In 1984, a woman in her 40s was sitting at home reading when she heard a voice that was not her own. It was polite about it. “Please don’t be afraid,” it said. “I know it must be shocking for you to hear me speaking to you like this, but this is the easiest way I could think of. My friend and I used to work at the Children’s Hospital, Great Ormond Street, and we would like to help you.”
The case was documented in the British Medical Journal in 1997 by Ikechukwu Obialo Azuonye, the consultant psychiatrist who treated the woman, under the title “A difficult case: Diagnosis made by hallucinatory voices.” He referred to the patient only as AB.
Azuonye examined her, found nothing physically wrong, and diagnosed her with functional hallucinatory psychosis. He prescribed thioridazine, an antipsychotic, along with counseling. It worked. Within two weeks the voices stopped, and AB went on vacation abroad.
Then the voices came back, and this time they were specific. They told AB to return to England immediately because she needed treatment. They gave her an address, which turned out to be the computerized tomography department of a large London hospital. They told her she had a brain tumor and that her brain stem was inflamed.
Azuonye still had no clinical evidence of anything. No physical signs pointed to a tumor. But AB was badly distressed, so he requested a scan for what he wrote was essentially the purpose of reassuring her, explaining in his letter exactly why he was asking, that hallucinatory voices had told his patient she had a brain tumor, and that he had found no signs of one.
The request was turned down. As he recorded in the report, it was declined “on the grounds that there was no clinical justification for such an expensive investigation. It was also implied that I had gone a little overboard, believing what my patient’s hallucinatory voices were telling her.”
He kept pushing. After some negotiation, the scan went ahead in April. The initial findings were concerning enough to warrant a second, enhanced scan in May, which revealed a left posterior frontal parafalcine mass extending through the falx to the right side. It had all the appearances of a meningioma, a tumor that grows in the membrane covering the brain, positioned between the two hemispheres.
A neurosurgeon offered AB a choice: Operate now, or wait until symptoms appear. She chose immediate surgery. The voices, she reported, were fully in agreement. The operation was performed in May 1984 without complications.
When she came around afterward, she heard the voices one final time. “We are pleased to have helped you. Goodbye.” They never returned. Twelve years later, she phoned Azuonye to wish him a merry Christmas and to tell him she was well, was off all medication, and had not heard the voices since.
Azuonye presented the case at a conference that year, where, by his account, the audience was split down the middle. Some attendees embraced a paranormal reading. Others suspected AB was withholding something.
Azuonye’s own explanation was neurological, and it’s the one the evidence supports. A meningioma of that size, he reasoned, probably produced faint sensations that never rose to the level of an identifiable symptom but were enough for some part of AB to register that something was wrong. The specifics about London hospitals likely came from knowledge she had absorbed and forgotten. The strongest evidence for this reading is the timing, since the voices disappeared for good the moment the tumor was removed, which ties the psychiatric symptoms directly to the lesion.
What Azuonye found genuinely without precedent wasn’t the mechanism but the character of it. “This is the first and only instance I have come across,” he wrote, “in which hallucinatory voices sought to reassure the patient of their genuine interest in her welfare, offered her a specific diagnosis, directed her to the type of hospital best equipped to deal with her problem, expressed pleasure that she had at last received the treatment they desired for her, bid her farewell, and thereafter disappeared.”
