THIS IDEA IS CONSISTENT with what was happening to Sylvia.
Although her regular hearing is distorted, familiar music can sometimes suppress her hallucinations for brief periods. In 2014, Timothy Griffiths thought he might be able to use this to support the prediction model of hallucinations.10
“The main obstacle to studying hallucinations and why they arise has always been an inability to control them—Sylvia gave us a chance to switch them on and off,” he says.
Griffiths and his colleagues had Sylvia come into their lab and lie down in a machine that analyzed her brain waves—the cyclic flow of electrical activity around the brain. While the machine was analyzing her brain activity, Griffiths’s team played Sylvia various passages from a familiar Bach concerto. Sylvia rated the intensity of her hallucinations every fifteen seconds throughout the study. At the time of the experiment, her musical hallucinations happened to consist of sequences from Gilbert and Sullivan’s musical HMS Pinafore. Immediately following the Bach, her hallucinations were silent for a few seconds, gradually increasing in volume until the start of the next excerpt. It was this that allowed Griffiths to measure her brain activity without the hallucinations and then with them.
Sylvia’s brain scans showed that, during her hallucinations, regions of the brain that process melodies and sequences of tones were talking to one another just as they might if she was listening to real music. Yet, because Sylvia is severely deaf, they were not constrained by the real sounds entering her ears. Her hallucinations are her brain’s best guess at what is out there.
This theory also explains why listening to some kinds of music can stop Sylvia’s hallucinations. When she is concentrating on Bach, something she is familiar with, the signal entering her brain is much more reliable and that constrains the aberrant conversation going on in higher areas; this then reconciles itself to what is actually happening in the real world.
This notion of hallucinations as errant predictions has also been put to the test in completely silent rooms known as anechoic chambers. At Orfield Laboratories in Minneapolis, Minnesota, you can find such a chamber, dubbed “the quietist place on earth.” The chamber is actually a pitch-black room built inside a room, built inside another room. It has three-foot-thick walls of steel and concrete and is lined with jagged padding, designed to absorb what’s left of any tiny sound. Once inside, you can hear your eyeballs moving and your skin stretching across your skull. People generally start to hallucinate within twenty minutes of the door closing.11 But what’s the trigger?
I asked Oliver Mason, a clinical psychologist at University College London who specializes in sensory deprivation. There are two possibilities, he said. One is that sensory regions of the brain occasionally show spontaneous activity that is usually suppressed and corrected by real sensory data coming in from the world. In the deathly silence of an anechoic chamber, under the influence of the ganzfeld technique or in the case of a permanent lost sense, the brain may make predictions based on this spontaneous activity that then run riot. The second possibility is that the brain misinterprets internally generated sounds. In an anechoic chamber, for instance, the sound of blood flowing through your ears isn’t familiar, so it could be misattributed as coming from outside you. “Once a sound is given significance, you’ve got a seed,” said Mason, “a starting point on which a hallucination can be built.”
NOT EVERYONE REACTS in the same way inside an anechoic chamber. Some people don’t hallucinate at all. Others do, but realize it is their mind playing tricks.
“Some people come out and say, ‘I’m convinced you were playing noises in there,’” says Mason.
This was something I was puzzled about—why did Sylvia hear hallucinations when others with hearing loss did not?
When I asked Mason about this, he told me there were several theories. Finding out the answer is incredibly important, he said, because it could reveal why some people are more prone to the delusions and hallucinations associated with mental illness.
We know that electrical messages passed across the brain are either excitatory or inhibitory—meaning they either promote or impede activity in neighboring neurons. In a recent unpublished experiment, Mason’s team analyzed the brain activity of volunteers while they sat in an anechoic chamber for twenty-five minutes. Those who had more hallucinatory sensations had lower levels of inhibitory activity across their brain. Perhaps, says Mason, weaker inhibition makes it more likely that irrelevant signals suddenly become meaningful.
People with schizophrenia often have overactivity in their sensory cortices, but poor connectivity from these areas to their frontal lobes. This might mean that the brain makes lots of predictions that are not given a reality check before they pass into conscious awareness, says Flavie Waters, a clinical neuroscientist at the University of Western Australia in Perth. In conditions like Charles Bonnet syndrome, it is underactivity in the sensory cortices that triggers the brain to start filling in the gaps, and there is no actual sensory input to help it correct course. In both cases, says Waters, the brain starts listening in on itself, instead of tuning into the outside world.
This kind of research is helping people like Max, who can spend whole days surrounded by strange smells, reconnect with the external world. If his smell hallucinations are driven by a lack of reliable information, then real smells should help him to suppress the hallucinations. He has been trialing sniffing three different scents three times a day. “Maybe it’s just wishful thinking,” he says, “but it seems to be helping.”
The knowledge that hallucinations can be a by-product of how we construct reality might change how we experience them. In his later years, Sacks himself became blind in one eye and had severe vision loss in the other. When he played the piano, he noticed that he would occasionally see showers of flats when he was looking carefully at musical scores. “Why they are flats, not sharps, I don’t know,” he said. He also hallucinated letters and the occasional words.
His hallucinations didn’t bother him, he told me. “I have long since learned to ignore them, and occasionally enjoy them. I like seeing what my brain is up to when it is at play.”
* * *
Recently, Sylvia’s musical hallucinations have become much quicker, so that the notes go at a faster pace. They’ve also become louder. Now, she says, her hallucinations have developed so much that if she practices a Mozart sonata on the piano and then stops, the whole of the first movement will play in her mind. She says it’s like having one’s own internal iPod. It has its downsides—December can become a nightmare for Sylvia: “There’ll be carols in all the supermarkets so I’ll get fragments of those playing over and over—it will drive me mad.”
Interestingly, words have also started to influence her hallucinations. The previous day, Sylvia had been reading, and the word “abide” was on the page. Suddenly the hymn “Abide with Me” had started to play on Sylvia’s internal iPod. Images can also trigger songs. When she was in a toy shop with her granddaughter, she caught sight of a jester with bells hanging off its hat. Suddenly, “When That I Was and a Little Tiny Boy” started playing—the jester song from Twelfth Night.
She says she has also begun to get a modicum of control over her hallucinations. That morning, for example, she had gone swimming. The wax earplugs make everything silent, which renders the tunes in her head even more obvious. “It was going ‘yada da bomb bomb, yada da bomb bomb,’” she says. “I didn’t want that going on all the time I was swimming so I pitched out loud a note that was a semi-tone up from what was playing to conflict with it. This made the tune hesitate. It sometimes takes a long time, but I can often make it change. I can also change it by singing another tune that I’d prefer to hear. Sometimes it works, sometimes it won’t. Sometimes it changes for a bit and then reverts back to the original annoying few notes—it’s like a stubborn child in there, saying, ‘No, I want to play this.’”
I ask her if she ever has more than a few seconds of silence.
“No, ne
ver,” she replies.
“Do you ever feel like you can tune into your own private radio and enjoy what you’re hearing when it’s a tune that you like?”
Sylvia thinks about this for a while. “I’ve been terribly careful not to let the tunes pick up any emotion, so that they don’t constantly make me emotional,” she says. “I mean they do still make me irritable. Sometimes I feel as if I haven’t fully rested when I wake up, sometimes it’s really intrusive when they start playing before you’ve even found your slippers. But perhaps that’s just me being an irritable old woman! But I don’t mind it so much when it’s a full tune that I recognize.” She smiles. “I laugh at it a bit. I listen to it. I marvel at it. I do my best not to sing to it in case it reinforces it.”
She pauses. “But then it contracts. It always contracts. It might play two or three times and then it gets shorter and I realize it’s only the first two pages, or the first two lines of the tune and eventually just two or three notes again. That’s the point when you can truly imagine being driven mad by it. Just ‘dah di dah dah dah, dah di dah dah dah, dah di dah dah dah, dah di . . .’”
I leave Sylvia’s later that afternoon amazed by her control, resilience and good humor over what could easily have become a soul-destroying condition. Society teaches us to be fearful of those things that are not present in the world, to associate seeing and hearing things that no one else does as a sign of mental unrest. Sylvia, Avinash, Max—even my own nan—prove that this need not be true. We shouldn’t be afraid to fight this misunderstanding, to speak out when we experience things a little unusual. It is possible that we are all hallucinating all of the time—some of us are just more aware of it than others.
Matar
Turning into a Tiger
Throughout history there have been legends of men who could turn into animals and then back into human form. The most feared of all is the werewolf, a bloodthirsty creature beset by murderous urges, devouring both the living and the dead.
This man-to-beast story has appeared in almost every period of human history—from our earliest popular fiction, Satyricon, to the Roman tales of Lycaon, the cruel leader of Arcadia, who was transformed into a wolf as punishment for trying to trick Zeus, god of the sky. Today, we only have to turn the pages of Harry Potter or the Twilight saga to see that the werewolf’s tale has lost none of its gory appeal.
You may wonder where werewolves fit into my quest to meet people with the world’s strangest brains. But the extraordinary truth of it is, werewolves aren’t restricted to popular fiction and folklore—there are references to people turning into animals in some of our earliest medical texts. Paulus Aegineta, an Alexandrian physician in the seventh century, described the affliction as something suffered by people with melancholy or an excess of black bile. Increasingly over the medieval period, it was interpreted as the work of magic and the devil. The result was a person who was said to be prone to beast-like howls, who would seek out raw meat and attack other humans.
What could have caused such an affliction? One possibility is that ointments prescribed at the time for other illnesses could have led to side effects akin to chronic pins and needles. This may have been interpreted as the feeling of hair growing inside the skin and “proof” of a person turning into an animal.
Historians have also suggested that ingestion of medicinal plants, such as poppies or henbane—a plant similar to toxic belladonna—might have been to blame. Seventeenth-century herbalists used henbane as a sedative, and as a cure for rheumatic pain and toothache. We now know that these treatments can produce vivid hallucinations. There are extensive accounts of people feeling like they’ve been temporarily transformed into leopards, snakes and mythological animals after ingesting such plants.
Over time, several cures were considered, which included drinking vinegar, purging the body of blood and, most drastic of all, being shot with a silver bullet.
One of the most famous werewolf accounts is that of fourteen-year-old Jean Grenier, from Les Landes, France. In the early seventeenth century, Grenier boasted of having eaten more than fifty children. He said he preferred to run around on all fours and felt cravings for raw flesh, “especially for that of little girls,” which, he claimed “is delicious.”1 Grenier was sentenced to be hanged and his body burned. However, before this could happen, the local council sent two doctors to examine him. They decided he was suffering from “a malady called lycanthropy—induced by an evil spirit, which deceived men’s eye into imagining such things.”2 Rather than face execution, Grenier was sent to a monastery.
It wasn’t until the mid-nineteenth century that a completely rational explanation prevailed, with physicians concluding that the condition was not mystical in nature, but a form of mental illness. In the past century, what is now known as clinical lycanthropy has been given a broader definition, encompassing the delusion of having turned into any animal. There have been reports of people thinking they have turned into a dog, a snake, a hyena and even a bee. It is incredibly rare. When Jan Dirk Blom, a psychiatrist at the Parnassia Psychiatric Institute in the Netherlands, searched through international records, he found just thirteen verified reports of people with the delusion of turning into a wolf in the previous 162 years.
I was intrigued but somewhat disturbed by this unusual disorder. Sharon and Rubén had shown me how easily one person’s perception of the world can differ from another’s, and Sylvia had opened my eyes to the hallucinations that we can all experience, but this felt so much more extreme. How can our brain be so dismissive of our human form? How can a person be convinced that they possess not arms and legs but claws or wings? What is it like, I wondered, to look into the mirror and see an animal staring back? And could it tell us anything about the way we think about our own bodies?
As Blom discovered, cases are few and far between, so I didn’t expect to be able to meet anyone who had suffered from clinical lycanthropy. Nevertheless, I regularly checked in with specialist physicians and psychiatrists to see whether they knew of anyone who’d had the disorder. It quickly became apparent that clinical lycanthropy is not a condition in its own right, but appears alongside other more common mental illnesses, such as schizophrenia. Most doctors I spoke to said they had never come across it. One man who had was Hamdy Moselhy, chair of the College of Medicine and Health Sciences at the United Arab Emirates University. In fact, he is one of the few researchers in the world who has treated the condition more than once.
Hamdy’s first encounter with clinical lycanthropy was back in the early 1990s, while working as a registrar at All Saints’ Hospital in Birmingham, England. There he met a thirty-six-year-old man who had been behaving strangely for several years, ever since being arrested for wandering into the path of an oncoming car. His patient had been crawling on the floor, barking and eating vomit from the streets. He told doctors that he believed he was a dog and heard voices telling him to do things that a dog would do, like drink water from the toilet.3
“I’d never heard of this phenomenon in psychiatry,” said Hamdy, when I first spoke to him about it. “I thought he might be pretending to feel this way in order to get away from a crime.” He talked to his supervisor who told him to go and read up on lycanthropy. Keen to learn from past cases, Hamdy scoured the medical literature.
He discovered a description of a thirty-four-year-old woman who came to the emergency room agitated and tense. Suddenly, she started jumping around like a frog, croaking and darting out her tongue as if to catch a fly. Another case study described a woman who had the strange feeling that she was becoming a bee—she felt she was getting smaller and smaller.4
Late in 2015, Hamdy emailed me to say that he had a patient called Matar who had suffered from lycanthropy on and off for years—for hours on end he would be convinced he had turned into a tiger. Now, though, he had his condition under control and was happy to talk to me about it. “Would you like to come to Abu Dhabi and meet him?”
* * *
It is nine o’
clock in the morning and already the thermometer in the car is creeping up to 111 degrees Fahrenheit. From the comfort of my air-conditioned taxi, I watch the gleaming skyscrapers flash by my window. The gigantic brown and gold turrets of the Sheikh Zayed Grand Mosque—the largest in the United Arab Emirates—stand on the horizon. We travel west until we reach the outskirts of the city, where the grand buildings disintegrate into tiny rows of rundown shops. As we turn onto a five-lane highway lined with palm trees, quite suddenly the buildings disappear, as if we’ve reached some invisible border. The view on either side becomes a barren mix of desert dunes, the odd tree and an occasional sign for a distant camel racetrack.
The scenery stays this way for an hour.
“The people of Al Ain are pure, local village people,” my driver, Amjud, says suddenly, waking me from my dune-induced trance. I look around and notice that the side of the road has become a little greener.
Its community may think of themselves as village people, but Al Ain is in fact the UAE’s fourth biggest city, situated close to the border of Oman. It is sometimes known as the garden city, a reflection of its numerous parks and tree-lined avenues.
Down one of these avenues is Al Ain Hospital, where Amjud parks and I jump out. The hot air hits me like the opening of an oven, and so I walk quickly toward the nearest air-conditioned building. There I am met by Hamdy and Rafia Rahim, a softly spoken and fiercely intelligent specialist physician. As the three of us head back into the main hospital, I ask Rafia if Matar is well.
“He is fine,” she says, “but he has been a little anxious this morning.”
MATAR IS SITTING in a chair at the side of a wide, busy corridor. He is wearing a traditional kandura (a long white shirtlike garment) and a white headdress. He is in his mid-forties, but the dark circles under his eyes age him. He has a thick black beard speckled with gray and chubby cheeks heavily lined with wrinkles.
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