Oliver Sacks – Hallucinations

November 05, 2012

Despite our individual differences, highlighted especially during an election, much of what we see, hear, smell or feel is shareable: that is, when standing in front of an object, we can more or less agree that it has a particular color, shape, texture, size and so on. But what if I tell you that I see an object clearly which you do not? Or hear a voice that doesn’t have a physical source? Now we enter the world of hallucinations.

Hallucinations, or perceptions of objects without an external reality, are not confined to the minds of people with schizophrenia or those who take hallucinogenic drugs. In many cultures, visions are considered a privileged state of consciousness; the trait of a special person chosen by some supernatural force to pass along an important message. But in our western worldview, hallucinations are often associated with a malfunctioning brain. What causes the startling, unbidden perception of something that seems very real, but has no material existence outside of our own minds?

With reference to his own mind-altering experiences, the ‘poet-laureate of medicine’, Dr. Oliver Sacks, takes us through the looking glass and into the fascinating world of hallucinations.

Oliver Sacks, M.D. is a physician, a best-selling author, and a professor of neurology at the NYU School of Medicine.

He is best known for his collections of neurological case histories, including The Man who Mistook his Wife for a Hat (1985), Musicophilia: Tales of Music and the Brain (2007) and The Mind’s Eye (2010). Awakenings (1973), his book about a group of patients who had survived the great encephalitis lethargica epidemic of the early twentieth century, inspired the 1990 Academy Award-nominated feature film starring Robert De Niro and Robin Williams.

Dr. Sacks is a frequent contributor to the New Yorker and the New York Review of Books, and a fellow of the American Academy of Arts and Letters as well as the American Academy of Arts and Sciences. His new book, Hallucinations (2012), has just been released.

A special thanks to Matt Licata for his help with this episode.

This is point of inquiry for Monday, November 5th, 2012. 

Welcome to Point of inquiry. I’m Indre Viskontas point of inquiry is the radio show and podcast of the Center for Inquiry, a think tank advancing reasons, science and secular values in public affairs and at the grassroots. Despite our individual differences highlighted especially during an election. Much of what we see, hear, smell or feel is shareable. That is when standing in front of an object, we can more or less agree that it has a particular color, shape, texture, size and so on. But what if I tell you that I see an object clearly, which you do not, or I hear a voice that doesn’t have a physical source? Now we enter the world of hallucinations, hallucinations or perceptions of objects without an external reality are not confined to the minds of people with schizophrenia or those who take hallucinogenic drugs. In many cultures, visions are considered a privilege state of consciousness. The trait of a special person chosen by some supernatural force to pass along an important message. But in our Western world view, hallucinations are often associated with a malfunctioning brain. What causes the startling, unbidden perception of something that seems very real but has no material existence outside of our own minds? With reference to his own mind altering experiences, the poet laureate of medicine, Dr. Oliver Sacks, takes us through the looking glass and into the fascinating world of hallucinations. Dr. Oliver Sacks is a physician, bestselling author and professor of neurology at NYU School of Medicine. He is best known for his collections of neurological case histories, including the man who Mistook His Wife for a Hat, Musicophilia and the Mind’s Eye Awakenings. His book about a group of patients who had survived the great and powerful, latest lethargic epidemic of the early 20th century inspired the Academy Award nominated film starring Robert De Niro and Robin Williams. Dr. Sachs is a frequent contributor to The New Yorker and the New York Review of Books and a fellow of both the American Academy of Arts and Letters and the American Academy of Arts and Sciences. His new book, Hallucinations, has just been released. Welcome to Point of Inquiry. Dr. Oliver Sacks. 

It’s nice to be with you. It’s an absolute pleasure to have you on the show. You have a new book coming out called Hallucinations. And some of our listeners may have already come across an excerpt which was published in The New Yorker called Altered States, in which you describe some of your own experiences with hallucinogenic drugs. But before we delve more deeply into the topic, I’d like to ask you to tell us what is it that distinguishes hallucination from other mental experiences, such as waking dreams or imagination? 

Well, I think summations can occur in full consciousness, unlike dreams. They are projected externally and appear to have a legal and objective reality, unlike an imagined object from the people who are similar to perfect, except they are, as it were, false prophets. Look, there’s nothing there to perceive duchesses as if the perceiving parts of the brain as being forcefully activated African features internally. 

And I was surprised in reading your book that you didn’t spend a lot of time discussing hallucinations in patients with schizophrenia, which for most of us seems to be almost the quintessential hallucinogenic experience. And instead, you focused on other types of hallucinatory experiences and patients. Why was it that you seemed to leave schizophrenia for another topic? 

Well, most people tend to be very shy about mentioning hallucinations and sometimes even about acknowledging them for themselves. Because this common notion in the public mind and also the medical mind a large extent is transformations portend schizophrenia or dementia or something very worrying, but for all sorts of hallucinations, which are relatively benign and don’t have any such connotation. And I felt I wanted to focus on these books that are the ones one most commonly run to class and in real life, medical practice and neurological practice. Anderson, seeing your schizophrenic hallucinations, which were a huge subject. And go with alterations of thinking and emotion of a very complex sort. To need them for another book. So I mentioned them defuzed as I mentioned, Greening’s briefly, but then excuse myself from two vast domains. 

Right. And I was I was initially really struck by the beginning of your book where you talk about people who have hallucinations in. 

Because one of their senses has an absence of stimulation. So, for example, in in Charles Bonnier syndrome, where people who are blind experienced visual hallucinations. Could you tell us a little bit more about what’s going on here? 

Well, first, a lot of my work is in old age four. I see a lot of people who have impaired vision or hearing, even though their intellect quite intact and a good proportion. I can’t say exactly the pain. And it would shrink to a fifth of. People develop hallucinations in the mode in which they affect us, totally blind or partially blind. People get visual hallucinations, which are completely silent, a purely visual from estimations. And yes, people get auditory hallucinations. Most commonly used to call often verbal, to have lost their sense of smell, get smell hallucinations. And one might say that people who’ve lost a limb get to a limb hallucinations. But I’m not quite sure where the phantom limbs, which I do discuss, belong in the form category. There’s a few others. I open the book with a description of a patient whom I’ve been following for many years. Actually, she became very dear to me and I was very sad when she died a few weeks ago, just short of her 100th birthday. I think she was a remarkable maiden. Ms. Strong-Minded and Peter made it the investing home phone. They found that she was apparently hallucinating and they didn’t know what was going on. And when I went to see her, she was puzzled. She said, I’ve been blind for five years. I see nothing. Why am I seeing things now? And I ask what sort of force? And she described scenes with animals, with people looking at her, with her falling snow and the folklore very vivid. Use your units maybe two or three minutes long. Then there would be another one. I asked if they would like to influence. He said no, they like film clips or maybe even wants theater. And interestingly, she could never recognize the people or places she hallucinates. And she felt say he’s there saying whatever it was autonomously without any relation to her own thoughts or feelings. And this is like a characteristic of these hallucinations of. Fondation from other hallucinations, sometimes task which was affect or the sense of similarity, but not the souls of ones. 

So why do you think that it took five years for these hallucinations to develop, even though she’d been blind for for that long? 

Well, I think the answer is we don’t really know. One can very consistently and information in an acute experimental context are using blindfolds. And here the majority of people, as a colleague of mine, plus her urine is has shown the majority of people start having visual hallucinations within two days and often quite relieved when the experiment is over. So acute visual depravation may be enough to cause hallucinations. But control, loss of sight may not do so in reality. Unclear why. Let’s say each year, 80 percent of people who become blind do not have complex information. And why with others and may not have them for years and then get them. And typically this happened with location. Hallucinations last a few days, sometimes a few weeks and disappear and then come back again. Obviously other variables at work. 

Mm hmm. And you mentioned that in the case of these visual hallucinations, they were of unfamiliar. Were things, whereas I think you also mentioned that when people have musical hallucinations, they’re generally of familiar melodies or tunes or or music that they’ve heard before. Is that fair to say? 

Yes, it’s a very striking difference. Someone I’ve wondered whether it’s because music has an already constructed feeling with whether one 10000 pieces of music come from as opposed to transsexual singles, which may not be confused. And of course, some estimates for painting or photograph Bartnoff. It’s sly. It’s very much as if what some fish has already constructed as like imaginary images, whereas musical ones are very much more like memories. 

And do you do you know of any research that in which people have looked at what’s going on in the brain during these hallucinations? And if there is a difference, if, say, for example, in the visual hallucinations, there’s some other part of the brain that’s also active that’s doing the, you know, imagining or creating the scene. 

That’s very interesting. And some very beautiful studies have become possible with the advent of functional brain imaging. If MRI and also more recent forms of brain imaging, tensor imaging shows the white matter, dominant dominatrix from London started to do imaging on people with Charles Bromination drums, and he would first get a very detailed description of the sort of hallucinations that had he recognized a dozen or more different sorts and his subjects would indicate what sort of hallucinations they were having at a given time. And he was able to show, for example, that if people were hallucinating faces that tended to be abnormal activity. And in the so-called fusiform face area, the back to the right hemisphere in full temporal cortex. And if, on the other hand, there were hallucinations, words or pseudo words or little unflexible hallucinations, then the visual word for mayor and the left hemisphere would be activated. And it looked very much as if it was parts of the brain, those systems which were involved in perceptual recognition, generally, the hallucinations of that sort. If they were being autonomously stimulated or released whenever it was going on. I think the study for musical hallucinations have I’m not sort of things out quite in this way because some people hear pieces of music with words and what some find as a very widespread activation of all those parts of the brain, which can include cerebellum and basal ganglia and motor cortex and so forth, which which are activated when one listens to music. Mm hmm. They’re visual transformations. Are our area here for specifying what goes on in brain? 

And so in these patients who are experiencing these hallucinations in the absence of stimulation and in particular those those people that you described who were blindfolded and after three days began to hallucinate, it’s almost seems as though the hallucinations are a comfort rather than something that they fear. Did you find that patients over time would learn to control either the content or the expression of their hallucinations? 

Usually men control or very little control was obtained. What floor tended to the accommodation? And once people were Charles Bonner really assured that there is no psychiatric or neurological calamity. They’re not on. And I think hallucinogenic. They may then become quite accepting of hallucinations. I think one man who who imagined his eyes saying we know blindness is no fun. So we have we have concocted this small syndrome as a sort of coda to your slice of life. That is not much the best we can do. 

I’m frankly misquoting him, but that’s essentially what he imagines, as I say. 

And the shells from his grandfather, who who, as it were, was your original subject, would often compare his transformation receptacles in a theater and would sometimes like to go in for a dark woman. Good afternoon. And for for a hallucination matinee. And other times these hallucinations are ignored. And this is especially easy if they are of a simple sort, just geometrical patterns and so forth. I’m a moderately visually impaired myself now, and I see he’s putting some things a little like Nessus all the while. But I ignore them because I know my tinnitus, which might make them with my deafness, but even conflict hallucinations can be ignored. 

I was struck along the same lines by a description of a patient that you wrote about. Her name was Gerti. See, I believe she was a Parkinsonian patient. Yes. 

And so could you tell us a little bit and tell our listeners about her story? 

Virtually. She was a patient who had had the same for years since afflatus lethargica. And the person suffering this syndrome, which immobilized her for four decades before she was put on hold. So far, she had all sorts of hallucinations as to the other patients on alto path. But it also became clear when she got to know me and trust me, and I followed her for 10 years or more, that she had had hallucinations long before she was put on little path, mostly of a role of pastoral sort. She she she imagined lying in a meadow or floating in water when she was put on to her, hallucinations became more social and more erotic. And the apparently under Christ out of control so that she she did not produce from each until evening and from when it was time for her to sleep at eight o’clock, she would say to our visitors firmly but courteously, that she was expecting a gentleman to visit us from out of town. Perhaps we could have another day. And her gentleman, it was an apparition came in through the window and thought, how much comfort? Social insects. But she she really seemed to have control of this. It never spread out of control. It had a sense of humor which which was in danger. But she was an old hand at the Museum of Aging, maybe some schizophrenic patients. She was not schizophrenic, but maybe some schizophrenic people may also get on comfortable terms from the sort of way with their hallucinations. Incidentally, I mentioned another patient who have Parkinson’s disease, not patients committed and who was prone to hallucinations, visits to the visitors. But they never followed him out of the apartment. They were confined to his apartment and he could always get away from them if he wished by going outside. 

His amazing stories. 

About a year ago, I cohosted a television show on the Oprah Winfrey Network in which I had the opportunity to investigate claims of miracles across the U.S. and several of the episodes included people who had who reported having had visions of a religious sense. And they would be. Very offended if I intimated at all that they might have been hallucinating. But is there is that is there a difference, at least in the medical field, between what people think of as a religious vision and hallucination? 

Well, they’re certainly different term in character and on people often rather quiet about auditory hallucinations. Whereas with a man for plain and religious experiences becoming almost evangelical, there’s a book in front of me at this moment of extremes. There’s been much talked about and was on the cover of Newsweek. It’s called Proof of Heaven. And subtitled Amela Surgeon’s Journey into the Afterlife. A man called Alexander. 

Yes, I’ve heard about it. 

Well, here he had a nasty bacterial meningitis. He was in coma for several days. But when you came to you describe an enormously complex, so-called near-death experience, these experiences are often rather stereotyped in quality. People may feel they’re in a dark corridor and moving towards some bright light. Feelings of bliss envelop them and see if they move aside and said drawn towards the light. They sense in a way, if feel that the light is the boundary between life and death. And they will then come back. Or Fernbach back in Musicophilia describes such a sequence with a patient, with a subject, another surgeon that just happens to be struck by lightning. And he has this sort of blissful movement. Then he said, Slam, I was back. She was back because someone was doing CPR on his heart and his heart started beating again 20 or 30 seconds afterwards. So his his whole cosmic journey not only occupies a matter of seconds, Dr. Alexander feels that his cortex was often action while he was having his visions. And therefore, this must have been direct supernatural intervention. I, I see such a claim can’t be sustained and continued. You know, a few seconds of of altered consciousness as one emerges from coma would be almost to give him to allow such a state. People who have these states may insist on their reality and feel their lives are transformed. And as you say, may get angry if one says it was a hallucination. Of course, hallucinations being brain events in the absence of any any sort of objective world around, one can’t be evidence for anything, much less proof of anything. I tend to think that people who insist on the certainly the being in heaven and information may feel real at the time. But in retrospect, I think many people will almost regretfully say, well, it was a hallucination. It seemed intensely real. But budget comedy that other people may stick for the feeling prevailed in vouchsafe day. A glimpse of some of the afterlife or on TV. Family and friends have quite a long shadow on this. There is a sentence. I can’t find it instantly with one hand. Dr. Alexander’s book Crazy. He imagines that without cholent, ability to resuscitate people after cardiac arrest and treat all sorts of conditions which would otherwise have been fatal for years. Near-death events may be much commoner. And there may be many, many people who’ve had an experience of the afterlife. He says that no one from Tamilians. I think that’s a very extravagant estate box. But from I don’t know. Of course, there are other people, the evangelicals, who believe they have it, that they see and hear and feel the divine. And I have not met any evangelicals and I speak second hand. But from what I’ve read, it seems that their prayer discipline issues very. My youth and civic energy. So they’re told what Jesus looked like. Which direction was her face and how was he dressed and what color was his hair? And the colors and imagery become greater and greater in these people. And at some point, they may leap over this hallucination and a hallucination. They then seemed to confirm the reality. One knows that what one imagines is not reality, but if it leaks into hallucination, that may be. But I don’t think hallucinations are ever going to reality any more than imagining. 

And I was struck by how in the book you describe almost a continuum of belief in their own hallucination. So you have people who, for example, on one extreme have Antine syndrome in which they have damaged the occipital lobe and they blind cortically, but yet they deny their impairment despite overwhelming evidence to the contrary. And on the other hand, you have people who immediately know that their hallucinations aren’t real and they’re skeptical of them. What is the difference between these two sets of people, people who believe their own hallucinations and those who, despite the evidence, simply won’t believe that they’re hallucinating? 

Well, I’m concerned since hematomas touch on briefly. So certainly involves all sorts of disconnection, some from reality testing. But Tara Rich, complex temporal lobe hallucinations, which can be which is people come to surgery, can be induced by stimulation, the temporal lobe cortex or the right place, which which intentionally did goosh can produce what can feel called experience or for you sensations which he can see real, although there may be a sort of doubling of consciousness. So the patient can say, I know I’m in Dr. Canfield’s operating room, but I’m also at the corner of 25th from North Avenue in South Bend, Indiana. 

I don’t know fussbudget in India and maybe in different. 

And the genes are maybe 10 cents of I’m from familiarities and they’re investing to invest in the presence. I think one one has to think in terms of the various levels you shall follow. Hallucinations are relatively low down in the visual pathway. The Venice Film Festival pathway. But by the time one comes to these temporal lobe hallucinations, one is finding Coro activation of a mythical LA and hippocampal system. And this may invest. We’re certainly with a strong sense of of emotion and familiarity. And and I bought some extent of the. 

And you also describe and I believe it is in the temporal lobe, epilepsy patients, these ecstatic hallucinations. 

Oh, yes, indeed. Soquel ecstatic hallucinations are not CRH full of it. When the term came in, they are described for many years. And clearly in the medical journals, it guards haven for genuine literature, referring to Rudolf Friskies descriptions of his own seducers descriptions, which he also speaks among many of his characters. 

But he would suddenly be arrested and cry. God exists, God exists. And why he would feel that he was from heaven and that everything was unified and made sense. And he said that he didn’t know how long the state had lost. Its will sometimes be followed by a convulsion. But he said for five seconds of the state he would give him her life. She in these ecstatic hallucinations, there is a sudden transport of joy and also a sense of being transported to heaven or or into communication with God. And. Few seem intensely real. The people and dumb and fashionable, so an interesting study a few years ago when was an attempt to to treat patients with ecstatic seizures and a lot of them refused to talk medication. And some of them indeed found ways of reducing their own future. So if a seizure can be pleasant, this sounds like it. Usually there is some spanking and the range of temporal lobe at the same time as people are having their divine vision. And there may be a bit out of touch, Will, with a sort of daily reality Ron Lindsay. But lives will be transformed by this. One of my favorite case histories, which I quote actually is a robust conductor in London who I think was puncturing particular, suddenly thought that she was in heaven and told this to all his passengers. And he remains of a very elated state for three days. I think we can sometimes be a sort of almost Poohsticks or mania. And then he continued to tell a more moderate level, deeply religious. Until we have another bunch of things or three years later and said this clears his mind and now he no longer believes in God and angels and Christ in an afterlife or heaven. And interesting, even the second conversion to Aesir, some carry the fading litas and revelation qualities as the forced warmth to religion. 

That’s amazing. So we’re running a little bit short on time. And I did want to ask you about a personal experience of mine. I don’t think I’ve ever experienced a full-blown hallucination that, you know, at least to my knowledge. But you might remember from the conversation we once had at dinner that I am a grapheme color synesthete. So for our listeners who are unfamiliar with the term, it means that I see letters and numbers in color. Is this a hallucination? 

No, I am. I think that sort of thing. Letters and numbers and Talaal seeing music and color is really a physiological constant. The physiological coupling between two areas in the cortex. It is a letter reading one of the color and one I think is some sort of thing which you can probably verify from your own experience with Siskins is the of an early age and and and doesn’t change. I suppose one might call us with an illusion. But one sensation is invested with the qualities of another sensation. This can take very complex forms. There’s one professional musician. 

It’s amazing, I mean, for me, it just feels so natural. And yet I know intellectually that the the appearance of the color doesn’t happen until my brain has somehow understood the symbolic meaning of a letter, for example. 

That’s interesting. They feel different sort of string of a nonsense, string of letters to stuff that doesn’t like the truth. 

Well, the letters do, but it’s not until say it. Like if I see two intersecting lines, it’s not until my brain decides whether it’s a T or an owl that I see the color. So if if, you know, letters are occluded and I don’t know what the letter is, there is no color. 

But as soon as it feels instantaneous to me that the color comes on, as soon as the, you know, in line with the meaning of the letter. And so in that way, I kind of wondered if there wasn’t a part of my brain that then is overlaying what seems like a hallucination. But I can see your point that it’s more of an illusion because it’s unchanging and it’s it’s always present. 

And we would probably, if you spoke to another US finish shoot, would probably find this he or she had different colors from from you. 

Yes. In fact, I’ve been I’ve been working on with a graphic illustrator on a graphic novel. Her name is MGE Lord and she’s also a synesthete. 

And we have very heated arguments about what what color is the letter should be Nabokov discovered when he was his child that he was with Shinnosuke. So she complained to his mother that the letters in the alphabet Szeps was the long color. 

She had to leave with him. 

But when she said the colors they were to her, the two of them disagree together. And it helps them in general. Finnessey says Exaction agrees. This is a special striation musical fantasy and which could be added to the Rimsky course for forecastable musical color seamlessly. And they thought this was something absolute. But when they met, they found these very different colors and couldn’t agree about anything. 

So I’d like to sort of wrap up the interview with a more personal note from your own experiences. I was very much struck by one experience that you described in which you had taken hallucinogenic drug and you were waiting for a hallucination to appear and then nothing happened. And your friends, Jim and Cathy, came over and you cooked them ham and eggs. Can you describe that experience? 

Yes. Well, I had dreams. I was living in down on on Venice Beach. And I am very in the early 60s and a lot of blokes around. And people said to me, if you really want something striation peak afternoon are tennis of Belladonna. Leighann Lord puts in Houston treating Parkinson’s. And I should just take 20 will surely be in partial control. Anyhow, I took these tablets and forced I noticed nothing. I had rather dry mouth difficulty accommodation. Right. Pupils were dilated, nothing else. And then I heard a car door slam and footsteps and drums. I thought of my friends, Jim and Cathy. They often visited on Sunday. I started coming in and we chatted. I was in the kitchen when the full swing glaus between the kitchen and sitting room. I said, How do you like your Eddystone? And we’ve chatted before. Five minutes, five prepare to have an edge. So they walked up to that. They perform a trade. And was just wonder. And I was so shocked. Kay always dropped the tray. It hadn’t occurred to me for a moment that all the order from this major, at least from their part of the conversation, was Folsom Major. And I thought I’d better watch myself. But this was followed by some even strange things, including having a conversation with a spider. 

The spider was little about the Ron Lindsay visual element. But this spider said hello and for some reason it didn’t surprise me bit more. Alice was surprised by the white rabbit. I said hello yourself. 

We had our conversation after a little abstract conversation about some parents and other Lycett philosophers. Many years later, why I mentioned we’re still friends, minor events, biologist as a philosophical spy. The with folks like Thorp’s and Russell Rogers is settings with essence of that. I as the species of. That’s a softly if I was computer hallucinations. It didn’t occur to me and I didn’t personally for a moment that this was fool’s formation. 

And what was amazing was that you were you were expecting it. You were waiting for a hallucination. 

Yes. Or although I didn’t think it would take that form. I thought there would be sort of all sorts of dramatic misperceptions and hallucinations as one of me gets will from LSD or masculine ghost likes. But this time it was purely auditory and an oddly humdrum more or although it will sense how deeply absurd. I wonder what maybe one would have thought have we should move to learn at least the spider. 

I wish I could have seen that. 

But on that note, I’d like to let listeners know that Dr. Sax’s fantastic new book, Hallucinations, is available through our website Point of Inquiry dot org. 

Dr. Oliver Sacks, thank you so much for being on point of inquiry. It’s been very nice speaking with you. 

Thank you for listening to this episode of Point of Inquiry to join the discussion about today’s show on hallucinations visit point of inquiry dot org. You can also send questions and comments to feedback at point of inquiry, dot org on Twitter, at point of inquiry and on Facebook at slash point of inquiry. Views expressed on point of inquiry aren’t necessarily the views of the Center for Inquiry, nor its affiliated organizations. 

Point of inquiry is produced by Adam Isaac in Amherst, New York. And our music is composed for us by Emmy Award winning Michael Waylan. Today’s intro featured Debbie Goddard. I’m your host Indre Viskontas. 

Indre Viskontas