Hallucination, imagery, dreaming: reassembling stimulus-independent perceptions based on Edmund Parish's classic misperception framework.

Within the broad field of human perception lies the category of stimulus-independent perceptions, which draws together experiences such as hallucinations, mental imagery and dreams. Traditional divisions between medical and psychological sciences have contributed to these experiences being investigated separately. This review aims to examine their similarities and differences at the levels of phenomenology and underlying brain function and thus reassemble them within a common framework. Using Edmund Parish's historical work as a guiding tool and the latest research findings in the cognitive, clinical and computational sciences, we consider how different perspectives may be reconciled and help generate novel hypotheses for future research. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Tracing the Roots of Dementia Praecox: The Emergence of Verrücktheit as a Primary Delusional-Hallucinatory Psychosis in German Psychiatry From 1860 to 1880.

While the roots of mania and melancholia can be traced to the 18th century and earlier, we have no such long historical narrative for dementia praecox (DP). I, here, provide part of that history, beginning with Kraepelin's chapter on Verrücktheit for his 1883 first edition textbook, which, over the ensuing 5 editions, evolved into Kraepelin's mature concepts of paranoia and paranoid DP. That chapter had 5 references published from 1865 to 1879 when delusional-hallucinatory syndromes in Germany were largely understood as secondary syndromes arising from prior episodes of melancholia and mania in the course of a unitary psychosis. Each paper challenged that view supporting a primary Verrücktheit as a disorder that should exist alongside mania and melancholia. The later authors utilized faculty psychology, noting that primary Verrücktheit resulted from a fundamental disorder of thought or cognition. In particular, they argued that, while delusions in mania and melancholia were secondary, arising from primary mood changes, in Verrücktheit, delusions were primary with observed changes in mood resulting from, and not causing, the delusions. In addition to faculty psychology, these nosologic changes were based on the common-sense concept of understandability that permitted clinicians to distinguish individuals in which delusions emerged from mood changes and mood changes from delusions. The rise of primary Verrücktheit in German psychiatry in the 1860-1870s created a nosologic space for primary psychotic illness. From 1883 to 1899, Kraepelin moved into this space filling it with his mature diagnoses of paranoia and paranoid DP, our modern-day paranoid schizophrenia.

"Escrúpulos religiosos extremos" y delirio místico - religioso: entre la devoción cristiana y la psicopatología en Colombia, 1920-1960 / "Extreme religious scruples" or mystical delirium - religious: between christian devotion and psychopathology in Colombia, 1920-1960

OBJETIVO: comprender la semiología del delirio místico-religioso y la incidencia del contenido sociocultural en la configuración de los síntomas en la psicopatología moderna en Colombia, 1920-1960. METODOLOGÍA: investigación histórico-hermenéutica, mediante análisis de una serie de historias clínicas del antiguo Manicomio Departamental de Antioquia y del Asilo Psiquiátrico San Isidro del Valle del Cauca. RESULTADOS: entre las psicopatologías más recurrentes en las que se manifestaron los delirios se encuentra el grupo de las manías, principalmente la intermitente, psicosis maniaco-depresiva y melancolía; seguido por la esquizofrenia paranoide, y también fue frecuente en la psicosis puerperal o posparto; asimismo, se presentó en la parálisis general progresiva (neurosífilis) y en el síndrome cerebral agudo o estado de confusión agudo, nosografía moderna dada al delirio. Según las historias clínicas, la exaltación de ideas religiosas confluye en un delirio polimorfo. Los síntomas más recurrentes fueron las alucinaciones visuales y auditivas, logorrea o locuacidad, insomnio, negativismo alimentario acompañado de miedo a ser envenenado, excitación psicomotora o hiperquinética, accesos de furia controlados con camisa de fuerza y otros medios de contención, intento de suicidio y tendencia a la fuga de la casa, por lo tanto, se consideraba de peligrosidad para sí mismos y para los demás

OBJECTIVE: To understand the semiotics of mystical-religious delirium and the incidence of sociocultural content in the configuration of symptoms in modern psychiatry in Colombia, 1920-1960. METHODOLOGY: hermeneutic historical, research by analysis of a series of case histories of the old Madhouse Department of Antioquia and the Psychiatric Asylum San Isidro del Valle del Cauca. RESULTS: Among the most frequent psychopathologies in which delusions demonstrated is the group of hobbies, mainly intermittent, manic depression and melancholy; followed by paranoid schizophrenia, and was also common in puerperal or postpartum psychosis; He also appeared in general paresis (neurosyphilis) and acute brain syndrome or acute confusional state, delirium given modern nosography. According to medical records, the exaltation of religious ideas comes together in a polymorph delirium. The most frequent symptoms were visual and auditory hallucinations, logorrea or talkativeness, insomnia, accompanied food negativism fear of being poisoned, psychomotor or hyperkinetic excitement, fits of rage controlled straitjacket and other means of containment, attempted suicide and trend the escape of the house, therefore it was considered dangerous to themselves and others

Las alucinaciones visuales en la obra de Oliver Sacks / Visual hallucinations in the works of Oliver Sacks

Introducción: Las alucinaciones visuales constituyen una de las manifestaciones más singulares de diversas situaciones clínicas, ya sea en el ámbito de las enfermedades mentales, de las alteraciones físicas o del consumo de drogas. Sin embargo, el análisis detallado de su vivencia en relación con las causas que pueden producirlas es poco frecuente. Objetivo: Considerar la representación de las alucinaciones visuales en las publicaciones del neurólogo y escritor Oliver Sacks, con especial atención a su obra Hallucinations. Desarrollo: Las alucinaciones han llamado la atención de la cultura, la religión y el arte, lo que ha conllevado múltiples interpretaciones. El interés de Sacks por la percepción de las sensaciones le llevó a investigar los mecanismos por los que se producen las alucinaciones, debido al escaso conocimiento que se tenía sobre el tema. Las alucinaciones aparecieron ya en obras como Migraine, Awakenings o A leg to stand on. En Musicophilia abordó las alucinaciones auditivas, y en Hallucinations las consideró de forma monográfica. En esta última obra, Sacks analizó especialmente las presentes en el síndrome de Charles Bonnet, en situaciones de privación sensorial y en pacientes con epilepsia, las precipitadas por la levodopa y las causadas por drogas de abuso. Conclusiones: Hallucinations es una de las obras de Oliver Sacks con mayor contenido neurooftalmológico. La descripción de las alucinaciones de sus pacientes o las experimentadas en su propia piel y la reflexión sobre el mundo de la percepción hacen de Hallucinations una de las obras más fascinantes de Sacks

Introduction: Hallucinations are one of the most bizarre experiences in several diseases. They appear in mental diseases as well as in physical illnesses and may be the consequence of the usage of drugs of abuse. However, a detailed analysis of how patients feel under hallucinations caused by different diseases is uncommon. Aim: This article analyses how visual hallucinations are considered in the works of the neurologist and writer Oliver Sacks, with special attention to his book Hallucinations. Development: Hallucinations have been under consideration by culture, religion and arts, which has led to multiple interpretations. Sackss interest in perception of sensations led him to work on the analysis of hallucinations, given the limited knowledge on the topic. References to hallucinations appeared in several of his books like Migraine, Awakenings and A leg to stand on. In Musicophilia Sacks approached the auditory hallucinations and in Hallucinations he considered them in depth. In the latter work, Sacks analyses especially those present in Charles Bonnet syndrome, in situations of sensory deprivation, in patients with epilesy, those present during treatment with levodopa and those caused by drug of abuse. Conclusions: Hallucinations is one of Sacks’s books with greater neuroophthalmological content. The descriptions of the hallucinations of his patients or those experienced by himself, as well as the reflective analysis on the world of perception make this book one of the most fascinating works of Oliver Sacks

Away with the fairies: the psychopathology of visionary encounters in early modern Scotland.

In early modern Scotland, several visionaries experienced vivid relationships with spirits. This paper analyses their experiences historically, with the aid of modern scholarship in medicine, psychology and social science. Most of the visionaries were women. Most of their spirit-guides were fairies or ghosts. There could be traumas in forming or maintaining the relationship, and visionaries often experienced spirit-guides as powerful, capricious and demanding. It is argued that some visionaries experienced psychotic conditions, including psychosomatic injuries, sleepwalking, mutism and catatonia. Further conditions related to visionary experience were not necessarily pathological, notably fantasy-proneness and hallucinations. Imaginary companions and parasocial relationships are discussed, as are normality, abnormality and coping strategies. There are concluding reflections on links between culture and biology.

Jacques Jean Lhermitte and the syndrome of peduncular hallucinosis.

Jacques Jean Lhermitte (1877-1959) was among the most accomplished neurologists of the 20th century. In addition to working as a clinician and instructor, he authored more than 800 papers and 16 books on neurology, neuropathology, psychiatry, and mystical phenomena. In addition to the well-known "Lhermitte's sign," an electrical shock-like sensation caused by spinal cord irritation in demyelinating disease, Lhermitte was a pioneer in the study of the relationship between the physical substance of the brain and the experience of the mind. A fascinating example of this is the syndrome of peduncular hallucinosis, characterized by vivid visual hallucinations occurring in fully lucid patients. This syndrome, which was initially described as the result of a midbrain insult, also may occur with injury to the thalamus or pons. It has been reported as a presenting symptom of various tumors and as a complication of neurosurgical procedures. Here, the authors review the life of Lhermitte and provide a historical review of the syndrome of peduncular hallucinosis.

Neurology versus Psychiatry? Hallucinations, Delusions, and Confabulations.

Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. The neurological diseases manifesting with such symptoms (dementia, epilepsy, Korsakoff's disease, brain tumors, Parkinson's disease, migraine, right hemisphere stroke and others) would be the key to understand their biological mechanisms, while the cognitive sciences, neuropharmacology and functional neuroimaging would be the tools of such researches. It is possible to understand the perceptive rules of the mind and the mechanisms of the human consciousness based on these symptoms. However, hallucinations and delusions manifest with extraordinary vehemence with psychiatric disorders such as psychosis and schizophrenia, with which there is no evidence of brain lesions. Furthermore, they are subjective symptoms, and they do not have biological markers. Hence, they are prone to high inter-individual variability and depend on other variables (such as education, history of trauma), and are therefore difficult to reduce to unequivocal constructs. Causative mechanisms are probably multiple. For understanding these symptoms, a common framework between neurology and psychiatry is still missing. The psychopathology of French alienists over the 19th century, of S. Freud, and of Henry Ey over the 20th century gave way, in the second half of the 20th century, to the adoption of the DSM and neurosciences, to pursue a pure neurological perspective. However, although psychodynamic models seem nowadays (in a technological era) less influential, detailed clinical evaluations focusing on emotional-cognitive paradigms are probably the only way to lead to new neurobiological researches.

Peduncular hallucinosis according to Jean Lhermitte.

Peduncular hallucinosis (PH) is a rare clinical syndrome with dream-like visual hallucinations intruding normal consciousness. It was initially reported in a 72-year-old woman by Jean Lhermitte in 1992. We uncovered the medical file of this patient with handwritten notes by Lhermitte and commented on it in the light of neurological knowledge that was common at that time. All along his career, Lhermitte has always been fascinated by consciousness disturbances, dreams and hallucinations. He had here the brilliant intuition of linking PH to awareness mechanisms located in the mesencephalic area. This PH case represented a good opportunity to him to emphasize the close relationships between neurology and psychiatry.

Historical Trends in the Diagnosis of Peduncular Hallucinosis.

BACKGROUND: Peduncular hallucinosis (PH) describes the clinical syndrome of vivid, dream-like visual hallucinations that intrude on normal wakefulness. Additional clinical deficits, especially ophthalmoparesis, have historically been an important part of the diagnosis and localization of this syndrome. We examined how modern neuroimaging has impacted the diagnosis of PH. METHODS: We reviewed all available cases of PH, including 3 of ours and all previously reported in the literature. We determined whether other eye movement abnormalities were part of the clinical presentation and whether a neuroimaging study was performed to make the diagnosis. RESULTS: A total of 85 cases were identified and evaluated. Eye movement abnormalities were present in 12/15 (80%) without a neuroimaging study but in only 24/70 (34%) of cases in which a neuroimaging study was performed (P = 0.001). CONCLUSIONS: Although eye movement abnormalities historically have been considered a key localizing clinical feature supporting the diagnosis of PH, we found that in the era of modern neuroimaging, co-occurring eye movement abnormalities are far less frequent and are not a requisite feature of the diagnosis.

Possessions Including Poltergeist: "Are You There, Madness?"

Beliefs involving the devil and possession figured in the nosography of mental illness that alienists gradually established during the 19th century. The description of this form of cenesthetic hallucination resulted in "the possessed" being viewed as patients, which protected them from the trials and punishments they so frequently faced in earlier centuries. According to psychologists, this illusion of mental duality is linked to impairment of introspective capacities. Current brain imaging suggests inappropriate activity of the default mode network, which interferes with attentional systems during the hallucinatory episode.

[Accessory symptoms of schizophrenia: E. Bleuler's concept]. / Aktsessornye simptomy shizofrenii: kontseptsiia E. Bleuler.

The analysis of E. Bleuler's concept of accessory symptoms of schizophrenia: delusions, hallucinations, depersonalization disorders, splitting of the ego, memory disorders, catatonic symptoms and acute syndromes (manic and melancholic states, acute paranoia, twilight states, clouding of consciousness, confusion, fugues and dipsomania) is presented. The relationship of accessory symptoms with primary and secondary schizophrenic symptoms according to the second concept of E. Bleuler is highlighted. The mechanisms of the origin of psychopathological accessory symptoms and E. Bleuler's understanding of many schizophrenic psychopathological symptoms as a quantitative increasing of a normal psychic phenomenon are discussed.

Might Hallucinations Have Social Utility?: A Proposal for Scientific Study.

There are many historical examples of people who heard voices or saw visions but were not classified as having a mental illness and who were supported by a religious community. The article offers a perspective for effective psychosocial supports for schizophrenia. The author analyzes data on 95 people who experienced verifiable persistent non-drug-assisted hallucinations in Europe, North America, and Australasia and discusses the life outcomes of 39 subjects. They include founders of religions, dysfunctional monarchs, persons with cosmological beliefs, and mental health workers. Their psychoses were intrinsic to their personalities and contributions. Hallucinations generated by psychosis were useful for cultural innovation, particularly in religion as many hallucinators were integrated into church history. Community, work, friendship, and supportive practices are discussed. A scientific study of effective psychosocial support to supplement medication for schizophrenia is outlined.

Léon Marillier and the veridical hallucination in late-nineteenth- and early-twentieth-century French psychology and psychopathology.

Recent research on the professionalization of psychology at the end of the nineteenth century shows how objects of knowledge which appear illegitimate to us today shaped the institutionalization of disciplines. The veridical or telepathic hallucination was one of these objects, constituting a field both of division and exchange between nascent psychology and disciplines known as 'psychic sciences' in France, and 'psychical research' in the Anglo-American context. In France, Leon Marillier (1862-1901) was the main protagonist in discussions concerning the concept of the veridical hallucination, which gave rise to criticisms by mental specialists and psychopathologists. After all, not only were these hallucinations supposed to occur in healthy subjects, but they also failed to correspond to the Esquirolian definition of hallucinations through being corroborated by their representation of external, objective events.

History and conceptual problems of the relationship between obsessions and hallucinations.

Contemporary psychiatric nomenclature defines schizophrenia (SCZ) and obsessive-compulsive disorder (OCD) as distinct disease entities characterized by non-overlapping diagnostic criteria. Nevertheless, a complex association between SCZ and OCD exists on the psychopathological level. And although the relationship between obsessions and delusions has been widely studied and discussed, the relationship between obsessions and hallucinations has not received the same attention. This article presents an historical overview of the studies on the co-occurrence of obsessions and hallucinations. We also analyze the clinical significance of this overlap, as discussed in the early descriptions of these phenomena in the nineteenth century and continuing through the most recent, contemporary conceptualizations. In clinical practice today, we may encounter both SCZ patients with typical ego-dystonic obsessive-compulsive symptoms and SCZ patients affected by obsessions that intertwine with psychotic symptoms, generating complex psychopathological syndromes (e.g. "obsessive hallucinations"). A further complication is that some OCD patients show perceptual disturbances. Taking into consideration the possible coexistence of obsessive-compulsive symptoms and psychotic symptoms is crucial for proper diagnosis, prognosis, and treatment. Further investigations are required to fully evaluate the psychopathological interrelationships between obsessions and hallucinations.

Subjectivity in clinical practice: on the origins of psychiatric semiology in early French alienism.

The aim of this article is to contribute to the analysis of the origins of psychiatric semiology, which by emphasizing subjectivity in clinical practice, gave birth to psychopathology as the scientific and intellectual enterprise of alienism. In other words, beyond simple anatomical and clinical observation, there was an effort to 'listen to' and 'read' the patient's delirium. In essence, the basic thesis which this short paper seeks to defend is that, despite a growing anatomical and clinical mind-set and a clear interest in physically locating mental illness within the body, during the Romantic period, psychiatry was able to construct a semiology largely based on the experience of the ego, on the inner world of the individual. This makes it possible to establish, from a clinical perspective, that the birth of alienism - of psychiatry - must be situated within the framework of a modernity in which the culture of subjectivity was one of its most characteristic features.