Hallucinations

by Oliver Sacks

  For months afterward, I searched for indigo. I turned over little stones and rocks near my house, looking for it. I examined specimens of azurite in the natural history museum—but even they were infinitely far from the color I had seen. And then, in 1965, when I had moved to New York, I went to a concert in the Egyptology gallery of the Metropolitan Museum of Art. In the first half, a Monteverdi piece was performed, and I was utterly transported. I had taken no drugs, but I felt a glorious river of music, four hundred years long, flowing from Monteverdi’s mind into my own. In this ecstatic mood, I wandered out during the intermission and looked at the ancient Egyptian objects on display—lapis lazuli amulets, jewelry, and so forth—and I was enchanted to see glints of indigo. I thought: Thank God, it really exists!

  During the second half of the concert, I got a bit bored and restless, but I consoled myself, knowing that I could go out and take a “sip” of indigo afterward. It would be there, waiting for me. But when I went out to look at the gallery after the concert was finished, I could see only blue and purple and mauve and puce—no indigo. That was nearly fifty years ago, and I have never seen indigo again.

  When a friend and colleague of my parents’—Augusta Bonnard, a psychoanalyst—came to Los Angeles for a year’s sabbatical in 1964, it was natural that we should meet. I invited her to my little house in Topanga Canyon, and we had a genial dinner together. Over coffee and cigarettes (Augusta was a chain-smoker; I wondered if she smoked even during analytic sessions), her tone changed, and she said, in her gruff, smoke-thickened voice, “You need help, Oliver. You’re in trouble.”

  “Nonsense,” I replied. “I enjoy life. I have no complaints; all is well in work and love.” Augusta let out a skeptical grunt, but she did not push the matter further.

  I had started taking LSD at this point, and if that was not available, I would take morning glory seeds instead (this was before morning glory seeds were treated with pesticides, as they are now, to prevent drug abuse). Sunday mornings were usually my drug time, and it must have been two or three months after meeting Augusta that I took a hefty dose of Heavenly Blue morning glory seeds. The seeds were jet black and of agate-like hardness, so I pulverized them with a pestle and mortar and then mixed them with vanilla ice cream. About twenty minutes after eating this, I felt intense nausea, but when it subsided, I found myself in a realm of paradisiacal stillness and beauty, a realm outside time, which was rudely broken into by a taxi grinding and backfiring its way up the steep trail to my house. An elderly woman got out of the taxi, and, galvanized into action, I ran towards her, shouting, “I know who you are—you are a replica of Augusta Bonnard. You look like her, you have her posture and movements, but you are not her. I am not deceived for a moment.” Augusta raised her hands to her temples and said, “Oy! This is worse than I realized.” She got back into the taxi, and took off without another word.

  We had plenty to talk about the next time we met. My failure to recognize her, my seeing her as a “replica,” she thought, was a complex form of defense, a dissociation which could only be called psychotic. I disagreed and maintained that my seeing her as a duplicate or impostor was neurological in origin, a disconnection between perception and feelings. The ability to identify (which was intact) had not been accompanied by the appropriate feeling of warmth and familiarity, and it was this contradiction which had led to the logical though absurd conclusion that she was a “duplicate.” (This syndrome, which can occur in schizophrenia, but also with dementia or delirium, is known as Capgras syndrome.) Augusta said that whichever view was correct, taking mind-altering drugs every weekend, alone, and in high doses, surely testified to some intense inner needs or conflicts, and that I should explore these with a therapist. (In retrospect, I am sure she was right, and I began seeing an analyst a year later.)

  The summer of 1965 was a sort of in-between time: I had completed my residency at UCLA and had left California, but I had three months ahead of me before taking up a research fellowship in New York. This should have been a time of delicious freedom, a wonderful and needed holiday after the sixty- and sometimes eighty-hour workweeks I had had at UCLA. But I did not feel free; I get unmoored, have a sense of emptiness and structurelessness, when I am not working—it was weekends which were the danger times, the drug times, when I lived in California—and now an entire summer in my hometown, London, stretched before me like a three-month-long weekend.

  It was during this idle, mischievous time that I descended deeper into drug taking, no longer confining it to weekends. I tried intravenous injection, which I had never done before. My parents, both physicians, were away, and, having the house to myself, I decided to explore the drug cabinet in their surgery on the ground floor for something special to celebrate my thirty-second birthday. I had never taken morphine or any opiates before. I used a large syringe—why bother with piddling doses? And after settling myself comfortably in bed, I drew up the contents of several vials, plunged the needle into a vein, and injected the morphine very slowly.

  Within a minute or so, my attention was drawn to a sort of commotion on the sleeve of my dressing gown, which hung on the door. I gazed intently at this, and as I did so, it resolved itself into a miniature but microscopically detailed battle scene. I could see silken tents of different colors, the largest of which was flying a royal pennant. There were gaily caparisoned horses, soldiers on horseback, their armor glinting in the sun, and men with longbows. I saw pipers with long silver pipes, raising these to their mouths, and then, very faintly, I heard their piping, too. I saw hundreds, thousands of men—two armies, two nations—preparing to do battle. I lost all sense of this being a spot on the sleeve of my dressing gown, of the fact that I was lying in bed, that I was in London, that it was 1965. Before shooting up the morphine, I had been reading Froissart’s Chronicles and Henry V, and now these became conflated in my hallucination. I realized that what I was gazing at from my aerial viewpoint was Agincourt, late in 1415, that I was looking down on the serried armies of England and France drawn up to do battle. And in the great pennanted tent, I knew, was Henry V himself. I had no sense that I was imagining or hallucinating any of this; what I saw was actual, real.

  After a while the scene started to fade, and I became dimly conscious, once more, that I was in London, stoned, hallucinating Agincourt on the sleeve of my dressing gown. It had been an enchanting and transporting experience, literally so, but now it was over. The drug effect was fading fast; Agincourt was hardly visible now. I glanced at my watch. I had injected the morphine at nine-thirty, and now it was ten. But I had a sense of something odd—it had been dusk when I took the morphine; it should be darker still. But it was not. It was getting lighter, not darker, outside. It was ten o’clock, I realized, but ten in the morning. I had been gazing, motionless, at my Agincourt for more than twelve hours. 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.

  At the end of that summer of 1965, I moved to New York to begin a postgraduate fellowship in neuropathology and neurochemistry. December 1965 was a bad time: I was finding New York difficult to adjust to after my years in California, a love affair had gone sour, my research was going badly, and I was discovering for myself that I was not cut out to be a bench scientist. Depressed and insomniac, I was taking ever-increasing amounts of chloral hydrate to get to sleep, and was up to fifteen times the usual dose every night. And though I had managed to stockpile a huge amount of the drug—I raided the chemical supplies in the lab at work—this finally ran out on a bleak Tuesday a little before Christmas, and for the first time in several months I went to bed without my usual knockout dose. My sleep was poor, broken by nightmares and bizarre dreams, and upon waking, I found myself excruciatingly sensitive to sounds. There were always trucks rumbling along the cobblestoned streets of the West Village; now it sounded as if they were crushing the cobblestones to powder as the
y passed.

  Feeling a bit shaky, I did not ride my motorcycle to work as usual, but took a train and bus. Wednesday was brain-cutting day in the neuropathology department, and it was my turn to slice a brain into neat horizontal sections, to identify the main structures as I did so, and to observe whether there were any departures from normal. I was usually pretty good at this, but that day I found my hand trembling visibly, embarrassingly, and the anatomical names were slow in coming to mind.

  When the session ended, I went across the road, as I often did, for a cup of coffee and a sandwich. As I was stirring the coffee, it suddenly turned green, then purple. I looked up, startled, and saw that a customer paying his bill at the cash register had a huge proboscidean head, like an elephant seal. Panic seized me; I slammed a five-dollar note on the table and ran across the road to a bus on the other side. But all the passengers on the bus seemed to have smooth white heads like giant eggs, with huge glittering eyes like the faceted compound eyes of insects—their eyes seemed to move in sudden jerks, which increased the feeling of their fearfulness and alienness. I realized that I was hallucinating or experiencing some bizarre perceptual disorder, that I could not stop what was happening in my brain, and that I had to maintain at least an external control and not panic or scream or become catatonic, faced by the bug-eyed monsters around me. The best way of doing this, I found, was to write, to describe the hallucination in clear, almost clinical detail, and, in so doing, become an observer, even an explorer, not a helpless victim of the craziness inside me. I am never without pen and notebook, and now I wrote for dear life, as wave after wave of hallucination rolled over me.

  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.

  I managed somehow to get off at the right bus stop and onto the train, even though everything was now in motion, whirling vertiginously, tilting and even turning upside down. And I managed to get off at the right station, in my neighborhood in Greenwich Village. As I emerged from the subway, the buildings around me were tossing and flapping from side to side, like flags blowing in a high wind. I was enormously relieved to make it back to my apartment without being attacked, or arrested, or killed by the rushing traffic on the way. As soon as I got inside, I felt I had to contact somebody—someone who knew me well, who was both a doctor and a friend. Carol Burnett was the person: we had interned together in San Francisco five years earlier and had resumed a close friendship now that we were both in New York City. Carol would understand; she would know what to do. I dialed her number with a grossly tremulous hand. “Carol,” I said, as soon as she picked up, “I want to say good-bye. I’ve gone mad, psychotic, insane. It started this morning, and it’s getting worse all the while.”

  “Oliver!” Carol said. “What have you just taken?”

  “Nothing,” I replied. “That’s why I’m so frightened.” Carol thought for a moment, then asked, “What have you just stopped taking?”

  “That’s it!” I said. “I was taking a huge amount of chloral hydrate and ran out of it last night.”

  “Oliver, you chump! You always overdo things,” Carol said. “You’ve got a classic case of the DT’s, delirium tremens.”

  This was an immense relief—much better DT’s than a schizophrenic psychosis. But I was quite aware of the dangers of the DT’s: confusion, disorientation, hallucination, delusion, dehydration, fever, rapid heartbeat, exhaustion, seizures, death. I would have advised anyone else in my state to get to an emergency room immediately, but for myself, I wanted to tough it out, and experience it to the full. Carol agreed to sit with me for the first day; then, if she thought I was safe by myself, she would look by or phone me at intervals, calling in outside help if she judged it necessary. Given this safety net, I lost much of my anxiety, and could even enjoy the phantasms of delirium tremens in a way (though the myriads of small animals and insects were anything but pleasant). The hallucinations continued for almost ninety-six hours, and when they finally stopped, I fell into an exhausted stupor.10

  As a boy, I had known extreme delight in the study of chemistry and the setting up of my own chemistry lab. This delight seemed to desert me at the age of fifteen or so; in my years at school, university, medical school, and then internship and residency, I kept my head above water, but the subjects I studied never excited me in the same intense way as chemistry had when I was a boy. It was not until I arrived in New York and began seeing patients in a migraine clinic in the summer of 1966 that I began to feel a little stirring of the intellectual excitement and emotional engagement I had known in my earlier years. It was in the hope of stirring up these intellectual and emotional excitements even further that I turned to amphetamines.

  I would take the stuff on Friday evenings after getting back from work and would then spend the whole weekend so high that images and thoughts would become rather like controllable hallucinations, imbued with ecstatic emotion. I often devoted these “drug holidays” to romantic daydreaming, but one Friday, in February 1967, while I was exploring the rare book section of the medical library, I found a hefty volume on migraine entitled On Megrim, Sick-Headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms, written in 1873 by one Edward Liveing, MD. I had been working for several months in the migraine clinic, and I was fascinated by the range of symptoms and phenomena that could occur in migraine attacks. These attacks often included an aura, a prodrome in which aberrations of perception and even hallucinations occurred. They were entirely benign and would last only a few minutes, but those few minutes provided a window onto the functioning of the brain and how it could break down and then reintegrate. In this way, I felt, every attack of migraine opened out into an encyclopedia of neurology.

  I had read dozens of articles about migraine and its possible basis, but none of them seemed to present the full richness of its phenomenology or the range and depth of suffering which patients might experience. It was in the hope of finding a fuller, deeper, and more human approach to migraine that I took out Liveing’s book from the library that weekend. So, after downing my bitter draft of amphetamine—heavily sugared to make it more palatable—I started reading. As the amphetamine effect took hold of me, stimulating my emotions and imagination, Liveing’s book seemed to increase in intensity and depth and beauty. I wanted nothing but to enter Liveing’s mind and imbibe the atmosphere of the time in which he had worked.

  In a sort of catatonic concentration so intense that in ten hours I scarcely moved a muscle or wet my lips, I read steadily through the five hundred pages of Megrim. As I did so, it seemed to me almost as if I were becoming Liveing himself, actually seeing the patients he described. At times I was unsure whether I was reading the book or writing it. I felt myself in the Dickensian London of the 1860s and ’70s. I loved Liveing’s humanity and social sensitivity, his strong assertion that migraine was not some indulgence of the idle rich but could affect those who were poorly nourished and worked long hours in ill-ventilated factories. In this way, his book reminded me of Mayhew’s great study of London’s working classes, but equally, one could tell how well Liveing had been trained in biology and the physical sciences, and what a master of clinical observation he was. I found myself thinking, This represents the best of mid-Victorian science and medicine; it is a veritable masterpiece! The book gave me what I had been hungering for during the months that I had been seeing patients with migraine, frustrated by the thin, impoverished articles which seemed to constitute the modern “literature” on the subject. At the height of this ecstasy, I saw migraine shining like an archipelago of stars in the neurological heavens.

  But a century had passed since Liveing worked and wrote in London. Rousing myself from my reverie of being Liveing or one of his contemporaries, I came to and said t
o myself, Now it is the 1960s, not the 1860s. Who could be the Liveing of our time? A disingenuous clutter of names spoke themselves in my mind. I thought of Dr. A. and Dr. B. and Dr. C. and Dr. D., all of them good men but none of them with that mix of science and humanism that was so powerful in Liveing. And then a very loud internal voice said, “You silly bugger! You’re the man!”

  On every previous occasion when I had come down after two days of amphetamine-induced mania, I had experienced a severe reaction in the other direction, feeling an almost narcoleptic drowsiness and depression. I would also have an acute sense of folly, thinking that I had endangered my life for nothing—amphetamines in the large doses I took would give me a sustained pulse rate close to 200 and a blood pressure of I know not what; several people I knew had died from overdoses of amphetamines. I would feel that I had made a crazy ascent into the stratosphere but had come back empty-handed and had nothing to show for it; that the experience had been as empty and vacuous as it was intense. This time, though, when I came down, I retained a sense of illumination and insight; I had had a sort of revelation about migraine. I had a sense of resolution, too, that I was indeed equipped to write a Liveing-like book, that perhaps I could be the Liveing of our time.

  The next day, before I returned Liveing’s book to the library, I photocopied the whole thing. Then, bit by bit, I started to write my own book. The joy I got from doing this was real—infinitely more substantial than the vapid mania of amphetamines—and I never took amphetamines again.

  1. Curiously, lower plants—cycads, conifers, ferns, mosses, and seaweeds—lack hallucinogenic substances.

  Some nonflowering plants, however, contain stimulants, as the Mormons, among others, discovered. Mormons are forbidden to use tea or coffee. But on their long march along the Mormon Trail to Utah, the pioneers who were to found Salt Lake City, the new Zion, noticed a simple herb by the roadside, an infusion of which (“Mormon tea”) refreshed and stimulated the weary pilgrims. The herb was ephedra, which contains ephedrine, chemically and pharmacologically akin to the amphetamines.