It is not very uncommon for epileptics to have vague and yet exceedingly elaborate mental states at the onset of epileptic seizures . . . The elaborate mental state, or so-called intellectual aura, is always the same, or essentially the same, in each case.
Such descriptions remained purely anecdotal until the extraordinary studies of Wilder Penfield, half a century later. Penfield was not only able to locate their origin in the temporal lobes, but was able to evoke the ‘elaborate mental state’, or the extremely precise and detailed ‘experiential hallucinations’ of such seizures by gentle electrical stimulation of the seizure-prone points of the cerebral cortex, as this was exposed, at surgery, in fully conscious patients. Such stimulations would instantly call forth intensely vivid hallucinations of tunes, people, scenes, which would be experienced, lived, as compellingly real, in spite of the prosaic atmosphere of the operating room, and could be described to those present in fascinating detail, confirming what Jackson described sixty years earlier, when he spoke of the characteristic ‘doubling of consciousness’:
There is (1) the quasi-parasitical state of consciousness (dreamy state), and (2) there are remains of normal consciousness and thus, there is double consciousness ... a mental diplopia.
This was precisely expressed to me by my two patients; Mrs O’M. heard and saw me, albeit with some difficulty, through the deafening dream of ‘Easter Parade’, or the quieter, yet more profound, dream of ‘Good Night, Sweet Jesus’ (which called up for her the presence of a church she used to go to on 31st Street where this was always sung after a novena). And Mrs O’C. also saw and heard me, through the much profounder anamnestic seizure of her childhood in Ireland: ‘I know you’re there, Dr Sacks. I know I’m an old woman with a stroke in an old people’s home, but I feel I’m a child in Ireland again—I feel my mother’s arms, I see her, I hear her voice singing.’ Such epileptic hallucinations or dreams, Penfield showed, are never phantasies: they are always memories, and memories of the most precise and vivid kind, accompanied by the emotions which accompanied the original experience. Their extraordinary and consistent detail, which was evoked each time the cortex was stimulated, and exceeded anything which could be recalled by ordinary memory, suggested to Penfield that the brain retained an almost perfect record of every lifetime’s experience, that the total stream of consciousness was preserved in the brain, and, as such, could always be evoked or called forth, whether by the ordinary needs and circumstances of life, or by the extraordinary circumstances of an epileptic or electrical stimulation. The variety, the ‘absurdity’, of such convulsive memories and scenes made Penfield think that such reminiscence was essentially meaningless and random:
At operation it is usually quite clear that the evoked experiential response is a random reproduction of whatever composed the stream of consciousness during some interval of the patient’s past life ... It may have been [Penfield continues, summarising the extraordinary miscellany of epileptic dreams and scenes he has evoked] a time of listening to music, a time of looking in at the door of a dance hall, a time of imaging the action of robbers from a comic strip, a time of waking from a vivid dream, a time of laughing conversation with friends, a time of listening to a little son to make sure he was safe, a time of watching illuminated signs, a time of lying in the delivery room at birth, a time of being frightened by a menacing man, a time of watching people enter the room with snow on their clothes ... It may have been a time of standing on the corner of Jacob and Washington, South Bend, Indiana . . . of watching circus wagons one night years ago in childhood ... a time of listening to (and watching) your mother speed the parting guests ... or of hearing your father and mother singing Christmas carols.
I wish I could quote in its entirety this wonderful passage from Penfield (Penfield and Perot, pp. 687ff.) It gives, as my Irish ladies do, an amazing feeling of ‘personal physiology’, the physiology of the self. Penfield is impressed by the frequency of musical seizures, and gives many fascinating and often funny examples, a 3 per cent incidence in the more than 500 temporal-lobe epileptics he has studied:
We were surprised at the number of times electrical stimulation has caused the patient to hear music. It was produced from seventeen different points in 11 cases (see Figure). Sometimes it was an orchestra, at other times voices singing, or a piano playing, or a choir. Several times it was said to be a radio theme song . . . The localisation for production of music is in the superior temporal convolution, either the lateral or the superior surface (and, as such, close to the point associated with so-called musicogenic epilepsy).
AUDITORY EXPERIENTIAL RESPONSES TO STIMULATION.
1. A voice (14); Case 28. 2. Voices (14). 3. 1 voice (15). 4. A familiar voice (17). 5. A familiar voice (21). 6. A voice (23). 7. A voice (24). 8. A voice (25). 9. A voice (28); Case 29. 10. Familiar music (15). 11. A voice (16). 12. A familiar voice (17). 13. A familiar voice (18). 14. Familiar music (19). 15. Voices (23). 16. Voices (27); Case 4. 17. Familiar music (14). 18. Familiar music (17). 19. Familiar music (24). 20. Familiar music (25); Case 30. 21. Familiar music (23); Case 31. 22. Familiar voice (16); Case 32. 23. Familiar music (23); Case 5. 24. Familiar music (Y). 25. Sound of feet walking (1); Case 6. 26. Familiar voice (74). 27. Voices (22); Case 8. 28. Music (15); Case 9. 29. Voices (14); Case 36. 30. Familiar sound (16); Case 35. 31. A voice (16a); Case 23. 32. A voice (26). 33. Voices (25). 34. Voices (27). 35. A voice (28/ 36. A voice (33); Case 12. 37. Music (12); Case 11. 38. A voice (17d); Case 24. 39. Familiar voice (14). 40. Familiar voices (15). 41. Dog barking (17). 42. Music (78). 43. A voice (20); Case 13. 44. Familiar voice (i7J. 45. A voice (12). 46. Familiar voice (13). 47. Familiar voice (14). 48. Familiar music (15). 49. A voice (16); Case 14. 50. Voices (2). 51. Voices (3). 52. Voices (5). 53. Voices (6) 54. Voices (10). 55. Voices (11); Case 15. 56. Familiar voice (15). 57. Familiar voice (16). 58. Familiar voice (22); Case 16. 59. Music (10); Case 17. 60. Familiar voice (30). 61. Familiar voice (31). 62. Familiar voice (32); Case 3. 63. Familiar music (8). 64. Familiar music(10). 65.Familiar music (D2); Case 10. 66.Voices (11); Case7.