Hallucinations are disorders of perception, when a person, due to mental disorders, sees, hears, feels what in reality does not exist. It is said to be perception without an object.
Hallucinations cannot be attributed to mirages - phenomena based on the laws of physics. Like illusions, hallucinations are categorized by sense organs. Usually, auditory, visual, olfactory, gustatory, tactile and the so-called hallucinations of the general feeling are distinguished, which most often include visceral and muscle hallucinations. There may be combined hallucinations (for example, the patient sees a snake, hears its hissing and feels its cold touch).
All hallucinations, regardless of whether they are visual, auditory or other deceptions of the senses, are divided into true and pseudo-hallucinations.
True hallucinations are always projected outward, connected with a real, concretely existing situation (the "voice" sounds from behind a real wall; "devil", wagging its tail, sits on a real chair, braiding its legs with its tail, etc.), most often it does not cause patients to have no doubts about their real existence, are just as vivid and natural for the hallucinating person as real things. True hallucinations are sometimes perceived by patients even more clearly and distinctly than really existing objects and phenomena.
Pseudo-hallucinations more often than true ones are characterized by the following distinctive features:
a) most often they are projected inside the patient's body, mainly in his head (the "voice" sounds inside the head, inside the patient's head he sees a business card with indecent words written on it, etc.);
Pseudo-hallucinations, first described by V. Kandinsky, resemble representations, but differ from them, as V. Kandinsky himself emphasized, in the following features:
1) independence from human will;
Promotional video:
2) obsession, violence;
3) completeness, form of pseudo-hallucinatory images.
b) even if pseudo-hallucinatory disorders are projected outside their own body (which happens much less often), then they are devoid of the nature of objective reality inherent in true hallucinations, are completely unrelated to the real situation. Moreover, at the moment of hallucination, this situation seems to disappear somewhere, the patient at this time perceives only his hallucinatory image;
c) the appearance of pseudo-hallucinations, without causing the patient to doubt their reality, is always accompanied by a feeling of being made, adjusted, guided by these voices or visions. Pseudohallucinations are, in particular, an integral part of the Kandinsky-Clerambeau syndrome, which also includes delusions of exposure, therefore, patients are convinced that they "made a vision" with the help of special devices, "voices are directed directly into the head with transistors."
Auditory hallucinations are most often expressed in the patient's pathological perception of some words, speeches, conversations (phonemes), as well as individual sounds or noises (acoasms). Verbal (verbal) hallucinations can be very diverse in content: from the so-called hailings (the patient "hears" a voice calling his name or surname) to whole phrases or even long speeches uttered in one or more voices.
The most dangerous for the patient's condition are imperative hallucinations, the content of which is imperative, for example, the patient hears an order to be silent, to hit or kill someone, to harm himself. Due to the fact that such "orders" are a consequence of the pathology of mental activity of a hallucinating person, patients with this kind of painful experiences can be very dangerous both for themselves and for others, and therefore need special supervision and care.
Threatening hallucinations are also very unpleasant for the patient, since he hears threats against him, less often - against people close to him: they "want to stab him," "hang him," "throw him off the balcony," etc.
For auditory hallucinations are also commenting on when the patient "hears speech" about everything about whatever he thought or whatever did.
A 46-year-old patient, a furrier by trade, who has been abusing alcohol for many years, began to complain about the “voices” that “do not give him a pass”: “he is now sewing skins, but it’s bad, his hands are shaking,” “I decided to take a break,” “I went for vodka "," What a good skin did he steal ", etc.
Antagonistic (contrasting) hallucinations are expressed in the fact that the patient hears two groups of "voices" or two "voices" (sometimes one on the right and the other on the left) with a contradictory meaning ("Let's deal with them now." - "No, wait, he not so bad ";" There is nothing to wait, come on with an ax. "-" Don't touch it, he's his own on the board ").
Visual hallucinations can be either elementary (in the form of zigzags, sparks, smoke, flame - the so-called photopsies), or object-related, when the patient very often sees animals or people that do not exist in reality (including those whom he knows or knew), animals, insects, birds (zoops), objects or sometimes parts of the human body, etc. Sometimes it can be whole scenes, panoramas, for example, a battlefield, hell with many running, grimacing, fighting devils (panoramic, cinematic). "Visions" can be of ordinary sizes, in the form of very small people, animals, objects, etc. (Lilliputian hallucinations) or in the form of very large, even gigantic (macroscopic, Gulliver hallucinations). In some cases, the patient can see himself, his own image (double hallucinations, or autoscopic).
Sometimes the patient “sees” something behind him, out of sight (extracampal hallucinations).
Olfactory hallucinations most often represent an imaginary perception of unpleasant odors (the patient feels the smell of rotting meat, burning, decay, poison, food), less often - a completely unfamiliar smell, even less often - the smell of something pleasant. Often, patients with olfactory hallucinations refuse to eat, as they are sure that "poisonous substances are added to their food" or "they are fed with rotten human meat."
Tactile hallucinations are expressed in the sensation of touching the body, burning or cold (thermal hallucinations), in the sensation of grasping (haptic hallucinations), the appearance of some liquid on the body (hygric hallucinations), insects crawling over the body. The patient may feel as if he is being bitten, tickled, scratched.
Visceral hallucinations - the feeling of the presence in one's own body of some objects, animals, worms ("a frog sits in the stomach", "tadpoles have multiplied in the bladder", "a wedge is driven into the heart").
Hypnagogic hallucinations are visual deceptions of perception, which usually appear in the evening before falling asleep, with closed eyes (their name comes from the Greek hypnos - sleep), which makes them more akin to pseudo-hallucinations than true hallucinations (no connection with the real situation). These hallucinations can be single, multiple, scene-like, sometimes kaleidoscopic (“I have a kind of kaleidoscope in my eyes,” “I now have my own TV set”). The patient sees some kind of faces, grimacing, showing his tongue, winking, monsters, bizarre plants. Much less often, such hallucinations can occur during another transitional state - upon awakening. Such hallucinations, also occurring with closed eyes, are called hypnopompic.
Both of these types of hallucinations are often among the first harbingers of delirium tremens or some other intoxication psychosis.
Functional hallucinations are those that arise against the background of a real stimulus acting on the senses, and only during its action. A classic example, described by VA Gilyarovsky: a patient, as soon as water starts pouring from the tap, heard the words: "Go home, Nadenka." The auditory hallucinations also disappeared when the tap was tightened. Visual, tactile, and other hallucinations can also occur. Functional hallucinations differ from true hallucinations by the presence of a real stimulus, although they have a completely different content, and from illusions - by the fact that they are perceived in parallel with the real stimulus (it does not transform into some kind of "voices", "visions", etc.).
Induced and induced hallucinations. Hallucinatory deceptions of the senses can be instilled during a hypnosis session, when a person will feel, for example, the smell of a rose, throw off the rope that wraps around him. With a known readiness to hallucinate, hallucinations may appear even when these deceptions of feelings no longer appear spontaneously (for example, if a person has just suffered delirium, especially alcoholic). Lipman's symptom is the induction of visual hallucinations by light pressing on the patient's eyeballs, sometimes a corresponding suggestion should be added to the pressure. The symptom of a blank sheet (Reichardt's symptom) is that the patient is asked to very carefully examine a blank sheet of white paper and tell what he sees there. With Aschaffenburg's symptom, the patient is offered to talk on the switched off phone;thus, the readiness for the occurrence of auditory hallucinations is checked. When checking the last two symptoms, you can also resort to suggestion, saying, for example: "Look, what is your opinion of this drawing?", "How do you like this dog?", "What does this female voice tell you on the phone?"
Occasionally, suggested hallucinations (usually visual) can also have an induced character: a healthy, but suggestible, with hysterical traits of character, a person can, after the patient, "see" a feature, angels, some flying objects, etc. Induced hallucinations are even less common. can occur in several people, but usually for a very short time and without that clarity, imagery, brightness, as it happens in patients.
Hallucinations are a symptom of a painful disorder (although sometimes short-term, for example, under the influence of psychotomimetic drugs). But sometimes, as already noted, quite rarely, they can occur in healthy people (suggested in hypnosis, induced) or in pathology of the organs of vision (cataract, retinal detachment, etc.) and hearing.
At the same time, hallucinations are often elementary (flashes of light, zigzags, multi-colored spots, noise of foliage, falling water, etc.), but they can also be in the form of bright, figurative auditory or visual deceptions of perception.
A 72-year-old patient with vision loss to the level of light perception (bilateral cataract), who showed no mental disorders, except for a slight memory loss, after an unsuccessful operation began to say that she saw some people, mostly women, on the wall. Then these people “came off the wall and became like real people. Then a small dog appeared in the arms of one of the girls. For a while there was no one, then a white goat appeared. " Later the patient sometimes "saw" this goat and asked those around why the goat suddenly found herself in the house. The patient did not have any other mental pathology. A month later, after a successful operation on the other eye, the hallucinations completely disappeared and during the follow-up (5 years) no mental pathology, except for memory loss, was detected in the patient.
These are the so-called hallucinations of the type of Charles Bonnet - a naturalist of the 17th century, who observed hallucinations in the form of animals and birds in his 89-year-old cataract grandfather.
Patient M., 35 years old, who abused alcohol for a long time, after suffering pneumonia, began to experience fears, sleep poorly and restlessly. In the evening, anxiously called his wife and asked, pointing to the shadow of the floor lamp, "remove this ugly face from the wall." Later I saw a rat with a thick, very long tail, which suddenly stopped and asked in a "disgusting squeaky voice": "What, got drunk?" Toward nightfall I saw the rats again, suddenly jumped on the table, tried to throw the telephone on the floor, "to scare these creatures." While stationary in the emergency room, feeling his face and hands, he said irritably: "Such a clinic, but they lit the spiders, the spider web stuck around my face."
Hallucinatory syndrome (hallucinosis) is an influx of profuse hallucinations (verbal, visual, tactile) against a background of clear consciousness, lasting from 1-2 weeks (acute hallucinosis) to several years (chronic hallucinosis). Hallucinosis can be accompanied by affective disorders (anxiety, fear), as well as delusional ideas. Hallucinosis is observed in alcoholism, schizophrenia, epilepsy, organic lesions of the brain, including syphilitic etiology.
Source: Korkina M. V., Lakosina N. D., Lichko A. E. Psychiatry - M.: Medicine, 1995.