I was about eleven, in bed with a high fever, when I heard some heavenly music. I understood it to be a choir of angels, even though I found this odd, as I don’t believe in heaven or angels and never have. So I decided it must be coming from Christmas carolers on our front doorstep below. After a minute or so, I realized it was springtime, and that I must be hallucinating.
A number of people have written to me that they have
As a child, I ran high fevers when sick. With each spell, I would hallucinate. This was an optical hallucination involving musical notes and stanzas. I did not hear music. When the fever was high, I would see notes and clef lines, scrambled and out of order. The notes were angry and I felt unease. The lines and notes were out of control and at times in a ball. For hours, I would try to mentally smooth them out and put them in harmony or order. This same hallucination has plagued me as an adult when feverish.
Tactile hallucinations, too, can come with fever or delirium, as Johnny M. described: “When I had high fevers as a child I had very weird tactile hallucinations … a nurse’s fingers would switch from being beautiful smooth porcelain to rough, brittle-feeling twigs or my bed sheets would go from luscious satin to drenched, heavy blankets.”
Fevers are perhaps the commonest cause of delirium, but there may be a less obvious metabolic or toxic cause, as recently happened with a physician friend of mine, Isabelle R. She had had two months of increasing weakness and occasional confusion; finally she became unresponsive and was taken to the hospital, where she had a florid delirium, with hallucinations and delusions. She was convinced that a secret laboratory was hidden behind a picture on the wall of her hospital room — and that I was supervising a series of experiments on her. She was found to have extremely high levels of calcium and vitamin D (she had been taking large doses of these for her osteoporosis), and as soon as these toxic levels dropped, her delirium ceased, and she returned to normal.
Delirium is classically associated with alcohol toxicity or withdrawal. Emil Kraepelin, in his great 1904
particular real perceptions … are mingled with numerous very vivid false perceptions, especially of sight and hearing. As in a dream, a whole series of the most strange and remarkable events take place with occasional sudden changes of scene.… Given the vivid hallucinations of sight, the restlessness, the strong tremors, and the smell of alcohol, we have all the essential features of the clinical condition called
The innkeeper had some delusions, too, perhaps produced by his hallucinations:
We learn, by questioning him, that he is going to be executed by electricity, and also that he will be shot. “The picture is not clearly painted,” he says; “every moment someone stands now here, now there, waiting for me with a revolver. When I open my eyes they vanish.” He says that a stinking fluid has been injected into his head and both his toes, which causes the pictures [he] takes for reality.… He looks eagerly at the window, where he sees houses and trees vanishing and reappearing. With slight pressure on his eyes, he sees first sparks, then a hare, a picture, a washstand-set, a half-moon, and a human head, first dully and then in colours.
While deliria such as the innkeeper’s may be incoherent, without any theme or connecting thread, other deliria convey the sense of a journey, or a play, or a movie, giving coherence and meaning to the hallucinations. Anne M. had such an experience after she had run a high temperature for several days. She first saw patterns whenever she closed her eyes to go to sleep; she described them as resembling Escher drawings in their sophistication and symmetry:
The initial drawings were geometric but then evolved into monsters and other rather unpleasant creatures.… The drawings were not in color. I was not enjoying this at all because I wanted to sleep. Once a drawing was complete it was copied so all four or six or eight quadrants of my visual field would be full of these identical pictures.
These drawings were succeeded by richly colored images that reminded her of Brueghel paintings. Increasingly, these too became full of monsters and subdivided themselves, polyopically, into a cluster of identical mini-Brueghels.
