rachelmanija: (Books: old)
rachelmanija ([personal profile] rachelmanija) wrote2013-02-01 03:34 pm

Hallucinations, by Oliver Sacks

A book on hallucinations which are not caused by schizophrenia and other psychotic disorders. (It also doesn’t deal much with culturally normal hallucinations, which is too bad.) Hallucinations – sensory perceptions which occur during waking and are not based on consensus reality - are surprisingly common, and include many experiences which probably most people don’t think to define as hallucinatory.

While drifting off to sleep, with my eyes closed, I often see kaleidoscope-like geometric patterns, faces (often grotesque or witch-like), and occasionally swarming insects. They are not dreams, are not perceived as being part of reality or projected into the real visual field, and do not have emotional connotations. I always assumed they were caused by going from visual perception to blank darkness while drifting toward sleep: a sort of meditative optical illusion/visual imagination.

They are called hypnogogic hallucinations and are extremely common, and the particular things I see are commonly seen, along with other stereotyped visuals. (“Stereotyped” as in common to people who experience the phenomenon, as opposed to “unique.”) They are caused, in simple terms, by the visual centers of the brain “idling” before sleep.

Hypnopompic hallucinations are less common, and are more vivid, often briefly perceived as real, often frightening illusions which occur upon waking from sleep. I've had those too, thankfully only a few times; mine were quite unpleasant, full-sensory illusions of being entombed in stone. They were not nightmares, though; I could also see my real surroundings. Once someone in the room with me verified that I had my eyes wide open and could track movement and respond to voices.

I have also sometimes, while wide awake, heard my name being called, when no one is there or when nobody called it. This is also extremely common. People in dangerous situations often hear voices giving helpful commands or suggestions; grieving people often see or hear their loved ones. These phenomena are common and “normal.”

I wish Sacks had analyzed those situations more in neurological terms, because I find that fascinating. The main theory he suggests, regarding auditory hallucinations in general, is that they’re a glitch caused by the brain failing to recognize its own thoughts. Another possibility is that people become consciously aware of the non-verbal stream of consciousness beneath their articulated thoughts, and perceive it as coming from the outside.

Sacks covers a number of hallucinatory experiences caused by neurological conditions, such as Charles Bonnet Syndrome, in which blind people hallucinate certain types of sights. Also, in a fairly funny chapter, his own youthful drug use.

The non-psychotic hallucinations are typically either never experienced as “real,” or are easily believed to be unreal once someone explains that they aren’t real, or are understood to not be real once they’re over. This is quite different from psychotic disorder-type hallucinations, which are often believed to be real, even when they end. (A person with PTSD may hallucinate, but they typically either always know the hallucination isn’t real, or, as in the case with flashbacks, figure it out in retrospect.) Regarding culturally normal hallucinations like ghosts, people may believe that they did literally see a spirit, but they also regard it as a spirit – a visitor from another realm. That’s a different experience from literally believing that Abraham Lincoln is living in your guest bedroom. (To avoid wank, let’s assume that I am only discussing those perceptions of spirits, God, etc, when they really are hallucinated and not objectively real.)

Hallucinations without accompanying delusions don’t usually cause major life problems for people. They are not “crazy,” though they might worry that they are. Delusions seem to be what cause the life problems.

The book is well-written and intriguing, as one would expect from Sacks, but more descriptive than analytical. Some types of hallucinations, particularly visual ones with a clear-cut neurological basis such as migraine auras, are explained in neurological terms, but others are simply described. The descriptions are quite evocative and the material is fascinating, but I would have liked more neurological speculation, especially on why certain situations or conditions create certain types of hallucinations, like fever deliriums causing distorted perceptions of size, which are almost invariably perceived as unpleasant or threatening.

I also wish he’d covered auditory hallucinations in more depth. At times he speculated on historical figures who might have heard voices. The problem is, many people write about the simple perception of their own thoughts in voice-like terms, so it’s very hard to tell whether someone literally meant they heard a voice, or only that their thoughts were so vivid that they seemed voice-like. It seems entirely possible, too, that two different people might have a neurologically identical experience, but one might attribute it to an outside voice and one to distinctive inner thoughts.

Please discuss your own experiences of and theories on hallucinations, if you wish.

Hallucinations
naomikritzer: (Default)

[personal profile] naomikritzer 2013-02-02 04:13 pm (UTC)(link)
I think you're on to something there.

Lyda's mother was having olfactory hallucinations recently (Lyda told me about it after a tense morning in a hospital waiting room with her mother, during which her mother informed her that she smelled funny and she disliked her scented deodorant. Lyda had showered that morning and was not wearing anything scented.) I looked up olfactory hallucinations later and found that they can be caused by anything from a brain tumor to a sinus infection.

[identity profile] mrissa.livejournal.com 2013-02-02 04:15 pm (UTC)(link)
(Which is terrifying once they think they've ruled out "sinus infection," by the way, because most of the other things that cause olfactory hallucinations are game-changers.)
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[personal profile] naomikritzer 2013-02-02 04:20 pm (UTC)(link)
Point. Although apparently they can also be totally random and not the result of anything at all.

[identity profile] mrissa.livejournal.com 2013-02-02 04:22 pm (UTC)(link)
Indeed, which is not comforting when they come with exhaustion. Thankfully in my case we had to reconsider the sinus infection notion--it was a very strange sinus infection. But the time in the middle where I was getting checked for brain tumors, MS, and epilepsy was not awesome.
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[personal profile] naomikritzer 2013-02-02 04:24 pm (UTC)(link)
Does the book talk at all about synesthesia, and the ways that it can intersect with hallucination? I have an online friend who gets tastes for names, and from what I understand, she actually experiences the taste in her mouth, briefly.

"Naomi" is canned green beans, FWIW. Every now and then people will remember this particular talent and bombard her with names to have her say the flavors for, and Naomi was green beans the first time, canned green beans the second time, so this stuff is noticeably consistent. (And yeah, I asked again not because I'd forgotten but because with a five-year gap I was curious if it would stay consistent.)

Her husband found the picking-a-name process frustrating as hell, because so many names got vetoed on the grounds that she didn't like the taste. And then there were names that tasted good, but she still didn't like the name.
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[personal profile] naomikritzer 2013-02-02 04:26 pm (UTC)(link)
Er yeah, "it might be a brain tumor" is pretty much never what you want to hear during the diagnostic process.

In fact, when discussing self-diagnosis-via-google that's usually the example I give for Dr. Google's fondness for catastrophic diagnoses. Tingling in your toes? Well, it might just be that you sat on your foot funny OR MAYBE IT'S A BRAIN TUMOR.

[identity profile] rachelmanija.livejournal.com 2013-02-02 07:29 pm (UTC)(link)
Olfactory hallucinations are not that uncommon. Sacks mentions that they can be caused simply by vivid memory; perhaps relatedly, people with PTSD have them fairly often.

Sacks hears about hallucinations a lot because, I suspect, he specifically asks people about them (which most doctors don't) and presents his questions in a non-pathologizing way, I would guess with a side of "isn't the human brain fascinating?"

[identity profile] rachelmanija.livejournal.com 2013-02-02 07:31 pm (UTC)(link)
How cool!

I think Sacks mentions synesthesia but doesn't get into it. It deserves its own book.

The thing about the names is hilarious. Now I want to know what "Rachel" tastes like, and if it's different from "Rachael."

[identity profile] asakiyume.livejournal.com 2013-02-02 07:48 pm (UTC)(link)
Oh olfactory hallucinations! I once had one maybe?

I was driving home in very bad (snowy) weather, and all of a sudden the car seemed to fill up with sandalwood incense. It felt very portentous. And then it faded. And then when I did finally make it home, I found out that Waka had been burning incense. Oooh, twilight zone.

As for other sorts of hallucinations, I have had visual ones on the verge of sleep, things I think I see, and then I look again, and they're not there. My kids have had the auditory ones--they'll be relieved to hear they're normal.
Edited 2013-02-02 19:50 (UTC)

[identity profile] telophase.livejournal.com 2013-02-02 09:21 pm (UTC)(link)
Sleep paralysis! Essentially, your brain paralyzes your body during part of the sleep cycle so you don't act out your dreams and hurt yourself, but it's a wee bit glitchy, because if you start to wake up, you sense that you're paralyzed and your dreaming brain tries to figure out why.

I get it a lot if I'm exhausted such that my body wants to do nothing but sleep but my brain is racing too much to really let go and sleep, and I experienced it yesterday after a nap I'd taken after taking migraine meds--I kept trying to call for or text my husband to ask him what we were doing for dinner, and I'd fall back into the dream-state and dream that I talked to him or that I texted him, then wake up out of it a bit and realize that not only did I not do it, I couldn't move to text or call him. Over and over again. Annoying, because I knew what was happening in the more lucid moments, and the dreams were vivid enough that I really had to stop and think if it had happened or not!

[identity profile] telophase.livejournal.com 2013-02-02 09:26 pm (UTC)(link)
There are very few people who I will allow to shorten my first name, but I think that if my full first name tasted bad to her, I'd be fine with her using the shortened version!

[identity profile] jeremytblack.livejournal.com 2013-02-02 11:45 pm (UTC)(link)
I will write about this on my journal sometime in the next couple of days and then email you. This is interesting and I do have some thoughts, but not today.

Does he write about preparatory hallucinations? (That's my terminology, not sure what it would be called.) To wet your whistle about my delusional hallucinatory "daydream" I have, I think it happens because subconsciously I feel I have to prepare for being in a mass shooting situation. So I'll let you know whenever I post that.

[identity profile] rachelmanija.livejournal.com 2013-02-02 11:56 pm (UTC)(link)
No idea. Do you mean vivid daydreams, or literally seeing, hearing, or otherwise sensing non-existent illusions projected into the outside world?
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[personal profile] naomikritzer 2013-02-03 03:54 pm (UTC)(link)
Well, I looked through the threads and sadly she never did the name Rachel. I would guess Rachel and Rachael would taste the same, because Erin and Aaron taste the same.

The technical term for her kind is lexical-gustatory synasthesia. Her own kids have names that taste like cotton candy, and Cocoa Pebbles. A random sampling of some of the names people threw at her, and what she said they tasted like:

Rob/Robert - a bean burrito
Hudson - pumpkin seeds
Avery - biscuit (wow, there is a lot of biscuits on this thread, lol)
Carter - wax lips!!
Jaylen - very strong one!!! Toast w/strawberry jam
Melody - marshmallow
Hernan - nothing
Isaac - green pepper
Hannah - tater tots. But soft ones, not crunchy. Almost like a tater tot casserole. lol
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[personal profile] naomikritzer 2013-02-03 03:57 pm (UTC)(link)
And I totally think a book about synesthesia is warranted. I think the problem is that it hasn't been investigated all that much because it's one of those neurological novelties that's cool but neither a superpower nor a major problem, so while everyone finds it interesting, not a lot of people study it in depth.

I find synesthesia so fascinating I put it in one of my books (the synesthetic character has an artistic process that is loosely based on Elise Matthesen's artistic process, although the character is not nearly as nice as Elise is. Elise is a synesthete.)

[identity profile] jeremytblack.livejournal.com 2013-02-03 04:59 pm (UTC)(link)
I realize I may never get around to writing about this in my journal. But I still may.

In short: I suddenly think of what would happen if a mass shooting starts right now/right here, and then for a short time afterwards (and then recurring for several hours after), I imagine myself taking actions to fight back. I know this isn't real; however, like explosions in my mind, entire scenes "happen" and inside my mind I'm having vivid, emotional reactions to the situation. (If I'm alone I may cry and grieve "made up" people's death or heroism, and then perhaps I'll find myself actually crying while doing dishes.)

Often it involves me coming up with weapons in various scenarios one could use to fight back. For instance, if the shooter is armored as in the Aurora case, but this is my office, the letter opener is an example, and I may go for the killer's eyes (which is unimaginably horrifying if thought isn't "forced" on me). In public settings I imagine asking people for "anything sharp."

I'm also the "hero" in this "rehearsal fantasy," which probably serves some psychological purpose for me.

That's the gist of these types of things. I don't think they're quite "hallucinations," but they seem to have the power and force of delusions and involve seemingly independent agents (other victims, the police arriving and I have to surrender, the press, Ann Coulter saying on some show that "imagine what he could have done with a gun", etc.) saying things that "surprise" me and feel like they're coming from outside.

These often lead directly into me writing something fictional. Yesterday's scenario of this sort evolved past being about "me" and evolved into helping me understand the psychology of one of my characters (a female ex-Marine who finds herself in a group of civilians under fire). It helped me relate to her, which I needed.

Anyway, these things fascinate me and I wonder whether there's anything "kind of" like it in the book. To me the MAIN thing going on here seems to be a rehearsal for an imaginary situation that is causing me worry. (Similar to some of my nightmares where I'm fighting zombies, only it seems this is a more realistic fear/concern.)
Edited 2013-02-03 17:02 (UTC)

[identity profile] rachelmanija.livejournal.com 2013-02-03 06:32 pm (UTC)(link)
I do that too. ;)

Those are very vivid daydreams. It's not a hallucination unless you literally see, hear, or otherwise perceive things as occurring outside of your own mind, and projected into the outside world. Surprising twists in your own scenarios are not the same thing. Similarly, delusions require actual belief in their objective reality, not just a sense that they're vivid or could happen.

[identity profile] lady-ganesh.livejournal.com 2013-02-03 06:37 pm (UTC)(link)
I had 'proper' hallucinations exactly once, when I was having a (very) bad reaction to medication. Interestingly, the hallucinations, rather than the extreme hyperactivity, were what sent my parents in a panic back to the doctor.

I've had auras for years; they used to come with more detailed hallucinations and now they just look kind of like an oil slick in my field of vision. I'm not sure if my young imagination/memory made the hallucinations more detailed or they were really like that.
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[identity profile] goldjadeocean.livejournal.com 2013-02-03 09:46 pm (UTC)(link)
Heh, last night I called an Indian restaurant to place an order; the moment a woman picked up and I could hear the rush of the kitchen behind her, I could smell curry, as though there was a dab of it on the phone receiver.

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