A very interesting article appeared in the New York Times OP-ED section a few days ago by T.M. Luhrmann, a professor of anthropology at Stanford University. The article, entitled “The Violence in our Heads” describes interviews he carried out with 20 schizophrenic patients in the United States compared to a similar population interviewed in India. It is a common feature of schizophrenia—and often the first presenting symptom—to hear voices giving commands that are sometimes threatening. The recent tragic shooting in the Navy Yard by Aaron Alexis was associated with voices that he heard which are quite typical of schizophrenia. The voices are “real” in the sense that fMRI images during an auditory hallucination reveal activity over the temporal lobe where our language information is stored—the neuronal activity underlying the hallucination is enhanced, in a sense, making the hallucination “real.”
Schizophrenia is a world-wide health problem that has penetrated every culture in which about 1 percent of the population is affected. It is often a devastating disease in which brain functions are compromised; it is common for schizophrenics to become dependent on the social safety net.
The phenothiazine drugs, introduced in the 1950s (these drugs are antihistamines), emptied about a million beds in psychiatric care hospitals because they made the patient more manageable, but these drugs did not cure the disease and many homeless people on our streets are schizophrenics, some of whom are not on medication. About a third of all schizophrenics who have been diagnosed and treated, stop taking their medication because of terrible side effects. Although we didn’t know it at the time these drugs were first used to treat schizophrenics, phenothiazines are dopamine antagonists and dopamine plays a major role in the regulation of motor control and other functions, including a sense of pleasure when taking addictive drugs.
By comparing the auditory hallucinations of schizophrenics in India and the United States, Luhrmann discovered a compelling difference between the two patient populations. Patients in the United States more commonly had auditory hallucinations in which the patient was commanded to commit violence, such as “cut the heads of people off and drink their blood” or commands to commit suicide or go to war and commit acts of violence. But in India, the internal voices of schizophrenics were more commonly related to commands surrounding daily chores such as cooking, cleaning, eating and bathing. When horrible commands occurred in the Indian population, they were more commonly related to sex. One woman said “male voice, very vulgar words, I would cry.”
Luhrmann argues that the differences between the two schizophrenic populations may indicate that culture has a lot to do with the nature of the voices to which schizophrenics are subjected. Thus the more violent auditory hallucinations of the American schizophrenic reflects the more violent nature of our culture. Who can argue? We are the most heavily armed citizenry in the world and video games without violence as a major theme probably don’t sell very well.
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