PAPERS / ABSTRACTS

Dr Peter Fenwick

Introduction

Our view of the world is conditioned by our personal philosophy and system of beliefs. In this scientific era there is little to support the view that mind is more than neural nets and enurological processes. Science demands a neurocognitive explanation for all subjective experience. But here is the difficulty. For as yet we have no comprehensive explanation of subjectivity. As sherrington said, when using the energy to trace the light from a star to the eye, retina, optic nerve, pathways and cortex: "At this point the sceme puts its finger to its lips and is silent." There is no explanation of how the star comes into subjective experience.

Models of the World

Our science is based on the rationalism of Descartes, Galileo, Locke and Newton. Galileo defined a two stuff universe: matter and energy. This stuff, he said, had primary and secondary qualities. The primary qualities were those aspects of nature that could be measured, such as velocity, acceleration, weight, mass etc. There were also secondary qualities. These qualities were those of subjective experience, such as smell, vision, truth, beatuy, love, etc. Galileo maintained taht the domain of science was the domain of primary qualities. Secondary qualities were non-scientific. This view has conditioned science ever since and has led to the rejection by science of secondary qualities or subjective experience. Descartes had a similar world view. He argued again that there were two substances in the world, that of the physical world, the ers extensor, and that of the mental world, the res cogitans. Science, he claimed, acted in the domain of the res extensor, thus supporting the view of Galileo.

With the evolution of physics and the understanding of relativity, Einstein's recognition that mass and energy could be precisely equated, changed Galileo's two-stuff universe into a one-stuff universe. And that is the universe that we have today. The other major advance of the early part of the 20th Century was the discovery of quantum mechanics and Bell's theorem. This theorem postulated the non-locality of matter, and gave an explanation for the wave particle duality theory of Schrodinger. In its simplest form this principle states that the wave function which defines each particle before the collapse of th wave function is spread throughout space. At the momnet of trying to measure a particle, the wave function collapses and the position of the particle can then be measured within the rules of quantum mechanics.

Mind models

The view that matter is distributed throughout the universe does not easily accord with the view that mind is only a function of the brain. It is important to understand the tow major philosophical schools which currently attempt to explain brain function. Dennett's neuro-philosophy characterises one extreme. He argues that consciousness and subjective experience are just the functions of neural nets. Explain neural nets in detail and you will also have explained subjective experience and peresonal consciousness; nothing else is required. This is clearly a reductionist approach, equating subjective experience with neural mechanisms.

The other extreme is characetised by the philosophy of Nagel, who argues that it is never possibel to learn what it is like to have a first person experience. Subjective experience is not available to the scientific method, as it is not in the third person and cannot be validated in the public domain. Nagel argues that however much we understand about the neurophysiology of the functioning of a bat's brain, we will never know what it is like to be a bat. This view suggests that the explanation of subjective experience requires a new principle which is beyond neural nets.

Searle argues from an intermediate position. He regards subjective experience as being a property of neural nets, but he does not agree with Dennett that our current understanding of neural net functioning is sufficient to explain subjective experience. Recently he has expressed the opinion that we need an entirely new principle - an Einstein of neurophysiology - to produce a synthesis between first and third person experience.

Until there is a satisfactory philosophical explanation of the nature of mind, it will not be possible to answer questions relating to the nature of subjective experience, religious experience and the possibility of extrasensory perception. This field is by definition still beyond the confines of science. At present, any scientific theory must explain everything in terms of brain function. However, I expect there are many people who, like Schrodinger, feel claustrophobic when asked to accept that the broad sweep of the soul is contained only within the grey porridge of the brain.

Veridical versus non-veridical

The gold standard of science is the repeatability of a third person phenomenon. When considering the significance of subjective experience the question must always be asked as to wether or not the experience has a veridical element, or whether it is entirely subjective, as for example the passivity phenomena of schizophrenia, where the schizophrenic patient feels that he is able to read the minds of others. Experiences arising from disorders of the temporal lobe, such as premonitions fall directly into this category.

1. The Physiology of the Religious Experience

Religious experience is very common in the population. Although very little evidence exists concerning wide mystical states, there are many studies of mystical or religious experience. Hay,k in his book Exploring Inner Space (1982), reviews the early literature on religious experience. Early religious experience studies (Gloch and Stark, 1965) showed that over 45% of Protestants, and 43% of Roman Catholics had had 'a feeling that you are somehow in the presence of God.' Gallup surveys in the United States by Back and Buorque in 1963, 1966 and 1967, showed that 20,5%, 32% and 44% respectively had had a 'religious or mystical experiences. The percentage increased as the decade advanced, presumably due to the Hippie movement allowing people to express their mystical experiences more freely. However, by 1978 the Princeton Religion Research Centre found, in answer to a similar question, that the positive response was down to 35%, possibly a reflection of a waning of popular interest in the mystical. In Britain, David Hay organised a NOP survey in 1976, asking a similar question, and found a similar rte of reply; about 36% gave positive responses. Of interest is the finding taht although about a third of all peo;ple have had the experience, only 18% have had it more than twice and only 8% 'often' and more. There was no correlation with age, but positive replies were commonest in those whose education went beyond 20, e.g., the more articulate university graduates. There was also interestingly, a sex difference: 41% of women gave positive replies, against 31% of men. 51% siad it lasted between seconds and minutes, 74% that it lasted less than a day.

Wider mystical states, in which the subject describes a feeling of universal love, occur much less often. These ecstatic states occur spontaneously, but they, or fragments of them, may also occur in near death experiences, very occasionally in temporal lobe epilepsy, and frequently in psychosis, usually associated with an elevation of mood, and in certain drug experiences. It is thus likely taht the ability to experienc an ecstatic state is part of normal brain function. This would be supported by the training processes carried out in many Eastern religions which lead directly to the experoemce of feeling of universal love.

Buck, a Canadian psychiatrist who lived at the turn of the century, was one of the first Western scientist to attempt to define (in his book Cosmic consciousness) mystical experience. He dealt mainly with very wide experiences: "Now came a period of rapture so intense that the Unvierse stood still as if amazed at the unutterable majest y of the spectacle: only one in all the infinite universe. The all-caring, perfect one, perfect wisdom, truth, love and purity: and with rapture came insight. In that same wonderful moment of what might be called supernal bliss came illumination.... what joy when I saw that there was no break in the chain - not a link left out - everything in its place and time. Worlds, systems, all blended in one harmonious world, universal, synonymous with universal love."

Buck lists nine features which have been used as a basis by subsequent authors to categorise the elements of the experience. Pahnke and Richards (1966) give a comprehensive account of the features of drug-induced mystical experience: this is essentially comparable with Buck's list.

1. Unity. The feeling that the panorama of life is underpinned by a unifying and eternal principle.

2. Objectivity and reality. Shown by a) insightful knowledge or illumination and b) authoritativeness, or the certaintly from the experiences that such knowledge is truly or ultimately real, in contrast to subjective feelings which are a delusion.

3. Transcendence of space and time. Space and time are generally meaningless concepts although one can look back in a transcendent way on the totality of history.

4. The sense of sacredness. A non-rational intuitive hushed palpitant response in the presence of inspiring realities. It has a special value and is capable of being profaned.

5. Deeply felt positive mood. Feelings of joy, blessedness, peace, and bliss.

6. Paradoxicality. Mystical consciousness is often felt to be true in spite of violating Aristotelian logic. The ego is transcended and the experience is unviersal. They are still clearly personal experience.

7. Ineffability. The subject claims taht language is inadequate to contain or even adequatly to reflect such experience.

8. Transiency. Unless the subject becomes spiritually 'realised' the duration of the mystical consciousness is temporary.

9. Positive change in attitude or behaviour. The person is said to be marked by his experience and frequently has positive changes in attitude towards himself, others, life and mystical consciousness itself.

All the features described above are quoted widely in mystical literature, but what is clear is that they are not in any way limited to the rare, spontaneous mystical experience, but are part of everyday experience. In their more extensive states they are also included in pathological experiences such as psychoses. If mystical experience is so common, then it is logical to assume that there must be a brain mechanism which allows the expression of the experience. The question then is, what emchanism?

Much of the evidence we have about the brain mechanisms which mediate suhc states has bee acquired through the study of pathologically-induced mystical experiences. Epileptic states are one such example.

TLE and mystical experience

The prime exapmple of a mystical expreience associated with an epileptic seizure is that of Prince Mishkin in Dostoevsky's The Idiot. "He was thinking ... there was a moment or two in his epileptic condition ... when suddenly amid the sadness, spiritual darkness, and depression, his brain seemed to catch fire at brief moments ... all his agitation, all his doubts and worries seemed composed in a twinkling, culminating in a great calm, full of serene and harmonious joy and hope, full of understanding and knowledge of the final cause." Dostoevsky was known to have epilepsy and so it seems reasonable to assume that he was describing his own experience. Others have suggested that it was his leterary genious taht ascribed this experience to the epilepsy, and that it did not occur in his aura but independently of a seizure.

In any event, positive epxeriences as part of the temporal lobe aura are extermely rare. In Gowers 1881 study of 505 epileptic auras only 3% were said to be emotional, and none positive. In the Lennox (1960) study of 1017 auras, only 9 were said to be pleasant (0.9%) and of these, "only a few showed positive pleasure". Penfield and Kristiansen (1951) cite only one case of an aura with a pleasant sensation, followed by an epigastic feeling of discomfort. However, in 1982 Cirignotta published an account of a patient who had just such an aura as that described by Dostoevsky before a temporal lobe seizure arising in his right temporal lobe. There is thus undoubted scientific evidence that such auras do exist prior to a seizure and that they are likely to be associated with the right side of the brain. It is not uncommon to find fragments of this experience in the epileptic aura. They often occur in patients who have had a psychotic episode and are associated with seizures arising usually but not exclusively in the left temporal lobe. A standard question to ask a patient is whether, during their auras, they have spoken to God. It is surprising how often the answer is yes. These findings suggest again a common link between psychosis and temporal lobe function and between temporal lobe function and mystical experience.

Dewhurst and Beard (1970) in an excellent paper look specifically at those cases of temporal lobe epilepsy collected from the Maudsley and Queen Square Hospitals which showed religious conversion. The conversion usually came suddenlty anmd was not always related to a mystical aura; of more interest, the majority of their cases had previously had a psychotic illness. It was thus difficult to know whether their experience was related to their epilepsy or their psychosis. It is worth noting that both the Slater and Beard studies, and the Dewhurst and Beard studies had several patients in common and so were not totally independent.

TLE, mystics nad saints

Many authors have drawn attention to the relationship between the mystical experience of some of the saints and reported alterations in their consciousness and behaviour. Often changes in behaviour are accompanied by an alternation in consciousness which could be interpreted as being peileptic in nature. Dewhurst and Beard mentioned that St Catherine dei Ricci (1522-1590) had frequent hallucinations and stigmata. She lost consciousness regularly, at weekly intervals, being 'our' from noon on Thrusday till 4.00 p.m. the next day. These could have been epileptic although they are rather too long; some were possibly hysterical.

St Theresa of Lisieux (1873-1897) had a series of mystical experiences when she was 9 years old. They started with attacks of violent trembling, such as she thought she was going to die. Later, she had frightening hallucinations leading to a mystical experience and complete conversion. These experiences could possible be attributed to temporal love epilepsy. Dewhurst and Beard quote from Leuba (1925) as saying:

These other Christian mystics also suffered from abnormal mental states which he tentatively diagnosed as hysteria, although their symptoms equally well suggest temporal lobe epilepsy. They were St Catherine of Genoa (1447-1510), Mme Guyon (1648-1717) and St Margaret Marie (1647-1690). These mystics had periodic attacks which include the following symptoms: sensations of extremes of heat and cold, trembling of the whole body, transient aphasia, automatisms, passivity feelings, hyperaesthesie, childish regression, dissociation, somnambulism, transient paresis, increased suggestibility, and inability to open the eyes.

Bryant (1953) suggests that St Paul's 'thorn in the flesh' could have been epilepsy and he quotes in support of this his sudden religious conversion on the road to Damascus, with photism, paralysis, transient blindness and confusion. Bryant is also an enthusiast about genius and epilepsy. In his book he quotes the following people as both genius, epilepsy and some mystical experince: Buddha, Socratres, St Cecilia, Caligula, Bohme, Pascal, Napoleon, George Fox, Caesar, Alexander, St Paul, Mahomet, Van Goch, Peter the First (the Great), Paul 1st of Russia, Swedenborg, William Pitt, Byron and Swinburne. But not everyone agrees. It is important to keep in mind that despite the wide ranging of peileptologists throughout the world's mystical literatuer, very few true examples of the ecstatic aura and the temporal lobe siezure had been reported in the world scientific literature prior to 1980. It is likely that the earlier accounts of temporal lobe epilepsy and temporal lobe pathology and the relation to mystic and religious states owes more to the enthusiasm of their authors than to a true scientific understanding of the natyure of temporal lobe functioning.

Work by Waxman and Geschwind (1975), Geschwind (1979), Bear and Fedio (1977) gave, a strong impetus to the link between temporal pathology and religious experience. Subsequent studies controlling for brain damage, psychiatric morbidity and type of epilepsy have not found the same relationship (Mungus 1982, Bear et al 1982).

It would thus seem clear that the temporal lobe is to some extent involved in the synthesis of mystical feelings and states, but it is also clear that these states are associated equally with normal brain function and in illness with psychosis. A parsimonious view would be that mystical experiences are normal and that temporal lobe structures are involved with their synthesis but that their expression in fragmented form is frequently associated with pathology.

The Maudsley Hospital Population

Sensky and Fenwick (1982) were interested in whether the American experience relating to temporal lobe epilepsy and religious experience could cross the Atlantic. Confusion with regard to terminology rages unchecked through the literature. Religiosity, religious interest, mystical states and ecstatic states, have been frequently used as synonyms or left undefined. In this study, this was taken into account, using standard questions. Subjects were taken from the Maudsley Hospital Epilepsy Clinica and the subjects were compared with national samples of the general population obtained from other studies.

Mystical states were assessed by questionnaire: the questions included: "Did you faith come gradually or was there a point at which you suddenly 'saw the light'"? And "Have you ever felt at one with the Universe and in touch with the Universal." If the responses were thought to occur as part of a psychotic illness they were discounted. There was a 76% response rate to the questionnaire. Of the 55 responders, 28 were male and 27 female. 14 patients had generalised epilepsy (26%) and 30 (56%) had a diagnosis of TLE. Of the TLE, 16 had dominant foci, 7 non-dominant and 7 bilateral.

Our results show that our subjects with TLE are not more incluned towards religion than those with generalised epilepsy. Nor did they report more frequently a belief in, or an experience of, mystical or psychic states. Of more importance, the epileptics under-report mystical and psychic states compared to the general population. This finding would seem to be at variance with the American workers who find 'religiosity' over-erpresented in their temporal lobe epileptics. It does suggest taht the term religiosity may not be travelling across the Atlantic very well and tht part of the confusion is a confusion of terminology.

Psychic gifts and the mystical experience

Many anecdotal accounts from the psychic literature have linked head injury with the onset of psychic powers. There is a frequently quoted case of a Dutchman who fell off a ladder, and on regaining consciousness in hospital found that he could read the minds telephathically of his doctors and nurses. Nelson (1970) found temporal lobe EEg oabnormalities in 10 out of 12 mediums, suggesitng an abnormality of temporal lobe function. Neppe (1980) describes a significant similarity between temporal lobe epileptic symptoms and subjective paranormal experiences. A definite hemisphere asymmetry with the non-dominant hemisphere being important in psychic experiences has been suggested by Andrew (1975), Broad and Broad 1975 and Broughton 1975.

In a study of psychic sensitives Fenwick et al 1983 asked about the occurrence of psychic gifts and mystical experiences. The study wa set up to study psychic snsitivity and see how this related to brain function. Twenty psychic sensitives were allocated to the study by the College of Psychic Studies, although only 17 took part. Seventeen age and sex matched controls were obtained from local Church congregations: they had to have attended Church weekly throughout the preceding eyar. Each subject was given a long interview enquiring about medical data, head injuries, periods of unconsciousness, mystical and psychic experiences. Each subject was then given the shortened WAIS test, the WEchsleer Ligical Memory Test (test of left temporal functioning) and Benton's visual Retention Test (right hemisphere and right temporal functioning.)

The relationship between the medical history, psychic gifts and mystical experiences showed that precognition and clairaudience were significantly associated with right hemisphere damage, as was he presence of a psychic helper or psychic guide. Telepathy showed a trend towards being significantly correlated with head injury.

Significant mystical experience was statistically more common among the sensitives. 88%, but it was also surprisingly common among he controls (47%). Note that the control rate is little different from general popuplation syurveys. Other differences were also seen between the groups, the sensitives being rather more fragile than the controls. The sensitives were single significantly more often. They ahd more serious illnesses, head injuries, episodes of being knowcked unconscious, having had blackouts and had consulted a psychiatrist more frequently. The psychological tests showed a significant difference in verbal IQ between the groups - 129 for the sensitives and 139 for the controls. There was no difference in performance IQ - this was 118 in both groups. No significant differences were found for any of the otehr tests, so the groups were then combined. There were no left hemisphere abnormalities for either group, although both right hemisphere and right temporal abnormalities were found.

In the combined groups, there is a clear relationship betwen the previously significant psychic gifts, clairvoyance, and mystical expreince, all with right hemisphere damage. But it must be recognised that there was nocorrelation between tests of right temporal lobe impairment and right hemisphere impairment. In our study tow subjects, one control and one sensitive, who had moderatley severe head injuries with right temporal memory scores of nearly zero, had very wide mystical experiences after their head injuries. Our study adds support to other studies which suggest that the right hemisphere and particularly the right temporal lobe may be impaired in some subjects who have mystical experience. But it also suggests that mystical experince can occur in those subjects without any right hemisphere impairment.

Implications

The studies that I have discussed have several implications. It would seem reasonable to assume that there is a relationship between the right temporal lobe, mystical experience, and psychic gifts. It is clear that we have failed to substantiate an absolute relationship as many subjects in the control group who were clearly not brain damaged and did not have temporal lobe lesions, also had mystical experiences. With the distribution of mystical experiences being so common in the general population it is very difficult to subscribe their ocurrence simply to pathology. A much better hypotehsis would be that althoug htere is a relationship in some people with right hemisphere dysfunction, this is only one of amny possible mechanisms. It would suggest that these experiences may require a large right temporal input in their genesis, but tht they also involve many different brain areas which can be triggered in different ways.

The implications for epilepsy are also clear. There is certainly evidence that discharges in the right medial temporal structures can lead to an aura with some features of the mystical expreince. It is not clear that there is any other direct relationship. In our survey it was the patients with generalised seizures who more often reported belief in and experiene of mystical phenomena.

Psychic phenomena are more difficult to explain and clarly ahve a multiple causation. In our survey, the mediums were more fragile people, who had had more serious illnesses, more blackouts, and had consulted psychiatrists more frequently. Neitehr the contorls or the psychics suffered from epilepsy and yet there was a significiantly greater number of blackouts in the psychic group. Both groups certainly showed a relationship between psychic gifts and head injury. The interpretation of this is difficult. An unusually snesitive personality may allow them to see connections and interpret bodily sensations in a way that eheir more robust brethren do not. The relationship with head injury is only preliminary and needs further studies to validate it. It could be argued that the appearance of psychic gifts is due to a release of a natural capability after a head injury, or it could be that the head injury itself distorts brain function so that the faults in cognitive processing are interpreted as psychic gifts. We shall have to wait for more evidence.