ALCOHOLIC HALLUCINOSIS

by Lida Prypchan

Very rare in its pure form, alcoholic hallucinosis, also known as hallucinatory paranoia and chronic alcoholic delirium, characteristically exhibits auditory hallucinations which generate delusions of persecution, while retaining clarity of the senses without impairment.  It differs from delirium tremens in the predominance of auditory and tactile hallucinations and clarity of consciousness; in that the prolonged abuse of alcohol as displayed among younger drinkers is not inevitable; in that it is not characteristic of those who drink spirits, hence its frequency among women, and in the lack of serious organic changes.  Some authors concur that delirium tremens and alcoholic hallucinosis are pathogenically identical.  Kraepelin concedes that the onset of delirium tremens is caused by sudden inundation of the brain by alcoholic metatoxins, whereas if there are fewer of them, they attack only the auditory centers, causing sounds of voices and slight obnubilation, a pathogenic explanation for the intensity of the delirium and the mildness of the hallucinosis.  The observations of Wolfer, Sberger and Bleuler tend to attach great importance to the schizophrenic tendency of the constitution, which is set in motion by the metabolic changes produced by alcohol.  This hypothesis has been supported in the cases of hallucinosis where the final development is clearly schizophrenic.  In hallucinosis the somatic and neurological symptoms of chronic alcoholism are imperceptible or not particularly pronounced, whereas sleep is always insufficient and never peaceful.

The main psychic symptoms are the auditory hallucinations, or voices, of one or more invisible people who talk about the subject in the third person, referring to his habits and practices and uttering true or false accusations.  In very advanced cases the subject participates in the dialogue himself.  Some of the voices speak in his favor and others against him, although in the beginning they are not too clear, more a sort of murmur.  Frequently tactile hallucinations follow next, such as being pinched or nipped.  Then come visual hallucinations in which the individual sees a person in the darkness or behind the door.  When hallucinations of coenesthesia, smell and taste occur, schizophrenia must be considered.  The hallucinations are accompanied by delusions, concerning guilt over alcoholic abuse and real or imaginary errors.

The voices present delusions of persecution, plans for escape, always senseless and passing uncriticized by the victim.  The tremendous anxiety caused by harassment from these presumed persecutors induces the victims to commit acts of self-abuse.

Clarity of their senses is preserved almost intact, although hallucinatory experiences mingle with actual perceptions.  Orientation is perfect and behavior correct, to the point of not attracting the attention of colleagues at work.  Concentration and attention appear normal, and they can carry on a lucid conversation, although from time to time they withdraw from it to attend to their voices.  Memory remains intact, proof of which is that they often relate minute details of their hallucinatory experiences and the events in their lives without tending to lie.  The predominant emotion ruling their behavior is anxiety.  Duration of alcoholic hallucinosis is somewhat longer than that of delirium tremens, between a week and three months, abstinence being indispensable for a cure.

Lastly I will dedicate a short space in commenting on a movie which impressed me both with the theme and the harshness of its portrayal.  I am referring to “Ironweed”, with Jack Nicholson and Meryl Streep, who won an Oscar for best actress instead of Cher, since Ms. Streep managed a rather difficult role which not just any actress could have done.  It is about the life of a couple of alcoholic vagrants who are reduced to poverty by their addiction.  She is a singer, successful in radio, whose downfall is caused by the temporary relief and euphoria produced by alcohol.  She ends up as a vagrant who, so as not to die of cold or be devoured by the hungry denizens of the streets, takes refuge in a man’s car, the price of this sojourn being to have sex with him.  He was apparently married with children and in one of his drunken bouts returns home and accidentally causes the death of his youngest daughter and on other occasions gets involved in some disturbance or strike, causing the accidental deaths of still more people.  What is certain is that because of his alcoholic excesses he has visual hallucinations which consist in seeing all these people whom he has harmed and who ask him questions, watch and deride him.  One guesses, we are not actually shown, that both of the couple end up committing suicide.