20: The Visions of Hildegard

In this chapter, the patient’s symptoms were primarily described as hallucinations, more specifically, visual auras that can manifest in association with migraines (Teeple, Caplan & Stern, 2009). Sack’s described the nature of her hallucination as containing multiple phosphenes (i.e., imagined light), fortified figures/auras (bands of light representative of zigzags), but some argue the patient’s drawings and descriptions are not aligned with that of migraine hallucinations (e.g., had human figures) (Schott, 2007). An alternate hypothesis to Sacks diagnosis could be her visual hallucinations were the result of a lesion in the pathway between the eye and the areas of the cortex related to vision (Boksa, 2009). The area of the brain that could be responsible for causing these symptoms is primarily the visual cortex. Dr. Sacks never discussed the treatment of the patient but the patient could address the symptoms today by taking any one of a number of migraine-reducing medications (Sacks, 1985; Teeple et al., 2009).

There are a variety of medications utilized to address symptoms of visual hallucinations, from SSRIs to antidepressants to anticonvulsants (if affiliated with seizures) (Teeple et al., 2009). The specific nature and symptoms of the patient, beyond just the visual hallucinations, would need to be evaluated to determine the right treatment for the migraines and auras (i.e., visual disturbance). Different patients experience migraines differently but it is not unheard of for individuals who have migraines to experience these visual auras (Teeple et al., 2009). What makes this case study unique is, unlike other patients with visual hallucinations, this patient interprets the figures and lights she sees as visions from God (Sacks, 1993). Her neurophysiology was interpreted as divine intervention, and Sack’s recognizes her interpretation as something of wonder, harmony, and inspiration for the power of the mind and its ability, via physiological processes, to cause the world to diminish into a spiritual dimension (Sacks, 1993).

Summary by Michelle Paul, Introduction to Neurobiology, University of Michigan-Dearborn, Fall 2015

References

Boksa, P. (2009). On the neurobiology of hallucinations. Journal of Psychiatric Neuroscience, 34(4), 260-262.

Teeple R.C., Caplan, J. P. & Stern, T.A. (2009). Visual hallucinations: Differential diagnosis and treatment. Primary Care Companion Journal of Clinical Psychiatry, 11(1), 26-32.

Schott, G. D. (2007). Exploring the visual hallucinations of migraine aura: The tacit contribution of illustration, Journal of Neurology, 1690-1703.