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A specific focus lies on visual hallucinations, where individuals encounter vivid and distorted images that may appear real despite lacking an external source.
Today, we are going to talk about hallucinations.
Quite straightforward, don’t you think? Well, in medicine, patients who are presented with hallucination can be quite complicated especially if we seek to understand the exact mechanism of it.
Too many diseases can cause hallucination and the first thing that comes to mind when we are talking about this kind of psychopathology is, of course, psychiatric illnesses.
Not everyone has the luxury (well, I wouldn’t call it a luxury though) of experiencing voices, creeping sensation or seeing something, hmm, how should I put it, things that are not from this world (ghost, apparition, angel and such), so most of us don’t understand, how it feels like to perceive something that is not even there.
In everyday conversations, sometimes, people use the word “delusion” (most common) or “illusion” when they actually meant hallucination. Even though it might appear the same for a layman, all of those three words are quite different; well to be fair, delusion is quite different from the other two. Hallucination is a perception without apparent stimuli while an illusion is an inappropriate perception to the existing stimuli (for example, a child might perceived curtains as ghosts at night), so it is understandable if someone confused illusion with hallucination.
Delusion is an unshakable belief which is held with utmost convictions despite evidence to the contrary.
The false beliefs which are perceived by delusional people are usually out of keeping with the usual cultural and social norms. For example, in persecutory (paranoid) delusion, people who were delusional insist that they were being followed, spied or pursued by a serial killer which, in reality, doesn’t exist.
In some cases, people who are delusional claimed that their life partners were cheating on them, allegedly, so they went for extra measures of spying, hiring a spy or checking their husband/wife clothes for some evidence of their infidelity; which is essentially non-existence.
Most of the delusional patients that I have seen in a clinic have poor insight and they were often treated with a cocktail of mixed therapies comprised of any of the antipsychotic, antidepressant and probably some mood stabilisers.
Being delusional is the primary feature of a paranoid schizophrenia and without proper treatment and adherence to medications, they can be very difficult to live with.
Imagine living with someone who suspects every single thing that you do will eventually harm them in some possible ways. It’s tiring, really.
In this series, however, we are not going to discuss either delusion or illusion. In this article, we are going to discuss some introduction to hallucinations.
It is important for you to understand even if you experience a somewhat similar presentation to a specific diagnosis included in this series, it doesn’t necessarily mean you have it.
Hallucination is not pathognomonic (specific) to a certain disease so it would be a great idea for you to refer yourself to a psychiatrist if you are experiencing hallucinations; some healthy people often misinterpret their symptoms as hallucinations even though it is not.
Even if it is not diagnostic, most of the cases of hallucinations are studied through patients who have been diagnosed with schizophrenia.
It’s not that surprising since schizophrenia is the hallmark of psychiatric illnesses; people with schizophrenia can literally present with any of the symptoms found in other psychiatric illnesses.
Still, it would be appropriate for us to use the latest guideline to diagnose schizophrenia or we will end up seeing schizophrenia in every single individual.
What Causes Hallucinations?
To be honest, I’m not an expert in neurobiology nor will I be in the next 5 years or so, thus, this section of discussion is purely based on what I read in some review journals that have been published; if you have disagreements or some insights to the discussion, I welcome your opinion in the comment section, below.
It is important to know that, everyone, including healthy people, could experience hallucination; though the experience can be quite different from what people with a specific medical condition went through. In 2009, data from 6 different countries yielded between 7 to 30% of healthy children and adolescents who have experienced some form of hallucinations without any medical condition or risk factors to be affected by it.
The result was proven to be true by a study conducted by Scott J. et al which stated that despite all of the possible clinical correlations or demographics, adolescents might be the most frequent population of healthy subjects who experienced hallucinations.
Apart from idiopathic causes, people who lose someone (death) could experience hallucinations (mostly visual) related to the deceased as a part of their grieving process.
People’s mind is a powerful tool of survival and pathological grieving could trigger a defence mechanism which would allow people to see someone they desire (deceased) to curb their sadness from leading them to unwanted consequences; though ironically, this defence mechanism eventually would cost them later.
Most of the studies that are conducted to investigate the source of hallucinations came from people with schizophrenia so it is not known whether appropriate to assume it is the same for other diseases as well.
Obviously, the commonest type of hallucination is different between psychiatric and organic problems; in psychiatric illnesses, the most common type of hallucination would be auditory.
Other forms of hallucinations such as gustatory, visual or tactile are usually caused by organic diseases though that doesn’t rule out psychiatric illnesses; one thing I hate about medicine, there is no definite answer for some questions.
In individuals with good mental health, the most common cause of hallucination is brain lesion.
Compared to delusions, hallucinations are quite easy to be recognized even by someone who knows but is not familiar with the subject; the trick is to add the word “might” in front of your statement.
You heard someone see, hear or feel something that is not there, well, they might be hallucinating.
Most of the brain lesions that have resulted in hallucinations were found to affect pathways associated with sensory modalities related to the type of hallucinations (i.e. visual pathway, somatic pathway, auditory pathway).
One of the best examples would be patients who experienced a condition called Charles Bonnet Syndrome (CBS). In this condition, people who can’t see (completely or partially blind) by eye’s condition such as cataract, diabetic maculopathy or glaucoma, experienced visual hallucination as if their visions are perfectly normal.
The degree of severity varies but some patients claimed that they can see perfectly what has been going on around them for a moment, and when we asked them to describe the experience, most of them are too good to be true or bizarre.
The thing about images that are projected due to CBS, you can’t control or manipulate them; the brain is provided with a false sense of sighting experience which can’t be manipulated in any way imaginable.
It is, therefore, reasonable to assume that hallucinations presented in patients with schizophrenia can be quite different from people who experienced hallucinations from other diseases.
Most of the studies which utilized the latest technology of neuroimaging have produced comprehensive pieces of information regarding hallucinating brains.
Although most of them are studied among patients with schizophrenia, the basis of hallucination is thought to remain the same regardless of the causes of the hallucination itself.
In patients with schizophrenia, it was found that auditory hallucinations can potentially be caused by a reduction of grey matters in some areas of the brain which are responsible for the perception of sounds (or other respective area associated with the type of hallucinations); this is the most common and consistent findings and it almost resembles the brain of people who are drunk with alcohol (though it might be much more significant for an alcoholic).
This would lead to a bad connectivity termed as faulty frontotemporal interactions which are important for a normal social interaction and language perception; a faulty frontotemporal communication would cause patients to perceive false external stimuli which are interpreted internally (faulty internal signal generation).
It is best for you to note that this is the most frequent finding when people with schizophrenia experienced hallucinations.
This psychopathology is still poorly understood and most of the treatment modalities focused on treating the disease itself thus the hallucination; there are up until now, no medication which caters to hallucinations alone.
Some medications or drugs can induce hallucination, especially in an abuse setting making it a popular choice among people to escape reality by letting the brain to construct a world which is non-existent, filled with things that can’t manipulate or be manipulated.
Most of the animal studies suggested that medications that can cause psychosis in humans would alter their behavior in a certain way in which we can differentiate, either they act based on either thing of their surrounding or from themselves.
In other words, behavioral changes among animal who received medications (source of psychosis) would be similar with when they perceived sounds/visuals are coming from the other animal (in this case, there are no other animals nearby, they were hallucinating).
Nevertheless, behavioral changes caused by hallucinations in animals are too nonspecific making it unreliable predictors whether or not they were hallucinating. It is undeniable that more studies are needed to understand the thing which might have caused hallucinations.
Hallucinations In Sleep Paralysis
Waking up in the middle of the night can be frustrating especially if you are clinically depressed. Apparently, there is no amount of melatonin that can maintain your sleep when you have a high level of cortisol, swimming around your circulation.
Even more so, if you woke up and found that you can’t move, only your eyes kept on blinking and for a few seconds, gaze upon your whole visual field; the experience can be traumatic.
Sleep paralysis is a common unexplained disorder that can be somewhat distressful especially for those who aren’t aware of this condition.
People would usually resort to a paranormal reasoning first when they were freaking out, unable to move and probably, for some, saw something sitting on their body.
Studies in the past found that some people (40% of the general population) would eventually experience sleep paralysis that would make their life miserable at some point in their life.
It is unclear what is the exact mechanism that causes temporary paralysis, but researchers thought that it occurs due to an accidental awakening while we are in the rapid eyes movement (REM) phase of the sleep cycle. Neat isn’t it?
During the REM phase, our muscles become paralysed to prevent us from acting out whatever we are dreaming about.
, sleep paralysis indicates that at some point, we are aware of our surrounding, but our body doesn’t even know that we have woke up.
Being paralysed can be physiological for a healthy individual who sleeps it off through the REM cycle but for people who experienced sleep paralysis, this would disrupt a part of the brain which holds neural map information of the body.
We became confused, clueless and scared despite our brain best effort to try and configure some instruction for the limb to move.
One interesting thing about that particular part of the brain (people assume it is the parietal lobe) it holds information regarding our body images which could have leaked and projected as hallucinations; in other words, the “thing” that was sitting on us is our own self-reflected images.
It seems plausible to consider the “thing” to be paranormal since they looked distorted but not all of the images’ information was projected and interpreted as external stimuli.
According to Baland Jalal, the only way to test this hypothesis is to conduct an experiment on people who have different body images for example amputee. In this case, the “thing” that sits on their body would appear amputated as well.
Due to a poor understanding regarding the pathophysiology of sleep paralysis, it is quite difficult to explain to laymen that this condition wasn’t caused by paranormal entities.
In 2013, a study was conducted in two different societies [most people are religious (Egypt) and most people are atheist (Denmark)] to investigate the relationship between stresses imposed by cultural beliefs and the rate of sleep paralysis.
It was found that people from Egypt experienced a much intense and prolonged sleep paralysis as compared to people who are from Denmark.
When asked, people from Denmark believe that sleep paralysis was caused by brain malfunctions while nearly half of the Egyptians claimed that such condition was caused by a spirit called Jinn (or Djinn).
If people who believe that supernatural entities were the primary cause of the disorder, the reason for their prolonged episode of sleep paralysis can potentially be “fear”.
However, like any other hypotheses, a lot of things need to be considered before jumping to a definite conclusion. Hallucinations are quite complicated and it is possible that different diseases exhibit a different mechanism or pathway that would eventually lead to hallucination.
Even though I’m quite fascinated by ghost stories and paranormal documentation, I’m a guy who believes every single occurrence has their own explanation; whether we have the luxury of knowing it or not is another thing to be considered.
Paranormal activities have gained much attention from the media and people from all over the globe. It seems like we are not only afraid of something we couldn’t understand but also fascinated by it.
We are currently living in the world, full of people who can’t differentiate between truly getting haunted, unexplained hallucinations or relatively risked to be killed by something.
Even though we have a lot of explanations which can rule out paranormal occurrences from our own differential diagnoses such as infrasound and aberrant electromagnetic field in certain places, nothing surpassed the danger of being poisoned by carbon monoxide while thinking you were haunted by apparitions.
There is a lot of stuff in your home which contains carbon monoxide, a gas which can’t be seen by our naked eyes and retain its potency to kill people while giving a false sense of horror, frequently misinterpreted as “being haunted”.
One of the most popular examples was documented by an ophthalmologist named W.H. Wilmer who hypothesized that carbon monoxide leak is the reason why a whole family experienced various symptoms such as hallucinations, lethargy and feeling dreaded for no reason after they moved into a new (yet old) house.
Carbon monoxide has a greater affinity towards red blood cell compared to oxygen that would eventually cause oxygen deprivation to the brain.
There have been a few records in which people who were poisoned by carbon monoxide felt like they weren’t themselves anymore. It was accompanied by various aural hallucinations causing people to see whatever they weren’t supposed to see (yeah, I’m talking about ghosts).
Take Carrie Poppy as an example.
Putting aside the fact that she had an awesome and supportive friend who ask her to burn some sages to repel ghosts away, she was totally convinced that there are other creatures which live in a different dimension that can’t be perceived by our senses but we can totally feel them.
As the time goes by her symptoms were getting worse and eventually, she was told that she might have been poisoned by carbon monoxide.
Reading up all the facts and compared it with what she has experienced, she decided to call the gas company and check her house for a potential gas leak.
Thank God she took the action relatively quickly or she might suffer from irreversible consequences which have no medical treatment, death. If you were able to see something which no one else could perceive, carbon monoxide poisoning can be one of the potential diagnoses, but it certainly not definite.
Most of the paranormal occurrences (I think all which has been investigated) have their own scientific explanation but due to various factors such as culture, religious belief etc., investigation regarding those occurrences can be hindered either by other people or that particular individual themselves, fearing they will get cursed by supernatural means.
I live in Malaysia and I’ve seen enough the significance of ghosts and anything related to it to the culture of people in this particular country. They knew they supposed to call upon some religious figure in order to repel ghosts or any evil spirit in a specified cleaning ritual (somewhat depends on religious belief).
A Muslim will recite some verses from the Quran, a Christian would have brought holy water and I’m not sure what others would do; my point is, no one seems to have the initiative to call upon scientists or anyone who is capable of investigating these paranormal occurrences through scientific means.
Just to clarify, I’m not saying that I don’t believe in ghosts, apparitions, spirits etc. I do hope someday we would have proofs that they exist but until then, I will commit to what I can see or what I can perceive.
While hanging out in the clinic yesterday, one of my supervisors told me a story about a patient who came with symptoms that could point him towards the diagnosis of carbon monoxide poisoning but he was convinced that he was haunted by ghosts.
He came to the clinic to get some sleeping pills to help him sleep and after a brief history taking, it seems he is quite convinced that a doctor can’t help him; he can only be treated by spiritual healers.
I get it, we (doctors) have been wrong for more than once but that doesn’t mean medicine can be the frontier of treating people with hallucinations or anything related to paranormal stuff.
According to a paper written by Angela L. Chiew and Nicholas A. Buckley which has been published in 2014, people who are exposed to carbon monoxide for a long duration are prone to get severe neurological long-term effects such as a decrease in attention span, short-term memory and sure, depression.
I mean, who wouldn’t, if you are being disturbed by those things every single day, you pretty much live in fear.
We can deduce that most of the damages caused by carbon monoxide poisoning came from the fact that haemoglobins can’t really carry sufficient oxygen to meet the metabolic demands of tissue all across the body, including the brain. However, according to a few research papers, the most significant damages were caused by reactive oxygen species that were generated through the binding of the carbon monoxide and the cytochrome C oxidase in the brain.
If you were thinking that treatment could make it better, you were right but not immediate. In some cases, catching up with severe carbon monoxide poisoning could cause apoptosis, increase in the production of reactive oxygen species and widespread systemic inflammatory reactions from various agents including platelets.
The symptoms would be much more severe in people who had anemia, heart or lung condition and genetic variants of diseases that could affect the integrity of the red blood cells.
Every single year, approximately 500 Americans succumbed to carbon monoxide poisoning and since they (carbon monoxide) were silent killers, it’s pretty much difficult for people to admit themselves were having problems and submit to treatments.
I mean, we believe only things we can see right and since we can see ghosts (and not carbon monoxide), it is easier to believe that you were haunted and rush yourself to the nearest church/mosque/temple or any spiritual places to dispel them.
So, Why People Are Seeing Ghosts?
If it is carbon monoxide, then it’s relatively easy to be detected but there are others which are not being poisoned by carbon monoxide but they were seeing things. Seeing, hearing, feeling something on your skin when there was nothing, that was hallucinations. An illusion is a misinterpreted stimulus (i.e. we misinterpret white curtains as ghosts).
Neither I not everyone else can say for sure what has been bugging you all day long, but with a few investigations and probably environment scanning, we can pretty much figure out and rule out some causes to achieve a definite conclusion.
Science has been winning all the paranormal battles (they were supposed to win all), and I would expect someday, if we were to discover other forms of entities, it would be by using science as well. There are a lot of people who have been listening to unknown voices especially when they were stressed, usually known as the auditory hallucination.
Schizophrenia is one of the most popular diagnoses of mental disorder if people started to complain they can hear, see, perceive or feel something that isn’t there.
I have repeated over and over again that nothing is absolute in medicine.
Even though schizophrenia is a popular opinion among medical practitioners, scientists have found various explanation to uncover the mystery of seeing things that others can’t.
It was speculated that all of the places across the globe, possessed various degrees of electromagnetic waves.
This particular wave can mess with our head as they can interact and alter the activity in the temporal lobe causing visual and auditory hallucination.
Some research at the most haunted places in the world has proved that electromagnetic waves can cause different sets of symptoms that give weird sensation to an individual. We are talking about feeling dread for no reason, feel like being followed/observed, hear weird sounds etc.
One of the most popular experiment to investigate the effect of high electromagnetic waves on humans was carried out by Dr Michael Persinger by utilising a specific apparatus called Koren’s helmet developed by Stanley Koren.
Of course, you might know this particular apparatus with different names, sometimes it is called God helmet and sometimes, people knew this apparatus as Shiva helmet.
All of the name mentioned describe the same apparatus and initially, it was developed to study the effect of religion on the temporal lobe’s activity.
The helmet can’t really produce high electromagnetic waves but the level of emission (which is relatively weak) is just enough to trigger an unusual temporal lobe’s activity which would cause some kind of perception that there is something in a specified place whereas normal, healthy individual would find nothing.
There are a lot of discussions which have been held in the past regarding this topic but most of the scientists believe that the most important factor which could have made you hallucinate is not only the emission of weak electromagnetic forces but rather suggestibility.
People would see what they want to see/believe. It’s undeniable that our mind holds the power of making certain things possible when someone is really convinced that they were, in fact, would become affected by a specified variable of an event.
People who think they are sick would really get sick and sicker as the day goes by and it was well-documented regarding how mass hysteria could cause some manifestations of unrelated physical symptoms that couldn’t be explained by any medical diagnosis.
When people saw someone was sick and they were convinced they have been infected, any related symptoms that would have appeared after that would only make things worse (even if they have that kind of symptoms when they were healthy like tremors etc.).
Can people see ghosts if they were affected by a certain level of electromagnetic waves? Probably but I can say for certain that it can be caused by others as well.
We have a lot of deductions and even research papers which has been presented in certain publication sites regarding how certain factors can cause people to hallucinate and see something others don’t i.e. infrasound, electromagnetic waves, psychological consequences, psychiatric condition, drugs and alcohol intoxication etc.
So far, whatever has been documented still can be explained by science but as a believer, even if we believe there is a realm which can’t be perceived with our naked eyes, even if we can’t really prove that kind of hypothesis, doesn’t necessarily mean they aren’t real.
Yeah, we might be living with other paranormal entities in the same world (different realms) but if someone saw something which can’t be perceived by others and can be explained by science or a specific medical condition, then, it is pretty much null on the ghost hypothesis, isn’t it?
Yeah, people have their own right to see any kind of spiritual healers when they believe they have been possessed by evil spirits, but my recommendation would be to never abandon science as a potential solution to the problem at hand.
Whatever kind of hallucination you would have experienced, I bet some of them can be fatal or causes some kind of deterioration in health status; it will be too late if the condition progresses up to the point there is nothing we can do, even with science.
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