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Hallucinations in the movies tend to be about chaos, violence and mental distress. But they can be positive too

<p><em><a href="https://theconversation.com/profiles/christopher-patterson-308185">Christopher Patterson</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/nicholas-procter-147517">Nicholas Procter</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180"><em>University of South Australia</em></a></em></p> <p>Hallucinations are often depicted in the movies as terrifying experiences. Think Jake Gyllenhaal seeing a monstrous rabbit in <em><a href="https://www.imdb.com/title/tt0246578/">Donnie Darko</a></em>, Leonardo DiCaprio experiencing the torture of <em><a href="https://www.psychologytoday.com/au/blog/reel-therapy/201002/shutter-island-separating-fact-fiction">Shutter Island</a></em>, Natalie Portman in <em><a href="https://www.imdb.com/title/tt0947798/">Black Swan</a></em>, or Joaquin Phoenix as the <em><a href="https://www.theguardian.com/film/2019/oct/21/joker-mental-illness-joaquin-phoenix-dangerous-misinformed">Joker</a></em>.</p> <p>Each character experiences some form of psychological distress. Scenes connect to, or even explain, a decline into chaos and violence.</p> <p>Experiencing hallucinations can be distressing for some people and their loved ones. However, focusing solely on such depictions perpetuates myths and misconceptions about hallucinations. They also potentially perpetuate harmful stereotypes of mental distress.</p> <p>Movies such as Joker use a broad, <a href="https://www.theguardian.com/film/2019/oct/21/joker-mental-illness-joaquin-phoenix-dangerous-misinformed">arguably incorrect</a>, brush to connect hallucinations, mental health issues and violence. This reinforces the misconception that hallucinations always indicate mental health issues, when this is not necessarily true.</p> <h2>What are hallucinations?</h2> <p>Hallucinations are perceptions that occur without a corresponding external stimulus. They can involve any of the human senses.</p> <p>Auditory hallucinations involve hearing things that aren’t there, such as voices or sounds. Visual hallucinations involve seeing things that aren’t there, such as lights, objects or people. Tactile hallucinations involve feeling things that aren’t there, such as a sensation of something crawling on your skin. Gustatory hallucinations involve taste and smell.</p> <p>People often confuse hallucinations and delusions. The two can be related, but they are not the same thing. Delusions are false beliefs, firmly held by a person despite evidence to the contrary. A person might believe someone is following them (a delusion), and see and hear that figure (a hallucination).</p> <p>Before the 17th century, hallucinations were commonly thought to be of <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00991/full">cultural and religious</a> significance.</p> <p>However, between the mid-1600s and 1700s, hallucinations began to be understood as medical concerns, related to both mental and physical illnesses. This medical lens of hallucination remains. Now we know which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702442/">parts of the brain</a> are activated when someone has a hallucination.</p> <h2>What causes hallucinations?</h2> <p>Hallucinations can be a sign of serious mental health issues. The presence or experience of hallucinations is, for example, one of the criteria used to <a href="https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Schizophrenia.pdf">diagnose schizophrenia</a> (delusions are another).</p> <p>Hallucinations may also provide insight into mental health issues such as bipolar disorder, post-traumatic stress disorder and depression.</p> <p>However, hallucinations can also be linked to other medical conditions.</p> <p>Hallucinations can be caused by fever, as well as disease or damage impacting the brain or <a href="https://theconversation.com/what-is-charles-bonnet-syndrome-the-eye-condition-that-causes-hallucinations-122322">optic nerves</a>. Parkinson’s disease causes visual, auditory and tactile hallucinations <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116251/">in up to 75% of people</a>. Epilepsy and migraine headaches are also linked to hallucinations, and can cause perceptual disturbances, sometimes for days. Substance use, particularly of <a href="https://theconversation.com/weekly-dose-ayahuasca-a-cautionary-tale-for-tourists-eager-to-try-this-shamanic-brew-73953">hallucinogenic drugs</a> such as LSD or ketamine, can also cause hallucinations.</p> <p>Hallucinations can also occur in people without any underlying medical conditions. For example, some people may experience hallucinations during times of <a href="https://academic.oup.com/schizophreniabulletin/article/46/6/1367/5939754">extreme distress or grief</a>.</p> <p>Environmental factors such as <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00303/full">sleep deprivation</a> can cause a range of perceptual disturbances, including visual and auditory hallucinations. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354964/">Sensory deprivation</a>, such as being placed in a soundproof room, can also cause hallucinations.</p> <p>But still, the common image that hallucinations are connected only to mental health issues persists.</p> <h2>Hallucinations can be frightening, but not always</h2> <p>Hallucinations can be frightening for people, and their families. And the <a href="https://journals.sagepub.com/doi/10.1177/0020764016675888">stigma</a> and misconceptions surrounding hallucinations can have a significant impact on someone who experiences them.</p> <p>People who have hallucinations may be afraid or embarrassed of being considered “bizarre” or “unsafe”, and therefore may avoid seeking help.</p> <p>But hallucinations are <a href="https://www.intervoiceonline.org/voices-visions/voices-as-a-gift">not always scary or disturbing</a>. Some hallucinations can be neutral or even pleasant. People have been sharing on social media their positive and empowering experience of hallucinations. In the example below, we see one person’s positive experience of hearing voices. Yet we rarely see such depictions of hallucinations in the movies.</p> <hr /> <p><iframe id="tc-infographic-853" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/853/9f702c4fefadeb810f9d64d7b4512b39a655a262/site/index.html" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <h2>How to support someone having hallucinations</h2> <p>If you are with someone who is having hallucinations, particularly if these are new or distressing for them, here are several ways you can support them:</p> <ul> <li> <p>ask the person if they want to talk about what they are experiencing and listen to them without judgment: “I cannot hear what you are hearing, can you tell me about it?”</p> </li> <li> <p><a href="https://tuneinnotout.com/videos/r-u-ok-ask-experts-nicholas-procter/">listen</a>. Don’t argue or blame. Acknowledge that hallucinations are real to the person, even if they are seemingly unusual and not based in reality: “I cannot see what you see, but I do understand you see it.”</p> </li> <li> <p>empathise with how the person feels about their experiences. “I cannot feel or taste it, but I can imagine it would be a difficult experience. I can see how much it is concerning you.”</p> </li> <li> <p>support someone to seek care. Persistent or distressing hallucinations should always be evaluated by a qualified health professional. Establishing potential causes is important: “I cannot hear it like you, but let’s talk to a health professional about it. They can help us understand what might be happening.”</p> </li> <li> <p>encourage the person to <a href="https://www.intervoiceonline.org/national-networks#content">reach out to their peers</a> as well as to <a href="https://www.tandfonline.com/doi/full/10.1080/01612840.2023.2189953?src=recsys">hearing voices groups</a> for ongoing support.</p> </li> </ul> <p><em>We’d like to acknowledge <a href="https://www.nswmentalhealthcommission.com.au/staff-profile/tim-heffernan">Tim Heffernan</a>, Deputy Commissioner of the Mental Health Commission of New South Wales, who contributed to this article.</em></p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. <!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/christopher-patterson-308185">Christopher Patterson</a>, Senior Lecturer, School of Nursing, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/nicholas-procter-147517">Nicholas Procter</a>, Professor and Chair: Mental Health Nursing, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hallucinations-in-the-movies-tend-to-be-about-chaos-violence-and-mental-distress-but-they-can-be-positive-too-204547">original article</a>.</em></p>

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What is Charles Bonnet syndrome – the eye condition that causes hallucinations?

<p>Visual hallucinations, or seeing things that aren’t really there, can be frightening and distressing.</p> <p>They may occur due to a large variety of physical and psychiatric conditions. But a lesser known cause is Charles Bonnet syndrome (pronounced <em>bo-nay</em>), named after the <a href="https://www.britannica.com/biography/Charles-Bonnet">Swiss scientist</a> who first described the condition in 1760.</p> <p>Charles Bonnet syndrome (also called visual release hallucinations) refers to visual hallucinations in patients with severe vision loss due to eye, optic nerve or brain disease.</p> <p>We don’t know the exact cause of Charles Bonnet syndrome. But the most commonly accepted theory is the loss of visual sensory signals to the brain (for example, when a person becomes blind) means the brain cannot put the brakes on <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1479-8301.2009.00288.x">excessive and unwanted brain activity</a>.</p> <p>This leads the part of the brain responsible for the sensation of vision (the visual cortex) to fire signals inappropriately. The person in turn perceives they are seeing something in the absence of a true stimulus – a visual hallucination.</p> <p>If these symptoms are affecting you, a friend or family member who has become blind in one or both eyes, it’s important to understand it’s not a sign of “going mad”.</p> <p><strong>What are Charles Bonnet hallucinations like?</strong></p> <p>The hallucinations may be “simple” (such as lines, shapes, or flashes of light) or “complex” (such as formed images of animals, like butterflies). Simple hallucinations are much more common.</p> <p>They may occur for seconds or minutes to hours or continuously, and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/9091601">frequency ranges</a> from isolated episodes to multiple times a day. It’s normal for Charles Bonnet syndrome to <a href="https://pubmed.ncbi.nlm.nih.gov/24825847-negative-outcome-charles-bonnet-syndrome/?from_term=Cox+TM&amp;from_cauthor_id=24825847&amp;from_pos=1">last for years</a>; some people will experience symptoms for the rest of their lives.</p> <p>The nature of Charles Bonnet hallucinations is highly variable. That is, people who are affected often don’t see the same thing repeatedly, and one person with Charles Bonnet syndrome will see different things from the next person.</p> <p>Charles Bonnet hallucinations often have little or no emotional meaning, allowing affected people to <a href="https://www.ncbi.nlm.nih.gov/pubmed/8622335">recognise they are not real</a>. This is distinct from hallucinations associated with mental illness.</p> <p>Other features of visual hallucinations unique to Charles Bonnet syndrome include:</p> <ul> <li>hallucinations only appear in the areas where vision is lost (for example, a person who is blind in their left eye will perceive hallucinations only in that eye)</li> <li>hallucinations are more frequently seen with the <a href="https://www.ncbi.nlm.nih.gov/pubmed/8622335">eyes open than closed</a>, and may disappear when the person closes their eyes or looks away</li> <li>hallucinations are more common in settings of <a href="https://www.ncbi.nlm.nih.gov/pubmed/8622335">sensory deprivation</a> (for example, at night time or in dim lighting, or during periods of inactivity).</li> </ul> <p><strong>Who is affected?</strong></p> <p>Most people with Charles Bonnet syndrome are <a href="https://www.ncbi.nlm.nih.gov/pubmed/18983551">older adults</a> (usually over 70). This is probably because vision loss is most common in this age group. But any person of any age with acquired vision loss can develop Charles Bonnet syndrome.</p> <p>The causes of blindness that lead to Charles Bonnet syndrome are usually macular degeneration, glaucoma, <a href="https://www.hollows.org/au/eye-health/diabetic-retinopathy?gclid=Cj0KCQiA2vjuBRCqARIsAJL5a-JKWwv0VqzUfB0BH7XZVpJzIKDMYh_5kfXTuPe13_CGEjkAd4OlnXAaAhV5EALw_wcB&amp;gclsrc=aw.ds">diabetes</a>, <a href="https://www.visionaustralia.org/information/eye-conditions/stroke?utm_source=google&amp;utm_medium=cpc&amp;gclid=Cj0KCQiA2vjuBRCqARIsAJL5a-JO8Ty6cKPi-X8IkE7mWs90kZtUbz4UvwbewgvMyqgXYyybMfFTvVEaAp-pEALw_wcB">stroke</a> and injury – but any disease that leads to blindness may cause Charles Bonnet syndrome.</p> <p>The syndrome does not occur in congenital blindness (people born blind from birth).</p> <p>We currently have no conclusive data on how many Australians have Charles Bonnet syndrome, although <a href="https://www.ncbi.nlm.nih.gov/pubmed/18983551">one study</a> estimated more than 17% of people aged over 60 with impaired vision had it. In <a href="https://www.ncbi.nlm.nih.gov/pubmed/2314586">another study</a>, as many as 57% of participants with vision loss reported perceived visual hallucinations.</p> <p>Importantly, it may be more common than estimated because of lack of reporting. That is, people who are affected may not report their hallucinations due to fear of psychiatric disease or of being perceived to be “going mad”.</p> <p>Further, people who do report their symptoms may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555593/">misdiagnosed</a> with psychosis or dementia.</p> <p><strong>Treatment options are limited</strong></p> <p>Seeing a general practitioner (often in conjunction with a neurologist and/or geriatrician) is an important first step to exclude other causes of hallucinations. These could include dementia, physical neurological conditions (for example, a brain tumour), epilepsy and delirium due to infections or medications. Your doctor may order blood tests and/or brain imaging to rule these out.</p> <p>Treatment for Charles Bonnet syndrome is very limited, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/11711837">many patients report</a> reassurance is all they need, especially for infrequent hallucinations or those that don’t adversely affect quality of life.</p> <p>Strategies to minimise the frequency and duration of hallucinations include frequent blinking or rapid eye movement, going to a lighter place or switching a light on, and increasing social interaction, which helps to counter inactivity.</p> <p>For patients with debilitating symptoms, doctors may trial medications such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/23676430">antidepressants</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23037678">antipsychotics</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27485168">antiepileptic drugs</a>, though their efficacy is variable and may be outweighed by side effects.</p> <p>Hallucinations may disappear if the cause of vision loss can be corrected (for example, if severe cataracts were causing blindness and the patient has a cataracts operation).</p> <p>Unfortunately though, generally the causes of vision loss that lead to Charles Bonnet syndrome can’t be treated.</p> <p><em>Written by Jason Yosar. Republished with permission of <a href="https://theconversation.com/what-is-charles-bonnet-syndrome-the-eye-condition-that-causes-hallucinations-122322">The Conversation.</a> </em></p>

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