Hallucinations

Prior to Hallucinations, my first reading of Oliver's* work, I've been a fan through his appearances on Radiolab and recommendations by friends. What I found most enjoyable in his writing is the characteristic way he elucidates neurological phenomena through a humanitarian lens. I have a rudimentary education in science and lean towards the humanities in interest, so being able to read the first-hand accounts of patients made an otherwise dense topic approachable and relatable. It also allows for the reader to empathize with these patients in their search for understanding and consolation, which seems most important when dealing with neurological disorders that are so readily stigmatized as psychosis. Our contemporary scientific and medical practices have a tendency to isolate the person from the ailment in the search for understanding. Oliver trekked against the tide by placing the patient back into focus.

Here are the four concepts I've found most insightful after reading Hallucinations...

1. Perception is a two-way street, involving not only reception but also generation:

“We are not given an already made, preassembled visual world; we have to construct our own visual world as best can. This construction entails analysis and synthesis at many functionals levels in the brain, starting with perception of lines and angles and orientation in the occipital cortex. At higher levels, in the inferotemporal cortex, the “elements” of visual perception are of a more complex sort, appropriate for the analysis and recognition of natural scenes, objects, animal and plant forms, letters, and faces. Complex visual hallucinations entail the putting together of such elements, an act of assemblage, and these assemblages are continually permuted, disassembled, and reassembled.”

2. The stigmatization of hallucinations, especially hearing voices, is a recent societal development:

“Psychiatry, and society in general, had been subverted by the almost axiomatic belief that ‘hearing voices' spelled madness and never occurred except in the context of severe mental disturbance. This belief is a fairly recent one, as the careful and humane reservations of early researchers on schizophrenia made clear. But by the 1970s, antipsychotic drugs and tranquilizers had begun to replace other treatments, and careful history taking, looking at the whole life of the patient, had largely been replaced by the use of DSM criteria to make snap diagnoses.”

3. Hallucinations are an incredibly common neurological phenomenon, occurring as a result of sensory deprivation (sometimes within one hour), the loss of limbs, migraines, Parkinson's disease, post-traumatic stress, intoxication, hypnagogic and hypnopompic “sleep” states, exhaustion, sleep deprivation, epilepsy, brain damage i.e. strokes, dementia, delirium, and schizophrenia—to name a few.

4. The meaning-making that we place on hallucinations is an entirely subjective exercise largely influenced by the superstitions of the current social climate, i.e. witch trials:

“In Charles Bonnet syndrome, there seems to be a mechanism in the brain that generates or facilitates hallucination—a primary physiological mechanism, related to local irritation, “release,” neurotransmitter disturbance, or whatever—with little reference to the individual's life circumstances, character, emotions, beliefs, or state of mind. While people with such hallucinations may (or may not) enjoy them as a sensory experience, they almost uniformly emphasize their meaninglessness, their irrelevance to events and issues of their lives.”

“But one can readily see why others, perhaps of a different disposition, might interpret the “sure knowledge of the close presence of a sort of mighty person' and ‘a startling awareness of some ineffable good' in mystical, if not religious, terms. Other case histories in [William] James's chapter bear this out, leading him to say that “many persons (how many we cannot tell) possess the objects of their belief not in the form of mere conceptions which the intellect accepts as true, but rather in the form of quasi-sensible realities directly apprehended.

Thus the primal, animal sense of ‘the other,' which may have evolved for the detection of threat, can take on a lofty, even transcendent function in human beings, as a biological basis for religion passion and conviction, where the “other,” the “presence,” becomes the person of God.”

* * I think I would've enjoyed the book a bit more if it started with the chapter titled “Altered States.” In this chapter we learn about Oliver's own experiences of hallucinations, often under altered states of consciousness while on his “drug holidays.” It concluded with a revelatory story about how Oliver learned of his life's purpose while on a 10-hour amphetamine bender. This story vividly displayed the depth of his curiosity and intensity with which he approached life. It aptly frames the rest of the book as the thesis for his writing, but we only learn of it six chapters in.While there's a clear sense of Oliver's compassion for his patients, I feel like he relied too much on his patients in telling their own stories. The tone of the writing felt a bit hands-off in providing grander insights into the mystery of hallucinations, which I found surprising since it was written at the end of his career. I wanted more connective tissue between stories. While this came in full force during Oliver's own accounts of hallucination in Chapter 6, afterwards my interest began to waiver. It felt like I was being handed a stack of case studies to sift through, although each of the patient stories has its own poetic brilliance:“I am maneuvered into a delightfully soft chair. I sink, submerged as usual in shades of night...the sea of clouds at my feet clears, revealing a field of grain, and standing about it a small flock of fowl, not two alike, in somber plumage: a miniature peacock, very slender, with its little crest and unfurled tail feathers, some plumper specimens, and a shore bird on long stems, etc. Now it appears that several are wearing shoes, and among them a bird with four feet. One expects more color among a flock of birds, even in the hallucinations of the blind...The birds have turned into little men and women in medieval attire, all strolling away from me. I see only their backs, short tunics, tights or leggings, shawls or kerchiefs...Opening my eyes on the smoke screen of my room I am treated to stabs of sapphire, bags of rubies scattering across the night, a legless vaquero in a checked shirt stuck on the back of a small steer, bucking, the orange velvet head of a bear decapitated, poor thing, by the guard of the Yellowstone Hotel garbage pit. The familiar milkman invaded the scene in his azure cart with the golden horse; he joined us a few days ago out of some forgotten book of nursery rhymes or the back of a Depression cereal box...But the magic lantern show of colored oddities has faded and I am back in black-wall country without form or substance...where I landed as the lights went out.”—Virginia Hamilton Adair, poet (who suffered from Charles Bonnet Syndrome after losing her eyesight to glaucoma)I highly recommend this book to anyone interested in altered states of consciousness and the peculiar powers of perception. I plan to follow up this book with Oliver's memoir, On the Move, to hear more about this endearing man who turned over rocks looking for pure indigo, “the color of heaven,” “the color of the Paleozoic sea!”Oliver's writing style feels like he's writing more to a friend than an unknown reader, and “Oliver” has a much more pleasing sound than SACKS!