Hallucinations (26 page)

While we may have the most fantastical and surreal experiences in our dreams, we accept these because we are enveloped in our dream consciousness, and there is no critical consciousness outside it (the rare phenomenon of lucid dreaming is an exception). When we awake we can remember only fragments, a tiny fraction of our dreams, and can easily dismiss these as “just a dream.”

Hallucinations, in contrast, are startling and apt to be remembered in great detail—this is one of the central contrasts between sleep-related hallucinations and dreaming. My colleague Dr. D. has had only one hypnopompic hallucination in his life, and it occurred thirty years ago. But he retains the most vivid memory of it:

G
iven the outlandish quality of some hypnopompic images, their often terrifying emotional resonance, and perhaps the heightened suggestibility that may go with such states, it is very understandable that hypnopompic visions of angels and devils may engender not only wonder or horror but belief in their physical reality. Indeed, one must wonder to what degree the very idea of monsters, ghostly spirits, or phantoms originated with such hallucinations. One can easily imagine that, coupled with a personal or cultural disposition to believe in a disembodied, spiritual realm, these hallucinations, though they have a real physiological basis, might reinforce a belief in the supernatural.

The term “hypnopompic” was introduced in 1901 by F. W. H. Myers, an English poet and classicist who was fascinated by the emerging study of psychology. He was a friend of William James’s and a founding member of the Society for Psychical Research, where he sought to connect the abnormal and paranormal with normal psychological function. Myers’s work was highly influential.

Living in the late nineteenth century, a time in which séances and mediums were all the rage, Myers wrote extensively of ghosts, apparitions, and phantoms. Like many of his contemporaries, he believed in the idea of life after death, but he tried to place it in a scientific context. Although he felt that
experiences likely to be interpreted as supernatural visitations were especially apt to occur in hypnopompic states, he also believed in the objective reality of a spiritual or supernatural realm, to which the mind might be given brief access in various physiological states, such as dreaming, hypnopompic states, trance states, and certain forms of epilepsy. But at the same time, he thought that hypnopompic hallucinations might be fragments of dreams or nightmares persisting into the waking state—in effect, waking dreams.

Yet reading Myers’s 1903 two-volume
Human Personality and Its Survival After Bodily Death
, as well as
Phantasms of the Living
, the compilation of case histories he and his colleagues (Gurney et al.) published in 1886, one feels that the majority of “psychical” or “paranormal” experiences described are, in fact, hallucinations—hallucinations arising in states of bereavement, social isolation, or sensory deprivation, and above all in drowsy or trancelike states.

My colleague Dr. B., a psychotherapist, related the following story to me, about a ten-year-old boy who woke one morning “to find a woman dressed in blue hovering at the foot of his bed, surrounded by radiant light”:

Dr. B. added, “Although there would appear to be a high prevalence of hypnopompic hallucinations among healthy, well-adjusted persons, they are potentially traumatic, and it is crucial to explore the
meaning
and implications of such phenomena for the individual.”

Experiences so far out of the ordinary constitute a severe challenge to one’s world picture, one’s belief system—how can they be explained? What do they mean? One sees poignantly with this young patient how reason itself can be rocked by such nighttime visions, which insist on their own reality.

S
ometime in the late 1870s, Jean-Baptiste-Édouard Gélineau, a French neurologist from a wine-making family, had occasion to examine a thirty-eight-year-old wine merchant who had been having attacks of sudden, brief, irresistible sleep for two years. By the time he came to Gélineau, he was having as many as two hundred a day. He sometimes fell asleep in the middle of a meal, the knife and fork slipping from his fingers; he might drop off in the middle of a sentence or as soon as he had been seated in a theater. Intense emotions, sad or happy, often precipitated his sleep attacks and also episodes of “astasia,” in which there was a sudden loss of muscular strength and tone, so that he would fall helplessly to the ground, while remaining perfectly conscious. Gélineau regarded this conjunction of narcolepsy (a term he coined) and astasia (we now call it cataplexy) as a new syndrome—one with a neurological origin.
¹

In 1928 a New York physician, Samuel Brock, presented a broader view of narcolepsy, describing a young man of twenty-two who was prone not only to sudden sleep attacks and cataplexy but also a paralysis, with the inability to talk or move, following his sleep attacks. In this state of sleep paralysis (as the condition was later to be named), he had vivid hallucinations, which he experienced at no other time. Though Brock’s case was described in a contemporary (1929) review of narcolepsy as “unique,” it soon became apparent that sleep paralysis and the hallucinations associated with it were far from uncommon and should be regarded as integral features of a narcoleptic syndrome.

It is now known that the hypothalamus secretes “wakefulness” hormones, orexins, and that these are deficient in people who have congenital narcolepsy. Damage to the hypothalamus, from a head injury or a tumor or disease, can also cause narcolepsy later in life.

Full-blown narcolepsy can be incapacitating if untreated, but it is mercifully rare, affecting perhaps one person in two thousand. (Milder forms may be appreciably commoner.) People with narcolepsy are apt to feel embarrassed, isolated, or misunderstood (as with Gélineau’s patient, who was regarded as a drunk), but awareness is spreading, in part because of organizations such as the Narcolepsy Network.

Despite this, narcolepsy often goes undiagnosed. Jeanette B. wrote to me that her narcolepsy had not been diagnosed until she was an adult. In elementary school, she said, “I thought I
had schizophrenia, because of my hypnagogic hallucinations. I even wrote a paper on schizophrenia in sixth grade (never mentioning that I thought that was my problem).” Much later, when she went to a narcolepsy support group, she wrote, “I was astounded to find that many in the group not only had hallucinations, but the very same hallucinations as I did!”

When I heard recently that the New York chapter of the Narcolepsy Network was due to have a meeting, I asked if I might come along to listen to members discuss their experiences and to talk with some of them myself. Cataplexy—the sudden, complete loss of muscle tone with emotion or laughter—affected many at this meeting, and it was freely discussed. (Cataplexy, indeed, can scarcely be hidden. I spoke to one man, by chance a friend of the comedian Robin Williams’s, who said that whenever he met Robin, he would lie down on the ground preemptively; otherwise, he was sure to fall down in a fit of laughter-induced cataplexy.) But hallucinations were another matter: people often hesitate to admit to them, and there was little open discussion of the subject, even in a room full of narcoleptics. Nonetheless, many people later wrote to me about their hallucinations, including Sharon S., who described her own experience:

Sharon has also had hallucinations while driving:

While most of us have a robust sleep-wake cycle, with sleep occurring predominantly at night, people with narcolepsy can have dozens of “microsleeps” (some lasting for only a few seconds) and “in-between states” each day—and any or all of these may be charged with intensely vivid dreams, hallucinations, or some almost-indistinguishable fusion of the two. Sudden, narcolepsy-like sleep without cataplexy may also occur in toxic states or with various medications (especially sedatives), and there is often some tendency to it with aging, in the dozing or nodding off of the elderly into brief, dream-charged sleeps.

I have these increasingly often myself. Once, while reading Gibbon’s autobiography in bed—this was in 1988, when I was thinking and reading a great deal about deaf people and their use of sign language—I found an amazing description by Gibbon of seeing a group of deaf people in London in 1770, immersed in an animated sign discourse. I immediately thought that this would make a wonderful footnote for the
book I was writing, but when I came to reread Gibbon’s description, it was not there. I had hallucinated or perhaps dreamt it, in a flash, between two sentences of text.

Stephanie W. had her first narcoleptic hallucination when she was five, walking home from kindergarten. She wrote to me that her hallucinations frequently occur during the daytime, and she presumes they happen before or after very short microsleeps: