Hallucinations полностью

Feeling ill and unsteady, and with his memory occasionally playing tricks on him, Pinfold decides that a cruise to India might be restorative. His sleeping mixture runs out after two or three days, but his drinking stays at a high level. Barely has the ship got under way than he starts to have auditory hallucinations; most are of voices, but on occasion he hears music, a dog barking, the sound of a murderous beating administered by the captain of the ship and his doxy, and the sound of a huge mass of metal being thrown overboard. Visually, everything and everyone seems normal—a quiet ship with unremarkable crew and passengers, steaming quietly past Gibraltar into the Mediterranean. But complex and sometimes preposterous delusions are engendered by his auditory hallucinations: he understands, for example, that Spain has claimed sovereignty over Gibraltar and will be taking possession of the vessel, and that his persecutors possess thought-reading and thought-broadcasting machines.

Some of the voices address him directly—tauntingly, hatefully, accusingly; they often suggest that he commit suicide—although there is a sweet voice, too (the sister of one of his tormentors, he understands), who says she is in love with him, and asks if he loves her. Pinfold says he must see her, as well as hear her, but she says that this is impossible, that it is “against the Rules.” Pinfold’s hallucinations are exclusively auditory, and he is not “allowed” to see the speaker—for this might shatter the delusion.

Such elaborate deliria and psychoses have a top-down as well as a bottom-up quality, like dreams. They are volcano-like eruptions from the “lower” levels in the brain—the sensory association cortex, hippocampal circuits, and the limbic system—but they are also shaped by the intellectual, emotional, and imaginative powers of the individual, and by the beliefs and style of the culture in which he is embedded.

A great many medical and neurological conditions, as well as all sorts of drugs (whether taken for therapeutic purposes or for recreation), can produce such temporary, “organic” psychoses. One patient who stays most vividly in my mind was a postencephalitic man, a man of much cultivation and charm, Seymour L. (I refer to him and his hallucinations briefly in Awakenings). When given a very modest dose of L-dopa for his parkinsonism, Seymour became pathologically excited and, in particular, started to hear voices. One day he came up to me. I was a kind man, he said, and he had been shocked to hear me say, “Take your hat and your coat, Seymour, go up to the roof of the hospital, and jump off.”

I replied that I would not dream of saying anything like that to him, and that he must be hallucinating. “Did you see me?” I continued.

“No,” Seymour answered, “I just heard you.”

“If you hear the voice again,” I said to him, “look round and see if I am there. If you cannot see me, you will know it is a hallucination.” Seymour pondered this briefly, then shook his head.

“It won’t work,” he said.

The next day he again heard my voice telling him to take his hat and his coat, go up to the roof of the hospital, and jump off, but now the voice added, “And you don’t need to turn round, because I am really here.” Fortunately, Mr. L. was able to resist jumping, and when we stopped his L-dopa, the voices stopped, too. (Three years later, Seymour tried L-dopa again, and this time he responded beautifully, without a hint of delirium or psychosis.)

11

On the Threshold of Sleep

In 1992, I received a letter from Robert Utter, an Australian man who had heard me speak about migraine aura on television. He wrote, “You described how some migraine sufferers see elaborate patterns before their eyes . . . and speculated that they might be a manifestation of some deep pattern-generating function in the brain.” This reminded him of the experience that he routinely had upon going to bed:

This usually occurs at the moment when my head hits the pillow at night; my eyes close and . . . I see imagery. I do not mean pictures; more usually they are patterns or textures, such as repeated shapes, or shadows of shapes, or an item from an image, such as grass from a landscape or wood grain, wavelets or raindrops . . . transformed in the most extraordinary ways at a great speed. Shapes are replicated, multiplied, reversed in negative, etc. Color is added, tinted, subtracted. Textures are the most fascinating; grass becomes fur becomes hair follicles becomes waving, dancing lines of light, and a hundred other variations and all the subtle gradients between them that my words are too coarse to describe.