I’ve just been reminded of one of the most remarkable case studies in the psychiatric literature, of a patient who believed he had two heads and who seriously injured himself with a gunshot wound trying to remove the ‘second’ head.
He described a second head on his shoulder. He believed that the head belonged to his wife’s gynaecologist, and described previously having felt that his wife was having an affair with this gynaecologist, prior to her death. He described being able to see the second head when he went to bed at night, and stated that it had been trying to dominate his normal head.
He also stated that he was hearing voices, including the voice of his wife’s gynaecologist from the second head, as well as the voices of Jesus and Abraham around him, conversing with each other. All the voices were confirming that he had two heads; the voice from the second head had been telling him that it was the ‘king pin’, and would also say to him that it was going to take his wife away. He did not describe any other hallucinatory or delusional experiences.
“The other head kept trying to dominate my normal head, and I would not let it. It kept trying to say to me I would lose, and I said bull-shit.” “I am the king pin here” it said and it kept going on like that for about three weeks and finally I got jack of it, and I decided to shoot my other head off.”
He stated that he fired six shots, the first at the second head, which he then decided was hanging by a thread, and then another one through the roof of his mouth. He then fired four more shots, one of which appeared to have gone through the roof of his mouth and three of which missed. He said that he felt good at that stage, and that the other head was not felt any more. Then he passed out. Prior to shooting himself, he had considered using an axe to remove the phantom head.
I was reminded of the case study by McKay and colleagues chapter in the academic book Delusion and Self-Deception. I’ve been sent a free copy to review for an academic journal and am currently ploughing through it. It’s not very accessible for the general reader but is full of thought provoking theories on the cognitive science of delusions.