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Oliver Sacks – Hallucinations

Stephen L., an affable, outgoing man, first consulted me in the summer of 2007. He brought with him his "neurohistory," as he called it - seventeen pages of single-spaced typing - adding that he had "a little graphomania." He said his problems started after an accident thirty years before, when his car was broadsided by another, and his head slammed against the windshield.

He suffered a severe concussion but seemed to recover fully after a few days. Two months later, he started to have brief attacks of deja vu: he would suddenly feel that whatever he was experiencing, doing, thinking, or feeling he had already experienced, done, thought, or felt before. At first he was intrigued by these brief convictions of familiarity and found them pleasant ("like the breeze going past my face"), but within a few weeks he was getting them thirty or forty times a day. On one occasion, to prove that the feeling of familiarity was an illusion, he stamped his foot, threw one leg high in the air, and did a sort of Highland fling in front of a washroom mirror. He knew he had never done such a thing before, but it felt as though he were repeating something he had done many times.

His attacks became not only more frequent but more complex, the deja vu being only the start of a "cascade" (as he put it) of other experiences, which, once started, would move forward irresistibly. The deja vu would be followed by a sharp icy or burning pain in the chest, then by an alteration of hearing, so that sounds become louder, more resonant, seemed to reverberate all around him. He might hear a song as clearly as if it were being sung in the next room, and what he heard would always be a specific performance of the song - for example, a particular Neil Young song ‘'After the Gold Rush’, exactly as he had heard it during a concert at his college the year before.

He might then go on to experience a bland, pungent smell, and a taste "which corresponded with the smell”. On one occasion Stephen dreamt he was having one of his aura cascades and woke to find that he was indeed in the midst of one. But then to the usual cascade was added a strange out-of-body experience, in which he seemed to be looking down at his body as it lay in bed, through an elevated open window. This out-of-body experience seemed real-and very frightening. Frightening, in part, because it suggested to him that more and more of his brain was being involved in his seizures, and that things were getting out of control.

Nonetheless, he kept these attacks to himself until christmas of 1976, when he had a convulsion, a grand mal seizure; he was in bed with a girl at the time, and she described it to him. He consulted a neurologist, who confirmed that he had temporal lobe epilepsy, probably caused by injury to the right temporal lobe sustained during the car crash. He was put on anti-epileptics - first one, then others - but he continued to have temporal lobe seizures almost daily and two or more grand mal seizures a month. Finally after thirteen years of trying different anti-epileptic medications, Stephen consulted another neurologist for evaluation and consideration of possible surgery.

In 1990, Stephen had surgery to remove an epileptic focus in his right temporal lobe, and he felt so much better after the surgery that he decided to wean himself off medication.