Category: Featured

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!

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.

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 WilfulContrast 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!

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

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 LandscapeThe 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 PortrayalThe 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 TitleThe 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!

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

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

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

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

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

Anne Sexton

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

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

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

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

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

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

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

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

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

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

Most dictionaries describe religion as “a way of life”. Religious beliefs, practices and experiences of individuals in our society, appear to have a strong cultural basis in their evolution and have been described as part of every ancient civilisation discovered and studied by modern man. On the face of it, therefore, it seems inconceivable that religious experiences may have biological basis in our brains.Several questions remain unanswered in our quest to understand how religious experiences occur. Why are some people intense in their religious beliefs and practices and others considerably less enthusiastic? Or indeed, why do one’s religious attitudes, beliefs and practices change during a life span, progressing sometimes: from atheism to agnosia to intense religiosity (or indeed in the converse direction)? Can socio-cultural factors alone have such influence on our lives, or are there more inherent biological determinants of these experiences and behaviours? Empirical observation suggests that a simple sociocultural explanation may be inadequate. There are for example considerable differences in religious attitudes and practices between siblings born of the same set of parents. The socio-cultural ethos in this situation is a virtual constant. Yet variations in the quality, frequency and intensity of religious experiences are observed and it’s not uncommon to witness the entire spectrum, from intense religiosity to a strong atheistic tendency within the same family. While psychological experiences and social factors unique to each individual may have a significant role in determining these variations, they are often conjectures that arise from social and clinical observation.

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

A God Module in the Brain?Perhaps the most dramatic recent description of hyper-religiosity in epilepsy is that of V.S. Ramachandran in his book “Phantoms in the Brain”. In a chapter provocatively titled “God and the Limbic System”, Ramachandran draws on his clinical experience to give the reader an evocative description of a hyper-religious patient with temporal lobe epilepsy. He describes the dramatis persona complete with religious symbols and a prophetic fervour, accompanied by a firm belief (in that individual) that his life had special meaning and his existence a special purpose for the world we live in. While Ramachandran’s subject had symptoms that were decidedly exaggerated (a caricature rather than the norm), hyper-religiosity in people with TLE evolves over time (a trait phenomenon), not just appearing suddenly (as in a state phenomenon). Ramachandran poses the interesting question “is religiosity a pre-determined biological trait”; paraphrased, this could read “is there a god module in the human brain?” Research using MRI volumetry and functional MRI (fMRI) techniques have demonstrated rather interestingly, links between structures in the limbic brain, especially the hippocampus and religiosity. Indeed, one paper that I co-authored (Wuerfel et al, 2004) demonstrated links between a small right hippocampus and hyper-religiosity in epilepsy.

Unanswered QuestionsWhile putative associations between religious experiences and the limbic system have been demonstrated, a number of questions remain unanswered.First, what exactly is normal religiosity and what is hyper-religiosity? One suspects that this in itself is subject to transcultural influences. Western studies report about a third of people surveyed as being “religious” or “very religious”. We surveyed over 500 people using a suburban railway booking counter in Chennai and found almost 70 per cent of all individuals qualified as being “religious” or “very religious”. In the Indian social context, where religious expressions and beliefs are common place, the phenomenon of hyper-religiosity can be difficult to define. For example, in our Chennai survey, when we described hyper-religiosity as being two standard deviations from the median score in our questionnaire, we found only a small proportion of people qualified. Social norms of “normal religiosity” will therefore have a significant impact on what we perceive in each culture as hyper-religiosity.Second, are religious experiences a trait or state phenomenon? It seems clear that religiosity can be both a state and trait phenomenon when observed across the spectrum of neuropsychiatric disorders. Contrary to popular perception, trait behaviours do not stop developing with the onset of adulthood and continue to evolve subtly over many years. It is conceivable that religiosity as a trait behaviour in people with neuropsychiatric disorders may exist from early on, but become very much more apparent during the course of the lifespan, periods of acute emotional distress being particularly prone for religious expression. On the other hand, hyper-religiosity may also be a pure state phenomenon, as observed in mania or acute psychotic episodes, with the person reverting to baseline levels of religious expression, post-episode. In a person without neuropsychiatric illness the religiosity trait may evolve over a lifespan, and depending on life experience may enhance or become muted. Our religiosity may also periodically achieve enhancement during times of adversity, sorrow and grief or indeed euphoria; times when we instinctively reach out to powers beyond.Third, is religiosity a natural consequence of adversity rather than a pathological process? It seems entirely plausible, when viewed from a psychological perspective, that individuals meet adversity in their lives with an increase in religious interest and or experience. Indeed, society encourages and endorses such reactive religiosity and acute emotional breakdown states are often described as spiritual experience or transformation. The flight into hyper-religiosity in the context of a neuropsychiatric disorder may well be a helpful, socially endorsed coping mechanism; spiritual excess being better accepted in society than emotional distress. Why hyper-religiosity disappears in many disorders with the resolution of neuropsychiatric symptoms, and persists in others even after their resolution, does of course beg answers.Fourth, is hyper-religiosity a pathological phenomenon? With the finding of a small right hippocampus being associated with hyper-religiosity and other descriptions of altered limbic physiology in this state, it seems conceivable that biological influences may in some way affect the development or maintenance of hyper-religiosity. Is hyper-religiosity as behaviour pathological? To decide this, one would typically have to refer to the individual’s previous background (personal and socio-cultural) in the religiosity context. Religious behaviours especially those with sudden onset and not in keeping with the person’s background may well be, from a behavioural perspective, pathological.Finally, are the changes in limbic system structure and activity identified in brain imaging of hyper-religious individuals, a cause or consequence of this behavioural predilection? Changes in limbic system structure and function are thought to accompany the longitudinal course of many neuropsychiatric disorders: epilepsy, schizophrenia and depression to name a few conditions. Clarity about what precedes (structural change or behaviour) remains elusive and the changes observed in the brain may thus be both cause and consequence, the brain being a remarkably plastic organ.

Final analysisSo is there a god module in our brain? The evidence available seems to indicate that our emotional brain, the limbic system, the hippocampus in particular, perhaps more on the right side, plays a significant role in determining the nature and quality of one’s religious experience and expression. It is very likely, the rich neuro-chemical networks that populate this region, including dopamine and serotonin, have considerable influence on our religiosity, notwithstanding the alteration of brain structure, right hippocampal atrophy. Religiosity may thus be viewed as a trait, which can undergo both physiological and pathological evolution during the course of a person’s lifetime. The nature of the underlying biological framework in an individual is likely to determine the form, quantum and nature of religious experience and expression that psychosocial adversity and emotional illness provoke. The bio-psychosocial model of mental health and illness dictates that both the physiological and pathological manifestations of this trait marker are likely to be influenced strongly by the sociocultural ethos of the individual, as well as his psychological evolution during the course of a lifespan.We must acknowledge here, the very significant role that religion and spirituality play, in helping human beings maintain optimal emotional well being or indeed achieve restoration of emotional health after a breakdown. One must also acknowledge our collective ignorance, as a society, about the biological, neuropsychiatric and psychological effects and virtues of theism, atheism and their many-splendored, much-debated, interface. Whether our religious predilections have a role in protecting and preserving or indeed enhancing our emotional state, remains thus, a matter of conjecture. The influence of this god module in our brain, “The Almighty Within”, is however probably omnipresent, just as our ancients conceived the almighty himself to be. Strange then, indeed, are his ways!