Authors: Oliver Sacks
Hallucinations (15 page)
A
s a boy, I had known extreme delight in the study of chemistry and the setting up of my own chemistry lab. This delight seemed to desert me at the age of fifteen or so; in my years at school, university, medical school, and then internship and residency, I kept my head above water, but the subjects I studied never excited me in the same intense way as chemistry had when I was a boy. It was not until I arrived in New York and began seeing patients in a migraine clinic in the summer of 1966 that I began to feel a little stirring of the intellectual excitement and emotional engagement I had known in my earlier years. It was in the hope of stirring up these intellectual and emotional excitements even further that I turned to amphetamines.
I would take the stuff on Friday evenings after getting back
from work and would then spend the whole weekend so high that images and thoughts would become rather like controllable hallucinations, imbued with ecstatic emotion. I often devoted these “drug holidays” to romantic daydreaming, but one Friday, in February 1967, while I was exploring the rare book section of the medical library, I found a hefty volume on migraine entitled
On Megrim, Sick-Headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms
, written in 1873 by one Edward Liveing, MD. I had been working for several months in the migraine clinic, and I was fascinated by the range of symptoms and phenomena that could occur in migraine attacks. These attacks often included an aura, a prodrome in which aberrations of perception and even hallucinations occurred. They were entirely benign and would last only a few minutes, but those few minutes provided a window onto the functioning of the brain and how it could break down and then reintegrate. In this way, I felt, every attack of migraine opened out into an encyclopedia of neurology.
I had read dozens of articles about migraine and its possible basis, but none of them seemed to present the full richness of its phenomenology or the range and depth of suffering which patients might experience. It was in the hope of finding a fuller, deeper, and more human approach to migraine that I took out Liveing’s book from the library that weekend. So, after downing my bitter draft of amphetamine—heavily sugared to make it more palatable—I started reading. As the amphetamine effect took hold of me, stimulating my emotions and imagination, Liveing’s book seemed to increase in intensity and depth and beauty. I wanted nothing but to enter Liveing’s mind and imbibe the atmosphere of the time in which he had worked.
In a sort of catatonic concentration so intense that in ten
hours I scarcely moved a muscle or wet my lips, I read steadily through the five hundred pages of
Megrim
. As I did so, it seemed to me almost as if I were becoming Liveing himself, actually seeing the patients he described. At times I was unsure whether I was reading the book or writing it. I felt myself in the Dickensian London of the 1860s and ’70s. I loved Liveing’s humanity and social sensitivity, his strong assertion that migraine was not some indulgence of the idle rich but could affect those who were poorly nourished and worked long hours in ill-ventilated factories. In this way, his book reminded me of Mayhew’s great study of London’s working classes, but equally, one could tell how well Liveing had been trained in biology and the physical sciences, and what a master of clinical observation he was. I found myself thinking,
This represents the best of mid-Victorian science and medicine; it is a veritable masterpiece!
The book gave me what I had been hungering for during the months that I had been seeing patients with migraine, frustrated by the thin, impoverished articles which seemed to constitute the modern “literature” on the subject. At the height of this ecstasy, I saw migraine shining like an archipelago of stars in the neurological heavens.
But a century had passed since Liveing worked and wrote in London. Rousing myself from my reverie of being Liveing or one of his contemporaries, I came to and said to myself, Now it is the 1960s, not the 1860s. Who could be the Liveing of our time? A disingenuous clutter of names spoke themselves in my mind. I thought of Dr. A. and Dr. B. and Dr. C. and Dr. D., all of them good men but none of them with that mix of science and humanism that was so powerful in Liveing. And then a very loud internal voice said, “You silly bugger!
You’re
the man!”
On every previous occasion when I had come down after two days of amphetamine-induced mania, I had experienced a severe reaction in the other direction, feeling an almost narcoleptic drowsiness and depression. I would also have an acute sense of folly, thinking that I had endangered my life for nothing—amphetamines in the large doses I took would give me a sustained pulse rate close to 200 and a blood pressure of I know not what; several people I knew had died from overdoses of amphetamines. I would feel that I had made a crazy ascent into the stratosphere but had come back empty-handed and had nothing to show for it; that the experience had been as empty and vacuous as it was intense. This time, though, when I came down, I retained a sense of illumination and insight; I had had a sort of revelation about migraine. I had a sense of resolution, too, that I was indeed equipped to write a Liveing-like book, that perhaps
I
could be the Liveing of our time.
The next day, before I returned Liveing’s book to the library, I photocopied the whole thing. Then, bit by bit, I started to write my own book. The joy I got from doing this was
real
—infinitely more substantial than the vapid mania of amphetamines—and I never took amphetamines again.
1
. Curiously, lower plants—cycads, conifers, ferns, mosses, and seaweeds—lack hallucinogenic substances.
Some nonflowering plants, however, contain stimulants, as the Mormons, among others, discovered. Mormons are forbidden to use tea or coffee. But on their long march along the Mormon Trail to Utah, the pioneers who were to found Salt Lake City, the new Zion, noticed a simple herb by the roadside, an infusion of which (“Mormon tea”) refreshed and stimulated the weary pilgrims. The herb was ephedra, which contains ephedrine, chemically and pharmacologically akin to the amphetamines.
2
. Quite by accident, Hofmann discovered the hallucinogenic powers of LSD when he synthesized a new batch of the chemical in 1943. He must have absorbed some through his fingertips, for later that day he began to feel odd and went home, thinking he had a cold. As he lay in bed, he experienced “an uninterrupted stream of fantastic images of extraordinary plasticity and vividness and accompanied by an intense kaleidoscopic play of colors.” Jay Stevens, in his book
Storming Heaven: LSD and the American Dream
, recounted what came next:
Suspecting that LSD-25 had caused these fireworks, Hofmann decided to test this hypothesis.… [A few days later] he dissolved what he thought was a prudently infinitesimal amount of the drug—250 millionths of a gram—in a glass of water and drank it down. [Forty minutes later] he recorded a growing dizziness, some visual disturbance, and a marked desire to laugh. Forty-two words later he stopped writing altogether and asked one of his lab assistants to call a doctor before accompanying him home. Then he climbed onto his bicycle—wartime shortages having made automobiles impractical—and pedaled off into a suddenly anarchic universe.
3
. I am quoting from the translation provided by David Ebin in his excellent book
The Drug Experience: First-Person Accounts of Addicts, Writers, Scientists, and Others
.
4
. Louis Lewin, a German pharmacologist, published the first scientific analysis of the peyote cactus in 1886, and it was named
Anhalonium lewinii
in his honor. Later, he sought to classify various psychoactive substances based on their pharmacological effects, and he divided them into five general groups: euphoriants or sedatives (like opium), inebriants (like alcohol), hypnotics (like chloral and kava), excitants (like amphetamine and coffee), and hallucinogens, which he called phantastica. Many drugs, he noted, had overlapping and paradoxical effects, so that stimulants or sedatives could sometimes be as hallucinogenic as peyote.
5
. Benny Shanon uses this phrase as the title of his remarkable book
The Antipodes of the Mind
, which is based on personal experience as well as extensive cultural and anthropological experience with the South American hallucinogen ayahuasca. Ayahuasca is, in fact, a blend of two plants:
Psychotria viridis
and
Banisteriopsis caapi
, neither of which has any hallucinogenic power by itself. The leaves of
Psychotria
contain dimethyltryptamine (DMT), a very powerful hallucinogen—but DMT, if taken by mouth, is deactivated in the gut by monoamine oxidase (MAO).
Banisteriopsis
, however, contains compounds that inhibit the MAO and so allow the DMT to be absorbed. “When one thinks about it,” Shanon writes, “the discovery of Ayahuasca is indeed amazing. The number of plants in the rain forest is enormous, the number of their possible pairings astronomical. The common sense method of trial and error would not seem to apply.”
6
. Breslaw’s account is included in David Ebin’s book
The Drug Experience
.
7
. I have discussed neurological aspects of time and motion perception, as well as cinematic vision, at greater length in two articles, “Speed” and “In the River of Consciousness.”
8
. Very little was known in the early 1960s about how psychoactive drugs worked, and early research by Timothy Leary and others at Harvard, as well as the work of L. Jolyon West and Ronald K. Siegel at UCLA in the 1970s, focused mostly on the experiences of hallucinogens rather than their mechanisms. In 1975, Siegel and West published a wide-ranging collection of essays in their book
Hallucinations: Behavior, Experience, and Theory
. Here West set out (as he had in previous work) his release theory of hallucination.
It is now known that stimulants like cocaine and the amphetamines stimulate the “reward systems” of the brain, which are largely mediated by the neurotransmitter dopamine; this is also the case with opiates and alcohol. The classical hallucinogens—mescaline, psilocybin, LSD, and probably DMT—act by boosting serotonin in the brain.
9
. When, decades later, I told this story to my friend Tom Eisner, an entomologist, I mentioned the spider’s philosophical tendencies and Russellian voice. He nodded sagely and said, “Yes, I know the species.”
10
. Many years later, I experienced the much gentler effects of sakau, the intoxicating sap of a pepper (
Piper methysticum
, also called kava in Polynesia) cultivated in the South Pacific. Drinking sakau has been a central part of Micronesian life, as chewing coca leaves has been in the Andes, for thousands of years; and its use is formalized in elaborate sakau rituals. I described the effects of sakau at length in
The Island of the Colorblind;
it may evoke a delicious sense of floating and ease, as well as a variety of visual illusions or hallucinations.
Patterns: Visual Migraines
I
have had migraines for most of my life; the first attack I remember occurred when I was three or four years old. I was playing in the garden when a shimmering light appeared to my left, dazzlingly bright. It expanded, becoming an enormous arc stretching from the ground to the sky, with sharp, glittering, zigzagging borders and brilliant blue and orange colors. Then behind the brightness came a growing blindness, an emptiness in the field of vision, and soon I could see almost nothing on my left side. I was terrified—what was happening? My sight returned to normal in a few minutes, but these were the longest minutes I had ever experienced.
I told my mother what had happened, and she explained to me that what I had had was a migraine aura—a feeling or sensation that precedes a migraine; she was a doctor, and she too was a “migraineur.” It was a visual migraine aura, and the characteristic zigzag shape, she would later tell me, resembled that of medieval forts, so it was often called a fortification pattern.
Many people, she said, would get a terrible headache after seeing the aura.
I was lucky to be one of those people who got only the aura without the headache, and lucky, too, to have a mother who could reassure me that everything would be back to normal within a few minutes, and with whom, as I got older, I could share my migraine experiences. She explained that auras like mine were due to a sort of electrical disturbance like a wave passing across the visual parts of the brain. A similar “wave” could pass over other parts of the brain, too, she said, so one might get a strange feeling on one side of the body or experience an odd smell or find oneself temporarily unable to speak. A migraine might affect one’s perception of color or depth or movement, might make the whole visual world unintelligible for a few minutes. Then, if one were unlucky, the rest of the migraine would follow: violent headaches, vomiting, painful sensitivity to light and noise, abdominal disturbances, and a host of other symptoms.
1
Migraine was common, my mother said, affecting at least 10 percent of the population. Its classic visual presentation is a scintillating, zigzag-edged, kidney-shaped form like the one I saw, expanding and moving slowly across one half of the visual field over the course of fifteen or twenty minutes. Inside the shimmering borders of this
shape is often a blind area, a scotoma—thus the whole shape is called a scintillating scotoma.
For most people with classical migraine, the scintillating scotoma is the chief visual effect, and things go no further. But sometimes, within the scotoma, there are other patterns. In my own migraine auras, I would sometimes see—vividly with closed eyes, more faintly and transparently if I kept my eyes open—tiny branching lines like twigs or geometrical structures: lattices, checkerboards, cobwebs, and honeycombs. Unlike the scintillating scotoma itself, which had a fixed appearance and a slow, steady rate of progression, these patterns were in continual motion, forming and re-forming, sometimes assembling themselves into more complicated forms like Turkish carpets or complex mosaics or three-dimensional shapes like tiny pinecones or sea urchins. Usually these patterns stayed inside the scotoma, to one side or the other of my visual field, but sometimes they seemed to break loose and scatter themselves all over.