Hours: Monday - Friday 9:00 am - 6:00 pm

PO Box 43473 Birmingham, AL 35243

“JUST MY IMAGINATION RUNNING AWAY WITH ME”

“Vision without execution is a hallucination.”

-Thomas Edison

Jean-Michel Basquiat (American, 1960–1988). Untitled, 1982. Acrylic, spray paint, and oil stick on canvas

Once I had a 90-something year old patient brought in by her granddaughter for evaluation after she kept hearing a threatening man yelling outside her window. After some investigation, the family discovered there was no man present despite the patient’s convincing account of events. The differential diagnosis in this population includes an array of possibilities from toxic, metabolic, or infectious disturbance to sundowning. When someone perceives a sensory input (e.g. visual, auditory, tactile) that does not exist, it is known as a hallucination. Commonly hallucinations are associated with psychotic people. However, normal subjects can hallucinate also. For example, sleep-deprived individuals, bereaved persons, and those in solitary confinement for prolonged periods of time can see and hear things that are not there.

The neurobiology of hallucinations is quite fascinating. In people with schizophrenia who hear voices, research using functional imaging has shown there is altered connectivity between parts of the temporal lobe, prefrontal region, and the anterior cingulate gyrus. In normal subjects, these areas would communicate in such a way that differentiate “self” from “non-self” stimuli. Whereas, in the psychotic person with auditory hallucinations, the ability to make this distinction is lost. Ever wonder why you can’t tickle yourself? Go ahead…I’ll wait. Blakemore and colleagues propose that the response to self-generated stimuli (i.e. tickling yourself) is dampened because we anticipate the response. In people with hallucinations from psychosis, this attenuation does not occur. Therefore, they not only lack insight that the stimulus is self-generated but they also often can’t anticipate the occurrence.
Cultural bias blurs the lines between visions, spiritual revelations, imagination, and audiovisual misperceptions. For instance, in various religions, it doesn’t seem bizarre to “hear the voice of the Holy Spirit.” In most cases, society distinctly views this experience different from a psychotic individual who hears the voice of God. Often, there is a context that makes differentiation clear. But what if it wasn’t that easy to tell?
From time to time, I am struck by a visual hallucination of the life I envision for myself. It can be as vivid as the words on this page. I imagine that if you put me in a functional MRI machine at the time of this image, parts of my occipital lobe and prefrontal cortex would light up. I picture an interwoven communication circuit between these areas. All the while, I am aware that the picture generated by my mind has yet to come to pass. I certainly want it to be so. In fact, I will it into reality. When I begin to question myself or become overwhelmed by the immensity of the vision, I return to my heritage in the form of African proverbs for practical guidance:

· Look for a dark goat first in the daytime because you may not find it at night.

o Meaning: Prioritize your goals before it’s too late to accomplish them.

· The best way to eat an elephant is to cut it into pieces

o Meaning: The greatest task is accomplished by taking one small step at a time.

· Maize bears fruits once and dies because it is not rooted in the ground.

o Meaning: Without a solid foundation, it is difficult to be prosperous.

· If you want to walk fast, walk alone. If you want to walk far, walk with others.

o Meaning: On this journey called life, having a sense of community will get you further by not only providing focus and purpose but also encouragement along the way.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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“The anterior cingulate gyrus is part of the medial frontal lobe responsible for decision making, emotional control and regulation of autonomic function (such as heart rate and blood pressure). The temporal lobe houses the hearing centers as well as the memory system. The prefrontal cortex functions in personality, complex planning, and attention. In particular, the prefrontal cortex helps individuals to process and prioritize simultaneous, competing stimuli. The occipital lobe carries the vision center of the brain.”

Image Credit: https://www.thinglink.com/scene/714175929814876161

References

1. Blakemore SJ, Smith J, Steel R, Johnstone CE, Frith CD. “The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring.” Psychol Med. 2000 Sep;30(5):1131-9. 2. Boksa, Patricia. “On the neurobiology of hallucinations.” J Psychiatry Neurosci. 2009 Jul; 34(4): 260–262.

About me

Decontee Jimmeh , M.D. is a well-known and respected neurologist serving Birmingham and surrounding locations in the U.S. As a graduate of Xavier University of Louisiana and Temple University School of Medicine, Dr. Dee is a sought-after voice in the world of neurology. Her expertise and understanding of these conditions are coupled with…

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Monday - Friday 9:00 am - 6:00 pm

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PO Box 43473 Birmingham, AL 35243