“Hallucinations,” by Oliver Sacks (Alfred A. Knopf, 326 pages, $26.95)
This was the question asked by a woman who started to have hallucinations of the “Sesame Street” frog many times a day, several weeks after brain surgery. Kermit meant nothing to her, she said, and his shifting moods — sometimes he looked sad, sometimes happy, occasionally angry — had nothing to do with her own feelings. In the beginning, he occupied most of the left half of her visual field, but he gradually began getting smaller.
Her doctor, Oliver Sacks, told her he thought the images’ diminution was a good sign: “Perhaps one day Kermit would be too small to see at all.” Such curious apparitions are the subject of Sacks’ absorbing new book, “Hallucinations.” In these pages Sacks, a professor of neurology at the New York University School of Medicine, provides what he calls a kind of “natural history or anthology of hallucinations” drawn from his patients’ experiences, his own observations and from literature on the subject. He describes visual hallucinations, auditory hallucinations, olfactory hallucinations and hallucinations produced by illness, fevers, sleep deprivation, drugs, grief, trauma and exhaustion.
There are Rothkoesque hallucinations with bright, glowing clouds of color; Magritte-like hallucinations featuring surreal conflations of people’s heads and objects; and Picasso-esque hallucinations in which faces are grossly distorted or composed of fragments — “a nose, part of a mouth, an eye, a huge head of hair, all juxtaposed in a seemingly haphazard way.”
There are hallucinations in which images duplicate or multiply, much like a Warhol print sequence, and hallucinations in which people are haunted — as in a Poe or a Henry James story — by their doppelgangers.
Sacks conjures these apparitions in language that has an easy, tactile magic. As he’s done in so many of his earlier books, like “The Man Who Mistook His Wife for a Hat” and “An Anthropologist on Mars,” he uses his medical knowledge to illuminate the complexities of the human brain and the mysteries of the human mind.
At the same time, his compassion for his patients and his own philosophical outlook turn what might have been clinical case studies into humanely written short stories, animated as much by an intuitive appreciation of the human condition as by scientific understanding.
Some of the hallucinations chronicled in these pages are the author’s own. As a young doctor in California in the 1960s, Sacks experimented with psychedelics, and he recalls on one occasion combining amphetamines and LSD with “a touch of cannabis (for a little added delirium).” About 20 minutes after taking this elixir, he faced a white wall and exclaimed: “I want to see indigo now — now!”
Then, he remembers, “as if thrown by a giant paintbrush, there appeared a huge, trembling, pear-shaped blob of the purest indigo. Luminous, numinous, it filled me with rapture: It was the color of heaven, the color, I thought, which Giotto had spent a lifetime trying to get but never achieved.” On another occasion, Sacks says, he injected himself with morphine and spent more than 12 hours staring at the sleeve of his dressing gown, which was hanging on a door. The fabric became alive with a “miniature but microscopically detailed battle scene,” complete with silken tents of different colors, “gaily caparisoned horses, soldiers on horseback, their armor glinting in the sun, and men with longbows.”
He had just been reading Shakespeare’s “Henry V,” and he says he realized that he was looking at the Battle of Agincourt, with hundreds, thousands of soldiers — the armies of England and France — preparing to go to war. While he does not delve into the science of how the brain that can produce such amazing images, Sacks deftly conveys what it feels like to have such hallucinations — and the place these visions can assume in a person’s emotional and spiritual life.
One woman has epileptic seizures that transport her back to Chicago, where she had lived as a teenager, conjuring familiar landmarks, while strangely transforming the topography into a dreamscape.
A migraine patient has the same oddly specific vision in every attack: “a hallucination of a worker emerging from a manhole in the street, wearing a white hard hat with an American flag painted on it.”
One of Sacks’ patients, Rosalie, a blind woman in her 90s, who has Charles Bonnet syndrome (which can afflict the visually impaired), sees children in brightly colored Eastern clothes walking up and down stairs, women dolled up in hats and gold-trimmed furs and, later, little people, a few inches high, “like elves or fairies, with little green caps, climbing up the sides of her wheelchair.”
Bonnet syndrome images, Sacks writes, tend to be “more stereotyped than those of dreams and at the same time less intelligible, less meaningful” — they rarely yield “insights into the unconscious wishes, needs or conflicts of the person” but are instead the brain reacting to the loss of eyesight. The brain, he adds, “needs not only perceptual input but perceptual change,” and when a person with sight is subjected to darkness and solitude (say in prison) the “deprivation of normal visual input can stimulate the inner eye” to produce dreams or hallucinations.
Monotony of landscape can have a similar effect — as in the case of sailors spending days gazing at a becalmed sea; polar explorers caught in a vast white icescape; or pilots flying for hours in an empty sky.
Although modern Western cultures have tended to regard hallucinations as a sign of “madness or something dire happening to the brain,” Sacks observes, other cultures regard them, like dreams, “as a special, privileged state of consciousness — one that is actively sought through spiritual practices, meditation, drugs or solitude.”
“Do the geometric patterns seen in migraine and other conditions prefigure the motifs of Aboriginal art?” he asks. “Did Lilliputian hallucinations (which are not uncommon) give rise to the elves, imps, leprechauns and fairies in our folklore? Do the terrifying hallucinations of the nightmare, being ridden and suffocated by a malign presence, play a part in generating our concepts of demons and witches or malignant aliens? Do ‘ecstatic’ seizures, such as Dostoevsky had, play a part in generating our sense of the divine?”
Many psychical or paranormal experiences, Sacks suggests, may in fact be hallucinations stemming from bereavement, isolation, sensory deprivation or “drowsy or trancelike states.” Whatever their cause, he says, hallucinatory experiences “generate a world of imaginary beings and abodes — heaven, hell, fairyland.”
In response to physiologically based visions, we create narratives to explain what we’ve seen, and when old-fashioned figures like devils and witches “are no longer believed in, new ones — aliens, visitations from `a previous life’ — take their place.”