Can Someone Negatively Hallucinate?

Hallucinations are internally generated sensory experiences. In short, the perception of something for which there is no stimulus. Given there is the addition of something present, this is considered a “positive” experience or hallucination, and these come in all sensory varieties.

The most common include auditory and visual types. Less-encountered forms are the tactile (feel), olfactory (smell), gustatory (taste), somatic (internal sensations), extracampine (“6^th sense presence”), and proprioceptive (motion). The latter three might be new to some readers, and are discussed at length in 3 Types of Hallucinations You've Probably Never Heard of.

An unusual hallucination

As if those three types of hallucinations aren't interesting enough, would you believe there is such a thing as a “negative hallucination"?

I first heard of the concept years back while studying Milton Erickson, the psychiatrist who pioneered hypnosis and solution-oriented practices in psychotherapy. Interested readers can get a good introduction to Erickson in Dr. Elinor Greenberg's post, How Milton H. Erickson Revolutionized Hypnotherapy.

Those familiar with Erickson realize he thought so far outside of the box there wasn’t one in sight. A profound example of this involves negative hallucination induction to help patients become unaware of problematic sensory experiences. Those interested in how Erickson achieved "negative hallucination" in patients can learn more in Ernest Rossi's The Collected Papers of Milton H. Erickson on Hypnosis, Volume 2 (pp 36-40).

The term “negative hallucination” was coined by Hyppolite Bernheim around 1884 to describe how people, under hypnosis, could be made to believe that a certain object in their perceptual field was missing. Blom (2009) wrote that this was sometimes referred to as “hypnotic blindness.” Scrutinizing researchers, wrote Blom, like Wilhelm Wundt and Edmund Parrish, opined that, given such experiences stemmed from a hypnotist inducing narrowed consciousness/distraction, it is not really a hallucinatory experience. Instead, Parrish noted something actually hallucinatory would be if someone could be made to apperceive something without diverting their attention.

The above definitions, however, remain within the realm of hypnosis. This, of course, might be handy in clinical interventions like Ericksonian psychotherapists might utilize. There is a more psychologically autogenerated experience, though, that could be part of a psychotic disorder picture. Parrish wrote that this would be “…the failure to perceive an object or stimulus in the extracorporeal world because it is ‘blocked’ or ‘covered’ by a positive hallucination.” Imagine someone who can’t hear music at a party because their hallucinated voices are loud enough to overpower the stereo, or a person who can’t see a house in the distance because a hallucination of a crowd is blocking it. Nonetheless, this is still only a-perceptual in that a “positive” hallucination is interfering with perceiving what is actually present.

Source: Elina Araja/Pexels

Negative hallucinations, revisited

In 2019, however, a Kuwait-based psychiatrist, Ahmed Naguy, made note in the journal Australasian Psychiatry that, while negative hallucinations have become all but forgotten, there are instances in clinical practice where one may encounter an “actual” negative hallucination. It involves a type of extracampine hallucination. Extracampine literally means “beyond the possible sensory field,” thus the “6^th sense” manner of its general description.

People with extracampine hallucinations can encounter phenomena such as confusion about where the real self is during autoscopic hallucinations. An autoscopic hallucination is a hallucinatory doppelgänger experience.

Anzelotti et al (2011) explained that usually the “double” is described as “foggy,” “pale,” or “as through a veil,” and can even behave autonomously. It may or may not entirely mirror the individual’s appearance and maintains sidedness (presumed to mean facing the individual as if a reflection).

During an autoscopic hallucination, if there is imitation of bodily movements by the double, said Anzelotti, it can give rise to the illusion that the doppelgänger contains the real mind. The individual hallucinating can become confused, recognizing the self as “existing over there.” Thus, because they do not identify with where they actually are in space, if placed in front of a mirror, the person sees no reflection. This is referred to as a “negative autoscopic hallucination.” Naguy elaborated:

[Negative autoscopic hallucination] has been described in psychiatric literature to denote a transient failure to perceive one’s own mirror image – like Dracula! This is akin to the neurological phenomenon of auto-prosopagnosia or facial neglect. Another closely related phenomenon, the mirror sign or Le signe du miroir, describes inability to recognize oneself in a reflecting surface while recognizing others is typically intact.

Chances are, even people working with psychotic populations will rarely encounter this, as it seems associated with Cotard’s Syndrome, a rare forms of nihilistic psychosis. Here, sufferers are convinced they are dead amongst the living, or have a dead/dying portion of themselves. Thankfully, the cases often respond well to electroconvulsive therapy (ECT).

Even if a practitioner isn't likely to encounter negative hallucinations, knowing about the unusual experience serves as a reminder of the intensity of some mental health struggles, and the importance of careful evaluation to encourage correct intervention.