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.


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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