Hallucinations

by Oliver Sacks

Seeing moving pictures even on television may lead to hallucinatory perseverations. Once, watching a television program that showed people descending from a plane, Zelda began to hallucinate minute replicas of the figures, which continued their descent off the screen and down the wooden cabinet of the television console.

Okay, that sounds like a scene right out of the Ring.

(Some researchers have called them “proto-objects” or “proto-images.”) In this way, CBS images seem more raw, more obviously neurological, not personal like those of imagination or recollection.

(Hallucination of particularly vile smells is called cacosmia.)

Great to know that. Root caco- as in cacophony, I'm guessing.

This experiment, designed by David Rosenhan, a Stanford psychologist (and himself a pseudopatient), emphasized, among other things, that the single symptom of “hearing voices” could suffice for an immediate, categorical diagnosis of schizophrenia even in the absence of any other symptoms or abnormalities of behavior.

The voices that are sometimes heard by people with schizophrenia tend to be accusing, threatening, jeering, or persecuting. By contrast, the voices hallucinated by the “normal” are often quite unremarkable, as Daniel Smith brings out in his book Muses, Madmen, and Prophets: Hearing Voices and the Borders of Sanity.

Important distinction, right there.

Some researchers have proposed that auditory hallucinations result from a failure to recognize internally generated speech as one’s own (or perhaps it stems from a cross-activation with the auditory areas so that what most of us experience as our own thoughts becomes “voiced”).

We need hope, the sense of a future. And we need freedom (or at least the illusion of freedom) to get beyond ourselves, whether with telescopes and microscopes and our ever-burgeoning technology or in states of mind which allow us to travel to other worlds, to transcend our immediate surroundings. We need detachment of this sort as much as we need engagement in our lives.

This shocked and sobered me, and made me realize that one could spend entire days, nights, weeks, even years of one’s life in an opium stupor. I would make sure that my first opium experience was also my last.

Good for you, doc.

Description, writing, had always been my best way of dealing with complex or frightening situations—though it had never been tested in so terrifying a situation. But it worked; by describing what was going on in my lab notebook, I managed to maintain a semblance of control, though the hallucinations continued, mutating all the while.

There are things that I am scared about as well (shockers!) I'll be sure to take this tip up.

Migraine-like patterns, indeed, can be found in Islamic art, in classical and medieval motifs, in Zapotec architecture, in the bark paintings of Aboriginal artists in Australia, in Acoma pottery, in Swazi basketry—in virtually every culture, going back tens of thousands of years.

That actually explains a lot.

Ecstatic or religious or mystical seizures occur in only a small number of those who have temporal lobe epilepsy. Is this because there is something special—a preexisting disposition to religion or metaphysical belief—in these particular people? Or is it because the seizure stimulates particular parts of the brain that serve to mediate religious feeling?11 Both, of course, could be the case. And yet quite skeptical people, indifferent to religion, not given to religious belief, may—to their own astonishment—have a religious experience during a seizure.

There are similar irrefutable beliefs in patients who lose the perception of their left side and the left side of space but maintain that there is nothing missing, even though we can demonstrate convincingly that they live in a hemi-universe. Such syndromes—so-called anosognosias—occur only with damage to the right half of the brain, which seems to be especially concerned with the sense of bodily identity.

What Mr. Utter described so vividly are not dreams but involuntary images or quasi-hallucinations appearing just before sleep—hypnagogic hallucinations, to use the term coined by the French psychologist Alfred Maury in 1848. They are estimated to occur in a majority of people, at least occasionally, although they may be so subtle as to go unnoticed.

I think I've experienced this myself.

More than half of McKellar’s subjects reported hypnagogic imagery, and auditory hallucinations (of voices, bells, or animal or other noises) were just as common as visual ones. Many of my own correspondents also describe simple auditory hallucinations: dogs barking, telephones ringing, a name being called.

The most typical one would involve me sitting up in bed and seeing a person—often an old lady—staring at me at some distance from the foot of my bed. (I imagine that such hallucinations are thought to be ghosts by some people—but not by me.) Other examples are seeing a foot-wide spider crawling up my wall; seeing fireworks; and seeing a little devil at the foot of my bed riding a bicycle in place.

Nope, not scary at all.

Given the outlandish quality of some hypnopompic images, their often terrifying emotional resonance, and perhaps the heightened suggestibility that may go with such states, it is very understandable that hypnopompic visions of angels and devils may engender not only wonder or horror but belief in their physical reality. Indeed, one must wonder to what degree the very idea of monsters, ghostly spirits, or phantoms originated with such hallucinations. One can easily imagine that, coupled with a personal or cultural disposition to believe in a disembodied, spiritual realm, these hallucinations, though they have a real physiological basis, might reinforce a belief in the supernatural.

Cataplexy—the sudden, complete loss of muscle tone with emotion or laughter—affected many at this meeting, and it was freely discussed.

But one does not have to have narcolepsy to experience sleep paralysis with hallucinations—indeed, J. A. Cheyne and his colleagues at the University of Waterloo have shown that somewhere between a third and half of the general population has had at least occasional episodes of this, and even a single episode may be unforgettable.

I used to think my buddy had this. Nope, he was just a sleep-deprived teenager.

The “mare” in “nightmare” originally referred to a demonic woman who suffocated sleepers by lying on their chests (she was called “Old Hag” in Newfoundland). Ernest Jones, in his monograph On the Nightmare, emphasized that nightmares were radically different from ordinary dreams in their invariable sense of a fearful presence (sometimes astride the chest), difficulty breathing, and the realization that one is totally paralyzed. The term “nightmare” is often used now to describe any bad dream or anxiety dream, but the real night-mare has dread of a wholly different order; Cheyne speaks of “the ominous numinous” here. He suggests that the term for the night-mare proper be spelled with a hyphen, and this convention has been adopted by other workers in the field.

Adler studied a group of Hmong refugees from Laos who had immigrated to central California in the late 1970s and were not always able to perform their traditional religious rites during the upheaval of genocide and relocation. In Hmong culture, there is a strong belief that night-mares can be fatal; this evil expectation, or nocebo, apparently contributed to the sudden unexplained nocturnal deaths of almost two hundred Hmong immigrants (mostly young and in good health) in the late 1970s and early 1980s. Once they were more assimilated and the old beliefs lost their power, the sudden deaths stopped.

When traditional figures—devils, witches, or hags—are no longer believed in, new ones—aliens, visitations from “a previous life”—take their place. Hallucinations, beyond any other waking experience, can excite, bewilder, terrify, or inspire, leading to the folklore and the myths (sublime, horrible, creative, and playful) which perhaps no individual and no culture can wholly dispense with.

For two months I avoided the office, the place where I had fallen, because it provoked this quasi-hallucination of falling and the crunch of breaking bone. This is one example—a trivial one, perhaps—of a reaction to trauma, a mild traumatic stress syndrome. It is largely resolved now, but it will, I suspect, lurk in the depths as a traumatic memory that may be reactivated under certain conditions for the rest of my life.

The survivors of trauma may be unable to achieve the detachment of retrospection or recollection; for them the traumatic events, in all their fearfulness and horror, all their sensorimotor vividness and concreteness, are sequestered. The events seem to be preserved in a different form of memory, isolated and unintegrated.

In his book The Devils of Loudun, Aldous Huxley described the delusions of demonic possession that swept over the French village of Loudun in 1634, starting with a mother superior and all the nuns in an Ursuline convent. What began as Sister Jeanne’s religious obsessions were magnified to a state of hallucination and hysteria, in part by the exorcists themselves, who, in effect, confirmed the entire community’s fear of demons. Some of the exorcists were affected as well. Father Surin, who had been closeted for hundreds of hours with Sister Jeanne, was himself to be haunted by religious hallucinations of a terrifying nature. The madness consumed the entire village, just as it would later do in the infamous Salem witch trials.

It is evident, from all of this work, that the brain’s representation of the body can often be fooled simply by scrambling the inputs from different senses. If sight and touch say one thing, however absurd, even a lifetime of proprioception and a stable body image cannot always resist this. (Individuals may be more or less susceptible to such illusions, and one might imagine that dancers or athletes, who have an exceptionally vivid sense of where their bodies are in space, may be harder to fool in this way.)

There may indeed, though very rarely, be a congenital absence of body image in an otherwise normal limb; this is suggested, at least, by the numerous reported cases of what Peter Brugger has termed “body-integrity identity disorder.” Such people feel, from childhood onward, that one of their limbs, or perhaps a part of a limb, is not theirs, but an alien encumbrance, and this feeling may engender a passionate desire to have the “superfluous” limb amputated.

One evening, while awaiting surgery, he fell out of bed in a peculiar way—almost, the nurses said, as if he had thrown himself off the bed. When I asked him about this, he said that he had been asleep and awoke to discover a leg—a dead, cold, hairy leg—in his bed. He could not think how someone else’s leg had got into his bed, unless—the idea suddenly occurred to him—the nurses had taken a leg from the anatomy labs and slipped it into his bed as a joke. Shocked and repelled, he used his good right leg to kick the alien thing out of his bed, and, of course, he came out after it, and was now aghast because “it” was attached to him. I said, “But it is your leg,” and pointed out to him that the size, the shape, the contour, the color were precisely the same in the two legs; but he would have none of it. He was absolutely certain that it was someone else’s.

But one can readily see why others, perhaps of a different disposition, might interpret the “sure knowledge of the close presence of a sort of mighty person” and “a startling awareness of some ineffable good” in mystical, if not religious, terms.

Thus the primal, animal sense of “the other,” which may have evolved for the detection of threat, can take on a lofty, even transcendent function in human beings, as a biological basis for religious passion and conviction, where the “other,” the “presence,” becomes the person of God.