You're sitting in a darkened room, or perhaps lying in bed. Suddenly, you hear your name being spoken. Perhaps it's a familiar voice. You start, you may even get up- but more likely you just realize there's no one there. You must have imagined it.
Has this ever happened to you? It would be odd if it hadn't. Most people have had this experience, and experiences like it. If and when it happened to you, your first thought was probably "I must have imagined it." You might also have thought about telling someone else about it- but then thought better of it. Normal people don't have hallucinations, right? That's something that happens to crazy people.
But hallucinations are a near-universal phenomenon, and they're not limited only to those people suffering from mental disorders. In fact, the hallucinations of schizophrenics, which are usually auditory in nature, make up a very small subset of the range of hallucinations that people experience. There are a great many conditions, both internal and external, that can result in hallucinations in all modalities- sight, hearing, smell, touch, and taste. There are kinesthetic hallucinations that affect a person's perception of the position of their body, or pain, or the passage of time. For every perception, there are hallucinations.
Many, if not most, people don't report hallucination for fear of being labeled crazy. There's a very common, yet underreported condition called Charles Bonnet Syndrome, or CBS for short, that commonly afflicts older people who suffer from some visual impairment. The impairment can be peripheral in nature, like macular degeneration, or central, as in a stroke affecting visual cortex or thalamus; the important thing is that all or part of the visual field is damaged, or missing. Sufferers of CBS see things- patterns, animals, people- all manner of visual hallucinations. They usually know that what they're perceiving isn't real, but at the same time they're very reticent to report their experiences for fear of be labeled as suffering from dementia, so the condition goes largely unreported. Most doctors, nurses and nursing home staff have never heard of it. And yet CBS has been known since Charles Bonnet first described it in 1760.
The hallucinations seen by CBS sufferers are triggered when the brain is deprived of perceptual information. Your mind is constantly busy constructing the perceptual world you inhabit. Most of what you experience as perception is in reality a fiction compiled from memory, constantly update by new perceptual information. When that input is disrupted, the brain starts filling in the missing bits. If part of your visual field is destroyed- as happened to Sacks- the brain tries to complete the scene, using stored memories. Sometimes the bits it fills in make sense. Often they don't.
There are other conditions in which sensory deprivation can trigger hallucinations. Phantom limb pain, a common complaint of patients who have had limbs amputated, is this sort of hallucination. So are the visions seen when people are placed in sensory deprivation tanks. Hallucinations can also be triggered by unnatural activity in the brain. Electrical stimulation (used in neurosurgery to identify function in the brain), epilepsy (which can be thought of as a spreading electrical "storm" in the brain), and hallucinogenic drugs can evoke hallucinations by raising the level of activity in part of the brain, evoking memories and stored perceptions. Many migraine sufferers are aware of the visual hallucinations that accompany or precede migraine headaches. These hallucinations are often caused by unusual activity in the visual cortex, and the migraine sufferer will typically perceive geometric forms that echo the organization of neurons in visual cortex.
Oliver Sacks is well known as a neurologist who has a particular gift for writing about the various pathologies of the human nervous system, and in Hallucinations he follows his usual pattern of telling a fascinating story via historical background, scientific research, and a large number of clinical cases he has consulted on. He begins with a discussion of Charles Bonnet Syndrome, and from there goes on to sensory deprivation, auditory hallucinations, hallucinations associated with Parkinson's disease, hallucinogenic drugs, epilepsy, sleep, religious experiences, and more. As he did in
The Mind's Eye (Vintage), he brings his own experiences into the narrative as well- having lost vision in one eye from a tumor, Sacks himself experienced a range of visual hallucinations that helped him understand the experiences of some of his patients.
Perhaps because of his own experiences, Sacks seeks to demystify hallucinations, and to de-stigmatize those who experience them while being otherwise untroubled by psychiatric issues. He notes that about a third of all Parkinsons patients eventually experience hallucinations as a consequence of their medication, and this has led to many sufferers being labeled as psychotic by their doctors. While the administration of large- Sacks would say, excessive- doses of L-Dopa and dopamine agonists can indeed put patients in a delusional state, many patients experience mild hallucinations that they can identify as such, and some even find them amusing or entertaining. One patient of Sacks' found himself comforted by visits from a hallucinated cat while his own cat was at the veterinarian's. While many psychotics suffer from hearing voices, so do a number of decidedly non-psychotic people. Some even find them helpful. Sacks mentions Julian Jaynes' hypothesis (described in
The Origin of Consciousness in the Breakdown of the Bicameral Mind) concerning the origins of consciousness, and speculates, like Jaynes, that early man may have experienced these voices at some stage in human evolution.
I have every one of Sacks' previous books (they're lined up on a shelf next to my psychology and neuroscience textbooks) and I can certainly say that I found this volume every bit as interesting as any of his previous works. Sacks does a marvelous job of making complex neurological issues clear to the lay reader, and his use of case studies brings the reader a real perspective regarding the experiences of the sufferers. Sacks' patients are more than numbered case studies; they're people with real lives, with whom the reader can empathize. Readers of his previous works will know what I'm talking about. Readers new to Sacks will, I suspect, find this volume as fascinating as I did, and will be just as anxious to read his earlier books as I was when I first discovered him for myself.