Lucid Experiences of Altered Reality

[geomancer]

Science 26 July 2013:
Vol. 341 no. 6144 p. 346
DOI: 10.1126/science.1240782

Lucid Experiences of Altered Reality

Lauren DiPerna

Hallucinations. Oliver Sacks. Knopf, New York, 2012. 343 pp. $26.95. ISBN 9780307957245. Picador, London. £18.99. ISBN 9781447208259.

The reviewer, a 2010 AAAS Mass Media Fellow, is a freelance science writer based in San Francisco.
E-mail: [email protected]

In the early 1970s, eight people were admitted to different psychiatric hospitals across the United States for hearing voices. None were insane; researchers had instructed them to complain about hearing voices to hospital staff. Other than fabricating their names and occupations, they were told to tell the truth and behave normally. The purpose of the experiment was twofold: could hospitals distinguish between sane and insane people, and was there a bias toward assuming people with auditory hallucinations were mentally ill? The study revealed not only that the psychiatrists were unable to make the distinction but also that they assumed hallucinations were concrete evidence of a mental illness, such as schizophrenia. This was a troubling conclusion because although people with schizophrenia generally have hallucinations, the reverse is not necessarily true: hallucinations are not indicative of insanity.

In his latest book, Hallucinations, neurologist and best-selling author Oliver Sacks details the incredible range of apparitions that completely sane people experience. Each chapter describes a medical condition—such as migraine, epilepsy, or hearing loss—that can cause a mix of visual, auditory, and tactile hallucinations. Sacks uses firsthand accounts to bring these conditions to life and to introduce the scientific research behind them. Many of these first-person accounts came from his readers, who hoped that their stories might help remove the stigma associated with hallucinations. These personal narratives become increasingly compelling as the hallucinations described progress from benign (hearing musical sounds or seeing a gathering of medieval characters) to painful or terrifying (feeling excruciating sensations in phantom limbs or sensing the presence of malevolent beings).

One of the most unsettling accounts came from a woman with narcolepsy. Her condition was not like Hollywood's comical version of the disorder. In addition to falling asleep at random moments, she experienced sleep paralysis and visual and auditory hallucinations. In a letter to Sacks, she described one of her episodes. As she was falling asleep, her body became completely paralyzed. She felt at first as though something were sitting on her back; then it lay down next to her. “I laid eyes on an abnormally tall man in a black suit. He was greenishly pale, sick-looking, with a shock-ridden look in the eyes. I tried to scream, but was unable to move my lips or make any sounds at all.” Slowly she came out of her sleep paralysis, and the apparition vanished. Though the experience felt real, the woman understood it was not—a capacity that separates her from the insane.

As the 1970s experiment demonstrated, there is no categorical list of symptoms that can be used to diagnose someone with a mental illness. However, a defining feature of sane people who hallucinate is that they lead ordinary lives—their hallucinations do not affect how they interact with other people. When Sacks establishes that the book will focus on hallucinations that can occur in transient, “‘organic’ psychoses,” he offers this explanation: “The hallucinations often experienced by people with schizophrenia … demand a separate consideration, a book of their own, for they cannot be divorced from the often profoundly altered inner life and life circumstances of those with schizophrenia.”

Today, sane people assume their hallucinations are not real because contemporary society has no place for ghosts, witches, or elves. But, as Sacks remarks, because hallucinations seem real, “one must wonder to what extent hallucinatory experiences have given rise to our art, folklore, and even religion.” This is just one of the many fascinating questions that Sacks introduces but leaves to the reader for further exploration.

Hallucinations will be accessible to a wide audience. Sacks includes explanations behind each disorder but never becomes overly clinical. He provides a popular survey of an otherwise esoteric topic. The book will appeal to readers who would never think to open a neuroscience or clinical psychology journal but would nevertheless be interested in the research results it reports. Although the book's structure has a textbook feel, the first-person accounts produce an intimate tone that draws in the reader. If you catch yourself talking to friends about each new medical revelation, there is a reason: Sacks's fascination with the brain is contagious.