Reviewed by Graham Kidd
Ben Alderson-Day is an associate Professor of Psychology and a fellow of the Institute for Medical Humanities at Durham University. This institute researches “hidden experiences”, those that are “easy to hide, but difficult to comprehend, explain or get help for. We believe a medical humanities approach can shed new light on these hidden experiences to improve health policy and practice and benefit the lives of communities and individuals.” Its stance is of course materialistic, with no hint of interest in the parapsychological, and that is the tenor of this book. However, it must be said that his line of research is not only fascinating but essential if one is not to be misled up enticing paths of fantastic magical explanations of tricky to understand phenomena.
Alderson-Day has published numerous studies concerning perceptual oddities including voice hearing and hallucinations, and has spoken to the Spirituality and Psychiatry Special Interest Group of the Royal College of Psychiatrists, an institution to which I belong. The overlap between experiences that may be deemed truly paranormal or spiritual in nature and those that are clearly the result of unusual or distorted perceptions or brain disturbance is of course huge, and has been a source of controversy and discussion since the times of the Greek philosophers and physicians. With the development of evolutionary theory, medical science and psychological understanding, materialistic explanations became paramount in the Western scientific world, and mainstream psychiatry was entirely organic in its approach in the 20th century.
The spiritual section, existing since 1999, is overtly concerned with how to address existential problems that may be causing undue stress in patients. It has to be admitted that some psychiatrists would seem to add their own religious views to the mix in understanding their patient’s problems, and indeed may treat accordingly, for example using Spirit Release Therapy that they believe is indeed casting out real entities (rather than regarding it as a ritualistic technique to diminish the power of subpersonalities). Even Ian Stevenson, the psychiatrist who convincingly confirmed the possibility at least of reincarnation, during a lecture for the SPR, acknowledged, in passing, that he could not find evidence for the telepathic powers that those diagnosed as schizophrenics frequently assert they have (for a review of the literature, see Rogo, 1982).
Alderson-Day does discuss paranormal possibilities with seeming respect, but he does not here actively endorse them. Having said that, he is supremely well qualified to add to our knowledge base of possible mechanisms at play. In the preface, he describes what he means by a sense of presence, the concept of which has fascinated thinkers for centuries. William James, as always, sums it up well. “... a feeling of objective presence, a perception of something there, … more deep and more general than any of the special ʻsenses’ by which the current psychology supposes existent realities to be originally revealed.” James also mentions the useful concept of “... an hallucination imperfectly developed ...”, which may be associated with tactile experiences and such like. Having stated the experience to be investigated, Alderson-Day wisely states that he will not produce an astonishing theory, but warns that he will use concepts such as psychosis and hallucination. His PhD incidently was on autism and as a result he developed an interest in language and the mind, in particular how inner speech affects thinking and such like. Attempting to understand the sense of presence evokes many possible variables, psychological and anatomical, as with any function involving the brain. However, he is well qualified for this task and I believe he has made a good stab at it.
Having laid out the basic concepts, the first chapter then consists of the results of interviews with four voice hearers in which he attempted to understand more about their experiences. Invariable with hearing voices there is an associated sense of presence, not surprisingly perhaps. He points out incidently that some 75% of those diagnosed as schizophrenics hear voices, and also that 15% of “normal” adults report hearing voices if briefly at some time in their lives. Alderson-Day describes the development of the concept of schizophrenia usefully, including the fact that the meaning of the voices was regarded as not worth exploring as it was so beyond normality (though C. G. Jung, which he does not mention, would have disagreed). With the discovery of medicines that seemed to help seeking meaning became irrelevant. Currently the concept of schizophrenia as a psychiatric diagnosis is changing, insofar as it is less likely to be regarded as one disease but different syndromes with different aetiologies, one of which pertaining to the development of distinct ego states as a result of environmental challenges.
In the following chapter, as well as attempting to define the relevant associated concepts of hallucinations and delusions he discusses dissociation as a useful mental mechanism, together with its various aberrations including Dissociative Identity Disorder (formerly known as multiple personality disorder). He is attempting to explain the experiences reported by Ernest Shackleton and his party as they crossed South Georgia. He describes their journey in detail. Each of the three men experienced the presence of a supportive fourth person. What Alderson-Day does not clarify is whether the three had reported this independently or discussed their experiences as they travelled, thereby raising the possibility of suggestion or folie a deux, which he does mention, as well as pareidolia and hallucinations as a result of extreme fatigue.
In chapter three he raises the topic of physical disorder of the brain causing perceptual disturbance, in particular epilepsy, an attack of which in his interview subject seemed to presage the start of repeated experiences of presences which were occasionally accompanied by a voice of someone he knew. We are also introduced to some basic neuroanatomy. He follows this with an account of Strindberg’s paranoid condition which included a presence which mirrored his movements, possibly a double, and other examples of neurologically induced perceptual abnormalities. Alderson-Day describes a case in some detail in chapter four which was the result both of extreme physical conditions and brain tumour. He recognizes the need for a psychological explanation of the content, which in this case differed from Shackleton’s in that the presence was following rather than guiding, as if lost itself.
In chapter five he reflects further on the complexity of the possible neurological explanations raised by these strange and variable stories, including the role of the temporoparietal junction, which when stimulated directly or by an epileptic fit may evoke a sense of presence or an out-of-body experience. Alderson-Day describes ingenious experiments that demonstrate that disrupting perceptual synchrony provokes illusions. The sense of presence seems to be evoked as a way that the mind attempts to understand the cause of sensations which counter expectations. This does not explain the accompanying sense of identity that those with schizophrenia report. Emotion clearly plays a part. He recognizes if not in so many words that a major function of the brain is to relate the body to the environment, and I would add to have a model at least of the causation of disturbances in the environment.
Chapter six describes the role of Parkinson’s disease in inducing the sense of presence, a not uncommon accompanying symptom. He mentions conditions of sensory impairment which are frequently associated with sometimes complex hallucinations, such as the visions of blind sufferers of the Charles Bonnet Syndrome. The need for the brain to fill in gaps and find or suggest meaning where it can, with its propensity to generally keeping busy seems to be at play. The meaning that is ascribed, with its emotional accompaniment, may of course be an outcome of past experience, which may also set up templates to aid perception, sometimes inaccurately it has to be said. Alderson-Day refers to this as top down predictive processing, but I am of the opinion that to a large extent it is in fact bottom up, in that the templates are generated often by emotionally powerful experiences which are significant especially if having an immediate survival component.
Alderson-Day balances stories with discussion and explanation together with relevant scientific references. His excursions into the details of various topics may not always seem relevant, but given the possible factors involved, as well as to lighten the factual load for the reader, they may be considered helpful and of general interest. Medical facts abound. He raises the valid but tricky distinction between so called organic state and functional states. One could assume, as many psychiatrists do, that schizophrenia will be demonstrated at some time to be organic when we can measure the role of networks and the relation with the anatomy accurately. There is always an interaction though with the executive function of the brain and the rest of the body brain complex.
Part two of the book he entitles “Fellow Travellers”, reverting to a discussion of the sense of presence often accompanying trials of endurance, Shackleton and his team being not the only people who experienced such illusions. It so happens that on the radio, following the discovery of the children who survived forty days in the Amazonian jungle, several similar survivors recounted their hallucinatory experiences. Dehydration, exhaustion, isolation and continuous stress are all factors. As well as describing others experiences in detail the author himself relates his own sense of isolation when running a half marathon. In the following chapter he discusses different forms of sleep disturbances, with illustrative interviews, including hypnagogic hallucinations and the fearful sense of presence that may accompany sleep paralysis. He attempts to delineate the difference between knowing and feeling. Sleep of course is essential for the efficient functioning of the mind and body but is a state when predators can take advantage. The immediate survival brain therefore remains alert, and in my view, as it cannot process perceptions in detail, (which in any event takes too much time), will respond with a black and white safety first take of assuming the worst. Feelings are tied immediately to this interpretation preparing the body for fight or flight, and this is accompanied by a sense of conviction which is part of the prioritization process. This is essentially the conclusion that the author comes to after an extensive and interesting discussion.
The next chapter however may galvanize the interest of members of the SPR, as the author asks the pertinent question at last, whether or not ghosts actually play a part. First, however, he considers the debate as to whether there is a continuum of a tendency to experience psychotic type experiences or whether such an experience is always abnormal. He cites some interesting experiments elucidating the issue. (I believe there is a continuum, with some having the tendency for whatever reason to have excessive experiences which overwhelm homeostatic mechanisms that maintain the relationship with material reality, and that this depends on the relative activity of the executive versus the emotional brain.)
Eventually, he mentions, respectfully at first, the work of the SPR, beginning with illustrations from Phantasms of the Living. However, he feels it has a fatal flaw of response bias ... and that is that. One could argue that although this may increase the likelihood of coincidence playing a part, it is unlikely to explain all the remarkable stories. He goes on to push over a straw man in the form of the contentious Harry Price, and also to deem poltergeist phenomena to “feel very much part of their time.” I am not sure that this does not portray an ignorance of how reports of poltergeist type phenomena have persisted consistently across time and place and continues to do so. However, he seems on the verge of changing his mind when describing the sensory experiences of the deceased (SEDs) which may not all be grief driven, and he admits are common even now. His research involving interviews with mediums, who of course claim to sense presences at will, is of interest and the mental mechanisms that he suggest are at play cannot be easily discounted. Again, however, the information that they convey cannot always be easily explained, although he does his best with the usual explanations. He concludes what might be considered obvious, that sensitivity to mediumistic perception is a result of talent, practice and of open mindedness.
The next chapter seems rather banal in so far as he discovers the power of the imagination, stimulated by literature for example but is in fact of great significance and confirms my own opinion that the imaginative faculty has unlimited capacity to create models of possibilities in such detail that its product may appear hallucinatory. The emotional brain, which harbours unprocessed perceptual information and can be primed with skills and further information of all sorts, is of course very creative, and what it creates, given direction and motive, may be delivered to the self-aware mind which relates to the environment in all its complexity in time and place. If the self-aware analytical brain is not sufficiently energetic to judge where the information is coming from, the possibility is that the perhaps overactive emotional and creative brain is given license to attribute their constructs to whatever ego state or personality takes the fancy, consciously primed or otherwise.
In the section entitled “Animal magic” the process is analysed in more detail through a description of tulpamancy, the ability through exercising the power of the imagination to create seemingly autonomous entities, tulpas. In psychiatric terms this would be termed an ego state which might arise normally as a response to environmental exigencies. Alderson-Day interviewed writers who claim their characters take on a life of their own, as Dickens experienced, and indeed composers such as Mozart, (which are not mentioned), who merely listened to what was being presented to them without much effort other than paying attention. This is what is meant by metacognition, the ability to notice in a detached way without cognitive interference and maintain an accurate appreciation of causation. Those who cannot distinguish may believe they are possessed, a not uncommon psychiatric syndrome.
Inner speech development in childhood and inner dialogue, and the importance of others in the development of a sense of self is discussed. In the final chapter the author reviews factors that contribute to a sense of presence through descriptions of the experiences of zooming, the method of having meetings via the computer made popular during the covid lockdown, and virtual reality. Interaction plays a major part. It seems this also may play a part in therapy involving talking to the voices, a subject Alderson-Day goes into in some detail, as he does the psychology of schizophrenia. Research so demonstrates that schizophrenics have blurred boundaries of personal space, which one suspects is an outcome of a poorly defined sense of self. He indulges in much discussion about psychosis, emphasizing the role of environment, but failing to mention genetic components of its aetiology. He concludes not surprisingly that felt presence is a hallucinatory phenomenon.
In conclusion, this book is an excellent and enjoyable discourse on the topic, written engagingly for the general reader, and covering much associated ground. What may be a disappointment to SPR members is the author’s cavalier dismissal of the paranormal in general. While I for one am strongly of the opinion that it is imperative that explanations of unusual experiences are subject to scientific analysis, by way of neuropsychology in this instance, one would have thought that a proper appreciation at least of the strong evidence of possibly paranormal phenomena that cannot yet be explained in this way should at least be properly acknowledged. I am inclined as a psychiatrist to accept the medical view of, for example, possession syndrome, but the carefully garnered evidence of the existence of the strange phenomena of the paranormal, experimental and otherwise, cannot be so lightly dismissed, even if one rejects the spiritual hypothesis. Nevertheless, every academic parapsychologist should be familiar with the content of this book if they are not already, as should every amateur ghost hunter and those interested in investigating the paranormal, for which this is heartily recommended.
Reference
Rogo, D. S. (1982). ESP and schizophrenia: An analysis from two perspectives. Journal of the Society for Psychical Research, 51, 329-342.
This review first appeared in the Journal of the Society for Psychical Research, volume 87(3).