Mar 17 2014

Life Imitates Science Fiction

A man is in an extended coma after a traumatic injury. When he finally awakes from his coma he finds that he has brought something back with him from the darkness –  psychic powers. Yes, this is the plot of the 1983 Stephen King movie, The Dead Zone. It is also the alleged story of a 23 year old Southend student named Rob Ball.

Ball was assaulted and hit in the side of the head resulting in a two week coma. He had significant brain injury, and after waking from the coma he suffered from significant memory loss and needed extensive physical therapy in order to walk. Describing his injuries, he said:

 ”It feels like my head is going to blow up and I’m convinced I’m going to die all the time now, because it’s had such an impact on my life. I get deja vu all the time. I don’t know if it’s something to do with the head injury, but I keep thinking ‘I remember this before’, and think something is about to go wrong.”

Memory loss and headaches are typical symptoms of a traumatic brain injury. The deja vu is an interesting symptom – this is the phenomenon of feeling as if a current experience is familiar, as if it has happened before. We do not yet fully understand the neuroanatomical correlates and functional causes of deja vu, but we have some fairly compelling leads.

One way to think about deja vu is that our brains require a mechanism to distinguish an experience that is currently happening from a memory. A lot of the same circuitry is involved in both – seeing a picture and remembering the picture, for example. There are probably several mechanisms involved in distinguishing memories from active experiences, and one seems to be familiarity. I wrote recently about evidence that reality testing is likely another such mechanism.

Deja vu can therefore result from several specific things, but a false sense of familiarity seems to be one. Deja vu is a common symptom of temporal lobe epilepsy. Such cases of pathological deja vu can tell us about what structures are likely involved.

Getting back to Ball, he had temporal lobe trauma, and so likely has a post-traumatic pathological form of deja vu caused by damage to one or more structures involved in memory, reality testing, or determination of familiarity. It is also possible he is having post-traumatic seizures, although this is not necessary to explain his symptoms.

Ball also reports hearing voices in his head telling him things about other people:

“Soon they were so clear that I was telling people what popped in my head about them – often strangers in the street. I was getting messages predicting illness, love and death. People are shocked when I can tell them personal details.”

This is very interesting in light of the recent article by psychologist Phillip Gerrans in which he discussed deja vu and delusions as potentially part of one underlying neurological phenomenon – a failure of reality testing. He argues that a “metacognitive failure” of reality testing could result is a sense of hyperfamiliarity (deja vu). This can also result in an inability to distinguish internal thoughts from external voices.

We all have voices in our heads, but we recognize them as our own thoughts. It is important to keep in mind that everything our brains do,  every mental process, must have corresponding neural networks. If those networks are disrupted, then that function of the brain is disrupted. Part of the challenge for neuroscientists is determining what the basic units of neurological function are – knowing what specific mental tasks our brains are doing. Simple stuff, like contracting our muscles or constructing visual images, are the easy ones to think of. But there are some very non-obvious ones, like generating a sense of ownership over our body parts, or determining the degree of familiarity of experiences.

In this regard pathological conditions (strokes, seizures, brain damage) have been invaluable. We mostly learn about subtle brain functions by examining patients in whom that specific function is not working. We recognize functions by their absence.  To add another layer of complexity, often a brain function is inhibitory, and so the absence of the inhibitory function results in an increase in some other brain activity.

Taking all of this into consideration, it is a reasonable neurological hypothesis that Ball has temporal lobe damage resulting from his injuries, and this has affected his reality testing circuitry resulting in both deja vu and auditory delusions, specifically the interpretation of internal thoughts as if they were external voices.

There is another relevant pathological neurological phenomenon here, known as anosagnosia, or the inability to recognize neurological deficits. This is most dramatic clinically with neglect syndromes, such as people who are completely paralyzed on one side of their body but do not recognize it. I think the best way to conceptualize this phenomenon is that the region of the brain responsible for evaluating an ability is the same area that creates the ability, so when that region is damaged you lose both the function and the ability to evaluate the function. That piece of your consciousness is deleted from the aggregate whole.

Even healthy individuals have a documented tendency to first blame external factors for their behavior (called the fundamental attribution error). It is also well documented that patients with neurological damage, especially when they have reduced awareness of their deficits, will explain their odd behavior or inabilities on external factors, rather than recognize that they have neurological deficits.

It is therefore not surprising that some people like Ball who have seizures or a new injury and as a result have bizarre neurological symptoms, will try to explain the symptoms as an external phenomenon rather than simply deficits arising from brain injury. This is likely to be especially true if that deficit is in reality testing.

The authors of one review report that 2/3 of people who believe they have estrasensory ability have a history of brain injury. The authors come to the wrong conclusion from this fact – they believe such subjects can tell us about the causes of real ESP. Rather, I think such cases can tell us about the mechanisms that lead someone to falsely believe they have psychic ability, such as the case of Rob Ball.

It is also not surprising that Ball would come to believe that his “predictions” were valid. It only takes a little subjective validation, confirmation bias, and cold reading to create the powerful illusion that such predictions are far more accurate than would be expected by chance.

Conclusion

The details of Rob Ball’s injury and subsequent experiences are not in contention. However, there are two competing narratives to explain those details. The narrative being credulously reported in the media follows that of the 1983 Stephen King movie – life imitating science fiction. We see this frequently in the world of the paranormal – there is a cultural interplay between paranormal beliefs and depictions in popular media. A story like The Dead Zone is inspired by popular belief in ESP and psychic detectives, but then the book and subsequent movie add narrative details (like waking from a coma with psychic abilities) that then help shape popular belief. We see this also with depictions and beliefs of demonic possession, UFO and aliens, mediums, and many other such phenomena.

The other narrative is at once more prosaic but (to me, at least) is also much more fascinating and satisfying – the neurological narrative. Rob Ball’s brain function was altered by physical trauma. The region of his brain that was damaged is known to be associated with the exact changes he is now experiencing, deja vu and hearing voices. His interpretation of these changes is also in line with decades of psychological research. There is therefore a compelling neuro-psycho-cultural interpretation of Ball’s story that is consistent with all the evidence and satisfies Occam’s Razor by not having to introduce any new assumptions or phenomena.

The trick is in getting the media to see how cool and fascinating the science-based narrative is (not to mention that it is far more likely to be true).

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21 responses so far

21 Responses to “Life Imitates Science Fiction”

  1. The Other John Mcon 17 Mar 2014 at 10:28 am

    “The authors of one review report that 2/3 of people who believe they have estrasensory ability have a history of brain injury.”

    Incredible that the authors didn’t think to try turning the causal arrow around in their explanation, because that is definitely an interesting observation. Their “explanation” fits so well with the common pop-psychology meme that we all have this vast reservoir of untapped cognitive potential in our heads, waiting to be unleashed….if only we could all get hit on the head with a brick….you know, the crap about “we only use 10% of our brains”

  2. carbonUniton 17 Mar 2014 at 10:57 am

    “We all have voices in our heads, but we recognize them as our own thoughts.”

    It seems to me that people who think they hear God are really just hearing themselves. When they say “God impressed me to do/not do this or that”, it’s kind of like a mental version of the ideomotor effect. It’s their thoughts, but once they become aware of them, they credit the deity (or aliens, or whatever external force.) It happens enough in “normal” religious people – must happen a lot in people with various forms of mental impairment.

  3. thestrangequarkon 17 Mar 2014 at 11:20 am

    Hello,

    I’m a longtime reader and first time poster. I apologize in advance for what may be a rambling string of questions…maybe not even good questions, but I’m curious, so I might as well ask!

    Have you ever encountered (or heard of) a case of neurological dysfunction similar to Mr Bell’s, but in which the affected individual recognized the dysfunction for what it was? Are there levels of impairment to reality-testing, so that an individual may fail to distinguish between internal and external voices, but may still have the capacity to recognize that, since ESP doesn’t exist, his experience must be neurological? Or does impairment to reality-testing by definition mean that one is no longer capable of incredulity?

    I suppose what drives my curiosity is an out of body experience I had during surgery at the age of 12. Even at that young age, I leant toward skepticism, and attributed the experience to something strange happening in my brain rather than my soul actually leaving my body and floating around (in my experience, I actually felt as if I’d disintegrated into billions of tiny fragments and hovered around the operating room). It never occurred to me at any time that something supernatural was happening. I know it’s well within the realm of possibility for traumatic brain injury to change my personality and thought-processes such that I would no longer be so skeptical, but I can’t help wondering what I’d think of what was happening to me if I were in Mr Bell’s shoes.

    On a related note, are there people who awaken from NDEs and just think, “Wow, the brain is weird!”? Is this just bias: we only hear about those who assume their experience was supernatural, or is there something inherent about such experiences that make people more prone to believing they are supernatural.

    So, yeah, a bit of a rambling mess, but maybe there’s a worthy question in there somewhere.

    Thanks for your time!

  4. Steven Novellaon 17 Mar 2014 at 12:02 pm

    quark – that’s a great question. In general people’s first reaction to these kinds of symptoms are not “brains are weird” but “something weird is happening to me.”

    However, we do see a range of reactions. This probably has to do with the degree of impairment of reality testing, and the density of whatever the neurological lesion is, and the person’s baseline personality and cognitive style.

    There is also a general trend that over time people do come to realize the problem is with their brain and not the external world. At least, with physician feedback and counseling they can come to realize this. But this may also have to do with their brain healing, or plasticity – reality testing reasserting itself over time.

    However – if the patient gets locked into a belief system that offers a comforting or exciting narrative to explain their new neurological functioning, this can persist indefinitely. This is partly why I feel it is harmful for patients to be given magical narratives for their brain symptoms. I have written about this before in the context of people with sleep phenomena thinking they are being abducted by aliens, or people with psychotic symptoms thinking they are possessed by demons. It’s generally not a good idea to validate delusions.

  5. Bronze Dogon 17 Mar 2014 at 12:41 pm

    There is another relevant pathological neurological phenomenon here, known as anosagnosia, or the inability to recognize neurological deficits. This is most dramatic clinically with neglect syndromes, such as people who are completely paralyzed on one side of their body but do not recognize it. I think the best way to conceptualize this phenomenon is that the region of the brain responsible for evaluating an ability is the same area that creates the ability, so when that region is damaged you lose both the function and the ability to evaluate the function. That piece of your consciousness is deleted from the aggregate whole.

    I’m reminded of something from The Hitchhiker’s Guide to the Galaxy, though I don’t remember in great detail. A spaceship had a section damaged, including the internal sensors that would notify the ship’s computer of that damage. Since those sensors weren’t sending warning signals, the computer assumed all was well.

    Not as detailed as the neurological examples, but I think it illustrates the kind of “meta” perspective you need to understand how self-evaluation can go wrong. We have a lot of cognitive abilities we take for granted.

  6. Peter Hildebrandon 17 Mar 2014 at 1:12 pm

    This is very interesting in light of the recent article by psychologist Phillip Gerrans in which he discussed deja vu and delusions as potentially part of one underlying neurological phenomenon – a failure of reality testing. He argues that a “metacognitive failure” of reality testing could result is a sense of hyperfamiliarity (deja vu). This can also result in an inability to distinguish internal thoughts from external voices.”

    Isn’t hearing voices an example of a hallucination, and not a delusion? I don’t mean to nitpick, but I want to make sure I’m understanding this correctly.

  7. The Other John Mcon 17 Mar 2014 at 3:10 pm

    quirk – there have been some experimental inducements of *something like* out of body experiences via brain stimulation, via virtual reality head-mounted displays, and less-scientifically, via mind-altering drugs. It doesn’t appear in these first two cases that the participants misattribute the cause of the sensations/perceptions, though I would bet such misattributions are common with drug trips…read a couple of “trip reports” from LSD or salvia users, for example, and you’ll get a flavor for what they experience. Pretty wild stuff.

  8. thestrangequarkon 17 Mar 2014 at 4:17 pm

    Thanks for the response, Dr Novella! I guess upon reading your answer and rethinking my question it seems fairly obvious that there would be degrees of impairment to reality-testing; clearly people normally function at varying degrees of reality-testing.

    Other John, I always assumed my own out of body experience was down to drugs — either that, or it was just an exceptionally vivid dream — and I have had conversations with many people about pharmacologically induced experiences of this nature. It is fascinating stuff, isn’t it?! (I wish I had an interrobang key.) I think you’re right that misattributions are common with drugs, and in a very unscientific statement, I will say that this has been my experience with drug users. In a slightly more scientific statement, I think we need only to look at the history of drug use in religious rituals to see that it’s the case.

  9. locutusbrgon 17 Mar 2014 at 4:47 pm

    I hope you are vilifying the media aspect of this. You are implying that some medical person is feeding the delusion credulously. I cannot find any stories that verify that a medical professional is somehow feeding his delusion. Unless of course in your research you found this. I got the impression from your comment that there is tacit approval that from medical sources for this story, and that they are permitting him to believe his own delusions. Which I fervently hope that is not the case.

  10. Steven Novellaon 17 Mar 2014 at 5:16 pm

    locutus – I did not imply anywhere that his medical doctors are feeding the psychic delusion. It is often popular culture that feeds the delusion.

    However, I have encountered many misguided professionals or pseudoprofessionals who do specialize in feeding paranormal delusions. Always sad.

  11. tmac57on 17 Mar 2014 at 6:39 pm

    I have had many deja vu experiences over the years,but most were when I was much younger,and many before I even knew there was a word for it. But what I have always wondered since I found out that other people have them too,is, are we experiencing the same thing?
    I wonder about this,since some people describe a kind of vague sense that “gee,this seems familiar” where I would describe my experience as a more profound moment where I am almost viewing the scene like a movie (detached) and disconnected for a few seconds in an almost dream like state,with the intense feeling that I know exactly what is about to occur next.But in reality,I never have been able to predict the next instant,and that’s when I get pulled back to present.
    Another similar thing that used to happen to me often when I was 6 or 7 years old,was a sudden sensation that the room was retreating,like zooming out with a camera,and simutaneously,my hearing would mute a bit,and a light ringing (like tinnitus)would occur,and then the whole scene would slowly drift back to normal.Really weird! Now I wonder if I was having some sort of neurological event,having read this piece.

  12. Paul Parnellon 17 Mar 2014 at 9:02 pm

    For me deja vu seemed to be associated with repeating dreams. I was having a flying dream that I was not remembering while awake. However each time I had the dream I would have a powerful memory of having dreamed it before. This I experienced as a full body “Ah! This!” twang. It was a very powerful dream yet unremembered.

    In the awake state something would ping the “Ah! This!” memory without the memory of the dream. Eventually I was able to make the connection between the dreams and deja vu but only inside the dream. This enabled me to remember the dream while awake. This seemed to cause a decline in both the flying dream and incidents of the deja vu.

    Or maybe my brain just invented a story to explain unrelated events.

  13. tmac57on 17 Mar 2014 at 9:27 pm

    Paul Parnell- Yeah,I use to have recurrent flying dreams as well (I think that they are quite common).Always the same one,much like a re-run on TV. They were exhilarating and vivid,and I always awoke with a racing heartbeat followed by a let down that it wasn’t real.
    But I would say the deja vu experience,at least for me,was a qualitatively different thing. The deja vu happens while awake and fully conscious for me.

  14. Paul Parnellon 17 Mar 2014 at 11:22 pm

    tmac57 – Yes of course deja vu happens when you are awake. But what I am saying is that deja vu is a waking memory of a portion of a repeating dream that you otherwise cannot remember except while in the dream.

    It is the memory the feeling of having remembered something very powerful without without remembering what you remembered. Without the reference to what you remembered the sense of remembering attaches to your current situation as an almost out of body sense of familiarity.

    Once you remember the dream while awake the sense of familiarity has a correct reference and the deja vu is gone. Remember you forget most of the dreams you have or only remember fragments. But a repeating dream can trigger a memory of previously having had the dream even while nothing triggers those memories while awake. And when you wake the memory is gone again except possibly for a disconnected fragment. If that fragment is a powerful sense of having remembered something then deja vu.

    As a metaphor think of it as a dangling pointer in a program. Say you allocate some memory to store an object. You need a pointer to point to the location of that object. Now if you deallocated that object you have a pointer that may point to an object that no longer exists. If you put some other object in that place then your pointer is pointing to the wrong thing.

    You have a sense of remembering a dream within the dream you are remembering. You then forget (deallocate) the dream. The sense of remembering then is like a pointer to an object that no longer exists. Because you were dreaming when you remembered the dream the place the memory is stored is current working memory.

    Now that sense of remembering the dream should go away when the dream is forgotten but sometimes fragments of dreams remain. So now that sense of remembering is still pointing to current memory but the dream is no longer there. So you have a sense of familiarity with whatever you are currently looking at because that is current working memory.

    Or not. Nobody really understands how the brain works.

  15. tmac57on 18 Mar 2014 at 9:49 am

    From my personal experience of the phenomenom , I think that the conflation of current experience with memory makes a lot of sense,because even though it feels like I know what is going to happen next,I can’t really predict it,and even trying brings me out of the event. In that way,it is much like awaking from a dream and not being able to remember it.
    I really hope they nail this down some day.It has puzzled me for years.

  16. Newcoasteron 19 Mar 2014 at 6:23 am

    Perhaps it’s my own déjà vu, but didn’t Oliver Sacks describe a similar case in one of his books?

    As a family doc, I have looked after many stroke patients, and the changes in personality that sometimes accompany the physical deficits are fascinating, from purely a clinical perspective. We really are just the wetware between our ears.

    More recently my own mother had a stroke, and one of the things that is most profound was her loss of a sense of humour, despite the gradual improvement in her unilateral weakness, that part of her hasn’t come back. Jokes puzzle her, she tries hard and can say “I see why that is funny” but she no longer laughs. The saddest part of it is she doesn’t realize that something is missing, she feels the same.

  17. BillyJoe7on 19 Mar 2014 at 7:33 am

    ” The saddest part of it is she doesn’t realize that something is missing, she feels the same.”

    Sad for you and rest of her family and friends but, fortunately, not for her.
    It’s like “locked-in syndrome”, the family are continually looking for signs of consciousness, but I hope for the patient’s sake that there is none.

  18. Newcoasteron 19 Mar 2014 at 9:17 am

    @BillyJoe7
    You are quite correct, it is only sad for the family, she is blissfully unaware that a piece of her is missing.

  19. SteveAon 19 Mar 2014 at 10:14 am

    tmac57: “From my personal experience of the phenomenom , I think that the conflation of current experience with memory makes a lot of sense”

    Same here.

    The way it was explained to me was: the mind experiences something, then mis-files it in long-term memory rather than short-term memory. The similarity between the ‘old’ memory and ongoing events then cause the mind dredge it up as a déjà vu experience.

    Accurate or not, this description ties in perfectly with what I experience once or twice a year.

  20. AlisonMon 19 Mar 2014 at 1:41 pm

    It’s confusing not to know. Prior to brain surgery, I was unaware that I had huge areas of my visual field completely missing and that my sense of spatial relations was distorted – and I continued to drive and couldn’t understand why suddenly I was having near-misses with other cars. I rationalized it many ways because I simply couldn’t conceptualize that I wasn’t seeing them coming until I had almost hit them or cut them off. I rationalized a lot of things because in my mind, I was fine. It was other things being different, not me.

    If you had told me then that I was impaired, I wouldn’t be able to understand it. That red light I ran must have just changed. That car that almost hit me must have been going so fast that it wasn’t there when I changed lanes in front of it. We got lost because someone must have torn down a building that I used as a landmark for navigating.

    I can see this in retrospect, but I had no idea at the time. I did stop driving several months before surgery because I did realize that I was having a problem – MRIs can really drive that point home. So while it might be OK to some extent to let a patient have his illusions so as not to upset him, you do have to draw a line when he presents a danger to himself and others. Taking advantage of his condition in this way is different, but pushes the bounds of morality, I feel.

    What bothers me about reading this is the realization that I may still have impairments that I don’t perceive in addition to the ones of which I’m unfortunately aware. I went through a neuropsych evaluation and will be speaking with the doctor this week. I’m sure there are going to be some surprises for me. It’s unnerving to consider, but I’d rather know.

  21. Bill Openthalton 24 Mar 2014 at 8:11 am

    AllisonM –

    Your experience proves (to me at least) that consciousness is not an all-seeing supervisor, but merely a well-meaning spokesperson with limited information, trying to put the best possible spin on what’s happening.

    This might be the same type of cognitive limitation we see in people with less “obvious” dissonances between reality and their experience (such as believing in ghosts, or even god).

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