Hallucinations полностью

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.)

1. In addition to the overt delirium that may be associated with life-threatening medical problems, it is not uncommon for people to have slight delirium, so mild that it would not occur to them to consult a physician, and which they themselves may disregard or forget. Gowers, in 1907, wrote that migraine is “often attended by quiet delirium of which nothing can be subsequently recalled.”

There has always been inconsistency in defining delirium, and as Dimitrios Adamis and his colleagues pointed out in their review of the subject, it has frequently been confused with dementia and other conditions. Hippocrates, they wrote, “used about sixteen words to refer to and name the clinical syndrome which we now call delirium.” There was additional confusion with the medicalization of insanity in the nineteenth century, as German Berrios has noted, so that insanity was referred to as délire chronique. Even now the terminology is ambiguous, so that delirium is sometimes called “toxic psychosis.”

2. Just such an appearance of delirious images when closing the eyes, and their disappearance when the eyes are opened, is described by John Maynard Keynes in his memoir “Dr. Melchior”:

By the time we were back in Paris, I was feeling extremely unwell and took to my bed two days later. High fever followed.… I lay in my suite in the Majestic, nearly delirious, and the image of the raised pattern on the nouveau art wall-paper so preyed on my sensibilities in the dark that it was a relief to switch on the light and, by perceiving the reality, to be relieved for a moment from the yet more hideous pressure of its imagined outlines.

3. In a prefatory note to a later edition, Waugh wrote: “Three years ago Mr. Waugh suffered a brief bout of hallucinations resembling what is here described.… Mr. Waugh does not deny that ‘Mr. Pinfold’ is largely based on himself.” Thus we may accept The Ordeal as an autobiographic “case history” of a psychosis, an organic psychosis, albeit one written with a mastery of observation and description — and a sense of plot and suspense — that no purely medical case history has.

W. H. Auden once said that Waugh had “learned nothing” from his ordeal, but it at least enabled him to write a richly comic memoir, a new departure quite unlike anything he had written previously.