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Spiritual experiences in temporal lobe epilepsy: A literature review


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Profound spiritual experiences have been observed as a trait of temporal lobe epilepsy (TLE), as described in the Geschwind syndrome. This systematic review considers the evidence for ictal and interictal religiosity, and the neurological, psychiatric and cultural factors. Research in this area is at an early stage of development, with indications that a temporal focus is an important factor in spiritual experiences of epilepsy, albeit as a relatively rare and nebulous trait. The literature indicates that spiritual feelings may arise from a reciprocity of biological and psychosocial factors, but nurseq should afford the possibility of a genuinely transcendent experience. Further research may help to explain whether the complex, partial seizures of TLE are a cause of abnormal religiosity or an accessory to spiritual enlightenment.
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346 British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6
Spiritual experiences in temporal lobe
epilepsy: a literature review
experiences of various prophets, saints and gurus to
seizures of temporal focus, including those of
Buddha, Mohammed, Teresa of Avila and Mormon
founder Joseph Smith. Other cases suspected of TLE
include father of existentialist philosophy Søren
Kierkegaard, and scientist and latterly Christian
visionary Emmanuel Swedenborg (Temkin, 1971).
A clear pattern to these cases may be discerned.
In the nineteenth century, religiosity was observed
in asylum inmates labelled with epileptic insanity;
Howden (1872) contrasted their piety and proclivity
for unprovoked violence. After the introduction of
electroencephalography (EEG), it was found that a
disproportionate number of epileptic patients in
mental hospitals had seizures of temporal lobe
origin. A combination of temporal lobe focus,
mental disturbance and religiosity was illustrated in
psychiatric case reports (Bartlet, 1957). Slater and
Beard (1963) reported mystical delusions in 26 of 69
epileptic patients with psychoses of schizophrenic
presentation; in 6 of these cases, sudden religious
conversion occurred, as in this 33-year-old
dropout from medical training (Dewhurst and
Beard, 1970, p500):
‘He stopped taking his anticonvulsants; within six weeks
he was having ts every few hours; he had become
confused and forgetful. At this point he suddenly realised
that he was the Son of God; he possessed special powers
of healing and could abolish cancer from the world … “It
was a beautiful morning and God was with me … God
isn’t something hard looking down on us, God is trees and
owers and beauty and love. God was telling me to carry
on and help the doctors here.”’
Three years later this patient still believed that he
was under the inuence of a strange, possibly electrical
power, through which God was revealing a virtuous
path. The most legendary conversion was on the road
to Damascus, where Paul, hitherto tormentor of
Christians, was arrested by a vision; medical historians
have explained this as a hallucinatory event of partial,
complex seizure.
Alongside the adjacent limbic structures of the
amygdala and hippocampus, the inner temporal lobe
has been implicated in our sense of self. Building on
Niall McCrae and Samantha Elliott
An intriguing phenomenon in temporal lobe
epilepsy (TLE) is the occurrence of mystical
experiences around the time of seizure.
Common to this form of epilepsy are partial, complex
seizures entailing altered states of consciousness.
Often described as ‘absences’, such ts typically last
2 or 3 minutes; the person remains awake but may
become detached from reality. Russian novelist
Fyodor Dostoyevsky described the aura that preceded
his seizures as the pinnacle of ecstasy, with visions of
heavenly perfection. Recurring ictal phenomena of
divine content may lead to interictal personality
changes. Transient images or voices of angels or a
supreme being can have profound and enduring
impact, in some cases spurring messianic zeal.
On observing pronounced religious expression in
the aficted, ancient Greek and Hebrew physicians
declared epilepsy ‘the sacred disease’. Hippocrates
asserted pathological causation, but religious associa-
tions with epilepsy have persisted. Although such
diagnoses cannot be conrmed, medico-psychological
retrospect has attributed the intense spiritual
Profound spiritual experiences have been observed as a trait of temporal
lobe epilepsy (TLE), as described in the Geschwind syndrome. This systematic
review considers the evidence for ictal and interictal religiosity, and the
neurological, psychiatric and cultural factors. Research in this area is at an
early stage of development, with indications that a temporal focus is an
important factor in spiritual experiences of epilepsy, albeit as a relatively
rare and nebulous trait. The literature indicates that spiritual feelings may
arise from a reciprocity of biological and psychosocial factors, but nurses
should afford the possibility of a genuinely transcendent experience.
Further research may help to explain whether the complex, partial seizures
of TLE are a cause of abnormal religiosity or an accessory to spiritual
Key Words Epilepsy, religion, seizures, neurology, psychiatry, psychology
Authors Niall McCrae is Lecturer, King’s College London; Samantha Elliott is Paediatric
Staff Nurse, Guy’s and St Thomas’ Hospital
Accepted 29 August 2012
This article has been subject to double-blind peer review.
British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6 347
the seminal work of neurosurgeon Wilder Peneld,
experiments by Michael Persinger indicated that most
people are amenable to mystical experiences through
micro-seizures induced by transcranial magnetic stim-
ulation. Persinger (1987) saw this as evidence that
God resides not in heaven but in neural networks.
Encouraged by such ndings, a specialism of neuro-
theology emerged. However, ‘God helmet’ effects
appear supercial compared with spontaneous
mystical occurrences, and the validity of Persinger’s
results was challenged by Granqvist et al (2005), who
suspected suggestibility.
Seizures of temporal focus may be a naturalistic
facilitator of spiritual phenomena. In the 1970s
neurologist Norman Geschwind described a personal-
ity disorder in TLE comprising religiosity, compulsive
writing and low sexual drive; patients display
‘increased concern with philosophical, moral or
religious issues, often in striking contrast to [their]
educational background’ (Geschwind, 1979, p217).
The Geschwind syndrome links historical ideas about
religious sentiment in epilepsy with current knowledge
of the functioning of the temporal lobe and adjacent
limbic structures. Trimble (1991) estimated its
incidence at 7% of people with TLE, but the religiosity
trait could be more common as neurologists do not
routinely enquire into such beliefs or experiences. In
their secular empiricism and standardised diagnostic
practices, the disciplines of neurology and psychiatry
are likely to pathologise or overlook unusual religious
or quasi-religious experiences. While functional
magnetic resonance imaging reveals neural correlates
of intense spiritual feelings, it neither conveys the
meaning for the patient nor refutes the ontological
basis of faith.
In recent decades there has been much growth in
the literature on spirituality in health care, but
evidence of practitioners attending to this aspect of
patients’ lives is sparse. According to Paley (2007,
p182), nurses rarely provide spiritual care, and when
they do ‘it is infrequent, inconsistent, unsystematic,
and apparently uncomfortable’. Consequently,
patients’ spiritual world remains a private domain,
and opportunities to understand the dynamics of
mind, body and spirit are missed.
Enquiring into mystical experiences may not be a
priority for nurses working with epileptic patients.
Practical intervention is necessary to control seizures
and maintain safety. However, nursing is not
exclusively focused on physical needs. Queally and
Lailey (2012) urged nurses to assess how patients
felt before, during and after seizures, taking the
opportunity to consider spiritual sensations beyond
the connes of symptomology. Better knowledge of
the infrequent but signicant mystical phenomena
of TLE would enhance nurses’ understanding of
patients’ experiences, potentially informing
developments in practice.
To systematically review empirical evidence of the
relationship between TLE and spiritual experiences,
and to discuss the implications for nursing.
Studies of spiritual experiences in TLE were sought
by electronic search of the databases Medline,
PsychInfo, ATLA Religion and Cumulative Index
to Nursing and Allied Health. Search terms were
combined as follows: epilep* or seizure* or ictal or
convuls* and delusion* or hallucinat* or psycho* and
religio* or spiritual* or faith.
Inclusion criteria were reports of primary research
on samples or multiple cases in English language,
published in peer-reviewed journals in the period since
the Geschwind syndrome was described (Waxman
and Geschwind, 1975). Excluded were single case
studies and reviews. Although the focus was on TLE,
papers were included if samples of mixed types of
epilepsy presented results specically for temporal
lobe cases. As spirituality and religion were not always
mentioned in abstracts, papers were also examined that
used other terms for metaphysical experiences during
or following seizures (e.g. ecstasy), on the condition
that spiritual phenomena were specically investigated.
Manual searching was performed in relevant journals,
reference lists and authors’ publication lists. Critique
of the design and conduct of the studies was followed
by thematic analysis.
Of 288 papers found by electronic search, on examining
abstracts only six papers were found to full the
criteria. Four additional studies were found by manual
search, producing ten papers in total. The papers are
summarised in Table 1.
Most of the studies had small samples, inhibiting
statistical analysis and generalisation. There was wide
methodological variation with little attempt at replica-
tion. Some studies were specically of TLE only
(Bear and Fedio, 1977; Mungas, 1982; Tucker et al,
1987; Trimble and Freeman, 2006; Lin et al, 2008),
others were of partial seizures (Ogata and Miyakawa,
1998; Åsheim Hansen and Brodtkorb, 2003; Wuerfel
et al, 2004; Dolgoff-Kasper et al, 2011), and another
was of epilepsy generally (Khwaja et al, 2007). All of
the studies used neurological examination to conrm
the type of epilepsy and localisation of seizures, either
from existing clinical data or as a research procedure.
One study (Tucker et al, 1987) recorded EEG during
seizures. Bear and Fedio (1977) developed an instru-
ment for measuring the behavioural disturbances of
TLE, and this was used in three other studies
(Mungas, 1982; Wuerfel et al, 2004; Trimble and
Freeman, 2006). In three studies, data on spiritual
348 British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6
Table 1 (part 1). Summary of the papers included in the review
Paper Objective Design Findings
Strengths and
Bear and
Fedio (1977)
To determine whether
distinct behavioural
proles exist in TLE of
right and left
Comparison of four groups: 15 patients with
right-sided TLE, 12 with left-sided TLE, 9 with
neuromuscular disorders, and 12 healthy
volunteers. A scale developed by the authors
measured 18 traits including religiosity
Consistent prole of changes in
behaviour, thought (including religious
and philosophical interest) and affect,
apparently as specic consequence of
temporal lobe seizures. Religiosity was
particularly common in left laterality
Small sample. Cases of
TLE may have had
disproportionate rate
of psychiatric
There were two
studies: the objective
of the rst was to
compare behavioural
traits between TLE
and psychiatric
illness; that of the
second was to
measure the inuence
of psychiatric illness
on these traits
Study 1 included three groups of 14 patients:
one group with TLE, one with concomitant
neurological and behavioural disorders, and
one with psychiatric disorder but no
neurological abnormality. The Bear and Fedio
Inventory was completed by each participant
and a family informant. Study 2 used the
same groups plus patients with
neuromuscular disorders and healthy
volunteers. It used a self-rated Bear and
Fedio Inventory
Study 1 found no difference between
TLE and comparators in Bear and Fedio
Inventory scores. In study 2, in the TLE
group, psychiatric disorder accounted
for 40% of behavioural trait variance.
The authors concluded that TLE is not a
necessary condition for these traits
Small sample. Problem
of differentiating
epileptic psychosis
from psychiatric
Tucker et al
Investigate frequency
of hyperreligiosity in
Used three groups: 76 patients with complex,
partial seizures of unilaterial temporal lobe
focus; 31 with primary generalised seizures;
and 27 with pseudoseizures but no epileptic
seizures. Video EEG of ictal phase and
observation of concurrent behaviour were
No signicant group differences were
Only overt behaviour
was measured
Ogata and
To examine the
frequency of and
contributory factors
for ictal and postictal
religious experiences
234 epileptic outpatients at a
neuropsychiatric clinic in Japan were
recruited from 1984–1997. Patients were
routinely interviewed about ictal experiences
Three patients, all with TLE, had ictal
religious experiences (1.3% of overall
sample, 2.2% of TLE). These cases also
had postictal psychosis and interictal
religious experiences
Large sample, with
137 having TLE. No
assessment of spiritual
Hansen and
To investigate ecstatic
auras in partial
Descriptive study at an epilepsy clinic in
Norway. Interviews with 11 consecutive
patients who had pleasant aura experiences
Five cases described spiritual or religious
phenomena. Two felt that these
experiences had a lasting impact
Small sample. No
assessment of spiritual
et al (2004)
To investigate the
neurological basis of
Geschwind syndrome
Analysis of correlation between Geschwind
features and volumes of mesial temporal
lobe structures. Included 33 patients with
refractory focal seizures at an epilepsy
treatment centre in the UK. The Neuro-
Behavioral Inventory (an extended version of
the Bear and Fedio Inventory) was completed
by each participant and a family informant.
MRI was also used
11 participants had hyperreligiosity. This
group had a smaller right hippocampus
on average than the group without
religious interests, but no difference in
the size of the left hippocampus or
amygdala. No correlation was found
between hypergraphia and
hyposexuality and size of amygdala and
Small sample.
Researcher measuring
hippocampus and
amygdala volumes
was blinded to
psychological data
Trimble and
To compare religious
experiences of people
with epilepsy and
regular church-goers
Comparison of three groups: 28 patients with
TLE and religiosity, 22 patients with TLE and
no religiosity, and 30 members of a Church of
England congregation. INSPIRIT, Hood’s
Mysticism Scale, Bear and Fedio Inventory,
Beck Depression Inventory, Hospital Anxiety
and Depression Scale were all used
No signicant difference was found in
the frequency of religious experiences
between the hyperreligious group and
the church-goers, but hyperreligious
participants had more intense
experiences. There were signicant
personality and behavioural differences
between the epileptic groups
Small sample. All
epileptic participants
from one neurology
centre. Criterion for
required prominent
religious interests for
at least 1 year
EEG, electroencephalogram; INSPIRIT, Index of Core Spiritual Experiences; MRI, magnetic resonance imaging; TLE, temporal lobe epilepsy
British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6 349
experiences were collected by interviews rather than
by standardised instrument (Åsheim Hansen and
Brodtkorb, 2003; Ogata and Miyakawa, 1998; Khwaja
et al, 2007). One study used video recording of ictal
behaviour (Lin et al, 2008).
Neuropsychiatric factors
A variety of ictal experiences, postictal psychosis and
interictal beliefs were observed. Trimble and Freeman
(2006) found higher frequency of postictal psychosis
in their hyperreligious group than in epileptic partici-
pants without religious interest. The validity of the
religiosity trait in TLE was supported by Bear and
Fedio (1977), who speculated that high emotional
intensity (as displayed in irritability, sorrow and
elation) is due to kindling, whereby limbic–cortical
connections become hypersensitive as a result of
previous aura experiences. However, the studies by
Mungas (1982) and Tucker et al (1987) indicated that
spiritual phenomena result from psychiatric comor-
bidity, although the Mungas study had a small sample
and the Tucker study only measured overt behaviour.
In study samples with mixed types of epilepsy, spiritual
phenomena were generally more frequent in TLE.
The three cases of spiritual experience observed in the
Ogata and Miyakawa (1998) study all had TLE.
Magnetic resonance imaging by Wuerfal et al (2004)
showed an abnormally small right hippocampus in
hyperreligious cases, implying that this structure has a
critical role in spiritual delusions.
Religious and cultural factors
Although the incidence of spiritual experiences was
generally low, the intensity and impact were often
highly signicant for those affected. As described by
Waxman and Geschwind (1975), religious phenomena
in TLE tend to deviate from the prevailing beliefs and
practices. In the Trimble and Freeman (2006) study,
18 of the 28 hyperreligious cases were afliated to
denominations other than Anglican or Roman
Catholic. In addition, in some cases the spiritual
presence was malign, provoking morbid and over-
whelming fear. The instances of religious experience
reported by Ogata and Miyakawa (1998) differed
from social norms in Japan, where a nominally
Buddhist populace lacks a tradition of overt religious
practice. In a devout Buddhist and two converts to
Christian sects, ictal experiences appeared to amplify
existing beliefs. In 12 patients with a high frequency
of spiritual auras, the Dolgoff-Kaspar et al (2011)
study found no instances of overt religious experience
but instead a sense of cosmic consciousness was
expressed; paranormal beliefs were disproportionately
common in this group. The researchers suggested that
the hyperreligiosity feature be renamed ‘cosmic spiritu-
ality’. By contrast, the Lin et al (2008) study in Brazil
Table 1 (part 2). Summary of the papers included in the review
Paper Objective Design Findings Strengths and weaknesses
Khwaja et al
To examine
and practices
before and after
onset of epilepsy
100 sequential patients with epilepsy
(aged 15–84 years) in an Indian
neurology centre were enrolled. CT was
used to differentiate idiopathic from
symptomatic epilepsy. Interviews
explored family history, beliefs,
practices, and mystical experiences
before and after diagnosis
29% of the participants became more
religious after onset of epilepsy. There were
two cases of mystical experiences but
neither had TLE. Religiosity was found in all
types of epilepsy. 80% stated that religion
helped them to cope with epilepsy, but some
saw epilepsy as punishment
No standardised assessment
of spiritual experiences. CT
scan in 80 participants, with
few cases of temporal lobe
focus determined, but
around a third had partial
seizures or absences
Lin et al
To evaluate the
ictal signicance
of the sign of
the cross
Cases identied from video records of
530 patients monitored at an epilepsy
centre in Brazil. Participants who made
the sign of the cross during a seizure
were interviewed. Spiritual experiences
were assessed by INSPIRIT
All four participants who made the sign of
the cross had localised seizure activity in the
right temporal lobe and atrophy of the right
hippocampus. Two participants also had
interictal religiosity. EEG results suggested
ictal automatism, with participants having
no recollection of making the action
Small number of cases. Video
recording. Sign of the cross
not transferable beyond
Christian culture
Kaspar et al
To investigate
in people with
experiences in
partial seizures
38 US adults with partial epilepsy were
enrolled. Seizures were localised by EEG.
Participants were divided into high and
low frequency of experiencing divine or
spiritual auras, as reported on an aura
checklist. Expressions of Spirituality
Inventory (Revised) were completed for
ictal and interictal experiences
High frequency group (12 participants) had
more metaphysical experiences ictally and
interictally. No participants reported overtly
religious experiences. High frequency group
had more paranormal beliefs
Small sample. Eligibility
criteria not stated. Only six
participants in the high
frequency group had seizures
of temporal focus
CT, computerised tomography; EEG, electroencephalogram; INSPIRIT, Index of Core Spiritual Experiences; TLE, temporal lobe epilepsy
350 British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6
produced video evidence of a religious automatism in
partial seizures, with four patients making the sign of
the cross with their hand; all were Catholic but did
not attend church regularly. In the Khwaja et al
(2007) study the participants were mostly Hindu
(77%), with 18 Muslims, 4 Sikhs and 1 Christian.
Religion and family background were major factors in
beliefs and experiences, with lingering traditional
beliefs about divine retribution (6% attributed their
epilepsy to a curse of God and 14% to bad karma).
Khwaja et al (2007) suggested that religiosity arises
not from ictal stimulus but from feelings of fear or
guilt; almost a third of the participants reported
becoming more religious after the onset of epilepsy.
Religiosity in TLE should be considered in the
context of contrasting ideas on the relationship
between the brain and spirituality. From the material-
ist stance, epitomised by Gilbert Ryle’s ‘ghost in the
machine’, the mind is an illusion, with all thoughts
and feelings products of neural processes (Tallis,
2011). As the brain is the physical medium of experi-
ence, it is reasonable to hypothesise organic causes of
abnormal emotions. Neurotheology is predicated on a
biological explanation for religion. From functional
brain scans on Tibetan monks, who signalled when
their meditations reached a peak of intensity,
Newberg and d’Aquili (2000) found that spiritual ela-
tion related directly to neurological changes including
increased blood ow in the frontal cortex, midbrain,
cingulate gyri and thalamus. Coles (2008, p1956)
argued that ‘without careful interpretation, this
contributes as much to the study of religious experi-
ence as a Chicago city plan does to an analysis of
American culture’, yet Newberg and d’Aquili (2000)
inferred evolutionary programming of faith. The true
scientic attitude is doubt. Fingelkurts and
Fingelkurts (2009) asked ‘is our brain hardwired to
produce God, or is our brain hardwired to perceive
God?’, but it seems unlikely that spirituality, being
strongly inuenced by personal and social factors, can
be pinpointed to a single structure.
A second explanation for religiosity is a dysfunction
of mind. As religious delusions are common in schizo-
phrenia and in transient psychotic states, psychiatrists
and psychologists may be inclined to interpret
extreme or culturally-divergent expression as sympto-
matic. Outspoken critic of psychiatry Thomas Szasz
(1974, p113) remarked: ‘if you talk to God, you are
praying; if God talks to you, you have schizophrenia’.
A third view is to critically accept the authenticity
of experience. Clinicians are expected to be sensitive
to the beliefs and values of patients, but the spiritual
concept of the soul is anathema to scientic episteme
(Walach, 2007). Humanistic psychologist Abraham
Maslow regarded spiritual events not as supernatural
but ‘within the jurisdiction of a suitably enlarged
science’ (1964, p19), with religious ecstasy as a variety
of ‘peak experience’ in which ultimate fullment is
attained. Rening his hierarchy of needs, Maslow
placed transcendence atop the pyramid. The current
enthusiasm for mindfulness in psychology is a secular-
ised form of Buddhist meditative practice that
pursues a higher plane of consciousness. Cosmic
enlightenment was taken seriously by pioneering
psychologist William James (1902/2002, p195):
‘If there be higher spiritual agencies that can directly
touch us, the psychological condition of their doing so
might be our possession of a subconscious region which
alone should yield access to them. The hubbub of the
waking life might close a door which in the dreamy
subliminal might remain ajar.’
James was an early proponent of phenomenology,
now an established paradigm in the human sciences.
While the patient’s perspective is valued in medical
and psychological research, generalisability of experi-
ential data is problematic amidst the Western dualism
of mind and matter. Adding to the challenge of
understanding spiritual events in epilepsy, ‘spiritual
and religious experiences are deeply personal and
verbally inexpressible’ (Devinsky and Lai, 2008,
p636). Yet without the personal account there would
be little to investigate. For all its aws, mind trumps
brain as informant.
Implications for nursing
Technological advances make an exciting environment
for neurological nursing, but practitioners should not
be blinded by science; the essence of nursing remains
in individualised care (Woodward, 2011). A holistic
approach is presented as a dening concept of nurs-
ing but, as Clarke (1999) explained, although this is
construed as a triad of physical, psychological and
social considerations, the philosophical idea of holism
means integration of mind, body and spirit. Spiritual
needs are emphasised by textbooks, but ambiguity is
apparent. Frontline practitioners of no religious belief
may lack condence or inclination to engage in
patients’ spirituality. However, Paley (2007) discussed
the apparent paradox of an agnostic society and a
burgeoning interest in spirituality in nursing. While
Christian worship declines, vague beliefs in a tran-
scendental life force or ultimate reality appear in its
place (Hay, 2006). Interest in Oriental spirituality is
shown by the popularity of yoga, although arguably
such dabbling in other belief systems is supercial, as
a commodity rather than a life-changing commit-
ment. In an increasingly multicultural society,
awareness of heterogenous beliefs is vital in nursing.
Instead of merely attributing an episode to culture, a
nurse hearing of a patient having a profound aura
experience should consult hospital chaplaincy, whose
pastoral support does not impose any doctrine but
British Journal of Neuroscience Nursing December 2012/January 2013 Vol 8 No 6 351
Key Points
Epilepsy has long been associated with spiritual phenomena
Religiosity is a feature of the Geschwind syndrome, observed in some
cases of temporal lobe epilepsy
Evidence for disproportionate spiritual experiences in temporal lobe
epilepsy is mixed, but sufcient to justify further research
Whenever possible, nurses should engage in the ictal experiences of
patients with epilepsy, both for individualised care and to contribute to
broader understanding
illuminates personal meanings in coping with illness.
Through their interpersonal rapport with patients,
nurses have an important role in developing the
knowledge of mystical phenomena in epilepsy.
Neuroscience nursing should be at the forefront of
creative, interdisciplinary partnerships in this area.
Systematic review and replication are constrained by
imprecise denitions of spiritual experience, which
demands subjective judgment in selection of papers.
Included here were studies contributing to knowledge
of the frequency and quality of spiritual phenomena
in TLE, but wider criteria would have accommodated
studies of elevated emotional states, which would
inevitably include mystical experiences. The review
only included papers in English; consequently, some
Japanese literature was omitted, although most of
these papers report single cases (Ogata and
Miyakawa, 1998).
In summary, research in this area is at an early stage
of development, with indications that a temporal
focus is an important factor in spiritual experiences of
epilepsy, albeit as a relatively rare and nebulous trait.
Spiritual feelings may arise from reciprocity of bio-
logical and psychosocial factors, but nurses should
afford the possibility of a genuinely transcendent
experience. Whether transcendence is real or epiphe-
nomenal, ‘epilepsy may have inuenced and formed
our cultural and religious history to a degree that has
not been fully acknowledged’ (Åsheim Hansen and
Brodtkorb, 2003). The impact on humanity is tremen-
dous if the insights of some of the most prominent
gures in history were indeed facilitated by ictal
excitation. Further research may help to explain
whether the complex, partial seizures of TLE are a
cause of abnormal religiosity or an accessory to
spiritual enlightenment. BJNN
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... Instead of merely attributing an episode to culture, a nurse hearing of a patient having a profound aura experience should consult hospital chaplaincy, whose pastoral support does not impose doctrine but illuminates personal meanings in coping with illness (McCrae & elliott 2013: 350). while this recognition of the chaplain's expertise in this area is helpful, very often nurses will be the first to hear about the patient's experience. ...
Chaplains are familiar with patient narratives which recount “extra-ordinary” experiences. These may include a vision or awareness of a deceased person. It may take other forms of description which do not fit into day-to-day discourse. There is also a significant multi-faith and multi-cultural diversity to the nature and expression of such events. This paper outlines a narrative structure which could be used authentically by health care staff to enable and value the patient’s experience of extra-ordinary episodes. This is seen as a significant way to support a patient’s dignity and enable them to integrate experiences in an effective way.
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Religion can serve the purpose of providing comfort during times of physical and/or emotional stress and can fill a void in the life of an individual experiencing substance use disorders. Neuroscience sheds some light and raises questions as to how the inner workings of the brain can affect the level of one's spirituality and the likelihood to engage in substance abuse. This article provides insight into factors that influence religiosity and considers the role that religion plays in the substance abuse recovery process. A reflective synopsis of a 6-week religious abstinence experience is discussed, and initial steps to abstain from using alcohol and other drugs are explained demonstrating the interconnectedness of religion and drug abuse. Implications for practice are also delineated.
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The argument of this paper is that the modern brain-consciousness debate has left out one important element: the question of a transpersonal or spirit-like element of consciousness. Thus the problem really is not a mind-body-problem or brain-consciousness problem, but a mind-body-spirit or brain-consciousness-soul problem. Looking at the history of the debate it can be seen that, explicitly or implicitly, this aspect has always been part of the philosophical debate. Most notably, this can be seen in the Aristotelian concept of the soul, which held that form and matter were both together necessary to constitute a unity. But on top of that, a Platonic strand of teaching existed in Aristotle, which was lost. This tradition stipulated an aspect of the soul, the active intellect, that was separate and separable. This idea has inspired other and later writers into postulating an immortal part of the soul. In the modern debate this tradition has been lost and was frequently amalgamated with dualist positions. Phenomenological descriptions of mystical experiences, as well as other unusual (or exceptional)mind-matter anomalies suggest that this aspect of the problem needs reconsideration. For this purpose a transcendental kind of monism is suggested which does not violate the consensus that only a monist description of the world is scientifically viable. Such a position would, in addition, provide the option to incorporate the transpersonal side of the debate.
• Two studies examine the degree to which the traits measured by the Bear and Fedio personality inventory are specific to temporal lobe epilepsy. In the first study, none of the 18 traits discriminated among a group of temporal lobe epileptics with behavioral-psychiatric disorders, a group of patients with concomitant neurological and behavioral-psychiatric disorders, and a group of patients with psychiatric but not neurological illness. The second study demonstrated that a very large percentage of variance in the traits can be accounted for by presence or absence of psychiatric illness. The results of these two studies suggest that previously reported differences between temporal lobe epileptics and normals on these trait variables reflect underlying differences in degree of nonspecific psychopathology and do not necessarily indicate the presence of a specific behavioral syndrome in temporal lobe epilepsy.
• A distinct syndrome of interictal behavior changes occurs in many patients with temporal lobe epilepsy. These changes include alterations in sexual behavior, religiosity, and a tendency toward extensive, and in some cases compulsive, writing and drawing. The concomitants of abnormal limbic activity therefore include behavior alterations as well as manifest seizures. The demonstration of interictal spike activity in temporal structures provides a pathophysiologic basis for this syndrome. The constellation of behavioral changes may be of great diagnostic value. In addition, it provides an example of a human behavioral syndrome associated with dysfunction at specific anatomic loci. The behavior syndrome of temporal lobe epilepsy may prove to be a useful model in studies on the neural substrates for behavior.
This article provides a general update regarding the definition of epilepsy, explanation of seizure classification, a brief outline of the treatment options available. The main theme is the safety implications for the patient with epilepsy reducing the risk of injury and death as a consequence of seizure activity in an acute setting. Sudden unexplained death in epilepsy (SUDEP) is discussed together with the nurse’s role and responsibilities when caring for a patient with epilepsy along with nursing assessment and management issues that should be considered. These include patient safety, observation pre-ictal, ictal and post-ictal.
Seventy-six subjects with the primary diagnosis of complex partial seizures with a unilateral temporal lobe focus were examined for the presence of hyperreligiosity. Fifty-one subjects had a left temporal lobe seizure focus and 25 had a right temporal lobe seizure focus. In addition to the temporal lobe epilepsy (TLE) groups, two reference groups were also examined. The first consisted of 31 subjects with primary generalized seizures. The second control group consisted of 27 subjects with documented pseudoseizures and no objective evidence of recurrent epileptic seizures. In all cases, the documentation of seizures or pseudoseizures as well as the localization of the seizure focus was accomplished through simultaneous videotaped recording of the 16-channel scalp EEG tracing and the concurrent overt behavior during the ictal phase. The results of this study fail to support the hypothesis that individuals with TLE are characteristically hyperreligious during the interictal state. There were no significant group differences between the left vs. the right TLE groups, nor were there any significant group differences between the two TLE groups vs. the two comparison groups.
In 1953, in an article intended for the general practitioner, Denis Hill made a brief reference to the chronic paranoid psychoses which may develop in association with temporal lobe epilepsy. He described the condition as likely to come on when the seizures were diminishing in frequency, as appearing gradually with onset in middle age, and as resembling a paranoid schizophrenic state. In 1957, D. A. Pond, from the same department of applied electro-physiology at the Maudsley Hospital, gave a more detailed account of the clinical features. He described the psychotic states as closely resembling schizophrenia, with paranoid ideas which might become systematized, ideas of influence, auditory hallucinations often of a menacing quality; and occasional frank thought disorder with neologisms, condensed words and inconsequential sentences. There were, however, also some points of difference, of a quantitative rather than qualitative kind: a religious colouring of the paranoid ideas was common; the affect tended to remain warm and appropriate; and there was no typical deterioration to the hebephrenic state. All the patients had epilepsy arising from the temporal lobe region with complex auras; occasional major seizures occurred in sleep only. EEG foci, always present, were sometimes only to be demonstrated in sleep-sphenoidal records. The epilepsy began some years before the psychotic symptoms, usually in the late teens or the twenties; and the latter often seemed to begin as the epileptic attacks were diminishing in frequency, either spontaneously or with drug treatment.
In the following observations I propose to describe a feature in the mental condition of Epileptics, which, to the best of my knowledge, has not attracted that attention to which its frequency entitles it. I refer to the exaltation of the religious sentiment. Irritability, suspicion, impulsive violence, egotism, strong homicidal propensities are among the most commonly observed characteristics in the insane epileptic; but in strange contradiction with these we very frequently find combined a strong devotional feeling, manifesting itself, it may be, in simple piety or in decided religious delusions. I do not pretend that the forms of religious insanity to be afterwards noticed are peculiar to epilepsy, but they are very frequently found in connection with it, and, I believe, I have only to describe a few illustrative cases to bring to your recollection numerous others which have occurred in your own experience. The causes which combine to develope a devotional frame of mind in Epileptics are probably numerous. In congenital cases or those arising from diseases of childhood education no doubt exercises a powerful influence. The epileptic child is necessarily less able to join in the amusements and occupations of healthy children, and a large share of his time and attention may be devoted at home to religious instruction. The mysterious nature of the disease, the consciousness of infirmity and helplessness developes a craving for sympathy in the epileptic which we rarely see in other lunatics. In the wards and airing-courts of our asylums, epileptics may be distinguished from their fellow-patients by the fact that they are generally found associating in little groups of twos or threes. They sympathize with each other, lean on each other for help in the time of trouble, and however much they exhibit violence and viciousness to others, they rarely attack each other. Along with this desire for sympathy, the epileptic is mercifully endowed with strong hope. He is always getting over his trouble, he thinks the turns are less severe, and will tell you perhaps the day before a fatal seizure that he thinks he will have no more fits. We all know how much hope has helped the physician in his efforts to combat this disease with a whole battery of drugs, each of which in its turn seems for a time to promise success, only too surely to fail in the end. This craving for sympathy finds a deep response in the highest development of hope—religion; and the sufferings of this life are assuaged by the assurance of sympathy and aid from heaven, and of a blessed future where suffering and sorrow are no more.
When I look at your heavens, the work of your fingers, the moon and the stars that you have established; what are human beings that you are mindful of them, mortals that you care for them? Yet you have made them a little lower than God, and crowned them with glory and honour. You have given them dominion over the works of your hands; you have put all things under their feet, all sheep and oxen, and also the beasts of the field, the birds of the air, and the fish of the sea, whatever passes along the paths of the seas . (New Revised Standard Version, Psalm 8: 3–9) On November 23, 1654, Pascal experienced God. His servant later found the mathematician's account of his ‘night of fire’ on some parchment sewn into the lining of a discarded doublet: From about half-past ten in the evening until half-past twelve. FIRE. The God of Abraham, the God of Isaac, the God of Jacob. Not of the philosophers and intellectuals. Certitude, certitude, feeling, joy, peace. (Bishop, 1936) This paradoxical fragmented certainty about the ineffable seems to be a common human experience, expressed famously by Albert Einstein. The most beautiful and most profound emotion we can experience is the sensation of the mystical. It is the sower of all true science. So to whom this emotion is a stranger, who can no longer wonder and stand rapt in awe, is as good as dead. To know that which is impenetretrable to us really exists, manifesting itself as the highest wisdom and the most radiant beauty which our dull faculties can comprehend only in their primitive forms - this knowledge, this feeling is at the centre of true religiousness. (Barnett, 1964) This is the religious impulse, the spark of something beyond …