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The Neural                                                 Substrates
                                                                             of Religious                                                Experience
                                                                             Jeffrey             L. Saver,                 M.D.
                                                                             John         Rabin,                M.D.




Religious          experience      is brain-based,         like all human    R        eligious              experience              is brain-based.                         This        should            be
                                                                                      taken        as an          unexceptional                    claim.           All human                   experi-
experience.     Clues to the neural substrates              of relig-
                                                                             ence     is brain-based,                             including                 scientific                  reasoning,
ious-numinous         experience       may be gleaned from
                                                                             mathematical          deduction,                           moral            judgment,                     and artistic
tern porolimbic     epilepsy,      near-death     experiences,               creation,           as well          as religious               states        of mind.              Determining
and hallucinogen         ingestion.      These brain disorders               the      neural           substrates                 of any           of      these            states         does        not
and conditions       may produce         depersonalization,                  automatically                     lessen           or demean        their                  spiritual               signifi-
derealization,     ecstasy,     a sense of timelessness         and          cance.1      The              external            reality  of religious                     percepts                 is nei-
                                                                             ther      confirmed                  nor         disconfirmed                  by       establishing                 brain
spaceless ness, and other experiences                   that foster
                                                                             correlates               of religious                experience.                     Indeed,              it has      been
religious-numinous             interpretation.         Religious
                                                                             argued            that        demonstrating                       the existence                       of a neural
delusions      are an important           subtype      of delusional         apparatus                sustaining         religious                experience                     can reinforce
experience       in schizophrenia,          and mood-congruent               belief because     it provides                            evidence     that                    a higher    power
religious     delusions      are a feature       of mania and                has so constructed        humans                             as to possess                      the capacity     to
depression.       The authors        suggest      a limbic marker            experience     the divine.2                             For the behavioral       neurologist
hypothesis      for religious-mystical             experience.      The      and neuropsychiatrist,                                the challenge     is to delineate                                   the
                                                                             distinctive          neural     substrates         of religious                                  experience              and
tern porolimbic       system      tags certain encounters             with
                                                                             their     alteration        in brain       disorders.
 external   or internal       stimuli    as depersonalized,      de-             Investigation            of the neural            ground                             of religious                expe-
 realized,   crucially     important,      harmonious,      and/or           rience          is hampered                  by the          absence             of a widely                  accepted
joyous,    prompting        comprehension        of these experi-            animal            correlate               that       would            allow            laboratory                  experi-
 ences within      a religious      framework.                               mentation.                Evidence                   with         neuroanatomic                             import              is
      (The   Journal    of Neuropsychiatry           and   Clinical          largely           derived       from                clinical         observations                         in patients
Neurosciences           1997;   9:498-510)                                   with        focal        brain           lesions,        especially                  epileptic              disorders,
                                                                             and      much            of this          is anecdotal.               We        will       review             data       that
                                                                             have     been    collected  on religious        experience           in normal
                                                                             individuals       and in different      neurologic          and neuropsy-
                                                                             chiatric    syndromes.     From    this scattered        literature,      a pre-


                                                                             From      UCLA-Reed                Neurologic          Research            Center,        710      Westwood            Plaza,
                                                                             Los    Angeles,          CA     90095.     Send      correspondence                   to Dr.      Saver     at the     above
                                                                             address.
                                                                                 Copyright            © 1997      American          Psychiatric           Press,       Inc.




498                                                                                                                     VOLUME              9 #{149}
                                                                                                                                                 NUMBER                 3 #{149}
                                                                                                                                                                             SUMMER                   1997
SAVER                   AND         RABIN


liminary            unifying                 model         of the          brain         basis       of religious                  that          perception                 of     the        divine           occurs           not           through              the
experience                 may        be constructed.                                                                              operation        of a distinctive      sensory      faculty,        but                                               through
                                                                                                                                   the     superimposition           upon     ordinary          sensations                                                     of        a
                                                                                                                                   unique               numinous-mystical                           feeling,       a feeling                          of direct
CIRCUMSCRIPTION                                       OF THE TOPIC                                                                 awareness                of a sacred                      or divine       presence.8’9                           Studies     of
                                                                                                                                   healthy              individuals                    and       neuropsychiatric                               populations
Most        religious             experience                 parallels          ordinary             experience.                   support                this         hypothesis                      and       suggest                  a distinctive
The       religious              sentiments               include           religious             joy,        religious            neurolimbic                      substrate.
love,       religious              fear,       and        religious             awe.         These            religious
emotions               are        analogues                of ordinary                   emotions                of joy,
love,       fear,          and        awe,        differing               not       in    their          emotional                 RELIGIOUS    EXPERIENCE                                               IN
tone,       but only    in being    directed                                 to a religious      object.                           NORMAL    INDIVIDUALS
Their       neural   substrate   is likely                                to contain     nothing     of a
specifically               religious            nature,          but      instead          to rest         upon            the     Surveys    suggest      that   religious-numinous                                                          experiences
same      limbic     and subcortical         networks       that                                  support     non-                 are common        in both    children       and adults,                                                  across     differ-
religious        joy, love, fear, and awe,            directed                                      by dorsolat-                   ent      historical              eras,        and       across        all cultures.                  #{176}‘    In national
eral and orbital          frontal    cortices      to religious                                      rather    than                surveys              in the        United             States,        Britain,           and          Australia,              20%
nonreligious                     targets.         The          neural           substrates               of     human              to 49%               of      individuals                   report            having             personally                  had
emotionality                   have    been     extensively        delineated.34                                                   numinous                    experiences,                    and           this figure              rises   to              more
  Similarly,                 religious      language        depends         upon                               the     cus-        than           60% when                   in-depth     interviews                          of randomly                            se-
tomary              dominant-hemisphere                                     perisylvian                   language                 lected           individuals                 are conducted.8                           Hardy     and his                        col-
cortices   for             its production,                      differing           only      in taking      sa-                   leagues8’6                 identified                 eight          major           types              of       numinous
cred rather                than   nonsacred                      topics          as linguistic       themes.                       experience                  in British              individuals,                   encompassing,                          in de-
Focal       left-hemisphere                          lesions        produce              aphasia              for relig-           scending      order      of frequency,                                    1) a patterning                     of events
ious     discourse       that                   parallels              aphasia     for            nonreligious                     in a person’s       life that convinces                                      him or her                   that in some
discourse,         as common                        clinical            experience                attests.     Pros-               strange    way they were            meant                                  to happen,                     2) an aware-
ody and             other      emotional        contributions         to discourse                                           of    ness       of the          presence             of God,             3) an awareness                            of receiving
the right            hemisphere           apply     to both    religious      and                                     non-         help   in answer    to a prayer,   4) an                                             awareness                        of being
religious              themes,          and     nondominant-hemisphere                                                             looked    after or guided   by a presence                                              not called                       God,   5)
lesions         have          been           reported            to produce                parallel             impair-            an awareness                       of being               in the      presence                of someone                    who
ments         of religious                   and nonreligious                       emotional        process-                      has died,   6) an awareness    of a sacred                                              presence    in nature,
ing.5       Similarly,                      scholastic/talmudic                            reasoning          is                   7) an awareness     of an evil presence,                                               and 8) experiencing
ordinary              reasoning               applied           to religious               problems                  and      is   in an extraordinary                             way         that      all things               are       “One.”            Stud-
undoubtedly                      mediated               by the           same       neural           networks                in    ies      in      identical               and          fraternal             twin        pairs              raised          apart
frontal   and parietal                         multimodal                  association                areas.                       suggest              that genetic    factors                         account       for 50% of interim-
   A first general                          observation,                 then,      is that            the neural                  dividual               variance   in religious                           interests     and attitudes.’7
substrate             for the preponderance                                  of religious      affect   and                        The        cross-cultural                      ubiquity      of numinous          experiences
cognition              is the whole     human                             brain,     employing        proc-                        and         the    heritability                    of religious      dispositions           argue
essing         that        is parallel,               distributed,                 affective,            and          sym-         strongly               for a biologic                       basis,       but    fail            to indicate     the
bolic,   with    contributions                              of large-scale                 neurocognitive                          specific             neural  mechanisms                               involved.                 Clues   to neural
networks      subspecialized                              for linguistic,                prosodic,      logical,                   substrate                 must       be gleaned                    from       the      sites          of brain            disor-
and       affective              processing.                                                                                       ders          that     provoke                qualitatively                  similar           experiences.
   What          might             be peculiarly                  distinctive                to religious                  ex-
perience          would              appear,            on first inspection,        to reside    not
in the         domains               of affect,           language,      or cognition,        but in                               EPILEPSY                    AND           RELIGIOUS                        EXPERIENCE
perception.                 It is the direct     sensory                        awareness       of God                       or
the divine                 that   is a quintessential                            mark     of specifically                          Humanity                    has      long           recognized                  a direct                link          between
religious          experience.        There   is, however,         no identifiable                                                 epilepsy      and the divine.      The early        Greeks      viewed    epi-
separate          organ       of religious     perception.           Accordingly,                                                  lepsy     as a “sacred   disease,”     a visitation        from     the gods,
sensory          apprehension           of the divine      is likely   to be medi-                                                 until    the notion    of divine     genesis       of seizures        was dis-
ated,    at least             in part, by the neural     systems      for ordinary                                                 pelled           by Hippocrates.18                          In the         Medieval                  and         early      Ren-
tactile,    visual,             auditory,  and olfactory       perception.        Wil-                                             aissance      periods,                    wide      currency                    was given                       the      biblical
liam       James           and       others           have       suggested,                and        we        concur,            view     that    epileptic                    seizures       are                manifestations                             of de-



JOURNAL               OF     NEUROPSYCHIATRY                                                                                                                                                                                                                       499
NEURAL                    SUBSTRATES                   OF       RELIGIOUS                   EXPERIENCE



monic            possession                  (Mark           9:14-29).’                  Esquirol2#{176} in             1838          arousal          with           set       cognitive                schemata.                    Epileptic               auras
and        Morel2’     in 1860 recognized                                  a heightened                     “religios-                themselves    are the most           convincing          evidence       of the
ity”       of epileptics,     which     they                              attributed                to     disability,                insufficiency   of attribution        theory,     instead      demonstrat-
social        isolation,              and greater      need                      for     religious            consola-                ing the existence        of distinct       physiologic          neural     sub-
tion.        The first              reported    conversion                             experience              directly               strates         for      several      specific                   emotional                       states.             Several
related              to     a seizure              was         noted            by      Howden,                    whose              “psychic”              auras,    including                      depersonalization,                                   dereali-
patient   experienced                           being  transported                         to Heaven     dur-                         zation,        dreamy                 states,          autoscopy,                  and         ecstasy,          are       par-
ing a fit. Spratlin3                           in 1904 reported                         a religious  aura in                          ticularly        likely          to engender                   religious                 interpretation                       and
52 of 1,325                patients          with        epilepsy               (4%).       In the         early        20th          experience,               and merit                 detailed         review.
century,              Turner24              and       others            suggested                that      epileptics                    Among              individuals                  with      partial      complex                       seizures,              the
develop    a distinctive          interictal          character,       among                                               the        frequency               of auras                ranges        from          23%          to 83%,             and         up      to
features  of which       is religious         fervor.      A substantial                                               num-           one-quarter              of auras                are     psychic          in content.2729                     The         most
ber of founders       of major         religions,         prophets,      and                                            lead-         common                psychic            or experiential                     ictal         manifestations                        of
ing religious                     figures         have      been   documented                              as having                  temporal     lobe epilepsy                            are fear, d#{233}j#{224}
                                                                                                                                                                                                             vu,jamais     vu, mem-
or suggested                      to have          epilepsy      (Table   1).                                                         ory recall,    and visual                          and auditory      hallucinations.
      Modern                investigations                   of     epilepsy-related                          religious                  Hughlings      Jackson                             was among       the first to identify
experience                   have been marked       by contradiction         and con-                                                 and       characterize                  less       common                 ictal      “intellectual                     auras”
flict. This               confusion   in part reflects    failure    to distinguish                                                   (“dreamy     states,” “cognitive     auras”)    in which    the expe-
among             epilepsy-related                          religious                experiences               of ictal,              rience   of the immediacy        and liveliness    of one’s    own or
subacute    postictal,                        and   chronic      interictal      occurrence.                                          external          reality              is altered.31               The            intellectual                 auras            in-
The phenomenology                               and neurobiology            of each differ                                     in     clude     depersonalization,             derealization,                                        and      double            con-
important    aspects.                                                                                                                 sciousness.            Depersonalization                                            auras             produce                an
                                                                                                                                      alteration    or loss of the sense     of one’s     own reality,  often
Ictal       Events                                                                                                                    accompanied        by a sense   of detachment         from others    and
Ictal       events              of any       type        may        be the             subject           of religious                 the environment,         and of acting     like an automaton.     Dere-
or cosmological                       explanation.                      Seizures             are paroxysmal,                          alization   auras    generate   an alteration      or loss of the sense
riveting,    and                  unexpected-sudden                                    intrusions      of unan-                       of the reality    of the external                              environment-for                                example,
ticipated                 and       often         extraordinary                      experience                into       the         the feeling    that the external                                surround       is just                      a dream-
ordinary              daily         flow     of consciousness.                          Patients           who          have          and   also are               often    associated                      with            a sense       of detach-
culturally                acquired            explanatory          systems    of a religious                                          ment.    Double               consciousness                         (“mental             diplopia”)        auras
character                 naturally           tend      to interpret       any ictal experi-                                          create      a simultaneous          experience                              of persisting        remnants
ence        as possessing                     religious            significance.                    Studies             have          of one’s         normal       consciousness                                 and      of a new         quasi-
demonstrated           that   experiences                                   that         are       personal,              im-         parasitical        consciousness          with                           a different      perception         of
portant,     negative,      and medical,                                    like        most         seizures,             are        reality.     Auras     of depersonalization,          derealization,                                                          and
particularly                    likely      to be interpreted                        in a religious                frame-             dreamy        state   account     for approximately          one-quarter                                                         of
work.25                                                                                                                               psychic      auras.32
    Some           psychologists           of religion      have                                   attempted             to               Well-documented             localizations       of spontaneous                                                            dis-
explain           religious      experience        by employing                                        classical       at-            charges         or electrical                   stimulations                 producing                     intellectual
tribution             theory.     Experiments          demonstrate                                        that     indi-              auras    are extremely      rare.                          Available                 evidence,     however,
viduals          not only interpret,          but also inwardly                                        experience,                    suggests     that mesolimbic                               structures,                  the hippocampus
the      same         physiologic                 stimuli         in strikingly                  different             ways           and       especially            the        amygdala,                 are      likely            the       critical        gen-
according                  to the cognitive        expectations         they                                  carry.         In       erators        of a feeling                of unreality                  about           the     self       or external
laboratory                   studies,   identical,        pharmacologically                                                in-        reality.33             The experience                         of unreality                      occurred               in 9%
duced           sympathetic                  arousals             are     variably             labeled           and      are         of patients             with  temporal                        lobe epilepsy                        in one              series,
experienced                   across      the spectrum                           of      valence,        from   re-                   often   accompanied                             by a sensation                    of fear.35 One                     patient
warding                   to distressful,      according                              to the individual’s                             in Penfield’s       series                        had a sense                     of “not    being                    in this
cognitive                 set at onset.26     Attribution                            theory       predicts    that                    world”        each    time    the first temporal            gyrus      was stimu-
religious             individuals              with epilepsy                     will      often          experience                  lated,     reflecting      either     direct     lateral     temporal       cortical
intrinsically               neutral           ictal physiologic                         events           as having                a   excitation        or rapid     spread     of afterdischarge           to mesolim-
religious-numinous                             character.                This         mechanism                may          in-       bic structures.                  One              patient           in     Gloor       and                 colleagues’
deed         mediate               some       ictal       religious              experiences.                                         more    recent              series37             repeatedly                experienced                       a faraway
   Human                experience,     however,                          is clearly             not      simply          the         feeling         during                 stimulation                   of      temporal                   mesolimbic
product               of an interaction          of                      nonspecific                    physiologic                   structures.



500                                                                                                                                                                             VOLUME               9 #{149}
                                                                                                                                                                                                          NUMBER                     3 #{149}
                                                                                                                                                                                                                                          SUMMER                 1997
SAVER           AND            RABIN



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JOURNAL           OF           NEUROPSYCHIATRY                                                                                                                                                                                                                                           501
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502                                                                                                                                                                                                                                      VOLUME   9 #{149}
                                                                                                                                                                                                                                                        NUMBER   3 #{149}
                                                                                                                                                                                                                                                                      SUMMER   1997
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)
The neural substrates of religious experience (saver & rabin 1997)

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The neural substrates of religious experience (saver & rabin 1997)

  • 1. The Neural Substrates of Religious Experience Jeffrey L. Saver, M.D. John Rabin, M.D. Religious experience is brain-based, like all human R eligious experience is brain-based. This should be taken as an unexceptional claim. All human experi- experience. Clues to the neural substrates of relig- ence is brain-based, including scientific reasoning, ious-numinous experience may be gleaned from mathematical deduction, moral judgment, and artistic tern porolimbic epilepsy, near-death experiences, creation, as well as religious states of mind. Determining and hallucinogen ingestion. These brain disorders the neural substrates of any of these states does not and conditions may produce depersonalization, automatically lessen or demean their spiritual signifi- derealization, ecstasy, a sense of timelessness and cance.1 The external reality of religious percepts is nei- ther confirmed nor disconfirmed by establishing brain spaceless ness, and other experiences that foster correlates of religious experience. Indeed, it has been religious-numinous interpretation. Religious argued that demonstrating the existence of a neural delusions are an important subtype of delusional apparatus sustaining religious experience can reinforce experience in schizophrenia, and mood-congruent belief because it provides evidence that a higher power religious delusions are a feature of mania and has so constructed humans as to possess the capacity to depression. The authors suggest a limbic marker experience the divine.2 For the behavioral neurologist hypothesis for religious-mystical experience. The and neuropsychiatrist, the challenge is to delineate the distinctive neural substrates of religious experience and tern porolimbic system tags certain encounters with their alteration in brain disorders. external or internal stimuli as depersonalized, de- Investigation of the neural ground of religious expe- realized, crucially important, harmonious, and/or rience is hampered by the absence of a widely accepted joyous, prompting comprehension of these experi- animal correlate that would allow laboratory experi- ences within a religious framework. mentation. Evidence with neuroanatomic import is (The Journal of Neuropsychiatry and Clinical largely derived from clinical observations in patients Neurosciences 1997; 9:498-510) with focal brain lesions, especially epileptic disorders, and much of this is anecdotal. We will review data that have been collected on religious experience in normal individuals and in different neurologic and neuropsy- chiatric syndromes. From this scattered literature, a pre- From UCLA-Reed Neurologic Research Center, 710 Westwood Plaza, Los Angeles, CA 90095. Send correspondence to Dr. Saver at the above address. Copyright © 1997 American Psychiatric Press, Inc. 498 VOLUME 9 #{149} NUMBER 3 #{149} SUMMER 1997
  • 2. SAVER AND RABIN liminary unifying model of the brain basis of religious that perception of the divine occurs not through the experience may be constructed. operation of a distinctive sensory faculty, but through the superimposition upon ordinary sensations of a unique numinous-mystical feeling, a feeling of direct CIRCUMSCRIPTION OF THE TOPIC awareness of a sacred or divine presence.8’9 Studies of healthy individuals and neuropsychiatric populations Most religious experience parallels ordinary experience. support this hypothesis and suggest a distinctive The religious sentiments include religious joy, religious neurolimbic substrate. love, religious fear, and religious awe. These religious emotions are analogues of ordinary emotions of joy, love, fear, and awe, differing not in their emotional RELIGIOUS EXPERIENCE IN tone, but only in being directed to a religious object. NORMAL INDIVIDUALS Their neural substrate is likely to contain nothing of a specifically religious nature, but instead to rest upon the Surveys suggest that religious-numinous experiences same limbic and subcortical networks that support non- are common in both children and adults, across differ- religious joy, love, fear, and awe, directed by dorsolat- ent historical eras, and across all cultures. #{176}‘ In national eral and orbital frontal cortices to religious rather than surveys in the United States, Britain, and Australia, 20% nonreligious targets. The neural substrates of human to 49% of individuals report having personally had emotionality have been extensively delineated.34 numinous experiences, and this figure rises to more Similarly, religious language depends upon the cus- than 60% when in-depth interviews of randomly se- tomary dominant-hemisphere perisylvian language lected individuals are conducted.8 Hardy and his col- cortices for its production, differing only in taking sa- leagues8’6 identified eight major types of numinous cred rather than nonsacred topics as linguistic themes. experience in British individuals, encompassing, in de- Focal left-hemisphere lesions produce aphasia for relig- scending order of frequency, 1) a patterning of events ious discourse that parallels aphasia for nonreligious in a person’s life that convinces him or her that in some discourse, as common clinical experience attests. Pros- strange way they were meant to happen, 2) an aware- ody and other emotional contributions to discourse of ness of the presence of God, 3) an awareness of receiving the right hemisphere apply to both religious and non- help in answer to a prayer, 4) an awareness of being religious themes, and nondominant-hemisphere looked after or guided by a presence not called God, 5) lesions have been reported to produce parallel impair- an awareness of being in the presence of someone who ments of religious and nonreligious emotional process- has died, 6) an awareness of a sacred presence in nature, ing.5 Similarly, scholastic/talmudic reasoning is 7) an awareness of an evil presence, and 8) experiencing ordinary reasoning applied to religious problems and is in an extraordinary way that all things are “One.” Stud- undoubtedly mediated by the same neural networks in ies in identical and fraternal twin pairs raised apart frontal and parietal multimodal association areas. suggest that genetic factors account for 50% of interim- A first general observation, then, is that the neural dividual variance in religious interests and attitudes.’7 substrate for the preponderance of religious affect and The cross-cultural ubiquity of numinous experiences cognition is the whole human brain, employing proc- and the heritability of religious dispositions argue essing that is parallel, distributed, affective, and sym- strongly for a biologic basis, but fail to indicate the bolic, with contributions of large-scale neurocognitive specific neural mechanisms involved. Clues to neural networks subspecialized for linguistic, prosodic, logical, substrate must be gleaned from the sites of brain disor- and affective processing. ders that provoke qualitatively similar experiences. What might be peculiarly distinctive to religious ex- perience would appear, on first inspection, to reside not in the domains of affect, language, or cognition, but in EPILEPSY AND RELIGIOUS EXPERIENCE perception. It is the direct sensory awareness of God or the divine that is a quintessential mark of specifically Humanity has long recognized a direct link between religious experience. There is, however, no identifiable epilepsy and the divine. The early Greeks viewed epi- separate organ of religious perception. Accordingly, lepsy as a “sacred disease,” a visitation from the gods, sensory apprehension of the divine is likely to be medi- until the notion of divine genesis of seizures was dis- ated, at least in part, by the neural systems for ordinary pelled by Hippocrates.18 In the Medieval and early Ren- tactile, visual, auditory, and olfactory perception. Wil- aissance periods, wide currency was given the biblical liam James and others have suggested, and we concur, view that epileptic seizures are manifestations of de- JOURNAL OF NEUROPSYCHIATRY 499
  • 3. NEURAL SUBSTRATES OF RELIGIOUS EXPERIENCE monic possession (Mark 9:14-29).’ Esquirol2#{176} in 1838 arousal with set cognitive schemata. Epileptic auras and Morel2’ in 1860 recognized a heightened “religios- themselves are the most convincing evidence of the ity” of epileptics, which they attributed to disability, insufficiency of attribution theory, instead demonstrat- social isolation, and greater need for religious consola- ing the existence of distinct physiologic neural sub- tion. The first reported conversion experience directly strates for several specific emotional states. Several related to a seizure was noted by Howden, whose “psychic” auras, including depersonalization, dereali- patient experienced being transported to Heaven dur- zation, dreamy states, autoscopy, and ecstasy, are par- ing a fit. Spratlin3 in 1904 reported a religious aura in ticularly likely to engender religious interpretation and 52 of 1,325 patients with epilepsy (4%). In the early 20th experience, and merit detailed review. century, Turner24 and others suggested that epileptics Among individuals with partial complex seizures, the develop a distinctive interictal character, among the frequency of auras ranges from 23% to 83%, and up to features of which is religious fervor. A substantial num- one-quarter of auras are psychic in content.2729 The most ber of founders of major religions, prophets, and lead- common psychic or experiential ictal manifestations of ing religious figures have been documented as having temporal lobe epilepsy are fear, d#{233}j#{224} vu,jamais vu, mem- or suggested to have epilepsy (Table 1). ory recall, and visual and auditory hallucinations. Modern investigations of epilepsy-related religious Hughlings Jackson was among the first to identify experience have been marked by contradiction and con- and characterize less common ictal “intellectual auras” flict. This confusion in part reflects failure to distinguish (“dreamy states,” “cognitive auras”) in which the expe- among epilepsy-related religious experiences of ictal, rience of the immediacy and liveliness of one’s own or subacute postictal, and chronic interictal occurrence. external reality is altered.31 The intellectual auras in- The phenomenology and neurobiology of each differ in clude depersonalization, derealization, and double con- important aspects. sciousness. Depersonalization auras produce an alteration or loss of the sense of one’s own reality, often Ictal Events accompanied by a sense of detachment from others and Ictal events of any type may be the subject of religious the environment, and of acting like an automaton. Dere- or cosmological explanation. Seizures are paroxysmal, alization auras generate an alteration or loss of the sense riveting, and unexpected-sudden intrusions of unan- of the reality of the external environment-for example, ticipated and often extraordinary experience into the the feeling that the external surround is just a dream- ordinary daily flow of consciousness. Patients who have and also are often associated with a sense of detach- culturally acquired explanatory systems of a religious ment. Double consciousness (“mental diplopia”) auras character naturally tend to interpret any ictal experi- create a simultaneous experience of persisting remnants ence as possessing religious significance. Studies have of one’s normal consciousness and of a new quasi- demonstrated that experiences that are personal, im- parasitical consciousness with a different perception of portant, negative, and medical, like most seizures, are reality. Auras of depersonalization, derealization, and particularly likely to be interpreted in a religious frame- dreamy state account for approximately one-quarter of work.25 psychic auras.32 Some psychologists of religion have attempted to Well-documented localizations of spontaneous dis- explain religious experience by employing classical at- charges or electrical stimulations producing intellectual tribution theory. Experiments demonstrate that indi- auras are extremely rare. Available evidence, however, viduals not only interpret, but also inwardly experience, suggests that mesolimbic structures, the hippocampus the same physiologic stimuli in strikingly different ways and especially the amygdala, are likely the critical gen- according to the cognitive expectations they carry. In erators of a feeling of unreality about the self or external laboratory studies, identical, pharmacologically in- reality.33 The experience of unreality occurred in 9% duced sympathetic arousals are variably labeled and are of patients with temporal lobe epilepsy in one series, experienced across the spectrum of valence, from re- often accompanied by a sensation of fear.35 One patient warding to distressful, according to the individual’s in Penfield’s series had a sense of “not being in this cognitive set at onset.26 Attribution theory predicts that world” each time the first temporal gyrus was stimu- religious individuals with epilepsy will often experience lated, reflecting either direct lateral temporal cortical intrinsically neutral ictal physiologic events as having a excitation or rapid spread of afterdischarge to mesolim- religious-numinous character. This mechanism may in- bic structures. One patient in Gloor and colleagues’ deed mediate some ictal religious experiences. more recent series37 repeatedly experienced a faraway Human experience, however, is clearly not simply the feeling during stimulation of temporal mesolimbic product of an interaction of nonspecific physiologic structures. 500 VOLUME 9 #{149} NUMBER 3 #{149} SUMMER 1997
  • 4. SAVER AND RABIN E ‘ -‘ 0 a .1 I) .. a .0._t >. 0 .-0- E e 0; . asa U’’0 aO. j.0’ U a Oa a5iI.. za Li 81 u . u’ uEa . 0. a - a - . 0. ‘B B B 81 ‘ ,j a..abc a 2 #{149}0a0 ‘‘ a 0a a . . U a :0 a a .0. #{149}E U 0.0 0 .0as a0.0 aO .0 a a u 0 0 LI.0. , LLI LI LI U LI. 1.1, ,., 0a a a“ a a s a . 0_ . . . . a a a a a so a i;’ U a . U.0 a a #{149} 8 #{149} 8 0 a .0 I.’ 0. -2 0 a.’ i.. i. a a a a a a a n. 2 0. 0. 0. 0. C -. x a . . U’8 0. 0 0 a.1 a a. a a< > a n. .0 , . .: 0. 2 a E 2 0 - B. 0 0. 0 0’ U W0. Li .2 u u u u LU a 81 0. + + + 01 + + + + + + + + 0. 01 #{149}0 c’. a a- a’ 4 .. a .-‘ 01 a I- :‘ a a 0’ a .C V 0 a aao o a a 0 C a 0 020 C 01 0 =-.0 F-0 a #{149}-a a C. 0 - a a a 5 a a- II. a U a) Ga 01 IL, .< LU U. a V . 81 E ..c,,,.a a .0 0 Oa a a a . . 081 a .0a8 a .‘.‘ 0 0 - .0 a U a tJ- 2a0 :0 01 aa :0 a 8 500 aO E0 a 0 a >s :00 C E.5 X 0 a 0 b00U= a 01 0 0 Oa:0aa.. .c 0 a a aU 01 0 ‘ a 0 81 abO0 aa . a.0 0. U .0 ..03 0a .0 a a 2_0m .0 . ‘a. . a aaa 0 a00a 0 .0 o. C 0.Q. 22 500 U aEij 2 2 .5a0 a ..‘,8J .0 0 0 :o0 U a a0CU a ‘C i0> ,j 0. > a 0.tj a a Li a - ,-a U o Un - c8L)0 a C so 01 a U00. .Oa:0,...E :- c a U LU 0. < , > - < > = a -. r’) 8 a Li j ‘C a’ 0 U 0 v-’ a .0 U . ._ 0 a .. a u a ‘ n.m ‘ ‘? E . aS ‘< “ a. ‘ 0 a . 0 c . . 5 < a 2 a 0. a 0 a . 0 a a 0 .E U- F-’-.’ .0 “U C U-’ a a.- a .- .- .- (I) #{163} c u < JOURNAL OF NEUROPSYCHIATRY 501
  • 5. NEURAL SUBSTRATES OF RELIGIOUS EXPERIENCE __7 . C -.n 0 ,0 a- U 0) V U aCa C 01 . .#{176}#{176}.‘ ‘ .. - ‘ nUa)a-0 a n.o C E aa a o a - C 0gb .00 01 a 0 a C .2 a U a 0 a 0 a.- N 0 . #{176} a- a- a a a a a a- a a 0 . . 0 . . .& . >.‘ 0) a,.. a a 0J aa... a a N a a.0 . a a- .E .9 a-a aa0 a- a a a aa0 a 0. na. 0. 0 a.0.’.’ 0. ,.. a 0. x xa xa x #{149} o a5n. a . n.ao) n. S 5#{176}Ea 5 E.’-. 0 U U 0.X U U.. U - .5. + + + : + + + + + + ga . + + a a a m .0 0) 0 a a 01 > 0 0 a a 81aa a a . N = ‘ om a81 .2 .0 C a 0.0’- 0.50 QJ ,-,a0 an 01 01 >0 0 .‘..‘=a a- 0 U001 01a) C. 010> 50 a - o P.00 2a a a U 1810 LU a U C 01 ‘-2. 0 ‘ E - oE” a 01 OE.0 ‘E C GaO :0a50 a- a U ‘a-.0 o ‘ . aU 0Jo a a -a . ‘aaa a- 01 0. > a Ca. a- Ca .-. a IC a) aai V.0 a01 .0.’.’ ba 0.0 C.a0G o. a _ ‘ 00 Ca-a O5 .5> - a C a)0 #{149}.0 C500. ._>.-C a .0”c n C a>5a 0 a- . 5050a0aCa aa 0 Ga- Ca a’- a-C aa ‘C 0. .0Ca 0UaC a 0 i2 a-aa a a> a)0 0 V a.0__ 0. o25a. 01 0 U 0 an Ox U cia 0. 0. cia 0. a .0 0 a.-., X 0.01 a C a .C-’ 1181 a a...., .0 ‘B 0 .C oo U oars C 0 a ,- -.‘ F- 0. LI. 502 VOLUME 9 #{149} NUMBER 3 #{149} SUMMER 1997