Lilliputian hallucinations are where small figures of animals or people appear as visions, often in the bottom half of the visual field, sometimes as dancing, playful creatures. Last year the German Journal of Psychiatry published a fascinating English-language article about these curious perceptual distortions.

They can appear in a number of conditions, including psychosis and schizophrenia, during alcohol withdrawal-induced delirium tremens, or when part of the retina starts to degrade in macular degeneration.

The article has three case studies that give a flavour of these often surprising hallucinations and goes on to discuss what we know about their cause.

Here’s an excerpt from one of the case studies of an alcohol dependent man (who was drinking about 50 units a day!) who suddenly cut-down on his drinking and started experiencing striking withdrawal effects as a result:

Following this, his sleep had markedly reduced and he started seeing little people all over the house. They were about a foot high, with funny colorful dresses, weird faces, big eyes and mouths. Some of them were also wearing spectacles. They would follow him all around the house and he could hear their footsteps. Patient would also see them drinking his blood (did not elaborate further) and complained of physical weakness as a result. Initially, patient attributed his experiences to some evil spirits present in the house and changed the house. But the experience continued.

Perhaps one of the most surprising causes of these hallucinations is macular degeneration, sometimes diagnosed as Charles Bonnet syndrome, owing to the fact that simple damage to the retina can lead to complex hallucinations that seem to take on a life of their own.

Link to ‘Lilliputian Hallucinations. Understanding a strange Phenomenon’.