Factors determining compliance with command hallucinations with violent content: the role of social rank, perceived power of the voice and voice malevolence

Abstract

We have examined the nature of the cognitive processes sub-serving compliance with command hallucinations. Specifically, we investigated the interaction between self beliefs of social rank in the voice-hearer and beliefs about the voice in determining compliance with content-specific violent commands (self-harm, harm-other). Thirty-two people who heard violent command hallucinations were asked to rate their beliefs about the power and the benevolence/malevolence of the commanding voice. They also rated their perception of their own inferiority/superiority within real-life social relationships. The study reliably identified two groups of ‘compliers’ and ‘non-compliers’ sub-divided into two groups of ‘self-harm command hearers’ and ‘harm-other command hearers’. No significant differences were found between the compliers and non-compliers on beliefs about benevolence or malevolence of the voice. The complier group reported that they perceived the command voice to be significantly more powerful than the non-complier group. Further, ‘self-harm command compliers’ reported significantly higher ratings of inferiority in social relationships, whilst ‘harm-other command compliers’ reported significantly higher ratings of superiority within social relationships. The results show that beliefs about social rank have potentially important mediating effects upon complying with content-specific commands (self-harm vs harm-other). Importantly, the results have highlighted that for people in contact with psychiatric services compliance with violent command hallucinations is far more common than non-compliance. This may mirror Milgram's (1974) findings of the rarity of resistance to obedience with authority. However, these conclusions must be tentative due to the small sample size in the non-compliance conditions.

Keywords:

• command hallucinations
• compliance
• benevolence
• malevolence
• social rank
• risk of future dangerousness

ACKNOWLEDGEMENTS

Thanks are due to Stella Austin and Tony Morrison for their most helpful comments on earlier drafts of this paper. Thanks are also due to all the professionals and staff that assisted us in our recruitment of participants. A special thank you goes to all the people who took part in this study for sharing their personal struggle with their voices.