any object of which it is asserted by the operator that it is no longer present. The reality of these positive and negative hallucinations of the hypnotized subject has been recently questioned, it being maintained that the subject merely gives verbal assent to the suggestions of the operator. But that the hypnotized subject does really experience hallucinations seems to be proved by the cases in which it is possible to make the hallucination, positive or negative, persist for some time after the termination of hypnosis, and by the fact that in some of these cases the subject, who in the post-hypnotic state seems in every other respect normal and wide awake, may find it difficult to distinguish between the hallucinatory and real objects. Further proof is afforded by experiments such as those by which Alfred Binet showed that a visual hallucination may behave for its percipient in many respects like a real object, e.g. that it may appear reflected in a mirror, displaced by a prism and coloured when a coloured glass is placed before the patient’s eyes. It was by means of experiments of this kind that Binet showed that hypnotic hallucinations may approximate to the type of the illusion, i.e. that some real object affecting the sense-organ (in the case of a visual hallucination some detail of the surface upon which it is projected) may provide a nucleus of peripherally excited sensation around which the false percept is built up. An object playing a part of this sort in the genesis of an hallucination is known as a “point de repère.” It has been maintained that all hallucinations involve some such point de repère or objective nucleus; but there are good reasons for rejecting this view.
h. In states of ecstasy, or intense emotional concentration of attention upon some one ideal object, the object contemplated seems at times to take on sensory vividness, and so to acquire the character of an hallucination. In these cases the state of mind of the subject is probably similar in many respects to that of the deeply hypnotized subject, and these two classes of hallucination may be regarded as very closely allied.
III. Hallucinations which occur as symptoms of both bodily and mental diseases.
a. Dr H. Head has the credit of having shown for the first time, in the year 1901, that many patients, suffering from more or less painful visceral diseases, disorders of heart, lungs, abdominal viscera, &c., are liable to experience hallucinations of a peculiar kind. These “visceral” hallucinations, which are constantly accompanied by headache of the reflected visceral type, are most commonly visual, more rarely auditory. In all Dr Head’s cases the visual hallucination took the form of a shrouded human figure, colourless and vague, often incomplete, generally seen by the patient standing by his bed when he wakes in a dimly lit room. The auditory “visceral” hallucination was in no instance vocal, but took such forms as sounds of tapping, scratching or rumbling, and were heard only in the absence of objective noises. In a few cases the “visceral” hallucination was bisensory, i.e. both auditory and visual.
In all these respects the “visceral” hallucination differs markedly from the commoner types of the sporadic hallucination of healthy persons.
b. Hallucinations are constant symptoms of certain general disorders in which the nervous system is involved, notably of the delirium tremens, which results from chronic alcohol poisoning, and of the delirium of the acute specific fevers. The hallucinations of these states are generally of a distressing or even terrifying character. Especially is this the rule with those of delirium tremens, and in the hallucinations of this disease certain kinds of objects, e.g. rats and snakes, occur with curious frequency.
c. Hallucinations occasionally occur as symptoms of certain nervous diseases that are not usually classed with the insanities, notably in cases of epilepsy and severe forms of hysteria. In the former disorder, the sensory aura that so often precedes the epileptic convulsion may take the form of an hallucinatory object, which in some cases is very constant in character. Unilateral hallucinations, an especially interesting class, occur in severe cases of hysteria, and are usually accompanied by hemi-anaesthesia of the body on the side on which the hallucinatory object is perceived.
d. Hallucinations occur in a large, but not accurately definable, proportion of all cases of mental disease proper. Two classes are recognized: (1) those that are intimately connected with the dominant emotional state or with some dominant delusion; (2) those that occur sporadically and have no such obvious relation to the other symptoms of disease. Hallucinations of the former class tend to accentuate, and in turn to be confirmed by, the congruent emotional or delusional state; but whether these are to be regarded as primary symptoms and as the cause of the hallucinations, or vice versa, it is generally impossible to say. Patients who suffer delusions of persecution are very apt to develop later in the course of their disease hallucinations of the voices of their persecutors; while in other cases hallucinatory voices, which are at first recognized as such, come to be regarded as real and in these cases seem to be factors of primary importance in the genesis of further delusions. Hallucinations occur in almost every variety of mental disease, but are commonest in the forms characterized by a cloudy dream-like condition of consciousness, and in extreme cases of this sort the patient (as in the delirium of chronic alcohol-poisoning) seems to move waking through a world consisting largely of the images of his own creation, set upon a background of real objects.
In some cases hallucinations are frequently experienced for long periods in the absence of any other symptom of mental disorder, but these no doubt usually imply some morbid condition of the brain.
Physiology of Hallucination.—There has been much discussion as to the nature of the neural process in hallucination. It is generally and rightly assumed that the hallucinatory perception of any object has for its immediate neural correlate a state of excitement which, as regards its characters and its distribution in the elements of the brain, is entirely similar to the neural correlate of the normal perception of the same object. The hallucination is a perception, though a false perception. In the perception of an object and in the representation of it, introspective analysis discovers a number of presentative elements. In the case of the representation these elements are memory images only (except perhaps in so far as actual kinaesthetic sensations enter into its composition); whereas, in the case of the percept, some of these elements are sensations, sensations which differ from images in having the attribute of sensory vividness; and the sensory vividness of these elements lends to the whole complex the sensory vividness or reality, the possession of which character by the percept constitutes its principal difference from the representation. Normally, sensory vividness attaches only to those presentative elements which are excited through stimulations of the sense-organs. The normal percept, then, owes its character of sensory reality to the fact that a certain number of its presentative elements are sensations peripherally excited by impressions made upon a sense-organ. The problem is, then, to account for the fact that the hallucination contains presentative elements that have sensory vividness, that are sensations, although they are not excited by impressions from the external world falling upon a sense-organ. Most of the discussions of this subject suffer from the neglect of this preliminary definition of the problem. Many authors, notably W. Wundt and his disciples, have been content to assume that the sensation differs from the memory-image only in having a higher degree of intensity; from which they infer that its neural correlate in the brain cortex also differs from that of the image only in having a higher degree of intensity. For them an hallucination is therefore merely a representation whose neural correlate involves an intensity of excitement of certain brain-elements such as is normally produced only by peripheral stimulation of sensory nerves in the sense-organs. But this view, so attractively simple, ignores an insuperable objection. Sensory vividness is not to be identified with superior intensity; for while the least intense sensation has it, the memory image of the most intense sensation lacks it completely.
