Agnes most often sees apparitions from the windows of her twenty-second-floor apartment. From here, she has “seen” a skating rink on top of a (real) church, “people in tennis courts” on neighboring rooftops, and men working just outside her window. She does not recognize any of the people she sees, and they continue whatever they are doing without paying any attention to her. She watches these hallucinatory scenes with equanimity and sometimes with enjoyment. (Indeed, I got the impression that they help her pass the time—time which now seems to pass more slowly with her relative immobility and difficulties reading.) Her visions are not like dreams, she said; nor do they resemble fantasies. She has a great love for travel and for Egypt in particular, but she has never had “Egyptian” hallucinations or travel ones.
She sees no patterns to her hallucinations—they may come at any time of day, when she is busy with others or when she is alone. They seem to have nothing to do with current events, with her feelings, thoughts, or moods, or with the time of day she takes her medication. She cannot will them to come, or will them away. They superimpose themselves on what she is looking at and vanish, along with actual visual perception, when she closes her eyes.
Ed W. often describes a persistent feeling of a “presence”—something or someone he never actually sees—on his right. Professor R., while doing very well on L-dopa and other anti-parkinsonian drugs, also has “a companion” (as he calls it), just out of sight on his right. The sense of someone there is so strong that he sometimes wheels round to look, though there is never anyone to be seen. But his chief illusion is the transformation of print, words and sentences, into musical notation. The first time this happened was about two years ago. He was reading a book, turned away for a few seconds, and found, when he returned to the book, that the print had been replaced by music. This has occurred many times since, and may also be induced by staring at a page of print. Occasionally the dark border of his bath mat turns into staves and lines of music. There is always something—letters or lines—that is transformed into music; this may be why he regards these as “illusions,” not hallucinations.
Professor R. is a very good musician; he started to play the piano when he was five and still plays for many hours a day. He is curious about his illusions, and he has done his best to transcribe or play the illusory music. (His best chance of “catching” this phantom music, he has found, is to set up a newspaper on the music stand and play it as soon as the newsprint turns into music.) But the “music” is scarcely playable, because it is always very highly ornamented, with innumerable crescendo and decrescendo markings, while the melody line is three or more octaves above middle C, and so may have half a dozen or more ledger lines above the treble staff.
Seeing music has been described to me by others (see pages 13–15). Esther B., a composer and music teacher, wrote to me that, twelve years after being diagnosed with Parkinson’s, she started to have “a rather peculiar visual phenomenon.” She described this in detail:
When I look at a surface—like a wall, or a floor, or a garment someone is wearing, or a curved surface like a tub or sink, or other surfaces too numerous to mention—I see a sort of collage of music scores superimposed upon the surface, especially with my peripheral vision. When I try to focus on any one image, it dims out or disappears elusively. These images of music scores come unbidden and are especially vivid after I’ve been working with any written music. The images always appear more or less horizontal, and if I tilt my head one way or the other, the horizontal images will tilt accordingly.
Howard H., a psychotherapist, began to notice tactile hallucinations soon after being diagnosed with Parkinson’s, as he wrote:
I would feel that the surfaces of various objects were covered by a film of fuzz, like peach fuzz, or the down in a pillow. It could also be described as cotton candy or spider webs. Sometimes the webs and fuzz can get very “lush,” as when I reach down to pick up something that has fallen under my desk and my hand feels as if it has become submerged in a huge pile of this “stuff.” But when I try to scoop up that pile, I see nothing and yet feel that I have a large amount of this “stuff” in my hands.
Is the use of L-dopa wholly responsible for such effects? Can L-dopa be regarded as a hallucinogenic drug? This seems unlikely in view of the fact that it is used in treating other conditions (such as dystonias) without provoking any hallucinations. Is there then something in the parkinsonian brain, or at least in some parkinsonian brains, which may predispose to visual hallucinations?27
