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Adolescents Adults Bipolar Disorder Children Elders Epilepsy & Seizures Expert Blogs Featured

The Curious Case of Vincent van Gogh

Vincent van Gogh is one among many famous personalities in history who have rightly or wrongly been credited with having suffered from epilepsy. It seems fairly clear that Vincent van Gogh did suffer from symptoms of brain and mind; seizures, hallucinations, mood swings and explosive impulsive behavior that have been variously attributed to bipolar disorder, Meniere’s disease and interestingly, personality features linked with epilepsy.

Van Gogh was not just a productive painter (over 2000 works in a relatively short lifetime); he was a very prolific letter writer. Indeed, in one very productive period in Arles (1888-1889) he is believed to have produced 200 paintings and 200 watercolors, a painting every 36 hours; he also managed to write to his brother Theo, an art dealer in Paris, and to fellow impressionists, 200 letters filling 1700 pages, the shortest six pages long.

van Gogh was probably hypergraphic, both in letter and painting, the latter having been described as a manifestation of hypergraphia by Michael Trimble, the eminent London-based Behavioral Neurologist. van Gogh had a history of seizures, probably even experiencing one while painting the portrait “Over the Ravine” revealed in the rough brush strokes and resulting in a torn canvas.

He also probably demonstrated other traits of the Geschwind Syndrome: intense mood swings, with irritability and anger; and a spectrum of sexual behavior (hyposexuality, hypersexuality, bisexuality and homosexuality). The last (among others) was with Paul Gauguin, in an intense argument with whom he experienced hallucinations (a voice that asked him to kill).

Provoked to be aggressive, he then experienced a biblical injunction “And if thine offend thee, pluck it out” and turned the razor, famously, on to his own ear (self portrait with a bandaged ear).

Indeed, his relationship with Gauguin was typically intense. van Gogh was observed by Gauguin to experience difficulty in terminating arguments and discussions (emotional stickiness). Another intense argument is thought to have resulted in van Gogh’s suicide: he threatened his physician with a pistol, was rebuffed, left the office, and shot himself in the chest.

He died two days later. It is noteworthy that van Gogh was the son of a preacher and started his life as one (probable hyper-religiosity). Indeed, it has been proposed by the neurologist and art scholar Prof. Khoshbin that van Gogh had all the five core traits of Geschwind Syndrome ( http://goo.gl/VyjxzK ). His extraordinary creativity and inspired genius makes his case all the more curious, indeed!

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Adolescents Adults Cerebral Musings Children Elders Expert Blogs

Why Humans Like to Cry? Tragedy, Evolution & The Brain

Professor Michael Trimble the renowned British Neuropsychiatrist begins this,  his second popular science work, by stating affirmatively that emotional crying is unique to the human species. He goes on to dismiss as myths reports about apes, elephants and dolphins being capable of crying for emotional reasons. Not only is emotional crying unique to us, says the good professor, we have through our tradition of “tragedies” converted it over centuries, into an fine art form.

Music, gave rise to the birth of tragedy, which according to Nietzsche contains a fusion of Apollonian beauty with Dionysian creative energy and art.

Many other philosophers have taken up this two god theme- Mann, Hesse & Ibsen to name a few. “Apollo is the cold hard separatism of Western personality and categorical thought. Dionysius, is energy, ecstasy, hysteria, promiscuity, emotionalism, heedless indiscriminateness of idea or practice….Complete harmony is impossible, our brains are split and the brain is split from body. The quarrel between Apollo and Dionysius is the quarrel between the cortex and the older reptilian limbic brain”.

And thus does Trimble set the stage for his dissertation. From why and how we humans cry, through the neuroanatomy of the limbic system and it’s association areas, its neurobiological links with the lacrimal gland which causes us to tear (both in joy and sorrow); through the power of aesthetics- art, poetry, literature, painting, archeology, but most of all and most significantly so, according to the author, music!

What follows is a smorgasbord of philosophical, neurobiological, cultural and literary information; pearls of wisdom in every page. The “cutaneous shiver” of William James, and Shelley’s verse on the power of music, all find a place in the author’s evocative descriptions.

“I pant for the music which is divine
My heart in its thirst is a dying flower;
Pour forth the sound like enchanted wine,
Loosen the notes in a silver shower;
Like a herb less plain for the gentle rain,
I gasp, I faint, till they wake again.”

Using the theory of mind as the centrepiece of his dissertation, the author delves into the role of altruism and empathy in the development of the human social brain, which a number of studies of emotional-facial recognition using MRI scans have pointed to. “The evolution of cognitive empathy with corresponding increase in the size of the human pre-frontal cortex, provides experimental and neuroanatomical evidence explaining, from a neurobiological perspective, the human ability to feel the sadness of others, and cry emotional tears”. From an anthropological perspective, he also links empathy and tears to an awareness of the self: which according to Clive Finlayson “produced an animal capable of locating itself in space and time, an animal that became aware of the consequences of its own behaviour and mortality”.

The importance of language and linguistic processing is well brought out in the book. “Linguistic representations can influence how emotional states are represented and thus experienced”. Trimble points to the right hemisphere of the brain, quoting Norman Cook “At every level of linguistic processing that has been investigated experimentally, the right hemisphere has been found to make characteristic contributions, from the processing of affective effects of intonation, through the appreciation of word connotations, the decoding of metaphors and figures of speech, to the understanding of the overall coherency of verbal humour, paragraphs and short stories”. Trimble also points to the amygdala as a central organ that modulates human emotion, alluding to the elegant work of Zeki and colleagues who have used functional imaging to extensively study emotion.

Of music, Trimble points to, apart from linguistic impact, the triadic quality of the tonal Western harmonic system, whereby the tonic pitch on which harmonies are built, by means of progression from chord to chord, using such musical techniques of composition such as repetition, modulation and transformation, move away from these centres only to return with harmonic resolution. Through this “acousamatic” quality, calm and tension are developed, discord requiring a return to concord, provoking restlessness, suspensions and anticipation all requiring resolution. At these moments of “chills” or “shivers down the spine”, scientists have described changes in brain imaging (MRI and PET) involving the amygdala, insula, cingulate, per-frontal cortex and limbic association areas. Further, music has been demonstrated to elicit autobiographical memories, thus underlining its power to influence human emotion.

The author concludes that “Tears are an accompaniment of tragedy as an art form, and they reflect the tears of everyday human tragedy, which is linked to loss and mourning. These feelings have arisen in the course of our long evolutionary history, notably with the rise of self-consciousness, the development of small communities, the growing potential of love and hence an even greater sense of loss”.  As Semir Zeki, Professor of Neuroesthetics, University College of London has elegantly put: “This book is not a page turner. It is much better than that, one that is full of insights and of material for reflection on almost every page”.

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Adolescents Children Expert Blogs Neurodevelopmental Disability (NDD)

Understanding Developmental Disability

Sad but true! One in five children, in a developing nation like India, emerge into this world with their innate human capital compromised. A range of neurodevelopmental disorders (NDD) are the outcome of such compromise: learning disability, childhood epilepsy, cerebral palsy, mental retardation, attention deficit and hyperactivity disorder, autistic spectrum disorder; conditions that strike early and leave lasting impact on the child. On the occasion of the International Day of People with Disabilities (3rd December) we delve further.

What is neurodevelopmental disability?

A range of conditions that follow abnormal brain development and impact on motor function (strength, dexterity, coordination); or cognitive function (intelligence, learning, aptitude); or emotions & behavior (temperament, mood swings, emotionality, aggression, hyperactive-impulsive behaviours, socialization issues etc.). In all these instances, there are demonstrable changes in the brain and its development, either structural or in it’s functioning.

Why NDD? 

While some humans have NDD imprinted in their biological code (through genetic, hormonal, and other neurobiological factors), for many others, the causes lie in critical stages of development, with a range of factors causing compromise. Factors that affect maternal health around conception and through pregnancy; trauma through injury, drugs (both prescription and non-prescription), alcohol, smoking; exposure of the pregnant mother to infections or toxins; and maternal malnutrition, commonly compromise this desired state of “optimality”. Factors affecting the child include birth trauma and infection through poorly planned and executed deliveries, neonatal compromise (asphyxia, jaundice, early trauma through accidents or abuse, infections, malnutrition); untreated epilepsy; other progressive neuropsychiatric disorders etc. Contributory factors include late recognition of the problem, failure to be evaluated in formal medical settings, and the failure to seek and secure early interventions.

Who is at risk?

The global lesson from the “Human Genome Project” was that about 10% of all neurological conditions are explained by abnormalities in a single gene. The majority of disorders were thus deemed to be multifactorial- more than one genetic abnormality being responsible, with strong contributions from environmental events that have impact. This probably holds good for NDD as well. In general, having a parent or first degree relative affected by a neuropsychiatric or developmental condition, may double the risk of NDD.

When should we suspect NDD?

At the one end of the spectrum are children with overtly manifested disability with severe problems that are apparent early and demand medical interventions. They only form the tip of the iceberg. The larger group who go undetected, are children with minimal brain dysfunction. Typically, they are slow-learners in school, who find academic progress challenging; may be clumsy and lack dexterity, with poor handwriting; or indeed demonstrate a range of emotional and behavioral patterns.

Why should we take action early?

These children are often the poor performers and/or perceived troublemakers in school. Rather than receiving special attention, they are at worst punished and at best ignored, in many mainstream schools. Without adequate help and support, these children will slowly and surely slide down the educational scale, out of mainstream schooling, into special schooling systems that cannot really tap their potential. Further, children who do not receive support are likely to feel stigmatized and lose their self-confidence.

Where should I take my child, when in doubt?

Your pediatrician should be the first port of call. The class teacher may also have valuable inputs. When either pediatrician or class teacher (or both) suspect a problem, more specialized inputs become necessary. Problems in learning and intelligence are best assessed by a clinical psychologist; problems in motor or other brain function (like epilepsy) by a neurologist, sometimes with the assistance of an occupational therapist; problems in behavior by psychiatrists, often with the assistance of a counselor. When language development is affected, ENT doctors supported by speech and language therapists may need to be consulted. In many instances, comprehensive assessment requires a team approach. Depending on the problem the specialists consulted may require a range of laboratory tests- brain scans, brain wave (EEG) and other electrophysiological tests; blood and urine tests including hormonal assays and so on.

How should I progress once diagnosed?

  • Your pediatrician should be your primary support
  • Your child’s school needs to be briefed transparently and kept in the loop. Don’t worry about being asked to leave. If the school cannot accept the problem and work with you, it may not be the best place for your child.
  • Identify a team of professionals; be consistent in your interactions and regular in follow up. Make sustainable plans and set realistic goals. Prepare for the marathon, not a sprint.
  • Don’t focus only on the disability; your child may also have special interests and abilities. Put focus on them too.
  • Don’t be preoccupied by academic results; focus on overall development.
  • Caregiving is challenging and tiring; share the care as a family, develop your own support networks with other parents and keep your spirit up.
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Adolescents Adults Cerebral Musings Children Elders Expert Blogs Featured

The Quintessential Rational Mind

The day of Vaisakh Purnima (May 27 this year), is significant for three reasons. It was on this day that Gautama Buddha was born as Prince Siddhartha at Lumbini in Nepal in 560 B.C; the day when he attained enlightenment at Gaya in India; and the day he attained Nirvana (Unity with the Absolute) in 480 B.C. It is, therefore, observed as Buddha Purnima, worldwide. To mark this day in 2010, we examine the rational mind, as conceived by Buddha.

It has become fashionable and commonplace to associate Buddhism with the metaphysical. This is in stark contrast with Buddha’s emphasis on rational thought and insistence on empirical verification. He encouraged the development of theories that were verifiable and was strongly opposed to dogma, which he viewed as an impediment to the truth. To him the truth was supreme, and ideas that hinder the discovery of truth best avoided. He believed in full freedom in thought and action; “the gates of freedom will cease to be gates, if people start clinging to the gates.”

Buddha also had very interesting, remarkably contemporary views on the mind and some of these are enumerated below.

On Thoughts and Ideas: The very first verse of the Dhammapada translates as“you are nothing but your mind”, based on which, “Sarvam Buddhimayam Jagat” has been proposed. The word used by Buddha ‘ mana’ translates both as thoughts and as mind, and can be interpreted to mean the brain. Buddha’s emphasis is on the flow of thoughts and the continuous change in the thinking process. In his concept, ideas are not constant, they change all the time. Ideas have no independent origination; they have ideas preceding and following them. Consequently, all ideas are interrelated and there are no stand alone or absolute ideas. The thinker, the thought and the concepts therein cannot be separated. Interestingly, this concept has parallels in modern psychiatry. A primary delusion, a first rank symptom of Schizophrenia is said to arise when the person, following a “delusional mood” has a thought “out of the blue” and “without antecedents”. To have such a thought that has no thoughts preceding it, and possibly therefore no basis in fact, was abnormal to the Buddha, and remains so in modern concept.

On Perception: Both the Surangama Sutra and the Lankavatra Sutra attribute perception, physical and emotional, to the mind. “Both delusion and enlightenment originate within the mind and every existence or phenomenon arise from the functions of the mind.” The Surangama Sutra poses an interesting question: “A man opens his hand and the mind perceives it; but what is it that moves? Is it the mind, or is it the hand? Or is it neither of them? If the hand moves then the mind moves accordingly, and vice versa; but the moving mind is only a superficial appearance of mind”. According to the Buddha, all perception had basis within oneself. This concept of the Buddha has neuro-scientific underpinnings. If one were to replace the “mind” as Buddha called it, with “brain” as he probably meant, and is contemporary concept; that all our perception and action has basis in the brain, is truism. Prof. VS Ramachandran has described in his book Phantoms in the Brain, novel representation areas for human body parts that have been amputated, developing in the brain.

This illustration leads to another important question, namely, what is ‘me’ and what is ‘mine’? Buddha, through fables, encourages us to think about this existential dilemma. The parable is about a man who takes shelter in an abandoned structure on a stormy night. Sitting in a corner of a dilapidated room he sees around midnight, a demon enter, with a corpse. The demon leaves the corpse on the floor; suddenly another demon appears and claims the corpse. Both demons turn to the man and ask him to decide on the ownership of the corpse. Being truthful, he indicates he saw the first demon bring in the corpse. On hearing this, the second demon is enraged, tears away and eats the hand of the unfortunate man, which the first demon, immediately replaces with the one taken from the corpse. After the demons leave, the man wonders and thinks aloud, “the replaced hand is ‘mine’ but is it ‘me’?

Again, the questions raised have neuro-scientific relevance. After damaging physical trauma, and transplants, it is well reported that people sometimes feel dissociated from their new organs. Indeed, having an organ replaced can be a life-changing experience. At another level, damage to the brain, the parietal lobe in particular, can result in the sufferer neglecting his body parts, as he does not recognise them as his own. The phenomenon of anosognosia, leading to neglect of one half of the body (hemi-neglect), is a well described phenomenon after a stroke. Here, the person sees the paralysed limb lying beside him on the bed, but is unable to recognise it as his own.

Buddha did, therefore, begin the mind-matter debate much before it became fashionable in contemporary philosophy. He placed human emotion firmly within the organ he referred to as the mind, which we now understand to be the brain. His statement – “If we learn that there is no world of delusion outside the mind, the bewildered mind becomes clear” – is remarkably accurate.

On Perception and Memory

Buddha made a distinction between the flow of thoughts and the stock of memory influencing our perception. In his view our perceptions are influenced by our memory. Thus we view the present through the coloured glass of past experience and do not see things as they exist or as they are constituted. When a person perceives an object, both the memory of the same or similar object and the feelings the person had on the earlier occasion are rekindled. Moreover, comparisons are made between imaginary constructions of the object and the object itself. However, this distinction between stock and flow is more analytical than exclusive. Indeed, stock and flow interact all the time.

This view mirrors our current understanding of how the limbic system in the brain works. It has been proposed that the hippocampus is the storehouse of memories. Adjacent and connected to it by a chemical rich neural network is the amygdala, an organ deeply concerned with human emotion.

Any external stimulus results in activation of both organs; thus when a person sees a snake, his memory (and learning) tell him that it could be dangerous, and he experiences fear as a consequence. Memory and emotion are therefore in continuous interplay, as conceived by Buddha.

The Rational Mind

Buddha’s understanding of the human mind (and brain) was unique; both rational and contemporary. He encouraged debate and discourse; raised questions more often than he provided answers; encouraging his followers to think like him, with freedom. He recognised the pitfalls of blind faith, unquestioning belief and intolerance of contradictory ideas. He laid emphasis on empirical verification and on understanding the world, as it is and as it is constituted. Indeed, through his radical empiricism, he laid the foundations of scientific spirit and enquiry 2500 years ago. His was the quintessential rational mind.

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Cerebral Musings Children Expert Blogs

The Predominance of Brain Dominance

On the threshold of a new academic year, parents and students are again confronted by the dilemma of career choices. But insights from neurological and behavioural sciences can help you make an appropriate choice.As schools and colleges reopen, those of us with an interest in brain development and behaviour are witness to, yet again, a stream of anxious parents and their wards seeking advice and support. Course and career choices that young people are about to embark on challenge the best equipped families and provoke considerable debate (and conflict). What is clearly apparent is that both parents and their wards have not, in most cases, prepared themselves adequately for these unique milestones.

We live in an aspirational society, where higher standards of achievement are generally, constantly, being set as the norm. Also one where success has acquired many new connotations! This has its effect on both parents and their wards. Many people set as targets for their children all those goals they wanted to achieve (or wish they had achieved) but couldn’t. Others are keen to ensure their wards follow in their own footsteps, in the belief that this will give them “a leg up” in their careers. What gets forgotten amidst these parental aspirations is that the child may not share these parental goals, nor have the aptitude and ability to see them to fruition. Youngsters too, influenced as they are by a changing society, sometimes set unreasonable targets for themselves; targets for which they may not necessarily have the ability, aptitude or at a pragmatic level, wherewithal. Peer pressure also plays on both parents and their wards. One often encounters otherwise relaxed parents degenerating into a state of panic at the thought of admissions and career choices. There is no doubt therefore that this scenario causes much distress to all concerned.

Help at Hand: A question that is not asked often enough is whether there is a science that will help us approach career and course choices logically. Today, neurological and behavioural scientists have a sophisticated understanding of human brain development and behaviour. Application of even working knowledge in these fields can help both parents and their wards. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence aptitude, learning, behaviour and consequently success.From a cognition perspective, people who are left brain dominant have a better verbal memory, better linguistic abilities, reasoning and logical skills and better vocabulary! From a behavioural perspective, these left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty. On the other hand, people with right brain dominance have a better visual memory, better perception of space, better appreciation of the fine arts, and greater creative ability. They also tend to be more mood and emotion driven in making their choices. As a consequence, they may work with inspirational bursts of energy, not for reasons of purpose, duty, outcome or workplace ethic alone. Those in the creative professions are commonly observed to have such predilections. Put simply, left brain dominant individuals think with their heads; those who are right brain dominant, with their hearts!

Plenty of Options: Can these concepts be useful in making course and career choices? Courses and careers that leverage on a person’s natural aptitude and ability are most likely to be enjoyed and to result in successful outcomes. Pre-eminent among these for the left brain dominant individual are careers that demand literary learning, verbal memory, logical reasoning and diligence; medicine, law, business studies, accounting and finance, computing, research, some humanity disciplines (philosophy, psychology, sociology, history, economics etc.), teaching conventional subjects, to name a few important choices. On the other hand a right brain dominant person may choose the fine arts, theatre, cinema, music, architecture, design, advertising and media, and a range of other careers that demand creative endeavour. Indeed, it may not be just in the choice of careers that brain dominance plays a role. Even within these professions, brain dominance may help define specialisation, role functioning and ability.Parents and their wards may therefore do well to consider these factors in making decisions about courses, careers ands the future. The rapid strides that we have made in economic and social development in urban India have engendered a certain egalitarian ethos in our work places and across professions. No longer does one have to be a doctor, lawyer, accountant, bureaucrat or manager in order to “succeed”. While these career choices remain rather more secure and acceptable across social strata, the career buffet that the young person is presented with today accommodates a range of aptitudes and abilities, with differences in qualification or educational endowment not really being reflected in the pay cheque, in the grossly discriminatory manner so familiar even a decade ago. Young people today have the option of starting work relatively early in life, with fewer formal qualifications, often being paid better for their efforts than older, more experienced and perhaps better qualified individuals in their own families. When such glasnost has percolated into the workplace, then pray why the angst and obsession about traditional and safe career choices? Why not just allow young people to make the choices their brains are dominant for; accepting thereby the predominance of brain dominance!

Facts:

  • Courses and careers that leverage on a person’s natural aptitude and ability are most likely to be enjoyed and to result in successful outcomes.
  • Reading the brain Put simply, left brain dominant individuals think with their heads; the right brain dominant, with their hearts! Why not just allow young people to make the choices their brains are dominant for? Both parents and wards are not prepared adequately to tackle these unique milestones.
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Adolescents Adults Canine Neuropsychiatry Cerebral Musings Children Elders Expert Blogs Featured

Temperamental, Indeed

Life with my pet canines is not just joyful and entertaining; it reveals to me each day, profound neuro-scientific insights. Carlo, my German Shepherd, is a classic example of his breed; in looks and temperament. A “Master’s” dog, his life revolves around my routines. A glance in his direction, slight change in tone, low whistle, all will ensure his immediate compliance with “his Master’s” desires. Obedient and devoted to a fault, Carlo is also extremely high strung and anxious, alert to every change in his environment, and protective of it; so much so that I rarely catch him in fitful slumber. Blessed with an uncanny sixth sense for “his Master”, a trait that his breed is famous for, Carlo actually heads for the gate, minutes before my arrival at home from work. Not one to break rules, he will not enter a room or defile a piece of furniture, once forbidden. Natty and fastidious about his appearance, he remains shiny coated through the week, not an ounce of dirt on him, nor a doggy odour.

Unpredictable and Wilful: Contrast this with my later acquisition Coco, a Basset Hound. A handsome specimen with the classic sad and droopy face, jowls et al, Coco suffers from both occasional seizures and frequent mood swings. An approach in his direction, with best intentions, can evoke dramatically different responses: from a friendly, excited, tail-wagging welcome, to total loss of control; sometimes a resentful, even angry growl, bark or snap in the general direction of approach. Unpredictable mood swings from hypomania and hyperactivity to depression and profound apathy characterise his eventful existence. Disobedient, wilful and obstinate, he can be depended on to do exactly the opposite of what is intended, oblivious to “his Master’s” pleas, commands and threats. Indeed so agnostic is Coco of his surroundings that he can collapse like a sac, his numerous folds spread around him, in fitful slumber, no matter what the circumstances are. House rules mean little to this brat! Stride he will into any room at will, climb on any piece of furniture that strikes his fancy; and somehow manage at least once in each week to manifest for our benefit the pinnacle of filth; no part of the garden, however muddy, having been spared during his meanderings.

Not surprisingly, he emits a profound doggy odour so striking that dog lovers claim it should be bottled and sold (Chanel by Coco is our private joke). Guests without a fondness for canines, beat a hasty retreat from our abode when he decides to bless our company with his presence.

The contrasts in doggy behaviour become most apparent in our morning walk together. Carlo, the German Shepherd, needs no leash, walking three to four kilometres on the footpath that runs alongside arterial roads near our home. Rarely straying more than 10 feet from “his Master”, purposeful in his stride, nary a glance asunder, whatever the provocation, Carlo is the epitome of walking propriety, even his ablutions being timed for completion at a certain discreet spot.

Coco, the Basset Hound, on the other hand, treats the walk as a grand exploration of sorts; an opportunity to experience for himself this beautiful world that the good God has created. Constantly tugging at his leash in an angle perpendicular to the general direction of travel; sparing no human, animal or plant form en route from his nasal excursions, Coco is anything but purposeful about his morning constitutional, his ablutions being intermittent and erratic, intruding into the well directed journey of his fellow canine and Master, much to their combined annoyance. No order is heard, let alone obeyed; no single purpose complied with, other than that, which his doggie mind is set on.

My clinical experience in brain and mind matters has led me to conclude that Carlo, my German Shepherd, is left-brained and Coco, my Basset Hound, right-brained. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence behaviour and temperament.

Left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty.

On the other hand, right brain dominant people have a better appreciation of the world around them, greater creative ability; a proclivity for the finer aspects of life; and tend to be more mood and emotion driven in making their choices; both day to day ones and those that are life-defining. Put simply, left brained individuals think with their heads, the right brained with their hearts; and can be quite a study in contrasts, experiencing great difficulty understanding one another. Little wonder then that many professional and personal relationships run into rough weather; the two parties failing to understand each other’s contrasting preferences and predilections.

Unique Temperamental Attributes

Carlo and Coco have taught me that brain dominance is not an exclusive prerogative of the human race. And love them as I do, equally, I have learnt through them to celebrate rather than despair in these unique temperamental attributes conferred on us by our brain, that marvellous wonder of creation. To understand my family and friends better by observing their brain dominance. To choose correctly my activity companions: left brained for the purposeful and right brained, the hedonistic; and to tailor my expectations of them, appropriately. Carlo and Coco have enhanced my understanding of human nature; and thanks in part to them, I find myself at peace with my fellow men; well most of the time. It is a dog’s life, indeed!

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Adolescents Adults Cerebral Musings Children Elders Expert Blogs

In a New Light

An exploration of Jiddu Krishnamurti’s well-documented ‘transformational’ experience that lead him to a state of god-intoxication.

Jiddu Krishnamurti! The name conjures up many images: benevolent soul who dominated the spiritual world; silver-haired seer with unparalleled vision and verbal felicity; educationist and thinker par excellence; institution builder; diminutive gentle giant with the unique ability to usher peace and joy into troubled lives and minds. In Toto, an enlightened soul, supremely in touch with himself and the world.

How did he evolve to this enlightened state? Was he born with a special mind? Was he transformed by experience, education and mentorship? Or, did he have a moment of spiritual awakening that changed his life forever, as his associates and biographers say? Unlike many world seers whose transformational experiences are hearsay, JK’s was well documented by those close to him at that moment. It is the subject of this exploration.

Well known, but worth recapitulating. Born to a poor rural Brahmin family in the now famous Rishi Valley area in Andhra Pradesh, JK moved to Madras as a young boy. Frail and unremarkable, he was spotted playing on the banks of the Adyar River by C.W. Leadbeater, an associate of Annie Besant, founder of the Theosophical Society. He came under their combined influence. Identified as “the chosen one” by them, he was told he should await the emergence of the master. His transformational experience occurred soon after. Noteworthy that he awaited “the Master” living in a beautiful place, surrounded by mountains.

The Turning Point: Described by his brother Nithya, who was with him during this period, the transformation begins with JK feeling ill; the sequence of events leading to the turning point is summarised in the box titled “The Prelude”.The setting for the transformation is described, “We were a strange group on the verandah. The sun had set an hour ago and we sat facing far off hills, purple against the pale sky in the darkening twilight, speaking little, and a feeling came upon us of an impending climax; all our thoughts and emotions were tense with a strange peaceful expectation of some great event”.JK is described as sitting under a roof of delicate leaves, black in a starlit sky. He is heard murmuring “unconsciously”; then a sigh of relief. “Oh, why didn’t you send me out here before?” This is followed by the weary repetition of a daily “mantra”. Then, silence.JK on the transformed mind: “I was supremely happy for I had seen. Nothing could be the same again. I have drunk at the clear and pure waters at the source of the fountain of life and my thirst was appeased. Never could I be thirsty, never more could I be in utter darkness. I have seen the light. I have found compassion, which heals all sorrow and suffering; it is not for myself but for the world. I have stood in the mountain top and gazed at the mighty beings. Never can I be in utter darkness. I have seen the glorious and healing light. The fountain of truth has been revealed to me, the darkness has been dispersed. Love in all its glory has intoxicated my heart; my heart can never be closed. I have drunk at the fountain of joy and eternal beauty. I am god intoxicated!”In a letter to Leadbeater written two days later, he goes on to say… “After August 20th I know what I want to do and what lies before me – nothing but to serve the Masters and the Lord. Now I feel I am in the sunlight with the energy of many, not physical but mental and emotional. My whole life, now, is, consciously on the physical plane, devoted to the work and I am not likely to change.”His words were, as the world later discovered, remarkably prophetic.

The Clinical-Science Perspective: The spectrum of symptoms during the prelude: pain, increased temperature, altered consciousness, exaggerated response to sound and touch (“exaggerated startle”) and repeated episodes of shaking with teeth clenched and fists closed indicate a seizure syndrome — an electrical storm in the brain. There are unusual features: quiet when comforted; quiet during mealtimes; having memory of the event and the ability to describe it later. All these are not normally encountered in a seizure syndrome. Was JK then experiencing psychosomatic symptoms: physical symptoms that have no physical cause and are underpinned by severe psychological stress?In this particular situation one must not forget that he was a mere slip of a boy, aged 16. He had been told that he was the “chosen one” and that he was to await “the Master”, a much anticipated event, both for him and those around him. Were his experiences brought on by the weight of collective expectation?He has said himself, “I wanted to meet with the Master as soon as I could. I thought about it every day but this was done most casually and carelessly. I realised where I was wrong and thereafter meditation became easy. I realised that there was a need to harmonise all my other bodies with the Buddhic plane (highest plane of consciousness) by keeping them vibrating at the same rate as the Buddhic. The main interest was to see Lord Maithreya and the Master.”Freud proposed that the human tendency is to repress emotional conflicts that are anxiety provoking and so the conscious mind cannot possibly contemplate them. Emotional repression results in these conflicts remaining firmly rooted in the sub-conscious mind. Inevitably, there are times when repressed emotions transcend to the conscious, but given their unacceptable nature, manifest as a physical symptom. Medical men term this “hysterical conversion”. These and other explanations for the events leading to JK’s transformational experience are outlined in the box titled “Neuropsychiatric Interpretations of JK’s Turning Point”.

Trinity Talking Eureka Moments: Should the clinician hesitate to make a diagnosis here? JK’s experience was not followed by any decompensation in mental faculties. Indeed, they were enhanced! He underwent a positive transformation and went on to occupy a special place in the world, beginning his journey as a spiritual leader. Further, the experience was not repeated; and it was both shared and documented; all of which render it less likely to be “a figment of the imagination”. JK is described by his biographers as being reticent in describing and discussing his experience, for a number of reasons that people have thought fit to attribute.

I for one wonder if transformational experiences reflect unique moments when one is in touch with one’s soul, that undeterminable part of the human psyche. Perhaps they represent a union between the brain (cognition), mind (emotion) and soul (realisation): a trinity talking “eureka” moment. Moments in which there is sudden clarity, often following a period of confusion and turmoil. Moments of insight, decision, and action.

Interestingly, both functional Magnetic Resonance Imaging (fMRI) and electroencephalogram (EEG) studies in Carmelite nuns, when they were “in a perceived state of union with god” have revealed activation of several brain regions concerned with emotion, memory and judgment, the temporal and frontal lobes and the connections that link them. It has also been suggested in these studies that personality rather than personal orientation may have a significant role in determining such experiences. Of course, what we do not know is whether these brain changes precede and therefore are presumably responsible for transformational experiences; or indeed whether they are the result of such a transformational experience.

The Transformed Mind: Transformational, life-changing experiences are well described among many seers, and often are a defining part of their reaching enlightenment. Our look at JK’s turning point indicates that they defy conventional paradigms of understanding in clinical science. Positive transformation in the JK mould may well require a very special and unburdened mind: sans expectation, dogma, and prejudice; explaining perhaps the early age at which many seers attained realisation. Perhaps, too, it needs in some instances, preparation, opportunity, encouragement and mentorship, all of which JK enjoyed. Most importantly, perhaps, transformation requires that Eureka moment, when the brain, mind and soul trinity are talking to one another!

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The Entrepreneurial Mind

Many years ago, I remember watching a BBC program on the qualities of entrepreneurship. A diverse group of young individuals who did not know each other and had no knowledge of each other’s identity were being put through a series of tests, to identify secret entrepreneurs in their midst. One test stands out in my mind: the participants were asked to aim for and hit a target from a distance of their choice. Needless to say, the greater the distance from which one tried to accomplish the task, the more the rewards and indeed, the risks. Interestingly, the entrepreneurs in the group were the ones who chose to try from seemingly impossible distances. This appetite for risk is well recognized as being a quintessential entrepreneurial quality. But pray, what else characterizes the entrepreneurial mind? This is the subject of our exploration.

Five Minds!

Howard Gardner has described “the five minds” that are necessary for leadership. He begins with “the disciplined mind” acquired through years spent in scholarship, a craft or a profession, which he estimates takes the average person a decade to master. He prescribes that the disciplined mind emerges from consistent work done to develop skill sets and a knowledge base. This concept of “the disciplined mind” necessitates education and/or training, of course. But is education or training an essential pre-requisite for the entrepreneur? Many famous entrepreneurs have had very limited formal education, and in many instances have dropped out of the educational system, only to prosper. Famous examples of people who did not survive the educational system for a variety of reasons include Bill Gates, Richard Branson, Steve Jobs and our own Dhirubhai Ambani; all synonyms of successful entrepreneurship. So is education at all necessary for entrepreneurial excellence?

John Warrilow in a recent article identifies some reasons why an MBA may be bad for entrepreneurship.

1. Causal rather than Effectual Reasoning:

Entrepreneurs use effectual reasoning (they assess what resources they have and ask themselves what can be created) while conventional CEO’s use causal reasoning (they set goals and develop systematic plans to achieve those goals). MBA programs teach causal rather than effectual reasoning.

2. Adaptive rather than Innovative Thinking:

Adaptors are cautious and pragmatic. They take others ideas and try to innovate them, incrementally. On the other hand innovators overturn other ideas, challenge conventional concepts and are into big-bang thinking. MBA programs teach adaptive thinking rather than innovation, which is an entrepreneurial quality.

The advantages of the disciplined mind notwithstanding, one must address the question therefore, whether formal education is necessary for entrepreneurship, or whether indeed it is an impediment for success. John Warrilow points out that an MBA is bad for entrepreneurs also because “your classmates will not be entrepreneurs” and “you will waste 40% of your risk free years in a classroom”. It is a truism that the higher one climbs on the academic ladder, the more one usually has by way of formal employment opportunities, and the greater are the risks when one chooses to pursue an entrepreneurial venture in favor of well paid employment. Thus, too many years spent in education maybe a disincentive for risk, that important entrepreneurial quality. On the other hand it has to be acknowledged that formal education such as an MBA does bestow on one credibility, a critical element for entrepreneurial progress, at least in the early years. A doctor turned entrepreneur recently remarked to me, rather ruefully, that it took an ivy league MBA for people to be convinced about the seriousness of his entrepreneurial intent and ability.

Howard Gardner goes on to describe “the synthesizing mind” as learning to integrate disparate sources of information, identifying the links between them. Synthesis he says is identifying the jobs that need to be done and the people available to do those jobs. Synthesis is the identification of priorities and the way forward, balancing past visions with future aspirations. Synthesis enables one to examine new ideas in the light of one’s knowledge base. In this concept one needs the discipline of education combined with the ability to integrate disparate sources of information, an ability that usually comes with work experience.

Gardner then describes “the creating mind”, more a function of the leader than of the manager. Entrepreneurs are leaders and are generally bestowed with a strong sense of creativity, the ability to innovate and think out of the box. In general, the leadership of organizations require the development of compelling narrative, which then gets embodied in the leaders life. Good leaders (and entrepreneurs) are therefore expected to live by the principle “my life is my work; my work is my life” and to bring about changes to the lives of those

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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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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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