may find his sitting room crowded with hallucinatory people who are also listening. Sometimes their mouths move as if they are speaking or singing along with the radio. These visions are not unpleasant, and they seem to provide a sort of hallucinatory comfort. It is a social scene, which he enjoys. 9
In the last two years, Marlon has also started to see a mysterious man who always wears a brown leather coat, green pants, and a Stetson hat. Marlon has no idea who it is but feels that this man has a special message or meaning, though what the message or meaning is eludes him. He sees this figure at a distance, never close up. The man seems to float through the air rather than walk, and his figure can become enormous, “as tall as a house.” Marlon has also spotted a small, sinister trio of men, “like FBI, a long way off.… They look real, real ugly and bad.” Marlon believes in angels and devils, he tells me, and he feels that these men are evil. He has started to suspect that he is under surveillance by them.
Many people with mild cognitive impairment may be organized and oriented during the daytime—this is the case with Marlon, especially when he is at the senior center or at a church social, actively engaged with other people. But asevening comes, there may be a “sundowning” syndrome, and fears and confusions start to proliferate.
Generally, in the daytime, Marlon’s hallucinatory figures deceive him briefly, for a minute or two, before he realizes they are figments. But late in the day, his insight breaks down, and he feels his threatening visitors as real. At night, when he finds “intruders” in his apartment, he is terrified—even though they seem uninterested in him. Many of them look “like criminals” and wear prison garb; sometimes they are “smoking Pall Malls.” One night one of his intruders was carrying a bloodstained knife, and Marlon yelled out, “Get out of here, in the name of the blood of Jesus!” On another occasion one of the apparitions left “under the door,” slipping away like a liquid or vapor. Marlon has ascertained that these figures are “like ghosts, not solid,” and that his arm will go right through them. Nevertheless, they
seem
quite real. He can laugh about this as we talk, but it is clear that he can be quite terrified and deluded when he is alone with his intruders in the middle of the night.
P eople with CBS have, at least in part, lost the primary visual world, the world of perception. But they have gained, if only in an inchoate and fitful way, a world of hallucinations, a secondary visual world. The role CBS may play in an individual’s life varies enormously, depending on the sort of hallucinations that occur, how often they occur, and whether they are contextually appropriate, or frightening, or comforting, even inspiring. There are, at one extreme, those who may have had only a single hallucinatory experience in their life; othersmay have had hallucinations, on and off, for years. Sometimes hallucinations can be distracting—seeing patterns or webs over everything, not knowing whether the food on one’s plate is real or hallucinatory. Some hallucinations are manifestly unpleasant, especially those that involve deformed or dismembered faces. A few are dangerous: Zelda, for instance, does not dare drive, since she may see the road suddenly bifurcate or people jumping on the hood of her car.
For the most part, however, the hallucinations of CBS are unthreatening and, once accommodated to, mildly diverting. David Stewart speaks of his hallucinations as being “altogether friendly,” and he imagines his eyes saying, “Sorry to have let you down. We recognize that blindness is no fun, so we’ve organized this small syndrome, a sort of coda to your sighted life. It’s not much, but it’s the best we can manage.”
Charles Lullin, too, enjoyed his hallucinations and would sometimes go into a quiet room for a brief hallucinatory break. “His mind makes