Writing characters with: hallucinations

First up, the textbook stuff.

When someone perceives something that doesn’t exist, we call that thing a hallucination. Simple enough. Someone who experiences hallucinations might see, hear, smell, taste, or touch something that isn’t really there.

Hallucinations are often confused with, but completely different from, delusions. A delusion is a persistent strong belief in spite of all evidence to the contrary, i.e., ‘the government is watching me’. Think conspiracy theories, but acted upon as though they must be real. People who hallucinate might be fully aware that the things they perceive aren’t real. Delusions are what happen when there’s a breakdown in judgement and logical thinking; hallucinations are what happen when there’s a breakdown in perception.

The word ‘hallucination’ comes from Latin, and means “to wander mentally”. In my opinion, this is both absolutely wonderful, and also an oddly whimsical way to describe what can often be abjectly terrifying experiences.

Hallucinations are caused by a variety of different things, some internal and some external. Among the most common causes are:

• Schizophrenia. The most common hallucinations schizophrenia induces are visual and auditory (sight and sound). There are many other types of psychotic disorders that often present with hallucinations, but schizophrenia is the most widely known, and the biggest reason people confuse hallucinations with delusions. Both are co-presenting symptoms of schizophrenia.

• Drugs. There are a variety of drugs, both legal and illegal, that can trigger hallucinatory episodes. Sometimes that’s the intended effect, and sometimes a completely unexpected side effect. This is your fun regular reminder that we still have practically no idea how the brain works, and no one can tell you with 100% certainty how a particular drug will affect your cognition.

• Parkinson’s Disease. Roughly half of people who suffer from Parkinson’s Disease report experiencing hallucinations. Parkinson’s Disease is a degenerative neurological condition that affects the central nervous system and the brain’s ability to control body movement; it’s currently unclear why that can also cause hallucinations.

• Dementia. Alzheimer’s Disease and Lewy body dementia are the most common forms of dementia that cause hallucinations, typically in the advanced stages of the condition. Alzheimer’s Disease targets brain cell connections, and Lewy body dementia targets the movement of chemicals (neurotransmitters) in the brain.

• Charles Bonnet Syndrome. Progressive loss of vision can often result in both simple and complex visual hallucinations, for reasons that, again, aren’t clearly understood. The occipital lobe, the part of your brain that processes incoming visual data, is basically an incompetent wizard. Ever tried out some optical illusions? This is your secondary fun regular reminder that your brain has no idea what it’s doing and it’s frankly a miracle you’ve lived as long as you have.

• Brain tumour. A cancerous growth in the brain that can often have unpredictable effects on functioning, depending on where in the brain the tumour is located.

• Epilepsy. A disorder in which brain cell activitiy is disturbed, resulting in seizures. Abnormal sensations often occur during seizures, especially strange tastes and unfamiliar noises.

• Migraines. Many people who suffer from migraines report visual hallucinations related to them, including a visual ‘aura’ in one eye, thought to be caused by an electrical or chemical wave across the visual cortex in the brain. (You know, the incompetent wizard.)

—> Why should I listen to you about hallucinations?

Those who know me, feel free to skip right past this section. (Or if you don’t care. I promise, I won’t mind.)

I’ve dealt with hallucinations my whole life. My situation is a highly unusual one in many ways: for one thing, my hallucinations can present through any of my senses, instead of the more ‘standard’ visual and auditory. This means that in addition to seeing and hearing things that aren’t there, I’ll smell, taste, and feel things that aren’t there as well, on a regular (read: daily) basis.

Because I grew up with them, I’m very skilled in telling the difference between hallucinations and reality. This is obviously not true for a lot of people who experience hallucinations, and this is largely because hallucinations are most commonly understood as a symptom of a psychotic disorder — for example, schizophrenia. Schizophrenia often presents as hallucinations, and robs you of the ability to think rationally during a hallucinatory episode. The hallucinations I experience are, as far as three different psychiatrists and countless therapists can tell, not linked to a specific psychotic disorder, or to any physical cause at all. My brain is just wired that way, apparently!

Basically, my experience is unusual. I can tell you what it’s like to hallucinate, but I can’t pretend that I speak for everyone who hallucinates. Mine tend to be internally consistent and, after a point, predictable. Most people would never use the word ‘predictable’ to describe their hallucinations, and for good reason.

—> Okay, so what are hallucinations?

Heads up: hallucinations are a normal part of brain functioning.

‘Say what?’ I imagine you, the curious reader, exclaiming. ‘But isn’t the whole point of hallucinations that something has gone horribly wrong?’

Have you ever sworn you heard someone calling your name when no one did? Have you ever imagined eating something you had a craving for, and almost tasted it, even though you weren’t eating it? Have you ever seen something out of the corner of your eye that looked dangerous, only to realise when you get a good look at it that it’s a harmless mailbox? Have you ever been convinced there’s a thin hair or a spiderweb on your skin when nothing was there? Have you ever sworn you heard someone walking around in your house, even when there couldn’t possibly be anyone else there? Have you ever stayed up for two nights in a row, long enough to start seeing things in semi-darkness? When you were a kid, did you ever look at something scary and see a monster?

Everyone hallucinates. It’s normal. In a neurotypical brain, hallucinations are what occur when the brain makes too many connections at once, and since the brain is constantly making connections and noticing patterns, there are bound to be hiccups. In a grown-up neurotypical brain, hallucinations are easily identified and filed away as nothing more than momentary lapses of reality judgement. You might think you heard someone calling your name, realise no one did, shrug, and carry on with your day, thinking ‘boy, that was weird’.

By themselves, hallucinations are not dangerous. When their cause is a loss of visual function, for example, like in people with Charles Bonnet Syndrome, the person is usually aware of their own hallucinations and able to ignore them as appropriate. I’m also aware of my own overactive hallucinations, and I’m able to deal with them accordingly. Sometimes I still need to grab a friend and ask them if they can see or hear something when it might be dangerous if it was real, but in general, I’m pretty self-suficient.

The danger in hallucinations lies in the fact that they’re often a symptom of something going wrong in the brain’s normal functions. In a disorder like schizophrenia, hallucinations often co-present with delusional thinking, robbing the person of the ability to make rational reality judgements. The danger in hallucinations is when they’re overactive, confused with reality, and acted upon as though they are reality.

Here are the most common presentations of hallucinations:

• Visual. Seeing something that isn’t there. These can be complex — a person standing in the room, for example — or simple, like flashing lights and splashes of colour.

• Auditory. Hearing something that isn’t there. This is the most common type of hallucination. Once again, these can be complex — a voice speaking to you, reminding you of something you forgot — or simple, like tapping or creaking noises behind walls.

• Olfactory. Smelling something that isn’t there. Because the sense of smell is the one most closely tied to memory, this can also be the most unpredictable type of hallucination. Examples include pleasant scents, like the smell of your favourite flower, or unpleasant scents, like the smell of something burning. (Burning is one of my hallucinations I always get outside input on, just to be sure. The one time I don’t will inevitably be the one time it’s real.)

• Gustatory. Tasting something that isn’t there. Unlike olfactory hallucinations, this is almost always an unpleasant or strange taste. For example , people with epilepsy often report a metallic taste during or after a seizure.

• Tactile. Feeling something that isn’t there. A classic example involves the feeling of bugs crawling on your skin, or someone’s touch on your arm. For some people, this can also be internal — i.e., the feeling of internal organs moving around.

Whether or not a person’s hallucinations involve something familiar and understandable, or something unrealistic and outlandish, depends almost entirely on what’s causing their hallucinations to begin with. On top of that, the kinds of things people hallucinate tend to be as unique as the people who experience them, and we have absolutely no idea what triggers them; i.e., do we hallucinate our greatest fears? Our hopes? Repressed traumas? Or are they completely random? The answers to these vary widely, and we haven’t yet found any common patterns.

—> Have you written any characters who hallucinate? How did you do it?

I haven’t published any stories with characters who hallucinate (yet), but otherwise, yes.

Usually it’s had some type of magical cause — either detrimental, trying to confuse and disorientate the character because someone cast a spell on them, or beneficial and informative (think ‘magical girl protagonist hallucinates a mentor who helps her solve mysteries, save the day, and learn more about herself!’) I’ve written a portal fantasy where there’s a realm the characters can enter and have memories pulled from their minds to manifest as hallucinations.

Usually when I write these characters, the hallucinations are temporary, triggered by something specific, and tied to an internal challenge the character has to overcome. Sometimes it’s an event in the character’s past they need to confront; other times it’s a warning about the future. My personal feeling is that using hallucinations as plot drivers like that is fine when they’re externally caused; it’s a bit more wiggly for characters who hallucinate because of a mental health issue. Real people who hallucinate often can’t ‘level up’, solve a puzzle, figure out a mystery, or talk their way into never hallucinating again. Most real-world hallucinations aren’t nearly so helpful, or so logically clear. The trope where a genius character solves a mystery because someone they hallucinated told them the answer is particularly infuriating for me; hallucinations aren’t magical, and even if you do hallucinate a person you can interact normally with (which, I have to stress, is remarkably rare), they don’t know anything more than you do. Talking through a puzzle out loud can be helpful. Having someone to bounce ideas off can be helpful. But if your character’s hallucination is actively helping solve the challenge, there better be a really good reason why.

—> So what tips do you have for writing hallucinations?

With most mental health issues, my advice in this section will involve being careful of pitfalls, being aware of damaging stereotypes and tropes, utilising empathy as you write, and trying to get a beta reader / editor with experience in the area to look over your story when you’re done.

With hallucinations, my advice is a little different.

If you’re writing a character hallucinating because of an external cause (magic, metaphysics, etc.) — don’t think too much about trying to keep them representative and grounded in reality. Like I said above, hallucinations are as unique as the people who experience them, and very often, hallucinations are only fun to write and fun to read when they’re divorced from underlying mental health issues. My advice would be for the hallucinations to serve the story in some way — not the character, necessarily, or your character’s goals. But if I finish reading and I’m left wondering what the point of those hallucinations was, it leaves a sour taste in my mouth.

In other words, don’t write hallucinations if you’re only writing them because it seems cool. Keep them serving your story. Keep them serving a purpose.

If you’re writing a character who hallucinates because of an internal cause (schizophrenia, health issue, drugs, etc.) — then focus more on respectful representation. This isn’t to say you can’t have some fun with it — writing out drug-induced hallucinations can be a heck of a lot of fun — but try to stay within the realistic bounds of the human brain. And for gods’ sake, do not write a miracle cure, or some sort of miraculous situation that ends all your character’s hallucinations. I will straight up throw the book out a window if I read that. Medication for managing the symptoms of a mental health issue is one thing; ‘Look, ma! No more hallucinations ever!’ is very much another.

In conclusion: when magic is involved, write hallucinations to serve the story. Otherwise, write hallucinations according to character.

how do the hallucinations affect your character? How is your character going to address them? What has their setting taught them about hallucinations? Do they figure out they’re ‘seeing things’ right away, or does that take them a while to accept?

—> Any other things I should keep in mind for my character?

How do their hallucinations affect your character? Is this new for them, or same old, same old? How does your character address them? What has your character’s setting taught them about hallucinations? Do they figure out they’re hallucinating right away, or does it take them a while to accept?

If hallucinations are same old, same old: Does your character see the same sorts of things, or the same sorts of people, every time they hallucinate, or is it always something different? If your character hears voices, how helpful or aggressive do those voices tend to be? Has your character grown accustomed to them, or do they still react whenever it happens?

If your character is hallucinating for the first time, no matter what the reason is, remember that it can be bloody difficult to remember it’s not real. This can manifest in a whole lot of different ways; expecting their companions to notice what they’ve noticed, for example. Expecting their friends and family to know why they’re acting a certain way or what they’re talking about without being told. Responding to disembodied voices even after being asked not to do so. Hallucinations, like any other new experience, take adjustment, and recognising what’s real can take a lot of practice, even without the added difficulty of delusional thinking.

For further reading from people who deal with hallucinations, check out the following:

• An article featuring real-life stories of people living with schizophrenia or psychosis (content warning: there is some graphic description of terrifying hallucinations including body horror). ‘The Artist’, Rachel, and ‘The Mum’, Jacqui Dillon, I particularly recommend, because their stories of how they turned their hallucinations to their advantage are very similar to mine, and useful to consider in your writing. Tl;dr, both Rachel and Jacqui discovered that engaging with the voices they heard helped those voices become less aggressive.

• A short 5-minute interview on YouTube with Juno, who talks about hearing voices, hallucinations, and how they affect his life.

It’s difficult to find first-person accounts of day-to-day hallucinations, largely because A) hallucinations are closely associated with delusions and psychosis, which still bears a negative stigma in society, and B) people who hallucinate either don’t want to think about it, or consider it so normal that sharing their story often doesn’t occur to them. If you have a firsthand account, please comment and share it if you’re comfortable doing so.

If reading this was helpful to you, please consider supporting me on Patreon, or throwing a dollar or two my way on Ko-fi. If you have a question about a specific mental health topic I haven’t covered yet, let me know by emailing me at author@amariamson.com, or pinging me on twitter. Thanks for reading, and don’t forget to comment/share!