Oliver Sacks - Hallucinations

When I asked him what this state felt like, he said, “like a dream, confused, sort of crazy, spaced out. But I know I’m high, as well.” His attention seemed to dart about, touching on one thing and then another almost at random. He was very restless and had all sorts of involuntary movements. I had my own EEG machine at the time, and, wheeling that into Mr. F.’s room, I found that his brain waves were dramatically slowed — his EEG showed classic slow “liver waves” as well as other abnormalities. Within twenty-four hours of resuming his low-protein diet, though, Mr. F. was back to normal, as was his EEG.

Many people — especially children — experience delirium with a high fever. One woman, Erika S., recalled this in a letter to me:

I was 11 years old and was home from school with chicken pox and a high fever.… During a fever spike, I experienced a frightening hallucination for what seemed like a very long time, in which my body seemed to shrink and grow.… With each of my breaths, my body would feel like it was swelling and swelling until I was sure that my skin would burst like a balloon. Then when it felt so excruciating, like I had suddenly grown from a normal sized child to a grotesquely fat person … like a person-balloon … I would look down at myself, sure that I would see my insides bursting out of my inadequate amount of skin, and blood pouring from enlarged orifices that could not contain my swollen body. But I would “see” my normal sized self … and looking would reverse the process.… I would feel like my body was shrinking. My arms and legs would get thinner and thinner … then skinny, then emaciated, then cartoon thin (like the legs on Mickey Mouse in Steamboat Willie ) and then so pencil thin that I thought my body would disappear altogether.

Josée B. also wrote to me about her “Alice-in-Wonderland syndrome” as a child with fever. She remembered feeling “incredibly small or incredibly large and sometimes both at the same time.” She also experienced distortions in proprioception, her perception of her own body position: “One evening, I couldn’t sleep in my own bed — every time I lay down on it, I would feel I was standing tall.” She had a visual hallucination, too: “Suddenly I saw cowboys who were throwing apples at me. I jumped onto my mother’s dresser to hide behind a lipstick tube.”

Another woman, Ellen R., had visual hallucinations that took on a rhythmic, pulsing quality:

I would “see” a smooth surface, like glass, or like the surface of a pond.… Concentric rings would spread from the center to the outside edges, as though a pebble had been dropped right in the middle. This rhythm starts slowly [but] … eventually speeds up, so that the surface is constantly agitated, and as this happens, my own agitation is heightened. Eventually the rhythm slows, the surface smooths out, and I become relieved and calmer myself.

Sometimes in a delirium there may be a deep humming sound that waxes and wanes in a similar way.

While many people describe delirious swellings of body image, Devon B., when feverish, experienced mental or intellectual swellings instead:

What made them so strange was that they weren’t sensory hallucinations, but a hallucination of an abstract idea … a sudden dread of a very, very large and growing number (or a thing, but a thing I never really defined)…. I remember pacing up and down the hallway … in a growing state of panic and horror at an exponentially increasing, impossible number.… My fear was that this number was violating some very basic precept of the world … an assumption we hold that absolutely should not be violated.

This letter made me think of the arithmetical deliria which Vladimir Nabokov went through, wrestling with impossibly large numbers, as he described in his autobiography Speak, Memory:

As a little boy, I showed an abnormal aptitude for mathematics, which I completely lost in my singularly talentless youth. This gift played a horrible part in tussles with quinsy or scarlet fever, when I felt enormous spheres and huge numbers swell relentlessly in my aching brain.… I had read … about a certain Hindu calculator who in exactly two seconds could find the seventeenth root of, say, 35294​71145​76027​51323​01897​34205​586617​1392 (I am not sure I have got this right; anyway the root was 212). Such were the monsters that thrived on my delirium, and the only way to prevent them from crowding me out of myself was to kill them by extracting their hearts. But they were far too strong, and I would sit up and laboriously form garbled sentences as I tried to explain things to my mother. Beneath my delirium she recognized sensations she had known herself, and her understanding would bring my expanding universe back to a Newtonian norm.

Some people feel that the hallucinations and strange thoughts of delirium may provide, or seem to provide, moments of rich emotional truth, as with some dreams or psychedelic experiences. There may also be revelations or breakthroughs of deep intellectual truth. In 1858, Alfred Russel Wallace, who had been traveling the world for a decade, collecting specimens of plants and animals and considering the problem of evolution, suddenly conceived the idea of natural selection during an attack of malarial fever. His letter to Darwin proposing this theory pushed Darwin to publish On the Origin of Species the following year.

Robert Hughes, in the opening of his book on Goya, writes about a prolonged delirium during his recovery from a nearly fatal car crash. He was in a coma for five weeks and hospitalized for almost seven months. In intensive care, he wrote,

One’s consciousness … is strangely affected by the drugs, the intubation, the fierce and continuous lights, and one’s own immobility. These give rise to prolonged narrative dreams, or hallucinations, or nightmares. They are far heavier and more enclosing than ordinary sleep-dreams and have the awful character of inescapability; there is nothing outside them, and time is wholly lost in their maze. Much of the time, I dreamed about Goya. He was not the real artist, of course, but a projection of my fears. The book I meant to write on him had hit the wall; I had been blocked for years before the accident.

In this strange delirium, Hughes wrote, a transformed Goya seemed to be mocking and tormenting him, trapping him in some hellish limbo. Eventually, Hughes interpreted this “bizarre and obsessive vision”:

I had hoped to “capture” Goya in writing, and he instead imprisoned me. My ignorant enthusiasm had dragged me into a trap from which there was no evident escape. Not only could I not do the job; my subject knew it and found my inability hysterically funny. There was only one way out of this humiliating bind, and that was to crash through.… Goya had assumed such importance in my subjective life that whether I could do him justice in writing or not, I couldn’t give up on him. It was like overcoming writer’s block by blowing up the building in whose corridor it had occurred.

Alethea Hayter, in her book Opium and the Romantic Imagination , writes that Piranesi, the Italian artist, was “said to have conceived the idea of his engravings of Imaginary Prisons when he was delirious with malaria,” a disease he contracted

while he explored the ruined monuments of Ancient Rome … among the nocturnal miasmas of that marshy plain. He was bound to get malaria; and the delirious visions when they came to him may have owed something to opium as well as to a high temperature, since opium was then a normal remedy for ague or malaria.… The images which were born during his delirious fever were executed and elaborated over many years of fully conscious and controlled labour.

Delirium may produce musical hallucinations, as Kate E. wrote: