Hallucinations полностью

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.

Gertie C. had had a half-controlled hallucinosis for decades before she started on L-dopa — bucolic hallucinations of lying in a sunlit meadow or floating in a creek near her childhood home. This changed when she was given L-dopa, and her hallucinations assumed a social and sometimes sexual character. When she told me about this, she added, anxiously, “You surely wouldn’t forbid a friendly hallucination to a frustrated old lady like me!” I replied that if her hallucinations had a pleasant and controllable character, they seemed rather a good idea under the circumstances. After this, the paranoid quality dropped away, and her hallucinatory encounters became purely amicable and amorous. She developed a humor and tact and control, never allowing herself a hallucination before eight in the evening and keeping its duration to thirty or forty minutes at most. If her relatives stayed too late, she would explain firmly but pleasantly that she was expecting “a gentleman visitor from out of town” in a few minutes’ time, and she felt he might take it amiss if he was kept waiting outside. She now receives love, attention, and invisible presents from a hallucinatory gentleman who visits faithfully each evening.