1A Thickness in the Air
The interview is drawing to an end. We have been talking for over an hour. I look up from my notes at the young man across from me.
“Before we finish, is there anything you want to describe that we’re missing? Anything we haven’t talked about but should?” I ask.
“There’s nothing, really, I don’t think. I think we’ve covered it all,” he replies. “I mean, apart from the presence thing.”
“The presence thing…” I answer, looking back and down at my notes again. He takes a few seconds before continuing.
“Yeah, like when they are there, I can feel them there. The voices.”
“What—even when they’re not talking?” I ask.
“Yeah, just there, right next to you. Like someone is standing behind you, looking over your shoulder.”
Alex hears four voices that other people cannot hear. He has heard voices for as long as he can remember. They talk to him every day. That’s what our interview is about: how often he hears voices, what they sound like, and how they make him feel. Of all Alex’s voices, one talks nearly constantly. It shouts, it cajoles, it criticizes, and it threatens; it is an incessant menace in his life. The first time I met Alex to do an interview—nearly three years prior—I asked him at one point what that voice was saying, right at that moment. It was telling him to throw some pens at me (he didn’t). I think I got off lightly.
The voice Alex hears nearly constantly is positioned very close to him, he explains. Just off to the right, behind his ear. “You know when it feels like someone is watching you? Like that,” he says. I try to imagine what that must be like. A set of voices with you all the time. Commenting on everything you do, questioning your actions, your decisions—even your thoughts themselves. The previous week, someone else had told me her voices were like “a proper little mackem1 gang, talking about you all the time.” She felt like they were constantly waiting near her house, plotting.
“If they are speaking most of the time, are you just getting used to them being there?” I suggest. “Like you expect them to say something, even when you aren’t hearing them?”
“Well, yeah, but it’s not just that,” says Alex. He pauses, thinking of the best way to help me understand. “In the morning when I wake up, it’s like I have a brief moment of peace, and then they make me jump, and I remember they are there,” he says.
“And how does that make you feel?”
“It’s horrible, really.” He shudders. “I mean, I know some of them are OK. But you still don’t want them around all the time. It’s just … creepy.”
This is the third time I have interviewed Alex. He is taking part in a research study that we are running with the National Health Service (NHS), trying to understand more about “voices” and how they might change over time, for the people who hear them. By voices, I mean auditory verbal hallucinations—hearing things that no one else can hear, an experience that most people would usually associate with schizophrenia. Roughly 75 percent of people with a diagnosis of schizophrenia report auditory hallucinations, and between 5 and 15 percent of adults will also hear voices at some point in their lives.2 The latter statistic can be a surprise, but once you start asking people about unusual experiences they might have had—a shout of their name, a vision in the night, a weird, premonition-like dream—many of them can describe at least something like that, and some have encountered these occurrences more than once. When people tell you about them, they often do so quietly and cautiously. Some are just pleased to know they aren’t the only one.
Not everybody hears the kind of voices that Alex does. He’s using early intervention in psychosis (EIP) services, the frontline NHS pathway that people access when they first start to show frequent signs of psychosis. Psychosis involves a break from reality. Distinguishing the real and unreal becomes challenging, even impossible, while feelings of distress and confusion spiral and multiply. People experiencing psychosis might have hallucinations involving sounds, smells, visions, or any of the senses. Their thinking might change as well: they might hole themselves up in their home or apartment for fear of a plot to kidnap them; they might think someone has implanted something in their brain, or they might think the world around them is transformed somehow. Strong unusual beliefs in this vein are often referred to as delusions, and it is very common to see them accompanying hallucinations when someone is in a state of psychosis. All the participants in the research study are using EIP to help them with their experiences. They don’t all have a diagnosis of schizophrenia—and in fact, many don’t at this stage. Psychosis can happen for lots of reasons. It can occur in people with conditions like bipolar disorder, depression, anxiety, and post-traumatic stress disorder, and it can be prompted by drugs or alcohol, or severe stress and sleep deprivation.
The first time I met Alex, he was still getting his head around the idea that he was hearing voices. Many people don’t realize initially that others can’t hear the voices; for young people in particular, if it has been happening for a while, it might take a long time before they realize that other people don’t hear the voices too. Alex is in his early twenties, and when I ask him, he thinks this has been happening since at least primary school. He says it started with two voices—a man’s and a woman’s. Then it became four voices, but he finds it hard to remember specifically when that happened. He can’t recall exactly when he realized he was hearing voices; it began to dawn on him the year before we first spoke, or the year before that. He then told his parents, and they were concerned. They got him to talk to his general practitioner (GP), then a crisis team, then the people from EIP services.
We meet in an old mental health hospital that looks alarmingly gothic and strange—literally the last place you would want to go if you were in distress. Many of the older NHS buildings have been sold off now for flats, but this one has survived for some reason. Inside, the surroundings are more modern and clinical, but unsettling in a different way. It is all cleaning fluid and rounded edges: no door handles in sight, with each room looking like the inside of a 1980s Star Trek spaceship but with unfinished furnishings. Alex isn’t an inpatient here, it’s just where we could get a room for the research study. This is true of most of our participants. Although their experiences are distressing, they generally manage them at home and in the community. They would only have been admitted to an inpatient ward if and when they were acutely unwell and couldn’t manage outside.
There are a lot of stereotypes about what it’s like to hear voices, and that can make people reluctant to talk. No one wants to be labeled as crazy or dangerous. The person most likely to ask about voices would usually be a clinician of some kind, who then decides what pathway the patient should proceed to (i.e., what services they are offered), what (if any) medication should be prescribed, or whether to start a process of therapy. It might be important to assess for the risk of things like self-harm or suicide. And if time is limited or the connection isn’t there, some questions may get missed in favor of others.
Because our interviews are for research, I have the luxury of time when I see people like Alex. We let people talk as much or as little as they need to, and we tend to ask more questions about the immediate subjective experience of voices—what is sometimes referred to as their phenomenology. I’m not a clinician—I’m a researcher and a lecturer, trained in psychology, but not someone qualified to deliver therapy or prescribe drugs. I’m just there to try to understand more about what the experience is like.
The second time I talk to Alex, we discuss some of the differences between his voices. There are still four, but only two really speak. One is an angry, dominant male voice—this is the one that talks almost constantly, and he sounds middle-aged. The other is a woman, just a little older than Alex, who seems to be more supportive. She will often argue with the male voice, and she might defend Alex against taunts and accusations. But she can also be manipulative, he says—it’s hard to know sometimes what she is after. For Alex, the voices can say one thing and mean another; they can be sarcastic, or disingenuous—despite the fact that their words are all they are, ultimately. When I ask if these voices remind him of anyone he knows, Alex shrugs. He’s thought about this question a number of times with his therapist, tried out different people for size, tried to fit words to faces. But the voices don’t track his past and the people in it, not quite. If they are people he knows, they have gone through a deep and elaborate transformation, as if they have passed through a hall of mirrors.
The other thing we talk about in our second interview is the bigger picture—what else might be going on for Alex. We’ve kept the focus on voices so far, but it’s important to consider what other things might be occurring for someone in this situation. When people start hearing voices, they might reach for explanations about what is happening. How can voices come from walls or comment on thoughts? Neighbors, technology, spies, even spirits—all become plausible candidates. Voices change the lens through which people view reality; they (sometimes literally) announce an essential shift in the universe. Each time they speak, they act as a reminder that they are here now, with you, and the world that you thought existed doesn’t anymore. They might warn you against attempting to explain it to others; they say it will fall flat or cause alarm. Better keep this new world to yourself.
And that world has gaps; things you still can’t explain. In those gaps—answering that uncertainty—develop new ideas that provide a better fit for the frame. You might become convinced that the voices might be right and they know things that you don’t. Or some of your other suspicions might feel right, and you search the house for bugs and hidden cameras. Maybe neither of those things feels quite right—but you feel different somehow, you are special. Not necessarily in a big way (there are fewer messiahs in an EIP clinic than one might think), but in a quiet, subtle way, as if your center of mass is slightly off balance, pulling you forward, an uneasy suggestion of impulse and momentum. The voices are here for you—and you have been chosen.
The second time we meet, Alex tries to describe a feeling of that kind. It comes at the end of the interview, and it is clearly something he is hesitant about sharing. Even after all the talk of disembodied voices, this is somehow more personal—something that perhaps makes him more vulnerable to misinterpretation. Maybe he thinks it makes him sound even crazier.
What he describes is a feeling that, over and above everything else, someone or something is pulling the strings. Someone is organizing everything in his life, sending the voices to answer some sort of transgression. Their purpose is orchestrated, being part of some grand plan or design. And Alex is, if not quite at ease with it, accepting of the idea. It provides comfort: at least someone is in control.
When we talk for the third time, Alex’s voices haven’t changed that much, although the angry man is quieter now and further away. He used to “check in” with the female voice from time to time, but he doesn’t much anymore. When I ask Alex, he is feeling much more in control of what is going on—something he puts down to working closely with his therapist, a clinical psychologist in the local NHS trust.
But it’s the feeling of presence that we end up talking about. The end of his third and final interview in the study, the topic of a voice that can be felt but not heard comes up. He had mentioned it in passing earlier, but he didn’t elaborate. Secretly I am relieved when he returns to it at the end of the interview—I wanted to understand it properly (or at least a little better). The exchange we have makes me more curious, though. A voice without sound; a presence alone.
“The best way I can describe it is goosebumps—you feel it up the back of your neck,” says Alex. “I don’t even try to describe it in therapy, it’s just so weird. That was the bit that I thought no one had. Like, you learn about how lots of people hear voices, and that’s helpful—but this just seemed bizarre. I don’t even know really how to describe it.”
He shakes his head as he says this. How do you describe a voice that isn’t heard, a presence that is only felt? Alex had tried—but it was clear that he wasn’t satisfied with his description.
This was not a comfortable familiarity for Alex; the voices being around was not like the welcome presence of a childhood friend or the regular appearance of a neighbor. It sounded more like a haunting of some kind; an unruly spirit that had latched on to Alex’s person. I wondered whether Alex’s presences would stay like that forever. If a voice just sticks around, even when it has mostly stopped speaking, will it always just feel like someone is there? As if someone is constantly reading over your shoulder, or standing too close?
This was where we ended up; this was the last thing he tried to talk about amid everything else going on. We had gone from voices to grand plans to presence. This last feeling was the hardest, weirdest, most unsettling thing. This, of all things, was where the words just stopped.
As it happens, I had heard someone describe it before.
Daniel
The seminar room is light and airy. People bustle in and say hello to one another; some people clearly know each other already, others are quieter and wait to be spoken to. I am one of the latter, and I take a seat with my back to the wall, near the door. Across from me sits a young man with a neat beard and spiky hair. His arms are powerful and toned, and he sits forward in his chair as if ready to spring, his balance already on the balls of his feet. Like me, he’s not really talking to anyone yet, bar the odd smile and hello, and a question here and there.
I’m not talking much because I am new here. I am a postdoctoral researcher—the bit of an academic’s career immediately following a PhD but before moving on to a permanent role, like a lecturer. My PhD had been on autism, and I became interested in language and the mind—how we talk to ourselves, and how that might affect our thinking and our mental health. Through that I came to learn about a new project at Durham University—Hearing the Voice—an initiative funded by the Wellcome Trust to further the understanding of auditory hallucinations. The project caught my eye because it planned to do this research in an unconventional way, drawing upon ideas and study from lots of different areas—so not just psychologists or psychiatrists doing the work but also philosophy and religious studies scholars, for example. I had studied a bit of philosophy as a student, and I was keen to see how this would work in practice.
Once we sit down, the first thing I notice is the lack of mixing. Like on a school playground, the safety of a preexisting tribe is hard to ignore, and we cluster in that room in rough groupings of disciplines—a literary studies corner, a couple of philosophers, the historian sat next to the medievalist. And, on his own, the young man opposite me.
“Thank you and welcome, everyone,” says the facilitator, standing at the front. “We won’t go around to everyone, but I would just like to welcome Daniel to the session today. Daniel is joining us from the Recovery College. Welcome, Daniel.”
The team acknowledges the visitor with a mixture of smiles, nods, and mumbled hellos. The Recovery College is an education center in a town nearby for people who are struggling with their mental health. Daniel is here with us because he’s a voice-hearer, the term many people prefer to use when they hear voices for a long period of time. Daniel has been asked to take part in the seminar not as a speaker but as a participant; another academic is presenting that day. Daniel, though, is very engaging and open—chipping in with questions and observations from the start and fielding any number of awkward enquiries from us. Before long, the session has become a Q&A, with Daniel holding court.
The topic of voices is one that invites a number of interpretations. Across epochs and cultures, it is the kind of experience that wouldn’t always have been considered a symptom of illness but maybe instead a sign of inspiration, or revelation. As recently as the early twentieth century, attitudes toward unusual and hallucinatory experience could be much more mixed than the largely pathological lens that we view things through today. How we think about unusual experiences is shaped by the times we live in, so we have to try to think about it from more than one point of view. Even the more recent history of hearing voices is a mishmash of psychiatry, psychotherapy, neuroscience, and philosophy.
For quite a few people in the seminar room that day, it is the first time they have met someone who hears voices. Everyone has different questions. Does Daniel know when the voices are about to speak? Surely there would be some sort of stirring or change in the world, something that marked their arrival? Does Daniel’s voice feel like a character in a book? Can he picture him? What is his backstory?
I say “voice,” singular, because Daniel is clear that he hears one main voice; a military-style male voice that comments on his daily thoughts and activities. Daniel is not long out of the forces himself, and his experiences have gotten worse following his time in the military. I would later learn that he always sits with a view of the door, like he had that day. Daniel can picture this voice in his mind’s eye. He isn’t sure if there has always been an image, or whether that is something he has come to know; a figure emerging from the commands and barks in his head. The voice looks out for him, he says; but it also criticizes and mocks him, sometimes mercilessly. He has been around so long that Daniel describes his own thoughts intertwining with the voice at times. It can be hard to know who has said and who has thought what.
Daniel’s a natural talker. We have been going for half an hour, maybe longer, and I can see the facilitator is keen to move on. I wonder about whether Daniel needs a break, and whether we should be bombarding him in this way. Well-meaning curiosity can go too far, and Daniel’s not here to be a subject of research. My thoughts are interrupted then by something Daniel has just said.
You know, sometimes you don’t even have to hear him—sometimes you just know he’s there.
Just there. What does that mean? No sound, no vision—just there. Daniel can describe what he thinks his voice looks like—in full military garb—but he doesn’t mean he pictures the voice there. He means something more basic, something indivisible. A voice that is there, and there alone.
The scholars around the room lean in for clarification. New questions come in, and Daniel fields each with politeness and patience, sometimes with just a shrug. It feels important—the shift in focus, the change of parameters. It feels as if our topic—voices—is a mere cardboard cutout, or a building front on a film set, with the real experience somewhere behind, in the shadows. It’s one thing to hear a voice and imagine what the person looks like, or listen for a voice that you expect to speak. But a voice, or rather, an identity, that can just be felt—not heard, not imagined—seems like something very different entirely.
* * *
WHAT DID THEY mean, Alex and Daniel? Since that day in the seminar room, I have continued to wonder. I talked to more people who had heard voices and felt something similar. Some weren’t quite as definitive: they might hear a voice and describe that as somehow having a real presence itself. It was as if the voice heralded the arrival of someone, in a way that felt almost impossible to ignore, as it would if a person actually arrived in your company. In a study we ran with over 150 voice-hearers, one participant wrote: “I have never encountered anyone with as powerful a presence as my voices. They are loud and feel enormous.… They feel very much here when I hear them.”3 For some, their voices had bodies, or made their own body feel different: their presence was in their physicality, a tangible reverberation that signified that someone was close.
But for others, they were adamant: the voices could be there without speaking, a cloud of pure identity, hovering and amassing, threatening to sweep across and rain down new words.
I searched for comparable experiences and read what I could, trying to understand more but not getting much further. A colleague of mine asked, “Is that a thing, then, in psychology? Felt presence—is it a concept that gets used?” I shrugged sheepishly—not that I was aware of. I’d heard of a few similar things in very different contexts: survival stories, brain damage, that sort of thing. Nothing quite like this, though. It felt altogether too hard to grasp, too experiential. You could try to describe that kind of feeling, but how would you ever investigate it? It’s not even clear we know how to define what it is. It felt like trying to catch a ghost on camera.
What Daniel had been talking to us about sounded a bit more like a delusion than a hallucination—in other words, a matter of belief and facts, not senses and perceptions. Hallucinations and delusions carve up the world of psychosis into perception and belief. Hallucinations rely on sensory content; by definition they involve perceiving something without a corresponding stimulus in the outside world (a sound, a touch, or a smell, for example). Delusions, by contrast, are the stuff of thoughts. They are usually about something in the world (what philosophers sometimes call “intentionality”), but they don’t involve sensation.
The presence of Daniel’s voice didn’t seem to have any sensation attached. It didn’t speak, and he didn’t describe it touching him or appearing in his sight. Its sensory content was bare. In contrast, he said he “knew” the voice was there—it was something he was aware of, that he expected, that he believed about the world. He held it to be true that this voice, or entity, or whatever it might be, was accompanying him. In psychiatric terms, this notion of presence was merely delusional; thinking, not feeling, that someone was there.
A few months after our meeting with Daniel, a senior professor visits us, a psychologist who has worked in the field for a long time. He’s not having a great day—his train is late, his accommodation booking doesn’t quite work, and he isn’t sure how long he can stay. He presents some of his new work, on stigma and beliefs about voices.
Afterward, some of us accompany the visitor to the pub. We try to describe the concept of presence, alongside other ideas, like voices feeling like characters or imaginary people. It felt like a question that had been overlooked: What might be experienced beyond the immediate properties of a voice? Are we missing something?
“Well, people come to believe lots of strange things about their voices,” he says with a shrug, finishing his pint.
As he gets up to leave, I wonder if that’s all it is. Maybe we are looking for something that isn’t there—conceptually, I mean. Maybe we are reading too much into something that’s just peripheral to what people are experiencing. Maybe we’re just academics looking for something to justify our musings, but little else.
It didn’t feel like that, though. It felt like an itch that needed to be scratched, a question that would keep arising. What else was there, with the voice? It was as if the idea itself was looming over us, unwilling to leave us be.
Keira
It’s 2018. I’m finishing another interview, this time with Keira. She has a poetic way of talking about her voices, but she’s struggling a lot as well. A successful interview brings up loads of new ideas and questions, but it can also feel intrusive, one-sided. I want to ask about presence, but I can’t—it’s the sort of thing that if you describe it, you might end up leading people to give the kinds of answers you want instead of truthful answers. Fortunately, it comes up after the interview is over. As I’m packing up, Keira asks me if it’s just voices that I’m interested in. I clumsily try to describe the presence feeling. She doesn’t hesitate.
“I know exactly what you mean, yeah. It’s like a thickness in the air.”
Inside I curse that I’d already turned off the recorder following the conclusion of the interview. I desperately want to ask her more, ask what she could see or feel—but our time is up, and we had already run over. Still, I feel pleased that she has recognized what I suggested. It is the opposite of the feeling the psychologist left me with. There is something there—something not being talked about.
A little over a year later, we are finishing the coding of interviews for the first year of the study; forty voice-hearers, all from EIP services, all describing their experiences in detail, for us. Over half report felt presences.4
Mice on the walls
Accounts of hallucinations and delusions can be found in some of the earliest clinical descriptions of what would now be called schizophrenia, although their prominence (as clinically important “symptoms” of disorder) has changed considerably over the past century. The term schizophrenia was coined by the Swiss psychiatrist Eugen Bleuler in 1908, but histories of the concept tend to begin with the work of his contemporary Emil Kraepelin, who first described a different kind of madness affecting younger people than that typically observed in old age. Kraepelin’s name for the condition was “dementia praecox,” denoting a degenerative condition of the mind occurring prematurely (i.e., in young adulthood). For Kraepelin, this dire prognosis and chronicity was what made the disorder distinct from other kinds of insanity, such as manic depression (today’s bipolar disorder). It was a biologically driven disorder of the mind and brain, but not something primarily characterized by hallucination or delusion.5
Hallucinations were given a more prominent and influential role—along with delusions—in the work of Karl Jaspers and Kurt Schneider, two psychiatrists who drew upon ideas from existential philosophy in their study of schizophrenia. One of Jaspers’s main contributions is the claim that the form of psychiatric symptoms is more important than their content, with the latter often being so bizarre as to be “un-understandable.”6 It’s debatable what that means, but the typical interpretation is that the kinds of things people experience in psychosis are so unusual, so far from the logic of everyday life, that we are pursuing a lost cause interrogating their meaning. Instead, efforts should be focused on identifying which hallucinations and delusions someone might have rather than trying to understand their content, and this in turn could help to indicate what treatment they might need or the specific diagnosis they should receive. It was Schneider who placed hallucinations and delusions right at the heart of diagnosing schizophrenia, with the claim that specific forms of each make up the “first-rank” symptoms of the disorder.7
The distinction between hallucinations and delusions, and their prominence in psychosis, has stuck in clinical practice and research to the present day. Different treatments are increasingly being developed to target aspects of hallucinations and delusions respectively, including therapies that slow down reasoning and thinking to avoid jumping to paranoid and suspicious conclusions.8 In practice, though, experience is an unruly customer. This is true of anyone’s lived experience, whether they are in distress or deemed as having a form of psychosis. As long as the concepts of hallucination and delusion have been deployed, they have also been challenged and queried. Can we really cleave apart what we believe and what we perceive?
Some things that we see or hear might be so strongly shaped by what we expect that it can be hard to know what was experienced and what was simply thought or imagined. If we take UFO sightings, for example, the desire to believe will shape how people interpret what they see in ambiguous situations—it will perhaps even directly determine what is seen. Conversely, some of our strongest beliefs aren’t so far from sensations or feelings. Our core beliefs are not like rational propositions that we entertain, as if they were abstract debating motions that we can pick up and put down at will. They are felt, at a gut level, often to a degree that we just know couldn’t be any other way. Political beliefs, moral convictions, and taboos are all ideas, but nevertheless we might feel them with our body, with the whole of our being. When someone says “they just know” something but can’t offer any evidence for it, the distinction between knowing and feeling is almost impossible to define. And between those concepts, into the cracks and fissures in our categories, a lot of things can fall and get lost—particularly those experiences that are the hardest to put into words.
Despite this, presences do feature in some of the earliest descriptions of psychosis—but they can be hard to tease apart from other unusual phenomena. Bleuler, for example, also described unusual things like “soundless” voices, where people are convinced that they are being spoken to or are receiving messages of some kind, and yet they deny any experience of sound. One patient of Bleuler’s explained that “I do not hear it in my ears. I have the feeling in my breast. Yet it seems as if I heard a sound.” In the words of another, “I could be stone deaf and still hear the voices.”9 As the philosopher Sam Wilkinson and psychologist Vaughan Bell have noted, examples of soundless voices lead us to think about what kind of character might seem to linger “behind” a voice that is usually heard.10
Something closer to felt presence appears in the work of Karl Jaspers. Jaspers wrote of leibhaftige Bewusstheit (bodily awareness),11 which he described as “a certain feeling (in the mental sense) or awareness that someone is close by, behind them or above them, someone that they can in no way actually perceive with the external senses, yet whose actual/concrete presence is directly/clearly experienced.”12
Jaspers also described a number of examples of presence in people diagnosed with dementia praecox.13 One patient reported “the feeling that someone was inside me and then stepped out, perhaps out of the side or somehow.… I felt as if someone constantly walked by my side.” In other words, this was a following presence, tethered to the person somehow. A second felt “as if his father were in the room behind him,” denoting that identity could be perceived as part of the experience—just as Alex knew which voices were where. Others described more mixed feelings: a sensation of being propelled by another—again from behind—or of having their movements matched as they traveled through space. The final case summed up the archetypal leibhaftige Bewusstheit: a presence “constantly felt, as though someone were present, whom [the subject] could not see and who was watching her.”
A similar idea is seen in some of the experiences described by Bleuler as “extracampine” hallucinations—literally, hallucinations beyond the (sensory) field. In a review of Bleuler’s work14 in 1904 for the Journal of Mental Science, Conolly Norman provided the following examples of extracampine hallucinations:
(1) a patient sees things out of the window though his back is turned to the window
(2) a delirium tremens patient complains that jets of water play upon the back of his hand from a certain corner of the ceiling; he does not see them, but he feels with the skin of the back of his hand that they come from this particular spot …
and
(4) a patient is conscious of mice on the walls; she does not see them but feels their movement in her skin.15
Felt presence seems similar to this in some ways, but not in others. In feeling that something is there, but not via our normal senses, we are sensing something impossible—we are “going beyond” the ordinary sensory field. But at the same time, these experiences don’t quite seem to fit the sensation of presence we have encountered already. They are beyond what someone could conceivably experience, but they don’t pick out the social bit—the sense of someone being there. These extracampine experiences also include sensory content, even if transported and at impossible distances—things are still felt as a touch, or seen in impossible ways. In contrast, the confusing thing about presence is the lack of any clear content. How does Daniel or Alex know that their voices are there? They feel them there, but they don’t mean by being touched or by catching a glimpse of them. They are purely there.
For these reasons, it has been suggested that applying the label extracampine leads us down the wrong path when it comes to presence.16 It probably pushes us to assume too much sensory content and ignores the thorny question of what is really going on when literally nothing is being sensed. A whole swathe of other terms have been suggested along the way: “false proximate awareness,” “vivid physical awareness,” “concrete awareness,” “idea of a presence,” “false bodily awareness,” and the German Anwesenheit (simply, “presence”).17 We may need aspects of all of these ideas to understand presence: proximity, vividness, physicality and the body, and the concrete stuff of things versus the abstract world of ideas. By these various names, presence can come to be defined—but only via a long and circuitous journey.
Presences, then, are not new. They have been there all along, with people trying to describe them but unable to pin them down or grasp why they come, why they are there. What Alex or Daniel described was not undiscovered territory; it was something that had been observed and documented since the beginnings of psychiatry.
But that doesn’t mean it is old news. These kinds of early accounts are vital to how we approach the topic of presence today. Examples like these highlight the possibility that it can just be a feeling; it can be something that is more akin to a sensory experience than a belief, despite being divorced from normal perception.
I feel them closing in
If hallucinations can occur beyond the sense somehow, then where are they? If presences are just there—what does there mean? A precise spatial location? An impossible location, like Bleuler’s mice? Or a position relative to ourselves?
When we turn back to Alex, we find that he was very clear where his voices were. They took up space and were anchored to him. This might make sense, given that they were his voices, in his mind, and no one else’s, but there is no reason why that had to be the case. Some voices proliferate at walls, doors, or thresholds—in other words, the boundaries of our immediate space. Others might be strongly associated with specific rooms or situations. Alex’s voices, whether speaking or not, took up consistent locations, relative to Alex’s point of view.
Added to this was the feeling of the voices being just over his shoulder—as if someone was looking over it, paying attention to the same things as Alex was. When we realize people are doing this, we often react with annoyance, discomfort, or even alarm—we might wonder how long someone has been there and ask them to move away or explain themselves. When people, uninvited, stand that close, it feels intrusive, not only physically but mentally, as if they were a surreptitious passenger on one’s train of attention or a backseat driver of the mind.
The colloquial term for that zone around us is personal space; an area that we protect and only open to those we know the best. People who don’t respect our personal space are rude, clumsy, or even abusive. Another term used in psychological research on the body is peripersonal space; in other words, the area immediately around us in which we can extend our limbs, reach objects, and generally be active agents in the world. Think of this space like that which a large Hula-Hoop occupies that has swung so most of it is in front of you. We can’t see what’s behind us, and our arms and legs aren’t designed to easily reach backward, so the zone of our possible actions extends out in front of us instead.
If someone is in that space, the things we can do are more limited. I might want to walk straight ahead, but I will need to change my path; you might want that apple, but I might pick it up first; you might step forward, and I need to step back. The unexpected whisper at my ear, or sudden feeling of something behind me, immediately prompts me to wheel around and establish space to determine who or what is there. By doing so, I change that zone again to allow for more effective action and reaction. The feeling of peripersonal space changes when someone else is there; it’s not just about the uneasy feeling of someone being too close but about how that closeness changes my options, possibilities, even aspirations, as a person in the world. If you are in my space, you change what I can do; by doing that, you change my possible world.
Voices that do not speak are not inert. It might be unbearable when voices threaten to harm or prey on one’s worst fears, but when silent even that persistence has an impact. By occupying space—whether we call it personal or peripersonal—they affect how Alex, Daniel, and Keira view and think about the world. The voices might be literally disembodied, but by taking up space they affect the bodies of the people hearing them; the space warps and wefts with the reminder that though you thought the voices were gone, they are still there, and they might always be. Every time they appear, the space that remains diminishes a little. I recall what Simon, another voice-hearer, told me once: “The best way to describe it is, the feeling as if someone has just stepped over your grave. It’s chilling.”
Whether presence is a hallucination or a delusion, a feeling or a knowing—to some extent these are just academic questions, issues around the naming of things, but little more. When it comes to psychosis, there will always be a question to grapple with, with some people having a complex mixture of knowledge, expectation, and gut feeling picking out the uneasy visitor in the room.
What is not in doubt is that this feeling is experienced with a vividness that cannot be ignored. Alex, Daniel, Keira, and Simon had all tried to describe it to me, and all had struggled to do so. Something that is so clearly there but cannot be named; a feeling that can be recognized but not shared; a story that defies efforts to be told.
After seeing Alex that last time, I realized that I had to try to understand that feeling. What he was describing may not be new—it may have been known to some people for a long time—but it might as well have been the first time anyone had tried to describe it, let alone explain it. From what I could see, we weren’t any closer to understanding this feeling than we were a hundred years ago.
I needed to know more, and for that I knew I would need to look elsewhere. I needed to hear other stories of presence, to hear how others had tried—and perhaps failed—to find the words, to capture an essence. I needed to know how to put a name to a phantom.
Copyright © 2023 by Ben Anderson-Day. Illustrations copyright © 2023 by Scarlett Barclay. All rights reserved.
