In addition to such isolated or occasional hallucinations, people with Parkinson’s may develop elaborate and frightening hallucinations, often of a paranoid sort. Such
a psychosis took hold of Ed toward the end of 2011. He started to have hallucinations of people who entered his apartment, emerging from “a secret chamber” behind the kitchen.
“They invade my privacy,” Ed said. “They occupy my space. . . . They are very interested in me—they take notes, take photos, rifle through my papers.” Sometimes they
had sex—one of the intruders was a very beautiful woman, and sometimes three or four of them would occupy Ed’s bed when he was not using it. These apparitions never appeared if he had
real visitors or when he was listening to music or watching a favorite TV show; nor would they follow him when he left his apartment. He often regarded these persecutors as real and might say to
his wife, “Take a cup of coffee to the man in my office.” She always knew when he was hallucinating—he would stare fixedly at one point or follow an invisible presence with his
eyes. Increasingly, he started to talk with them—or
Ed’s neurologist, on hearing this, advised him to have “a drug holiday,” to stop all his anti-Parkinson’s medications for two or three weeks, but this left Ed so incapacitated he could hardly move or speak. He then planned a gradual reduction of medication, and, two months later, on half his previous dose of L-dopa, Ed’s hallucinations, his fears, and his psychosis have cleared completely.
In 2008, Tom C., an artist, came to my office for a consultation. He had been diagnosed with Parkinson’s disease and put on medication about fifteen years earlier. Two years later, he started to experience “misperceptions,” as he calls them (like the others, he avoids the term “hallucinations”). He is fond of dancing—he finds that this can unfreeze him, releasing him, for a while, from his parkinsonism. His first misperceptions occurred when he was in a nightclub; the skin of the other dancers, even their faces, seemed to be covered with tattoos. At first he thought the tattoos were real, but they started to glow and then to pulse and writhe; at that point he realized they must be hallucinatory. As an artist and a psychologist, he was intrigued by this experience—but frightened, too, that it might be the beginning of uncontrollable hallucinations of all sorts.
Once, while sitting at his desk, he was surprised to see a picture of the Taj Mahal on his computer monitor. As he gazed, the picture became richer in color, three-dimensional, vividly real. He heard a vague chanting, of the sort he thought might be associated with an Indian temple.
Another day, while he was lying on the floor, frozen by his parkinsonism, the reflections on a fluorescent ceiling lamp started to change into old photographs, mostly in black and white. These seemed to be photographs from earlier days, mostly of family, with some of strangers. “I had nothing else to do” in this immobilized state, he said, so he happily indulged this mild hallucinatory pleasure.
For Ed W. and Tom C., hallucinations usually remain on the “misperception” side, but Agnes R., a seventy-five-year-old lady who has had Parkinson’s disease for twenty years, has had frank visual hallucinations for the last decade. She is, as she says, “an old hand” at hallucinations: “I see a whole array of things, which I enjoy—they are fascinating; they don’t frighten me.” In the clinic waiting room, she had seen “women—five of them—trying on fur coats.” The size, color, solidity, and movement of these women looked perfectly natural; they seemed absolutely real. She knew that they were hallucinations only because they were out of context: no one would be trying on fur coats on a summer day in a doctor’s office. In general, she is able to distinguish her hallucinations from reality, but there have been exceptions: on one occasion, seeing a furry black animal leap onto the dining table, she jumped. At other times, while walking, she has stopped abruptly to avoid bumping into a hallucinatory figure just in front of her.
