hallucination

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American Heritage Dictionary:

hal·lu·ci·na·tion

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(hə-lū'sə-nā'shən) pronunciation
n.
    1. Perception of visual, auditory, tactile, olfactory, or gustatory experiences without an external stimulus and with a compelling sense of their reality, usually resulting from a mental disorder or as a response to a drug.
    2. The objects or events so perceived.
  1. A false or mistaken idea; a delusion.
hallucinational hal·lu'ci·na'tion·al or hal·lu'ci·na'tive adj.


Perception of objects, sounds, or sensations having no demonstrable reality, usually arising from a disorder of the nervous system or in response to certain drugs ( hallucinogen). Hallucinations are in many ways similar to dreams: they derive their content from perceptions known to memory, though these can be greatly transformed. Hallucinations can result when attention collapses from intense arousal due to extreme anxiety, fatigue, excitement, or other causes. They figure prominently in the diagnosis of schizophrenia.

For more information on hallucination, visit Britannica.com.

A perceptual experience in the absence of external stimulation. Hallucinations differ from illusions, which are changes in the perception of a real object. Hallucinations tend to fade with fixation or with attention to the content. Except for afterimages, which lie like a film over objects, hallucinations replace objects and object space. A hallucination is not objectlike in its realness. The conviction of reality is due to the loss of an object for comparison and the inability to disprove the image through other sensory modalities.

Hallucinations that are recognized as such by the experiencer include those resulting from sensory deprivation, drug use, and the phantom limb state. See also Schizophrenia.

Hallucinations may occur in a range of neurologic and psychiatric conditions, although they are usually considered hallmarks of schizophrenia. Delusional misidentification syndromes are subtype of hallucinations and may also occur in neurological and psychiatric disease. For example, Capgras syndrome, which is commonly seen in schizophrenia, causes the individual to replacea familiar person (usually the spouse) with an imposter with the same or similar physical appearance. Frégoli syndrome is the delusional confusion of an individual as a familiar person in disguise.

Neurotransmitters are directly involved in the regulation of drug-induced and schizophrenic hallucinations, with many accounts pointing to the involvement of serotonin and dopamine. Therefore, it is possible to treat individuals with antipsychotic drugs that stabilize the chemical systems involved.

With localized damage to the brain, hallucinations are usually brief and intermittent, though in some cases, especially neurologic damage involving the brainstem, hallucinations can be chronic and sustained.

Physical input to the eyes and ears constrains and guides the construction of mental images,but the final result—the perception of an object or sound as a meaningful event occurringin the external world—also reflects very complex physiological processes. They begin in the brainstem, pass to the limbic system of the brain, and finally involve the temporal, parietal, and occipital areas of the cerebral cortex. Various types of hallucination are caused by disruptions that occur at different levels along that sequence of brain processes. See also Cognition.

At its earliest phase, damage to the upper brainstem produces peduncular (crepuscular) hallucinations of faces, torsos, and occasionally geometric patterns or landscapes near the viewer at the close of day. The images may be static and immobile or may change in content and affective tonality while being viewed. A smiling young boy, for example, may change into a scowling oldwoman. The hallucinations are often vivid and chromatic, and tend to be multimodal: they are seen, heard, and even touched, and occur over the entire visual field. Olfactory and gustatory images have also been described. Peduncular hallucinations are similar to the hypnagogic hallucinations that are experienced when falling asleep. See also Sleep and dreaming.

Neurologic damage involving limbic and temporal-lobe structures yields hallucinations of faces or formed scenes laden with meaning and affect. Changes in size (micropsia, macropsia) and shape (metamorphopsia) may occur. Déjà vu, derealization, and dreamy states are common. Auditory hallucinations are usually of speech or music. Microscopic (Lilliputian) and autoscopic (out-of-the-body) hallucinations also occur with temporal-lobe lesions. Exposure to a wide range of drugs and many psychiatric disorders, especially schizophrenia, can lead to hallucinations whose form suggests dysfunction involving limbic or temporal-lobe structures. See also Psychotomimetic drug.

Damage to the parietal lobe leads to illusory distortions of shape, size, and motion, whereas occipital lesions or stimulation—or migraine—gives elementary hallucinations of sparks, flames, lines, or simple patterns. These hallucinations share features with afterimages.Palinopsia, the hallucinatory persistence of an object after the viewer has turned away, is a form of pathological afterimagery. See also Perception.


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Hallucination may be simply defined as the perception of an external object in the absence of a corresponding stimulus, yet such a simple definition obscures a whole series of conceptual difficulties which surround the medical and psychiatric use of the term. The range of conditions subsumed under this category is massive, and includes such varied phenomena as religious visions, phantom limbs, tinnitus, psychedelic ‘trips’, schizophrenic inner voices, the personal experience of doppelgangers, and a sceptical apprehension of the unreality of the outer world.

Such variety has naturally frustrated any attempt at providing a clear classification of the phenomenon. Attempts to distinguish the various forms of hallucination according to their origins, their content, their intensity, and the condition of their hosts have been largely unsuccessful. Most psychiatrists in Europe and North America have now adopted a fairly broad definition of the phenomenon, simply relying upon the distinction between illusion, which resulted from the misinterpretation of an existing external object, and hallucination, in which the false perception is generated without any reference to the outside world. Even this definition, which was introduced by the French psychiatrist J. E. D. Esquirol in the early nineteenth century, fails to account for such borderline phenomena as synaesthesia in which the sensations provoked by an object become confused, so that the subject may taste colours or see sounds.

Alongside this ongoing contest over the definition and classification of hallucination there exists a more fundamental struggle over the meaning and significance of the phenomenon. Artists and mystics have long criticized the modern medicalization of hallucinations, portraying the process as a secularizing attempt to pathologize religious or spiritual experience. Certainly popular attitudes to hallucination have been transformed across the last thousand years. In the Platonic tradition of classical philosophy, the subjective vision was celebrated as a form of privileged insight beyond the phenomenal experience of the external world. Likewise in the Christian and Jewish religions the objective quality of the inner hallucination had long been regarded as a proof of its spiritual reality, although its origin could have been either demonic or divine.

These Platonic and Christian traditions were united in the work of the Primitive Church fathers. Their writing held up the visionary experience as a charism, a gift from God which allowed individuals to perceive some object which was normally invisible to men. This conception was further refined by St Augustine, who divided visions into three classes: the corporeal, in which an apparition of an object was presented before the individual's eyes through either natural or spiritual means; the imaginative, in which an image was supernaturally created in the host's mind; and the intellectual, in which sense of personal assurance was created directly by God, without recourse to implanted words or images.

This framework for interpreting the hallucinatory experience persisted into the nineteenth century. Many romantic writers, such as Coleridge and Wordsworth, complained that normal vision enslaved the mind to the mundane world of material object. In contrast, they proposed a ‘Spiritual Optics’ (to borrow Thomas Carlyle's phrase) in which the inner eye would be awakened to the creative inspiration of the spirit. Such a programme sat unhappily with contemporary medical investigations in this field. In the late eighteenth and early nineteenth centuries, many writers commented upon the correlation between hallucination, injury, and disease. This correlation suggested that the hallucination had a somatic basis, originating in either the disordered operations of the peripheral nerves or an aberrant psychological process in the brain.

This interpretation of hallucination as a symptom of organic nervous disorder persisted throughout the nineteenth century. In 1881 the Italian psychiatrist, August Tamburini, presented a coherent neurological model for the experience, arguing that hallucination was produced through a pathological excitement or epilepsy in the higher sensory centres of the brain. This materialist account did little to diminish the mystical celebration of hallucination. Writers influenced by spiritualism and the Swedish mystic Emanuel Swedenborg accepted the scientific identification of hallucination with organic disturbance, arguing that this identity provided strong evidence for the objective reality of visions.

The mystical assessment of the significance of hallucinations was undermined by a series of psychological surveys at the end of the nineteenth century. During the 1880s the statistician, Francis Galton, circulated questionnaires on mental imagery to schools and acquaintances. From the responses he was able to demonstrate a gradation between hallucination and the familiar acts of visualization which occurred in everyday life. Galton suggested that hallucination was not a distinct experience, but rather that it represented an extreme point on two axes representing the strength of the mental image and its resistance to conscious control. This statistical erosion of the boundary between normal visualization and pathological hallucination was reinforced in a more wide-scale survey published by the Society for Psychical Research (SPR) in 1892. The SPR's ‘Census of Hallucinations’ discovered 1684 cases of waking hallucination amongst 17 000 respondents. Further analysis suggested that hallucination was most prevalent amongst women, children, and the insane, although the experience could occur in almost any individual.

In the twentieth century the hallucinatory experience seems to have lost its spiritual significance. The popular use of hallucinogenic drugs, such as LSD and psilocybin, and increased understanding of the chemical mechanisms of their actions, has encouraged a more instrumental attitude towards the visionary experience. Hallucination is no longer seen as a gratuitous event except in pathological cases such as fever or schizophrenia. Rather it is a state which can be induced directly through chemical, electrical, or mechanical means. As the neurosurgeon Wilder Penfield demonstrated, intense mental images may be created through the electrical stimulation of a subject's brain. Likewise hallucinations of movement (see proprioception) can be induced at a particular joint through the mechanical vibration of the muscles attached to it. Through such technical advances the meaning and cultural significance of hallucination has been transformed. The vision, which once revealed the mind of God to men, is now seen as a symptom revealing the disordered mind of man to others.

— Rhodri Hayward

Bibliography

  • Berrios, G. E. (1995). The history of mental symptoms. Cambridge University Press, Cambridge.
  • Critchley, M. (1987). Hallucinations and their impact upon art. Carnegie Press, Preston

See also illusions.

Roget's Thesaurus:

hallucination

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noun

  1. An erroneous perception of reality: delusion, ignis fatuus, illusion, mirage, phantasm, phantasma, will-o'-the-wisp. See real/imaginary.
  2. An illusion of perceiving something that does not really exist: phantasmagoria, phantasmagory. Slang trip. See real/imaginary.

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n

Definition: dream, delusion
Antonyms: experience, fact, reality, truth

The occurrence of an experience in itself indistinguishable from a perception of something, but without an appropriate external cause. Hallucination is sometimes distinguished from pseudohallucination, in which the experience occurs but is not mistaken for the perception of an external object. Both are distinct from illusion, in which there is an external source, but its nature is mistaken (a mirage is thus an illusion, but not a hallucination). The possibility of hallucination is a frequent starting-point for the distinction between appearance and reality. See also illusion, argument from.

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hallucination, false perception characterized by a distortion of real sensory stimuli. Common types of hallucination are auditory, i.e., hearing voices or noises and visual, i.e., seeing people that are not actually present. Hallucinations play a prominent role in schizophrenia and in the mania stage of bipolar disorder (see depression). They are also significant during withdrawal from various drugs, particularly depressants such as barbiturates, heroin, and alcohol (see delirium tremens), and under the influence of hallucinogenic drugs such as LSD, mescaline, and psylocybin. Hallucinations may occur in normal people under conditions of sensory deprivation, emotional stress, religious exaltation, or great fatigue.


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A state of mind whereby a person senses something that in reality does not exist; a perception of an object having no reality. 90 S.E. 2d 593, 596. Any of the senses may be involved, although sight or hearing are most commonly affected.
The state of hallucination most often results from mental illness or from ingesting drugs designed to create these perceptions. See controlled substance [hallucinogens].

A false perception of sensory vividness arising without the stimulus of a corresponding sense impression. In this it differs from illusion, which is merely the misinterpretation of an actual sense perception. Visual and auditory hallucinations are the most common, but hallucinations of the other senses may also be experienced. Human figures and voices most frequently form the subject of a hallucination, but in certain types other classes of objects may be seen, as, for instance, the rats and insects of delirium tremens.

Although hallucination is often associated with various mental and physical diseases, it may nevertheless occur spontaneously while the agent shows no departure from full vigor of body and mind. It may also be induced (i.e., in hypnotism) in a high percentage of subjects. The essential difference between sane and insane hallucinations is that in the former case the agent can, by reflection, recognize the subjective nature of the impression, even when it has every appearance of objectivity, whereas in the latter case the patient cannot be made to understand that the vision is not real.

Until the early twentieth century, hallucinatory percepts were regarded merely as intensified memory images; however, the most intense of ordinary representations do not possess the sensory vividness of the smallest sensation received from the external world. It follows that other conditions must be present besides the excitement of the brain, which is the correlate of representation. The seat of excitement is the same in actual sense perceptions and in memory images, but in the former the stimulus is peripherally originated in the sensory nerve, whereas in the latter it originates in the brain itself.

When a neural system becomes highly excited—a state which may be brought about by emotion, ill health, drugs, or a number of other causes—it may serve to divert from their proper paths any set of impulses arising from the sense organs. Because any impulse ascending through the sensory nerves produces an effect of sensory vividness—normally, a true perception—the impulses thus diverted gives to the memory image an appearance of actuality not distinguishable from that produced by a corresponding sense impression—a hallucination.

In hypnosis a state of cerebral dissociation is induced, whereby a neural system may be abnormally excited and hallucination thus readily engendered. Drugs, especially hallucinogens, which excite the brain, also induce hallucinations.

In 1901 the British physician Sir Henry Head demonstrated that certain visceral disorders produce hallucinations, such as the appearance of a shrouded human figure. The question of whether there is any relationship between the hallucination and the person it represents is, and has long been, a vexing one. Countless well-authenticated stories of apparitions coinciding with a death or some other crisis are on record and would seem to establish some causal connection between them. In former times apparitions were considered to be the doubles or "ethereal bodies" of real persons, and Spiritualists believe that they are the spirits of the dead (or, in some instances, of the living) temporarily forsaking the physical body.

The dress and appearance of the apparition does not necessarily correspond with the actual dress and appearance of the person it represents. Thus a man at the point of death, in bed and wasted by disease, may appear to a friend miles away as if in ordinary health and wearing familiar clothing. Nevertheless, there are notable instances where some remarkable detail of dress is reproduced in the apparition. It seems clear, however, that it is the agent's general personality that is, as a rule, conveyed to the percipient, and not, except in special cases, his or her actual appearance.

It has been suggested that those images that do not arise in the subliminal consciousness of the agent may be telepathically received by him or her from other minds. A similar explanation has been offered for the hallucinatory images that many people can induce by crystal gazing or staring into a pool of water, a drop of ink, or a magic mirror in search of information about scenes or people they know nothing about.

Collective hallucination is a term applied to hallucinations shared by a number of people. There is no firm evidence, however, of the operation of any agency other than suggestion or telepathy.

Hallucination and Psychical Research

One of the most succinct definitions of hallucination occurs in Phantasms of the Living (2 vols., 1886), by Edmund Gurney, F. W. H. Myers, and Frank Podmore: "percepts which lack, but which can only by a distinct reflection be recognised as lacking, the objective basis which they suggest." If the sensory perception coincides with an objective occurrence or counterpart, the hallucination is called veridical, (truth-telling), as in the phantasm of the dying. If the apparition is seen by several people at the same time, the case is called collective veridical hallucination.

In the years following the foundation of the Society for Psychical Research (SPR), London, the hallucination theory of psychic phenomena was in great vogue. If no other explanation was available the person who had had a supernormal experience was told it was a hallucination, and if several people testified to the same occurrence it was said that the hallucination of one was communicated to the others. Sir William Crookes counters that idea in his Researches in the Phenomena of Spiritualism (1870): "The supposition that there is a sort of mania or delusion which suddenly attacks a whole roomful of intelligent persons who are quite sane elsewhere, and that they all concur, to the minutest particulars, in the details of the occurrences of which they suppose themselves to be witnesses, seems to my mind more incredible than even the facts which they attest."

Charles Richet, in Thirty Years of Psychical Research (1923), omits hallucination completely in his discussion of metapsychical phenomena (a term for paranormal). He believed that hallucination should be reserved to describe a morbid state when a mental image is exteriorized without any exterior reality. According to Richet, "It is extremely rare that a person who is neither ill, nor drunk, nor hypnotised should, in the walking state, have an auditory, visual, or tactile illusion of things that in no way exist. The opinion of alienists that hallucination is the chief sign of mental derangement, and the infallible characteristic of insanity seems to me well grounded. With certain exceptions (for every rule there are exceptions) a normal healthy individual when fully awake does not have hallucinations. If he see[s] apparitions these correspond to some external reality or other. In the absence of any external reality there are no hallucinations but those of the insane and of alcoholics."

An instance recounted by Sir John Herschel did not conform to Richet's idea. He had been watching with some anxiety the demolition of a familiar building. On the following evening, in good light, he passed the spot where the building had stood. "Great was my amazement to see it," he wrote, "as if still standing, projected against the dull sky. I walked on, and the perspective of the form and disposition of the parts appeared to change as they would have done if real."

In the case of hauntings where a ghost is seen, Gurney suggests that a person thinking of a given place that is at the time actually experienced in sense perception by others may be imparting into the consciousness of the others a thought existing in his own.

Of course, data provided by a registering apparatus or photography may rule out the hallucination theory as applied to hauntings, provided that there is some proper scientific control. Similarly, if objects are displaced, as in poltergeist cases, the theory of hallucination is no longer tenable. As Andrew Lang writes in Cock Lane and Common Sense (1896), "Hallucinations cannot draw curtains, or open doors, or pick up books, or tuck in bedclothes or cause thumps."

The things seen during a psychic experience of an otherwise normal person should also be distinguished from the hallucinations of the mentally deranged, of the sick, drunk, or drugged. The latter are not veridical, nor telepathic, nor collective. In the "Census of Hallucinations," published in the Proceedings of the SPR (1894), the committee excluded, as far as possible, all pathological subjects. J. G. Piddington (see Proceedings, vol. 19), in testing this census for cases that would show the same nature as hallucinations arising from visceral diseases, concluded that there was not a single case in the census report that fell into line with the visceral type.

In hypnotic hallucinations the hypnotized subject may see apparitions if so suggested and may not see ordinary people who are in the same room. But the subject may hear the noises they make, see the movement of objects they touch, and be frightened by what appears to be poltergeist phenomena. If the suggestion is posthypnotic the subject may also see a phantom shape when given a signal or at a prescribed time.

The visions seen by some people on the verge of sleep were called " hypnagogic hallucinations" by F. W. H. Myers. The afterimages on waking from sleep he named "hypnopompic hallucinations." A comprehensive study of both classes of phenomena was published by G. E. Leaning in the Proceedings of the SPR, (vol. 35, 1926).

The difference between hallucination and illusion is that there is an objective basis for the illusion, which is falsely interpreted. In hallucination, although more than one sense may be affected, there is no external basis for the perception.

Sources:

Besterman, Theodore. Crystal-Gazing. London, 1924. Reprint, New Hyde Park, NY: University Books, 1965.

Bramwell, J. M. Hypnotism: Its History, Practice, and Theory. London, 1903.

Gurney, Edmund, F. W. H. Myers, and Frank Podmore. Phantasms of the Living. 2 vols. London: Trubner, 1886. Reprint, Gainesville, FL: Scholars Facsimiles Reprints, 1970.

Huxley, Aldous. The Doors of Perception. London, 1954. Johnson, Fred H. The Anatomy of Hallucinations. Chicago: Nelson Hall, 1978.

MacKenzie, Andrew. Apparitions and Ghosts. London: Barker, 1971. Reprint, New York: Popular Library, 1972.

——. Hauntings and Apparitions. London: Heinemann, 1982.

Myers, F. W. H. Human Personality and Its Survival of Bodily Death. 2 vols. London: Longmans Green, 1903. Reprint, New York: Arno Press, 1975.

Podmore, Frank. Apparitions and Thought Transference. London, 1894.

Reed, Graham. The Psychology of Anomalous Experience. Boston: Houghton Mifflin, 1974.

Richet, Charles. Thirty Years of Psychical Research. London: W. Collins, 1923. Reprint, New York: Arno Press, 1975.

Rogo, D. Scott. Mind Beyond the Body: The Mystery of ESP Projection. New York: Penguin, 1978.

Samuels, Mike. Seeing With the Mind's Eye: The History, Techniques, and Uses of Visualization. New York: Bookworks; Random House, 1975.

Tyrrell, G. N. M. Apparitions. London: Duckworth, 1953. Reprint, London: Society for Psychical Research, 1973.

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Briefly defined as sensory perception in the absence of external stimuli, hallucination has three characteristics: thoughts or memory images, perhaps when they are as vivid and immediate as perceptions, are experienced as if they were perceptions; they are externalized, or projected, being experienced as if they came from outside the person; and the mistaking of imagery for perception is not corrected in the light of the other information available. The term pseudohallucination has been used to describe imagery as vivid and immediate as perception but not mistaken as such. Pseudohallucinations are more likely to be perceived in response to isolation or an intense emotional need: for example, shipwrecked sailors may visualize boats coming to their rescue. The fanciful elaboration of perception of external stimuli — for example, faces seen in the fire — is illusion. The imagery of a vision is experienced as if it came from outside, although not from ordinary reality as perception does.

Young children often fail to distinguish between imagery and perception and suppose that what they imagine is external and perceptible to others. Adults sometimes fail to make the distinction, especially at a time of high expectation or arousal. A widow mourning her husband may see him or hear his voice or footsteps repeatedly after his death, resulting in a 'sense of presence' which fades with the passage of time. In a wood at night, dark shadows are seen as lurking beasts. Waking from a frightening dream, a person feels that what he has experienced has happened in reality.

Mistakes like these are corrected when the person recognizes that they conflict with other information or the views of others. Normally imagery is continually reappraised in the light of further information becoming available, and further information is sought by testing reality. Hearing a noise, a person makes a small head movement and tests whether the change in the strength and character of the noise conforms to his expectation. Perceiving someone in a crowd as an acquaintance, a person looks again or asks a companion for confirmation. Macbeth in Shakespeare's play, while planning to murder Duncan, hallucinates a dagger, and asks: 'Art thou not, fatal vision, sensible to feeling as to sight? Or art thou but a dagger of the mind, a false creation, proceeding from the heat-oppressed brain?'

After a long period of wakefulness or busyness, attention tends to be withdrawn from the outside world, and the testing of reality to be impaired and reduced. Hallucination is relatively common under these conditions and remains uncorrected for longer. Sufficient information is available but is not used. On the other hand, the subjects of experiments on the effects of sensory deprivation, who are put into a darkened and soundproofed room, do not get sufficient information to enable them to test reality and to reappraise their hallucinatory experiences. (See isolation experiments.) Also, a person on his own is less able to test reality and to reappraise what he has experienced.

Hallucinations tend to be disowned, the person feeling that he has no control over the imagery, which he feels is imposed on him by an outside agency. They are often reported as distressing, threatening, or tormenting, only occasionally, for example by a widow, as reassuring. There are other distressing phenomena that are not hallucinations, although akin to them in some respects. Thus, some recurring images obtrude and cannot be stopped, but are accepted as belonging to the individual. Such images are termed obsessions. Ringing in the ear ('tinnitus'), resulting, for instance, from disease of the ear, is sometimes described by a fanciful simile, e.g. as being like sea flowing over shingle, or as if there were nearby a machine crushing stones. What is being described may be thought mistakenly to be hallucination if the explicit comparison of the 'like' or the 'as if' fails to be noted.

Hallucination is common in patients who have suffered damage to the brain as a result of trauma, infection, or intoxication by drugs or alcohol. The association of hallucination, fearfulness, and agitation in these cases may be described as delirium. A patient who suffers from delirium tremens as a result of alcoholism may see such frightening things as red spiders or pink elephants, or he may feel that lice are crawling over his skin, because hallucination although usually visual may be experienced through any of the senses. Indeed, hallucinations in functional psychoses are more often auditory than visual. Schizophrenic patients may hear the voices of their persecutors, conversations about themselves between third parties, or their own thoughts spoken aloud (echo de pensée). Severely depressed patients may hear voices making derogatory remarks or threatening them with punishment or torture. Some schizophrenic patients even experience tactile hallucinations which give rise to delusional beliefs that they are being sexually assaulted. Olfactory hallucinations are sometimes perceived by severely melancholic patients who come to believe that they are giving off revolting odours from their bodies causing people to avoid them. Patients mistake hallucinations of all these kinds for perceptions coming from outside themselves, and attribute to others what they experience, usually without any testing of reality.

Explanations of hallucination refer to several processes. In delirium there tends to be a high level of arousal and at the same time a lowering of vigilance, impairment of perception, and impairment and reduction of reality testing. Enhancement of imagery as a direct effect of drugs or toxins on nervous tissue is similar to that of electrical stimulation of the temporal lobes of the brain when it produces, in a conscious patient whose brain has been exposed during surgery, intense visual, auditory, or other imagery as 'strips' of experience. Poisoning by drugs may also, more importantly, increase the random activity of nervous tissue. Sensations then become blurred, to produce background noise, which is then elaborated into illusion. A person poisoned by LSD may see visual patterns like lace curtains, usually coloured. In some illnesses in which there is hallucination, the functioning of peripheral nerves is affected by neuritis, and as a result the patient may experience numbness, pins and needles, or itching, which is elaborated into the illusion of lice. Similarly, the result of neuritis of the retina may be spiders dangling in front of the eyes, brain-elaborations of phosphenes. In schizophrenia, the patient has typically disengaged from social activities, and the testing of reality is reduced as a result, but this does not account for his disowning of what he experiences. It has to be supposed that thoughts and feelings have been dissociated as a psychological defence in order to reduce the anxiety which would otherwise arise. The patient positively resists any reappraisal of what he has experienced.

(Published 1987)

— Derek Russell Davis

    Bibliography
  • Galton, F. (1907). Inquiries into Human Faculty and its Development.
  • Harris, J. P., and Gregory, R. L. (1981). 'Tests of hallucinations of Ruth'. Perception, 10.
  • Siegel, R. K. (1993). Fire in the Brain: Clinical Tales of Hallucination.
  • — —  and West, J. L. (eds., 1975). Hallucinations.


Word Tutor:

hallucination

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pronunciation

IN BRIEF: Something that is not real but of which someone is aware.

pronunciation Someone who travels in the desert might have a hallucination of a swimming pool.

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A false perception that appears to be real, as when, for example, a man dying of thirst in a desert thinks that he sees a lake. (See also delusion.)

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(həl-ōō′sin-ā′shən)
n

An artificial sensory experience without the presence of an external cause.

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categories related to 'hallucination'

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Random House Word Menu by Stephen Glazier
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Hallucination
Classification and external resources

My eyes at the moment of the apparitions by August Natterer.
ICD-10 R44
ICD-9 780.1
DiseasesDB 19769
MeSH D006212

A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. The latter definition distinguishes hallucinations from the related phenomena of dreaming, which does not involve wakefulness; illusion, which involves distorted or misinterpreted real perception; imagery, which does not mimic real perception and is under voluntary control; and pseudohallucination, which does not mimic real perception, but is not under voluntary control.[1] Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus (i.e. a real perception) is given some additional (and typically bizarre) significance.

Hallucinations can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive.

A mild form of hallucination is known as a disturbance, and can occur in any of the senses above. These may be things like seeing movement in peripheral vision, or hearing faint noises and/or voices. Auditory hallucinations are very common in paranoid schizophrenia. They may be benevolent (telling the patient good things about themselves) or malicious, cursing the patient etc. Auditory hallucinations of the malicious type are frequently heard like people talking about the patient behind their back. Like auditory hallucinations, the source of their visual counterpart can also be behind the patient's back. Their visual counterpart is the feeling of being looked-stared at, usually with malicious intent. Frequently, auditory hallucinations and their visual counterpart are experienced by the patient together.

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up.

Hallucinations can be associated with drug use (particularly deliriants), sleep deprivation, psychosis, neurological disorders, and delirium tremens.

Contents

Classification

Hallucinations may be manifested in a variety of forms.[2] Various forms of hallucinations affect different senses, sometimes occurring simultaneously, creating multiple sensory hallucinations for those experiencing them.

Visual

The most common modality referred to when people speak of hallucinations. These include the phenomena of seeing things which are not present or visual perception which does not reconcile with the physical, consensus reality. There are many different causes, which have been classed as psychophysiologic (a disturbance of brain structure), psychobiochemical (a disturbance of neurotransmitters), and psychological (e.g. meaningful experiences consciousness), this is also the case in Alzheimer's disease. Numerous disorders can involve visual hallucinations, ranging from psychotic disorders to dementia to migraine, but experiencing visual hallucinations does not in itself mean there is necessarily a disorder.[3] Visual hallucinations are associated with organic disorders of the brain and with drug and alcohol related illness.[4]

Sometimes internal imagery can overwhelm the sensory input from external stimuli when sharing neural pathways, or if indistinct stimuli is perceived and manipulated to match one's expectations or beliefs, especially about the environment. This can result in a hallucination[5], and this effect is sometimes exploited to form an optical illusion.

Auditory

Auditory hallucinations (also known as paracusia)[6] are the perception of sound without outside stimulus. Auditory hallucinations can be divided into two categories: elementary and complex. Elementary hallucinations are the perception of sounds such as hissing, whistling, an extended tone, and more. In many cases, tinnitus is an elementary auditory hallucination. However, some people who experience certain types of tinnitus, especially pulsatile tinnitus, are actually hearing the blood rushing through vessels near the ear. Because the auditory stimulus is present in this situation, it does not qualify as a hallucination.

Complex hallucinations are those of voices, music, or other sounds which may or may not be clear, may be familiar or completely unfamiliar, and friendly or aggressive, among other possibilities. Hallucinations of one or more talking voices are particularly associated with psychotic disorders such as schizophrenia, and hold special significance in diagnosing these conditions. However, many people not suffering from diagnosable mental illness may sometimes hear voices as well.[7] One important example to consider when forming a differential diagnosis for a patient with paracusia is lateral temporal lobe epilepsy. Despite the tendency to associate hearing voices, or otherwise hallucinating, and psychosis with schizophrenia or other psychiatric illnesses, it is crucial to take into consideration that even if a person does exhibit psychotic features, they do not necessarily suffer from a psychiatric disorder on its own. Disorders such as Wilson's disease, various endocrinological disorders, numerous metabolic disturbances, multiple sclerosis, systemic lupus erythematosis, porphyria, sarcoidosis, and many others can present with psychosis.

Musical hallucinations are also relatively common in terms of complex auditory hallucinations and may be the result of a wide range of causes ranging from hearing-loss (such as in musical ear syndrome, the auditory version of Charles Bonnet syndrome), lateral temporal lobe epilepsy,[8] arteriovenous malformation,[9] stroke, lesion, abscess, or tumor.[10]

The Hearing Voices Movement is a support and advocacy group for people who hallucinate voices, but do not otherwise show signs of mental illness or impairment.

High caffeine consumption has been linked to an increase in the likelihood of experiencing auditory hallucinations. A study conducted by the La Trobe University School of Psychological Sciences revealed that as few as five cups of coffee a day could trigger the phenomenon.[11]

Command hallucinations

Command hallucinations are hallucinations in the form of commands.[12] The contents of the hallucinations can range from the innocuous to commands to cause harm to the self or others.[12] Command hallucinations are often associated with schizophrenia. People experiencing command hallucinations may or may not comply with the hallucinated commands, depending on circumstances. Compliance is more common for non-violent commands.[13]

Olfactory

Phantosmia is the phenomenon of smelling odors that aren't really present. The most common odors are unpleasant smells such as rotting flesh, vomit, urine, feces, smoke, or others. Phantosmia often results from damage to the nervous tissue in the olfactory system. The damage can be caused by viral infection, brain tumor, trauma, surgery, and possibly exposure to toxins or drugs.[14] Phantosmia can also be induced by epilepsy affecting the olfactory cortex and is also thought to possibly have psychiatric origins.[citation needed] Phantosmia is different from parosmia, in which a smell is actually present, but perceived differently from its actual smell.

Olfactory hallucinations can also appear in some cases of associative imagination, for example, while watching a romance movie, where the man gifts roses to the woman, the viewer senses the roses' odor (which in fact does not exist).

Olfactory hallucinations have also been reported in migraine, although the frequency of such hallucinations is unclear.[15][16]

Tactile hallucinations

Tactile hallucinations are the illusion of tactile sensory input, simulating various types of pressure to the skin or other organs. One subtype of tactile hallucination, formication, is the sensation of insects crawling underneath the skin and is frequently associated with prolonged cocaine or amphetamine use[17] or with withdrawal from alcohol or benzodiazepines. However, formication may also be the result of normal hormonal changes such as menopause, or disorders such as peripheral neuropathy, high fevers, Lyme disease, skin cancer, and more.[17]

Gustatory

This type of hallucination is the perception of taste without a stimulus. These hallucinations, which are typically strange or unpleasant, are relatively common among individuals who have certain types of focal epilepsy, especially temporal lobe epilepsy. The regions of the brain responsible for gustatory hallucination in this case are the insula and the superior bank of the sylvian fissure.[18][19]

General somatic sensations

General somatic sensations of a hallucinatory nature are experienced when an individual feels that his body is being mutilated i.e. twisted, torn, or disembowelled. Other reported cases are invasion by animals in the person's internal organs such as snakes in the stomach or frogs in the rectum. The general feeling that one's flesh is decomposing is also classified under this type of hallucination.[20]

Stages of a hallucination

  1. Emergence of surprising or warded-off memory or fantasy images[21]
  2. Frequent reality checks[21]
  3. Last vestige of insight as hallucinations become "real"[21]
  4. Fantasy and distortion elaborated upon and confused with actual perception[21]
  5. Internal-external boundaries destroyed and possible pantheistic (or personally felt or believed, possibly profound, internal spiritual or religious) experience[21]

Cause

Hallucinations can be caused by a number of factors.

Hypnagogic hallucination

These hallucinations occur just before falling asleep, and affect a surprisingly high proportion of the population. The hallucinations can last from seconds to minutes, all the while the subject usually remains aware of the true nature of the images. These may be associated with narcolepsy. Hypnagogic hallucinations are sometimes associated with brainstem abnormalities, but this is rare.[22]

Peduncular hallucinosis

Peduncular means pertaining to the peduncle, which is a neural tract running to and from the pons on the brain stem. These hallucinations usually occur in the evenings, but not during drowsiness, as in the case of hypnagogic hallucination. The subject is usually fully conscious and then can interact with the hallucinatory characters for extended periods of time. As in the case of hypnagogic hallucinations, insight into the nature of the images remains intact. The false images can occur in any part of the visual field, and are rarely polymodal.[22]

Delirium tremens

One of the more enigmatic forms of visual hallucination is the highly variable, possibly polymodal delirium tremens. Individuals suffering from delirium tremens may be agitated and confused, especially in the later stages of this disease. Insight is gradually reduced with the progression of this disorder. Sleep is disturbed and occurs for a shorter period of time, with rapid eye movement sleep.

Parkinson's disease and Lewy body dementia

Parkinson's disease is linked with Lewy body dementia for their similar hallucinatory symptoms. The symptoms strike during the evening in any part of the visual field, and are rarely polymodal. The segue into hallucination may begin with illusions[23] where sensory perception is greatly distorted, but no novel sensory information is present. These typically last for several minutes, during which time the subject may be either conscious and normal or drowsy/inaccessible. Insight into these hallucinations is usually preserved and REM sleep is usually reduced. Parkinson's disease is usually associated with a degraded substantia nigra pars compacta, but recent evidence suggests that PD affects a number of sites in the brain. Some places of noted degradation include the median raphe nuclei, the noradrenergic parts of the locus coeruleus, and the cholinergic neurons in the parabrachial and pedunculopontine nuclei of the tegmentum.[22]

Migraine coma

This type of hallucination is usually experienced during the recovery from a comatose state. The migraine coma can last for up to two days, and a state of depression is sometimes comorbid. The hallucinations occur during states of full consciousness, and insight into the hallucinatory nature of the images is preserved. It has been noted that ataxic lesions accompany the migraine coma.[22]

Charles Bonnet syndrome

Charles Bonnet syndrome is the name given to visual hallucinations experienced by blind patients. The hallucinations can usually be dispersed by opening or closing the eyelids until the visual images disappear. The hallucinations usually occur during the morning or evening, but are not dependent on low light conditions. These prolonged hallucinations usually do not disturb the patients very much, as they are aware that they are hallucinating.[22] A differential diagnosis are opthalmopathic hallucinations.[24]

Focal epilepsy

Visual hallucinations due to focal seizures differ depending on the region of the brain where the seizure occurs. For example, visual hallucinations during occipital lobe seizures are typically visions of brightly colored, geometric shapes that may move across the visual field, multiply, or form concentric rings and generally persist from a few seconds to a few minutes. They are usually unilateral and localized to one part of the visual field on the ipsilateral side of the seizure focus, typically the temporal field. However, unilateral visions moving horizontally across the visual field begin on the contralateral side and move towards the ipsilateral side.[18]

Temporal lobe seizures, on the other hand, can produce complex visual hallucinations of people, scenes, animals, and more as well as distortions of visual perception. Complex hallucinations may appear real or unreal, may or may not be distorted with respect to size, and may seem disturbing or affable, among other variables. One rare but notable type of hallucination is heautoscopy, a hallucination of a mirror image of one's self. These "other selves" may be perfectly still or performing complex tasks, may be an image of a younger self or the present self, and tend to be only briefly present. Complex hallucinations are a relatively uncommon finding in temporal lobe epilepsy patients. Rarely, they may occur during occipital focal seizures or in parietal lobe seizures.[18]

Distortions in visual perception during a temporal lobe seizure may include size distortion (micropsia or macropsia), distorted perception of movement (where moving objects may appear to be moving very slowly or to be perfectly still), a sense that surfaces such as ceilings and even entire horizons are moving farther away in a fashion similar to the dolly zoom effect, and other illusions.[25] Even when consciousness is impaired, insight into the hallucination or illusion is typically preserved.

Schizophrenic hallucination

Hallucinations caused by schizophrenia.

Schizophrenia is when one is unable to tell the difference between real and unreal experiences, accompanied by the inability to think logically, have contextually appropriate emotions, and to function in social situations. [26]

Drug-induced hallucination

Hallucinations caused by the consumption of psychoactive substances such as deliriants.

Sensory deprivation hallucination

Hallucinations can be caused by sense deprivation when it occurs for prolonged periods of time, and almost always occur in the modality being deprived (visual for blindfolded/darkness, auditory for muffled conditions, etc.)

Experimentally-induced hallucinations

Main article : Hallucinations in the sane

Pathophysiology

Various theories have been put forward to explain the occurrence of hallucinations. When psychodynamic (Freudian) theories were popular in psychology, hallucinations were seen as a projection of unconscious wishes, thoughts and wants. As biological theories have become orthodox, hallucinations are more often thought of (by psychologists at least) as being caused by functional deficits in the brain. With reference to mental illness, the function (or dysfunction) of the neurotransmitters glutamate and dopamine are thought to be particularly important.[27] The Freudian interpretation may have an aspect of truth, as the biological hypothesis explains the physical interactions in the brain, while the Freudian deals with the origin of the theme of the hallucination. Psychological research has argued that hallucinations may result from biases in what are known as metacognitive abilities.[28]

These are abilities that allow us to monitor or draw inferences from our own internal psychological states (such as intentions, memories, beliefs and thoughts). The ability to discriminate between internal (self-generated) and external (stimuli) sources of information is considered to be an important metacognitive skill, but one which may break down to cause hallucinatory experiences. Projection of an internal state (or a person's own reaction to another's) may arise in the form of hallucinations, especially auditory hallucinations. A recent hypothesis that is gaining acceptance concerns the role of overactive top-down processing, or strong perceptual expectations, that can generate spontaneous perceptual output (that is, hallucination).[29]

Treatments

There are few treatments for many types of hallucinations. However, for those hallucinations caused by mental disease, a psychologist or psychiatrist should be alerted, and treatment will be based on the observations of those doctors. Antipsychotic and atypical antipsychotic medication may also be utilized to treat the illness if the symptoms are severe and cause significant distress.[citation needed] For other causes of hallucinations there is no factual evidence to support any one treatment is scientifically tested and proven. However, abstaining from hallucinogenic drugs, managing stress levels, living healthily, and getting plenty of sleep can help reduce the prevalence of hallucinations. In all cases of hallucinations, medical attention should be sought out and informed of one's specific symptoms.

Epidemiology

One study from as early as 1895[30] reported that approximately 10% of the population experienced hallucinations. A 1996-1999 survey of over 13,000 people[31] reported a much higher figure, with almost 39% of people reporting hallucinatory experiences, 27% of which were daytime hallucinations, mostly outside the context of illness or drug use. From this survey, olfactory (smell) and gustatory (taste) hallucinations seem the most common in the general population.

See also

Further reading

  • Johnson FH (1978). The anatomy of hallucinations. Chicago: Nelson-Hall Co. ISBN 0-88229-155-6.
  • Bentall RP, Slade PD (1988). Sensory deception: a scientific analysis of hallucination. London: Croom Helm. ISBN 0-7099-3961-2.
  • Aleman A, Larøi F (2008). Hallucinations: The Science of Idiosyncratic Perception. American Psychological Association (APA). ISBN 1-4338-0311-9.

References

  1. ^ Leo P. W. Chiu (1989). "Differential diagnosis and management of hallucinations" (PDF). Journal of the Hong Kong Medical Association 41 (3): 292–7. http://sunzi1.lib.hku.hk/hkjo/view/21/2100448.pdf. 
  2. ^ Chen E. and Berrios G.E. (1996) Recognition of hallucinations: a multidimensional model and methodology. Psychopathology 29: 54-63.
  3. ^ Visual Hallucinations: Differential Diagnosis and Treatment (2009)
  4. ^ semple,David."oxford hand book of psychiatry" oxford press.2005.
  5. ^ Horwitz, M. (1975). Hallucinations: An information-processing approach. New York: Wiley. pp. 163–194. 
  6. ^ "Medical dictionary". http://medical-dictionary.thefreedictionary.com/paracusia. 
  7. ^ Thompson, Andrea (September 15, 2006). "Hearing Voices: Some People Like It". LiveScience.com. http://www.livescience.com/humanbiology/060915_hearing_voices.html. Retrieved 2006-11-25. 
  8. ^ Engmann, Birk; Reuter, Mike: Spontaneous perception of melodies – hallucination or epilepsy? Nervenheilkunde 2009 Apr 28: 217-221. ISSN 0722-1541
  9. ^ Murat Ozsarac, Ersin Aksay, Selahattin Kiyan, Orkun Unek, F. Feray Gulec, De Novo Cerebral Arteriovenous Malformation: Pink Floyd's Song 'Brick in the Wall' as a Warning Sign, The Journal of Emergency Medicine, In Press, Corrected Proof, Available online 13 August 2009, ISSN 0736-4679, DOI: 10.1016/j.jemermed.2009.05.035.
  10. ^ "Rare Hallucinations Make Music In The Mind". ScienceDaily.com. August 9, 2000. http://www.sciencedaily.com/releases/2000/08/000809065249.htm. Retrieved 2006-12-31. 
  11. ^ Medical News Today: "Too Much Coffee Can Make You Hear Things That Are Not There"
  12. ^ a b Beck-Sander, A.; Birchwood, M.; Chadwick, P. (1997). "Acting on command hallucinations: A cognitive approach". The British journal of clinical psychology / the British Psychological Society 36 (1): 139–148. PMID 9051285.  edit
  13. ^ Lee, T. M.; Chong, S. A.; Chan, Y. H.; Sathyadevan, G. (2004). "Command hallucinations among Asian patients with schizophrenia". Canadian journal of psychiatry. Revue canadienne de psychiatrie 49 (12): 838–842. PMID 15679207.  edit
  14. ^ Phantom smells
  15. ^ Wolberg FL, Zeigler DK (1982). "Olfactory Hallucination in Migraine". Archives of Neurology 39 (6): 382. PMID 7092619. 
  16. ^ Sacks, Oliver (1986). Migraine. Berkeley: University of California Press. pp. 75–76. ISBN 978-0-520-05889-7. 
  17. ^ a b Berrios G E (1982) Tactile Hallucinations. Journal of Neurology, Neurosurgery and Psychiatry 45: 285-293
  18. ^ a b c Panayiotopoulos, Chrysostomos P. A clinical guide to epileptic syndromes and their treatment: based on the ILAE classification and practice parameter guidelines. 2. ed. London: Springer, 2007.
  19. ^ Barker, P. 1997. Assessment in Psychiatric and Mental Health Nursing In Search of the Whole Person. UK: Nelson Thornes Ltd. p245.
  20. ^ Barker, P. 1997. Assessment in Psychiatric and Mental Health Nursing in Search of the Whole Person. UK: Nelson Thornes Ltd. P245.
  21. ^ a b c d e Horowitz MJ (1975). "Hallucinations: An Information Processing Approach". In West LJ, Siegel RK. Hallucinations; behavior, experience, and theory. New York: Wiley. ISBN 0-471-79096-6. 
  22. ^ a b c d e Manford M, Andermann F (Oct 1998). "Complex visual hallucinations. Clinical and neurobiological insights". Brain 121 ((Pt 10)): 1819–40. doi:10.1093/brain/121.10.1819. PMID 9798740. http://brain.oxfordjournals.org/cgi/content/abstract/121/10/1819. 
  23. ^ Mark Derr (2006) Marilyn and Me, "The New York Times" February 14, 2006
  24. ^ Engmann, Birk (2008). "Phosphenes and photopsias - ischaemic origin or sensorial deprivation? - Case history" (in German). Z Neuropsychol. 19 (1): 7–13. doi:10.1024/1016-264X.19.1.7. http://www.psycontent.com/content/m507n73711u73652/?p=400b10f998844a6abe524fcf44626323&pi=1. 
  25. ^ Bien CG, Benninger FO, Urbach H, Schramm J, Kurthen M, Elger CE (2000) Localizing value of epileptic visual auras. Brain 123:244–253 PubMed
  26. ^ Stannard, Lia. "Schizophrenia Types of Hallucinations." LiveStrong. Demand Media, Inc., 11 May 2011. Web. 14 Dec 2011.
  27. ^ Kapur S (Jan 2003). "Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia". Am J Psychiatry 160 (1): 13–23. doi:10.1176/appi.ajp.160.1.13. PMID 12505794. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=12505794. 
  28. ^ Bentall RP (Jan 1990). "The illusion of reality: a review and integration of psychological research on hallucinations". Psychol Bull 107 (1): 82–95. doi:10.1037/0033-2909.107.1.82. PMID 2404293. http://content.apa.org/journals/bul/107/1/82. 
  29. ^ Grossberg S (Jul 2000). "How hallucinations may arise from brain mechanisms of learning, attention, and volition". J Int Neuropsychol Soc 6 (5): 583–92. doi:10.1017/S135561770065508X. PMID 10932478. 
  30. ^ Francis Nagaraya, Myers FWH et al. (1894). "Report on the census of hallucinations". Proceedings of the Society for Psychical Research 34: 25–394. 
  31. ^ Ohayon MM (Dec 2000). "Prevalence of hallucinations and their pathological associations in the general population". Psychiatry Res 97 (2–3): 153–64. doi:10.1016/S0165-1781(00)00227-4. PMID 11166087. http://linkinghub.elsevier.com/retrieve/pii/S0165178100002274. 

External links


Translations:

Hallucination

Top

Dansk (Danish)
n. - hallucination, sansebedrag

Nederlands (Dutch)
hallucinatie, waanvoorstelling

Français (French)
n. - hallucination

Deutsch (German)
n. - Halluzination

Ελληνική (Greek)
n. - παραίσθηση, ψευδαίσθηση, φαντασιοπληξία

Italiano (Italian)
allucinazione

Português (Portuguese)
n. - alucinação (f), (m) desvario

Русский (Russian)
галлюцинации

Español (Spanish)
n. - alucinación

Svenska (Swedish)
n. - hallucination

中文(简体)(Chinese (Simplified))
幻觉, 幻想

中文(繁體)(Chinese (Traditional))
n. - 幻覺, 幻想

한국어 (Korean)
n. - 환각, 착각, 망각

日本語 (Japanese)
n. - 幻覚, 妄想, 錯覚, 幻想

العربيه (Arabic)
‏(الاسم) الهلوسه, الهذيان‏

עברית (Hebrew)
n. - ‮הזיה‬


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formication (psychology)