CURRENT BOOKS: Seeing What Isn’t There

Irina deFischer, MD

Hallucinations, by Oliver Sacks, Knopf, 352 pages.

If you’ve ever wondered if a patient who reports vivid hallucinations but seems otherwise of sound mind should be referred to a psychiatrist, this is the book for you. Author Oliver Sacks--whose many other books include Awakenings, The Man Who Mistook His Wife for a Hat, and A Leg to Stand On--is a professor of neurology at NYU. His latest book, Hallucinations, is a catalog of every imaginable type of hallucination, other than those associated with frank psychosis. He draws on historical accounts as well as his own experiences and those of his patients and correspondents.

Hallucinations is organized into 15 chapters, forming a natural history or anthology of hallucinations, based primarily on first-hand accounts. The first chapter begins with Charles Bonnet syndrome, named for the 18th century Swiss naturalist who first described the condition. The syndrome is characterized by elaborate visual hallucinations in people who have lost their eyesight. Sacks goes on to describe hallucinations induced by other forms of sensory deprivation, as well as a variety of auditory hallucinations, such as voices and music.

Another chapter focuses on the illusions of Parkinsonism, in which hallucinations can stem from both the disease and the medications used to treat it. One of the more remarkable chapters is the one on altered states, in which Sacks begins with a history of humans’ use of hallucinogenic plants to transcend their day-to-day lives, whether in search of a religious experience of for pleasure and euphoria. Sacks goes on to recount the discovery of LSD and then proceeds to describe his own experiences with a staggering array of hallucinogens, stimulants and sedatives while a neurology resident at UCLA in the 1960s. Apparently he restricted their use to weekends and was able to continue putting in 60-80 hour workweeks. After completing his residency, he moved to New York for a research fellowship, where he treated his insomnia with large doses of chloral hydrate, then experienced a full-blown delirium when his supply was exhausted. One summer in London at his parents’ home, he went so far as to inject morphine out of boredom, but he decided that once was enough.

In other chapters, Sacks describes visual phenomena associated with migraines and hallucinations of epilepsy, referred to by Hippocrates as the “sacred disease,” or disorder of divine inspiration. In one example, Sacks attributes Joan of Arc’s powerful visions to the ecstatic aura of temporal lobe epilepsy. Russian writer Fyodor Dostoevsky also experienced ecstatic seizures that produced feelings of ecstasy or transcendent joy, as described in several of his novels.

Sacks attributes many examples of divine and artistic inspiration to a variety of hallucinations. I do not entirely agree with his reductionist approach, but I found his book interesting and informative, although it was not an easy read. I recommend taking it slowly, a chapter or two at a time. Then you can reassure your patients they’re not necessarily crazy if they’re seeing or hearing things that aren’t there!

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Dr. deFischer, a family physician at Kaiser Petaluma, is president of MMS.

Email: irinadefischer@gmail.com