Hearing voices

When “A Beautiful Mind” – Ron Howard’s film about schizophrenic mathematician John Nash – debuted in 2001, it was criticized in some circles for its depiction of schizophrenic hallucinations. As a filmmaker, of course, Howard chose to unspool his tale of madness – and thus build suspense – visually.

But in fact, schizophrenic hallucinations are auditory, says Dr. Mark Rubinstein. The schizophrenic doesn’t see images that aren’t there. He hears voices that don’t exist except inside his head.

The subject of hallucinations – which Rubinstein defines as “sensory perceptions by an individual with no perceivable source” – is a complex one. The Wilton resident has had more than his share of encounters with these as a general and forensic psychiatrist who is now a full-time writer and author of the new thriller “Love Gone Mad.”

“Hallucinations run a spectrum from normal to extremely pathological,” he says. Within the realm of normal experience are the auditory and visual hallucinations you experience while dreaming. You might also experience a flash of light or hear a bell or a voice – phenomena that are hypnagogic or pompnagogic, depending on whether or not they occur respectively as you are about to fall asleep or between sleep and wakefulness.

Other hallucinations are far more disquieting. They can be the visual hallucinations of “the proverbial pink-elephant kind,” Rubinstein says, caused by everything from alcoholism and cocaine addiction to certain kinds of fevers to uremic poisoning.

“Visual hallucinations have a toxic, metabolic or physical causation,” he says.

Then there are somatic hallucinations that manifest themselves as formications. You feel as if bugs are crawling over your skin or a tingling sensation. Again, these can present themselves in cases of severe alcoholism.

Auditory hallucinations can be associated with severe depression, bipolar disorder and schizophrenia. There are different types of schizophrenia, which in turn are just some of the forms of psychosis, “which involves an individual losing the ability to determine the difference between reality and fantasy,” Rubinstein says.

Not all of the schizophrenic’s hallucinations may be dangerous. They could be a pleasant voice saying “Hello” or a more insistent one commanding you to “Go to bed.”

But in some cases, the voices can be accusatory or paranoid, leading to feelings of unworthiness and fear and spurring the schizophrenic to suicide and/or murder. Such appears to be the case of government contractor Aaron Alexis, a paranoid schizophrenic who heard voices and believed people were following him and using machines to cause vibrations in his body. His delusion, which Rubinstein defines as “a false, fixed belief that is not held by your peers and is contrary to actual experience,” may be what led him to kill 12 people in the Washington Navy Yard Sept. 16 before police killed him.

Alexis is also an example of how hallucinations take on “a cultural coloration,” Rubinstein says. Some 150 years ago, there were no hallucinations involving low-frequency radio waves, which Alexis believed were tormenting him. But though the means through which hallucinations present themselves change with technology, there are some constants, Rubinstein says. These include Jesus, perhaps the seminal figure in Western civilization, and more generally God and the Devil.

Visions and voices date from at least ancient times. Rubinstein points to Saul of Tarsus, who persecuted the early Church but was converted on the road to Damascus, where he was struck blind and heard the voice of Jesus saying, “Saul, Saul, why do you persecute me?” Rubinstein notes that Saul, better known today as St. Paul, was an epileptic, which might explain his Damascus moment – science not being in the business of validating mysticism.

The truth, Rubinstein says, is that we don’t know what causes hallucinations. In his provocative 1976 book “The Origins of Consciousness and the Breakdown of the Bicameral Mind,” the late Princeton University psychology professor Julian Jaynes suggests that they are a remnant of an early age when men received godlike commands (as in Homer’s “The Iliad”) that were nothing more than the nonverbal right brain instructing its chatty left-brain counterpart. When consciousness developed after a string of geopolitical crises, hallucinations became the exception rather than the rule.

But Rubinstein says there is no evidence for this. What is proven is that with antipsychotic drugs, therapy and strong family support, schizophrenics can lead normal lives.

Nonetheless, he adds, “what typically happens is the patient feels better, stops taking the medication, and then it’s back to square one.”

For more on Mark Rubinstein, visit markrubinstein-author.com.

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