Hallucinations

Hallucinations have always had an important place in our mental lives and in our culture. Indeed, one must wonder to what extent hallucinatory experiences have given rise to our art, folklore, and even religion. Do the geometric patterns seen in migraine and other conditions prefigure the motifs of Aboriginal art? Did Lilliputian hallucinations (which are not uncommon) give rise to the elves, imps, leprechauns, and fairies in our folklore? Do the terrifying hallucinations of the night-mare, being ridden and suffocated by a malign presence, play a part in generating our concepts of demons and witches or malignant aliens? Do “ecstatic” seizures, such as Dostoevsky had, play a part in generating our sense of the divine? Do out-of-body experiences allow the feeling that one can be disembodied? Does the substancelessness of hallucinations encourage a belief in ghosts and spirits? Why has every culture known to us sought and found hallucinogenic drugs and used them, first and foremost, for sacramental purposes?

This is not a new thought — in 1845, Alexandre Brierre de Boismont, in the first systematic medical book on the subject, explored such ideas in a chapter titled “Hallucinations in Relation to Psychology, History, Morality, and Religion.” Anthropologists including Weston La Barre and Richard Evans Schultes, among others, have documented the role of hallucinations in societies around the globe.³ Time has only broadened and deepened our appreciation of the great cultural importance of what might at first seem to be little more than a neurological quirk.

I will say very little in this book about the vast and fascinating realm of dreams (which, one can argue, are hallucinations of a sort), other than to touch on the dreamlike quality of some hallucinations and on the “dreamy states” which occur in some seizures. Some have proposed a continuum of dream states and hallucinations (and this may be especially so with hypnagogic and hypnopompic hallucinations), but, in general, hallucinations are quite unlike dreams.

Hallucinations often seem to have the creativity of imagination, dreams, or fantasy — or the vivid detail and externality of perception. But hallucination is none of these, though it may share some neurophysiological mechanisms with each. Hallucination is a unique and special category of consciousness and mental life.

The hallucinations often experienced by people with schizophrenia also demand a separate consideration, a book of their own, for they cannot be divorced from the often profoundly altered inner life and life circumstances of those with schizophrenia. So I will refer relatively little to schizophrenic hallucinations here, focusing instead on the hallucinations that can occur in “organic” psychoses — the transient psychoses sometimes associated with delirium, epilepsy, drug use, and certain medical conditions.

Many cultures regard hallucination, like dreams, as a special, privileged state of consciousness — one that is actively sought through spiritual practices, meditation, drugs, or solitude. But in modern Western culture, hallucinations are more often considered to portend madness or something dire happening to the brain — even though the vast majority of hallucinations have no such dark implications. There is great stigma here, and patients are often reluctant to admit to hallucinating, afraid that their friends and even their doctors will think they are losing their minds. I have been very fortunate that, in my own practice and in correspondence with readers (which I think of, in some ways, as an extension of my practice), I have encountered so many people willing to share their experiences. Many of them have expressed the hope that telling their stories will help defuse the often cruel misunderstandings which surround the whole subject.

I think of this book, then, as a sort of natural history or anthology of hallucinations, describing the experiences and impact of hallucinations on those who have them, for the power of hallucinations is only to be understood from firstperson accounts.

Some of the chapters that follow are organized by medical categories (blindness, sensory deprivation, narcolepsy, etc.), and others are organized by sensory modality (hearing things, smelling things, etc.). But there is a great deal of overlap and interconnection between these categories, and similar hallucinations may occur in a wide variety of conditions. Here, then, is a sampling which I hope will give a sense of the great range, the varieties, of hallucinatory experience, an essential part of the human condition.