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The Stranger In The Mirror

Mad Tales looks at the way Hindi cinema has portrayed human emotions, madness in particular, down the decades and what these caricatures tell us about ourselves as a society.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly.

Mad tales from Bollywood, Professor Dinesh Bhugra, Maudsley Monographs number Forty-eight, Psychology Press, U.K.Art is often viewed as a caricature of society — an exaggerated portrayal of the life and times it evolves in. In no art form perhaps is this a greater truism than the world of cinema. Human emotion takes the centre-stage in most cinematic endeavour: from romance to war, epics, social drama and magical realism. Indeed, even the most Kafkaesque (or for that matter, Tarantinoesque) contribution, is fashioned around bedrock of human emotion.

Mad Tales from Bollywood (2006: Psychological Press, Hove, U.K.) is a unique effort by a London based academic psychiatrist of Indian origin, Professor Dinesh Bhugra. In this work he analyses from a cultural viewpoint the portrayal of human emotions and mental illness in Indian Cinema.

The book begins on a technical note, defining and introducing some basic terms and concepts. One of these, “The Other”, an individual who stands for something quite opposite to what we stand for, is of interest from the perspective of how mental illness and villainy are portrayed. How this other gets defined, vilified, criticised, made fun of, or rejected outright is crucial, as mental illness may be then viewed as a visitation, mitigating one’s responsibility for it and engendering greater acceptance of the sufferer.

The author explores the socio-cultural underpinnings of Indian cinema, paying attention to the extended family in Indian society with its attendant religious undertones. The use of song and dance in Indian movies, to convey emotions of love, passion, anger and hatred, with the protagonists often being far apart from one another, is dealt with in some detail. The roles of gender, social and class factors, besides that of patriarchal hierarchy, dictate how songs are used in Indian society. The new boldness that has swept Indian cinema halls, particularly in how sexual emotions are dealt with, is discussed here.

While in the yesteryears the coming together of flowers or butterflies would convey erotica, or indeed, such portrayal will be relegated to the vamp or coquettish mistress, there is today a sexual brazenness sweeping Indian cinema, reflecting the changing sexual mores of Indian society. The fact that the character played by Amitabh Bachchan in “Hum” could sing, “Jumma, chumma de de (kiss me…)” and the heroine in “Khalnayak” asked, “What is under your blouse?” reflects the social shift towards a more open acknowledgement of sexual desire and erotic thoughts.

Changing Landscape: The author traces the history of Indian cinema against the background of the changing political, economic, cultural and social landscape of the country, the hero being the focus of this exploration. In the 1950s and 1960s, several Muslim socials (as films with Muslim stories and characters were often called) of the time represented the zenith of that culture in Indian cinema. After the initial shock of the Partition, these films were placed very much in the Islamic context, and they exploited the culture of a bygone and much-mourned era. There was also a post-independence idealism that marked this period, many films with patriotic fervour being released at that time. The 1960s, widely regarded as the golden era, was characterised by a certain romanticism, with family and social melodramas, excellent lyrics and good songs that had wholesome family appeal. The hero was our aspirational ideal: good looking, vibrant and romantic. In the 1970s, the euphoria of independence had disappeared. The protagonist is shown as a marginalised individual whom the audience can identify with. He is much wronged and exploited, and has suffered physically, emotionally and psychologically. He does what we would like to do, but are prevented from doing because of social mores and our own private morals. Interestingly, this change coincided with the imposition of the “Emergency” in India and the widespread social disaffection this provoked in Indian society. This theme continued well into the next decade, with the portrayal becoming more prominent, aggressive and violent.

The dominance of the angry young man continued in the 1990s. However, his anger was no longer directed against society. Instead, it became a symbol of love. The roles of Shah Rukh Khan as the love-obsessed stalker in films like “Deewana”, “Darr”, “Baazigar” and “Anjaam” heralded the arrival of a psychopath who feels no remorse or guilt. Another theme that emerged in this period, which has continued in this millennium, is a new idealism involving young people with high aspirations and dreams, either in urban India, or often living abroad, but culturally conscious of their “Indian-ness”. This evolution, which coincided with economic liberalisation and globalisation, appeals both to the younger audience of Indians and to the Indian Diaspora. Family dramas and romance have made their reappearance reflecting also an interesting coexistence of tradition and modernity. Interestingly, the psychopath who engages in mindless violence (“Abhay” in Hindi, “Alavandan” in Tamil); the person with an explosive impulsive personality (Shah Rukh Khan in many films); the multiple personality disorder sufferer (“Manichitratazhe” in Malayalam; “Chandramukhi” in Tamil); all continue to engage our cinematic cultural consciousness, as do themes of marital jealousy and infidelity (“Astitva”), unusual relationships that transgress social class and mores (“Chandni Bar”, “Ek Chalis ki Local”); differences in age (“Jogger’s Park”, “Nishabdh”, “Cheeni Kum”) and other conventional barriers. Indeed, it could be said that Indian cinema has demonstrated the maturity to explore many an unconventional emotive theme, while continuing to remain curiously infantile in Toto, largely reflecting a male dominated parochial society.

Appalling Portrayal: The portrayal of madness in Indian cinema is appalling. Those with mental illness are clowns, feeble and weak. Those treating them are caricatures, all in white coats and, absurdly enough, they get the hero to face the truth by setting up situations, as a detective might. Prof. Bhugra reviews several Indian (mainly Hindi) movies to make this point. As in “Khamoshi”, the senior psychiatrist chairs a meeting with at least 10 other psychiatrists to decide whether the protagonist is insane or not. They take turns in asking questions to assess his mental state; with one psychiatrist (unusually) instructing him to keep his answers short and to the point. The interview is more like an inquisition with rapid fire questioning.

Illogical and unrealistic portrayals of mental illness in Indian cinema are highlighted here. The heroine, usually a nurse or, more recently, doctor, makes it her life’s mission to “cure” the mentally ill protagonist, often going far beyond the call of her profession; more alarmingly, often breaching clinical ethics by falling in love; the submission of the heroine to many a risky assignation in order to diagnose or identify the cause of the protagonists madness; the explosive climax which puts all including the protagonist at risk of losing life, limb and sanity; the ward filled with several mentally ill people, most engaged in some ridiculous form of repetitive activity (running around, body rocking, asking the same comical question repeatedly, staring into space) all of which reduce mental illness to a caricature; the delivery of treatment in a most unethical, unacceptable and unrealistic manner etc. without discussion or consent, etc. The common thread that binds these cinematic situations together is that they are designed to shock the viewer and dissociate him from mental illness, making the mentally ill person the classic “other”. Indeed, Western films too share the tendency to portray mental illness and its treatment unrealistically, resulting in worldwide misconceptions about the role of the psychiatrist and psychiatric treatments. Electroconvulsive Therapy (ECT) or shock treatment as it is popularly referred to, has suffered and been demonised in particular due to its unrealistic portrayal in cinema. People are often given ECTs when fully conscious and sitting up, a most unusual practice, not in the armamentarium of any right thinking psychiatrist.

Curiously, however, there is also a humanism that is often conveyed through this bizarre portrayal. The nurse is often portrayed as having genuine empathy for her patients while remaining fiercely loyal towards the doctor, resulting in an emotional conflict (for her). The patients appear to form a closer network and, to their minds, “the other” is obviously the hierarchy and the establishment.The chronological approach adopted in this book enables the reader to study the evolution of Indian cinema over time, to comprehend the change in perception and portrayal of various subjects including mental illness over the decades and how the changes in politics, economics, culture and society affect changes in cinema, ensuring that he leaves no ambiguity in conveying his findings.

The films that Dr. Bhugra has made references to are popular, decade-specific contributions that attracted large audiences in their respective times, were influenced by the social climate of the country, and in turn influenced society as well. The cumulative effect of viewing film after film is the creation of a mental warehouse full of internal stereotypes stored in the preconscious and unconscious memory banks. He calls for more studies on the influence of external factors on the way films are conceived and made, so that a more accurate picture of mental illness can be projected by cinema, which is a rather powerful medium influencing public opinion.

Deceptive Title: The title of the book and of its many constituent chapters is deceptively light hearted and in some ways does not do justice to it. This book is a comprehensive and scholarly analysis of the gamut of philosophical, psychological, social and cultural issues associated with human emotion (including mental illness) in Indian cinema, dealt with in a serious, theoretical manner. The book does largely limit itself to Hindi cinema save a few references to regional contributions. The author draws on a vast theoretical and academic base to convey his point authentically. The wide array of references ensure that the book is a storehouse of information not only for cinema buffs and mental health professionals, but also students across the spectrum of humanities.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly. With the great mass of Indian cinema audiences being highly vulnerable to the influences of this medium, accurate and responsible attempts at portraying human emotion and mental illness are necessary, as also avoiding portrayals that trivialise and dehumanise important disorders of the mind. However, as the author has pointed out rather eloquently, the trivialisation of madness in India cinema may in itself be a reflection of the liberal, forgiving and largely tolerant society that we are!

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Inspirational Genius

When we refer to our minds, we often touch our hearts, or our heads. Yet, the mind as a physical entity, one that can be localised in a scan for example, does not reside anywhere in the human body. Our feelings, thoughts and emotions do — they are represented in our brains. To try and unravel this conundrum, let us take a computer analogy. When we consider cognition and behaviour, our brain is the hardware, the equipment and processes that make computers work. On the other hand, the mind is an operating system that draws upon the hardware but does not have significant physical representation, much like the software in our computers. The mind, therefore, is a virtual entity, one that reflects the workings of the neural networks, chemical and hormonal systems in our brain.

Having accepted that the brain and the mind are a unitary organ with diverse functions, it becomes imperative that we consider the “soul”, traditionally an esoteric and controversial concept. A noun variously defined as “psyche, inspiration and energy”, the soul has many synonyms in the English language. Where the soul resides is, however, a matter of conjecture; a question that is both difficult to answer and difficult to objectively experiment on. However, if one were to consider “the soul” as the vital force that inspires, energises and stimulates us, then it may be possible to study its manifestations and effects in all human activity having those qualities.

The possibility that one could study the soul by associating inspirational human experience, religion, music, poetry and literature, with the brain, is tantalising to say the least. In his book The Soul in the Brain, Michael R. Trimble, Emeritus Professor of Behavioural Neurology at University College of London, expounds the neurological correlates of such inspirational human experiences that were once considered to be the exclusive purview of the heart. Trimble commences his book with the words, “If you fear that opening your mind will cause your brain to fall out, then this book is not for you. If you are unhappy discussing neuroscience in the context of poetry, music and, above all, religion, then again this text cannot be recommended.”

Basis of Emotions: Trimble begins by exploring the brain anatomy of human emotion, implicating the Limbic System as the seat of human emotion. Seated deep within the brain and consisting of a network of critical structures, the Limbic System is the oldest part of the mammalian brain. There is considerable data today from brain imaging studies to show that this part is closely associated with emotional disorders. For example, the Amygdala, a multinucleated structure intricately connected with many brain parts, has been shown to both vary in size and to have different levels of neurochemical activity in various emotional disorders. The Amygdala is today the focus of much of the brain research that is concerned with human emotion and emotional disorders. Expounding on the neurobiology of emotion beyond these structures, Trimble discusses their links with other critical brain areas. He quotes extensively from the work of 20th century experts who have contributed to our understanding of emotional brain function, exploring brain anatomy beyond limbic structures that has a role in human emotion.

Poetry and literature are areas that Trimble explores at some length in this book. He describes how the use of the language of poetry and metaphor produces heightened activity of the right hemisphere of the brain. Pointing out that certain neuropsychiatric conditions have strong associations with specific creative pursuits, he draws attention to the links between literary creativity and Bipolar Affective Disorder (Manic Depressive Illness), an association strangely not witnessed with another major mental illness, Schizophrenia. He quotes extensively from the works of several poets with Bipolar Affective Disorder such as William Cowper (1731-1800), Robert Lowell (1917- 1977) and Anne Sexton (1928-74). For example, Anne Sexton, who frequently took drug overdoses and finally committed suicide, wrote:

Anne Sexton

Sleepmonger,
deathmonger,
with capsules in my palms each night,
eight at a time from sweet pharmaceutical bottles
I make arrangements for a pint-sized journey.
I’m the queen of this condition.
I’m an expert on making the trip
and now they say I’m an addict.
Now they ask why.
WHY!
Don’t they know that I promised to die!
…
Yes
I try
to kill myself in small amounts,
an innocuous occupation.

One cannot help but draw a parallel with the famous Tamil poet of the Indian independence movement, Subramanya Bharathi, who was renowned for his extraordinary creativity, intermingled with profound emotionality supplemented by generous doses of nationalistic and religious fervour (see box). Indeed, the creative human brain has perhaps an excessive proclivity for emotionality; quite understandably, given that creativity is often inspired; and inspiration in all forms requires feeling!

Another Meeting Ground: Religion is another area that exemplifies this meeting of the “trinity”. Most dictionaries describe religion as “a way of life”; religious beliefs, practices and experiences have a strong cultural basis in their evolution. It seems inconceivable therefore that religious experience may have its basis in the brain. However, why are some people more intense in their practice of religion, while others are considerably less enthusiastic; or why do one’s religious attitudes, beliefs and practices change during one’s life span? Can this be explained by sociocultural factors alone, or are there more inherent biological determinants of these behaviours? For example, there are considerable differences in how siblings experience and practise religion even though their sociocultural ethos are similar, and we witness the entire spectrum from intense religiosity to strong agnostic tendency within a family.

Further, religiosity is an important component of many brain and mind disorders. The depressed, anxious or avoidant individual is almost desperate in his pleas for religious salvation, rather different from the intense ritualism of the person with Obsessive Compulsive Disorder.

The religious ecstasy of the person with mania is qualitatively different from the prophetic fervour of the person with paranoid schizophrenia or temporal lobe epilepsy. The hyper-religious individual with temporal lobe epilepsy has on occasion been described as a dramatic persona complete with religious symbols and a prophetic fervour, with an unshakeable belief that his existence had a special purpose for the world we live in. In his chapters on “Neurotheology”, Trimble also quotes patients with epilepsy, dementia and head injury who have religious experiences. The triad of hyper-graphia (the keeping of copious and detailed notes and diaries), hyper-religiosity ( an increased interest and practise of religious matters) and hypo-sexuality (a diminished interest in matters sexual) is well described in the syndrome of temporal lobe epilepsy; especially in long standing and poorly controlled patients with recurrent temporal lobe epileptic seizures. It is accompanied by an obsessional and viscous personality. Trimble points out that while the note taking and diary keeping is copious, it lacks, unlike the poetry of the person with bipolar disorder, creativity and appeal. This fundamental difference may reflect the different brain substrates that underlie these conditions.

“The content of the writing from hypergraphic patients with epilepsy often reflects religious or mystical themes.” (Roberts, Robertson, and Trimble, 1982.)In his chapter on “Music and the brain” Trimble brings out the emotional nature of musical language.

‘Plato considers that music played in different modes arouses different emotions… Major chords are cheerful, minor ones sad; the ups and downs of life…”

While music and the brain is a topic that has been covered widely elsewhere, the uniqueness of Trimble’s contribution is in developing the links between the brain, mind and music. Pointing out that music and poetry have the unique ability to bring one to tears, often as part of a state of ecstasy, he goes on to explore the brain processes that may mediate emotional crying, which he points out as being a uniquely human experience. Why are we, the human race, so moved by art, poetry and music that we are reduced to tears, not those of sorrow, but of elation and ecstasy? In Indian lore, musical saints and savants are often described to reach states of ecstasy in the development or indeed deliverance of their favourite compositions, usually in praise of their favourite lord. The great composer Thyagaraja attained this state in the worship of Lord Rama; Purandaradas in the worship of Vitobha; Bharathi in the worship of his favourite Parasakthi; the list is indeed long. What brain and mind processes lead to these states of intense devotion and creative focus, combined with religious fervour?

The Creative Half: Trimble in his book quotes many studies that implicate right hemisphere activity in musical perception. It is widely understood that the right hemisphere is the “creative half” of the human brain. Interestingly, the right hemisphere also happens to be the emotional hemisphere. That right hemisphere dominant individuals are both creative and emotional may explain why those engaged in artistic pursuits express both qualities in ample measure. There is an impression among clinicians that Bipolar Affective Disorder (Manic Depressive Illness) is for example over represented in the creative professions; the biological basis for this may well rest in the right brain. Trimble himself has pointed out that the relationship between the brain and aesthetic experiences, rather than being the rule, may indeed be exceptional: “… not all patients with bipolar disorder become poets, of course nor are all poets manic-depressive” (p. 106). Further, it may be erroneous to conclude that these experiences belong to the brain alone. The mind, while an abstract construct in this the 21st century, remains an important part of clinical and scientific lore. The contributions of the mind to poetry, music, art and religion cannot therefore be ignored. Trimble’s work is commendable as a rare attempt to relate the highly technical specialty of neuroscience with something as abstract as art and in doing so fills an important void in scientific and popular literature.“The neuroscientific community has generally shown little interest in exploring the finer aspects of human behaviour and thought, especially aesthetic experience and creativity.”

Tangible Markers: Intellectual debate about where the soul resides is likely to continue for eons. Through this important work we understand emotional experience and creative pursuits are vicarious markers of the human soul. We may then develop a persuasive argument that a critical mass of brain structures and their connections are associated closely with these vicarious markers of the soul. While this does not prove that these critical brain structures are where the soul does indeed reside; not even that the vicarious markers are a true soul representation; it is an important scientific link between profoundly moving human experience and the brain. One could still argue that the soul does not necessarily reside in the human brain and that we do not have adequate “proof of this concept”. Which does of course leave us asking, “Pray, just where doth the soul reside”?

Everyday Relevance: What is the relevance of “Trinity Talking” concept to our lives, you may well ask. All of us come across people in society who excel in their creativity. Obviously these individuals have inspirational periods when their mind, brain and soul are in sync! The more productive the individual and the more evocative her/his productions, the more frequently is their “Trinity Talking” may well be one explanation. Indeed, going beyond the creative pursuits to other professions and trades, every one of us will possibly have at least one moment in our life, profession or vocations when we experience this spark of “enlightenment”, however brief. In these periods there is sudden clarity that often follows a period of confusion and turmoil. In these periods we often make momentous decisions and take definitive actions that may have an impact on our whole life. In these periods we experience true “self actualisation”. One may contend that the more frequent and more sustained these experiences, and more willing the person to explore and follow up on them, the more successful and productive he is. Clearly these are precious moments when our thoughts, beliefs and emotions meet with.

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The Inside Man

Personality is a term with many varying connotations, depending on the context of usage. It is a term that may be used to denote a celebrity (a public personality of figure), one’s character and temperament, or the way one comes across to others (he or she has a good personality). In medical and psychological parlance, however, personality is used to denote “those characteristics of a person that account for consistent patterns of feeling, thinking and behaving”; unique and enduring patterns of behavior and emotional response, which make us distinct individuals.

It seems rational to assume that one’s personality is a product of one’s upbringing and experience. We often cluck our tongues disapprovingly and say “Poor boy, with a disturbed background like that, how else would you expect him to behave” or indeed to warmly suggest, “One would expect no less from her; after all she comes from such a good family”. Psychological research seems to support these social assumptions that we regularly make. There is little doubt in the notion that our personalities are in good measure a product of our upbringing, the positive and negative experiences we have in our lives, the human interactions that influence us, and the patterns of emotional response we consequently develop.But is that all? Can every aspect of the human personality be explained on the basis of upbringing and experience? Do disturbed families yield disturbed children who may then grow up into disturbed adults only because of environment? Or are there genetic and other biological factors that influence these developments? Indeed, why do some people from very disturbed backgrounds remain stable and productive, while others from seemingly stable backgrounds display enduring disturbances in their ways of thinking, feeling and behaving? These are questions that continue to befuddle us.

Localising Mind and Brain Interactions: Given the mind does not exist as a physical entity and is widely regarded as the software (the Brain being the hardware), it seems self evident that disturbances in brain function would have an impact on our mind (and possibly vice-versa). Surely, any affectation of these brain systems is likely to have an influence on our personality? Surely, also, our personalities are likely to result from biological imprints in our brain, imprints that lead to the very consistent patterns of thinking, feeling, and behaving, making us the individuals we are?Perhaps the earliest attempt to link human temperament with the brain was “Phrenology”, the study of the human skull, its characteristics, and the correlation of these with various aspects of behavior, emotion and temperament. From this time emerged also what has become an enduring tradition in clinical neurology practice; repetitive and careful observation and documentation of patients: the symptoms they described, and the signs that were manifest during the clinical examination, an approach that yielded excellent descriptions of emotions, behavior and temperament in brain disorders. Correlating these with studies of brain biology using brain scans, genetic, chemical and hormonal studies etc., and autopsy data, has improved our understanding of mind-brain interactions. The personality in neurological disorders such as epilepsy is now relatively well documented, and we are able to build models linking different brain structures with typical behavioral patterns that are observed in these disorders.

A Tale of Two Personalities: While there are several striking descriptions in the literature of personality changes associated with brain disease, the illness in which classic personality features are well described is epilepsy, providing a template to understand the neurological contributions to human personality. Epilepsy is a paroxysmal disorder that often begins in childhood or adolescence, and may continue throughout a person’s life. Epilepsy is characterised by recurrent seizures or fits, usually involving loss of consciousness, fall, jerking of the limbs, clenching of the jaws, injury (often tongue bite), and incontinence (involuntarily urination and/or defecation). Epilepsy may, however, also manifest in partial or minor forms as involuntary movements or repetitive behaviors of which the person is unaware or partially aware. The illness which begins as short circuit in normal brain activity is commonly characterised as primary or secondary generalised: primary generalised epilepsy arises from a central pacemaker in the brain and secondary generalised from a distinct part of the brain (usually a lesion or scar) later spreading to involve other parts (generalising). Distinct personality types are described in the two different forms of epilepsy: the obsessive-emotive personality of temporal lobe epilepsy and the labile-disinhibited personality of juvenile myoclonic epilepsy.

The Obsessive Neurotic: One of the most striking descriptions of personality in neurology is in patients with epilepsy that arises from the temporal lobes. The temporal lobes are located on either side of the brain, roughly in the area beneath the ears and are the seat of human memory and emotion. It has been shown in a number of studies that disturbances in this region can result in striking behavioral or cognitive (memory, attention etc.) change.An American neurologist, Normal Geschwind, widely regarded as the father of behavioral neurology, described specific personality features in people with temporal lobe epilepsy. These include:

  • A tendency to write copiously (but not necessarily in a creative way) and to keep voluminous diaries (Hypergraphia)
  • A tendency to be overly religious, often in a ritualistic manner, out of keeping with the person’s family/ cultural background (Hyper-religiosity)
  • A tendency to have a decreased interest in sexual matters (Hypo-sexuality)
  • A tendency for anxiety and obsessionality; to dwell on minor matters and to experience difficulty in terminating social intercourse (emotional viscosity or stickiness)
  • An increased interest in spiritual or ideational issues in the absence of pragmatic interests
  • Turbulent emotions — irritability, agitation, anxiety, restlessness, paranoia etc.
  • Mood swings, commonly spells of depression with occasional elation
  • Psychotic and quasi-psychotic phenomena; transient hallucinations, delusional thinking etc. occurring on and off

These personality traits have been described mainly in people with chronic temporal lobe epilepsy that failed to respond to anti-epileptic drug therapy. We must remember the vast majority of people with temporal lobe epilepsy are honest, conscientious, sincere and upright members of the community they live in, these positive qualities being aided perhaps by the personality traits described. Only in a small proportion of people, usually those with severe epilepsy, do these traits become severe and/or disabling. In some way therefore, these are probably the behavioral manifestations of the pathology in the brain that most often underlies temporal lobe epilepsy, sclerosis of a part of the temporal lobe called the hippocampus. The hippocampus is a small organ, no larger than a finger joint, which is the storehouse of memory and is located on either side, deep within the brain. Adjacent to it is the amygdala, a multinucleated structure that is believed to play a substantive role in human emotion. There is evolving literature that suggests a role for these structures in various disorders of the mind, schizophrenia and depression for example. One may argue that both behavioural and brain dysfunction are varying manifestations of a common underlying abnormality in brain biology. In disorders like temporal lobe epilepsy the patterns appear to be surfacing early providing the basis for enduring behaviour patterns i.e. the personality.

The Eternal Adolescent: In contrast to the person with Temporal Lobe Epilepsy, the person with Juvenile Myoclonic Epilepsy (JME) has been described as the eternal adolescent by Dieter Janz, the legendary German neurologist who first described the condition in the 1950s. Juvenile Myoclonic Epilepsy is characterised by myoclonic jerks; sudden jerky spasms of the limbs, even the whole body, which might even result in objects flying out of the person’s hand. These myoclonic jerks also have potential to generalise and manifest as a full blown seizure. Further, people with JME also suffer from “absence” periods, when they appear out of touch, albeit briefly, and “photosensitivity”, the sensitivity to flashing lights, these provoking myoclonic jerks or even a seizure episode.Describing the personality of people with JME, Janz and Christian found them to be of average intellectual ability with a tendency to “promise more than they can deliver”. They went on to describe the personality of people with JME as follows. “They often appeared self assured and bragging, the girls and women coquettish, but they only act decidedly mistruthfully and are timid, frightened and inhibited. Their labile feelings of self worth lead them to be both eager to help, to invite, to give, on the one hand and to be able to act in an exaggeratedly sensitive way on the other hand. Their mood changes rapidly and frequently. This makes their contact both charming and difficult. They are easy to encourage and discourage, they are gullible and unreliable. Their suggestibility makes contacts easily but makes trust difficult. This personality profile plays along a scale from likeable nonchalance or timidity, through a psychasthenic syndrome to the extremes represented by sensitive or reckless psychopathy.”In the clinic setting, treating the person with JME can often be an exasperating experience. They seldom follow through on instructions; often break rules willfully; for example, despite knowing that lack of sleep may provoke seizures, they favour late nights. They may be irregular with their epilepsy medication to the point of recklessness. They may show disinhibition in their patterns of interaction, political correctness not being their strength. Indeed, the person with JME demonstrates many features of frontal lobe dysfunction, emphasising the importance of this part of the brain in social behavior.

From Brain Circuits to Personality Traits: This tale of two personalities in epilepsy indicates clearly the differential role of frontal and temporal brain circuits in human personality development and change. Temporal lobe dysfunction underlies dominant obsessional neurotic personality traits and frontal lobe dysfunction, immature eternal adolescence. To assume, however, a direct impact of these brain circuits on behavioral patterns may be simplistic, as today, the brain is conceived as working in circuits (a sum of parts). However, these observations help establish a general principle that the brain has considerable impact, not only on the behavioral state of a person (current or ongoing dysfunction), but also on behavioral traits (enduring temperamental patterns).What is striking about the personality features in epilepsy is that they become established rather early in the person’s life (much like the illness, which often begins in childhood or in adolescence), and are not only personality changes consequent to progressive brain disease or brain injury as in Stroke, Multiple Sclerosis and Parkinson’s disease. They do therefore reflect to a large extent, the natural history of personality development in the human being, and are probably a product of both brain biology and life experience.

The Inside Man!: In highlighting the epilepsy example, it must be borne in mind that the severe personality changes in epilepsy are an exception rather than the norm; and are confined to a small proportion of people with difficult-to-treat epilepsy. Importantly, however, the changes in epilepsy described herein help us understand the biological underpinnings of the human personality, clarifying for us a role for nature, beyond nurture.One wonders if all personality traits have their biological imprints in the brain; that dominant personality trait patterns in each one of us merely reflect the pre-dominance of brain circuits? One may argue that both the behavioral and brain dysfunction in epilepsy are varying manifestations of a common underlying abnormality in brain biology. If that were true, then pray what role doth life experience have in shaping our personalities, you may well ask. Would not a lifetime of coping with the trials and tribulations of illness have an impact on the personality? Would the disability, physical, psychosocial and pragmatic that chronic illness confers on a person, not influence the personality, towards neurotic obsessionality or carefree adolescence? And pray, what lessons do these models have for understanding the personality of people without neurological illness? A plethora of questions assails us and begs for answers; answers that current medical and scientific knowledge do not possess.As medical technology evolves and we begin to visualise brain circuits in action, using techniques like Functional MRI, MRI Tractography and Positron Emission Tomography (PET), we expect to see the links between brain biology and human behavior unravel further. Perhaps, in time, we will all understand this “inside man (or woman)”; the personality that resides in our brains. In the interim, conditions like epilepsy are windows through which we can view the brain and mind. And view the brain and mind we must with compassion and understanding; without stigmatisation; combining science with medicine; cleverness with common sense; knowledge of medicine and the art of clinical practice; all the while thanking people with epilepsy for enhancing our understanding of the brain and mind.

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The Almighty Within

Most dictionaries describe religion as “a way of life”. Religious beliefs, practices and experiences of individuals in our society, appear to have a strong cultural basis in their evolution and have been described as part of every ancient civilisation discovered and studied by modern man. On the face of it, therefore, it seems inconceivable that religious experiences may have biological basis in our brains.Several questions remain unanswered in our quest to understand how religious experiences occur.

Why are some people intense in their religious beliefs and practices and others considerably less enthusiastic? Or indeed, why do one’s religious attitudes, beliefs and practices change during a life span, progressing sometimes: from atheism to agnosia to intense religiosity (or indeed in the converse direction)? Can socio-cultural factors alone have such influence on our lives, or are there more inherent biological determinants of these experiences and behaviours? Empirical observation suggests that a simple sociocultural explanation may be inadequate. There are for example considerable differences in religious attitudes and practices between siblings born of the same set of parents. The socio-cultural ethos in this situation is a virtual constant. Yet variations in the quality, frequency and intensity of religious experiences are observed and it’s not uncommon to witness the entire spectrum, from intense religiosity to a strong atheistic tendency within the same family. While psychological experiences and social factors unique to each individual may have a significant role in determining these variations, they are often conjectures that arise from social and clinical observation.

Insights from NeuropsychiatryNeurology, psychiatry and their interface discipline neuropsychiatry provide many interesting models for the study of religiosity. Religious phenomena vary tremendously across brain and mind disorders. The religious ecstasy of the person in a bipolar mania is qualitatively different from the prophetic fervour of the person with paranoid schizophrenia. The depressed, anxious or avoidant individual is almost desperate in his pleas for religious salvation, rather different from the intense ritualism of the person with OCD or indeed the magical beliefs of the schizotypal individual.

There are also variations in quality and intensity of religious experience across psychiatric disorders; for example, the acute hyper-religiosity of mania is rather different from the grumbling, slowly evolving, almost prophet-like religious fervour of the person with a schizophrenia-like illness. Are these variations in phenomenology, quality and intensity of religious experience governed by psychological and socio-cultural determinants alone? Or indeed do different brain mechanisms have a role to play in determining these variations?Neurology too has its share of religiosity models. The Geschwind syndrome is a personality syndrome that has been described in people with poorly controlled temporal lobe epilepsy. While a well defined cluster of behavioural symptoms characterise this personality type (see “The Inside Man”, The Hindu Magazinedated November 29, 2009), intense hyper-religiosity with intensified preoccupations related to moral, philosophical, religious, or ethical themes are a core feature of this syndrome (see also box on Kumagusu Minakata). Bear and Fedio (1977) provided a biological explanation for this syndrome (the sensory-limbic hyperconnection” hypothesis). They proposed that ongoing electrical activity in the temporal lobe (in the person with temporal lobe epilepsy or TLE) resulted in all sensory experience (seeing, hearing, feeling, smelling, tasting etc.) being suffused with a strong emotional coloration. This resulted in relatively ordinary experiences being viewed with a certain emotional intensity by the person with TLE. Hyper-connection of critical brain structures for emotion, specifically the limbic system comprising the amygdala, hippocampus and other critical structures, was therefore thought to be the biological underpinning that determined hyper-religiosity and other personality features in TLE.

A God Module in the Brain?Perhaps the most dramatic recent description of hyper-religiosity in epilepsy is that of V.S. Ramachandran in his book “Phantoms in the Brain”. In a chapter provocatively titled “God and the Limbic System”, Ramachandran draws on his clinical experience to give the reader an evocative description of a hyper-religious patient with temporal lobe epilepsy. He describes the dramatis persona complete with religious symbols and a prophetic fervour, accompanied by a firm belief (in that individual) that his life had special meaning and his existence a special purpose for the world we live in. While Ramachandran’s subject had symptoms that were decidedly exaggerated (a caricature rather than the norm), hyper-religiosity in people with TLE evolves over time (a trait phenomenon), not just appearing suddenly (as in a state phenomenon).

Ramachandran poses the interesting question “is religiosity a pre-determined biological trait”; paraphrased, this could read “is there a god module in the human brain?” Research using MRI volumetry and functional MRI (fMRI) techniques have demonstrated rather interestingly, links between structures in the limbic brain, especially the hippocampus and religiosity. Indeed, one paper that I co-authored (Wuerfel et al, 2004) demonstrated links between a small right hippocampus and hyper-religiosity in epilepsy.

Unanswered QuestionsWhile putative associations between religious experiences and the limbic system have been demonstrated, a number of questions remain unanswered. First, what exactly is normal religiosity and what is hyper-religiosity? One suspects that this in itself is subject to transcultural influences. Western studies report about a third of people surveyed as being “religious” or “very religious”. We surveyed over 500 people using a suburban railway booking counter in Chennai and found almost 70 per cent of all individuals qualified as being “religious” or “very religious”. In the Indian social context, where religious expressions and beliefs are common place, the phenomenon of hyper-religiosity can be difficult to define.

For example, in our Chennai survey, when we described hyper-religiosity as being two standard deviations from the median score in our questionnaire, we found only a small proportion of people qualified. Social norms of “normal religiosity” will therefore have a significant impact on what we perceive in each culture as hyper-religiosity.Second, are religious experiences a trait or state phenomenon? It seems clear that religiosity can be both a state and trait phenomenon when observed across the spectrum of neuropsychiatric disorders. Contrary to popular perception, trait behaviours do not stop developing with the onset of adulthood and continue to evolve subtly over many years. It is conceivable that religiosity as a trait behaviour in people with neuropsychiatric disorders may exist from early on, but become very much more apparent during the course of the lifespan, periods of acute emotional distress being particularly prone for religious expression. On the other hand, hyper-religiosity may also be a pure state phenomenon, as observed in mania or acute psychotic episodes, with the person reverting to baseline levels of religious expression, post-episode. In a person without neuropsychiatric illness the religiosity trait may evolve over a lifespan, and depending on life experience may enhance or become muted.

Our religiosity may also periodically achieve enhancement during times of adversity, sorrow and grief or indeed euphoria; times when we instinctively reach out to powers beyond.Third, is religiosity a natural consequence of adversity rather than a pathological process? It seems entirely plausible, when viewed from a psychological perspective, that individuals meet adversity in their lives with an increase in religious interest and or experience. Indeed, society encourages and endorses such reactive religiosity and acute emotional breakdown states are often described as spiritual experience or transformation. The flight into hyper-religiosity in the context of a neuropsychiatric disorder may well be a helpful, socially endorsed coping mechanism; spiritual excess being better accepted in society than emotional distress. Why hyper-religiosity disappears in many disorders with the resolution of neuropsychiatric symptoms, and persists in others even after their resolution, does of course beg answers.Fourth, is hyper-religiosity a pathological phenomenon? With the finding of a small right hippocampus being associated with hyper-religiosity and other descriptions of altered limbic physiology in this state, it seems conceivable that biological influences may in some way affect the development or maintenance of hyper-religiosity. Is hyper-religiosity as behaviour pathological? To decide this, one would typically have to refer to the individual’s previous background (personal and socio-cultural) in the religiosity context. Religious behaviours especially those with sudden onset and not in keeping with the person’s background may well be, from a behavioural perspective, pathological.Finally, are the changes in limbic system structure and activity identified in brain imaging of hyper-religious individuals, a cause or consequence of this behavioural predilection? Changes in limbic system structure and function are thought to accompany the longitudinal course of many neuropsychiatric disorders: epilepsy, schizophrenia and depression to name a few conditions. Clarity about what precedes (structural change or behaviour) remains elusive and the changes observed in the brain may thus be both cause and consequence, the brain being a remarkably plastic organ.

Final analysis: So is there a god module in our brain? The evidence available seems to indicate that our emotional brain, the limbic system, the hippocampus in particular, perhaps more on the right side, plays a significant role in determining the nature and quality of one’s religious experience and expression. It is very likely, the rich neuro-chemical networks that populate this region, including dopamine and serotonin, have considerable influence on our religiosity, notwithstanding the alteration of brain structure, right hippocampal atrophy. Religiosity may thus be viewed as a trait, which can undergo both physiological and pathological evolution during the course of a person’s lifetime. The nature of the underlying biological framework in an individual is likely to determine the form, quantum and nature of religious experience and expression that psychosocial adversity and emotional illness provoke.

The bio-psychosocial model of mental health and illness dictates that both the physiological and pathological manifestations of this trait marker are likely to be influenced strongly by the sociocultural ethos of the individual, as well as his psychological evolution during the course of a lifespan.We must acknowledge here, the very significant role that religion and spirituality play, in helping human beings maintain optimal emotional well being or indeed achieve restoration of emotional health after a breakdown. One must also acknowledge our collective ignorance, as a society, about the biological, neuropsychiatric and psychological effects and virtues of theism, atheism and their many-splendored, much-debated, interface. Whether our religious predilections have a role in protecting and preserving or indeed enhancing our emotional state, remains thus, a matter of conjecture. The influence of this god module in our brain, “The Almighty Within”, is however probably omnipresent, just as our ancients conceived the almighty himself to be. Strange then, indeed, are his ways!

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The Godfather Paradox

Over four decades ago, Mario Puzo gave us, through his The Godfather, an insight into the mind of the socially enabled psychopath. Born in Corleone, a small village in Sicily, that troubled, deprived and violent part of Italy we have learnt to associate closely with the “mafia”, Vito Corleone earned his stripes as a young boy, learning to use the Sicilian gun “the Lupara” with finesse and precision. His flight from Sicily, early years in New York as a humble immigrant, barely managing to make ends meet, and struggling to provide for his young family during the great depression, and his eventual entry into the grey belly of the New York “underworld” after his shrewd murder of a local don, were brought to life most brilliantly by Puzo. Incredibly, the “Godfather” who emerged from these violent beginnings metamorphosed over time into “a reasonable man”, a fact the author takes pain to reiterate several times during the course of the complex tale.

The Mind of the Psychopath: Vito Corleone, the Godfather who emerged from these humble beginnings in Puzo’s novel and went on to occupy a pre-eminent position in the underworld, makes a fascinating case study, one of the finest descriptions of psychopathic personality in popular fiction. The prototypical psychopath has deficits or deviances in some core areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial (or socially deviant) behaviour, and do not experience shame, guilt, or remorse for their actions. A classic trait among psychopaths is the lack of a sense of guilt or remorse for any harm they may have caused others. Instead, the psychopath rationalises his behaviour, blames it on others, or denies it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath’s tendency for genuine emotion to be short lived and egocentric with an overall cold demeanour. Their behaviour is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, recognise the inherent risk of being caught, disbelieved or injured as a result of their behaviour.Emotionally, the fundamental traits underlying this personality are an inability to empathise with others, to feel their emotions, to share their love, joy, pain and sorrow in a deep way. Indeed, the emotions that this personality experiences are distinctly shallow and poorly sustained. It is not that the psychopath does not feel emotions; he feels them so fleetingly and his being carried away by them is so transient (albeit intense) that those feelings fail to have any impact on how he perceives and reacts to the emotions of others. In other words, his emotional experience probably has little impact on his emotional learning and development as a human being.

Research has shown that psychopaths have poor perception of the facial emotions others express, and experience difficulties in affect recognition (i.e. gauging the other person’s mood). They also seem to have difficulty in integrating contextual cues in their environment; their perception of an environmental cue is linked to how it relates to goal-relevant environmental information. Put simply, the psychopath fails to perceive environmental cues in the context they are and may thus react inappropriately.

As a consequence, psychopathic personalities may fail to perceive fear in the object of their aggression; fail to recognise his abject submission; and therefore perhaps, fail to tailor their aggression to that which will merely provoke a desired response. In the process, their aggressive reactions may be far in excess of that needed to achieve their ends.Psychopaths also often do not sense right and wrong in conventional ways accepted by society: in other words, they often choose to operate from their own reality framework and do not necessarily fit within the moral and legal framework that we accept as a society. From Al Pacino to Veerappan, Real life examples of “Godfathers”, like Veerappan, have been (with few exceptions) intensely proud men, who are not afraid to write their own rule books; judge right and wrong in their unique ways; seldom appearing to feel, certainly not expressing remorse for their actions, however impactful, including the ending of human life, both of perceived opponents and of their own kith and kin. For example, Puzo’s godfather, in mourning the violent death of his favourite older son, focuses more on his (son’s) inability to control his impulses rather than on his own contribution to the sadness that has visited his family. Curiously, the Godfather’s wife, a devout Christian, is described as fervently praying for his (the Godfather’s) soul and presumably its salvation.

A Reasonable Man: What is fascinating about Puzo’s Godfather is his quality of “reasonableness”, so important for a leader, yet so unusual for a psychopath. Indeed, Vito Corleone is almost statesmanlike in his responses. Highly moralistic in his personal values, he is portrayed as having very strong views about appropriate public behaviour, family honour and sexuality in particular, and is seen to frown on social inappropriateness of any kind. Indeed his second son’s fondness for company with the opposite sex becomes the major reason for the Godfather to summarily reject him, despite having lost his older son to the ravages of his profession. Particular about language and its usage, he reserves his strongest rebuke, “infamita”, to markedly inoffensive situations; even so, it conveys squarely to those around him his displeasure about a person, his statements or actions. That someone so moralistic does not see it amiss to eliminate a rival through murder in cold blood, or indeed coerce a recalcitrant and arrogant movie producer by decapitating his favourite, priceless race horse, leaving the (race horse’s) head in his bedroom for him to wake up beside, experiencing untold terror in the process, exemplifies for us the paradox the Godfather is. Strangely also, throughout the book, the Godfather stands out for his willingness to negotiate; “I will reason with them” is his favourite refrain when confronted with a difficult situation.

The Godfather ParadoxSo if Puzo’s Godfather is a psychopath, what manner of psychopathy does he represent? The primary quality of psychopathy that the Godfather possesses to a great extent appears to be the ability to be ruthless in achieving his own ends. A second psychopathic quality the Godfather exudes is a distorted reality of the impact of his actions; not quite consonant with traditional expectations or social beliefs, nor indeed particularly empathetic. A third, perhaps most striking psychopathic quality the Godfather possesses is his ability to manipulate people and situations rather skilfully. His dispensation of favours is usually with a caveat; that one day, at an appropriate time, the favours will have to be returned. Hesitation to accept or return the Godfather’s favour is viewed with open contempt, suspicion, even derision.

There are, however, several differences. Quite contrary to the typical psychopathic personality, the Godfather’s is a slow to warm, even phlegmatic, temperament, and he does not exude a superficial charm. Nor does he lose control over his emotions at any point in time, whatever the provocation; indeed, he regards the inability to control one’s emotions as being an “animal” quality, unbecoming of a sensible human being. His is also a remarkably sensitive personality; quick to take offence and very perceptive of the moods, emotions and reactions of those around him. His ability to perceive social and emotional cues is highly developed, quite unlike the conventional psychopath who appears oblivious to these. Finally, his almost statesman-like willingness to reason makes him stand out from the conventional image we have of the psychopath as a society. Puzo’s Godfather does, therefore, present us with a paradox; cruel psychopath to some, beloved friend and protector to others; a unique combination of sense and sensibility on the one hand, balanced against latent potential for ruthless violence. Does he then represent the socially enabled psychopath?

Are effective leaders socially enabled psychopaths?

While “goodness” and “greatness” within organisations is determined in large part by their in-built value systems, leaders often have potential to change value systems, goals, performance and outcomes both positively and negatively. In traditional professions and businesses, leadership is often either supervisory or strategic: the former focussing on getting the organisation (or a group within it) to perform effectively; the latter on managing change and uncertainty effectively, positioning the organisation for future growth. While many forms of leadership have been described, “inspirational leadership” has as its focus “the emotional connect” with people’s energies and goals, converting them into effective followers under all circumstances. This form is perhaps predominant in the leader who is a socially enabled psychopath.Effective leadership is often about helping people and organisations achieve the goals they have set for themselves. Engagement in such goal-oriented activity does call for a certain focus; where the goals set achieve primacy over other concerns, for example, those of the ethical or moral kind. In the competitive world of business, for example, the most effective leader is often perceived as the one who “delivers” whatever the means he employs. It is in this environment that the socially enabled psychopath with his unique perceptions of reality, willingness to shift societal norms and expectations to suit his agenda, and most importantly “willingness to reason with his fellow men” using a range of strategies from charming persuasion to latent threat, comes into his own. His “killer instinct”, lack of empathy and inability to experience and empathise excessively with the pathos of his fellow men consequent to his actions, serve him well here. His actions may hurt his fellow men, or be distasteful; but in the rough and tumble modern world we inhabit, the ability to achieve tangible and productive goals profitable to his organisation and to him, without twinges of conscience or feelings of regret, is often advantageous.

The modern-day CEO is, therefore, in many cases, a socially enabled psychopath, effective leaders in business, science, technology, medicine, politics, and religion all exemplifying this “Godfather Paradox”.To label all effective leaders as “socially enabled psychopaths” would clearly be uncharitable to society at large and too much of a generalisation. However, empirical observation does highlight the predominance of aforementioned qualities in various permutations and combinations, among leaders in society, which is curious, to say the least. One may even argue that a certain amount of “social psychopathy” is necessary in order for leaders to succeed, as excessive empathy towards different stakeholders, lack of a personal reality orientation, and inability to “reason” can in many situations be detrimental to the larger cause one represents. Perhaps modern society would eventually deem acceptable a breed of leaders with such “benevolent positive psychopathic traits” without an iota of physical or emotional violence in them. Perhaps, we will as a society, one day, celebrate rather than vilify, “the Godfather Paradox”. Perhaps!

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