Most research into hallucinations focuses on unimodal hallucinations — hallucinatory experiences that only affect one sensory modality, such as hearing or touch. But for decades there has been evidence that multimodal hallucinations (which affect more than one sense at once) may be quite common. One of the main challenges in investigating them, however, has been capturing and communicating the wide array of features that comprise multimodal experiences.
However, thanks to new research in EClinicalMedicine from Katie Melvin and colleagues at the University of Leicester, this may be about to change. To improve our understanding of the feelings and sensations associated with hallucinations, the team gathered a group of participants to create what they dubbed MUSE maps — visual and written representations of what hallucinations feel like throughout (and around) the body. Not only do their findings suggest that most hallucinations seem to have emotional and multisensory components, but their new method offers a more intuitive way to communicate and understand hallucinatory experiences.
For their study, the team recruited twelve participants who were experiencing hallucinations daily and had been given psychotic-spectrum diagnoses. For one week, these participants kept a visual diary documenting the feelings and modalities associated with their hallucinations.
In the diary entries, participants were encouraged to write and sketch about the details of their hallucinatory experiences. Each day’s diary page contained a tick-box list of modalities that were involved in hallucinations, free text boxes in which to write about the feelings and sensations associated with them, and a body-map to indicate which feelings were experienced in which parts of the body. The participants could use any medium to express the lived experience of their hallucinations, though all ultimately chose to provide their input using pen or pencil. The data gathered from these diaries were collectively referred to as multimodal unusual sensory experience (MUSE) maps. Finally, when the week was over, the participants came into a clinic to further discuss each of their MUSE maps in a 30-minute interview with the primary researcher.
The participants reported a wide range of hallucinatory experiences, such as auditory or gustatory hallucinations, all the way through to disruptions in the feeling of time. All participants shared that they experienced bodily feelings and sensations as co-occurring with hallucinations, and provided detailed schematic illustrations of their experiences on the body map templates provided (several of which are reproduced in the published article). Though some favoured words and arrows pointing to various points of the body, others took a more intuitive and artistic approach, illustrating waves of sensations with lines, sectioned bodies, broken hearts, and literally weighted limbs.
Generally speaking, although hallucinations are typically thought of as unimodal experiences, 10 of the 12 participants in this study shared that many of their experiences were multimodal, regularly crossing emotional and sensory boundaries. Each participant typically experienced recurring sensations in particular areas of their body during hallucinations in different modalities, including feelings of pain, heat, or tension.
Analysis of written responses revealed 106 terms pertaining to feelings during hallucinations. The authors found that these divided into four main groups. All but one participant used emotional language, and most of the emotions were negative (eg. fear, powerlessness), with positive emotions only being reported in the minority of cases. Words pertaining to feelings of knowing were employed by half of the participants, who reported a wide range of feelings from boredom all the way to being alert during hallucinatory experiences. Feelings of reality being affected, such as feeling a presence, paranoia, or disorientation, were reported by almost all participants. Participants also reported bodily feelings, such as tiredness or heaviness.
Taken together, this data clearly illustrates that many hallucinations are in fact multimodal, are commonly associated with bodily sensations, and are often accompanied by unpleasant emotional responses. The exploratory nature of MUSE maps, however, does mean that this approach has some limitations. For example, the team highlights that MUSE maps may miss some pertinent sensations, in part because participants themselves decide which sensations are relevant to report, without too much prompting. Body maps including a back view, as opposed to just the front view used in this study, would also be necessary in future studies. In addition, the low sample size of this research may have failed to capture some aspects of multimodal hallucination experiences, or indeed issues with the MUSE map method. As such, future research looking at expanding the sample size and diversity is needed.
Even so, these findings echo contemporary research into hallucinations which suggests that multimodal experiences are common, if considerably harder to communicate. This extra layer of difficulty may have led to the general assumption that unimodal hallucinations are more prevalent. But, the authors say, tools such as MUSE maps may help to close this gap in understanding. The extent of hallucinatory experiences illustrated by the MUSE maps in this study suggest that clinicians may wish to consider broadening their assumptions on whether hallucinations are likely to be unimodal, and perhaps even consider modifying their clinical environment to be more comfortable for those with disturbances across multiple senses.
– The feeling, embodiment and emotion of hallucinations in first episode psychosis: A prospective phenomenological visual-ecological study using novel multimodal unusual sensory experience (MUSE) maps
Emma L. Barratt (@E_Barratt) is a staff writer at BPS Research Digest