The situation in which for a person the reality around him differs from the real one is traditionally classified as a visual disorder.

In addition, these patients may have hearing, smell, and other sensory disturbances, but at a much lower frequency. There is a fairly broad classification of deviations in the perception of reality. The most common among them are illusions and hallucinations.

After reviewing the information below, you will find out what is the difference between illusions and hallucinations and other diseases. For a better understanding of the material, an example of each significant and common disorder will be given.

Illusion in general

The difference between deviations of perception lies, first of all, in the affected sense organs and the affected aspects of activity. Their manifestation often differs depending on the environment in which a person lives.

An example is the following: the patient lives in his apartment or house and is cared for by caregivers. In this case, a sharp change in the usual environment can lead to the occurrence of deviations. A similar example can be given for any disorder. At the same time, the changes do not have to be too significant and significant.

Example: a person sat at home, went to the store, communicated with strangers to a minimum. During one of the outings for groceries, he accidentally met with an old acquaintance. It would seem that the situation is not the most terrible. However, in a person with mental disorders, this can cause a significant shock, provoking the appearance of illusions and hallucinations.

Classification of erroneous visual perceptions

Most often, patients and the people around them regard the optical illusion as hallucinations, sometimes illusions. But in reality there can be many more problems. Consider a description and an example for each case.

1. Illusions. The category of illusions includes erroneous perception and incorrect identification of surrounding objects. The problem can be caused by the similarity of one object to another, surface characteristics (example - iridescent or reflective surface), as well as environmental conditions (example - lighting features). In short, illusions occur when a person sees an object incorrectly because it looks like something else.
2. Misperception. This problem appears in conditions of deficiency of visual information. An example - a person sees only some part of an object, which is why he incorrectly identifies it. Another example is the patient has poor eyesight, which is why the environment is perceived erroneously. Another example can be given - a person expected to see one thing in a particular situation, based on previous experience, which is why he did not attach much importance to new changes.
3. Agnosia. It differs from other disorders in that it is characterized as a neurological disorder, the essence of which is reduced to the incorrect recognition of objects and people. Damage to the cerebral cortex leads to the appearance of a problem. The visual apparatus, however, usually retains normal performance.
4. Aphasia. It is characterized by incorrect identification of objects. Rarely, but there are situations in which a person cannot find the right words to describe his impressions and feelings, cannot determine the appropriate name for objects. Damage to the areas of the brain responsible for speech lead to the appearance of a problem. Seen in a variety of dementias.
5. hallucinations. They differ from illusions, first of all, in that in such a state a person can see something that does not really exist. There are no external factors capable of provoking the occurrence of such disorders - the problem is determined purely by the peculiarities of the internal functioning of the brain. At the same time, problems can completely disappear only if the person is provided with appropriate qualified assistance, or if he realizes that the visions created by his brain are not real.

Otherwise, the duration of violations can be significantly stretched and accompanied by repeated cycles, inevitably affecting the behavioral characteristics and the overall psyche of the patient.

A variety of painful conditions provoked by injuries or infections, certain medications, mental illnesses, and alcoholism can lead to the appearance of visions.

If there are suspicions of hallucinations by someone from your environment, watch the person, try to calmly explain to him that imaginary objects do not exist, follow, understand and remember what you said.

If the person does not understand the meaning of your words, wait until he calms down and rests, then talk again. If it does not help, be patient and do not be nervous - there will be no sense from this. Try to be close to the patient, especially if he is afraid. Try to switch his attention to other events, provide support.

It is very difficult to determine what kind of disturbances in the perception of reality a particular person suffers without qualified medical diagnosis and subsequent assistance. Therefore, when the first deviations appear, you should consult a doctor. As a rule, examinations begin with a visit to a general practitioner (therapist). After completing the initial examination, the specialist will determine which doctor it is best for the patient to work with further.

In order for the clinician to make the most accurate diagnosis, the patient or members of his or her environment should collect the following information and answers to questions, if possible:

• the nature of the distortion of the perception of reality. You can tell what the patient sees, how he describes the environment, how different it is from reality, etc.;
• the period of the day during which visions appear and become most pronounced;
• events preceding the onset of illusions, hallucinations, or other disturbances considered. For example, some patients experience difficulties upon waking up, others shortly after physical exertion, in others they appear due to recent stresses, etc.;
• places where the patient most often hallucinates or experiences other disturbances in the perception of reality;
• the duration of violations and the frequency of their occurrence;
• external symptoms indicating a pathological emotional and / or physical condition of the patient;
• previous and current diseases, if any;
• a list of drugs taken previously and / or currently, the features of their use (frequency, dose, etc.);
• features of the psycho-emotional state of the patient, his susceptibility to stress, unpleasant situations;
• information about the characteristics of the use of alcohol, drugs;
• up-to-date data on the state of vision and other organs of perception with a description of the existing problems.

In order to avoid problems in the future, or at least minimize the likelihood of their occurrence, we must try to create the most comfortable environment for the patient. It has been established that as long as a person has everything in order at home, at work and in his personal life, mental deviations will make themselves felt with much less frequency and their severity will be significantly lower.

Along with this, the situation is aggravated by the presence of various kinds of cognitive disorders. When these occur, it becomes more difficult for the patient to cope with problems and his psyche can give a serious failure.

It has been established that a tritely improperly organized interior can lead to the appearance of an optical illusion. Care must be taken to ensure that such lighting is organized in the house, in which the surrounding objects will not cast a shadow and will take on their natural appearance.

The walls in the apartment / house in which the patient lives should be light and plain. With regard to the colors of interior items, furniture and doors, the recommendation is the opposite: it is better that they are bright and contrast with the walls.

For example, clinical studies have found that Alzheimer's patients show more interest in food when using bright kitchen utensils, and installing a bright door in the toilet helps solve their incontinence problem - the patient simply finds a place to cope with natural needs faster.

If the patient, due to age or other circumstances, is forced to use the handrails, they should be as visible as possible so that their search does not take much time and nerves.
The use of floor coverings, wallpapers and other decorative elements decorated with overloaded ornaments should be refrained from. It is better that the floor and ceiling, as well as the walls, be light. Materials, however, should not be glossy. With such an interior design, the overall illumination of the room will significantly increase, but the patient will not be blinded by additional light.

If possible, the room should be devoid of contrasting joints on the floor surface - the patient may regard them as an obstacle, which will cause difficulties when moving, because. the patient may be afraid to fall.

Thus, there is one big difference between illusions and hallucinations: in the first case, a person simply incorrectly assesses the type of an existing object, in the second, he sees something that is not really there.

Also, the difficulties of perceiving reality may have a different character and nature - you have already familiarized yourself with the information regarding these moments.
Respond in a timely manner to adverse changes in your condition, follow the recommendations of the treating specialists and be healthy!

Perceptual disturbance(disorders) - violation of the process of integral reflection of the subject. There are four types of violations:

1. Psychosensory disorders

Psychosensory disorders- a perceptual disorder in which a real-life perceived object is recognized correctly, but in an altered, distorted form. There are two groups:

• Derealization(the real world does not seem to be the same) is expressed as a violation (distortion) of the shape, size, weight and color of the perceived object.
  • micropsia- reduction in the size of perceived objects;
  • macropsia- increase in the size of perceived objects;
  • color perception disorder(for example, everything appears red);
  • Violation of time and space- with manic depressive syndrome (with it, time “goes very quickly”) or with some depressive syndromes (time, on the contrary, “takes a very long time”).
• Depersonalization(a state accompanied by a change or loss of a sense of self)
  • Somatopsychic(violation of the body scheme);
  • autopsychic- is expressed in the feeling of change of one's "I".

2. Agnosia

Agnosia- violation of perception expressed in the inability to recognize and explain the meaning of sensory sensations (visual, auditory, tactile). I distinguish:

• True
  • total agnosia- does not know anything;
  • color agnosia;
  • Spatial agnosia- can not orient in space;
  • Geographic agnosia- not recognizing the area;
  • facial agnosia- does not recognize the faces of acquaintances or himself;
  • Astriognosia- tactile agnosia;
  • somatognosia- not recognizing your body;
  • auditory agnosia;
    • Amusia- unrecognition of musical sounds;
• Pseudoagnosia- have an additional element that is not present in agnosias: diffuse, undifferentiated perception of signs (with).
  • Simultaneous agnosia- does not recognize an object in an inverted position.

3. Illusions

Illusions- a violation of perception, in which a really existing object is perceived as completely or partially different. Distinguish:

1. Physical(due to the peculiarities of the environment in which the perceived object is located).
2. Physiological(arise in connection with the conditions of functioning of the receptors).
3. Mental(inadequate reflection of the perceived object).
4. affective illusions arise against the background of fear or anxiously depressed mood.
5. visual illusions - sees words, letters.
   • Pareidolia- false images arise from the illusory perception of a real object (the heart sees in the clouds).
6. Auditory illusions - distortion of the strength of sound, etc.
   • Verbal illusions (a kind of auditory) - a person hears words. He hears the wrong words.
7. Tactile illusions - parasthesias - as if snakes, beetles crawl over the body, although they are not there. alien hand syndrome Some part of the body feels like someone else's.
8. Olfactory illusions,
9. Flavoring illusions.

4. Hallucinations

hallucinations- imaginary perception, a false image without sensory stimulation. Distinguish:

• Simple and complex.
• By modality(analyzer type) - visual, auditory, motor, vestibular, visceral, gustatory, olfactory, hallucinations of the skin sense.
• True and pseudo hallucinations.
• According to the condition of occurrence- functional, psychogenic, etc.

Simple hallucinations(one analyzer):

• photopsies- elementary visual hallucinations in the form of circles, flies, mesh, flashes, sparks from the eyes;
• Acoasma- simple auditory hallucinations in the form of noise, knocking, creaking, squeaking, roaring;
• Phonemes(speech deceptions) - the patient hears individual words, calls.

Complex hallucinations(more than one analyzer):

• verbal character The patient hears voices.
• visual- visions of complex objects, people, etc. Depending on the nature of the visions, there are: fragmentary (fragments of the body), panoramic, scene-like, anthropomorphic (I see the dead), zoopsy (I see animals), demonomaniac (I see evil spirits), visceroscopic, autovisceroscopic hallucinations, etc.
• Olfactory.

hallucinations of general feeling:

• Visceral hallucinations(endoscopic) - the perception of foreign objects inside the body.
• motor hallucinations.

true hallucinations perceived as an objective reality. They are bright, not
different from the objects of reality. Pseudo-hallucinations perceived as something special, different from reality. They are not projected into the outside world, but “arise” inside the head, body, or “come” from a parallel world (hears voices inside the head that give orders).

Types of hallucinations depending on the conditions of their occurrence:

• Psychogenic- “suggested”, arise after stress, for example, the death of a loved one.
• induced- delusions of perception in persons who are, for example, in a crowd engulfed in religious ecstasy.
• Functional- arise under the influence of a real stimulus and exist in the same modality of sensations.

Sources and literature

• Materials for preparing for the exam in psychopathology.

The word “illusion”, which came from the Latin language, is translated as deception or delusion. This remains the most accurate description of the term. The bright colorful world of illusion is not always fiction, but it is always a deceptive feeling that pulls you out of reality and prevents you from living an ordinary life. There are many reasons for the emergence of illusions, as well as its types.

What is an illusion?

Such a phenomenon can be created by a skilled magician or mother nature herself, but it happens that a person introduces himself into a deception. An illusion is when a real object or a phenomenon is perceived in a distorted form and is understood ambiguously. It is believed that the illusion is a satellite of some kind, but this is not entirely true, a healthy person is also able to feel the illusion on himself. How can you see an illusion?

1. Due to optical illusion.
2. Being in an unusual state for a person (drug intoxication, with pathology or standing of passion).

In everyday terms, illusion means hopes and dreams. The unreal world that illusion creates is a world of self-deception, and serves as a means that makes life easier for a person or is completely a flight of his imagination. The human consciousness always seeks to protect itself from shocks and strive for illusion, induces dreams of a miracle, creates images of a “beautiful life” or ideal people.

How are illusions different from hallucinations?

Life situations can create conditions in which people will experience perceptual disorders. Illusions and hallucinations can cause such disorders; even a healthy person is not protected from them. How to distinguish one from the other:

1. Due to the illusion, one can see real things from a completely different angle or with a great distortion of reality. The usual mistakes with which a person can see something, for example, in the dusk, take some things and objects for others, take a bright leaf from a tree for a mushroom hat, can be in quite healthy people. Such errors should be distinguished from a painful perception of reality.
2. Hallucinations appear where there is nothing. Haunting images may arise against a background of psychosis. In healthy people, they occur if they are in a state where their consciousness is changed.

Illusions of perception

Human perception is imperfect, and sometimes you can see an image, hear a sound, feel a taste that is not what it really is. It is normal that, against the background of distorted perception, the brain builds images that do not correspond to reality. A person is able to create the appearance of something that is not in reality or, on the contrary, not to notice the evidence. The illusion of perception in psychology is the observation of phenomena, even if a person understands that this is on the verge of being possible. So you can see a mirage, the distortion of an object in water, and much more.

What are illusions?

For each sense organ there is at least one illusion, there are a lot of them. The types of illusions that a person can experience have their own division:

• optical - this is an erroneous visual perception;
• sound - hearing failure;
• physiological - peripheral or central links of the sense organs did not work correctly;
• awareness - a sense of presence, is also referred to as a form of hallucination;
• physical - associated with natural phenomena;
• affective - may appear with a sharp change in mood;
• organic - erroneous perception of colors, sizes and shapes;
• pareidological - the creation of pictures with the help of thought.

Pareidolic illusions

Illusory perceptions of real objects are called pareidological illusion. Such illusions can arise when a person considers a pattern of wallpaper, fabric, spots or cracks, clouds. You can see not only faces or objects, but also fantastic images. This happens as a result of the effect of a dual image, when the illusion of the emergence of depth or recognition images is created specifically for provocation. This view can be observed in several people at once when considering some well-known object, such as cultural heritage.

affective illusions

Being in a certain emotional state of mind, and at the same time, being in an unfamiliar place, a person is able to see almost unbelievable. A striking example is a night visit to a cemetery. Being under the influence of fear and in anticipation of something unkind, any person is able to see an affective illusion. Or with the fear of spiders, and the presence of a new, unfamiliar place, a person will be afraid of their appearance from everywhere. Many people are able to see different kinds of illusions. An affective illusion can appear even in a healthy person.

physical illusions

Some pilots in their stories emphasize that if you fly over the sea, when the stars are reflected in it, then there is a feeling of an inverted flight. The main feature of physical illusions is their dependence on the mental state. Illusions physiological or physical are short-term phenomena, they are episodic. If a person is able to critically assess the situation, to understand that this is an illusion, then this indicates him.

How are physiological illusions created? A striking example is a violation of the eye, when it is very difficult to determine the distance from a person to an object “by eye”. Real indicators and a false perception of distance give rise to this type of illusion. Almost all people encounter this type of illusion, and knowing that it is an illusion, it is easy to correct it. A similar type of illusion is a feature of the structure of the eye and lighting effects.

cognitive illusions

Such phenomena arise due to the fact that a person begins to make assumptions about the world, which leads to analysis, sometimes unconscious. Cognitive illusions are erroneous thinking, it develops as a result of mental behavior. Such an illusion of a person is an example of fast thinking, if a person had initially analyzed his thoughts, then it would not have arisen. Cognitive distortions are actively studied by psychotherapy because they carry consequences of a personal and social nature.

Illusions - psychology

All people are prone to experiences, making difficult decisions, looking for answers to questions. People have illusions to remove uncertainty in some issues. What is an illusion in psychology? This is the formation of one's own image of vision and its substitution, instead of the present and real. Illusions can help a person relieve anxiety and tension. Even if in illusions the image is negatively colored, the person will be warned of what he should be afraid of.

Such thinking is initially erroneous and may have nothing to do with reality. Psychologists do not attribute such illusions to human diseases, but they recommend stopping living in an illusory world. To live in illusions all the time is, to say the least, stupid. If a person lives and constantly harbors illusions about other people, then he needs to turn to a psychologist.

Reasons for illusions

When a person watches how a spoon is bent when immersed in a glass of water, this is not a mental disorder. This is an illusion that can occur in any healthy person. Illusions often arise in a person with a stormy, visit creative people. From tension or fatigue, people can see and hear things wrong. But if the illusion is already a true friend and visits with an enviable frequency, then this is rather a disease of the psyche.

It also matters what specific illusion comes to a person. The sound of dripping water from a closed tap is not a reason to run to the doctor, much more serious if voices are heard periodically. The causes of many illusions are not known to this day, they have no scientific explanation. To live in a world of illusions is to carry out the construction of one's life as if the existence of a person takes place in another world. It doesn't matter if the illusory world is better or worse, the main thing is that it is different.

How to stop living in illusions?

Human behavior in certain situations and his decisions always lead to certain consequences. A person who has chosen for himself the path of living with illusions begins to use the rules of the fictional world in the real one. He chooses for himself that model of behavior that could be effective in his illusory world, but not in reality. Having illusions in a mild form is even sometimes useful, but living in them is dangerous, so you need to know how to get rid of illusions.

1. It is worth making an attempt to bend the world of illusion under oneself. With him, you need to start a war in your subconscious and burn out all those ideas that are far from reality. People who continue to live in a fantasy world are the future demonstrators. They are ready to pour out their wrath on all who are at hand. They complain about life to random people, fellow travelers, c.
2. A person should understand that reality is what it is, it will not be different. All failures are caused not by the fact that a person is bad, but by the fact that he acts incorrectly, looking back at his illusions. The person needs to grow up. To become an adult is not to give up your goals and stop wanting to see your life better, it means to accept the truth, to know the world, to learn to understand it correctly.

In childhood, illusory deceptions are much more common than in adults. Their development is facilitated by emotional lability characteristic of children - states of excitement, anxiety, fear, increased activity of the imagination inherent in children, suggestibility, as well as states of overwork.

Unlike physiological, pathological illusions are characterized by repetition, uniformity, the presence of a pronounced affective component and, in some cases, a secondary interpretation.

Visual illusions occur already in early childhood. Auditory deceptions, as well as the interpretive component of illusions, appear at school age (for example, the sound of rain is heard as the sound of approaching steps, the sound of water in pipes is perceived as a conversation). Tactile and olfactory illusions are less common in children (the fold of a blanket is perceived as a snake, the smell of food from the kitchen is felt as the smell of medicine).

Most often, illusions in children occur with delirious stupefaction in the acute period of intoxication and infectious psychoses. Visual illusions and pareidolia predominate. In schizophrenia, illusions are characterized by fantastic images (a lampshade is a “bird without a head”), often with a delusional interpretation. Separate illusory deceptions within the framework of neuroses are also possible - against the background of fear, anxious fears.

Hallucinations (from Latin hallucinatio - delirium) are a complex psychopathological phenomenon. The term "hallucinations" was first used by Boissier de Sauvage. There are a number of definitions of hallucinations in the literature. One of the most common is the following: hallucinations - the perception of images that arise without the presence of real objects that affect the senses.

In addition, hallucinations were viewed as:

Deceptions of the senses that do not have a source of irritation, in which the patient is unable to renounce the inner conviction that he currently has sensory sensations; while in fact his external feelings are not affected by any object that can excite such sensations (J. Esquirol).

Representation of unusual sensual liveliness (E. Kraepelin).

Such states of consciousness, which are either completely equivalent to normal perceptions, or, in the absence of the latter, are able to replace them with themselves (V.Kh. Kandinsky).

Deceptions of perception, which are not distortions of true perceptions, but arise by themselves as something completely new and exist simultaneously with true perceptions (K. Jaspers).

An image of representation visualized in the psyche (A. Hey).

True perception in the sense that the hallucinator actually sees, hears, etc., and not only thinks he sees, hears, etc. (V. Chizh).

Projection outside objectified, "received flesh and blood" representations, and not perceptions (V.A. Gilyarovsky).

Representations characterized by involuntary, intense sensuality, projected into the real world and thereby acquiring the properties of objectivity (A.V. Snezhnevsky).

Common signs of hallucinations are the absence of an objective stimulus and the patient's belief in the reality of experiences.

Along with the general ones, there are private criteria for hallucinations:

A sense of reality is a sense of the real existence of a hallucinatory image. It is most pronounced in hallucinations that occur against the background of clouded consciousness, as well as in true hallucinations with extra projection.

The sensibility of a hallucinatory image is the degree of its belonging to sensual images (as opposed to the category of representations). True hallucinations have the greatest degree of sensory:

“People with dogs - they walked like an army to my house. There was a terrible bark. They came from all directions. They began to stand in front of my windows. If they saw that I go to the window, they instantly disappear. I saw them under every tree.”

Hallucinoids (incomplete pseudohallucinations) and pseudohallucinations have a lesser degree.

"A knock or tremor from the wall, an invisible and inaudible sound, as if the wall were shaking."

Violence of images, a sense of alienation, made. Hallucinations always occur involuntarily and are usually uncontrollable:

“There is a vision of pages from a grammar book, seen by the head, and not by the pelvis. The text is clear and easy to read.

The feeling of violence without the experience of being done is observed mainly in hallucinations with extra projection.

“I saw the devil: I was lying on my bed, and he was walking behind me, black, bent over me. I had a round vase, the most frightening moment was when this terrible head was on the vase.

The feeling of being made differs from the experience of violence by the presence of a delusional addiction - the images are specially "made", "induced" by someone, arose by someone's evil will under the influence of "hypnosis", "equipment". It is characteristic of pseudohallucinations:

The patient sees "portraits of familiar and unfamiliar people that appear before her eyes" and notes that "visions are shown using a system of lenses and rays."

state of attention. Directing attention to true and pseudo-hallucinations increases their intensity, diverting attention weakens them. Hallucinoids disappear when attention is paid to them.

The patient, called aside at the moment of hallucination, immediately laughs at himself in conversation, calls himself "crazy", understands that voices are a "disease". But, left alone, he again hears how he is scolded, called a "drunkard", scolded.

Psychic hallucinations of Bayarger

The first group considers hallucinations depending on the degree of their complexity.

1. Elementary hallucinations are visions of flashes of light, fog, colored spots, etc. (photopsies, phosphrenes); perception of noise, ringing, bells, creaks, etc. (acoasma) or calls, groans, crying, laughter (phonemes). These hallucinations are characterized by the incompleteness of the objective image.

Simple hallucinations have a clear, complete image and are the most common type of hallucinatory deception.

Complex hallucinations-images appear simultaneously in several analyzers.

Complex hallucinations also capture several senses and, moreover, are united by a common content.

The second group presents the division of hallucinations according to the sense organs.

2. Visual hallucinations appear in images:

Various items.

People, both familiar and unfamiliar, living or already dead - anthropomorphic hallucinations.

Mystical, mythological characters (angels, devils, witches, mermaids, etc.) - demonic hallucinations.

Animals (rats on the floor, dogs, cats running around the room, insects on the blanket, flies sitting on the skin and biting the patient, etc.) - zoooptic hallucinations.

Landscapes, colorful landscapes, disaster paintings and other paintings; usually static - panoramic hallucinations.

Habitual household or professional environment - palingnostic hallucinations.

Own double - autoscopic or deuteroscopic hallucinations. They are characteristic of relatively severe forms of organic brain lesions, most often of the temporal, parietal lobes, somatogenic psychoses, for example, postoperative psychoses against the background of hypoxia.

Own internal organs - autovisceroscopic hallucinations:

The patient, with his eyes closed, clearly saw a beating heart, pink in color, the size of a fist, which was seized by a black paw. I saw my lungs, brown in color, covered with yellow smoke. The paw reached for them, but did not get it.

Objects or living beings inside your body - endoscopic hallucinations.

The same patient saw a yellow-green crocodile 1/4 cm in size appear under the skin, in the groin area. It crawled down under the skin of the legs and disappeared. Then a black snake appeared from the groin area, began to move up the intestines, made its way into the stomach, passed the esophagus and stuck its head out through the mouth. I saw two herring heads lying side by side in the stomach, and then a gray ball of wool, which also moved through the intestines.

Visual hallucinatory images can have their usual sizes (normoptic hallucinations), be enlarged or reduced (macro- and micro-optical hallucinations):

For example, with infectious diseases, intoxication, patients see "little gnomes in bright dresses", "small figures of people with naked sabers riding small horses."

Images can be static or moving. For example, visual hallucinations in alcoholic delirium are characterized by microzoopsia - visions of many moving small insects, animals (cockroaches, mice, rats). Scene-like hallucinations often appear - visions of plot-related events, scenes (adventure, funeral, battles, afterlife, etc.).

Split images or visions of multiple identical objects are possible (diplopic and polyopic hallucinations). In addition, there may be flat, devoid of three-dimensional visions, perceived as projected onto the surface of the wall (cinematic hallucinations).

Sometimes the patient sees objects that are out of his field of vision (extracampine hallucinations). Such deceptions are characteristic mainly of schizophrenia.

There are also negative or negative hallucinations, in which the patient does not see certain objects that are in his field of vision. Negative hallucinations can sometimes be induced artificially by hypnotic suggestion.

Among the auditory hallucinations, the most clinically important are the verbal hallucinations, described for the first time by G. Seglas. They are words, phrases, conversations, "voices" that are heard by the patient.

There are a number of varieties of verbal hallucinations, depending on their content:

Imperative - orders to do something or prohibitions on any actions that the patient most often cannot resist. Imperative hallucinations are very dangerous. In particular, "voices" can order the patient to kill someone or jump out of the window.

With schizophrenia, patients feel “loss of their will”, “impossibility to resist” orders, call themselves “robots”, “puppets”, unquestioningly carry out any orders of “voices”:

“I am a toy in someone else's hands. do this, do that";

“Forcing you to redo, for example, pull the rope, first one, then the other, and then - badly, you have to redo everything. They talk in the head, and sometimes they move their hands.”

This brings imperative hallucinations closer to mental automatisms and catatonic phenomena.

Teleological (according to E. Bleuler) - "voices" advise the patient what to do, how best to act, teach him.

Persuading - persuasion to do something, exhortations, communication to the patient of certain information, often false.

Threatening - the patient hears threats addressed to him, promises to punish him, deal with him, kill him, etc.:

"I will destroy you!. Your heart will stop! Now you are going to die!”

Insulting - abuse, insults, ridicule addressed to the patient:

"Bastard, when I was young I was better than now."

Accusing - condemnation, accusations of any misconduct, sins, both imaginary and those that have taken place.

Commenting - comments and evaluation of the patient's actions with "voices":

"Got up. went. opened the refrigerator. wants to get dressed.

Contrasting - advice or orders to do the opposite of what the patient is doing at the moment, or several "voices" with the opposite content.

There are verbal hallucinations in the form of a monologue - a continuous story about something, for example, about the patient's life, his biography, long-forgotten facts from his past (memoir hallucinations).

In addition to verbal hallucinations, there are musical hallucinations - music, singing, choir are heard. So, patients with alcoholic genesis of hallucinations hear ditties, drinking songs on an alcoholic theme, etc. Patients with epilepsy hear church, sacred music, bell ringing, magical "heavenly" music. Sometimes unfamiliar melodies are heard, which patients unsuccessfully try to remember or write down.

Olfactory hallucinations are represented by the perception of various smells - familiar and unfamiliar, pleasant, indifferent or, more often, unpleasant, disgusting.

Patients smell rot, blood, feces, burning, "radioactive snow", or flowers, perfumes, etc.

Smells can come from various external objects (from the ventilation duct, from food), as well as from the patient himself or from his internal organs. In the first case, olfactory hallucinations are often accompanied by delusions of poisoning, in the second - by delusions of bad smells, hypochondriacal and nihilistic delusions.

Episodes of strongly perceived odors may appear within the epileptic aura.

Taste hallucinations can occur both during meals and outside of it. Patients experience various taste sensations, usually of an unpleasant nature. The object of sensation may be familiar, or unknown, unusual (“metallic taste”, the taste of “potassium cyanide”, bitterness, etc.).

Often, gustatory hallucinations are combined with olfactory deceptions, delusions of poisoning, and can cause the patient to refuse food. In addition, unpleasant taste sensations occur in hypochondriacal and nihilistic delirium and are interpreted by patients as signs of a severe "illness", "decomposition" of the body.

Tactile hallucinations are sensations of the presence of various objects or living beings on the skin, in the skin or under the skin.

For example, in case of poisoning with tetraethyl lead, leaded gasoline, a sensation of the presence of hair, crumbs, threads in the mouth (a symptom of a foreign body in the mouth) is characteristic.

With cocaine psychosis, a symptom of Manyan is observed - a feeling of insects crawling under the skin, moving small objects, crystals.

A schizophrenic patient feels itching in the anus, genitals, where insects "nest" - "microscopic fleas, ants", which "scatter quickly like lightning" throughout the body.

Unlike senestopathies, with tactile hallucinations, a complete image of an object is perceived, and not just a sensation. Patients feel the touch of the hand, the crawling of living beings, scratching with a needle, etc. and can at the same time clearly describe the object-source of tactile sensation. There are tactile hallucinations:

Temperature character - "apply a red-hot wire."

Hygric hallucinations are the sensation of the presence of fluids on or under the skin.

Stereognostic - the feeling of the presence in the hand of an object - a glass, a coin.

Erotic - sensations of touching, obscene manipulations with the genitals.

Haptic - sudden sensations of sharp shocks from the outside, blows, grasping.

Visceral hallucinations (interoceptive, bodily, hallucinations of a general feeling) - a feeling of the presence inside the body of living beings, foreign bodies, additional internal organs, etc. Like tactile hallucinations, visceral hallucinations are characterized by objective completeness. Patients can describe imaginary objects accurately and in detail.

A patient with psychosis, which arose against the background of atherosclerotic brain damage, complained about the presence in her body of "little men - poltergeists", claimed that they penetrated through the anus and spread to all internal organs:

“There were a lot of them, mostly talking. They showed me my insides. Wanted to add a tail. They began to run around the body like little midges, little men. They ran and made a whole house. Blow bubbles at your feet. They did what they needed - a window above the left eye, there was always someone sitting there, like a dispatcher. I felt “telephone wires” in my stomach that the “little men” stretched out to talk to each other, “the phone installed the first of them - I hear that someone comes under the pillow and talks to those who are in me.” She felt small steps when the "poltergeists" ran inside her. In my head I felt a “little woman” who directed all the actions of the “little men”. She noted that "poltergeists" were capable of both causing disturbances in the internal organs and "correcting" them.

Motor hallucinations (kinesthetic) - imaginary sensations of movements (bending fingers, turning the head, running). In particular, with alcoholic delirium, patients feel that they are performing professional actions, going somewhere, etc., while in fact they are lying in bed.

According to E. Bleuler, motor hallucinations most often belong to the category of pseudo-hallucinations.

Vestibular hallucinations are sensations of falling, lowering or lifting in an elevator, rotation of one's own body.

3. The third group includes the following variants of hallucinations. Functional and reflex hallucinations. Unlike other hallucinations, they occur only at the moment when a real stimulus acts on the senses. However, in contrast to illusions, both the real object and the hallucinatory image are perceived (whereas the illusion replaces the real object).

A functional hallucination develops in the same analyzer that is affected by a real stimulus:

Simultaneously with the sound of wheels, the phrase is heard: “You will not live. You won't live."

With a reflex hallucination of Kalbaum (K. Kahlbaum), the stimulus acts on another analyzer:

The patient listens to music and sees before his eyes purple paths that move up and down.

Psychogenic hallucinations arise under the influence of acute psychotrauma and reflect its content. Most often, these are visual and auditory hallucinations. Their development is accompanied by anxiety, fear.

Often, within the framework of reactive psychoses, associated hallucinations of Segla (J. Seglas) develop. The logical sequence of appearing images is characteristic - the “voice” announces a fact that immediately happens:

Induced hallucinations occur under the influence of suggestion, persuasion. For their development, a pronounced emotional involvement of the subject in the experiences of the inducing person is necessary. In the vast majority of cases, these are visual deceptions. Characteristically, after breaking the connection with the inductor, hallucinations quickly disappear.

Sources of induced hallucinations can be:

A large number of people - for example, with massive religious or mystical visions.

Special effects - hypnosis, etc. Suggested hallucinations in a state of hypnotic trance are usually amnesiac when they exit.

Hypnagogic hallucinations (from the Greek hypnos - sleep and agogos - defiant) - occur when falling asleep, at the moment of transition from wakefulness to sleep. Usually these are visual, auditory, tactile deceptions. There are visions of individual objects, people, animals, a voice is heard, or the subject has a feeling that he is getting up, going somewhere.

They are observed at the initial stage of acute psychosis, for example, with alcoholic delirium, as well as with an asthenic condition.

Hypnopompic hallucinations (from the Greek. pompos-accompanying) - are observed upon awakening. They are less common than hypnagogic ones in the same states. Visual and auditory deceptions predominate.

M.I. Rybalsky classifies hypnagogic and hypnopompic deceptions as a group of illusions and hallucinations that occur with clouded consciousness, along with hallucinations in hysterical and epileptic twilight states, amentia, oneiric states, delirious and oneiric syndromes, and pseudohallucinosis. In some cases, they are hallucinoids.

Hallucinations of Dupre's imagination (E. Dupre) - a sudden perception in the form of a real object of those images that were previously actively and for a long time represented by the subject in the imagination. Usually these are visual or auditory deceptions, short-term, fragmentary. For the development of hallucinations of the imagination, a high emotional significance of the images is necessary. Often they arise in response to a traumatic event, reflecting it in their content.

It develops most easily in people with a well-developed imagination (including normal ones) - children, artists, musicians, as well as in people with hysterical character traits.

The ability to normally experience unusually vivid and sensual (sensory) images is called eidetism (from the Greek eidos - view, image). Eidetic images are perceived as arbitrary, differ from hallucinations in the preservation of criticism, the absence of a sense of violence and associated thought disorders.

With hallucinations of the imagination, the high sensoriality of images and their extra projection is supplemented by their visualization, as a result of which they are perceived as real.

Hallucinations of Charles Bonnet (Ch. Bonnet) are associated with pathological activation of sensory receptors or a decrease in external sensory stimulation. So, in patients with cataracts, retinal detachment, etc. there are visual hallucinations (visions of people, animals, landscapes), with hearing loss, acoustic neuritis - auditory.

Under conditions of sensory deprivation (restriction of sensory stimuli), visual, auditory and motor deceptions develop.

Usually Bonnet's hallucinations have a relatively simple structure and are accompanied by a critical attitude, however, with their high intensity and a pronounced anxious component, criticism may be lost.

Lermitte's peduncular hallucinations are characteristic of damage to the brain stem in the area of ​​\u200b\u200bthe legs. There are visual Lilliputian deceptions, mainly in the evening, most often against the background of disturbed consciousness. Patients see moving animals, birds, painted in natural colors. In cases of low intensity of deceptions, criticism of them may remain.

Platois hallucinations occur with neurosyphilis. These are loud verbal deceptions, often with the addition of a delusional interpretation, behavioral disorders, loss of a critical attitude.

Van Bogaert's hallucinations (L. Van Bogaert) are characteristic of leukoencephalitis - multiple color visions of various animals (animals, birds, fish, butterflies) that occur against a background of anxiety and anxiety, in the intervals between bouts of drowsiness. Usually precede the development of delirium.

With J. Berze's hallucinations, patients see luminous phrases on the wall, as if written by an invisible hand. These deceptions are characteristic of alcoholic psychoses and, more rarely, of schizophrenia.

Pick's hallucinations occur when the brainstem is damaged in the area of ​​the bottom of the fourth ventricle. Patients see people and animals through walls. During hallucinations, nystagmus and diplopia develop.

4. In the fourth group, depending on the clinical and psychopathological structure, true hallucinations, pseudo hallucinations and mental hallucinations of Bayarzhe are distinguished.

True hallucinations - have an external projection, are identified with real perception and are experienced as really existing. Images, as a rule, are brightly sensually colored. Patients are convinced that the perception of these images is available to others. Emotional reactions and behavior of the patient correspond to the content of hallucinations.

A patient with delirium tremens saw “guests” at his home, talked to them, set the table, invited his family members to join the company.

A patient with an acute hallucinatory-delusional state saw that under the windows “Dwarfs were standing in white overalls, and skulls were lying in the snow, and a hearse. They were waiting for me to die." He was anxious, restless.

Being on the street, a patient with a vascular disease of the brain heard people say about her: “That woman? No, not that one." I heard phrases addressed to her: "You sell guys, an infection." She stopped leaving the house, she was afraid for herself and her loved ones.

Pseudohallucinations were first identified and described by V.Kh. Kandinsky. Unlike true hallucinations, pseudo hallucinations:

are not identified with real objects and phenomena;

have the character of involuntary, violent (“made”) images as a result of extraneous influence;

have intraprojection, arise in subjective space;

characterized by an attitude as to real perceptions and at the same time as to artificial images;

lack of criticism.

By definition, V.Kh. Kandinsky, pseudohallucinations are very lively and sensual images that differ from true hallucinations in that they do not have the character of objective reality. On the contrary, they are perceived as subjective, but at the same time anomalous, new memories and fantasies different from ordinary images. In addition, he designated them as a pathological variety of these images, reproduced sensory representations.

Pseudohallucinations occur mainly with clear consciousness and are associated with a thought disorder (the sensorial form of this disorder, according to M.I. Rybalsky).

Pseudo-hallucinations, like true hallucinations, are divided according to the sense organs.

Pseudo-hallucinations of vision are one of the most common variants.

Reality. Indistinguishable from other perceived images. As a rule, they are adequately inscribed in the environment. They are perceived as images of a different origin, a “different reality”.

Made. Images are perceived as existing on their own, without the participation of extraneous influence. Characterized by a sense of made images, extraneous influence.

Projection Extra projection, images are perceived as being outside, in objective space. Intraprojection, images arise directly in the subjective psychic or bodily space (“the voice” sounds inside the head, in the stomach, etc., the picture appears “in the mind”, sees it with the “brain”, “third eye”).

Sensoriality (sensual brightness). They have “ordinary” sensory features (loudness, timbre, color), and do not differ from real objects in their sensory brightness. They have an "unusual" sensory character ("artificial", "metallic" "voice"). They have a qualitatively different brightness - more often dull, ghostly, incorporeal ("silent voice"), less often unusually bright and clear (vision in extremely bright, "unearthly magical colors").

Behavior. It is determined by the content of hallucinations (they talk with an imaginary interlocutor, shake something off themselves, run away from someone). Immersed in their inner experiences, indifferent to the environment, or suddenly show aggression or auto-aggression.

There is no criticism. A high degree of conviction in the actual existence of images. We are convinced that the images are "made" artificially and are perceived in a different, unusual way. There is no criticism.

No less common are auditory pseudohallucinations.

The same patient Lashkov once heard a loud voice uttering in syllables: “Pe-re-me-ni allegiance!”.

Another patient heard that “various reproaches are being mentally addressed to him: as if I am guilty of such and such a sin, and I need to impose fasting and repentance on myself, I hear how the following words do not stop repeating to me mentally : "Watch out for yourself if you want to avoid eternal death!".

Tactile, olfactory and gustatory pseudo-hallucinations are less delimited from true ones. However, they are also perceived by the patient as images that differ from real ones and are artificially evoked from outside.

In schizophrenia, pseudohallucinations are most often combined with mental automatisms and delusions of influence in the structure of the Kandinsky-Clerambault syndrome.

However, in schizophrenia, true hallucinations are also observed, and within the exogenous-organic group of psychoses and in epilepsy, pseudohallucinations are possible. In particular, V.Kh. Kandinsky gave a description of pseudohallucinations with fever, drug intoxication with opium, cannabis, belladonna. In these cases, pseudohallucinations usually have extreme brilliance and excessive sensory reality.

One of the important clinical signs of the presence of hallucinations is the nature of the patient's behavior. So, with true visual hallucinations, patients stare at something, turn away in fear, close their eyes, or begin to catch something in the air or on the floor.

With auditory deceptions, they listen to something, look around, during a conversation they suddenly fall silent, as if listening to something coming from the side. In addition, they can talk without an interlocutor, during a conversation they periodically throw phrases to the side or suddenly look under the table, start looking for something.

With olfactory hallucinations, they close their nose or sniff at something, often refuse to eat.

With tactile hallucinations, they shake off something from themselves, catch someone on their skin.

With pseudohallucinations, patients, on the contrary, are immersed in themselves, as if focused on their inner experiences, listening to their thoughts. They are often inhibited, do not answer questions, but they can also suddenly become excited, show aggression or auto-aggression, especially with imperative deceptions.

Bayarzhe's mental hallucinations (intellectual perceptions, according to J. Baillarger; made thoughts, suggested thoughts, Kalbaum's abstract hallucinations) are closest in structure to pseudo-hallucinations, as they have a sense of being made, alienation, unreality. However, they are distinguished by greater intraprojection and the absence of a sensual component.

Patients hear "silent thoughts", "secret inner voices". Deceptions are so closely connected with mental disorders that they often merge with the latter. Patients find it difficult to determine what they are experiencing - a "sounding thought" or "voice".

Psychic hallucinations

Hallucinoids

The clinical assessment is ambiguous. V.P. Osipov considered some phenomena of mental automatism as hallucinoids (“sounding thoughts”, “mental speaking”, “repetitions of thoughts”, “violent thinking”, etc.). E.A. Popov described hallucinoids as an intermediate phenomenon between normal representations and hallucinations, which later develops into true hallucinations. PC. Ushakov understood hallucinoids as visual hallucinations that occur in healthy individuals against the background of asthenia in the waking state, but with eyes closed.

M.I. Rybalsky attributed hallucinoids to incomplete pseudo-hallucinations, a phenomenon intermediate between true and pseudo-hallucinations. Hallucinoids arise against the background of an unclouded consciousness, are closely associated with impaired thinking, are characterized by extraprojection and at the same time the absence of a certain localization in space, fuzziness and lability of images. Hallucinoids do not fit into the environment and are rated as unrealistic.

In other words, hallucinoids do not have the basic properties of true hallucinations (reality, sensoriality, extra projection), but they are not complete pseudo-hallucinations either - fleeting obscure pictures or voices, vague images without a specific content and localization, disappearing when trying to peer into them. Common clinical features are fragmentation, a neutral and usually critical attitude. Often hallucinoids are a transitional stage in the development of hallucinations.

Hallucinosis

Hallucinosis is a condition, the clinical picture of which is characterized by an influx of hallucinations against the background of a clear consciousness. The term "hallucinosis" was proposed by K. Wernicke.

Allocate acute and chronic hallucinosis, depending on the type of hallucinations - verbal, visual and tactile.

At present, hallucinosis syndrome has a fairly definite value.

Hallucinosis develops against a background of clear consciousness, and, as a rule, is characterized by a critical attitude to perceptual deceptions and the absence of thought disorders. The appearance of images is accompanied by an affect of anxiety, fear, especially in cases of acute hallucinosis. Delusional disorders are rudimentary, reflect the content of hallucinations, occur mainly in chronic hallucinosis, or, in acute hallucinosis, immediately after hallucination. Hallucinosis is possible with an influx of both true and pseudo-hallucinations.

Among the clinical variants of hallucinosis, the most common are the following:

Verbal hallucinosis - an influx of auditory true or pseudo-hallucinations, can be acute and chronic.

Acute verbal hallucinosis is accompanied by a pronounced affective component (anxiety, fear). The images are often consistent, scene-like - patients hear "voices" talking about developing events (scenes of accusations, executions, excuses, etc.).

Chronic hallucinosis is characterized by stability, a smaller variety of deceptions (up to the monotonous repetition of the same phrases by the same “voice”), as well as resistance to therapy.

Among the nosological forms in which verbal hallucinosis develops, acute and chronic alcoholic hallucinosis, chronic atherosclerotic hallucinosis can be distinguished.

A patient with acute alcoholic hallucinosis suddenly heard the voice of her cousin from the street, scolding her obscenely. She opened the door, invited her sister in.

A patient with chronic alcoholic hallucinosis constantly hears two female "voices" that "repeat everything I do, wherever I go", for example, "I go to the store, and the voices repeat:" I went to the store. The voices discuss her, “they scare, threaten, say: “Anyway, we will bring you down, we are not alive, you will not get us anywhere.” He hears the dialogues: “The voice of cousin Galya and some Tamara”, expresses ideas of persecution against them, however, the latter are rudimentary and directly reflect the content of the hallucinations: “Everyone sees what I am doing, they got even more angry when I went to church.”

Visual hallucinosis is an influx of visual hallucinations. As well as verbal, it can be acute and chronic. The most common etiology is exogenously organic (acute alcoholic hallucinosis, intoxication, infectious psychoses).

A patient with acute alcoholic hallucinosis, being at the dacha, “saw two fireflies on the logs, they were talking: “Is she or not she?”.

Olfactory hallucinosis - an influx of olfactory hallucinations, often unpleasant content. In some cases, it is accompanied by delusions of poisoning, damage. As a rule, it is associated with an organic pathology of the brain.

A 53-year-old patient with Huntington's chorea complained that he was bitten and tortured by flies. He took them off his face, neck, hands. Hung the whole room with Velcro.

A 52-year-old patient began to feel itching in the perineum, then extremely painful itching and burning all over her body, neck, and face. Then I felt that some insects were crawling on the skin and under the skin. After defecation, small creatures the size of a chicken louse scattered from the anus, reached the face, felt them in the mouth, on the eyelashes, felt how they were pouring from the body. I experienced severe pain, biting, burning, I felt that they were making their way under the skin, accumulating in the nose, ears, and eyelashes. She shook them off, scratched herself. She constantly took a bath, washed off insects, got a job in a bathhouse, closer to the water. Dermatozoic delirium is characteristic of psychoses of late age (atherosclerotic psychoses, hypochondriacal and late schizophrenia, involutional depression), and is also observed with alcohol and cocaine intoxication. In addition to hallucinations, senestopathies play a significant role in the formation of dermatozoic delirium. Characterized by the suddenness of the emergence and persistence of delusional ideas, the lack of criticism, as well as the difficulty of qualifying perceptual disturbances attributable to tactile hallucinosis or illusory-tactile representations.

With schizophrenia, dermatozoic delirium is more complicated than with organic diseases of the brain, but it rarely develops further:

A 45-year-old patient, against the background of a toxic-allergic reaction, began to notice external changes in herself: “The face is not mine, the lips have become thin as threads, the chin is not mine, the eyes are evil, the legs and arms have become longer.” Then there were painful sensations of the presence under the skin of the chest, spine and head of a “snake”, which “crawled”, “squeezed” the spine, head. The patient repeatedly examined her body, tried to find the "snake". In the oral cavity and in the larynx she felt “sticky sponges”, in the feces she saw “pupas”. Experiences were accompanied by severe anxiety, fear, she was afraid to go out, asked for help, believed that she was "going crazy." Sensations intensified at night, criticism was lost, anxiety increased.

Comparative age aspect of hallucinations

In childhood, single true hallucinations can appear from 2-3 years of age. Their identification presents considerable difficulties, since it is necessary to distinguish between dream and eidetic images. Unlike the latter, hallucinations arise involuntarily, have an extra projection and are experienced with the nature of objective reality. Additional features include the repetition of images and the impossibility of dissuasion.

Visual and tactile deceptions predominate, elementary in content (the child sees flies flying around him, crawling snakes, spiders, etc.). Hypnagogic hallucinations are often observed.

A 2.5-year-old child, on the background of a feverish state, saw a “big black fly”, covered himself from it with his hands, asked to be driven away.

A 3.5-year-old girl complains that before falling asleep, “bees who want to sting” fly at her.

At an older age - at 5-8 years old - visual and tactile hallucinations are accompanied by a rudimentary delusional interpretation (the child sees scary people and says that they want to attack him, do something bad). Elementary auditory deceptions are observed (they hear knocking, crying, striking a clock, etc.) and, less often, more complex verbal hallucinations (incomprehensible voices, “talking in the ears”).

In addition, there are "oral hallucinations -" painful sensations of foreign bodies in the oral cavity:

"Paper and iron in the mouth."

"Hair in the mouth."

Imperative auditory hallucinations appear (orders "don't eat!", "don't go to school!").

In prepubertal and pubertal age, hallucinations are an integral part of delirium - peers “make fun of shortcomings”, “arrange to beat”. Olfactory hallucinations (the smell of one's own intestinal gases) are a component of body dysmorphic syndrome.

Hallucinosis is rare. Verbal hallucinosis is observed, in the form of phrases uttered by one or more voices. Visual hallucinosis is much less common.

Pseudo-hallucinations, as a more complex phenomenon, appear in children later than true ones - from 3-4 years old, often combined with rudimentary ideas of influence. Visual deceptions predominate, auditory deceptions are less common.

Children see strange men with long arms, bizarre animals, the dead, aliens. It is said that "they are not like the real ones"; "They do it like they do it in the movies."

In childhood, specific forms of perceptual delusions are observed in the form of hallucinations of the imagination, hypnagogic and dream hallucinations.

The occurrence of hallucinations of the imagination in children is associated with eidetism, deceptions arise directly from images of fantasy:

A patient with sluggish schizophrenia imagined little funny penguins. At times, these ideas were projected outward: "I see a lamp hanging, and then I see penguins."

Hypnagogic hallucinations occur spontaneously, have extra projection and unusual (fantastic) content:

A 10-year-old patient, while falling asleep, with her eyes closed, sees black cells along which a ball is rolling. Sometimes in fear he sees "a moving ball of men and snakes."

In schizophrenia, hypnagogic hallucinations are accompanied by a dissociation between the frightening nature of the images (the child sees dark frightening figures, eyes, heads) and the absence of a corresponding reaction.

Dream hallucinations are a kind of pseudo hallucinations that appear at the moments of falling asleep and waking up (“I had dreams”).

Compared to hypnagogic hallucinations, they are more vivid, scene-like, and are often accompanied by a feeling of outside influence (“I am not sleeping, but occupying an intermediate position”).

Deceptions of perception are observed in infectious diseases (delirious stupefaction) and schizophrenia.

Wrong, distorted perception of objects and phenomena is called an illusion. Certain types of illusions occur in healthy people. However, unlike the sick, these illusions do not disturb healthy people's generally correct identification of an object, since a healthy person has sufficient opportunities to verify the correctness and clarify his first impression. Many types of various illusions are described, which are noted in almost all healthy people.

Illusions can also be a manifestation of mental disorders. So, with mental illness, there is a syndrome of derealization, the basis of which is a distorted perception of the objects of the surrounding world (“everything is frozen, glassy”, “the world has become like a scenery or a photograph”). These distortions of perception can be quite definite in nature and relate to certain features of objects - shape, size, weight, etc. In these cases, they speak of metamorphopsia. The latter include, in particular, macropsia, when objects appear to be enlarged, micropsia - objects are perceived to be reduced. With porropsy, the distance estimate is violated - it seems to the patient that objects are further away than they are in reality.

Peculiar illusions in the form of a violation of the perception of one’s own body (“body schema disorders”) are observed in depersonalization syndrome, characterized by a distortion of the perception of one’s own personality (“feeling of loss or disintegration of the Self”, “alienation of the Self”, etc.). When the body scheme is disturbed, patients experience peculiar sensations of an increase or decrease in the whole body and its individual parts: arms, legs, head (“arms are very large, thick”, “the head has increased dramatically”). It is characteristic that these distortions in the perception of body parts are often critically evaluated by patients, they understand their painful, false nature. Body schema disorders also include a violation of ideas about the ratio of body parts, about the position of the body (“ears are now placed side by side - on the back of the head”, “the body is turned 180 °”, etc.).

Some forms of anosognosia also belong to disturbances in the perception of one's body, in which the patient does not notice that his limbs are paralyzed, and claims that he can get out of bed and go at any moment. Anosognosia of this type is usually observed with paralysis of the left limbs caused by damage to the right fronto-parietal region of the brain.

The nature of illusory perception is also polyesthesia - the sensation of several injections in the circle of that point on the surface of the skin at which the injection was made with the tip of the needle. With synesthesia, a prick is felt in symmetrical parts of the body. For example, when an injection is made in the region of the dorsum of the right hand, the patient simultaneously feels an injection in the corresponding point of the left hand.

Hallucinations differ from illusions in that false perception occurs here in the absence of the subject. Hallucinations occasionally occur in healthy people. For example, during long passages through the desert, when people are thirsty, it begins to seem to them that they can see an oasis, a village, water ahead, while in fact they are not.

In the vast majority of cases, hallucinations are observed in mental patients. The most common are auditory hallucinations. Patients hear the whistle of the wind, the noise of motors, the creak of brakes, although in reality these sounds do not exist in their environment. Often auditory hallucinations are verbal in nature. It seems to the patients that they are called out, they hear snippets of a non-existent conversation. Under the influence of verbal hallucinations of an imperative, commanding nature, such patients may commit wrong actions, including attempts to commit suicide. With visual hallucinations, a variety of pictures appear before the eyes of patients - they see terrible, unusual animals, frightening human heads, etc. Olfactory and gustatory hallucinations are also observed. In some cases, especially with visual hallucinations, there is a combination of them with hallucinations in the sphere of other senses, for example, with auditory and verbal hallucinations.

Hallucinations may be neutral in nature and devoid of emotional coloring. Patients perceive such hallucinations calmly, often even indifferently. However, in some cases, hallucinations have a sharp emotional coloring, most often negative. Frightening hallucinations also belong to the deceptions of the senses of this kind.

In some observations, hallucinations can be a source of positive emotions for patients. Thus, M. S. Lebedinsky described a mother who had lost her son, with a severe pathological reaction to his death. This patient often "saw" the deceased in hallucinations and rejoiced at these "meetings".

The false nature of perception usually goes unnoticed by patients suffering from hallucinations. They are convinced of the truth of their perception, it seems to them that incorrectly perceived objects and phenomena really exist in the environment.

In contrast to the so-called true hallucinations described above, with pseudohallucinations, patients are aware of their false nature. The hallucinatory image is localized not in the external environment, but directly in the ideas of the patients themselves. Pseudo-hallucinatory experiences can include, in particular, the sound of one's own thoughts, often experienced by patients with schizophrenia.

The mechanisms of illusions and hallucinations are still poorly understood. The reasons for the violation of the active, selective nature of perceptions revealed in illusions and hallucinations are still not clear enough.

Some illusions observed in healthy people can be explained by the so-called set, that is, the distortion of perception that occurs under the influence of immediately preceding perceptions. This phenomenon has been extensively studied by the Soviet psychologist D. N. Uznadze and his school. The following experiment can serve as an example of the formation of a set: the subject is placed in both hands 15-20 times in a row a large and a small ball of the same weight. Then two balls of the same volume are presented. Some subjects usually evaluate one of the balls as smaller, with the hand in which the small ball lay; other subjects find the opposite (contrasting) setting and evaluate with the same hand a ball of equal volume as large.

It is possible that the pathology of the installation mechanisms explains some of the illusions of the size of objects observed in patients. With regard to the pathogenesis, the origin of hallucinations, the most likely assumption is that they are associated with pathological, increased excitability of certain areas in the human brain. This point of view is supported, in particular, by the experiments of the famous Canadian neurosurgeon W. Penfield, who caused visual and auditory hallucinations by electrical stimulation of sections of the temporal and occipital lobes of the cerebral cortex during operations for epilepsy.

hallucinations are pathological symptoms that occur in disorders of mental activity, in which a person feels (sees, hears, etc.) something that does not actually exist in the space around him. Hallucinations are a clear pathological manifestation mental disorder, since normally, with an unchanged psyche, they are absent in people of all ages of both sexes.

This pathological symptom refers to disorders of perception of the surrounding reality. Depending on the analyzer in which the disturbance in the perception of the surrounding reality occurs, hallucinations are divided into auditory, visual, olfactory, tactile, gustatory, visceral, speech and motor hallucinations.

Hallucinations of any nature can be caused by mental illness, as well as brain damage (traumatic brain injury, meningitis, encephalitis, etc.) or severe pathologies of internal organs. Hallucinations in severe somatic diseases (internal organs) or brain damage are not a sign of a person's mental illness. That is, a person suffering, for example, from heart failure or having suffered a traumatic brain injury, may experience hallucinations, but at the same time he is completely mentally healthy, and a violation of the perception of the surrounding reality occurred due to a serious illness.

In addition, hallucinations can also appear in perfectly healthy people under the influence of substances that affect the functioning of the central nervous system, such as alcohol, drugs, psychotropic drugs, toxic substances, etc.

Brief description and essence of the symptom

Understanding the essence and scientific definition of hallucinations was made during the study of this problem within the framework of the general development of psychiatry. Thus, the translation of the Latin word "allucinacio" means "unfulfilled dreams", "idle chatter" or "nonsense", which is quite far from the modern sense of the term "hallucinations". And the term "hallucinations" acquired its modern meaning only in the 17th century in the work of the Swiss physician Plater. But the final formulation of the concept of "hallucination", which is still relevant today, was given only in the 19th century by Jean Esquirol.

So, Esquirol gave the following definition of hallucinations: "a person is deeply convinced that he has some kind of sensory perception at the current moment, and there are no objects within reach." This definition is relevant to this day, because it reflects the main essence of this psychiatric symptom- a violation of the sphere of perception of the surrounding reality, in which a person feels objects that are absent in reality and at the same time is completely convinced that he is right.

In short, hallucinations are the perception of something that is actually missing at the moment. That is, when a person feels smells that do not exist in reality, hears sounds that also do not exist in reality, sees objects that are absent in the surrounding space, etc., then these are hallucinations.

At the same time, mirages do not belong to hallucinations, since this phenomenon is not a consequence of a violation of mental activity, but a natural phenomenon, the development of which is based on the laws of physics.

Hallucinations must be distinguished from pseudo-hallucinations and illusions, which also relate to disturbances in the sphere of perception of the surrounding world that occur in severe mental disorders.

So, the main difference between hallucinations and pseudo-hallucinations is their pronounced outward orientation and connection with objects that really exist in the surrounding space. For example, a hallucination is that a person sees a spot sitting on a real-life chair, or hears sounds from behind a real existing door, or smells coming out of a ventilation that is in reality, etc. And pseudo-hallucinations, on the contrary, are directed inward, that is, on the perception of various non-existent objects inside the human body. This means that during pseudo-hallucinations, a person feels non-existent objects in his body, for example, voices in his head, cockroaches in the brain, a beam of radiation in the liver, the smell of blood in the vessels, etc. Pseudo-hallucinations are very intrusive, often have a threatening, imperative or accusing character. and little dependent on the thoughts of the person himself.

Illusions, unlike hallucinations, are a distorted perception of real-life objects and objects. Illusions are characteristic of all people of any age and gender, and they are due to the peculiarities of the work of the sense organs and the laws of physics. An example of a typical illusion is a hanging coat, which in low light conditions appears to be a figure of a lurking person. The illusion also includes the distinct hearing of the voice of a familiar person in the rustle of leaves, etc.

That is, summing up, we can briefly say that:

• Hallucination- this is a "vision" of a non-existent object on an object that actually exists in the surrounding space.
• Pseudo-hallucination- this is a "vision" of a non-existent object inside one's own body.
• Illusion- this is a "vision" of real-life objects distorted, with characteristics that they actually lack (a coat is perceived as a lurking person, a chair is seen as a gallows, etc.).

The line between all these psychiatric terms is rather thin, but very significant from the point of view of the mechanisms of their development and the degree of mental disorders, to which each variant of the disturbance in the perception of the surrounding world corresponds.

What are hallucinations?

Currently, there are several classifications of hallucinations, which subdivide them into types depending on the various characteristics of the symptom. Let us consider the classifications that are most important for understanding the characteristics of hallucinations.

So, depending on the nature and the analyzer involved, hallucinations are divided into 4 following types:

1. Associated hallucinations. They are characterized by the appearance of images with a certain logical sequence, for example, a stain on a chair predicts the appearance of flies from a faucet if a person tries to turn on the water.
2. Imperative hallucinations. They are characterized by the appearance of an orderly tone emanating from any surrounding objects. Usually such an orderly tone commands a person to perform some action.
3. Reflex hallucinations. They are characterized by the appearance of hallucinations in another analyzer in response to the impact of a real stimulus on any analyzer (auditory, visual, etc.). For example, turning on the light (an irritant for the visual analyzer) causes an auditory hallucination in the form of voices, orders, the noise of the installation for guiding laser beams, etc.
4. Extracampal hallucinations. They are characterized by going beyond the field of this analyzer. For example, a person sees visual images that are hallucinations behind a wall, etc.

In addition, there is a historically established and most commonly used classification of hallucinations according to the sense organs in the field of activity of which they occur. So, according to the analyzers of feelings available to a person, hallucinations are divided into the following types:

Besides, hallucinations are divided into the following types depending on their complexity:

True hallucinations - video

Pseudo-hallucinations - video

Hallucinations - Causes

The causes of hallucinations can be the following conditions and diseases:

1. Mental illnesses:

• Hallucinosis (alcoholic, prison, etc.);
• Hallucinatory-delusional syndromes (paranoid, paraphrenic, paranoid, Kandinsky-Clerambault).

2. Somatic diseases:

• Tumors and brain injuries;
• Infectious diseases affecting the brain (meningitis, encephalitis, temporal arteritis, etc.);
• Diseases that occur with severe fever (for example, typhus and typhoid fever, malaria, pneumonia, etc.);
• Syphilis of the brain;
• Cerebral atherosclerosis (atherosclerosis of cerebral vessels);
• Cardiovascular diseases in the stage of decompensation (decompensated heart failure, decompensated heart defects, etc.);
• Rheumatic diseases of the heart and joints;
• Tumors localized in the brain;
• Metastases of tumors in the brain;
• Poisoning by various substances (for example, tetraethyl lead - a component of leaded gasoline).

3. The use of substances that affect the central nervous system:

• Alcohol (hallucinations are especially pronounced in alcoholic psychosis, called "white tremens");
• Drugs (all opium derivatives, mescaline, crack, LSD, PCP, psilobicine, cocaine, methamphetamine);
• Medications (Atropine, drugs for the treatment of Parkinson's disease, anticonvulsants, antibiotics and antivirals, sulfonamides, anti-tuberculosis drugs, antidepressants, histamine blockers, antihypertensives, psychostimulants, tranquilizers);
• Plants containing toxic substances that act on the central nervous system (belladonna, dope, pale grebe, fly agaric, etc.).

4. Stress.

5. Chronic prolonged sleep deprivation.

Hallucinations: causes, types and nature of the symptom, description of cases of hallucinations, connection with schizophrenia, psychosis, delirium and depression, similarity with a dream - video

Treatment

The treatment of hallucinations is based on the elimination of the causative factor that provoked their appearance. In addition, in addition to therapy aimed at eliminating the causative factor, drug relief of hallucinations with psychotropic drugs is carried out. Antipsychotics are most effective for stopping hallucinations (for example, Olanzapine, Amisulpride, Risperidone, Quetiapine, Mazheptil, Trisedil, Haloperidol, Triftazin, Aminazin, etc.). The choice of a specific drug for the relief of hallucinations is carried out by the doctor in each case individually, based on the characteristics of the patient, the combination of hallucinations with other symptoms of a mental disorder, previously used therapy, etc.

How to induce hallucinations?

To cause hallucinations, it is enough to eat hallucinogenic mushrooms (pale toadstool, fly agaric) or plants (belladonna, dope). You can also take drugs, alcohol in large quantities, or drugs that have a hallucinogenic effect in large doses. All this will cause hallucinations. But simultaneously with the appearance of hallucinations, the body will be poisoned, which may require urgent medical care up to resuscitation. In severe poisoning, death is also likely.

The safest way to induce hallucinations is through forced sleep deprivation. In this case, a person will only face the consequences of lack of sleep, hallucinations will appear, but there will be no poisoning of the body with toxic substances.

Semantic hallucinations

Semantic hallucinations is the name of a popular musical group. There is no such thing in medical terminology. Before use, you should consult with a specialist.

MOSCOW, September 13 - RIA Novosti, Alfiya Enikeeva. In an unusual habitat, a perfectly healthy person sometimes experiences tactile illusions, loses orientation in space. This applies to those who operate in extreme conditions: pilots, astronauts, athletes. The habit of trusting the senses can be disastrous in some situations.

Loss of orientation

But even basic sensations, which, it would seem, can be completely trusted - tactile, often deceive us. For example, the distance between equidistant points on the skin feels different depending on where they are located, and stroking the tip of the nose with two crossed fingers gives a person the impression that he has two noses.

According to scientists from King's College London, such tactile illusions arise due to the structure of the skin. The surface of the human body is divided into so-called receptive fields - areas of skin dotted with receptors from a single nerve cell and stretched along the limbs. In more sensitive areas (for example, on the fingertips), these fields are numerous and small, in less sensitive areas the fields are larger, but there are fewer of them. The distance between two points is estimated by the brain by the number of these receptive fields lying on the line connecting them. This point of view was confirmed by an experiment in which volunteers perceived the lengths of the segments indicated on different parts of the forehead as different, although in fact they were the same.

People with a breakdown in the SCN9A gene, which encodes a protein that forms sodium channels in cell membranes, become hostages of tactile illusions. Through them, pain sensations are transmitted to the brain. If the channel does not work properly, the signal does not occur, and the brain has nothing to process. People in this case do not feel pain at all and do not even notice a very serious injury. According to Cambridge University professor Geoffrey Woods, one of the carriers of this rare mutation in Pakistan jumped off the roof of the house, thinking he was invulnerable. Of course, the 14-year-old teenager crashed to death, but his numerous relatives with the same genetic anomalies subsequently helped researchers understand the mechanisms of pain.

channeling

We do channeling sessions with the Higher Forces on various topics.

Illusions and hallucinations. Types and causes of hallucinations and illusions. Agnosia.

Illusions

Wrong distorted perception illusion

Illusions and hallucinations.

Illusions

Wrong distorted perception objects and phenomena is called illusion. Certain types of illusions occur in healthy people. However, in contrast to the sick, they do not disturb healthy people's generally correct identification of an object, since a healthy person has sufficient opportunities to verify the correctness of clarifying his first impression.

Many different illusions observed in almost all healthy people. The illusion of non-parallelism occurs when parallel lines are crossed by other lines. One of the types of illusion is also the transfer of the properties of the whole figure to its individual parts. A line segment that is part of a large figure seems to be longer than an equal line that is part of a small figure.

Illusions can also be a manifestation of mental disorders. Thus, in mental illness derealization syndrome which is based on a distorted perception of the objects of the surrounding world ("Everything is frozen, glazed", "The world has become like a scenery or a photograph").

These perceptual distortions can be quite definite in nature and relate to certain features of objects - shape, size, weight, etc. In these cases, one speaks of metamorphopsia. The latter include macropsia when objects appear enlarged, micropsia- Objects are perceived as reduced. At porropsy distance assessment is disturbed: the patient imagines that objects are further away than they are in reality.

Peculiar illusions in the form of a violation of the perception of one's own body("body schema disorders") are seen in depersonalization syndrome, characterized by a distortion of the perception of one's own personality ("Feeling of loss and split of I", "Alienation of I", etc.).

When the "body schema" is disturbed, patients experience peculiar sensations of an increase or decrease in the whole body and its individual parts: arms, legs, head ("Hands are very large, thick", "Head has increased dramatically"). It is characteristic that these distortions in the perception of body parts are often critically evaluated by patients, they understand their painful, false nature. Disorders of the "body scheme" also include a violation of the idea of ​​the ratio of body parts, the position of the body ("Ears are now placed side by side - on the back of the head", "The body is turned 180 °", etc.).

Some forms of anosognosia are also disorders of the perception of one's body., in which the patient does not notice that his limbs are paralyzed, and claims that he can get out of bed at any moment and go. Anosognosia of this type is usually observed with paralysis of the left limbs caused by damage to the right fronto-parietal region of the brain.

The nature of illusory perception is also polyesthesia- a feeling of several angles in the circle of a point on the surface of the skin, into which an injection was made with the tip of a needle. With synesthesia, a prick is felt in symmetrical parts of the body. So, when an injection is made in the region of the dorsum of the right hand, the patient simultaneously feels an injection in the corresponding point of the left hand.

hallucinations

hallucinations differ from illusion in that false perception occurs in the absence of the subject. Hallucinations occasionally occur in healthy people. So, during long passages through the desert, when people are thirsty, it begins to seem to them that there is an oasis, a village, water ahead, while in fact they are not.

In most cases, hallucinations are observed in mental patients. Most common auditory hallucinations. Patients hear the whistle of the wind, the noise of motors, the creak of brakes, although in reality these sounds do not exist in their environment. Often auditory hallucinations are verbal in nature. It seems to the patients that they are called out, they hear snippets of a non-existent conversation. Under the influence verbal hallucinations of an imperative, commanding nature, such patients can commit wrong actions, including attempts to commit suicide.

At visual hallucinations various pictures appear before the eyes of patients: they see terrible, unusual animals, frightening human heads, etc. There are also olfactory, gustatory hallucinations. In some cases, especially with visual hallucinations, there is a combination of them with hallucinations in the sphere of other organs, for example, with auditory and verbal hallucinations.

Hallucinations may be neutral in nature and devoid of emotional coloring. Patients perceive such hallucinations calmly, often even indifferently. However, in some cases, hallucinations have a sharp emotional coloring, most often negative. Frightening hallucinations also belong to the deceptions of the senses of this kind.

In some observations hallucinations can be a source of positive emotions for the sick. So, M.S. Lebedinsky described a mother who lost her son with a severe pathological reaction to his death. This patient often "saw" the deceased in hallucinations and rejoiced at these "meetings".

The false nature of perception usually goes unnoticed by patients suffering from hallucinations. They are convinced of the truth of their perception, it seems to them that incorrectly perceived objects and phenomena really exist in the environment.

Pseudo-hallucinations

In contrast to the so-called true hallucinations, pseudo hallucinations patients are aware of their false character. The hallucinatory image is localized not in the external environment, but directly in the ideas of the patients themselves. Pseudo-hallucinatory experiences can include, in particular, the sound of one's own thoughts, often experienced by patients with schizophrenia.

Causes of hallucinations and illusions

The mechanism of illusions and hallucinations is still poorly understood. The reasons for the violation of the active, selective nature of perceptions revealed in illusions and hallucinations are still not clear enough.

Some illusions observed in healthy people can be explained by the so-called attitude, i.e. distortion of perception arising under the influence of immediately preceding perceptions. This phenomenon has been widely studied by psychologist D.N. Uznadze and his school. The following experiment can serve as an example of the formation of a set. The subject is placed in both hands 15-20 times in a row a large and small ball of the same weight. Then two balls of the same volume are presented. Some subjects usually evaluate one of the balls as smaller, with the hand in which the small ball lay. Other subjects find the opposite (contrasting) setting and evaluate with the same hand a ball of equal volume as large.

It is possible that the pathology of the installation mechanism explains some of the illusions of the size of objects observed in patients. With regard to the pathogenesis of the origin of hallucinations, the most likely assumption is that they are associated with pathological, increased excitability of certain areas in the human brain. This point of view is supported, in particular, by the experiments of the famous Canadian neurosurgeon W. Penfield, who caused visual and auditory hallucinations by electrical stimulation of sections of the temporal and occipital lobes of the cerebral cortex during operations for epilepsy.

Agnosia.

Agnosia called a violation of visual, auditory and kinesthetic perceptions in local lesions of the cerebral cortex caused by vascular diseases, injuries, tumors and other pathological processes. At object agnosia the violation of the generalized perception of objects comes to the fore: patients cannot recognize the images of a table, chair, kettle, key and other objects, but in the case when they recognize an object, they can also indicate its individualized reference. So, having learned that this is a person’s face, patients can say whether this person is familiar to them, remember his last name. Having recognized the chairs in the doctor's office, patients with object agnosia can indicate the same type or other chairs in shape and decoration located in the wards, corridors of the clinic.

Some patients have visual disturbances, in which the generalized perception of objects remains relatively intact and the disorder of individualized perception comes to the fore. Such patients experience difficulty in recognizing specific single objects that they have seen before. These violations are especially pronounced when it is necessary to recognize familiar faces. Patients do not know whether they have seen this face before or not, a female or male face in front of them, they poorly distinguish facial expressions, do not catch expressions of joy, fun, laughter, sadness, crying. This form of visual agnosia is called face agnosia, or agnosia of individualized features.

One of the forms of violations of visual gnosis is called optic-spatial agnosia. With this form of visual agnosia, the patient's perception of the spatial arrangement of individual objects is disturbed, patients cannot correctly perceive spatial relationships. Once in the clinic, they cannot learn to find their way to the doctor's office, to the dining room, to the toilet. They recognize their ward only by indirect signs - by the number above the entrance to the ward or by the characteristic color of the ward door. These patients also experience great difficulty when trying to find their bed in the ward. They forget the location of the streets of the city in which they lived for a long time, they cannot tell about the plan of their apartment.

Causes of agnosia

Usually, visual agnosias are observed when the occipital or partially lower-posterior sections of the parietal lobes of the brain are affected.

With damage to the lower anterior parts of the parietal lobes of the brain, disorders of higher forms of tactile perception, called astereognosis, are noted. Feeling with closed eyes any object (key, coin, pencil, pen, comb, etc.) "patients cannot determine the shape and size of this object, recognize it. At the same time, with visual perception, patients quickly recognize this object and unmistakable.

There are also observations from auditory agnosia observed in lesions of the temporal regions of the brain. In patients with this form of agnosia, auditory perception is impaired. They cannot recognize the characteristic noise of the wind, an airplane, a car, the sounds made by different animals, the rustle of paper, etc.

At the heart of agnosia lie, apparently, violations of the processes of isolating a signal from noise, isolating the characteristic features of objects and comparing these features with those samples, standards that are stored in the memory of patients.

Illusions and hallucinations.

Correct, distorted perception of objects and phenomena is called an illusion. Certain types of illusions occur in healthy people. However, in contrast to the sick, they do not disturb healthy people's generally correct identification of an object, since a healthy person has sufficient opportunities to verify the correctness of clarifying his first impression.

Many different illusions have been written, which are noted in almost all healthy people. The illusion of non-parallelism occurs when parallel lines are crossed by other lines. One of the types of illusion is also the transfer of the properties of the whole figure to its individual parts. A line segment that is part of a large figure seems to be longer than an equal line that is part of a small figure.

Illusions can also be a manifestation of mental disorders. So, in mental illness, a derealization syndrome is observed, the basis of which is a distorted perception of the objects of the surrounding world (“Everything is frozen, glazed”, “The world has become like a scenery or a photograph”).

These distortions of perception can be quite definite in nature and relate to certain features of objects - shape, size, weight, etc. In these cases one speaks of metamorphopsia. The latter include macropsia, when objects appear enlarged, micropsia - objects are perceived to be reduced. With porropsy, the distance assessment is violated: the patient imagines that objects are further away than they are in reality.

Imaginary illusions in the form of a violation of the perception of one's own body ("disorders of the body scheme") are observed in the depersonalization syndrome, characterized by a distortion of the perception of one's own personality ("Feeling of loss and split of the Self", "Alienation of the Self", etc.).

With violations of the "body schema", patients experience peculiar sensations of an increase or decrease in the whole body and its individual parts: arms, legs, head (<Руки очень большие, толстые>, <Голова резко увеличилась>). It is characteristic that these distortions in the perception of body parts are often critically evaluated by patients, they understand their painful, false nature. To disorders<схемы тела>also includes a violation of the idea of ​​the ratio of body parts, the position of the body (<Уши теперь помещаются рядом - на затылке>, <Туловище повернуто на 180°>etc.).

Disturbances in the perception of one's body also include some forms of anosognosia, in which the patient does not notice that his limbs are paralyzed, and claims that he can get out of bed and go at any moment. Anosognosia of this type is usually observed with paralysis of the left limbs caused by damage to the right fronto-parietal region of the brain.

The character of illusory perception is also polyesthesia - the sensation of several angles in the circumference of a point on the surface of the skin, into which an injection was made with the tip of a needle. With synesthesia, a prick is felt in symmetrical parts of the body. So, when an injection is made in the region of the dorsum of the right hand, the patient simultaneously feels an injection in the corresponding point of the left hand.

hallucinations

Allucinations differ from illusion in that a false perception occurs in the absence of the subject. Hallucinations occasionally occur in healthy people. So, during long passages through the desert, when people are thirsty, it begins to seem to them that there is an oasis, a village, water ahead, while in fact they are not.

Most cases of hallucinations are observed in mental patients. The most common are auditory hallucinations. Patients hear the whistle of the wind, the noise of motors, the creak of brakes, although in reality these sounds do not exist in their environment. Often auditory hallucinations are verbal in nature. It seems to the patients that they are called out, they hear snippets of a non-existent conversation. Under the influence of verbal hallucinations of an imperative, commanding nature, such patients may commit wrong actions, including attempts to commit suicide.

With visual hallucinations, a variety of pictures arise before the eyes of patients: they see terrible, unusual animals, frightening human heads, etc. There are also olfactory, gustatory hallucinations. In some cases, especially with visual hallucinations, there is a combination of them with hallucinations in the sphere of other organs, for example, with auditory and verbal hallucinations.

Allucinations may be neutral and devoid of emotional coloring. Patients perceive such hallucinations calmly, often even indifferently. However, in some cases, hallucinations have a sharp emotional coloring, most often negative. Frightening hallucinations also belong to the deceptions of the senses of this kind.

Some observations of hallucinations can be a source of positive emotions for patients. So, M.S. Lebedinsky described a mother who lost her son with a severe pathological reaction to his death. This patient is often<видела>in the hallucinations of the deceased and rejoiced at this<встречам>.

The ardent nature of perception usually goes unnoticed by patients suffering from hallucinations. They are convinced of the truth of their perception, it seems to them that incorrectly perceived objects and phenomena really exist in the environment.

Pseudo-hallucinations

The difference from the so-called true hallucinations in pseudo-hallucinations, patients are aware of their false nature. The hallucinatory image is localized not in the external environment, but directly in the ideas of the patients themselves. Pseudo-hallucinatory experiences can include, in particular, the sound of one's own thoughts, often experienced by patients with schizophrenia.

Causes of hallucinations and illusions

The mechanics of illusions and hallucinations has been poorly studied to date. The reasons for the violation of the active, selective nature of perceptions revealed in illusions and hallucinations are still not clear enough.

Some illusions observed in healthy people can be explained by the so-called attitude, i.e. distortion of perception arising under the influence of immediately preceding perceptions. This phenomenon has been widely studied by psychologist D.N. Uznadze and his school. The following experiment can serve as an example of the formation of a set. The subject is placed in both hands 15-20 times in a row a large and small ball of the same weight. Then two balls of the same volume are presented. Some subjects usually evaluate one of the balls as smaller, with the hand in which the small ball lay. Other subjects find the opposite (contrasting) setting and evaluate with the same hand a ball of equal volume as large.

It is possible that the pathology of the installation mechanism explains some of the illusions of the size of objects observed in patients. With regard to the pathogenesis of the origin of hallucinations, the most likely assumption is that they are associated with pathological, increased excitability of certain areas in the human brain. This point of view is supported, in particular, by the experiments of the famous Canadian neurosurgeon W. Penfield, who caused visual and auditory hallucinations by electrical stimulation of sections of the temporal and occipital lobes of the cerebral cortex during operations for epilepsy.

Agnosia.

Gnosias is a violation of visual, auditory and kinesthetic perceptions in local lesions of the cerebral cortex caused by vascular diseases, injuries, tumors and other pathological processes. With object agnosia, a violation of the generalized perception of objects comes to the fore: patients cannot recognize the images of a table, chair, kettle, key, and other objects, but in the case when they recognize an object, they can also indicate its individualized relation. So, having learned that this is a person’s face, patients can say whether this person is familiar to them, remember his last name. Having recognized the chairs in the doctor's office, patients with object agnosia can indicate the same type or other chairs in shape and decoration located in the wards, corridors of the clinic.

Some patients have visual disturbances, in which the generalized perception of objects remains relatively intact and the disorder of individualized perception comes to the fore. Such patients experience difficulty in recognizing specific single objects that they have seen before. These violations are especially pronounced when it is necessary to recognize familiar faces. Patients do not know whether they have seen this face before or not, a female or male face in front of them, they poorly distinguish facial expressions, do not catch expressions of joy, fun, laughter, sadness, crying. This form of visual agnosia is called face agnosia, or agnosia of individualized features.

The bottom of the forms of violations of visual gnosis was called optical-spatial agnosia. With this form of visual agnosia, the patient's perception of the spatial arrangement of individual objects is disturbed, patients cannot correctly perceive spatial relationships. Once in the clinic, they cannot learn to find their way to the doctor's office, to the dining room, to the toilet. They recognize their ward only by indirect signs - by the number above the entrance to the ward or by the characteristic color of the ward door. These patients also experience great difficulty when trying to find their bed in the ward. They forget the location of the streets of the city in which they lived for a long time, they cannot tell about the plan of their apartment.

Causes of agnosia

Usually, visual agnosias are observed when the occipital or partially lower-posterior sections of the parietal lobes of the brain are affected.

In lesions of the lower anterior parts of the parietal lobes of the brain, disorders of higher forms of tactile perception, called astereognosis, are noted. Feeling with closed eyes any object (key, coin, pencil, pen, comb, etc.) > patients cannot determine the shape and size of this object, recognize it. At the same time, with visual perception, patients recognize this object quickly and accurately.

Observations with auditory agnosia, which is noted with damage to the temporal parts of the brain, are also known. In patients with this form of agnosia, auditory perception is impaired. They cannot recognize the characteristic noise of the wind, an airplane, a car, the sounds made by different animals, the rustle of paper, etc.

The basis of agnosia is, apparently, violations of the processes of isolating a signal from noise, isolating the characteristic features of objects and comparing these features with those samples, standards that are stored in the memory of patients.