Spiritual experiences in temporal lobe epilepsy: A literature review

Abstract

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.

Full text

Review
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
Abstract
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
enlightenment.
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.

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.
Aims
To systematically review empirical evidence of the
relationship between TLE and spiritual experiences,
and to discuss the implications for nursing.
Method
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.
Results
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.
Methodology
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

Review
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
weaknesses
Bear and
Fedio (1977)
To determine whether
distinct behavioural
proles exist in TLE of
right and left
laterality
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
disturbance
Mungas
(1982)
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
disorder
Tucker et al
(1987)
Investigate frequency
of hyperreligiosity in
TLE
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
conducted
No signicant group differences were
found
Only overt behaviour
was measured
Ogata and
Miyakawa
(1998)
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
standardised
assessment of spiritual
experiences
Åsheim
Hansen and
Brodtkorb
(2003)
To investigate ecstatic
auras in partial
epilepsy
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
standardised
instrument
assessment of spiritual
experiences
Wuerfel
et al (2004)
To investigate the
neurological basis of
Geschwind syndrome
(hyperreligiosity,
hypergraphia,
hyposexuality)
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
hippocampus
Small sample.
Researcher measuring
hippocampus and
amygdala volumes
was blinded to
psychological data
Trimble and
Freeman
(2006)
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
hyperreligiosity
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

Review
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
(2007)
To examine
religious
temperament
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
(2008)
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
Dolgoff-
Kaspar et al
(2011)
To investigate
hyperreligiosity
in people with
supernatural
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

Review
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.
Discussion
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

Review
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.
Limitations
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).
Conclusion
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
Åsheim Hansen B, Brodtkorb E (2003) Partial epilepsy with
‘ecstatic’ seizures. Epilepsy Behav 4(6): 667–73
Bartlet JEA (1957) Chronic psychosis following epilepsy. Am J
Psychiatry 114(4): 338
Bear DM, Fedio P (1977) Quantitative analysis of interictal
behaviour in temporal lobe epilepsy. Arch Neurol 34(8): 454–67
Clarke L (1999) Challenging Ideas in Psychiatric Nursing.
Routledge, London
Coles A (2008) God, theologian and humble neurologist. Brain
131(7): 1953–9
Devinsky O, Lai G (2008) Spirituality and religion in epilepsy.
Epilepsy Behav 12(4): 636–43
Dewhurst K, Beard AW (1970) Sudden religious conversions in
temporal lobe epilepsy. Br J Psychiatry 117(540): 497–507
Dolgoff-Kaspar R, Ettinger AB, Golub SA, Perrine K, Harden C,
Croll SD (2011) Numinous-like auras and spirituality in persons
with partial seizures. Epilepsia 52(3): 640–4
Fingelkurts AA, Fingelkurts AA (2009) Is our brain hardwired to
produce God, or is our brain hardwired to perceive God? A
systematic review on the role of the brain in mediating religious
experience. Cogn Process 10(4): 293–326
Geschwind N (1979) Behavioural changes in temporal lobe
epilepsy. Psychol Med 9(2): 217–9
Granqvist P, Fredrikson M, Unge P et al (2005) Sensed presence
and mystical experiences are predicted by suggestibility, not by
the application of transcranial weak complex magnetic elds.
Neurosci Lett 379(1): 1–6
Hay D (2006) Something There: The Biology of the Human Spirit.
Darton, Longman and Todd, London
Howden JC (1872) The religious sentiment in epileptics. J Ment Sci
18: 482–97
James W (1902/2002) The Varieties of Religious Experience: A
Study in Human Nature. Routledge, London
Khwaja GA, Singh G, Chaudhry N (2007) Epilepsy and religion.
Ann Indian Acad Neurol 10(3): 165–8
Lin K, Marx C, Caboclo LO, Centeno RS, Sakamoto AC,
Yacubian EM (2008) Sign of the Cross (Signum Crucis):
observation of an uncommon ictal manifestation of mesial
temporal lobe epilepsy. Epilepsy Behav 14(2): 400–3
Maslow AH (1964) Religion, Values and Peak-Experience. Penguin,
New York
Mungas D (1982) Interictal behaviour abnormality in temporal
lobe epilepsy: a specic syndrome or nonspecic
psychopathology? Arch Gen Psychiatry 39(1): 108–11
Newberg AB, d’Aquili EG (2000) The neuropsychology of religious
and spiritual experience. J Conscious Stud 7(11–12): 251–66
Ogata A, Miyakawa T (1998) Religious experiences in epileptic
patients with a focus on ictus-related episodes. Psychiatry Clin
Neurosci 52(3): 321–5
Paley J (2007) Spirituality and secularization: nursing and the
sociology of religion. J Clin Nurs 17(2): 175–86
Persinger MA (1987) Neuropsychological Bases of God Beliefs.
Praeger, New York
Queally C, Lailey S (2012) Care of the person with epilepsy in the
hospital environment – getting it right. Br J Neurosci Nurs 8(1):
14–20
Slater E, Beard AW (1963) The schizophrenia-like psychoses of
epilepsy. Br J Psychiatry 109: 95–150
Szasz TS (1974) The Second Sin. Doubleday, Garden City
Tallis R (2011) The Aping of Mankind: Neuromania, Darwinitis and
the Misrepresentation of Humanity. Acumen
Temkin O (1971) The Falling Sickness: A History of Epilepsy from
the Greeks to the Beginnings of Modern Neurology. (2nd edn).
Johns Hopkins University Press, Baltimore
Trimble M (1991) The Psychoses of Epilepsy. Raven, New York
Trimble M, Freeman A (2006) An investigation of religiosity and
the Gastaut-Geschwind syndrome in patients with temporal lobe
epilepsy. Epilepsy Behav 9(3): 407–14
Tucker DM, Novelly RA, Walker PJ (1987) Hyperreligiosity in
temporal lobe epilepsy: redening the relationship. J Nerv
Mental Dis 175(3): 181–4
Walach H (2007) Mind-body-spirituality. Mind Matter 5(2): 215–40
Waxman SG, Geschwind N (1975) The interictal behavior syndrome
of temporal lobe epilepsy. Arch Gen Psychiatry 32(12): 1580–6
Woodward S (2011) Technological advances: a help or a hindrance.
Br J Neurosci Nurs 7(3): 519
Wuerfel J, Krishnamoorthy E, Brown R et al (2004) Religiosity is
associated with hippocampal but not amygdala volumes in
patients with refractory epilepsy. J Neurol Neurosurg Psychiatry
75(4): 640–2