Theater of the mind: The world of hallucinations

When I crashed to the floor of my home in Bordeaux recently after two months of Covid-19 dizziness, I was annoyed. The next day I collapsed again. Now I was worried. What I didn’t know was that my brain was sloshing around inside my skull, causing a mild concussion. Nor did I know that I was in for a whole new world of weird and wonderful hallucinations.

We don’t hear much about these fantasies because patients tend to hide their experiences, afraid to be labeled “bonkers”, as the late Dr. Oliver Sacks charmingly put it. They creep up on you unannounced, drawing you into their world of shadows and ghosts. Even Dr. Sacks had trouble finding simple explanations for these phenomena. In a televised discussion of brain research shortly before he died, he acknowledged that the human mind behaves in ways that are still poorly understood. Hallucinations “don’t seem to be of our creation,” he said. “They seem to come from outside, and they are not under our control.”

Some professionals call hallucinations “The theater of the mind”.

My experience in this theater was compounded by a virulent strain of gastro-intestinal infection that hit France during the winter of 2021. I ended up dehydrated, a frequent prelude to visual hallucinations.

My doctor tried to rehydrate me by hanging one-liter bags of saline solution on a drip tree at my bedside plugged into my left thigh.  The bags were replaced daily with fresh water. The only notable effect on me was a continuous urge to drain my body’s natural urges. I filled most of the pots and pans from my kitchen at odd hours of the night.

CASE STUDY -- My hallucinatory images usually started without warning. The curved wall of my bedroom flattened out and five picture frames flipped into a smooth silver screen, perfect for the movies. As I watched the action, I realized I was seeing a fanciful sequel to “Wild River”, a Hollywood romance set during the construction of the Tennessee Valley Authority electrification project. Lee Remick and Montgomery Clift fell in love among the dirt-poor Tennessee hillbillies while trying to talk sense in their disjointed world.

CASE STUDY – Much of Dr. Sacks’ interviewing took place in moving cars. One lady in her 90s reported “seeing” her car heading forward along five parallel roads. A teen-aged boy was riding on the hood of the lead car. As the five roads merged into one, the boy shot into the air about 100 feet straight up where he disappeared into the night. She found this curious but not particularly disturbing.

CASE STUDY -- Much of the dialogue around these adventures was audible to me.  One sharecropper had just moved into a small cabin with an electric light switch on the wall. “Well… Who’d-a thought of that,” he said in amazement to an empty room. In the distance across the river I could see Thelma Ritter in a rickety rocking chair, about to be flooded out of house and home to fill a dam downstream She looked mad as hell.

CASE STUDY – Spontaneous and unrelated images flashed in and out of view, one particularly obscure. Strange forces had rearranged the walls of my bedroom so that I was hanging on a meat hook and my television set was illuminated on the “floor” below. The brain tried to make sense of this, allowing me to believe it yet grasp that it was outside the realm of reality. Brain researchers have determined that hallucinations often mimic reality but with significant variations.

CASE STUDY -- Late one night the subject matter became more current. I saw fragments of a film my mind invented titled “The Day After John Kennedy was Shot.” I was following a shadowy Jacqueline Kennedy dressed in black, walking alone down Pennsylvania Avenue, strangers standing still in the street. One was an attractive brunette, probably the pianist Hélène Grimaud, taking an oversized pet for a midnight stroll. The pet was bigger than she was. It turned out to be a wolf on a silver chain. All this seemed perfectly natural.

CASE SUDY – Hélène and I came upon a road block where two or three White House aides were discussing the events of the day. They were upset that the president’s doctor had just perished in a violent car accident. The doctor under discussion was identified as “Timmy Tommy O’Donnell.”

CASE STUDY – Later that night the scene changed again. On the wall there appeared a tiny door that opened silently as a priest about three feet tall stepped forward on to an empty altar. He never seemed to do anything but he gave off evil vibes. Dr. Sacks had noted in his book “Hallucinations” that much of the movement in these little stories are extremely boring. Nothing much happens. The real me approached the midget priest and I shouted “Begone”. The Biblical reference must have frightened him. He disappeared instantly and he never returned.

CASE STUDY – Boston guitarist Paul Rodriguez underwent heart surgery and two months of recovery interrupted with frequent hallucinations. He recalls feeling he was in the lower decks of a large ship. The ship visited tropical isles such as Hawaii, sometimes reliving parades and other scenes from the American civil war, other times “floating in space”. 

CASE STUDY -- Death came and went, leading Rodriguez to think, “So this is how it ends.” Yet he never felt fear. At other times he found himself talking to a dog’s shadow. As he entered bars and restaurants he recognized nurses and doctors as bartenders and waitresses. He came and went into neighborhoods where he grew up. “I was definitely in another world,” he recalls. 

A friend who enjoyed hearing of these fantastical adventures found humor in the stories. “I felt I wanted to bang my head against the wall so I could enjoy this new world.”

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