Visual hallucinations

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A hallucination, in the broadest sense, is a visual perception in the absence of a visual stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. These definitions distinguish hallucinations from the related phenomena of dreaming, which does not involve consciousness; illusion, which involves distorted or misinterpreted real perception; imagery, which does not mimic real perception and is under voluntary control; and pseudohallucination, which does not mimic real perception, but is not under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted genuine perception is given some additional (and typically bizarre) significance.

Hallucinations may occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, and thermoceptive.

A mild form of hallucination is known as a disturbance, and can occur in any of the senses above. These may be things like seeing movement in peripheral vision, or hearing faint noises and voices.

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up. Hallucinations may also be associated with drug or alcohol use (particularly deliriants), sleep deprivation, psychosis, neurological disorders, and delirium tremens.

Prevalence

Studies have shown that hallucinatory experiences take place worldwide. One study from as early as 1894 reported that approximately 10% of the population experienced hallucinations. A 1996-1999 survey of over 13,000 people reported a much higher figure, with almost 39% of people reporting hallucinatory experiences, 27% of which were daytime hallucinations, mostly outside the context of illness or drug use. From this survey, olfactory (smell) and gustatory (taste) hallucinations seem the most common in the general population.

Types of hallucinations

Hallucinations may be manifested in a variety of forms. Various forms of hallucinations affect the different senses, sometimes occurring simultaneously, creating multiple sensory hallucinations for the patient.

Auditory hallucinations

Auditory hallucinations (also known as Paracusia), particularly of one or more talking voices, are particularly associated with psychotic disorders such as schizophrenia, and hold special significance in diagnosing these conditions, although many people not suffering from diagnosable mental illness may sometimes hear voices as well. The Hearing Voices Movement is a support and advocacy group for people who hallucinate voices, but do not otherwise show signs of mental illness or impairment. Other types of auditory hallucinations include musical hallucinations, where people will hear music playing in their mind, usually songs they are familiar with. This can be caused by: lesions on the brain stem (often resulting from strokes); also, tumors, encephalitis, or abscesses. Other reasons include hearing loss and epileptic activity. Recent reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time. Auditory hallucinations are also a result of attempting a Wake-initiation of lucid dreams (WILD) which is a way people try to put themselves into a Lucid Dream

Olfactory hallucinations

Phantosmia is the phenomenon of smelling odors that aren't really present. The most common odors are unpleasant smells such as rotting flesh, vomit, urine, feces, smoke, etc. Phantosmia often results from damage to the nervous tissue in the olfactory system. The damage can be caused by viral infection, brain tumor, trauma, surgery, and possibly exposure to toxins or drugs. Phantosmia can also be induced by epilepsy affecting the olfactory cortex and is also thought to possibly have psychiatric origins.^{[How to reference and link to summary or text]} Phantosmia is different from parosmia, in which a smell is actually present, but perceived differently from its usual smell.

Hypnagogic hallucination

Main article: Hypnagogia

These hallucinations occur just before falling asleep, and affect a surprisingly high proportion of the population. The hallucinations can last from seconds to minutes, all the while the subject usually remains aware of the true nature of the images. These are usually associated with narcolepsy, but can also affect normal minds. Hypnagogic hallucinations are sometimes associated with brainstem abnormalities, but this is rare.

Peduncular hallucinosis

Peduncular means pertaining to the peduncle, which is a neural tract running to and from the pons on the brain stem. These hallucinations usually occur in the evenings, but not during drowsiness, as in the case of hypnagogic hallucination. The subject is usually fully conscious and can interact with the hallucinatory characters for extended periods of time. As in the case of hypnagogic hallucinations, insight into the nature of the images remains intact. The false images can occur in any part of the visual field, and are rarely polymodal.

Main article: Peduncular hallucinosis

Delirium tremens

Main article: Delirium tremens

One of the more enigmatic forms of visual hallucination is the highly variable, possibly polymodal delirium tremens. Individuals suffering from delirium tremens may be agitated and confused, especially in the later stages of this disease. Insight is gradually reduced with the progression of this disorder. Sleep is disturbed and occurs for a shorter period of time, with REM overflow.

Parkinson's disease and Lewy body dementia

Parkinson's disease is linked with Lewy body dementia for their similar hallucinatory symptoms. The symptoms strike during the evening in any part of the visual field, and are rarely polymodal. The segue into hallucination may begin with illusions where sensory perception is greatly distorted, but no novel sensory information is present. These typically last for several minutes, during which time the subject may be either conscious and normal or drowsy/inaccessible. Insight into these hallucinations is usually preserved and REM sleep is usually reduced. Parkinson's disease is usually associated with a degraded substantia nigra pars compacta, but recent evidence suggests that PD affects a number of sites in the brain. Some places of noted degradation include the median raphe nuclei, the noradrenergic parts of the locus coeruleus, and the cholinergic neurons in the parabrachial and pedunculopontine nuclei of the tegmentum.

Migraine coma

This type of hallucination is usually experienced during the recovery from a comatose state. The migraine coma can last for up to two days, and a state of depression is sometimes comorbid. The hallucinations occur during states of full consciousness, and insight into the hallucinatory nature of the images is preserved. It has been noted that ataxic lesions accompany the migraine coma.

Charles Bonnet syndrome

Charles Bonnet syndrome is the name given to visual hallucinations experienced by blind patients. The hallucinations can usually be dispersed by opening or closing the eyelids until the visual images disappear. The hallucinations usually occur during the morning or evening, but are not dependent on low light conditions. These prolonged hallucinations usually do not disturb the patients very much, as they are aware that they are hallucinating. A differential diagnosis are opthalmopathic hallucinations .

Focal epilepsy

Visual hallucinations due to focal seizures differ depending on the region of the brain where the seizure occurs. For example, visual hallucinations during occipital lobe seizures are typically visions of brightly colored, geometric shapes that may move across the visual field, multiply, or form concentric rings and generally persist from a few seconds to a few minutes. They are usually unilateral and localized to one part of the visual field on the ipsilateral side of the seizure focus, typically the temporal field. However, unilateral visions moving horizontally across the visual field begin on the contralateral side and move towards the ipsilateral side.

Temporal lobe seizures, on the other hand, can produce complex visual hallucinations of people, scenes, animals, and more as well as distortions of visual perception. Complex hallucinations may appear real or unreal, may or may not be distorted with respect to size, and may seem disturbing or affable, among other variables. One rare but notable type of hallucination is heautoscopy, a hallucination of a mirror image of one's self. These "other selves" may be perfectly still or performing complex tasks, may be an image of a younger self or the present self, and tend to be only briefly present. Complex hallucinations are a relatively uncommon finding in temporal lobe epilepsy patients. Rarely, they may occur during occipital focal seizures or in parietal lobe seizures.

thumb|400px|right|Some examples of the dolly zoom effect simulating a type of visual illusion that a focal seizure may produce. Distortions in visual perception during a temporal lobe seizure may include size distortion (micropsia or macropsia), distorted perception of movement (where moving objects may appear to be moving very slowly or to be perfectly still), a sense that surfaces such as ceilings and even entire horizons are moving farther away in a fashion similar to the dolly zoom effect, and other illusions. Even when consciousness is impaired, insight into the hallucination or illusion is typically preserved.

Tactile hallucinations

Other types of hallucinations create the sensation of tactile sensory input, simulating various types of pressure to the skin or other organs. This type of hallucination is often associated with substance use, such as someone who feels bugs crawling on them (known as formication) after a prolonged period of cocaine use.

Scientific explanations

Various theories have been put forward to explain the occurrence of hallucinations. When psychodynamic (Freudian) theories were popular in psychiatry, hallucinations were seen as a projection of unconscious wishes, thoughts and wants. As biological theories have become orthodox, hallucinations are more often thought of (by psychologists at least) as being caused by functional deficits in the brain. With reference to mental illness, the function (or dysfunction) of the neurotransmitter dopamine is thought to be particularly important. The Freudian interpretation may have an aspect of truth, as the biological hypothesis explains the physical interactions in the brain, while the Freudian deals with the origin of the flavor of the hallucination. Psychological research has argued that hallucinations may result from biases in what are known as metacognitive abilities. These are abilities that allow us to monitor or draw inferences from our own internal psychological states (such as intentions, memories, beliefs and thoughts). The ability to discriminate between internal (self-generated) and external (stimuli) sources of information is considered to be an important metacognitive skill, but one which may break down to cause hallucinatory experiences. Projection of an internal state (or a person's own reaction to another's) may arise in the form of hallucinations, especially auditory hallucinations. A recent hypothesis that is gaining acceptance concerns the role of overactive top-down processing, or strong perceptual expectations, that can generate spontaneous perceptual output (that is, hallucination).

Stages of a hallucination

1. Emergence of surprising or warded-off memory or fantasy images
2. Frequent reality checks
3. Last vestige of insight as hallucinations become "real"
4. Fantasy and distortion elaborated upon and confused with actual perception
5. Internal-external boundaries destroyed and possible pantheistic experience

In the media

Occasionally, television programs and films let the viewer see representations of hallucinations experienced by one or more of the characters.

• An episode of the medical drama Casualty showed a patient's delirium tremens hallucination, acted out by a tarantula.
• On the ABC show Lost, John Locke sends his protégé Boone on a vision quest via a compound induced hallucination.
• In the film Pirates of the Caribbean: At World's End, Jack Sparrow has hallucinations, seeing a crew made up entirely out of copies of himself.
• In the TV show Melrose Place, Dr Kimberly Shaw saw visions of a non-existent personality constantly. This hallucination was caused by a tumor pressing against her brain.
• In the legal drama Ally McBeal, the main character frequently has a hallucination of a dancing baby, because as she gets older, her biological clock ticks faster.
• In the TV show Scrubs, hallucinations of ludicrous hypothetical situations are commonplace as gags, such as JD's head blowing up.
• In the book and film A Scanner Darkly, the characters experience a large number of drug-induced hallucinations.
• In the film Dead Man's Shoes, the main character spends all his time with a man who is discovered to be a hallucination of his dead brother.
• In the book and film Fight Club, the entire plot is based on a hallucination of the main character, due to depression, sleep deprivation, and possibly insanity.
• Numerous examples of hallucination have appeared in the TV series House.
• In the Spider-Man film series, Harry Osborn hallucinates conversations with his dead father (the Green Goblin from the first film), mostly in a mirror, and is perverted to evil.
• In the film A Beautiful Mind, mathematician John Nash has hallucinations due to schizophrenia.
• In the Avatar: The Last Airbender episode, "The Fire Lord", Zuko hallucinates after becoming ill; and in the finale, Azula hallucinates and sees her mother in a mirror.
• In the film Hallucination, directed by Morteza Halimi, a very common type of hallucination is portrayed.
• In the film Jacob's Ladder, the character of Jacob Singer (played by Tim Robbins) undergoes a series of disturbing hallucinations, supposedly due to his exposure to mind-altering chemicals in the Vietnam War.
• A Russian rock band is named Smyslovye Gallyutsinatsii, which is translated as "hallucinations of meaning" or "semantic hallucinations".
• The Exorcism of Emily Rose (Where a girl dies under a demonic hallucination and there's made a case about how she died.)

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See also

• Apparitional experience
• Closed-eye hallucination
• Delusion
• Dimethyltryptamine
• Dream
• Focal seizures
• Folie à deux
• Form constant
• Hallucinations in the sane
• Illusion
• Imaginary friend
• Lucid dream
• Phantom eye syndrome
• Psychedelics, dissociatives and deliriants
• Psychosis
• Simulated reality
• Vision

Additional material

Papers

• Google Scholar

Further reading

• Johnson FH (1978). The anatomy of hallucinations, Chicago: Nelson-Hall Co.
• Bentall RP, Slade PD (1988). Sensory deception: a scientific analysis of hallucination, London: Croom Helm.
• Larøi F, Aleman A (2008). Hallucinations: The Science of Idiosyncratic Perception, American Psychological Association (APA).

External links

• INTERVOICE Online, website of the international hearing voices movement
• Hearing Voices Network
• "Anthropology and Hallucinations", chapter from The Making of Religion
• "The voice inside: A practical guide to coping with hearing voices"