Saturday, October 31, 2009

Werewolves of London, Ontario

An American Werewolf in London

In the last post, we learned about the Psychopharmacology of Lycanthropy (and "endogenous lycanthropogens") from the April 1, 1992 issue of the Canadian Medical Association Journal (Davis et al., 1992). In a more serious review on clinical lycanthropy in the British Journal of Psychiatry Coll, O'Sullivan, and Browne (1985; PDF) began by stating:
Lycanthropy is the delusion in which an individual believes he has been transformed into an animal, traditionally a wolf. Descriptions of this syndrome are found in the earliest medical writings such as those of the Greek Paulus Aegineta in the seventh century A.D. (Adams, 1844). There is also a biblical description of the syndrome in the Book of Daniel. Nebuchadnezzar (605-562 B.C.), the king who rebuilt Babylon, succumbed to a lycanthropic state after suffering from an apparent depressive illness for seven years.

Nebuchadnezzar, by William Blake

In his 1621 magnum opus, The Anatomy of Melancholy, Robert Burton (aka Democritus Junior) explained it thusly (in Part 1):
Lycanthropia, which Avicenna calls cucubuth, others lupinam insaniam, or wolf-madness, when men run howling about graves and fields in the night, and will not be persuaded but that they are wolves, or some such beasts. Aetius and Paulus call it a kind of melancholy; but I should rather refer it to madness, as most do. Some make a doubt of it whether there be any such disease. Donat ab Altomari saith, that he saw two of them in his time: Wierus tells a story of such a one at Padua 1541, that would not believe to the contrary, but that he was a wolf... And Nebuchadnezzar in Daniel, as some interpreters hold, was only troubled with this kind of madness. This disease perhaps gave occasion to that bold assertion of Pliny, some men were turned into wolves in his time, and from wolves to men again: and to that fable of Pausanias, of a man that was ten years a wolf, and afterwards turned to his former shape: to Ovid's tale of Lycaon, &c.
Not surprisingly, the modern-day diagnosis given to individuals afflicted with this delusion is usually a psychotic disorder in the context of schizophrenia (Fahy, 1989), severe depression (Coll et al., 1985; Rao et al., 1999; Younis & Moselhy, 2009), or bipolar disorder (Verdoux & Bourgeois, 1993).

Benicio del Toro stars in The Wolfman, to be released in Feb. 2010.

However, imaginary transmogrification isn't restricted to the lupine variety. A comprehensive review of the literature between 1966–2002 (Garlipp et al., 2004) identified 21 articles, primarily case studies:
In the current medical literature man–animal metamorphoses were described concerning the following animals: wolf/werewolf, dog, gerbil, rabbit, horse, tiger, cat, bird, unspecified animal species, frog and bee. In Asia, Africa and South America, metamorphoses in tiger, hyena, crocodile and shark were observed.
The authors mention that the specifics can be influenced by cultural factors. But then they deliver the psychodynamic perspective promised in the review's title (and a bit of condescension):
The symptomatology can be seen as a continuity spectrum of developmental and culture dependent normal behaviour via transitional – a fantasy of an artist – and partial forms to the whole picture of lycanthropy described by Keck et al. (1988). The length of transformation is usually short, symptomatology has mostly disappeared in a week's time. People who live in preindustrial societies and people living on isolated countrysides are predisposed. Other precipitating factors seem to be subconscious sexual conflicts.
Finally, they end with precipitating psychopathology:
Lycanthropic symptomatology can be seen in different mental diseases. Most of the patients suffer from an affective disorder or from schizophrenia. Furthermore, the man–animal metamorphosis can be seen after the intake of psychotropic substances including cannabinoids as well as alcohol abuse. Rarely, lycanthropy is reported in personality disorders. Case reports can be found concerning organic psychosyndromes, dementia and epilepsy.
We'll end with an article from the Canadian Journal of Psychiatry, on two unusual case reports (Gödecke-Koch et al., 2001):
Case Report 1
A 34-year old woman suffering from schizophrenia came to the emergency department. At first, she was mutistic; later she seemed agitated and tense. Suddenly, she started moving like a frog, jumping around, making frog-like noises, and showing her tongue as though in tend ing to catch a fly. We found out that she had taken part in a workshop about fairy tales prior to becoming symptomatic. An organic cause was excluded, and no drug intake was found.

Case report 2
A 24-year-old woman suffering from schizophrenia reported a strange feeling that could not be properly described, together with the feeling that she was becoming a bee and getting smaller and smaller. She also felt a burning sensation in her thighs. She attributed her metamorphosis to her being stung by bees as a child and the “splashes of bee” that had touched her. ... No organic causes could be found, and drug screening tested negative.

To date, the metamorphosis into a frog or a bee has not been described in the medical literature.
It's nearly a full moon, but somehow the idea of human/frog hybrids (and human bees, if not in swarms or of the killer variety) isn't all that scary.


Coll PG, O'Sullivan G, Browne PJ. (1985). Lycanthropy lives on. Br J Psychiatry 147:201-2. [PDF]

Fahy TA. (1989). Lycanthropy: a review. J R Soc Med. 82:37-9.

Garlipp, P., Gödecke-Koch, T., Dietrich, D., & Haltenhof, H. (2004). Lycanthropy - psychopathological and psychodynamical aspects. Acta Psychiatrica Scandinavica, 109 (1), 19-22. DOI: 10.1046/j.1600-0447.2003.00243.x

Gödecke-Koch T, Garlipp P, Haltenhof H, Dietrich DE. (2001). Lycanthropy: 2 case reports. Can J Psychiatry 46:659.

Rao K, Gangadhar BN, Janakiramiah N. (1999). Lycanthropy in depression: two case reports. Psychopathology 32:169-72.

Verdoux H, Bourgeois M. (1993). A partial form of lycanthropy with hair delusion in a manic-depressive patient. Br J Psychiatry 163:684-6.

Younis AA, Moselhy HF. (2009). Lycanthropy alive in Babylon: the existence of archetype. Acta Psychiatr Scand. 119:161-4

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Psychopharmacology of Lycanthropy

Fig. 5 (Davis et al., 1992): Drawing from an original photograph by Kirschbaum of one of his subjects undergoing transmogrification after experimental exposure to amplified illumination at lunar wavelengths.


From the Orphan Drug Research Institute (an affiliate of Yoknapatawpha University), 666 Rowanoak Circle, Jefferson, Miss. This is the first report from the institute's Orphan Drug Development Program.
Objective: To develop pharmacotherapies for the orphan disease lycanthropy through the pursuit of the etiologic hypothesis of a genetically determined hypersecretion of endogenous lycanthropogens.
Design: Quadruple-blind, Rubik's Cube matrix analysis.
Setting: Community practice and malpractice.
Participants: Subjects selected from inbred Ruficolla populations in Mississippi, Georgia, North Carolina and Minnesota. All who entered the study finished it.
Interventions: Chemical screening of blood samples over a hypothesized secretory cycle of lycanthropogen peaking on the day of maximum lunar illumination. Administration of synthetic lycanthropogens for behavioural testing. Experimental lycosomatization through the illumination method of Kirschbaum.
Outcome measures: None were post hoc, but some are still in hock.
Main results: Two putative lycanthropogens were isolated from the blood samples. Structural elucidation and synthesis permitted animal and clinical trials; in each of these, behavioural dysfunction was observed. Antilycanthropogen strategies included application of the principle of caged compounds and generation of a therapeutic immunoglobulin. The effects of a newly developed antihirsutic agent seemed promising. An interaction of the lycanthropogen-secretion system and ethanol was noted, which may explain behavioural aspects of alcoholism.
Conclusions: The incidence of lycomania in North America is underestimated. Soon-to-be-available pharmacotherapies should promote its early detection and treatment. Full control may depend upon advances in gene therapy.

Fig. 1 (Davis et al., 1992): Structural formulas of endogenous lycanthropogens.

The full paper is available as an open access article, so don't delay in reading this RECHERCHES EXTRAORDINAIRES in its entirety. It's Halloween, and there's a Bad Moon Rising...


Davis WM, Wellwuff HG, Garew L, Kydd OU. (1992). Psychopharmacology of lycanthropy. CMAJ Apr 1;146(7):1191-7.

Teen Wolf, shown Car Surfin' USA (Kids! Don't try this at home)...

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Friday, October 30, 2009

The Electroencephalographer's Couch

BRAIN WAVE SOFA, by lucas maassen
The Brain Wave Sofa is a representation of a 3 second wave of Alpha brain activity captured with a 3d EEG.
It shows the 3 seconds when the eyes closed.

From the 3d-EEG the file got directly milled in faom by a 3d milling machine and then upholstred in felt by hand.

in cooperation with Dries Verbruggen (Unfold)
Close your eyes and relax...

However, information aesthetics was a bit wrong when they said the purpose of alpha waves (in the EEG frequency band of 8-12 Hz) is only "to prepare the brain for the large input of signals when one opens the eyes." According to Başar et al. (1997), their function is much more complex:
The old concept stating that EEG alpha (10-Hz) activity reflects passive or idling states of the brain is giving way to modern views of 10-Hz oscillations in relation to diverse brain functions comprising sensory, motor, and memory processes: (1) Spontaneous alpha activity is not pure noise as shown by methods of chaos analysis. (2) Evoked alpha oscillations patterns (precisely time-locked to a stimulus; duration approx. 200-300 ms) depend on the modality of stimulation and the recording site. (3) Induced alpha oscillations are initiated by, but not closely time-locked to a stimulus. (4) 10-Hz oscillations are recorded in nervous systems of different complexities, from the human brain to isolated ganglia of invertebrates. The neural origins of 10-Hz oscillations are demonstrated by recordings at the cellular level. (5) Rather than trying to locate a unique alpha generator, it is preferable to assume that a 'diffuse and distributed alpha system' exists. A particular support for this hypothesis is given by stimulus-dependent hippocampal alpha responses in the cat brain. (6) The major physiological meaning of 10-Hz oscillations may be comparable to the putative universal role of gamma responses in brain signaling.

From Fig. 1A (Hughes & Crunelli, 2007).


Başar E, Schürmann M, Başar-Eroglu C, Karakaş S. (1997). Alpha oscillations in brain functioning: an integrative theory. Int J Psychophysiol. 26:5-29.

Hughes SW, Crunelli V. (2007). Just a phase they're going through: the complex interaction of intrinsic high-threshold bursting and gap junctions in the generation of thalamic alpha and theta rhythms. Int J Psychophysiol. 64:3-17.

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Monday, October 26, 2009

Unusual Changes in Sexuality: Case Studies in Neurology

Fig. 1 (Currier et al., 1971). Scalp EEG showing sharp wave activity from left anterior temporal region.

In the last post we learned a bit about hypergraphia, a compulsion to write that sometimes occurs in those with temporal lobe epilepsy (TLE). According to the late behavioral neurologist Norman Geschwind (reprinted in 2009; also see Devinsky & Schachter, 2009), hypergraphia is one in a cluster of interictal [between seizure] personality traits in some TLE patients1 which can also include religiosity, hypermorality, aggressiveness, clinginess, increased emotionality, and sexual changes (mostly hyposexuality but also other alterations):

Hyposexuality is the most common, but other kinds of sexual changes do occur. ... In England, Davies and Morgenstern went out and found, among the temporal lobe epileptics, several other patients who were transvestites. ... I’m sure that the great majority of transvestites don’t have temporal lobe epilepsy, but it’s interesting that for whatever reason it can cause this. Although I’ve seen many women with temporal lobe epilepsy, someone called to my attention a phenomenon that I hadn’t observed before. The last four women I have seen have all been bisexual, which again is a rather striking finding.
Sexual behavior preceding (auras) or during (automatisms) seizures is another story. The EEG traces in Fig. 1 above are from an epilepsy patient who experienced "sexual seizures" during which she engaged in somewhat purposeless "pseudointercourse" behavior, with no memory for the event afterward. Although the general consensus is that sexual automatisms are usually associated with seizure foci in the temporal lobes (Mascia et al., 2005), an influential earlier paper insisted the origin of "sexual seizures" was in the frontal lobes (Spencer et al., 1983).

Changes in sexuality can also occur after strokes or due to brain tumors. Neurophilosopher Patricia Churchland drew attention to one of these case reports in a New Scientist article on free will and criminal responsibility:

In 2003, the Archives of Neurology carried a startling clinical report [Burns & Swerdlow, 2003]. A middle-aged Virginian man with no history of any misdemeanour began to stash child pornography and sexually molest his 8-year-old stepdaughter. Placed in the court system, his sexual behaviour became increasingly compulsive. Eventually, after repeatedly complaining of headaches and vertigo, he was sent for a brain scan. It showed a large but benign tumour in the frontal area of his brain, invading the septum and hypothalmus - regions known to regulate sexual behaviour.

After removal of the tumour, his sexual interests returned to normal. Months later, his sexual focus on young girls rekindled, and a new scan revealed that bits of tissue missed in the surgery had grown into a sizeable tumour. Surgery once again restored his behavioural profile to "normal".

Figure 1 (Burns & Swerdlow, 2003). MRI scans at the time of initial neurologic evaluation: T1 sagittal (A), contrast-enhanced coronal (B), and contrast-enhanced axial (C) views. In A and B, the tumor mass extends superiorly from the olfactory groove, displacing the right orbitofrontal cortex and distorting the dorsolateral prefrontal cortex.

This case raises the issues of diminished capacity and criminal responsibility. The man knew what he was doing was wrong -- intact capacity and moral knowledge -- but he could not inhibit his inappropriate sexual behavior. It's hard to argue against the finding of diminished responsibility when staring at a gigantic brain tumor. But many other examples of impulsive sexual offenses (Langevin, 2006) aren't nearly as obvious (e.g. after head injuries when the damage might not be visible on an MRI scan). How does society deal with them?

A key factor is a change in behavior...

Multidirectional disorders of sexual drive in a case of brain tumour

The next report is from Poland (Lesniak et al., 1972 -- before the days of MRI or even CT scans). This case history is even more disturbing and involves greater criminal offenses than the patient of Burns and Swerdlow (2003).

A description and analysis of various disorders of sexual impulse are presented. They occurred gradually between the ages of 56 and 60 years in a man previously in good health. The disorders were as follows: harlotry, incestuous intercourse with his under-age daughter [used physical violence and threatened to kill her if she told], sodomy, hetero- and homosexual pedophilia, masochism [he demanded that his wife beat him with a club] with some symptoms of sadism, coprolalia and exhibitionism. [Also bestiality with cows and calves.] Pedophilia and exhibitionism [he fancied wearing a red ribbon around his exposed penis] were the counts of the man’s indictment. After twice-repeated forensic and psychiatric examination and observation, sexual psychopathy and male climacteric were also recognized; and the defendant was acknowledged to be responsible. In the course of further examination, the psychoorganic syndrome with symptoms of moria was recognized clinically. Further specialist examinations, especially by X-ray (pneumoencephalography) showed the presence of neoplasm (probably benign glioma or meningioma) situated at the basal paracentral part of the right forehead lobe [right orbitofrontal cortex again]. Its presence being acknowledged, the defendant was found irresponsible; due precautions and eventual neurosurgical treatment were proposed. It has been stressed that the appearance of the above disorders, especially in view of the age of the subject, must lead one to suspect an organic origin.
During the trial (reminiscent of the proceedings against serial child killer and cannibal Albert Fish), expert witnesses for the prosecution found nothing organically wrong, and declared the defendant “at the moment of committing the criminal acts he was charged with, had retained the ability to recognize the significance of these acts, whereas his ability to control his acts had been slightly restricted”. The defendant was found guilty, the defense appealed and a retrial was granted. He was placed under observation for 2 months at the Psychiatric Clinic in Cracow, when the authors became involved in his case:

The neurological examination revealed a considerable bilateral impairment of smell [a tell-tale sign of bilateral orbitofrontal damage] and a marked inequality of the reflexes of the lower extremities: the knee jerks and ankle jerks were weaker on the right. The EEG tracings showed a marked generalized flattening with scattered low-voltage theta waves. After stroboscopy the number of delta waves in the frontal and anterior temporal regions increased bilaterally.

...The pneumoencephalogram revealed ... a filling defect in the frontal horn of the right lateral ventricle which was, moreover, shifted dorsally... The radiological conclusion was that a tumour was present in the parabaso-central portions of the right frontal lobe.
The authors concluded their article with a fascinating discussion of sexual psychopathy, organic brain injury, and the question of legal responsibility. Thirty years before neuroethics and neurolaw emerged as recognized fields of study. And without the benefit of MRI.

A case of hair fetishism, transvestitism, and organic cerebral disorder

An unusual noncriminal case from Australia was reported by Dr. Ball (1968). The paper includes the author's regressive views of women and a Freudian explanation for hair fetishism:

Early in 1965 a forty six year old man suffering from severe anxiety was admitted to hospital. He had married after a short engagement, one month prior to admission, despite evasion and procrastination on his part. The marriage followed a brief courtship conducted with great ferocity by a childless widow in her early forties. Between the marriage and hospitalisation the patient became increasingly agitated, running away four times. The agitation had increased as his wife’s sexual demands stimulated his life-long hair fetishism and triggered fantasies of transvestitism which had been absent for some years.

When aged four, he became acutely upset on the day that his mother was about to have her long hair bobbed. As a result of his screaming and violent rage, the mother’s hair was not cut... Thereafter, the patient became increasingly preoccupied with long female hair. ... At about ten years of age he also began to transvest in his sister’s clothing. The transvestitism continued sporadically until his late thirties. ... He attempted intercourse very rarely and then with little success and less satisfaction.
Dr. Ball went on to state that "Hair fetishism can be the product of complex symbolisation." He also speculated that the boy's "aggressive outburst, associated with his mother’s hair, could have resulted in sexual stimulation." Yeah, OK, so where's the organic cerebral disorder? As a boy, the patient was delayed in walking and talking, was clumsy, and showed poor motor coordination. Doctors at the time (in the 1920s) could find nothing physically wrong with him. Back to the present day (1965), his demanding and ferocious wife had witnessed several nighttime grand mal seizures. And the guy's hair fetish was getting worse. When admitted to hospital the patient had abnormalities in his right hand and arm. He was diagnosed with:

invasive tumour affecting the left temporal region. [The tumor was causing the seizures.] It was felt that surgery was not indicated. He has since been maintained on an anticonvulsant, (Phenytoin Sodium), antiparkinsonian agents, (Benzhexol HCL [a muscarinic antagonist, not a dopamine drug]), and a phenothiazine, (Thioridazine [antipsychotic]). The phenothiazine was recently discontinued without ill effect. His epilepsy is less frequent, the abnormality of his right arm has not progressed and his fetishism is only occasionally troublesome. His sexual potency is much reduced, but his wife though despondent, copes well.
Or so the story goes.

Stroke turns Gay Man Straight!

A 57-year-old gay man, comfortable with his identity and aware of his sexual orientation since his early teens, came to the attention of Jawad et al. (2009) after suffering a stroke in the distribution of the left middle cerebral artery. He had experienced an earlier stroke 12 years before, a minor one in his right hemisphere but recovered completely. However...
The patient started complaining of his changed personality and heterosexual orientation 6 months after his second stroke. At the same time he complained of excessive mood swings and changed interests. He became preoccupied with photography and had a successful photographic exhibition a year after his second stroke. His sexual orientation remained heterosexual 4 years following the second stroke, and he preferred to describe himself as bisexual because of his previous homosexual orientation.

The authors did not present neuroimaging findings or results from neurological examination, which seems peculiar for a paper published in 2009. There was no mention of language or motor disturbances, but one is left to wonder. The middle cerebral artery is the blood supply for a rather large swath of cortex, so it's unclear exactly where the lesion was located. However, the authors do raise the obvious point that a change in sexual orientation is very unusual. Hyposexuality most often occurs after stroke (Tamam et al., 2008) and sometimes hypersexuality can be seen after brain injury (Miller et al., 1986). The Neurological Correlates blog describes two new cases of the latter in Manic Monday (late edition): Sudden hypersexuality.

Human sexuality is such a complex and multi-determined phenomenon that it's impossible to draw generalizations from the mix of case studies in the neurological literature. And it's important to avoid extrapolation from the few to the many. Very few people with temporal lobe epilepsy are transvestites or bisexuals, and the vast majority of transvestites and bisexuals do not have TLE. And all you fundamentalist reparative therapy advocates, take note: There is only one report in the literature of a "stroke turning a gay man straight." !! Nonetheless, it is informative to gather information about changes in sexuality and to relate them to lesions in specific brain areas, most often the frontal lobes (orbitofrontal cortex in particular) and the anterior and medial temporal lobes.


1 However, the specificity of the "TLE personality" classification is disputed by others (e.g. Mungus, 1982) who maintain that a substantial portion of the variance can be accounted for by psychiatric illness.


Ball, J. (1968). A CASE OF HAIR FETISHISM, TRANSVESTITISM, AND ORGANIC CEREBRAL DISORDER. Acta Psychiatrica Scandinavica, 44 (3), 249-254. DOI: 10.1111/j.1600-0447.1968.tb07511.x

Burns JM, Swerdlow RH. (2003). Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign. Arch Neurol. 60:437-40.

Currier RD, Little SC, Suess JF, Andy OJ. (1971). Sexual seizures. Arch Neurol. 25:260-4.

Jawad, S., Sidebothams, C., Sequira, R., & Jamil, N. (2009). Altered Sexual Orientation Following Dominant Hemisphere Infract [sic]. Journal of Neuropsychiatry, 21 (3), 353-354. PMID: 19776328

Langevin R. (2006). Sexual offenses and traumatic brain injury. Brain Cogn. 60:206-7.

Lesniak, R., Szymusik, A., & Chrzanowski, R. (1972). Multidirectional disorders of sexual drive in a case of brain tumour. Forensic Science, 1 (3), 333-338. DOI: 10.1016/0300-9432(72)90031-3

Mascia A, Di Gennaro G, Esposito V, Grammaldo LG, Meldolesi GN, Giampà T, Sebastiano F, Falco C, Onorati P, Manfredi M, Cantore G, Quarato PP. (2005). Genital and sexual manifestations in drug-resistant partial epilepsy. Seizure 14:133-8.

Miller BL, Cummings JL, McIntyre H, Ebers G, Grode M. (1986). Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry 49:867-73.

Spencer SS, Spencer DD, Williamson PD, Mattson RH. (1983). Sexual automatisms in complex partial seizures. Neurology 33:527-33.

Tamam Y, Tamam L, Akil E, Yasan A, Tamam B. (2008). Post-stroke sexual functioning in first stroke patients. Eur J Neurol. 15:660-6.

Medellin's famous transvestite's debut on the silver screen

A group of Canadian filmmakers are releasing a movie on La Dany, the Medellin transvestite street artist that makes Andy Warhol look like a boring heterosexual. The film will see its first screening in Colombia's second largest city on Tuesday.

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Friday, October 23, 2009


A proto-Live Journal moment from The Inman diary: a public and private confession, Volume 2. By Arthur Crew Inman. Edited by Daniel Aaron.

"HYPERGRAPHIA", a film currently in production... a narrative feature recounting the true story of the notorious Boston eccentric and recluse Arthur Crew Inman (1895-1963) and of "THE INMAN DIARY" he created. Published by Harvard University Press, Inman's gargantuan diary is one of the great literary curiosities of our age, a sprawling memory piece of more than 17 million words. A black comedy of epic proportions, the screenplay is a tightly wound biographical journey with documentary elements drawn from the extensive Inman Collection at Harvard. Historical scenes evoking world events of the first half of the 20th century (stock footage, news headlines, period movie montages) will be integrated with events from the entire 68 years of Inman's life and a good deal of human history in between, - a sort of March of Time with Arthur Inman as self-appointed narrator.
Hypergraphia, the behavior is defined as an overwhelming urge to write, often associated with the manic phase of bipolar disorder and with temporal lobe epilepsy (as one in a cluster of symptoms). Influential behavioral neurologist Norman Geschwind described the personality changes that can be observed in persons with temporal lobe epilepsy in a series of lectures1 and papers from the 1970s and 80s (reviewed in Devinsky & Schachter, 2009). He viewed these changes as:
...resulting from a stimulating lesion in the limbic system. This neurobiology accounted for the overarching increased interictal [time between seizures] emotionality that underlay the increased religious interests, hypergraphia, increased aggression, increased moral and philosophical concerns, viscosity, and seriousness (lack of humor).
Russian novelist Fyodor Dostoevsky is the classic example (see Crime and Punishment, The Brothers Karamazov, etc.). According to Geschwind,
Dostoevsky typified many personality features of the temporal lobe epileptic—tremendous concern about moral details, many of them small details, extremely pedantic, he was angrily impulsive, an impossible person to live with in every way, and extremely aggressive, even toward people who had befriended him. Yet he was also deeply emotional and despite these negative personality traits, many of those close to him felt a strong emotional bond.

From Dostoevsky, by Richard Freeborn. Also see Dostoevsky's Doodles, an exhibit held at the Harriman Institute.

In 1974 Waxman and Geschwind (reprinted in 2005) described copious writing and temporal lobe seizures in a series of patients:
The phenomenon of hypergraphia, or the tendency toward extensive and, in some cases, compulsive writing, in temporal lobe epilepsy is described in seven patients, in each of whom there was electroencephalographic demonstration of a temporal lobe focus. Unusually detailed and strikingly copious writing was evidenced in each patient. Six patients provided documentation of their extensive writing, which often was concerned with religious or moral issues. A seventh patient claimed to have written extensively, but refused to exhibit his writings. Aggressiveness, religiosity, and changes in sexual behavior in temporal lobe disorders have been described previously. The hypergraphia of temporal lobe epilepsy appears to be part of a specific behavioral syndrome of special interest because of its association with dysfunction at specific anatomic loci.
Did Arthur Inman have temporal lobe epilepsy? It seems his hypergraphia might have been more psychiatric in nature, driven by a combination of obsessive-compulsive behavior, grandiosity, self-loathing, and paranoia.

From The Inman diary.

Inman was also an extreme hypochondriac. A series of "thirty-four eminent doctors" (plus his long-time osteopath) could find nothing physically wrong with him. However, a 1988 article in The Atlantic explored the possibility that Inman did indeed have temporal lobe epilepsy (TLE):
As for Inman, clearly he had many, if not all, of the traits of the behavior syndrome. On a questionnaire designed by [neuropsychiatrist David] Bear and the psychologist Paul Fedio to determine the extent to which the syndrome is present in patients [Bear & Fedio, 1977],2 Inman scores well within the range of people with TLE and substantially above the control groups. The questionnaire was filled out for Inman separately by Bear and by Libby Smith, one of the editors of The Inman Diary. Smith, who spent seven years reviewing the unabridged diary and interviewing scores of people who knew its author, had never heard of TLE. Both she and Bear gave Inman high marks in nearly all of the eighteen traits listed on the questionnaire. ... "Compulsive attention to detail," for example, describes Inman's need to make lists and keep to rigid schedules. His childlike charm and tendency to fly into rages translate into high scores in several categories: "dependence," "deepening of all emotions," "humorlessness," and "paranoia." And his effort to chronicle his era demonstrates his "grandiosity" and "sense of personal destiny."


1 A 1974 lecture from Geschwind's course at Harvard Medical School (on The Neurology of Behavior) was reprinted in the journal Epilepsy & Behavior in 2009.

2 The view of a distinctive TLE personality is not without controversy, however. Some clinicians maintain that a substantial portion of the variance can be accounted for by psychiatric illness, e.g. Mungus (1982) who reported that:
...none of the 18 traits (Bear & Fedio, 1977) discriminated among a group of temporal lobe epileptics with behavioral-psychiatric disorders, a group of patients with concomitant neurological and behavioral-psychiatric disorders, and a group of patients with psychiatric but not neurological illness.


Devinsky, J., & Schachter, S. (2009). Norman Geschwind’s contribution to the understanding of behavioral changes in temporal lobe epilepsy: The February 1974 lecture. Epilepsy & Behavior, 15 (4), 417-424. DOI: 10.1016/j.yebeh.2009.06.006

Geschwind N. (2009). Personality changes in temporal lobe epilepsy. Epilepsy Behav. 15:425-33.

Waxman SG, Geschwind N. (2005). Hypergraphia in temporal lobe epilepsy. Epilepsy Behav. 6:282-91.

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Monday, October 19, 2009

EEG Speed Dating

Lust or Love?
The Science of Love

In Joyce Draganosky's The Science of Love, the battle between reason and emotion takes center stage. A professor, who believes she has found a way of determining scientifically whether someone is in love, clashes with her department chair, a woman who thinks love and attraction are far too complex to be mapped according to the certainties of science.
The director seems to have modeled her lead character after Helen Fisher, even down to the combination of evolutionary anthropology with brain imaging. Joy Hirsh at Columbia was a scientific consultant.

Further Reading (and viewing):

The Science of Love - Link to watch the entire short film (only if you live in the U.S.)

The EEG Mixer - Neurocritic classic

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Monday, October 12, 2009

The Hyperscanning of 'Paranormal Activity': A Neurocinematic Study of Collective Fear

Still from the promotional trailer for that viral movie phenomenon, Paranormal Activity.

Not since The Blair Witch Project (1999)1 ten years ago (in the BT [Before Twitter] dark ages) has there been such a grassroots "underground" buzz surrounding a cult-like, deliberately amateur, mega-scary, "found" reality footage-type movie. Unlike its predecessor, Paranormal Activity does get to benefit from Twitter as a trending topic:
Paranormal Activity is a popular topic on Twitter right now.

A ultra low-budget horror film about a couple experiencing demonic forces at night. The US limited release was Sept. 29, 2009, and there will supposedly be a nationwide release if it gets a million votes on Eventful.

51 more tweets since you started searching.

Here's the trailer:

Beyond word-of-mouth from the original target demographic attending midnight shows in college towns, mainstream media outlets such as CNN have picked up on the buzz:
Surprise hit 'Paranormal Activity' scares money out of moviegoers

updated 8:01 p.m. EDT, Mon October 12, 2009

(CNN) -- The new horror movie "Paranormal Activity" could be filling movie studio marketing departments with fear.

Using a campaign of limited showings, social media and word-of-mouth fan buzz, the film has managed to become a breakout hit without the aid of a glitzy marketing campaign -- or even a traditional movie trailer.

According to Variety, the very low-budget film (it reportedly cost $11,000), which played in fewer than 200 theaters, raked in $7.1 million over the weekend -- a record for a limited-release film. The film had an impressive $44,163 per-screen average and placement in the top five of the box office ratings over the weekend.
Most relevant for the ongoing Neurocinema Collection™ is this observation:
"Watching it with 250 strangers in a movie theater and getting everybody to jump at the same time definitely has an effect," [Kevin Carr] said. "It's the event film right now of the year, which is something that needs to be experienced."
"Watching it with 250 strangers in a movie theater" is the key phrase. We'll return to that later.

In the last post we learned about the new interdisciplinary field of “neurocinematic” studies. The term first appeared2 in the scholarly journal Projections: The Journal for Movies and Mind, in a 2008 paper written by Hasson and colleagues:
This article describes a new method for assessing the effect of a given film on viewers’ brain activity. Brain activity was measured using fMRI during free viewing of films, and inter-subject correlation analysis (ISC) was used to assess similarities in the spatiotemporal responses across viewers’ brains during movie watching. Our results demonstrate that some films can exert considerable control over brain activity and eye movements. However, this was not the case for all types of motion picture sequences, and the level of control over viewers’ brain activity differed as a function of movie content, editing, and directing style. We propose that ISC may be useful to film studies by providing a quantitative neuroscientific assessment of the impact of different styles of filmmaking on viewers’ brains, and a valuable method for the film industry to better assess its products.
The NYU researchers, led by Uri Hasson (now at Princeton), claim to study "to what extent are we all alike?"3 The research program originated in the laboratory of Prof. Rafael Malach and first hit the Science scene in 2004. In that study, five participants watched the first 30 min of The Good, The Bad, and The Ugly in an MRI scanner. The data were analyzed to determine commonalities in brain activation across subjects, revealing that 25% of the cortex showed significant intersubject correlation during the movie. The Projections article summarizes the results from subsequent experiments and develops the idea that different directors, and different filmmaking styles, exert varying levels of "control" over audio-visuo-higher-level cortical responses in the brains of the viewers.

This is all very interesting, you say, but it doesn't mimic the real life movie-going experience. How can you possibly evaluate the neural effects of watching a scary movie in a theater with 250 strangers?

The Hyperscanning of 'Paranormal Activity': A Neurocinematic Study of Collective Fear

In this imaginary experiment,4 the viewing experience is enhanced through several means. While in laying supine in the MRI scanner, individual research participants watch a specially-made DVD of Paranormal Activity shot from the perspective of the audience, as in the trailer. To encouraging bonding among the research subjects, the cool "hyperscanning" methodology is used. This technique was developed by Read Montague and his co-workers (Montague et al., 2002). Typically, hyperscanning involves two subjects who interact with each other while their brains are scanned simultaneously (in adjoining or distant magnets). Specially developed software (Networked Experiment Management Objects, or NEMO) coordinates the experiments across sites:
The scarcity of neuroimaging resources limits the ability to perform multi-subject experiments within the same facility, necessitating the ability to simultaneously scan across multiple institutions. Furthermore, in order to correlate behavior and brain activation among participants, sites participating in Hyperscan experiments must be synchronized so that the behavioral and imaging data gathered during the experiment can be reconciled to a common timeline.

Professional software developers at the Human Neuroimaging Laboratory (HNL) have created a distributed framework for executing Hyperscan experiments. The framework, called NEMO, consists of client and server components written in Java, a SQL database for storing experiment metadata and results, an experiment script execution environment based on the Jython scripting language, and pulse-sequence customizations to facilitate network-initiated scanning.
For our fright-filled neurocinematic study, five friends are scanned simultaneously. Each subject is informed that he/she will be watching the movie at the exact same time as the others, experiencing the exact same scanner environment (which can be claustrophobic, even under calm conditions). They're instructed that they must be still. They're asked to view the movie as a shared experience -- shared with the audience and with their friends. In an alternate scenario, ten strangers can meet each other beforehand through video conferencing and follow the same procedures. In either case, the data are analyzed for intersubject correlations not only in the cortex, but also in subcortical regions important for emotion (amygdala) and memory (hippocampus).

What percentage of brain activity will be correlated across subjects? Hasson et al. (2008) discussed the continuum of control employed by filmmakers: real life --> documentaries --> art films --> Hollywood --> propaganda. The filmmaking style of PA is not at all sophisticated in the vein of Alfred Hitchcock Presents, which
evoked similar responses across all viewers in over 65 percent of the cortex, indicating a high level of control of this particular episode on viewers’ minds.
Nevertheless, despite using shaky-cam real life amateurish filmmaking with little editing, the viewers' attention is directed to restricted locations: the bed, the door, the hallway, Katie Featherston's breasts [just out of frame, but there are a lot of deliberate close-ups], her face. These would activate category-specific regions in the visual processing stream: the parahippocampal place area, the fusiform face area, the extrastriate body area. Importantly, emotional reactions might be similar among like-minded friends, adding a new dimension to the ISC data.

But will the study provide a privileged (neural) measure of collective fright, beyond what can be revealed by eye movements and by peripheral autonomic responses such as heart rate and skin conductance? I don't know, but it'll sure make for great articles in Wired and CNN. And Science. Be sure to mention me in the Acknowledgments.

What is my opinion of Paranormal Activity? I went to the late show tonight, and I have to say...... the movie is WAY overrated.5 I didn't find it scary at all. You're waiting so long for something to happen, that a slight noise or movement of the door or a brief shadow are supposed to be scary. I kept waiting to jump out of my seat but never did, not even in the last 30 seconds. The trailer for Shutter Island was more frightening.


1 I thought BWP was highly overrated and not scary at all.

2 Correct me if I'm wrong.

3 From a neuroscientific standpoint, certain aspects of these findings can be considered trivial, as noted by an anonymous commenter. For this post, I have adopted a willing suspension of disbelief for artistic purposes.

4 For an earlier post about another fake experiment, see The Neurology of Twitter:
It was bound to happen. Some neuroimaging lab will conduct an actual fMRI experiment to examine the so-called "Neural Correlates of Twitter" -- so why not write a preemptive blog post to report on the predicted results from such a study, before anyone can publish the actual findings?
5 For like-minded reviews, see the Austin Chronicle and the New York Times.


Hasson U, Landesman O, Knappmeyer B, Vallines I, Rubin N, Heeger DJ. (2008). Neurocinematics: The Neuroscience of Film. Projections 2:1-26. [PDF]

Hasson U, Nir Y, Levy I, Fuhrmann G, Malach R. (2004). Intersubject Synchronization of Cortical Activity During Natural Vision. Science 303:1634-1640.

Montague PR, Berns GS, Cohen JD, McClure SM, Pagnoni G, Dhamala M, Wiest MC, Karpov I, King RD, Apple N, Fisher RE. (2002). Hyperscanning: simultaneous fMRI during linked social interactions. Neuroimage 16:1159-64.

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Neurocinema, Neurocinematics

Is there a difference?

In The Neurocinema Collection™, we established that the term "neurocinema" doesn't really refer to movies with "Neuro" in the title or films about neurology. Instead, neuromarketers have have used the word in the following fashion:
Neurocinema is a new filmmaking process that studies a viewer's sensorimotor, cognitive, and affective response to film stimuli. Researchers use technologies such as functional magnetic resonance imaging (fMRI) to measure changes in activity in parts of the brain,electroencephalography (EEG) to measure activity in specific regional spectra of the brain response, and/or sensors to measure changes in one's physiological state (heart rate, respiratory rate, galvanic skin response) to learn exactly what scenes excite or disinterest the viewer.
There have been no peer-review studies on this methodology, only articles in the popular press (e.g., and And from what was available in those reports, there was plenty to be neurocritical about.

On the other hand, Uri Hasson and his NYU colleagues published an article entitled Neurocinematics: The Neuroscience of Film in Projections: The Journal for Movies and Mind. Granted, that article is lacking the methodological details one would see in NeuroImage or Human Brain Mapping, but in fact the authors have published their work in prestigious journals (like Science and Neuron) without the "Neurocinematics" title.

In their Projections article, Hasson et al. (2008) state:
We propose that ISC [inter-subject correlation analysis] may be useful to film studies by providing a quantitative neuroscientific assessment of the impact of different styles of filmmaking on viewers’ brains, and a valuable method for the film industry to better assess its products. Finally, we suggest that this method brings together two separate and largely unrelated disciplines, cognitive neuroscience and film studies, and may open the way for a new interdisciplinary field of “neurocinematic” studies.

Hasson and colleagues first described the ISC method in their 2004 paper. In that study five subjects watched 30 min of The Good, The Bad, and The Ugly while laying supine in an MRI scanner. Unlike a typical fMRI experiment involving controlled presentation of individual pictures and performance of a categorization task, free viewing of a dynamic film is a more naturalistic situation. It also presents a more challenging data analysis problem. To tackle this, the researchers eschewed standard hypothesis-testing and adopted a purely data-driven approach to determine commonalities in brain activation across subjects.1

Figure 1B (Hasson et al., 2008). The ISC analysis measures similarity in brain activity across viewers by comparing the response time course in each brain region from one viewer with the response time courses obtained in the same brain region from other viewers during movie watching.

The results (Hasson et al., 2004) demonstrated that...
Despite the free viewing and complex nature of the movie, we found an extensive and highly significant correlation across individuals watching the same movie. Thus, on average over 29% ± 10 SD of the cortical surface showed a highly significant intersubject correlation during the movie.....

Close inspection of this across-subject correlation revealed that the synchronization was far more extensive than the boundaries of well-known audiovisual sensory cortex defined with conventional mapping approach. ...the across-subject correlation covered most of the visual system, including early retinotopic areas as well as high-order object areas within the occipitotemporal and intraparietal cortex. Moreover, the correlation extended far beyond the visual and auditory cortices to the entire superior temporal (STS) and lateral sulcus (LS), retrosplenial gyrus, even secondary somatosensory regions in the postcentral sulcus, as well as multimodal areas in the inferior frontal gyrus and parts of the limbic system in the cingulate gyrus.
When corrected for non-selective elements, the intersubject correlation remained at 24% ± 8.5. The other 75% of the brain not "in sync" across subjects included parietal lobe areas (supramarginal and angular gyri) and the bulk of prefrontal cortex. Subcortical areas important for emotion and memory (amygdala and hippocampus) were not examined.

A second analysis was also performed, which took a "reverse-correlation" approach to examine activity in two well-know category-specific areas: the fusiform face area (for faces) and the parahippocampal place area (for buildings). This type of functional specialization was demonstrated in an earlier paper as well (Bartels & Zeki, 2004). In that study, the participants watched a James Bond movie (Tomorrow Never Dies). Activity in category-specific regions (for color, faces, language, and human bodies) was correlated with the perceived intensity of these specific attributes (as rated by a separate group of subjects who watched the same movie).

The most fascinating result in my opinion was obtained in subsequent experiments (described in Hasson et al., 2008) that compared the ISC for The Good, The Bad, and The Ugly to those observed for an episode of the TV series Alfred Hitchcock Presents (which is on Hulu!!!), an episode of the semi-improvised comedy Curb Your Enthusiasm, and a real-life unedited video shot in Washington Square Park. Not surprisingly,
The extent of ISC differed for the four movies (Figure 7A). The percentage of cortex exhibiting high ISC provided a measure of the overall effectiveness, or collective engagement power, of each movie to induce similar responses across viewers (Figure 7B). The Hitchcock episode (green) evoked similar responses across all viewers in over 65 percent of the cortex, indicating a high level of control of this particular episode on viewers’ minds. The high ISC was also extensive (45%) for the Good, the Bad and the Ugly (blue), but much less so (18%) for Curb Your Enthusiasm (red). Finally... the unstructured segment of reality (orange) induced high ISC only in a small fraction of the cortex (less than 5%).

Figure 7 (Hasson et al., 2008).

Glossing over the technical details [I didn't read the 5 other cited papers] and discrepancies between the 2004 and 2008 studies [divergence in ISC values of 25% vs. 45% for the same film], the implication is that different directors, and different filmmaking styles, exert varying levels of "control" over audio-visuo-higher-level cortical responses in the brains of the viewers:
The fact that Hitchcock was able to orchestrate the responses of so many different brain regions (Figure 7, green), turning them on and off at the same time across all viewers, may provide neuroscientific evidence for his notoriously famous ability to master and manipulate viewers’ minds. Hitchcock often liked to tell interviewers that for him “creation is based on an exact science of audience reactions” (Douchet 1985).

Different filmmakers strive to achieve different levels of control over their viewers’ reactions. Our findings provide empirical evidence to support the long-lasting distinction in film theory between films that remain faithful as much as possible to reality and those that seek to control or distort it.
The amount of control employed by filmmakers exists on continuum that ranges from real life --> documentaries --> art films --> Hollywood --> propaganda. The authors conclude with a discussion of collective engagement in film and suggest that it can be measured in an "objective" fashion using ISC. Overall, the 2008 Projections paper was a BOLD proposal for a true merger of art and science in academia.

Neurocinema, Neurocinematics? A semantic distinction perhaps, but the terms first appeared in different contexts. The former was used to describe an unvalidated filmmaking "process" [and underdeveloped commercial application] aimed squarely at attracting Hollywood megabucks, whereas the latter was used in a scholarly publication to describe a new field of inquiry. Will a merger (of sorts) be far behind? Or more to the point, has the NYU group applied for a patent yet?


1 The methods for this were pretty brief and largely contained within Footnote 15 of the paper:
15. In order to search for correlation between two corresponding regions across subjects (intersubject correlation), we first aligned all brains into Talairach coordinate system and used a Gaussian filter of 12 mm full width at half maximum value (FWHM) to the data... To remove preprocessing artifacts, we excluded the first and last 10 time points of the experiment from the analysis. We then used the time course of each voxel of the source subject as a GLM predictor for modeling the activity in the corresponding voxel of the target subject. Only voxels whose P value was no more than 0.05 (corrected) were considered significant.

Bartels A, Zeki S. (2004). Functional brain mapping during free viewing of natural scenes. Hum Brain Mapp. 21:75-85.

Hasson U, Landesman O, Knappmeyer B, Vallines I, Rubin N, Heeger DJ. (2008). Neurocinematics: The Neuroscience of Film. Projections 2:1-26. [PDF]

Hasson, U. et al. (2004). Intersubject Synchronization of Cortical Activity During Natural Vision. Science, 303 (5664), 1634-1640. DOI: 10.1126/science.1089506

Further Reading

Neurocinematics - The Valve - A Literary Organ

Neurocinematics - Neurophilosophy blog

Neurocinematics! Where Neuroscience Meets Filmmaking - NYU panel discussion held May 4, 2009

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