Oliver Sacks: hallucinations reveal the human mind
神経科医であり作家でもあるオリバー・サックスがシャルル・ボネ症候群 ‐視覚障害者に生じる正常人が経験する幻覚症状の一種 ‐について語ります。自身の患者が体験した幻覚を心温まる細部に渡って描写しながら、あまり社会には知られていないこの現象の生態学へと案内します。「-そして私は、あなたが視力を失うと、脳の視覚部分がもはや何の入力も得られなくなるので、活動亢進して興奮し、自発的に発火し始めると言いました。」 (English) Neurologist and author Oliver Sacks talk about Charles Bonnet syndrome - a type of hallucination experienced by ordinary people that occurs in visually impaired people. Describing the hallucinations his patients experienced in heart-warming detail, he takes us on a journey into the ecology of this little-known phenomenon in society. - and I said that as you lose vision, as the visual parts of the brain are no longer getting any input, they become hyperactive and excitable and start to fire spontaneously.
Oliver Sacks: hallucinations reveal the human mind
A)
1)
We see with the eyes, but we see with the brain as well.
And seeing with the brain is often called imagination.
And we are familiar with the landscapes of our imagination, our inscapes.
We've lived with them all our lives.
But there are also hallucinations as well.
And hallucinations are entirely different.
They don't seem to be of our creation.
They don't seem to be under control.
They seem to come from the outside and mimic perception.
So I will be talking about hallucinations and a particular sort of visual hallucination I see among my patients.
2)
A few months ago, I got a phone call from a nursing home where I work.
They told me that one of their residents, an old lady in her 90s, was seeing things, and they wondered if she'd gone bonkers or, because she was an old lady, whether she'd had a stroke or Alzheimer's.
And so they asked me if I would come and see Rosalie, the old lady.
I went in to see her.
She was perfectly sane, lucid, and reasonably intelligent, but she'd been very startled and bewildered because she'd seen things.
3)
And she told me - the nurses hadn't mentioned this - that she was blind and had been completely blind from macular degeneration for five years.
But now, she'd been seeing things for the last few days.
So I said, "What sort of things?"
And she said, "People in Eastern dress, in drapes, walking up and down stairs.
A man turns towards me and smiles, but he has huge teeth.
Animals too.
I see a white building. It's snowing soft snow.
I see this horse with a harness dragging the snow away.
Then, one night, the scene changes.
I see cats and dogs walking toward me.
They come to a certain point and then stop.
Then it changes again.
I see a lot of children.
They're walking up and down stairs.
They wear bright colors, rose and blue, like Eastern dress."
Sometimes, she said, before the people come on, she may hallucinate pink and blue squares on the floor, which seem to go up to the ceiling.
4)
I said, "Is this like a dream?"
And she said, "No, it's not like a dream. It's like a movie."
She said, "It's got color. It's got motion.
But it's completely silent, like a silent movie."
And she said it's a rather boring movie.
She said, "All these people with Eastern dress, walking up and down, very repetitive, very limited."
And she had a sense of humor.
She knew it was a hallucination, but she was frightened.
She had lived 95 years, and she'd never had a hallucination before.
She said that the hallucinations were unrelated to anything she was thinking or feeling or doing, that they seemed to come on by themselves or disappear.
She had no control over them.
She said she didn't recognize any of the people or places in the hallucinations, and none of the people or the animals - well, they all seemed oblivious of her.
And she didn't know what was going on.
She wondered if she was going mad or losing her mind.
5)
Well, I examined her carefully.
She was a bright old lady, perfectly sane.
She had no medical problems.
She wasn't on any medications which could produce hallucinations.
But she was blind.
And I then said to her, "I think I know what you have."
I said, "There is a unique form of visual hallucination which may go with deteriorating vision or blindness.
This was originally described," I said.
"right back in the 18th century, by a man called Charles Bonnet.
And you have Charles Bonnet syndrome.
There's nothing wrong with your brain.
There's nothing wrong with your mind.
You have Charles Bonnet syndrome."
B)
6)
And she was very relieved at this, that there was nothing seriously the matter, and also rather curious.
She said, "Who is this Charles Bonnet?"
She said, "Did he have them himself?"
And she said, "Tell all the nurses that I have Charles Bonnet syndrome."
"I'm not crazy. I'm not demented. I have Charles Bonnet syndrome."
Well, so, I did tell the nurses.
Now, this, for me, is a common situation.
I work in nursing homes, largely.
I see a lot of older adults who are hearing-impaired or visually impaired.
About 10 percent of hearing-impaired people get musical hallucinations.
And about 10 percent of the visually impaired people get visual hallucinations.
You don't have to be completely blind, only sufficiently impaired.
7)
With the original description in the 18th century, Charles Bonnet did not have them.
His grandfather had these hallucinations.
His grandfather was a magistrate, an older man.
He'd had cataract surgery.
His vision was pretty poor.
And in 1759, he described to his grandson various things he saw.
The first thing he said was he saw a handkerchief in midair.
It was a large blue handkerchief with four orange circles.
And he knew it was a hallucination.
You don't have handkerchiefs in midair.
And then he saw a big wheel in midair.
But sometimes, he wasn't sure whether he was hallucinating or not because the hallucinations would fit in the context of the visions.
So on one occasion, when his granddaughters were visiting them, he said, "And who are these handsome young men with you?"
And they said, "Alas, Grandpapa, there are no handsome young men."
And then the handsome young men disappeared.
8)
It's typical of these hallucinations that they may come in a flash and disappear in a moment.
They don't usually fade in and out.
They are rather sudden, and they change suddenly.
Charles Lullin, the grandfather, saw hundreds of different figures and different landscapes of all sorts.
On one occasion, he saw a man in a bathrobe smoking a pipe and realized it was himself.
C)
9)
That was the only figure he recognized.
On one occasion, when he was walking in the streets of Paris, he saw - this was real - a scaffolding.
But when he got home, he saw a miniature of the scaffolding, six inches high, on his study table.
This repetition of perception is sometimes called "palinopsia."
With him and with Rosalie, what seems to be going on - and Rosalie said, "What's going on?" - and I said that as you lose vision, as the visual parts of the brain are no longer getting any input, they become hyperactive and excitable, and they start to fire spontaneously.
And you start to see things.
The things you see can be very complicated indeed.
Another patient of mine who also had some vision, her visions could be disturbing.
10)
On one occasion, she said she saw a man in a striped shirt in a restaurant.
And he turned round, then divided into six figures in striped shirts, who started walking towards her.
And then the six figures came together, like a concertina.
Once, when she was driving, or rather, her husband was driving, the road divided into four, and she felt herself going simultaneously up four roads.
She had very mobile hallucinations as well.
A lot of them had to do with a car.
Sometimes she would see a teenage boy sitting on the car's hood.
He was very tenacious and moved rather gracefully when the car turned.
And then, when they came to a stop, the boy would do a sudden vertical takeoff, 100 feet in the air, and then disappear.
11)
Another patient of mine had a different sort of hallucination.
This woman didn't have trouble with her eyes but the visual parts of her brain, a little tumor in the occipital cortex.
And, above all, she would see cartoons.
And these cartoons would be transparent and cover half the visual field, like a screen.
And especially, she saw cartoons of Kermit the Frog.
Now, I don't watch Sesame Street, but she made a point of saying, "Why Kermit?" she said, "Kermit the Frog means nothing to me."
You know, I was wondering about Freudian determinants: Why Kermit?
"Kermit the Frog means nothing to me."
She didn't mind the cartoons too much.
But what did disturb her was she got very persistent images or hallucinations of faces, and as with Rosalie, the looks were often deformed, with huge teeth or huge eyes.
And these frightened her.
Well, what is going on with these people?
12)
As a physician, I have to try and define what's going on and reassure people, especially to reassure them that they're not going insane.
Something like 10 percent, as I said, of visually impaired people, get these.
But no more than one percent of the people acknowledge them because they fear they will be seen as insane.
And if they do mention them to their doctors, they may be misdiagnosed.
In particular, the notion is that you're going mad if you see or hear things.
But the psychotic hallucinations are quite different.
Psychotic hallucinations, whether they are visual or vocal, they address you.
They accuse you. They seduce you; they humiliate you; they jeer at you.
You interact with them.
None of this quality of being addressed with these Charles Bonnet hallucinations.
There is a film. You're seeing a film which has nothing to do with you - or that's how people think about it.
13)
There is also a rare thing called temporal lobe epilepsy; sometimes, if one has this, one may feel transported back to a time and place in the past.
You're at a particular road junction.
You smell chestnuts roasting.
You hear the traffic.
All the senses are involved.
And you're waiting for your girl.
And it was that Tuesday evening back in 1982.
The temporal lobe hallucinations are all sense hallucinations, full of feeling and familiarity, located in space and time, coherent, and dramatic.
The Charles Bonnet ones are quite different.
14)
In the Charles Bonnet hallucinations, you have all sorts of levels, from the geometrical hallucinations - the pink and blue squares the woman had- to quite elaborate hallucinations with figures and especially faces.
Faces, and sometimes deformed faces, are the most ordinary thing in these hallucinations.
And one of the second commonest is cartoons.
So, what is going on?
D)
15)
Fascinatingly, in the last few years, it's been possible to do functional brain imagery, do fMRI on people as they hallucinate, and find that different parts of the visual brain are activated as they hallucinate.
The primary visual cortex is activated when people have these simple, geometrical hallucinations.
This is the part of the brain which perceives edges and patterns.
You don't form images with your primary visual cortex.
When images are formed, a higher part of the visual cortex is involved in the temporal lobe.
And in particular, one area of the temporal lobe is called the fusiform gyrus.
And it's known that if people damage the fusiform gyrus, they may lose the ability to recognize faces.
16)
But if there's an abnormal activity in the fusiform gyrus, they may hallucinate faces, which is precisely what you find in some of these people.
There is an area in the anterior part of this gyrus where teeth and eyes are represented. So that part of the gyrus is activated when people get deformed hallucinations.
Another part of the brain is primarily activated when one sees cartoons.
It's activated when one recognizes cartoons, when one draws cartoons and when one hallucinates them.
Interestingly, that should be specific.
Other brain parts are involved explicitly with recognizing and hallucinating buildings and landscapes.
Around 1970, it was found that there were not only parts of the brain but particular cells.
"Face cells" were discovered around 1970.
And now we know that there are hundreds of other sorts of cells, which can be very specific.
So you may have "car" cells and "Aston Martin" cells.
I saw an Aston Martin this morning. I had to bring it in.
And now it's in there, somewhere.
17)
So, now, at this level, in what's called the inferotemporal cortex, there are only visual images of figments or fragments.
It's only at higher levels than the other senses join in, and there are connections with memory and emotion,
And in the Charles Bonnet syndrome, you don't go to those higher levels.
You're in these levels of inferior visual cortex, where you have thousands and tens of thousands and millions of images, or figments or fragmentary figments, all neurally encoded in particular cells or small clusters of cells.
Usually, these are all part of the integrated stream of perception or imagination, and one is unaware of them.
It is only if one is visually impaired or blind that the process is interrupted.
And instead of getting normal perception, you're getting an anarchic, convulsive stimulation, or release, of all of these visual cells in the inferotemporal cortex.
So, suddenly, you see a face.
Suddenly, you see a car.
Suddenly this and suddenly that.
18)
The mind does its best to organize and to give some coherence to this, but not successfully.
When these were first described, it was thought that they could be interpreted as dreams.
But people say, "I don't recognize the people. I can't form any associations. So Kermit means nothing to me."
You don't get anywhere, thinking of them as dreams.
19)
Well, I've more or less said what I wanted.
I want to recapitulate and say this is common.
Think of the number of blind people.
Hundreds of thousands of blind people have these hallucinations but are too scared to mention them.
So this sort of thing must be noticed by patients, doctors, and the public.
Finally, they are infinitely fascinating and valuable, giving insight into how the brain works.
Charles Bonnet said 250 years ago that he wondered how thinking of these hallucinations and how, as he put it, the theater of the mind could be generated by the brain's machinery.
Now, 250 years later, I think we're beginning to glimpse how this is done.
Thank you very much.
E) - Interview
-You speak about these things with much insight and empathy for your patients.
Have you experienced any of the syndromes you write about?
I was afraid you would ask that.
Well, yeah, a lot of them.
And I'm a little visually impaired myself.
I'm blind in one eye and not good in the other.
And I see the geometrical hallucinations.
But they stop there.
-And they don't disturb you?
Because you understand what's doing it, it doesn't make you worried?
They don't disturb me more than my tinnitus, which I ignore.
They occasionally interest me, and I have many pictures of them in my notebooks.
I've had an fMRI to see how my visual cortex is ticking over.
And when I see all these hexagons and complex things, which I also have, in visual migraine, I wonder whether everyone sees something like this and whether things like cave art or decorative art may have been derived from them a bit.
-That was an utterly, utterly fascinating talk.
Thank you so much for sharing.
Thank you.
**
Ref)
Oliver Sacks:
1)
Oliver Sacks is a psychiatrist and neurologist best known for collecting case histories from the far borderlands of neurological experience.
2)
The Man Who Mistook His Wife for a Hat and An Anthropologist on Mars, in which he describes patients struggling to live with conditions ranging from Tourette's syndrome to autism, parkinsonism, musical hallucination, epilepsy, phantom limb syndrome, schizophrenia, retardation, and Alzheimer's disease.
3)
In 1966, Dr. Sacks began working as a consulting neurologist for Beth Abraham Hospital in the Bronx, a chronic care hospital where he encountered an extraordinary group of patients.
Many had spent decades in strange, frozen states, like human statues, unable to initiate movement.
4)
He recognized these patients as survivors of the great pandemic of sleepy sickness that had swept the world from 1916 to 1927.
And they treated them with a then-experimental drug, L-dopa, which enabled them to come back to life.
5)
They became the subjects of his book Awakenings, which later inspired a play by Harold Pinter and the Oscar-nominated feature film Awakenings.
6)
In July 2007, Sacks was appointed Professor of Neurology and Psychiatry at Columbia University Medical Center and designated the university's first Columbia University Artist.
7)
As a result, sack Latest book, Musicophilia: Tales of Music and the Brain (2007), has been Revised and Expanded in a new edition released in September of 2008.
8)
Question: Is it possible to change the brain with medication?
Oliver Sacks: From what I read, I think that's all sorts of changes, at least temporary changes may be possible.
One can undoubtedly get into states of calm, alter the brain rhythms, and have forms of trance.
Whether they're permanent changes, I don't know.
But any learning experience changes the brain and nothing more.
Incidentally, musicians' brains are visibly different and even grossly different from other people's brains in musical learning.
9)
Question: Are you a proponent of art therapy?
Oliver Sacks: Yeah. Very, very strongly.
Most of my work is with older adults with neurological problems of one sort or another.
And I can see how their lives could be transformed by music and sometimes by poetry and art.
10)
But, say, people with Parkinson's may be unable to move or speak unless there's music.
People with Alzheimer's are confused and lost and agitated or disoriented.
Yet, they can sometimes focus wonderfully on familiar pieces.
It will link them to the past and their memories which they can't access in any other way.
11)
And sometimes, people who are aphasic and have lost the power of language can get it back through music.
12)
I don't have direct experience with young people.
But from everything I read, I think music and other art forms need to be a central part of education.
This is an essential part of being human.
13)
And although I wouldn't locate everything in the right hemisphere, we are not calculating machines.
So we need the arts as much as we need everything else.
14)
Question: Is it possible to enhance your mental abilities by listening to Mozart?
Oliver Sacks: Well, this so-called "Mozart effect" was described, actually, in a very modest way about 15 years ago.
And then got taken up by the media and excited and exaggerated in a way that was rather embarrassing to the original description.
15)
I think there's very little to suggest that, although Mozart as the background will make any difference.
On the other hand, authentic engagement with music, especially performing music, or listening attentively, can make a great deal of difference.
16)
And especially early in life. You'd see this in people, say, who do Suzuki training.
And one year of Suzuki training can not only enhance one's musicality and alter the brain quite visibly.
But the effect seems to leak over to some extent into forms of visual thinking and logical thinking, pattern recognition, etc.
17)
So, a little musical background is not enough, but real musical engagement, I think, can be critical.
Milk from cows raised on Mozart is a hit even outside Awajishima isle
https://www.asahi.com/ajw/articles/14688232
Suzuki Method of Actor Training (workshop)
https://www.youtube.com/watch?v=2YujjdfQrxw
Oliver Sacks: hallucinations reveal the human mind.
https://www.youtube.com/watch?v=SgOTaXhbqPQ&t=2s
Oliver Sacks on Manipulating the Brain | Big Think
https://www.youtube.com/watch?v=bBTvD8Shwog
Dr. Oliver Sacks and the Real Life 'Awakenings' Video ABC
https://www.youtube.com/watch?v=-n4ypD6G3aI
Awakenings (1990) - FIRST 10 MINUTES
Oliver Sacks - Wikipedia
'Awakenings' Where is the real story? English Then and Now, Discussion and Clarification.
https://www.trivia-click.com/awakenings/