Reviewed by Craigan Usher

As a medical student I learned that one could screen for psychosis by inquiring: “Do you ever see or hear things that others do not see or hear?” In practice, I have found that asking about hallucinations in this way fails miserably because 99% of the people answer, if sheepishly, “yes.” “Yes, doctor, I hear my mother call to me whenever I rummage around the kitchen in the middle of the night, even though I haven’t lived with her in ten years.” “Yes, often when I go to sleep, I jerk awake to find something floating over the top of me.” “Yes, I hallucinated when I got too high/changed my medicine/had surgery/was daydreaming in the waiting room.” These responses usually come with nervous, quizzical glances, which many patients have told me reflect their worry: “Does he think I’ve lost my mind?”

It was thus with delight that I read Oliver Sacks’ Hallucinations. The book should reassure those who have either hallucinated themselves or know someone else who has. In other words, it is likely to help almost anyone.

In Hallucinations, Sacks, a physician and professor of neurology at the NYU School of Medicine, details neurological deceptions, sights, sounds and smells others do not sense, conveying his awe for those who suffer hallucinations as well as the neurologic pioneers who initially described these phenomena. For example, the author introduces us to his patient Rosalie and the 18th-century naturalist, Charles Bonnet. Sacks describes Rosalie as a nonagenerian who became overwhelmed when, after years of being completely blind, she began envisioning “people in Eastern dress…in drapes walking up and down stairs.” Sacks notes that the nursing home staff had consulted him, worried that Rosalie was suffering dementia, stroke or new-onset psychiatric illness.

After finding nothing that would point to these etiologies, the author explained to his patient and the staff that she suffered from Charles Bonnet Syndrome (CBS), a condition named after the Swiss writer, who in 1760 detailed the vivid imagery “seen” by his grandfather, Charles Lullin, an 87-year-old man suffering from severe cataracts. Rosalie, we learn, was reassured by her neurologist’s description of CBS, and when these visions resolved and later returned, Rosalie was never frightened by them in a sustained way again. In fact, after a subsequent bout of temporary visions led one staff member to comment that Rosalie was “not in her right mind,” the patient was able to use her knowledge of the condition to instruct a “young volunteer to track down an account of Charles Bonnet Syndrome on the internet and give copies to the nursing home staff.”

Throughout the book, Sacks tells tales of similarly empowered people. In a chapter entitled “The Haunted Mind,” Sacks writes of those suffering loss and trauma who report seeing or hearing loved ones or of flashbacks which feel more real than reality. The author concludes, reassuringly, that these are the brain’s way of working through grief –  neurological adaptations to pain.

Meanwhile, in “The Illusions of Parkinsonism” we read of Gertie C. and the relief from “the paranoid quality” of her hallucinations she enjoyed after starting L-dopa, the chief treatment for Parkinson’s disease, and the command she gained over her hallucinatory experiences after discussing them with her neurologist. Dr. Sacks writes that his patient “developed a humor and tact and control” over her visions, which transitioned from being frightening to charmingly amorous. “If her relatives stayed too late, she would explain firmly but pleasantly that she was expecting ‘a gentleman visitor from out of town’ in a few minutes time ... She now receives love, attention, and invisible present from a hallucinatory gentleman who visits faithfully each evening.”

Along the hallucinatory journey on which the author guides us, he stops at several figures in the neurology pantheon. In “Visual Migraines,” we learn that 19^th-century British neurologist William Gowers speculated that migrainous visual phenomena involved “active rippling waves” long before the underlying neuroelectrophysiology of such phenomena were understood. Meanwhile, in “Phantoms, Shadows and Sensory Ghosts,” we read of Silas Weir Mitchell, an American physician who compassionately gathered detailed histories from Civil War veterans, eventually coining the term “phantom limb” for the sensations perceived by amputees.

Hallucinations provides a tour not only of Sacks’ travels as a physician and medical historian, but also of his own pharmacologically-induced “trips.” In a chapter called “Altered States,” which ran as an essay in the August 2012 New Yorker, Sacks details his recreational use of hallucinogens while a neurology resident in the 1960s. On the one hand, the author’s disclosures demonstrate the roots of his empathy. The inclusion of this material suggests that without having suffered a frightening trip in reaction to a dose of Artane, a drug Sacks no doubt has prescribed to many patients suffering Parkinson’s disease, he would not so readily understand his patients’ anguish and concerns about losing their minds.

In treating us to a description of his own experiences, Sacks proves as charming, but also as distant, as the character he inspired, writer and neurologist Raleigh St. Clair, played by Bill Murray in Wes Anderson’s “The Royal Tenenbaums.” The author explains that people “need meaning, understanding, and explanation; we need to see overall patterns in our lives.” There dangles a promise that Sacks will not only tell us what happened when he took drugs, but also describe the  meanings, pleasures, pains and questions that preceded his drug use, occurred during his “highs,” and follow him to this day. Yet what he delivers are simply more descriptive patterns, drug X resulting in hallucination Y, a spider who wishes to talk of Bertrand Russell, phantom friends waiting for breakfast outside his kitchen, a bout of delirium tremens while withdrawing from sleeping pills.  As Bill Murray smirked in “The Royal Tenenbaums,” “How interesting. How bizarre.”  Still, I wanted more. We can hope that Sacks has in the works another volume describing the “inner needs or conflicts” that drove and emerged from his use of high dose neuropharmacological agents.

For those of us who are not prepared to follow Sacks’ empathy-building regimen from the 1960s, I suggest the same effect may be realized by a large bolus of Hallucinations. If and when you experience perceptual disturbances, your own or those of family, friends, or colleagues, this volume should help you meet them with grace and understanding.

Craigan Usher is a graduate of Georgetown University School of Medicine and Director of Child and Adolescent Psychiatry Education at Oregon Health and Science University. Invested in psychoanalytic theory, he is presently working on a course entitled: “Let’s Pickle! And Relish Your Symptom: Lacan in Portlandia.”