Saturday, May 16, 2015

Shooting the Phantom Head (perceptual delusional bicephaly)

I have two heads
Where's the man, he's late

--Throwing Muses, Devil's Roof

Medical journals are enlivened by case reports of bizarre and unusual syndromes. Although somatic delusions are relatively common in schizophrenia, reports of hallucinations and delusions of bicephaly are rare. For a patient to attempt to remove a perceived second head by shooting and to survive the experience for more than two years may well be unique, and merits presentation.

--David Ames, British Journal of Psychiatry (1984)

In 1984, Dr. David Ames of Royal Melbourne Hospital published a truly bizarre case report about a 39 year old man hospitalized with a self-inflicted gunshot wound through the left frontal lobe (Ames, 1984). The man was driven to this desperate act by the delusion of having a second head on his shoulder. The interloping head belonged to his wife's gynecologist.

In an even more macabre twist, his wife had died in a car accident two years earlier..... and the poor man had been driving at the time!

Surprisingly, the man survived a bullet through his skull (in true Phineas Gage fashion). After waking from surgery to remove the bullet fragments, the patient was interviewed:
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...

I'm two headed one free one sticky
--Throwing Muses, Devil's Roof

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 ... and decided to shoot my other head off.”

A gun was not his first choice, however... he originally wanted to use an ax.

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.

Not surprisingly, the patient was diagnosed with schizophrenia and given antipsychotics.
He was seen regularly in psychiatric out-patients following this operation and by March, stated that the second head was dead, that he was taking his chlorpromazine regularly, and that he had no worries.  [This was Australia, after all.]

Unfortunately, the man died two years later from a Streptococcus pneumoniae infection in his brain.  Ames (1984) concluded his lively and bizarre case report by naming the singular syndromeperceptual delusional bicephaly”:
This case illustrates an interesting phenomenon of perceptual delusional bicephaly; the delusion caused the patient to attempt to remove the second head by shooting. It is notable that following his head injury and treatment with chlorpromazine, the initial symptoms resolved, although he was left with the problems of social disinhibition and poor volition, typical of patients with frontal lobe injuries.

As far as I know, this specific delusion has not yet been depicted in a horror film (or in an episode of Perception or Black Box).


Ames, D. (1984). Self shooting of a phantom head The British Journal of Psychiatry, 145 (2), 193-194 DOI: 10.1192/bjp.145.2.193

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