Then she moved from abnormalities of perception—seeing things that were actually there, with perseveration or distortion—to hallucinations, seeing things that
were not there. Visions of people’s faces (including, at times, her own) became a frequent sort of hallucination. But the faces Ellen saw were “abnormal, grotesque, exaggerated,”
often just a profile with the teeth or perhaps one eye hugely magnified, completely out of scale with the rest of the features. At other times she saw figures with “simplified” faces,
expressions, or postures—“like sketches or cartoons.” Then Ellen started to hallucinate Kermit the Frog, the
Most of Ellen’s hallucinations were flat and still, like photographs or caricatures, though sometimes an expression would change. Kermit the Frog sometimes looked sad, sometimes happy, occasionally angry, though she could not connect his expressions with any of her own moods. Silent, motionless, ever changing, these hallucinations were almost continuous throughout her waking hours (“They are 24/7,” she said). They did not occlude her vision but were superimposed like transparencies over the left half of her visual field. “They have been getting smaller lately,” she told me. “Kermit the Frog is tiny now. He used to occupy most of the left half, and now he’s down to a little fraction of it.” Ellen wondered whether she would have these hallucinations for the rest of her life. I said that I thought their diminution a very good sign; perhaps one day Kermit would be too small to see at all.
What was going on in her brain? she asked me. Why, above all, was she getting these odd and sometimes nightmarish hallucinations of grotesque faces? From what depths did they come? Surely it was not normal to imagine such things. Was she becoming psychotic, going mad?
I told her that the impairment of vision on one side following her surgery had probably led to heightened activity in parts of the brain higher up in the visual pathway, in the temporal lobes, where figures and faces are recognized, and perhaps in the parietal lobes, too; and that this heightened, at times uncontrolled, activity was causing her complex hallucinations and also the extraordinary persistence of vision, the palinopsia, she was experiencing. The particular hallucinations which so horrified her—of deformed and dismembered faces or faces with exaggerated, monstrous eyes or teeth—were, in fact, typical of abnormal activity in an area of the temporal lobes called the superior temporal sulcus. They were neurological faces, not psychotic ones.
Ellen wrote to me periodically with updates, and six years after our initial visit, she wrote: “I would not say that I am entirely recovered from my visual problems; more that I am living more harmoniously with them. My hallucinations are much smaller, but they are still there. Mostly I see the colorful orb all the time, but it no longer distracts me as much.”
She still has some difficulty with reading, especially when she is tired. When she read a book recently, she said,
I lost a word or two in my color spot (I had a black/blind spot after surgery, but it turned into a colored spot a few weeks later, and I still have it. My hallucinations are around that spot.) . . . As I type now, after a very long day at work, there is a very faint black-and-white Mickey Mouse from the thirties just off center to the left. He’s transparent, so I’m able to see my computer screen as I type. I do, however, make many mistakes typing, as I can’t always see the key I need.
But Ellen’s blind spot has not prevented her from pursuing graduate courses and even marathon running, as she reported with characteristic good humor:
I ran the New York City marathon in November and tripped on this metal ring, a piece of garbage, on the Verrazano Bridge a little before the second mile. It was on my left side, and I didn’t even see it, as I was only looking to my right. I got back up and finished, although I did break a small bone in my hand—which, I think, makes for a wonderful running injury story. In the orthopedics waiting room when I was there, everyone else who had finished the marathon had knee or hamstring injuries.
