Colored positron emission tomography scan (PET scan) of the brain of a patient with schizophrenia who is experiencing a hallucination. Highlighted areas show brain activity. The patient’s hallucination consisted of heads that spoke to him. The active areas of the brain seen here (the auditory and visual areas) confirm that the patient “saw” and “heard” the heads in the hallucination.
Hallucinations are, to some, the true sign being really crazy. But it ain’t necessarily so. In my last post I suggested that hallucinations automatically get you a definition of schizophrenia. I must correct myself. I’ve been reading Phantoms in the Brain by V.S. Ramachandran & Sandra Blakeslee. In it, Dr. Ramachandran points out that there is a neurological syndrome called Charles Bonnet syndrome. In it, people who lose sight, either partially or completely, experience hallucinations which can be vivid, whimsical, and distracting. He relates a case where a young man who lost the bottom half of his field of view due to brain damage in an auto accident reported seeing a monkey in Dr. Ramachandran’s lap. He was not distressed and didn’t think there was a real monkey there because he reasoned that it would be extraordinarily unlikely for a physician to interview a patient while holding a monkey on his lap.
What’s interesting to me is that this particular syndrome, according to Dr. Ramachandran , doesn’t involve “slavering monsters” or “scenes of brutal carnage.” To be completely accurate, the statement is that the hallucinations are rarely negative, but in the cases he presents where he personally interviewed people, none of them report nasty images. He quotes a Lancet article in which it was found that out of 500 visually handicapped people, 60 saw hallucinations. So the syndrome is not particularly rare, but people don’t tend to report seeing things because they don’t want to be thought crazy. They are more likely to make statements like “my eyes are playing tricks on me.” Granted, the hallucinations can be very disconcerting– the patient who saw the monkey also had a problem of seeing an entire floor full of shoes while looking for his real shoes in the morning. there are also other conditions under which people hallucinate– sleep deprivation is one.
What gives me food for thought is some of the people I’ve worked with who had hallucinations or delusions due to diagnosed mental disorders– not neurological disorders. In these, some were unwilling to report the contents of auditory hallucinations particularly. What do the voices say? “Nothing nice.” The scariest kind of auditory hallucinations are command hallucinations– voices telling you what to do. These are the ones involved in some of the high profile public cases– but not all of them. In these types of mental disorders, the content, especially of auditory hallucinations, is usually negative, sometimes bizarre.
In all fairness, to qualify one set of hallucinations as “whimsical” and another set as “bizarre” might raise arguments about the meanings of words, but we can save that for another time and place. Most people would concede there’s a difference. Whimsical is nice, bizarre isn’t. The functional limitations imposed by one kind of hallucinations is completely different from the limitations imposed by the other, and the level of distress is greatly different also. In addition, folks with psychoses usually have several other symptoms to go along with the hallucinations– some of which are described as “impaired reality testing.” So the psychotic person would believe that there really is a monkey on the doctor’s lap, perhaps, whereas the Charles Bonnet person does some reality testing– and the monkey flunks.
One additional morsel of food for thought– the stigma of mental illness. It would be nice of people didn’t feel so likely to be judged, and their rights abridged, because of symptoms. We might get a lot of problems sorted out more quickly.