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

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 () 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.