditory centers are overcharged the visual images awaken directly an auditory image before the spoken words take place. Now this auditory image is so intense, on account of overcharge, that it becomes an auditory hallucination and the patient hears his own thoughts uttered aloud. This reflex action from one “ideational” center into another occurs while the patient reads or writes, and that is why he has the experience, the hallucination that there is a voice often regarded as “inner” which repeats his own words and phrases.
Cases where the voice utters the words and phrases before they are written are explained on the hypothesis that the central discharge into the overwrought, auditory centers occurs before the words are written down or before the motor discharge takes place. When, however, the patient hears the voice repeat the phrases soon after he has uttered them, the phenomena are explained on the supposition that the centripetal currents from the speech centers into the auditory centers give rise to the voices, the patient hearing his own words shortly after he has uttered them; the efferent discharge from the graphic centers into the auditory centers will give rise to an auditory hallucination of hearing the words and phrases he has just written.
In the phenomena of “double hearing” the patient hears his own voice while talking or reading aloud, and then hears another voice due to the discharge from the speech centers to the overcharged auditory centers. Thus in some patients these hallucinations of hearing are brought about by the voluntary suppression of speech, the patient then hears a voice uttering his own thoughts. This is claimed as confirming central initiation—the currents from the word images in the speech centers not having a free outlet run into the overcharged “ideational auditory centers,” and give rise to inner speech heard by the patient.
In opposition to this central theory of double thinking or of “inner speech” held in various forms by psychologists and psychopathologists, there are some who maintain the view that these “double thoughts” hallucinations are not of central, but of peripheral origin, being due to hyperaesthesia of the centripetal paths. The apparatus employed in speech carries out rot only the requisite delicate movements, but also forms the sensitive apparatus for information of the movements executed.
The sense of movement may be regarded as originating in the muscles, especially in the joints and articular surfaces. Sensory stimulations coming from these structures to their appropriate central systems give rise to kinaesthetic sensations and motor ideas. Now if the peripheral sensory tracts of the muscle sense or of kinaesthetic sensations become hyperaesthetic, kinaesthetic sensations and motor ideas are aroused automatically and may give rise to hallucinations of positions, movements and acts; movements which have not been performed are thus experienced.
If now the centripetal sensory tracts of the speech centers are hyperaesthetic, then kinaesthetic sensations and ideas arise which go to form the hallucinations known as “double thought.” The patient experiences “inner” speech, a voice repeats after him his own thoughts, his own words and phrases.
When the speech centers are overcharged and give rise to automatic, centrifugal discharges, then the hyperaesthetic centripetal paths bring it back in the form of spoken words, and the patient experiences his own thoughts uttered by an inner voice which is foreign to him. In speaking the inner voice comes after the speech and reverberates like an echo, it persists as an “after image” of the spoken word or phrase. When the patient is engaged in writing, the voice usually precedes the written phrase, because the spoken word image precedes the written word image, the inner voice thus anticipates the patient's writing by uttering his thoughts.
This theory seems further to be confirmed by cases in which such hallucinations take place. If one observes closely cases of “double thinking” or of “inner speech,” he often finds “involuntary whispering” present—the patient whispers to himself. These whispers come back to him; on account of the hyperaesthesia of the peripheral paths, he hears it as speech of some inner voice.
A close examination of the two theories, of the central and of the peripheral, reveals their inadequacy. The central theory, as it is generally put forth and commonly accepted, may possibly be regarded as the more inadequate of the two. For the central theory rests on the psychological fallacy, so prevalent in psychopathology that it may be regarded as the psychopathologist’s fallacy, namely, that an image may reach such a high pitch of intensity as to become sensory in nature and give rise to a percept. The percepts, formed by the visual perception of reading, awaken, according to this theory, also accompanying ideas of sound intimately related to and associated with visual word reading, and it is these ideas that reach such a high intensity as to give rise to hallucinations of hearing, the words are read aloud, as if by a strange voice.
This explanation, as we have already pointed out, is psychologically incorrect and rests on the fallacy that ideas or images have intensity, and that an intense idea becomes a sensation, or that a sensation is but an intense idea, and an idea is a weak, a faint sensation. To modify this view and assume that an intense idea stimulates and gives rise to the formation of a percept is to assume a supposition not warranted by facts that an idea is equivalent to the action of external stimuli or objects with their requisite physical structures and processes. In either case, the central theory as it stands is not in accord with psychological and physiological data, and, as such, cannot possibly be accepted, at least in the shape as it is usually put forth.
Furthermore, there is an inherent difficulty in the central theory itself. For if it be correct, as the theory claims, that the visual image calls forth an intense auditory image amounting to a hallucination, the hallucinatory voice should precede and not follow the patient’s reading. In order to explain the hallucinations of double thinking or of double hearing in the case when the voice follows the reading, it would have to be assumed first that the visual image of the written or printed word stimulates the speech centers, which, innervating the muscular apparatus of speech, give rise to reading, which in turn stimulates the peripheral auditory apparatus, awakening activity in the auditory centers, giving rise to the hearing of the read words, and that then only do the indirect stimulations of the visual image, coming from the visual centers, awaken once more the same central connections, thus bringing about a repetition of the self-same words heard.
We have to assume that the action of the visual centers in stimulating the motor speech centers with the resulting acoustic stimulations and functioning activity of the auditory centers are enacted before the direct central stimulations from visual center to auditory center take place; in other words we must assume central retardation. Now what does this central retardation mean? It means that the phenomena of double thinking or of double hearing are brought about by some form of central inhibition, of central blocking of pathways as it is usually put: in other words, the requisite condition of double thinking is reduced to the psychopathological state of central dissociation.
The inadequate side of the central theory as it is commonly advanced lies in the supposition of referring auditory hallucinations in the phenomena of double thinking or hearing to the intensification of the auditory image or idea, but no straining of an auditory image can get a sound out of it.
Moreover, were the central theory correct it would really involve a double auditory hallucination, one preceding and the other succeeding the reading. For in the process of reading the visual image of the word awakens the auditory image along with its kinaesthetic image, stimulating the centrifugal motor apparatus and giving rise to the spoken word. Now this awakened auditory image preceding the spoken word, on account of the assumed irritability of the auditory centers and the consequent “intensification” of the stimulated auditory images, should necessarily give rise to a full-fledged hallucination. When the voice also follows the reading, a sudden dissociation of the visual from the auditory centers is assumed, a momentary dissociation that gives rise to a secondary succeeding hallucination of the words and phrases read and spoken.
The fact that the central theory requires the presence in all phenomena of double thinking, that when the voice follows the reading, another hallucinatory voice must have also preceded, and that there is also a double stimulation from the visual into the auditory centers; that the hallucination first appears under conditions of association of visual and auditory centers, while the succeeding hallucination occurs immediately under the opposite conditions, namely dissociation,—all these assumptions make the central theory wholly unsatisfactory and unacceptable.
The peripheral theory of double thinking is on general grounds more acceptable as it falls in line with psychological and physiological principles and facts. Unfortunately the special facts which the theory is called for to explain do not exactly tally with it and may even be said to contradict the hypothesis. For if the hallucinations of double thought are due to hyperaesthesia of the centripetal sensory-motor tracts then reading aloud should intensify the hallucination, but the case is quite the reverse,—reading aloud makes the hallucinatory voice to disappear altogether.
On this theory again, the voice should follow and not precede the reading. We are thus confronted with the opposite difficulty met with in the central theory. On the central theory the hallucination should precede, while on the peripheral theory the hallucination should follow the reading. The central theory cannot account well for succeeding hallucinations, while the peripheral theory does not account well for preceding hallucinations.
On the central theory there should be double hallucinations in cases where the voice follows reading, while on the peripheral theory there should be double hallucinations, when the voice precedes the reading. Besides, “hyperaesthesia” should rob the perception of its hallucinatory character, the patient should be all the more conscious of his own utterance.
A closer examination of the peripheral theory discloses a fundamental fallacy which it primarily involves, a kind of ignoratio elenchi. The theory is probably correct in principle, but it misses the essential point of the whole problem; it may be an adequate explanation for motor, but not for auditory hallucinations. Hyperaesthesia of the central motor speech tracts would at most give rise to pure kinaesthetic hallucinations. The patient may have hallucinations of actions, tension, or of movements in his peripheral speech organs, but he will have no hallucinations of hearing.
To have an auditory hallucination, as to have an auditory perception in general, the auditory peripheral and central apparatus should be stimulated. No other organ but the acoustic apparatus can possibly supply sensations and percepts of an auditory quality, unless the hallucination be of a reflex, secondary character, but then it may be induced through any other peripheral source than that of kinaesthesis of the speech organs.
Although each theory taken by itself proves to be inadequate and leads to contradictions to facts, still the two may be regarded in a certain sense as supplementing each other. Now the central theory emphasizes the aspect of the central character of the phenomena, while the peripheral theory lays stress on centripetal factors.
Both theories can be brought in line with facts, if assuming centripetal factors of kinaesthesia and auditory hyperaethesia, we also refer to the central conditions of dissociation. The patient in double thinking is subject to subconscious states, to states of dissociation. This dissociation is of a central character and specially affects the visual and kinaesthetic systems. Impressions, on account of dissociation and peripheral hyperaesthesia, are subconsciously received and subconsciously reacted upon. The visual impressions of the written and printed characters are subconsciously perceived and subconsciously uttered in a whisper and sometimes quite loud, as I had occasion to observe in my cases. This subconscious utterance, unperceived by the patient, comes back to him as a strange, external voice proclaiming the patient's thoughts or repeating his words and phrases.
The phenomenon of “double hearing” is due to subconscious whispering which comes back to the patient as an auditory hallucination. I had the occasion to verify this phenomenon of subconscious whispering in cases in which functional dissociation was quite marked, and in which auditory hallucinations and double thought were quite persistent.
In cases where the auditory hallucinations precede the reading or writing it is the subconscious whispering along with kinaesthetic and auditory hyperaesthesia that give rise to the phenomena of “double thought,” or of “double hearing.” The dissociation being in the kinaesthetic systems the patient does not experience consciously the peripheral incoming sensations due to his subconscious whispering.
More often the patient continues to whisper subconsciously what he has just read consciously. Such a habit is common with many people in the normal state and is due to the persistence of the peripheral sensory impression, to a kind of verbal after-image. The absence, however, in the normal condition of dissociative states prevents the formation of subconscious whispering with its consequent auditory hallucinations partly due to hyperaesthesia of the auditory tracts.
If cases of “double thinking” are closely examined, one finds in them the presence of subconscious states with their psychomotor reactions; the patient in walking on the street, for instance, may hear a voice telling him words and phrases that can be traced to signs and advertisements which he has read subconsciously, though he himself has not been aware of it. What happens in such cases is this, the patient whispers or even utters aloud the words he subconsciously sees on the signs.
It is this subconscious whispering that comes back to him as an auditory hallucination of a voice. In my cases in which the patients suffered from auditory hallucinations I found on close examination the phenomenon of unconscious or subconscious whispering, which became aggravated in proportion to the state of distraction in which the patient was, ranging from an almost inaudible whisper to a loud talk, the patient being entirely ignorant of it, so that he could not be made aware of it, even when his attention was called to his talking. One of my patients suffering from pronounced auditory hallucinations, but in whom the dissociation is not deep, aptly describes his experiences as “autovocalization.”
Similar conditions can be induced in hypnosis, thus confirming our point of view by experiment on otherwise normal people. If a post-hypnotic suggestion of subconscious whispering is given, the subject experiences an hallucination analogous to that of “double thought,”—the subject hears a voice telling him the words and phrases which he himself whispers, but of which he personally is entirely ignorant. The peripheral character of the “double thought” under condition of central dissociation may thus be regarded as an efficient working theory in accord with facts.
From the whole course of our review of facts and theories it appears that we remain more closely in touch with facts, if we accept the view that hallucinations require states of dissociation as a central condition, and that they are primarily peripherally initiated, having secondary sensory elements as their main content; in other words, hallucinations are dissociated secondary percepts.
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