In Context
Book
Tricks of the mind
In his book Hallucinations, Oliver
Sacks, the renowned neurologist
and professor of neurology at
the New York University School
of Medicine, eloquently and
vividly describes a diverse range of
hallucinations associated with an
array of neurological disorders, from
parkinsonism to Charles Bonnet
syndrome. Sacks writes clearly,
compassionately, and concisely,
presents clinical material derived
from almost a lifetime of working
with patients who hallucinate, and
accurately describes the neural
pathways that underlie hallucinatory
experiences. Through his writing,
he de-stigmatises hallucinatory
experiences. This work is influenced
by his own experiences of migraine
and drug experimentation with
cannabis, mescaline, and LSD in the
1960s, which he discusses openly.
In this book, Sacks presents several
ideas. First, hallucinations, which
are typically seen by the lay public
(and often by medical professionals)
as signs of mental illness, often
occur in the non-clinically ill
general population—a fact that is
increasingly recognised in current
research into so-called normal
hallucinations. These hallucinations
are often unremarkable compared
with the persecutory, accusatory,
or threatening hallucinations that
typically occur in patients with
schizophrenia. Hallucinations in
non-mentally ill patients have
been recognised for the past
120 years, since the Society for
Psychical Research began to
collect examples of them in the
1880s. Second, many people are
not especially disturbed by their
hallucinations, which contests the
cultural view that they are always
terrifying. Third, unlike memory
or imagination, hallucinations are
generally externalised, and can
www.thelancet.com/neurology Vol 12 March 2013
sometimes possess a compelling
quality that causes the person
experiencing them to feel that
they are controlled by them.
Sometimes, for example in
epilepsy, the hallucinations have
an almost religious or spiritual
quality. Temporal lobe epilepsy, for
instance, is sometimes associated
with ecstatic, religious, and
paranormal experiences. Finally, as
neuroscientists are now beginning to
discover, hallucinations derive from
the same neural substrate as normal
perception.
Another idea that Sacks alludes to
is the fact that hallucinations might
have positive psychological effects,
such as the enhancement of creative
inspiration. For example, the French
neurologist Theophile Alajouanine
suggests that Dostoevsky’s epilepsy
resulted in a mystical awakening,
which affected such writings as The
Brothers Karamazov and The Double.
Other people have suggested that
as a result of his frequent fits he
developed Geschwind syndrome—
an interictal personality syndrome
that is often associated with hyper-
religiosity.
Hallucinations can provide
information that is beneficial to the
recipient and might even alleviate
anxiety. Sacks himself describes how,
when he was descending a mountain
with a badly injured leg, an inner
voice told him to go on, rather than
rest. He notes how this voice braced
and resolved him. Another common
experience is hallucinations of a loved
one after bereavement, which might
consist of visions or voices; these
are typically described as pleasant
and comforting. Future research
needs to focus on the ways in which
hallucinatory experiences can be
psychologically beneficial.
My own research has concen-
trated on religious hallucinations,
specifically the experience of
Pentecostal Christians in London,
UK, who thought that they were
hearing God’s voice. In this sample
group, the experience of hearing
God was prevalent, although for
those people who heard what they
perceived to be the voice of God,
it was an infrequent occurrence,
sometimes happening only once in
a lifetime. The voice of God could
be differentiated clearly from their
Hallucinations
own thoughts. By contrast with the Oliver Sacks. Knopf, 2012.
malevolent hallucinations reported Pp 322. £18·99.
in schizophrenia, the voice was ISBN 978-1447208259
calming, supportive, and reassuring.
Most importantly, recipients re-
ported that they heard God’s voice
during major life crises—the voice
would offer pragmatic advice rather
than metaphysical truths. In one case,
a 30-year-old man was distressed by
his doubts about fathering a child.
A voice told him he would have a
child called Isaac. After hearing the
voice, the man reported a significant
improvement in his anxiety. In terms
of similar research, Sacks quotes
anthropologist Tanya Luhrmann,
who describes how spiritual
practices in Evangelical Christians—
particularly prayer—can facilitate the
experience of absorption and result
in them believing that they can hear
and see God.
Although, as is his style of writing,
he does not produce any novel
theoretical insights or draw any
conclusions to bring the material
together, Sacks does provide rich
clinical visions about the experience
of hallucinations and I would strongly
recommend this book for mental
health professionals, neurologists,
the lay reader and, most importantly,
for those people experiencing
hallucinations.
Simon Dein
s.dein@ucl.ac.uk
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