Hallucinations полностью

6. Sarah Lipman has noted, in her blog (www.reallysarahsyndication.com), the phenomenon of “phantom rings” as people imagine or hallucinate the ringing of their cell phones. She links this to a state of vigilance, expectation, or anxiety, as when she thinks she may hear a knock at the door or her baby crying. “Part of my consciousness,” she wrote to me, “is straining to monitor for the sound. It seems to me that it is this hyper-alert state that generates the phantom sounds.”

7. There may be paroxysmal musical hallucinations during temporal lobe seizures. But in such cases, the musical hallucinations have a fixed and invariable format; they appear along with other symptoms (perhaps visual or olfactory hallucinations or a sense of déjà vu) and at no other time. If the seizures can be controlled medically or surgically, the epileptic music will cease.

8. Most people who get musical hallucinations are elderly and somewhat deaf; it is not unusual for them to be treated as if demented, psychotic, or imbecilic. Jean G. was hospitalized after she had an apparent heart attack, and a few days later, she began “hearing a male choir in the distance as if it were coming through the woods.” (Several years later, when she wrote to me, she still heard this, especially in times of stress or when she was extremely tired.) But, she said, “I quickly stopped talking about this type of music when faced with a nurse asking me, ‘Do you know your name? Do you know what day this is?’ I responded back, ‘Yes, I know what day this is — it is the day I am going home.’ ”

9. I have written at much greater length about musical hallucinations (as well as intrusive musical imagery, or “earworms”) in my book Musicophilia.

James Parkinson, in his famous 1817 Essay on the Shaking Palsy, portrayed the disease that now bears his name as one that affected movement and posture, while leaving the senses and the intellect unimpaired. And in the century and a half that followed, there was virtually no mention of perceptual disorders or hallucinations in patients with Parkinson’s disease. By the late 1980s, though, physicians had begun to realize (and only in response to careful inquiry, for patients are often reluctant to admit it) that perhaps a third or more of those being treated for Parkinson’s experienced hallucinations, as Gilles Fénelon and others reported. By this time, virtually everyone diagnosed with Parkinson’s was medicated with L-dopa or other drugs that enhance the neurotransmitter dopamine in the brain.

My own experience with parkinsonism as a young doctor was predominantly with the patients I described in Awakenings, who did not have ordinary Parkinson’s disease but a much more complex syndrome. They were survivors of the encephalitis lethargica epidemic that followed the First World War, and they had come down, sometimes decades later, with postencephalitic syndromes including not only a very severe form of parkinsonism but often a host of other disorders, especially sleep and arousal disorders. These postencephalitic patients were far more sensitive to the effects of L-dopa than patients with ordinary Parkinson’s disease. Many of them, once they were started on L-dopa, began to have excessively vivid dreams or nightmares; often this would be the first apparent effect of the medication. Several of them became prone to visual illusions or hallucinations, too.

When Leonard L. was started on L-dopa, he began to see faces on the blank screen of his television set, and a picture of an old western town that hung in his room would come to life as he looked at it, with people emerging from its saloons and cowboys galloping through the streets.

Martha N., another postencephalitic patient, would “sew” with hallucinatory needles and thread. “See what a lovely coverlet I have stitched for you today!” she said on one occasion. “See the pretty dragons, the unicorn in his paddock.” She traced their invisible outlines in the air. “Here, take it,” she said, and placed the ghostly thing in my hands.

With Gertie C., the hallucinations (precipitated by the addition of amantadine to her L-dopa) were less benign. Within three hours of receiving the first dose, she became intensely excited and deliriously hallucinated. She would cry out, “Cars bearing down on me, they’re crowding me!” She also saw faces “like masks popping in and out.” Occasionally she would smile rapturously and exclaim, “Look what a beautiful tree, so beautiful,” and tears of pleasure would fill her eyes.