Hallucinations

by Oliver Sacks

  [Congregants] practice seeing, hearing, smelling, and touching in the mind’s eye. They give these imagined experiences the sensory vividness associated with the memories of real events. What they are able to imagine becomes more real to them.

  And one day the mind leaps from imagination to hallucination, and the congregant hears God, sees God.

  These yearned-for voices and visions have the reality of perception. One of Luhrmann’s subjects, Sarah, put it this way: “The images I see [in prayer] are very real and lucid. Different from just daydreaming. I mean, sometimes it’s almost like a PowerPoint presentation.” Over time, Luhrmann writes, Sarah’s images “got richer and more complicated. They seemed to have sharper borders. They continued to get more complex and more distinct.” Mental images become as clear and as real as the external world.

  Sarah had many such experiences; some congregants might have only a single one—but even a single experience of God, imbued with the overwhelming force of actual perception, can be enough to sustain a lifetime of faith.

  Even at a more modest level, all of us are susceptible to the power of suggestion, especially if it is combined with emotional arousal and ambiguous stimuli. The idea that a house is “haunted,” though scoffed at by the rational mind, may nonetheless induce a watchful state of mind and even hallucination, as Leslie D. brought out in a letter to me:

  Almost four years ago I started a job that is housed in one of the oldest residences in Hanover, PA. On my first day, I was told there was a resident ghost, the ghost of Mr. Gobrecht, who lived here many years ago and was a music teacher.… I suppose he died in the house. It would be almost impossible to adequately describe how much I do NOT believe in the supernatural! However, within days I started to feel something like a hand tugging on my pant leg while I sat at my desk, and once in a while a hand on my shoulder. Just a week ago we were discussing the ghost, and I felt (very pronounced) fingers moving along my upper back, just behind my shoulder, distinct enough to make me jump. Power of suggestion, maybe?

  Children not uncommonly have imaginary companions. Sometimes this may be a sort of ongoing, systematized daydreaming or storytelling, the creation of an imaginative and perhaps lonely child; in some cases it may have elements of hallucination—a hallucination that is benign and pleasant, as Hailey W. described to me:

  Growing up without brothers or sisters, I created a few imaginary friends whom I played with frequently from approximately age three to six. The most memorable of these was a pair of identical twin girls named Kacey and Klacey. They were my age and size, and we would often do things together like play on the swings in the backyard or have tea parties. Kacey and Klacey also had a little sister named Milky. I had a strong image of them all in my mind’s eye, and they seemed very real to me at the time. My parents were mostly amused by it, though they did question whether it was natural for my imaginary friends to be so detailed and plentiful. They recall me having long conversations at the table with “no one,” and when asked, I would always say I was talking with Kacey and Klacey. Often when playing (with toys, or games) I would say I was playing with Kacey and Klacey or Milky. I would talk about them often as well, and for a period of time I remember being fixated on the idea of a seeing-eye dog, begging my mother to let me have one. Rather taken aback, my mother asked where I got the idea; I replied that Kacey and Klacey’s mother was blind, and that I wanted a seeing-eye dog like hers. As an adult, I am still surprised when someone tells me that they never had imaginary friends growing up, as they were such an important—and enjoyable—part of my childhood.

  And yet “imagination” may not be an adequate term here, for imaginary companions may seem intensely real, as no other products of fantasy or imagination do. Perhaps the difficulty of fitting our adult categories of “reality” and “imagination” to the thoughts and play of children is not surprising; for, if Piaget is right, children cannot consistently and confidently distinguish fantasy from reality, inner from outer worlds, until the age of seven or so. It is usually at this age, or a little later, that imaginary companions tend to disappear.

  Children may also be more accepting of their hallucinations, having not yet learned that hallucinations are considered (in our culture) “abnormal.” Tom W. wrote to me about his “intended” childhood hallucinations, hypnagogic visions he would bring on as entertainment from the ages of four to seven:

  I used to entertain myself while falling asleep by hallucinating. I would lie in bed and stare up at the ceiling in the halflight.… I would stare at a fixed point, and by holding my eyes very still, the ceiling would neutralize and gradually become swarming pixels, which would become patterns: waves and grids and paisleys. Then, in the midst of that, figures would start to appear and interact. I remember quite a few—[and] I remember the exceptional visual clarity of them. Once the vision was present, I could look around at things the way you would a film.

  There was another way I used to do this. There was a family portrait that hung at the foot of my bed, a classical staged photo of my grandparents, cousins, an aunt and uncle, my parents, my brother, and me. Behind us was a huge privet hedge. Again, in the evening, I would gaze at the portrait. Very quickly, strange and delightfully silly things would start to happen: apples would grow out of the privet hedge, my cousins would begin to chatter and chase each other around the group. My grandmother’s head would “pop off” and attach to her two calves, which would then start to dance about. Grim as that seems now, I found it hilarious then.

  At the other end of life, there is a special sort of hallucination that may attend death or the anticipation of death. Working in old-age homes and nursing homes, I have been struck and moved by how often patients who are lucid, sane, and fully conscious may have hallucinations when they feel that death is near.

  When Rosalie—the very old blind lady I described in the chapter on Charles Bonnet syndrome—became ill and thought she was dying, she had visions of her mother and heard her mother’s voice welcoming her into heaven. These hallucinations were completely different in character from her usual CBS hallucinations—they were multisensory, personal, addressed to her, and steeped in warmth and tenderness. Her CBS hallucinations, by contrast, had no apparent relation to her and aroused no emotion. I have known other patients (who did not have CBS or any other special condition facilitating hallucinations) to have similar deathbed hallucinations—sometimes the first and last hallucinations in their lives.

  1. Many of H. G. Wells’s short stories also involve guilt hallucinations. In “The Moth,” a zoologist who feels himself responsible for the death of his lifelong rival is haunted and finally driven mad by a giant moth that no one else can see, a moth of a genus unknown to science; but in his lucid moments, he jokes that it is the ghost of his deceased rival.

  Dickens, a haunted man himself, wrote five books on this theme, the best known of these being A Christmas Carol. And in Great Expectations, he provides a dramatic account of Pip’s vision after his first, horrified encounter with Miss Havisham:

  I thought it a strange thing then, and I thought it a stranger thing long afterwards. I turned my eyes—a little dimmed by looking up at the frosty light—towards a great wooden beam in a low nook of the building near me on my right hand, and I saw a figure hanging there by the neck. A figure all in yellow white, with but one shoe to the feet; and it hung so that I could see that the faded trimmings of the dress were like earthy paper, and that the face was Miss Havisham’s, with a movement going over the whole countenance as if she were trying to call me. In the terror of seeing the figure, and in the terror of being certain that it had not been there a moment before, I at first ran from it, and then ran towards it. And my terror was greatest of all when I found no figure there.

  2. Losing a spouse, of course, is one of the most stressful of life events, but bereavement may happen in many other situations, from the loss of a job to the loss of a beloved pet. A friend of mine was very upset when her twenty-year-old cat died, and for months she
“saw” the cat and its characteristic movements in the folds of the curtains.

  Another friend, Malonnie K., described a different sort of cat hallucination, after her beloved seventeen-year-old pet died:

  Much to my surprise, the next day I was getting ready for work and she appeared at the bathroom door, smiled and meowed her usual “good morning.” I was flabbergasted. I went to tell my husband and when I returned, of course, she was no longer there. This was upsetting to me because I have no history of hallucinations and thought I was “above” such things. However, I have accepted that this experience was, perhaps, a result of the phenomenally close bond that we had developed and sustained over nearly two decades. I must say, I am so grateful that she stopped by one last time.

  3. Loss, longing, and nostalgia for lost worlds are also potent inducers of hallucinations. Franco Magnani, “the memory artist” I described in An Anthropologist on Mars, had been exiled from Pontito, the little village where he grew up, and although he had not returned to it in decades, he was haunted by continual dreams and hallucinations of Pontito—an idealized, timeless Pontito, as it looked before it was invaded by the Nazis in 1943. He devoted his life to objectifying these hallucinations in hundreds of nostalgic, beautiful, and uncannily accurate paintings.

  4. Though “flashback” is a visual, cinematic term, auditory hallucinations can be very striking, too. Veterans with PTSD may hallucinate the voices of dying comrades, enemy soldiers, or civilians. Holmes and Tinnin, in one study, found that the hearing of intrusive voices, explicitly or implicitly accusing, affected more than 65 percent of veterans with combat PTSD.

  5. Sometimes this effect can be heightened by medications. In 1970, I had one patient with postencephalitic parkinsonism who was a concentration camp survivor. For her, treatment with L-dopa caused an intolerable exacerbation of her traumatic nightmares and flashbacks, and we had to discontinue the drug.

  6. In the “normal” neuroses commonly brought to psychotherapists, the buried, pathogenic material typically comes from much earlier in life. Such patients are also haunted, but as in the title of Leonard Shengold’s book, they are Haunted by Parents.

  7. Freud was deeply puzzled and troubled by the pertinacity of such post-traumatic syndromes after World War I. Indeed, they forced him to question his theory of the pleasure principle and, at least in this case, to see instead a much grimmer principle at work, that of repetition-compulsion, even though this seemed maladaptive, the very antithesis of a healing process.

  8. Many of the testimonies and accusations in the Salem witch trials described assaults by hags, demons, witches, or cats (which were seen as witches’ familiars). The cats would sit astride sleepers, pressing on their chests, suffocating them, while the sleepers had no power to move or resist. These are experiences we would now interpret in terms of sleep paralysis and night-mare, but which were given a supernatural narrative. The whole subject is explored by Owen Davies in his 2003 article “The Nightmare Experience, Sleep Paralysis, and Witchcraft Accusations.”

  Other conditions have also been suggested as contributing to the hallucinations and hysteria of seventeenth-century New En gland. One hypothesis, which Laurie Winn Carlson proposes in her book A Fever in Salem, sees the madness as a manifestation of a postencephalitic disorder.

  Others have proposed that ergot poisoning played a part. Ergot, a fungus containing toxic alkaloid compounds similar to LSD, can infest rye and other grains, and if contaminated bread or flour is eaten, ergotism may result. This happened frequently in the Middle Ages, and it could cause agonizing gangrene (which led to one of its popular names, St. Anthony’s fire). Ergotism could also cause convulsions and hallucinations very similar to those of LSD.

  In 1951, an entire French village succumbed to ergot poisoning, as John Grant Fuller described in his book The Day of St. Anthony’s Fire. Those affected endured several weeks of terrifying hallucinations and often compulsions to jump from windows, as well as extreme insomnia.

  9. This was shown experimentally by Brady and Levitt in a 1966 study, in which they suggested to hypnotized subjects that they “see” (i.e., hallucinate) a moving visual stimulus (a rotating drum with vertical stripes). The subjects’ eyes, as they did this, showed the same automatic tracking movements (“optokinetic nystagmus”) that occur when one is actually looking at such a rotating drum—whereas no such movements occur (and they are impossible to feign) if one merely imagines such a visual target.

  14

  Doppelgängers: Hallucinating Oneself

  Sleep paralysis may be associated, as some of my correspondents have emphasized, with a sense of floating or levitation, and even hallucinations of leaving one’s own body and flying through space. These experiences, so unlike the hideous night-mare ones, may go with feelings of calm and joy (some of Cheyne’s subjects used the term “bliss”). Jeanette B., who has had a lifetime of narcolepsy and sleep paralysis (which she refers to as “spells”), described this to me:

  It was after college that the spells became both a burden and a blessing. Not being able to pull myself out of the paralysis one night, I let go; and felt myself slowly rising out of my body! I had come through the terror part and felt a wonderful peaceful bliss as I rose out of my body and floated up. Now, as I experienced this I found it very difficult to believe it was a hallucination. All of my senses seemed unusually sharp: someone’s radio playing in another room, crickets chirping outside the window. Without going into detail, this was a hallucination that was more pleasant than anything I had ever experienced.…

  I suppose I became so nearly addicted to the out of body experiences, that when offered some meds from my neurologist to help with the nighttime paralysis and hallucinations, I refused, rather than give up the out of body experiences. I didn’t say that was the reason.

  For quite some time, I would try to will myself into that pleasant hallucination. I discovered it usually came after much stress or lack of sleep, and would deprive myself of sleep in order to achieve the experience of floating amongst the stars, high enough to observe the curvature of the earth.…

  But bliss can coincide with terror—Peter S., a friend, found this when he had a single episode of sleep paralysis with hallucination. It seemed to him that he left his body, cast a backward glance at it, then soared up into the sky. He had an enormous sense of freedom and joy, now that he had left the limitations of his human body, a feeling that he could roam at will through the universe. But there was also a fear, which became terror, that he might be lost forever in infinity, unable to rejoin his body on earth.

  Out-of-body experiences may occur when specific regions of the brain are stimulated in the course of a seizure or a migraine, as well as with electrical stimulation of the cortex.1 They may occur with drug experiences and in self-induced trances. OBEs can also occur when the brain is not receiving enough blood, as may happen if there is a cardiac arrest or arrhythmia, massive blood loss, or shock.

  My friend Sarah B. had an OBE in the delivery room, just after giving birth. She had delivered a healthy baby, but she had lost a lot of blood, and her obstetrician said that he would have to compress the uterus to stop the hemorrhage. Sarah wrote:

  I felt my uterus being squeezed and told myself not to move or cry out.… Then, suddenly, I was floating with the back of my head against the ceiling. I was looking down on a body which was not my own. The body was some distance from me.… I watched the doctor pound on this woman and heard him grunt loudly with his efforts. I thought, “This woman is very inconsiderate. She is giving Dr. J. a lot of trouble.” … So I was completely oriented to time, day, place, people, and event. I was just unaware that the center of the drama was myself.

  After some time, Dr. J. withdrew his hands from the body, stepped back, and announced that the bleeding had stopped. As he said this, I felt myself slip back into my body like an arm sliding into the sleeve of a coat. I was no longer looking, from a distance, down on the doctor; instead he was looming above and quite close to
me. His green surgical scrubs were covered with blood.

  Sarah had critically low blood pressure, and it was probably this—her brain getting insufficient oxygen—which precipitated the OBE. Anxiety may have constituted an additional factor, as reassurance did in ending the attack, despite her still very low blood pressure. Her not recognizing her own body is curious, though it is commonly reported that the body looks “vacated” or “empty” when the now-disembodied self looks down on its former home.

  Another friend, Hazel R., a chemist, told me of an experience she had many years ago, also when she was in labor. She was offered heroin for her pain (this was common in England in those days), and as the heroin took effect, she felt herself floating upwards, coming to rest beneath the ceiling in the corner of the delivery room. She saw her body beneath her, and she had no pain whatever—she felt that the pain had stayed in the body below her. She also had a sense of great visual and intellectual acuity: she felt that she could easily solve any problem (unfortunately, she said wryly, no problem presented itself). As the heroin wore off, she returned to her body and its violent contractions and pain. When her obstetrician told her she could have a further dose, she asked if it could affect the baby adversely. Once she was reassured that it would not, she assented to a second dose, and again she enjoyed a detachment from her body and its labor pains, as well as a feeling of supernal mental clarity.2 Although this occurred more than fifty years ago, Hazel still remembers every detail.

  It is not easy to imagine such detachment from the body if one has never experienced it. I have never had an OBE myself, but I was once involved in a remarkably simple experiment which showed me how easily one’s sense of self can be detached from one’s body and “reembodied” in a robot. The robot was a massive metal figure with video cameras for “eyes” and lobsterlike claws for “hands,” designed for training astronauts to operate similar machines in space. I donned goggles connected to the video cameras, so that in effect I was seeing the world through the robot’s eyes, and I inserted my hands into gloves with sensors that would register my movements and transmit them to the robot’s claws. As soon as I was connected, looking out through the robot’s eyes, I had the odd experience of seeing, a few feet to my left, an oddly small figure (did it seem small because I, embodied in the robot, was now so large?) sitting in a chair and wearing goggles and gloves, a vacated figure who I realized, with a start, must be me.