Hallucinations

by Oliver Sacks

  2. The importance of first-person accounts was emphasized by William James in his 1887 paper “The Consciousness of Lost Limbs”:

  In a delicate inquiry like this, little is to be gained by distributing circulars. A single patient with the right sort of lesion and a scientific mind, carefully cross-examined, is more likely to deepen our knowledge than a thousand circulars answered as the average patient answers them, even though the answers be never so thoroughly collated by the investigator.

  3. The reason for this was not to be clarified until a century later, when it became possible to visualize, with fMRI, the gross changes in the brain’s body mapping that could occur after an amputation. Michael Merzenich and his colleagues at UCSF, working with both monkeys and humans, have shown how rapid and radical such changes may be.

  4. Despite categorical assertions by many that “congenital” phantoms cannot occur, there have been several reports (as Scatena has noted in a review of the subject) indicating that some people with aplasia—congenitally defective or absent limbs—do have phantoms. Klaus Poeck, in 1964, described an eleven-year-old girl born without forearms or hands who was able to “move” her phantom hands. As Poeck wrote, “In her first years at school, she had learned to solve simple arithmetic problems by counting with her fingers.… On these occasions she would place her phantom hands on the table and count the outstretched fingers one by one.”

  It is not clear why some people born without limbs have phantoms and some do not. What is clear, as Funk, Shiffrar, and Brugger observed in one study, is that those who do have phantoms seem to have cerebral “action observation systems” similar to those of normally limbed people, allowing them to grasp action patterns by observing others and to internalize these as mobile phantoms. Those born without limbs who do not have phantoms, Funk et al. propose, may have problems in motion perception, especially judging the movements of other people’s limbs.

  5. When Henry Head introduced the term “body image” (fifty or so years after Weir Mitchell had introduced the term “phantom limb”), he did not mean it to refer to a purely sensory image or map in the brain—he had in mind an image or model of agency and action, and it is this which needs to be embodied in an artificial limb.

  Philosophers like to speak of “embodiment” and “embodied agency,” and there is no simpler place to study this than in the nature of phantoms and their embodiment in artificial limbs—prosthesis and phantom go together like body and soul. I have wondered whether some of Ludwig Wittgenstein’s philosophical notions were suggested by his brother’s phantom arm—thus his final work, On Certainty, starts from the certainty of the body, the body as embodied agency.

  6. Wade Davis describes this in his book Into the Silence: The Great War, Mallory, and the Conquest of Everest.

  7. Nonetheless, Nelson regarded his phantom as “a direct proof for the existence of the soul.” The survival of a spiritual arm after a corporeal one was annihilated, he thought, epitomized the survival of the soul after bodily death.

  For Captain Ahab, however, this was a matter for horror as much as wonder: “And if I still feel the smart of my crushed leg, though it be now so long dissolved; then, why mayst not thou, carpenter, feel the fiery pains of hell forever, and without a body? Hah!”

  8. This story, “The Man Who Fell Out of Bed,” is related more fully in The Man Who Mistook His Wife for a Hat.

  9. Several people have written to me with similar stories of sensing a presence just as they are going to sleep or waking. Linda P. observed that once, as she was drifting off to sleep, she felt “as if I was being held on my right side, as if someone had put their arms around me and was stroking my hair. It was a lovely feeling; then I remembered that I was alone, and [the feeling disappeared].”

  Acknowledgments

  I am most grateful, first and foremost, to the hundreds of patients and correspondents who have shared their experiences of hallucinations with me over many decades, and especially to those who have allowed me to quote their words and tell their stories in this book.

  I owe an enormous debt to my friend and colleague Orrin Devinsky, who has stimulated my thoughts with his many published and forthcoming papers and referred many of his patients to me. I have enjoyed and benefited from discussions with Jan Dirk Blom and from reading his wonderfully comprehensive Dictionary of Hallucinations and Hallucinations: Research and Practice. I am deeply grateful for the friendship and advice of my colleagues Sue Barry, Bill Borden, William Burke, Kevin Cahill, Jonathan Cole, Douwe Draaisma, Henrik Ehrsson, Dominic ffytche, Steven Frucht, Mark Green, James Lance, Richard Mayeux, Alvaro Pascual-Leone, Stanley Prusiner, V. S. Ramachandran, and Leonard Shengold. And I am grateful to Gale Delaney, Andreas Mavromatis, Lylas Mogk, Jeff Odel, and Robert Teunisse for sharing their own experiences (and sometimes patients) with me.

  I must also thank Molly Birnbaum, Daniel Breslaw, Leslie Burkhardt, Elizabeth Chase, Allen Furbeck, Kai Furbeck, Ben Helfgott, Richard Howard, Hazel Rossotti, Peter Selgin, Amy Tan, Bonnie Thompson, Kappa Waugh, and Edward Weinberger. Eveline Honig, Audrey Kindred, Sharon Smith, and others at the Narcolepsy Network kindly introduced me to many people with narcolepsy and sleep paralysis. Bill Hayes, a friend and a writer whom I much admire, read each chapter with his own writerly eye and made many valuable suggestions.

  For their support and encouragement, I thank David and Susie Sainsbury; Dan Frank, who has patiently reviewed draft after draft of this book (as with many previous ones); Hailey Wojcik, invaluable research assistant, typist, and swimming companion; and Kate Edgar, my friend, editor, and collaborator for thirty years, to whom this book is dedicated.

  Bibliography

  Abell, Truman. 1845. Remarkable case of illusive vision. Boston Medical and Surgical Journal 33 (21): 409–13.

  Adair, Virginia Hamilton. 1996. Ants on the Melon: A Collection of Poems. New York: Random House.

  Adamis, Dimitrios, Adrian Treloar, Finbarr C. Martin, and Alastair J. D. Macdonald. 2007. A brief review of the history of delirium as a mental disorder. History of Psychiatry 18 (4): 459–69.

  Adler, Shelley R. 2011. Sleep Paralysis: Night-mares, Nocebos, and the Mind-Body Connection. Piscataway, NJ: Rutgers University Press.

  Airy, Hubert. 1870. On a distinct form of transient hemiopsia. Communicated by the Astronomer Royal. Philosophical Transactions of the Royal Society of London 160: 247–64.

  Alajouanine, T. 1963. Dostoiewski’s epilepsy. Brain 86 (2): 209–18.

  Ardis, J. Amor, and Peter McKellar. 1956. Hypnagogic imagery and mescaline. British Journal of Psychiatry 102: 22–29.

  Arzy, Shahar, Gregor Thut, Christine Mohr, Christoph M. Michel, and Olaf Blanke. 2006. Neural basis of embodiment: Distinct contributions of temporoparietal junction and extrastriate body area. Journal of Neuroscience 26 (31): 8074–81.

  Asheim, Hansen B., and Eylert Brodtkorb. 2003. Partial epilepsy with “ecstatic” seizures. Epilepsy & Behavior 4 (6): 667–73.

  Baethge, Christopher. 2002. Grief hallucinations: True or pseudo? Serious or not? An inquiry into psychopathological and clinical features of a common phenomenon. Psychopathology 35: 296–302.

  Bartlett, Frederic C. 1932. Remembering: A Study in Experimental and Social Psychology. Cambridge: Cambridge University Press.

  Baudelaire, Charles. 1860/1995. Artificial Paradises. New York: Citadel.

  Berrios, German E. 1981. Delirium and confusion in the nineteenth century: A conceptual history. British Journal of Psychiatry 139: 439–49.

  Bexton, William H., Woodburn Heron, and T. H. Scott. 1954. Effects of decreased variation in the sensory environment. Canadian Journal of Psychology 8 (2): 70–76.

  Birnbaum, Molly. 2011. Season to Taste: How I Lost My Sense of Smell and Found My Way. New York: Ecco / Harper Collins.

  Blanke, Olaf, Stéphanie Ortigue, Alessandra Coeytaux, Marie-Dominique Martory, and Theodor Landis. 2003. Hearing of a presence. Neurocase 9 (4): 329–39.

  Blanke, Olaf, Shahar Arzy, Margitta Seeck, Stephan
ie Ortigue, and Laurent Spinelli. 2006. Induction of an illusory shadow person. Nature 443: 287.

  Bleuler, Eugen. 1911/1950. Dementia Praecox; or, The Group of Schizophrenias. Oxford: International Universities Press.

  Blodgett, Bonnie. 2010. Remembering Smell: A Memoir of Losing—and Discovering—the Primal Sense. New York: Houghton Mifflin Harcourt.

  Blom, Jan Dirk. 2010. A Dictionary of Hallucinations. New York: Springer.

  Blom, Jan Dirk, and Iris E. C. Sommer, eds. 2012. Hallucinations: Research and Practice. New York: Springer.

  Bonnet, Charles. 1760. Essai analytique sur les facultés de l’âme. Copenhagen: Freres Cl. & Ant. Philibert.

  Boroojerdi, Babak, Khalaf O. Bushara, Brian Corwell, Ilka Immisch, Fortunato Battaglia, Wolf Muellbacher, and Leonardo G. Cohen. 2000. Enhanced excitability of the human visual cortex induced by short-term light deprivation. Cerebral Cortex 10: 529–34.

  Botvinick, Matthew, and Jonathan Cohen. 1998. Rubber hands “feel” touch that eyes see. Nature 391: 756.

  Brady, John Paul, and Eugene E. Levitt. 1966. Hypnotically induced visual hallucinations. Psychosomatic Medicine 28 (4): 351–63.

  Brann, Eva. 1993. The World of the Imagination: Sum and Substance. Lanham, MD: Rowman & Littlefield.

  Brewin, Chris, and Steph J. Hellawell. 2004. A comparison of flashbacks and ordinary autobiographical memories of trauma: Content and language. Behaviour Research and Therapy 42 (1): 1–12.

  Brierre de Boismont, A. 1845. Hallucinations; or, The Rational History of Apparitions, Visions, Dreams, Ecstasy, Magnetism and Somnambulism. First English edition, 1853. Philadelphia: Lindsay and Blakiston.

  Brock, Samuel. 1928. Idiopathic narcolepsy, cataplexia and catalepsy associated with an unusual hallucination: A case report. Journal of Nervous and Mental Disease 68 (6): 583–90.

  Brugger, Peter. 2012. Phantom limb, phantom body, phantom self. A phenomenology of “body hallucinations.” In Hallucinations: Research and Practice, ed. Jan Dirk Blom and Iris E. C. Sommer. New York: Springer.

  Brugger, Peter, R. Agosti, M. Regard, H. G. Wieser, and T. Landis. 1994. Heautoscopy, epilepsy, and suicide. Journal of Neurology, Neurosurgery and Psychiatry 57: 838–39.

  Burke, William. 2002. The neural basis of Charles Bonnet hallucinations: A hypothesis. Journal of Neurology, Neurosurgery and Psychiatry 73: 535–41.

  Carlson, Laurie Winn. 1999. A Fever in Salem: A New Interpretation of the New England Witch Trials. Chicago: Ivan R. Dee.

  Cheyne, J. Allan. 2001. The ominous numinous: Sensed presence and “other” hallucinations. Journal of Consciousness Studies 8 (5–7): 133–50.

  ———. 2003. Sleep paralysis and the structure of waking-nightmare hallucinations. Dreaming 13 (3): 163–79.

  Cheyne, J. Allan, Steve D. Rueffer, and Ian R. Newby-Clark. 1999. Hypnagogic and hypnopompic hallucinations during sleep paralysis: Neurological and cultural construction of the night-mare. Consciousness and Cognition 8 (3): 319–37.

  Chodoff, Paul. 1963. Late effects of the concentration camp syndrome. Archives of General Psychiatry 8 (4): 323–33.

  Cogan, David G. 1973. Visual hallucinations as release phenomena. Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie 188 (2): 139–50.

  Cole, Jonathan, Oliver Sacks, and Ian Waterman. 2000. On the immunity principle: A view from a robot. Trends in Cognitive Sciences 4 (5): 167.

  Cole, Jonathan, Simon Crowle, Greg Austwick, and David Henderson Slater. 2009. Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Disability and Rehabilitation 31 (10): 846–54.

  Cole, Monroe. 1999. When the left brain is not right the right brain may be left: Report of personal experience of occipital hemianopia. Journal of Neurology, Neurosurgery and Psychiatry 67: 169–73.

  Critchley, Macdonald. 1939. Neurological aspect of visual and auditory hallucinations. British Medical Journal 2 (4107): 634–39.

  ———. 1951. Types of visual perseveration: “Paliopsia” and “illusory visual spread.” Brain 74: 267–98.

  ———. 1967. Migraine: From Cappadocia to Queen Square. In Background to Migraine, ed. Robert Smith. London: William Heinemann.

  Daly, David. 1958. Uncinate fits. Neurology 8: 250–60.

  Davies, Owen. 2003. The nightmare experience, sleep paralysis, and witchcraft accusations. Folklore 114 (2): 181–203.

  Davis, Wade. 2011. Into the Silence: The Great War, Mallory, and the Conquest of Everest. New York: Knopf.

  de Morsier, G. 1967. Le syndrome de Charles Bonnet: Hallucinations visuelles des vieillards sans déficience mentale. Annales Médico-Psychologiques 125: 677–701.

  Dening, T. R., and German E. Berrios. 1994. Autoscopic phenomena. British Journal of Psychiatry 165: 808–17.

  De Quincey, Thomas. 1822. Confessions of an English Opium-Eater. London: Taylor and Hessey.

  Descartes, René. 1641/1960. Meditations on First Philosophy. New York: Prentice Hall.

  Devinsky, Orrin. 2009. Norman Geschwind: Influence on his career and comments on his course on the neurology of behavior. Epilepsy & Behavior 15 (4): 413–16.

  Devinsky, Orrin, and George Lai. 2008. Spirituality and religion in epilepsy. Epilepsy & Behavior 12 (4): 636–43.

  Devinsky, Orrin, Edward Feldman, Kelly Burrowes, and Edward Bromfield. 1989. Autoscopic phenomena with seizures. Archives of Neurology 46 (10): 1080–88.

  Devinsky, O., L. Davachi, C. Santchi, B. T. Quinn, B. P. Staresina, and T. Thesen. 2010. Hyperfamiliarity for faces. Neurology 74 (12): 970–74.

  Dewhurst, Kenneth, and A. W. Beard. 1970. Sudden religious conversions in temporal lobe epilepsy. British Journal of Psychiatry 117: 497–507.

  Dewhurst, Kenneth, and John Pearson. 1955. Visual hallucinations of the self in organic disease. Journal of Neurology, Neurosurgery, and Psychiatry 18: 53–57.

  Dickens, Charles. 1861. Great Expectations. London: Chapman and Hall.

  Dostoevsky, Fyodor M. 1869/2002. The Idiot. New York: Everyman’s Library

  ———. 1846/2005. The Double and The Gambler. New York: Everyman’s Library.

  Draaisma, Douwe. 2009. Disturbances of the Mind. New York: Cambridge University Press.

  Ebin, David, ed. 1961. The Drug Experience: First-Person Accounts of Addicts, Writers, Scientists and Others. New York: Orion.

  Efron, Robert. 1956. The effect of olfactory stimuli in arresting uncinate fits. Brain 79 (2): 267–81.

  Ehrsson, H. Henrik. 2007. The experimental induction of out-of-body experiences. Science 317 (5841): 1048.

  Ehrsson, H. Henrik, Charles Spence, and Richard E. Passingham. 2004. That’s my hand! Activity in the premotor cortex reflects feeling of ownership of a limb. Science 305 (5685): 875–77.

  Ehrsson, H. Henrik, Nicholas P. Holmes, and Richard E. Passingham. 2005. Touching a rubber hand: Feeling of body ownership is associated with activity in multisensory brain areas. Journal of Neuroscience 25 (45): 10564–73.

  Ellis, Havelock. 1898. Mescal: A new artificial paradise. Contemporary Review 73: 130–41 (reprinted in the Smithsonian Institution Annual Report 1898, pp. 537–48).

  Escher, Sandra, and Marius Romme. 2012. The hearing voices movement. In Hallucinations: Research and Practice, ed. Jan Dirk Blom and Iris E. C. Sommer. New York: Springer.

  Fénelon, Gilles, Florence Mahieux, Renaud Huon, and Marc Ziégler. 2000. Hallucinations in Parkinson’s disease: Prevalence, phenomenology and risk factors. Brain 123 (4): 733–45.

  ffytche, Dominic H. 2007. Visual hallucinatory syndromes: Past, present, and future. Dialogues in Clinical Neuroscience 9: 173–89.

  ———. 2008. The hodology of hallucinations. Cortex 44: 1067–83.

  ffytche, D. H., R. J. Howard, M. J. Brammer, A. David, P. Woodruff, and S. Williams. 1998. The anatomy of conscious vision: An fMRI study of visual hallucinations. Nature Neuroscience 1 (8): 738–42.

  Foote-Smith, Elizabeth, and Lydia Bayne. 1991. Joan of Arc. Epilepsia 32 (6): 810–15.

/>   Freud, Sigmund. 1891/1953. On Aphasia: A Critical Study. Oxford: International Universities Press.

  ———. 1901/1990. The Psychopathology of Everyday Life. New York: Norton.

  Freud, Sigmund, and Josef Breuer. 1895/1991. Studies on Hysteria. New York: Penguin.

  Friedman, Diane Broadbent. 2008. A Matter of Life and Death: The Brain Revealed by the Mind of Michael Powell. Bloomington, IN: AuthorHouse.

  Fuller, G. N., and R. J. Guiloff. 1987. Migrainous olfactory hallucinations. Journal of Neurology, Neurosurgery and Psychiatry 50: 1688–90.

  Fuller, John Grant. 1968. The Day of St. Anthony’s Fire. New York: Macmillan.

  Funk, Marion, Maggie Shiffrar, and Peter Brugger. Hand movement observation by individuals born without hands: Phantom limb experience constrains visual limb perception. Experimental Brain Research 164 (3): 341–46.

  Galton, Francis. 1883. Inquiries into Human Faculty. London: Macmillan.

  Gastaut, Henri, and Benjamin G. Zifkin. 1984. Ictal visual hallucinations of numerals. Neurology 34 (7): 950–53.

  Gélineau, J. B. E. 1880. De la narcolepsie. Gazette des hôpitaux 54: 635–37.

  Geschwind, Norman. 1984. Dostoievsky’s epilepsy. In Psychiatric Aspects of Epilepsy, ed. Dietrich Blumer (pp. 325–33). Washington, D.C.: American Psychiatric Press.

  ———. 2009. Personality changes in temporal lobe epilepsy. Epilepsy & Behavior 15: 425–33.

  Gilbert, Martin. 1997. The Boys: The Story of 732 Young Concentration Camp Survivors. New York: Holt.

  Gowers, W. R. 1881. Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms and Treatment. London: Churchill.

  ———. 1907. The Border-land of Epilepsy. London: Churchill.

  Green, Celia. 1968. Out-of-the-Body Experiences. Oxford: Institute of Psychophysical Research.

  Gurney, Edmund, F. W. H. Myers, and Frank Podmore. 1886. Phantasms of the Living. London: Trubner & Co.