Hallucinations полностью

When I saw her in 2011, I asked her what her hallucinations were like. “Horrible!” she said. “It’s like watching a horror movie, and you’re part of it.” She saw little people (“Chuckys”) running around her bed at night; they seemed to be talking to each other, she saw their gestures and their lips move, but she could not hear any speech. On one occasion she tried to speak to them. Although they looked frightening and (she thought) had evil intentions, they never molested or approached her, though once one of them sat on her bed. But far worse were certain scenes enacted before her. “I saw my son murdered right in front of my eyes,” she told me. (“It was Darkside stuff,” her husband interpolated.) Once, when her husband visited, she said, “What are you doing here? They just had your funeral at Sacred Heart Church.” She often saw rats, and sometimes felt them in her bed. She also felt “fish” nibbling at her feet. Sometimes she had hallucinations of being part of an army marching into battle.

When I asked if she had any pleasant hallucinations, she said that she had sometimes seen people “in Hawaiian dress” in the corridor or outside her window, getting ready to play music for her, though she never actually heard any music. What she did hear, however, were various noises—especially the sound of running water. No voices. (“Good thing I didn’t have those,” she said, “or they’d think I was really crazy.”) There have been some olfactory hallucinations, too: “people around me with different kinds of scents.”

When her hallucinations started, Mrs. B. was understandably terrified, and took them for reality—“I did not even know the word ‘hallucination,’ ” she said. Then she found herself more able to distinguish hallucinations from reality, but this did not prevent her from being frightened when they occurred. She always looked to her husband for reality testing; she would ask him whether he saw, heard, felt, or smelled some of the things she did. Sometimes she would have distortions of vision—her husband’s face would be disfigured by a down-curving, sneering smile or occasionally his mouth would be upturned, “like a smiley face.” A particularly strange and frightening hallucination occurred recently. There is a poster of a Native American chief hanging above her bed, and this came to life for Mrs. B. the other day; the chief stepped out of the frame and seemed to be standing in the bedroom. To reassure her, her husband waved his hands in front of the picture to dissipate the hallucination—and the chief seemed to disintegrate, but then she felt she was disintegrating, too. On another occasion, clothes in the bedroom “started walking around,” and she had to have her husband shake a pair of jeans to show that it was just this, and nothing more.

Hallucinations may also occur in other types of dementia, including moderately advanced Alzheimer’s disease, though less often than they do in Lewy body disease. In such cases, hallucinations may give rise to delusions, or they may stem from delusions. There may also be, in Alzheimer’s or other types of dementia, delusions of duplication or misidentification. One patient of mine, sitting next to her husband on an airplane, suddenly saw him as “an imposter who, she believed, had murdered her husband and was now trying to take his place. Another patient of mine, while she recognized the nursing home she was in by day, felt that she had been transferred to a cunning “duplicate of the home each night. Sometimes psychoses can be centered on delusions of persecution, and occasionally these lead to violent behavior: one such patient assaulted a harmless neighbor, whom she felt was “spying on her. Hallucinations in Alzheimer’s disease, like those of Lewy body disease, are usually embedded in a complex matrix of sensory deceptions, confusion, disorientation, and delusions, and are rarely isolated, “pure” phenomena as in Charles Bonnet syndrome.

I worked for many years with the eighty deeply parkinsonian postencephalitic patients I described in Awakenings. Many of them had been “frozen” for decades, virtually immobilized by their disease. Once I got to know them well (after they had been enabled to move and talk by L-dopa), I found that perhaps a third of them had experienced visual hallucinations for years before L-dopa was introduced—hallucinations of a predominantly benign and sociable sort. I was not sure why they hallucinated in this way, but I thought it might be related to their isolation and social deprivation, their longing for the world—an attempt to provide a virtual reality, a hallucinatory substitute for the real world which had been taken from them.