In 2008, Tom C., an artist, came to my office for a consultation. He had been diagnosed with Parkinson’s disease and put on medication about fifteen years earlier. Two years later, he started to experience “misperceptions,” as he calls them (like the others, he avoids the term “hallucinations”). He is fond of dancing — he finds that this can unfreeze him, releasing him, for a while, from his parkinsonism. His first misperceptions occurred when he was in a nightclub; the skin of the other dancers, even their faces, seemed to be covered with tattoos. At first he thought the tattoos were real, but they started to glow and then to pulse and writhe; at that point he realized they must be hallucinatory. As an artist and a psychologist, he was intrigued by this experience — but frightened, too, that it might be the beginning of uncontrollable hallucinations of all sorts.
Once, while sitting at his desk, he was surprised to see a picture of the Taj Mahal on his computer monitor. As he gazed, the picture became richer in color, three-dimensional, vividly real. He heard a vague chanting, of the sort he thought might be associated with an Indian temple.
Another day, while he was lying on the floor, frozen by his parkinsonism, the reflections on a fluorescent ceiling lamp started to change into old photographs, mostly in black and white. These seemed to be photographs from earlier days, mostly of family, with some of strangers. “I had nothing else to do” in this immobilized state, he said, so he happily indulged this mild hallucinatory pleasure.
For Ed W. and Tom C., hallucinations usually remain on the “misperception” side, but Agnes R., a seventy-five-year-old lady who has had Parkinson’s disease for twenty years, has had frank visual hallucinations for the last decade. She is, as she says, “an old hand” at hallucinations: “I see a whole array of things, which I enjoy — they are fascinating; they don’t frighten me.” In the clinic waiting room, she had seen “women — five of them — trying on fur coats.” The size, color, solidity, and movement of these women looked perfectly natural; they seemed absolutely real. She knew that they were hallucinations only because they were out of context: no one would be trying on fur coats on a summer day in a doctor’s office. In general, she is able to distinguish her hallucinations from reality, but there have been exceptions: on one occasion, seeing a furry black animal leap onto the dining table, she jumped. At other times, while walking, she has stopped abruptly to avoid bumping into a hallucinatory figure just in front of her.
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.
