Hallucinations are false or distorted sensory experiences that appear to be real perceptions. These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even smelled or tasted.
A hallucination occurs when environmental, emotional, or physical factors such as stress, medication, extreme fatigue, or mental illness cause the mechanism within the brain that helps to distinguish conscious perceptions from internal, memory-based perceptions to misfire. As a result, hallucinations occur during periods of consciousness. They can appear in the form of visions, voices or sounds, tactile feelings (known as haptic hallucinations), smells, or tastes.
Patients suffering from dementia and psychotic disorders such as schizophrenia frequently experience hallucinations. Hallucinations can also occur in patients who are not mentally ill as a result of stress overload or exhaustion, or may be intentionally induced through the use of drugs, meditation, or sensory deprivation. A 1996 report, published in the British Journal of Psychiatry, noted that 37% of 4,972 people surveyed experienced hypnagogic hallucinations (hallucinations that occur as a person is falling to sleep). Hypnopomic hallucinations (hallucinations that occur just upon waking) were reported by 12% of the sample.
Causes and symptoms
Common causes of hallucinations include:
- Drugs. Hallucinogenics such as ecstasy (3,4-methylenedioxymethamphetamine, or MDMA), LSD (lysergic acid diethylamide, or acid), mescaline (3,4,5-trimethoxyphenethylamine, or peyote), and psilocybin (4-phosphoryloxy-N, N-dimethyltryptamine, or mushrooms) trigger hallucinations. Other drugs such as marijuana and PCP have hallucinatory effects. Certain prescription medications may also cause hallucinations. In addition, drug withdrawal may induce tactile and visual hallucinations; as in an alcoholic suffering from delirium tremens (DTs).
- Stress. Prolonged or extreme stress can impede thought processes and trigger hallucinations.
- Sleep deprivation and/or exhaustion. Physical and emotional exhaustion can induce hallucinations by blurring the line between sleep and wakefulness.
- Meditation and/or sensory deprivation. When the brain lacks external stimulation to form perceptions, it may compensate by referencing the memory and form hallucinatory perceptions. This condition is commonly found in blind and deaf individuals.
- Electrical or neurochemical activity in the brain. A hallucinatory sensation—usually involving touch—called an aura, often appears before, and gives warning of, a migraine. Also, auras involving smell and touch (tactile) are known to warn of the onset of an epileptic attack.
- Mental illness. Up to 75% of schizophrenic patients admitted for treatment report hallucinations.
- Brain damage or disease. Lesions or injuries to the brain may alter brain function and produce hallucinations.
Aside from hypnogogic and hypnopompic hallucinations, more than one event suggests a person should seek evaluation. A general physician, psychologist, or psychiatrist will try to rule out possible organic, environmental, or psychological causes through a detailed medical examination and social history. If a psychological cause such as schizophrenia is suspected, a psychologist will typically conduct an interview with the patient and his family and administer one of several clinical inventories, or tests, to evaluate the mental status of the patient.
Occasionally, people who are in good mental health will experience a hallucination. If hallucinations are infrequent and transitory, and can be accounted for by short-term environmental factors such as sleep deprivation or meditation, no treatment may be necessary. However, if hallucinations are hampering an individual's ability to function, a general physician, psychologist, or psychiatrist should be consulted to pinpoint their source and recommend a treatment plan.
Hallucinations that are symptomatic of a mental illness such as schizophrenia should be treated by a psychologist or psychiatrist. Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed.
In many cases, chronic hallucinations caused by schizophrenia or some other mental illness can be controlled by medication. If hallucinations persist, psychosocial therapy can be helpful in teaching the patient the coping skills to deal with them. Hallucinations due to sleep deprivation or extreme stress generally stop after the cause is removed.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Siegel, Ronald K. Fire in the Brain: Clinical Tales of Hallucination. New York: Dutton, 1992.
Bental, R. P. "The Illusion of Reality: A Review and Integration of Psychological Research on Hallucinations." Psychological Bulletin 107, no. 1 (Jan. 1990): 82-95.
Beyerstein, Barry L. "Believing is Seeing: Organic and Psychological Reasons for Hallucinations and Other Anomalous Psychiatric Symptoms." Medscape Mental Health 1, no. 11 (1996).
Ohayon, M. M., et al. "Hypnagogic and Hypnopompic Hallucinations: Pathological Phenomena?" The British Journal of Psychiatry 169, no. 4 (Oct. 1996): 459-67.
American Psychological Association (APA). 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. <ttp://www.apa.org>.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. <http://www.nami.org>.
Paula Anne Ford-Martin