Temporal Lobes

Temporal Lobe Functions

• Auditory
• Ventral visual stream
• Processing of auditory input
• Visual object recognition and categorization
• Long term storage of sensory input
• Amygdala – adds affective or emotional tone to sensory input and memories
• Hippocampus – cells code places in space and allow us to navigate space and remember where we are

Dominant Side (usually the left)

• Perception of words
• Process language related sounds
• Sequential analysis
• Increased blood flow during speech perception
• Process details, individual units
• Intermediate term memory
• Long term memory
• Auditory learning
• Retrieval of words
• Complex memories
• Visual and auditory processing

Dominant Temporal Lobe (usually left) Problems

• Decreased verbal memory (words, lists, stories)
• Difficulty placing words or pictures into discreet categories
• Trouble understanding the context of words
• Aggression, internally or externally driven
• Dark or violent thoughts
• Sensitivity to slights, mild paranoia
• Word finding problems
• Auditory processing problems
• Reading difficulties
• Emotional instability

Non-dominant Side Functions (usually the right)

• Perception of melodies
• Pitch/prosody
• Social cues
• Reading facial expression
• Increased blood flow during tonal memory
• Decoding vocal intonation
• Rhythm
• Visual learning

Non-dominant Temporal Lobe (usually right) Problems

• Difficulty recognizing facial expression
• Difficulty decoding vocal intonation
• Implicated in social skill struggles
• Trouble processing music
• Decreased social cues/context
• Poor visual imagery
• Decreased selective attention to visual input
• Decreased recall of nonverbal items – shapes, faces, tunes

Either or Both Temporal Lobe Problems

• memory problems, amnesia
• headaches or abdominal pain without a clear explanation
• anxiety or fear for no particular reason
• abnormal sensory perceptions, visual or auditory distortions
• feelings of déjà vu or jamais vu
• periods of spaciness or confusion
• religious or moral preoccupation
• hypergraphia, excessive writing
• seizures

Overview of Temporal Lobe Disturbance

• Disturbance of auditory sensation and perception
• Disturbance of selective attention of auditory and visual input
• Disorders of visual perception
• Impaired organization and categorization of verbal material
• Disturbance of language comprehension
• Decreased long term memory
• Altered personality and affective behavior
• Altered sexual behavior
• Inability to perceive or remember events
• Damage to the inferior aspect of the temporal lobe – decreased memory (conscious recall of information, in proportion to tissue damaged)

Temporal Lobe Personality

• proneness to aggressive outbursts
• overemphasis on trivia
• pedantic speech
• egocentric
• preoccupation with religion

Tests showing right ear advantage

• Digits
• Words
• Backward speech
• Morse code
• Difficult rhythms
• Ordering information

Tests showing left ear advantage

• Melodies
• Musical chords
• Environmental sounds
• Emotional sounds and hummed melodies
• Complex pitch perception

Learning Hints

In detail oriented classes sit on the left side of the classroom to process information with the right ear (information will go preferentially to the right ear and subsequently left hemisphere).

In creative or music oriented classes sit on the right side of the classroom to process information with the left ear (information will go preferentially to the left ear and subsequently right hemisphere).

Temporal Lobe Discussion with Abbreviated Case Studies

For too many years the temporal lobes have largely gone unnoticed. They are rarely talked about in psychiatric circles and, even most neurologists do not talk about the rich contribution they make to who we are and what we experience in life. Until we were able to map activity in the temporal lobes their function remained mysterious. Many professionals basically relegated them as arm rests for the brain. The brain imaging work we have done clearly shows that the temporal lobes play an integral part in memory, emotional stability, learning and socialization.

The most precious treasures we have in life are the images we store in the memory banks of our brains. The experiences. The sum of these stored images is responsible for our sense of personal identity and our sense of connectedness to those around us. Our experiences are significant in making us who we are. The temporal lobes, on either side of the brain behind the eyes and underneath the temples, store memories and images; they store our experiences. They help us define our sense of ourselves.

On the dominant side of the brain (usually the left side for most people) the temporal lobes are intimately involved with understanding and processing language, intermediate and long term memory, complex memories, the retrieval of language or words, emotional stability and visual and auditory processing.

Language is one of the keys to being human. It allows us to communicate with other human beings and it allows us to leave a legacy of our thoughts and actions for future generations. Receptive language, being able to receive and understand speech and written words, requires temporal lobe stability. The ability to accurately hear your child say, “I love you, daddy,” or to listen and be frightened by a scary story is housed in this part of the brain. The dominant temporal lobe helps to process sounds and written words into meaningful information. Being able to read in an efficient manner, remember what you read and integrate the new information relies heavily on the dominant temporal lobe.

Problems here contribute to language struggles, miscommunication and reading disabilities.

I often tell my patients that it is their memories that give them both their greatest joys and their greatest sorrows. Memories can make us strong and self-confident (remember the times you felt most competent) or they can bring us to our knees (remember your biggest mistakes). Memories influence every action and pattern of action you undertake. Essential components of memory are integrated and stored in the temporal lobes. When this part of the brain is damaged or dysfunctional memory is often impaired.

It is our memories that often sabotage our chances for success and effectiveness in situations. I once treated a couple with severe marital problems. The husband had problems with depression and attention deficit disorder. His wife tended to be rigid and unforgiving. Ultimately, it was her memories that destroyed the relationship. Shortly after they began therapy the husband was diagnosed with his problems and treated with medication. He got significant relief from his symptoms. Everyone, except his wife, noticed his improvement. Because his more positive behavior was new and inconsistent with her experience she could not see his progress and remained in old patterns of behavior. She blamed him and she was stuck on blaming him. Ultimately, the marriage died. It was her memories, rather than the new reality, which killed it.

Through our research we have also found that emotional stability is heavily influenced by this part of the brain. The ability to consistently feel stable and positive, despite the ups and downs of everyday life, is important for the development and maintenance of consistent character and personality. Optimum activity in the temporal lobes enhances mood stability, while increased or decreased activity in this part of the brain leads to fluctuating, inconsistent or unpredictable moods and behaviors.

The non-dominant temporal lobe (usually the right) is involved with reading facial expressions, processing verbal tones and intonations from others, hearing rhythms, appreciating music and visual learning.

Recognizing familiar faces and facial expressions and being able to accurately perceive voice tones and intonations and give them appropriate meaning is critical to social skill. Being able to tell when someone is happy to see you, scared of you, bored or in a hurry is essential for effectively interacting with others. A Quaglino, an Italian opthamologist, reported on a patient in 1867 who, after a stroke, was unable to recognize familiar faces despite being able to read very small type. Since the 1940s more than 100 cases of prosopagnosia (the inability to recognize familiar faces) have been reported in the medical literature. Patients who have this disorder are often unaware of it (right hemisphere problems are often associated with neglect or denial of illnesses) or they may be ashamed at being unable to recognize close family members or friends. Most commonly, these problems were associated with right temporal lobe problems. Results of current research suggest that knowledge of emotional facial expressions is inborn, not learned (infants can recognize their mother’s emotional faces). Yet, when there are problems in this part of the brain social skills can be impaired.

The temporal lobes help us process the world of sight and sound, and give us the language of life. This part of the brain allows us to be stimulated, relaxed, or brought to ecstasy by the experience of great music. The temporal lobes have been called the “Interpretive Cortex,” as it interprets what we hear and integrates it with stored memories to give interpretation or meaning to the incoming information. Strong feelings of conviction, great insight, and knowing the truth have also been attributed to the temporal lobes.

Temporal lobe abnormalities occur much more frequently than previously recognized. You’ll note many of the above symptoms are often thought of as psychological when, in reality, for many they are biological. The temporal lobes sit in vulnerable area of the brain in the temporal fossa (or cavity), behind the eye sockets and underneath the temples. The front wall of the cavity includes a sharp bony ridge (the lesser wing of the sphenoid bone), which frequently damages the front part of the temporal lobes in even minor head injuries. God would have done better to put bumper guards on that ridge. Since the temporal lobes sit in a cavity surrounded by bone on 5 sides (front, back, right side, left side and underside) they can be damaged from a blow to the head at almost any angle.

Like with other brain problems, temporal lobe problems can come from many different sources. The most common being genetic (you can get these problems from your parents), head injuries and toxic or infectious exposure. In my clinic, we will ask you five times whether or not you ever had a head injury. It amazes us how often people forget they have head injuries. My intake paperwork will ask you if you’ve ever had a head injury. My historian, who people see before seeing me asks this question. The structured computer testing we do asks this question. If I see that patients answer no, no, no to this question I’ll ask them again. If they say no for the fourth time I’ll ask them, “Are you sure? Have you ever fallen out of a tree, off a fence or dove into a shallow pool.” It is not uncommon for people to say, “Oh yeah, now I remember.” One man, after saying no four times to this question said, “Oh yeah, I fell out of a second story window. I forgot.” Other patients, after saying no four times, have told me about falling out of cars, going through car windshields, falling off porches 5 feet onto their heads, falling off balconies, down staircases, etc. Your brain is very soft and your skull is very hard. Your brain is more sophisticated than any computer we can design. You cannot just drop a computer and expect things will be okay. The temporal lobes, prefrontal cortex and cingulate gyrus are the most vulnerable brain areas to damage by virtue of their placement within the skull. They are the most heavily involved parts of the brain in terms of thinking and behavior.

Blain, age 60, came to see me from Indiana. His wife heard me speak at a national conference and she was sure he had a temporal lobe problem. He had memory problems. He was moody and he was often aggressive. Blain also frequently saw shadows out of the corner of his eyes and had an annoying “buzzing” sound in his ear, which his doctor could not find a cause. The temper problems just seem to come out the blue. “The littlest things seem to set me off. Then I feel terribly guilty,” he said. When Blain was 5 years old he fell of a porch headfirst into a pile of bricks. As a schoolboy he had a terrible time learning to read and he frequently got into fights. His brain SPECT study showed significant abnormalities in his left temporal lobe. It was decreased in both the front and back of the temporal lobe and there was an area of increased activity deep within the left temporal lobe. Seeing this abnormality, it was clear to me that many of Blain’s problems came from the instability of his left temporal lobe, likely from his childhood accident. I placed him on Depakote, an antiseizure medication known to stabilize activity in the temporal lobes. When I spoke to him three weeks later he was elated. The buzzing and shadows went away and he had not lost his temper since he started the medication. He said, “That was the first time in my life I can remember going three weeks and not screaming at someone.” Four years later his temper remains under control.

Common problems seen with left temporal lobe abnormalities include aggression, internally or externally driven, dark or violent thoughts, sensitivity to slights, mild paranoia, word finding problems, auditory processing problems, reading difficulties and emotional instability. Let’s look at each of these in detail.

The aggressiveness often seen with left temporal lobe abnormalities can either be externally expressed toward other or internally expressed in aggressive thoughts toward oneself. Aggressive behavior is complex, but in large study performed in my clinic on people who had assaulted another person or damaged property more 70% had left temporal lobe abnormalities. It seems that temporal lobe damage or dysfunction makes a person more prone to irritable, angry or violent thoughts (much more on this will be given in the chapter on violence). One patient of mine with temporal lobe dysfunction (probably inherited, as his father was a rageaholic) complains of frequent, intense violent thoughts. He feels shame over having these thoughts and didn’t understand where they came from. “I can be walking down the street,” he told me, “and someone accidentally brushes against me, and I get the thought of wanting to shoot him or club him to death. These thoughts frighten me.” Thankfully, even though his SPECT confirmed left temporal lobe dysfunction, he had good prefrontal cortex function so he is able to supervise his behavior and maintain impulse control over these terrible thoughts. In a similar case, Misty, a 45 year old woman, came to see me for anger outbursts. One day, someone accidentally bumped into her in the grocery store and she started screaming at the woman, which was the reason she came to see me. “I just don’t understand where my anger comes from,” she said. “I’ve had 16 years of therapy and it is still there. Out of the blue, I’ll go off. I get the most horrid thoughts. You’d hate me if you knew.” In her history, she had fallen off the top of a bunk bed when she was 4 years old. She was unconscious for only a minute or two. The front and back part of her left temporal lobe was clearly damaged. A little bit of Depakote was very helpful to calm the monster within.

I often see internal aggressiveness with left temporal lobe abnormalities, expressed in suicidal behavior. In a study from our clinic we saw left temporal lobe abnormalities in 62% of our patients who had serious suicidal thoughts or actions. After I gave a lecture about the brain in Oakland a woman came up to me in tears. “Oh Dr. Amen,” she said, “I know my whole family has temporal lobe problems. My paternal great grandfather killed himself. My father’s mother and father killed themselves. My father and two of my three uncles killed themselves and last year my son tried to kill himself. Is there help for us?” I had the opportunity to evaluate and scan three members in her family. Two had left temporal lobe abnormalities and Depakote was helpful in their treatment.

In terms of suicidal behavior, one very sad case highlights the involvement of the left temporal lobes. For years I wrote a column my local newspaper about the brain and behavior. One column was about temporal lobe dysfunction and suicidal behavior. O week or so later a mother came to see me. She told me that her twenty-year-old son had killed himself several months ago and she was grief stricken over the unbelievable turn of events in his life. “He was the most ideal child a mother could have,” she said. “He did great in school. He was polite, cooperative and a joy to have around. Then it all changed. Two years ago he had a bicycle accident. He accidentally hit a branch in the street and was flipped over the handlebars, landing of the left side his face. He was unconscious when an onlooker got to him, but shortly thereafter came to. Nothing was the same since then. He was moody, angry, easily set off. He started to complain of ‘bad thoughts’ in his head. I took him to see a therapist, but it didn’t seem to help. One evening, I heard a loud noise out front. He had shot and killed himself on our front lawn.” Her tears made me have tears. I knew that her son might well have been helped if someone had recognized his “minor head injury,” likely caused temporal lobe damage and that anticonvulsant medication may well have prevented his suicide. Of interest, in the past 20 years psychiatrists have been using anticonvulsants to treat many psychiatric problems. My suspicion is we are treating underlying brain problems we label as psychiatric.

In addition to aggression, we have seen people with left temporal lobe abnormalities be more sensitive to slights and even appear mildly paranoid. Unlike people with schizophrenia who can become frankly paranoid, temporal lobe dysfunction often causes a person to think others are talking about them or laughing at them when there is no evidence for it. This sensitivity can cause serious relational and work problems.

Reading and language processing problems are also common when there is dysfunction in the left temporal lobe. Being able to read in an efficient manner, remember what you read and integrate the new information relies heavily on the dominant temporal lobe. Being able to read, integrate and remember what you read is an essential skill in the modern-day world. It is currently estimated that nearly 20% of the U.S. population has difficulty reading. Our studies of people with dyslexia (underachievement in reading) often show underactivity in the back half of the left temporal lobe. Dyslexia can be inherited or it can be brought about after a head injury, damaging this part of the brain. Here are two illustrative cases.

Thirteen-year-old Denise came to see me because she was having problems with her temper. She had pulled a knife on her mother, which precipitated the referral. She also had school problems, especially in the area of reading for which she was in special classes. Due to the seriousness of her aggression and learning problems I decided to do order a SPECT study at rest and then again when she tried to concentrate. At rest her brain showed mild decreased activity in the back half of her left temporal lobe. When she tried to concentrate the activity in her left temporal lobe completely shut down. As I showed Denise and her mother the scans, I told Denise that it was clear that the more she tried to read the harder reading would become. As I said this she burst into tears. She cried, “When I read I am so mean to myself. I tell myself, ‘Try harder. If you try harder then you won’t be so stupid.’ But trying harder doesn’t seem to help.” I told her it was essential for her to talk nicely to herself and that she will do better reading in a setting that is interesting, fun and relaxed. I sent Denise to see the educational therapist who works in my office. She taught her a specialized reading program that taught her how to visualize words and use a different part of the brain to process reading.

Carrie, a forty-year-old psychologist, came to see me two years after she sustained a head injury in a car accident. Before the accident she had a remarkable memory and she was a fast, efficient reader. She said reading was one of her academic strengths. After the accident, she had memory problems, struggled more with irritability, and reading became difficult for her. She said that she had to read passages over and over to retain any information and that she had trouble remembering what she read past just a few moments. Again, her SPECT study showed damage to the front and back of her left temporal lobe (the pattern typically seen in trauma). I had her see my biofeedback technician to enhance activity in her left temporal lobe. Over the course of 4 months she was able to regain he reading skills and improve her memory and control over her temper.

In our experience, left temporal lobe abnormalities are more frequently associated with externally directed discomfort (such as anger, irritability, aggressiveness), while right temporal lobe abnormalities are more likely associated with internal discomfort (anxiety and fearfulness). The left-right dichotomy has been particularly striking in our clinic population. One possible explanation is the left hemisphere of the brain is involved with understanding and expressing language and perhaps when the left hemisphere is involved one could express their discomfort. When the non-dominant hemisphere is involved the discomfort is more likely expressed non-verbally.

Non-dominant (usually right) temporal lobe problems more often involve social skill problems, especially in the area of reading and recognizing facial expressions and recognizing voice intonations. Mike, age 30, illustrates the difficulties we have seen when there is dysfunction in this part of the brain. Mike came to see me because he wanted a date. He had never had a date in his life and was very frustrated by his inability to meet and successfully ask a woman out on a date. During the evaluation Mike said he was at a loss as to what his problem was. His mother, who accompanied him to the session, had her own ideas. “Mike,” she said, “misreads situations. He has always done that. Sometimes he comes on too strong, sometimes he is withdrawn when another person is interested. He doesn’t read the sound of my voice right either. I can be really mad at him and he doesn’t take me seriously. Or he can think I’m mad, when I’m nowhere near mad. When he was a little boy Mike tried to play with other children but he could never hold on to friends. It was so painful to see him get discouraged.” Mike’s SPECT showed marked decreased activity in his right temporal lobe. His left temporal lobe was fine. The intervention that was most effective for Mike was intensive social skills training. He worked with a psychologist who coached him on facial expressions, voice tones and proper social etiquette. He had his first date 6 months after coming to the clinic.

Abnormal activity in either or both temporal lobes can cause a wide variety of other symptoms including: abnormal perceptions (sensory illusions), memory problems, feelings of deja vu (that you have been somewhere before even though you haven’t), jamais vu (not recognizing familiar places), periods of panic or fear for no particular reason, periods of spaciness or confusion and preoccupation with religious or moral issues. Illusions are very common temporal lobe symptoms.

Common illusions include:

• seeing shadows or bugs out of the corner of the eyes
• seeing objects change size or shape (one patient would see lamp posts turn into an animals and run away, another patient would see figures move in a painting)
• hearing bees buzzing or static from a radio
• smelling odors or getting odd tastes in the mouth
• feeling bugs crawling on skin or other skin sensations.

Unexplained headaches and stomachaches also seem to be common in temporal lobe dysfunction. Recently, the anticonvulsant Depakote received a clinical indication for migraine headaches. Often when headaches or stomachaches are due to temporal lobe problems anticonvulsants seem to be helpful. Periods of déjà vu (the feeling you’ve been somewhere before even though you never have) and jamais vu (feeling unfamiliar in familiar surroundings) also are seen in temporal lobe states. Also, unexplained periods anxiety or fearfulness is one of the most common presenting symptoms with temporal lobe epilepsy. Many patients experience sudden feelings of anxiety, nervousness or panic. Frequently, many patients make secondary associations to the panic and develop fears or phobias. For example, if the first time you experience the feeling of panic or dread is when you are in a grocery store or at a park, you may then develop anxiety every time you go into a grocery store or go to the park.

Moral or religious preoccupation is a common symptom with temporal lobe dysfunction. I have a little boy in my practice who, at age 6, made himself physically sick by worrying about all of the people who were going to hell. Another patient spent 7 days a week in church, praying for the souls of his family. He came to see me because of his temper problems, frequently directed at his family, which were often seen in response to some perceive moral misgiving or outrage. Another patient came to see me because spent hours focused on the “mysteries of life” could not get any work done and was about to lose his job as a writer for a Bay Area magazine. All of these patients had temporal lobe abnormalities.

Hypergraphia, a tendency toward compulsive and extensive writing, has also been reported in temporal lobe disorders. One wonders whether Ted Kaczynski, the reported Unabomber, didn’t have temporal lobe problems given the lengthy, rambling manifesto he wrote, his proclivity toward violent behavior and his social withdrawal. His loathing of high technology would make SPECT out of the question for him. Some of my temporal lobe patients spend hours and hours writing. One patient, who moved to another state, used to write me 20 and 30 page letters, detailing all of the aspects of her life. As I learned about temporal lobe hypergraphia and had her treated with anticonvulsant medication her letters became more coherent and were shortened to 2 to 3 page, saying the same information. Of note, many people with temporal lobe problems have the opposite of hypergraphia, they are unable to get words out of their heads and have a paucity of writing. One of the therapists in my office, who’s a wonderful public speaker could not get the thoughts out of his head to write his book. On his scan there was decreased activity in both of his temporal lobes. On a very small dose of Depakote his ideas were unlocked and he could now write for hours at a time.

Memory problems have long been one of the hallmarks of temporal lobe dysfunction. Amnesia after a head injury is frequently due to damage to the inside aspect of the temporal lobes. Brain infections also cause severe memory problems. Harriet came to see me from New England. She was a very gracious 83-year-old woman who had lost her memory 15 years earlier during a bout of encephalitis. Even though she remembered events before the infection she could only remember small bits and pieces after the accident. An hour after she ate she would feel full but forgot what she ate. Her daughter heard me lecture in Burlington, Vermont and told her to come see me. Harriet said, “I left my brain to the local medical school. Hoping my problems would help someone else, but I don’t think they’ll do anything with my brain except give it to medical students to cut up. Plus I want to know what the problem is. And write it down. I won’t remember what you tell me!” Harriet’s brain showed marked damage in both temporal lobes, especially on the left side, like the virus went to that part of her brain and chewed it away.

Alzheimer’s Disease, a devastating progressive form of senile dementia, is one of the most common memory problems in the elderly. Unfortunately, it robs many people of their retirement years and leaves families physically, emotionally and financially exhausted. SPECT is an important tool in diagnosing this disorder. Before functional studies were available the only way to diagnoses Alzheimer’s Disease was through autopsy. SPECT studies show a typical Alzheimer’s pattern of decreased perfusion in both temporal lobes and decreased activity in the parietal lobes. Sometimes this pattern is seen three to six years before the onset of symptoms. Some of the new anti-Alzheimer’s drugs are showing promise in arresting the progression of this disorder and have been shown on SPECT to actually improve perfusion in the parts of the brain, mostly involved in memory and thinking, such as the temporal lobes. Here is a scan of a man with Alzheimer’s Disease who had become forgetful, frequently lost away from home, forgot how to do simple things such as dress himself and began getting aggressive with his wife.

Fyodor Dostoevsky was reported to have bouts of “temporal lobe seizures.” He felt his affliction was a “holy experience.” His biographer, Rene Fueloep-Miller, quotes Dostoevsky as saying, that his epilepsy “…rouses in me hitherto unsuspected emotions, gives me feelings of magnificence, abundance and eternity.” In The Idiot, Dostoevsky writes:

“There was always one instant just before the epileptic fit…when suddenly in the midst of sadness, spiritual darkness and oppression, his brain seemed momentarily to catch fire, and in an extraordinary rush, all his vital forces were at their highest tension. The sense of life, the consciousness of self, were multiplied almost ten times at these moments which lasted no longer than a flash of lightning. His mind and his heart were flooded with extraordinary light; all his uneasiness, all his doubts, all his anxieties were relieved at once; they were all resolved in a loft calm, full of serene, harmonious joy and hope, full of reason and ultimate meaning. But these moments, these flashes, were only a premonition of that final second (it was never more than a second) with which the fit began. That second was, of course, unendurable. Thinking of that moment later, when he was well again, he often said to himself that all these gleams and flashes of supreme sensation and consciousness of self, and therefore, also of the highest form of being, were nothing but disease, the violation of the normal state; and if so, it was not at all the highest form of being, but on the contrary must be reckoned the lowest. Yet he came at last to an extreme paradoxical conclusion. “What if it is disease? he decided at last. “What does it matter that it is an abnormal intensity, if the result, if the sensation, remembered and analyzed afterwards in health, turns out to be the acme of harmony and beauty, and gives a feeling, unknown and undivined till then, of completeness, of proportion, of reconciliation, and of startled prayerful merging with the highest synthesis of life?”

Lewis Carrol is reported to have “temporal lobe experiences” which were described in the visual distortions of Alice in Alice in Wonderland. Seven-year-old Brian became very upset when his mother read “Alice In Wonderland.” He said that he felt like Alice. “I have weird things happen to me,” he told her. “I see things.” During the day he saw objects change shapes, often getting smaller. He also saw green, shadowy ghosts at night. Brian also had a lot of anxiety symptoms. Frightened that Brian was losing his mind (a cousin had been diagnosed with a “schizophrenic-like” illness) his mother brought him to see me. On hearing of these symptoms, I suspected that one or both of his temporal lobes were acting up. His brain SPECT confirmed abnormalities in his right temporal lobe and increased basal ganglia activity. He was placed on Depakote (an anti-seizure medication effective in the temporal lobes) and he was also placed in psychotherapy to decrease his anxiety. Within two weeks, Brian’s strange experiences disappeared and over the next six months his anxiety lessened.

Ellen and Jack had similar histories: both had been somewhat reclusive; both had periods of spaciness; and both had periods of panic for no particular reason. Both had religious experiences which occupied a good deal of their lives. Ellen, age 32, was nearly paralyzed by these religious experiences, feeling that they had deep meaning for her. She was unable to work and socially isolated herself. Jack took great interest in these periods of “deep spiritual awakening,” but was never able to make out what they meant. Ellen was brought to my office by her parents who were concerned with her social isolation. Jack wanted an evaluation for the panic attacks. Their SPECT studies revealed marked increased activity in the deep aspects of their temporal lobes. The majority of the symptoms for Ellen and Jack went away on Depakote. Even with taking Depakote, both remained deeply religious people, but they were not preoccupied with their thoughts.

Like Ellen and Jack, Jim was bothered by periods of spaciness and panic. He also had periods of “religious thoughts,” but they were different. He felt the “presence of the devil” and he was unsure and afraid. The “presence of the devil” haunted him, kept him reclusive from others, and caused him to appear paranoid to his family. Their was a difference between Jim’s SPECT study and Ellen’s and Jack’s studies. Jim’s study revealed abnormal activity in the left temporal lobe, rather than the right. In my experience left sided temporal lobe problems are often associated with very negative or “dark” thoughts. After Jim was placed on Depakote, the “presence of the devil” was gone. Several years later, he doesn’t like to talk about how he used to feel; he’s just very happy he doesn’t have those feelings anymore.