2. Losing a spouse, of course, is one of the most stressful of life events, but bereavement may happen in many other situations, from the loss of a job to the loss of a beloved pet. A friend of mine was very upset when her twenty-year-old cat died, and for months she "saw" the cat and its characteristic movements in the folds of the curtains.

Another friend, Malonnie K., described a different sort of cat hallucination, after her beloved seventeen-year-old pet died:

Much to my surprise, the next day I was getting ready for work and she appeared at the bathroom door, smiled and meowed her usual "good morning." I was flabbergasted. I went to tell my husband and when I returned, of course, she was no longer there. This was upsetting to me because I have no history of hallucinations and thought I was "above" such things. However, I have accepted that this experience was, perhaps, a result of the phenomenally close bond that we had developed and sustained over nearly two decades. I must say, I am so grateful that she stopped by one last time.

3. Loss, longing, and nostalgia for lost worlds are also potent inducers of hallucinations. Franco Magnani, "the memory artist" I described in An Anthropologist on Mars, had been exiled from Pont.i.to, the little village where he grew up, and although he had not returned to it in decades, he was haunted by continual dreams and hallucinations of Pont.i.to-an idealized, timeless Pont.i.to, as it looked before it was invaded by the n.a.z.is in 1943. He devoted his life to objectifying these hallucinations in hundreds of nostalgic, beautiful, and uncannily accurate paintings.

4. Though "flashback" is a visual, cinematic term, auditory hallucinations can be very striking, too. Veterans with PTSD may hallucinate the voices of dying comrades, enemy soldiers, or civilians. Holmes and Tinnin, in one study, found that the hearing of intrusive voices, explicitly or implicitly accusing, affected more than 65 percent of veterans with combat PTSD.

5. Sometimes this effect can be heightened by medications. In 1970, I had one patient with postencephalitic parkinsonism who was a concentration camp survivor. For her, treatment with L-dopa caused an intolerable exacerbation of her traumatic nightmares and flashbacks, and we had to discontinue the drug.

6. In the "normal" neuroses commonly brought to psychotherapists, the buried, pathogenic material typically comes from much earlier in life. Such patients are also haunted, but as in the t.i.tle of Leonard Shengold's book, they are Haunted by Parents.

7. Freud was deeply puzzled and troubled by the pertinacity of such post-traumatic syndromes after World War I. Indeed, they forced him to question his theory of the pleasure principle and, at least in this case, to see instead a much grimmer principle at work, that of repet.i.tion-compulsion, even though this seemed maladaptive, the very ant.i.thesis of a healing process.

8. Many of the testimonies and accusations in the Salem witch trials described a.s.saults by hags, demons, witches, or cats (which were seen as witches' familiars). The cats would sit astride sleepers, pressing on their chests, suffocating them, while the sleepers had no power to move or resist. These are experiences we would now interpret in terms of sleep paralysis and night-mare, but which were given a supernatural narrative. The whole subject is explored by Owen Davies in his 2003 article "The Nightmare Experience, Sleep Paralysis, and Witchcraft Accusations."

Other conditions have also been suggested as contributing to the hallucinations and hysteria of seventeenth-century New En gland. One hypothesis, which Laurie Winn Carlson proposes in her book A Fever in Salem, sees the madness as a manifestation of a postencephalitic disorder.

Others have proposed that ergot poisoning played a part. Ergot, a fungus containing toxic alkaloid compounds similar to LSD, can infest rye and other grains, and if contaminated bread or flour is eaten, ergotism may result. This happened frequently in the Middle Ages, and it could cause agonizing gangrene (which led to one of its popular names, St. Anthony's fire). Ergotism could also cause convulsions and hallucinations very similar to those of LSD.

In 1951, an entire French village succ.u.mbed to ergot poisoning, as John Grant Fuller described in his book The Day of St. Anthony's Fire. Those affected endured several weeks of terrifying hallucinations and often compulsions to jump from windows, as well as extreme insomnia.

9. This was shown experimentally by Brady and Levitt in a 1966 study, in which they suggested to hypnotized subjects that they "see" (i.e., hallucinate) a moving visual stimulus (a rotating drum with vertical stripes). The subjects' eyes, as they did this, showed the same automatic tracking movements ("optokinetic nystagmus") that occur when one is actually looking at such a rotating drum-whereas no such movements occur (and they are impossible to feign) if one merely imagines such a visual target.

14

Doppelgangers: Hallucinating Oneself

Sleep paralysis may be a.s.sociated, as some of my correspondents have emphasized, with a sense of floating or levitation, and even hallucinations of leaving one's own body and flying through s.p.a.ce. These experiences, so unlike the hideous night-mare ones, may go with feelings of calm and joy (some of Cheyne's subjects used the term "bliss"). Jeanette B., who has had a lifetime of narcolepsy and sleep paralysis (which she refers to as "spells"), described this to me:

It was after college that the spells became both a burden and a blessing. Not being able to pull myself out of the paralysis one night, I let go; and felt myself slowly rising out of my body! I had come through the terror part and felt a wonderful peaceful bliss as I rose out of my body and floated up. Now, as I experienced this I found it very difficult to believe it was a hallucination. All of my senses seemed unusually sharp: someone's radio playing in another room, crickets chirping outside the window. Without going into detail, this was a hallucination that was more pleasant than anything I had ever experienced....

I suppose I became so nearly addicted to the out of body experiences, that when offered some meds from my neurologist to help with the nighttime paralysis and hallucinations, I refused, rather than give up the out of body experiences. I didn't say that was the reason.

For quite some time, I would try to will myself into that pleasant hallucination. I discovered it usually came after much stress or lack of sleep, and would deprive myself of sleep in order to achieve the experience of floating amongst the stars, high enough to observe the curvature of the earth....

But bliss can coincide with terror-Peter S., a friend, found this when he had a single episode of sleep paralysis with hallucination. It seemed to him that he left his body, cast a backward glance at it, then soared up into the sky. He had an enormous sense of freedom and joy, now that he had left the limitations of his human body, a feeling that he could roam at will through the universe. But there was also a fear, which became terror, that he might be lost forever in infinity, unable to rejoin his body on earth.

Out-of-body experiences may occur when specific regions of the brain are stimulated in the course of a seizure or a migraine, as well as with electrical stimulation of the cortex.1 They may occur with drug experiences and in self-induced trances. OBEs can also occur when the brain is not receiving enough blood, as may happen if there is a cardiac arrest or arrhythmia, ma.s.sive blood loss, or shock.

My friend Sarah B. had an OBE in the delivery room, just after giving birth. She had delivered a healthy baby, but she had lost a lot of blood, and her obstetrician said that he would have to compress the uterus to stop the hemorrhage. Sarah wrote:

I felt my uterus being squeezed and told myself not to move or cry out.... Then, suddenly, I was floating with the back of my head against the ceiling. I was looking down on a body which was not my own. The body was some distance from me.... I watched the doctor pound on this woman and heard him grunt loudly with his efforts. I thought, "This woman is very inconsiderate. She is giving Dr. J. a lot of trouble." ... So I was completely oriented to time, day, place, people, and event. I was just unaware that the center of the drama was myself.

After some time, Dr. J. withdrew his hands from the body, stepped back, and announced that the bleeding had stopped. As he said this, I felt myself slip back into my body like an arm sliding into the sleeve of a coat. I was no longer looking, from a distance, down on the doctor; instead he was looming above and quite close to me. His green surgical scrubs were covered with blood.

Sarah had critically low blood pressure, and it was probably this-her brain getting insufficient oxygen-which precipitated the OBE. Anxiety may have const.i.tuted an additional factor, as rea.s.surance did in ending the attack, despite her still very low blood pressure. Her not recognizing her own body is curious, though it is commonly reported that the body looks "vacated" or "empty" when the now-disembodied self looks down on its former home.

Another friend, Hazel R., a chemist, told me of an experience she had many years ago, also when she was in labor. She was offered heroin for her pain (this was common in England in those days), and as the heroin took effect, she felt herself floating upwards, coming to rest beneath the ceiling in the corner of the delivery room. She saw her body beneath her, and she had no pain whatever-she felt that the pain had stayed in the body below her. She also had a sense of great visual and intellectual acuity: she felt that she could easily solve any problem (unfortunately, she said wryly, no problem presented itself). As the heroin wore off, she returned to her body and its violent contractions and pain. When her obstetrician told her she could have a further dose, she asked if it could affect the baby adversely. Once she was rea.s.sured that it would not, she a.s.sented to a second dose, and again she enjoyed a detachment from her body and its labor pains, as well as a feeling of supernal mental clarity.2 Although this occurred more than fifty years ago, Hazel still remembers every detail.

It is not easy to imagine such detachment from the body if one has never experienced it. I have never had an OBE myself, but I was once involved in a remarkably simple experiment which showed me how easily one's sense of self can be detached from one's body and "reembodied" in a robot. The robot was a ma.s.sive metal figure with video cameras for "eyes" and lobsterlike claws for "hands," designed for training astronauts to operate similar machines in s.p.a.ce. I donned goggles connected to the video cameras, so that in effect I was seeing the world through the robot's eyes, and I inserted my hands into gloves with sensors that would register my movements and transmit them to the robot's claws. As soon as I was connected, looking out through the robot's eyes, I had the odd experience of seeing, a few feet to my left, an oddly small figure (did it seem small because I, embodied in the robot, was now so large?) sitting in a chair and wearing goggles and gloves, a vacated figure who I realized, with a start, must be me.

Tony Cicoria, a surgeon, was struck by lightning a few years ago and suffered a cardiac arrest. (I tell his whole, complex story in Musicophilia.) He recounted this to me:

I remember a flash of light ... hit me in the face. Next thing I remember, I was flying backwards ... [then] I was flying forwards. I saw my own body on the ground. I said to myself, "Oh s.h.i.t, I'm dead." I saw people converging on the body. I saw a woman ... position herself over my body, give it CPR.

Cicoria's OBE became more complex. "There was a bluish-white light ... an enormous feeling of well-being and grace"; he felt he was being drawn into heaven (his OBE had evolved into a "near-death experience," which is not the case with most OBEs), and then-it could have been little more than thirty or forty seconds from the moment he was struck by lightning-"Slam! I was back."

The term "near-death experience" (NDE) was introduced by Raymond Moody in his 1975 book Life After Life. Moody, culling information from many interviewees, delineated a remarkably uniform and stereotyped set of experiences common to many NDEs. A majority of people felt that they were being drawn into a dark tunnel and then propelled towards a brightness (which some interviewees called "a being of light"); and, finally, they sensed a limit or barrier ahead-most interpreted this as the boundary between life and death. Some experienced a rapid replay or review of events in their lives; others saw friends and relatives. In a typical NDE, all this was suffused with a sense of peace and joy so intense that being "forced back" (into one's body, into life) might be accompanied by a strong sense of regret. Such experiences were felt as real-"more real than real," as was often commented. Many of Moody's interviewees favored a supernatural interpretation for these remarkable experiences, but others have increasingly tended to regard them as hallucinations, albeit of an extraordinarily complex kind. A number of researchers have sought a natural explanation in terms of brain activity and blood flow, since NDEs are especially a.s.sociated with cardiac arrest and may also occur in faints, when blood pressure plunges, the face becomes ashen, and the head and brain are drained of blood.

Kevin Nelson and his colleagues at the University of Kentucky have presented evidence suggesting that, with the compromise of cerebral blood flow, there is a dissociation of consciousness so that, although awake, the subjects are paralyzed and subject to the dreamlike hallucinations characteristic of REM sleep ("REM intrusions")-in a state, therefore, with resemblances to sleep paralysis (NDEs are also commoner in people p.r.o.ne to sleep paralysis). Added to this are various special features: the "dark tunnel" is correlated, Nelson feels, with the compromise of blood flow to the retinas (this is well known to produce a constriction of the visual fields, or tunnel vision, and may occur in pilots subjected to high g-stresses). The "bright light" Nelson correlates with a flow of neuronal excitement moving from a part of the brain stem (the pons) to subcortical visual relay stations and then to the occipital cortex. Added to all these neurophysiological changes may be a sense of terror and awe going with the knowledge that one is undergoing a mortal crisis-some subjects have actually heard themselves p.r.o.nounced dead-and the wish that dying, if imminent and inevitable, should be peaceful and perhaps a pa.s.sage to a life after death.

Both Olaf Blanke and Peter Brugger have studied such phenomena in several patients with severe epilepsy. Like Wilder Penfield's patients in the 1950s, people with intractable seizures that do not respond to medication may need surgery to remove the epileptic focus responsible. Such surgery requires extensive testing and mapping to find the seizure focus and to avoid damaging vital areas. The patient must be awake during this procedure, so that he can report what he is experiencing. Blanke was able to demonstrate that stimulating certain areas of the brain's right angular gyrus invariably caused OBEs in one such patient, as well as feelings of lightness and levitation and changes in body image; the patient saw her legs "becoming shorter" and moving towards her face. Blanke et al. speculate that the angular gyrus is a crucial node in a circuit that mediates body image and vestibular sensations, and that "the experience of dissociation of self from the body is a result of failure to integrate information from the body with vestibular information."

At other times, one is not disembodied but sees a double of oneself from one's normal viewpoint, and the other self often mimics (or shares) one's own postures and movements. These autoscopic hallucinations are purely visual and usually fairly brief-they may occur, for instance, in the few minutes of a migraine or epileptic aura. In his delightful history of migraine, "Migraine: From Cappadocia to Queen Square," Macdonald Critchley describes this in the great naturalist Carl Linnaeus:

Often Linnaeus saw "his other self" strolling in the garden parallel with himself, and the phantom would mimic his movements, i.e. stoop to examine a plant or to pick a flower. Sometimes the alter ego would occupy his own seat at his library desk. Once at a demonstration to his students he wanted to fetch a specimen from his room. He opened the door rapidly, intending to enter, but pulled up at once saying, "Oh! I'm there already."

A similar hallucination of a double was seen regularly by Charles Lullin, the grandfather of Charles Bonnet, for about three months, as Douwe Draaisma describes:

One morning as he was quietly smoking his pipe at the window, he saw on his left a man leaning casually against the window frame. Except for the fact that he was a head taller, the man looked exactly like him: he was also smoking a pipe, and he was wearing the same cap and the same dressing gown. The man was there again the next morning, and he gradually became a familiar apparition.

The autoscopic double is literally a mirror image of oneself, with right transposed to left and vice versa, mirroring one's positions and actions. The double is a purely visual phenomenon, with no ident.i.ty or intentionality of its own. It has no desires and takes no initiatives; it is pa.s.sive and neutral.3

Jean Lhermitte, reviewing the subject of autoscopy in 1951, wrote: "The phenomenon of the double can be produced by many other diseases of the brain besides epilepsy. It appears in general paralysis [neurosyphilis], in encephalitis, in encephalosis of schizophrenia, in focal lesions of the brain, in post-traumatic disorders.... The apparition of the double should make one seriously suspect the incidence of a disease."

It is now thought that a substantial number-perhaps a third-of all cases of autoscopy may be a.s.sociated with schizophrenia, and even cases of manifestly physical or organic origin may be sensitive to suggestion. T. R. Dening and German Berrios described a thirty-five-year-old man whose apparitions were related to temporal lobe seizures following a head injury. The man said that he had once seen his ties hanging up as a rack of snakes, but when asked whether he had any outright hallucinations or autoscopic experiences, he said no. A week later, he came in for another appointment in a state of some excitement, for he had now had an autoscopic experience:

He had been sitting in a cafe, when he was suddenly aware of an image of himself, about 1520 yards away, looking in through the cafe window. The image was dark and looked like him at the age of nineteen (when his accident occurred). It did not speak and probably lasted for less than a minute. He felt amazed and uncomfortable, as though physically struck, and he felt he had to get up and leave. It is difficult not to suppose that the timing of this episode was influenced by the questions asked by the psychiatrist in the previous week.