“I’m hearing voices that aren’t there. Well… I guess they are there, but other people don’t hear them.”
I’ve listened to many patients in the ER describe their experience this way. Technically, the experience is called a hallucination, which Merriam-Webster defines as a “perception of objects with no reality usually arising from disorder of the nervous system or in response to drugs”. The object can also be a sound, as in the scenario above, in which case it is referred to as an auditory hallucination.
On the surface, our definitions for words like hallucination and psychosis are consistent and useful, enabling us to categorize ways of experiencing the world and determine how best to proceed if the experiences are disordered. When we look deeper, we see that these definitions hinge on a fundamental judgement about what is real. In Merriam-Webster’s definition of a hallucination, for example, a key phrase is “…with no reality…”.
What or who determines what is real?
This brings us to our second definition, again from Merriam-Webster. Real means:
“having objective independent existence”
“occurring or existing in actuality”
The problem is while most of us agree on the casual use of the word real in daily life, different philosophies interpret reality, actuality, and what is fundamental differently. At first glance, that may not seem like a big deal. Maybe it even seems irrelevant. Why bring philosophy into this after all?
I mention philosophy because philosophy is exactly the field of study that explores what is fundamental, or what the true nature of something is. Specifically, this branch of philosophy is called ontology. We may not recognize it, but all of us were taught a very specific kind of philosophy from grade school through college—the philosophy of materialism.
Materialism maintains that matter is fundamental, existing entirely independently of mind and perception. Most teachers and professors, including those with advanced degrees considered experts in their field, believe that science has validated materialism because their own minds have been molded in that pattern. They don’t recognize other ways of experiencing and describing the world that are as consistent or even more consistent with science than materialism.
The philosophy of idealism, for example, suggests that the world is entirely mental and non-material, a position that is also supported by many physicists. In this non-material sea, the mind interprets the experience of “objective independent” material objects, to use Merriam-Webster’s words.
We can easily define a physical object as an intersubjective perceptual experience. This screen you are seeing is an object from the materialist perspective. It exists independently of you. But from the idealist perspective, it is primarily a perception. The person next to you might also have the perceptual experience of the screen, in which case it now becomes intersubjective (between you both), or, in other words, apparently objective.
In fact, the intersubjective interpretation is more consistent with science in that the screen you observe is entirely dependent upon your nervous system’s interpretation of it, and therefore it is not truly objective. A different species would interpret its own version of the screen based on the specifications of its own nervous system. (For more on common misunderstandings about this idea, see this article.)
Replacing the idea of an external, independent, physical world with the more comprehensive idea of an intersubjective, mental world isn’t easy. If mentality is actuality and has independent existence, reality is not as we were taught. The very ground beneath our feet seems to fall away.
It’s scary to reconsider everything, no matter how many concepts, degrees, and awards one has piled up. Fortunately, neuroscience is catching up to philosophy to ease the transition. Neuroscientist Anil Seth recently gave a Ted talk titled “Your Brain Hallucinates Your Conscious Reality.” (What he leaves out is the brain itself would be part of that hallucinated reality.)
As the mind is released from the confines of materialism, our experience of ourselves and the world will shift. The self-imposed walls of physicality come down. Identity becomes more fluid. The hurriedly-drawn lines separating philosophy, science, spirituality, and religion soften and become transparent. All this will have a direct effect on our understanding of mental illness, including hallucinations and psychosis.
If you talk to God, you are praying; If God talks to you, you have schizophrenia.
This is not to say there is no such entity as mental illness, or to make light of it. Mental illness causes a great deal of suffering for patients and their friends and family. This is precisely why we must reconsider what we know.
What we call mental illness is a range of mental experiences that would not seem so strange and intractable were we to see it in a more complete context. Furthermore, a more complete context would significantly diminish the stigma around mental illness as we wouldn’t be able to draw hard, physical lines between illness and wellness. In other words, none of us could insulate ourselves. It would also help us explore new approaches to managing the mind and making it more useful, which is the ultimate goal of psychiatry.
This isn’t about philosophy. This is about understanding, experiencing, and managing unexplored domains of the mind, all the while growing into the full experience of being human.
Anoop Kumar, MD, MM is board certified in Emergency Medicine and holds a Master’s degree in Management with a focus in Health Leadership. He practices in the Washington, DC metro area, where he also leads meditation gatherings for clinicians. He is the author of the upcoming book Is This a Dream? He tweets @DrAnoopKumar.