Hallucinations Read Free Page A

better and recovered her insight into what was happening. At that point, she instructed a young volunteer to track down an account of Charles Bonnet syndrome on the internet and to give copies of this to the nursing home staff, so that they would know what had been going on.
    Over the next few days, her visions grew much fainter and ceased altogether when she was talking with others or listening to music. Her hallucinations had become “shyer,” she said, and now occurred only in the evening, if she sat quietly. I thought of the passage in
Remembrance of Things Past
where Proust speaks of the church bells of Combray, how their sound seemed muted in the daytime, only to be heard when the hubbub and blare of the day had died down.
    C harles Bonnet syndrome was considered rare before 1990—there were only a handful of case histories in the medical literature. 2 I thought this strange, for working inold-age homes and nursing homes for over thirty years, I had seen a number of blind or purblind patients with complex visual hallucinations of the Charles Bonnet type (just as I had seen a number of deaf or nearly deaf patients with auditory—and most often musical—hallucinations). I wondered whether CBS was actually much commoner than the literature seemed to indicate. Recent studies have confirmed that this is the case, although CBS is still little recognized, even by doctors, and there is much to suggest that many or most cases are overlooked or misdiagnosed. Robert Teunisse and his colleagues, studying a population of nearly six hundred elderly patients with visual problems in Holland, found that almost 15 percent of them had complex hallucinations—of people, animals, or scenes—and as many as 80 percent had simple hallucinations—shapes and colors, sometimes patterns, but not formed images or scenes.
    Most cases of CBS probably remain at this elementary levelof simple patterns or colors. Patients who have simple (and perhaps transient or occasional) hallucinations of this type may not take much notice or remember to report them when they visit a doctor. But some people’s geometrical hallucinations are more persistent. One old lady with macular degeneration, learning of my interest in such matters, described how in the first two years of her visual impairment, she saw
    a big blob of light circling around and then vanishing, followed by a colored flag in sharp focus … it looked exactly like the British flag. Where it came from, I do not know.… For the last few months I have been seeing hexagons, often hexagons in pink. At first there were also tangled lines inside the hexagons, and other little balls of color, yellow, pink, lavender, and blue. Now there are only black hexagons looking for all the world like bathroom tiles. 3
    While most people with CBS are aware that they are hallucinating (often by the very incongruity of their hallucinations), some hallucinations may be plausible and in context, as with the “handsome gentlemen” accompanying Lullin’s granddaughters, and these may, at least initially, be taken as real. 4
    With more complex hallucinations, it is typical to see faces, though they are almost never familiar. David Stewart, in an unpublished memoir, described this:
    I had another hallucination.… This time it was faces, the most prominent of which was one of a man who might have been a burly ship captain. It wasn’t Popeye, but along those lines. The cap he was wearing was blue with a shiny black visor. His face was grey, the cheeks rather chubby, bright eyes and a decidedly bulbous nose. He was no one I had ever seen before. This was not a caricature, and he seemed very much alive, someone I felt I might like to know. He gazed at me with a benign, unblinking, and altogether incurious expression.
    The burly ship captain, Stewart noted, appeared as he was listening to an audiobook biography of George Washington, which included a reference to some sailors. He mentioned, too, that he had one