Steven A Rogers. Miracles: God, Science, and Psychology in the Paranormal. Editor: J Harold Ellens. Volume 2: Medical and Therapeutic Events. Westport, CT: Praeger, 2008.
A soldier shelters himself in a foxhole while deep in the chaos of battle. He decides to change locations to get a better vantage point, and only a moment after running to his new firing spot, the foxhole he just came from is destroyed by enemy bombing.
A mother in her late fifties is told that it is medically impossible for her to have a child. Yet she stares down at a positive sign on the pregnancy test, knowing that a child is growing in her womb.
A teenager decides to jump off a 30-foot cliff onto protruding rocks in a desperate attempt to end a life of pain, abandonment, and rejection, but somehow survives, with only minimal cognitive and physical complications.
Each of these are true stories relayed to me by patients, and each patient has been quick to explain these events as modern-day miracles. Yet how do we really go about deciding something is a miracle? In each of these cases, the results are certainly advantageous and unexpected, but what leads us to elevate these events to miracle status and derogate the possibility that they are simply fortuitous chance events?
Interestingly, not much is known about the neurological mechanisms or processes involved in attributing events to miraculous intervention. Some of this is due to the rarity at which perceived miraculous events occur, making it difficult to capture someone’s reactions in the moment. It is also virtually impossible to scientifically create, assess, and analyze a miracle. If a miracle could be replicated for scientific study, by definition it would no longer be a miracle. Then again, even if science could come up with a logical and natural explanation for an event that seemingly defies natural explanation, this would not necessarily prevent individuals from still perceiving it or defining it as a miracle. Therefore, what seems to matter most is not whether a miracle is real, but rather our interpretation of the event and our cognitive turn toward using a miracle framework to explain it.
It is the contention of this chapter that the human frontal lobes have a large, though not singular, role in the process by which we ascribe events to be miraculous. Although recent attention to the religious features of temporal lobe epilepsy and schizophrenia has helped showcase the involvement of the temporal lobe and limbic system in religious experiences and hallucinations, less attention has been devoted to the large role of the frontal lobes in these experiences and the way we interpret them. One way of studying the neural substrates guiding this process is to examine neurological conditions that might make individuals more inclined toward miracle explanations. Both frontotemporal dementia and obsessive-compulsive disorder have atypical frontal functioning and are characterized by greater than normal levels of religiousness, which includes a propensity to ascribe counterintuitive events to miracles or religious explanations. By examining the functions of the frontal lobes and the neural substrates underlying these conditions, we may learn something about the role of the frontal lobes in our tendency to engage in miracle ascription.
What Are Miracles?
By their very nature, miracles defy explanation. This represents both a strength and a weakness for most major religions that rely on records of miraculous events as epistemological evidence or truth-claims for the veracity of their doctrines. But the definition of miracles is naturally difficult, not only because of the aforementioned problems in studying them, but also because a definition depends on one’s religious, cultural, and scientific background. Some cultures might ascribe miracle status to the appearance of rain after a long drought, whereas others might simply attribute this to a return to normal weather patterns. Others might call it miraculous when a malignant tumor mysteriously disappears, yet others might find some neurological explanation for this event, depending on their experiences and culture.
One constant across these definitions is that miracles involve counterintuitive events. They do not make sense in light of, and often contradict, our knowledge of natural or expected processes. This is consistent with philosopher David Hume’s (as cited in Pojman, 2001) understanding of miracles as violations of the laws of nature. We know that objects fall downward toward earth at a rate of 32.17 feet per second, that fire consumes wood, that the dead do not rise, and that something will only float if it has less density than the surrounding liquid. Any counterinstance of these laws arrests our attention due to the sheer improbability that the regularity of nature will be violated and by the innumerable occasions when the laws of nature are upheld (Pojman, 2001). In a sense, miracles are those events and episodes that are contrary to our customs, experiences, and understandings for how the world should generally work.
It is this counterintuitive nature that probably leaves so much room for speculation about the cause or origin of the unusual event. If these events occurred outside the typical laws of nature, then it is easy to assume the intervention of a nonnatural and divine cause. Others might agree that counterintuitive events are miraculous, but rather than invoke divine intervention, they may favor waiting for the discovery of a natural explanation. Whatever cause or explanation is ultimately invoked largely depends on the cognitive filter, schema, or lens through which we view the world. For some individuals, particularly those with leanings toward the religious, spiritual, or mystical, this lens may be shaped toward miraculous explanations. This suggests that what we perceive as unordinary and counterintuitive may actually be mediated by mental and neural mechanisms that are very ordinary (Boyer, 2003) and most likely governed by the frontal lobes.
The Frontal Lobes and Frontal-Subcortical Circuitry
The frontal lobes are the last region of the brain to develop, both from an evolutionary and ontogenetic perspective. They are the final, highest, and most advanced region of the brain, which most likely evolved to guide organisms toward selecting the behaviors and responses that confer the best chances of survival (Damasio & Anderson, 2003). As a result, they are intimately involved in personality, emotion, information processing, sustained attention, movement, language, and executive functions (e.g., set shifting, abstraction, planning, judgment, inhibition). They constitute almost one-third of the neocortex and are made up of everything anterior to the central sulcus, including the primary motor (precentral) cortex, the premotor cortex, and the prefrontal regions (Kolb & Whishaw, 2003; Martin, 2006). Of these, damage to the primary motor area can result in paralysis, whereas injury to the premotor regions can cause difficulties initiating and organizing movements, like speech production (McNamara, 2001).
Anterior to these is the prefrontal cortex (PFC), which is among the last brain regions to develop within the frontal cortex and therefore within the entire brain. It receives input from sensory association regions, has dense interconnections with several limbic sites, and has diffuse projections throughout the brain that allow it to regulate emotions, output to other cortical regions, and global cortical arousal levels (Damasio & Anderson, 2003). In short, it is interconnected with virtually all other cortical sites, so it can inhibit and regulate the input and output to most other cortical regions. Consequently, it is heavily involved in rational and directed activity, such as planning and strategy formation, personality and spontaneity of behavior, cognitive flexibility, encoding and retrieval, social behavior, and response inhibition (Martin, 2006). It is further subdivided into three main frontal-subcortical circuits that begin in separate areas of the prefrontal cortex and project to defined areas within the striatum, caudate nucleus, putamen, or nucleus accumbens.
The first of these, the dorsolateral prefrontal circuit, is directly responsible for mediating executive functioning and organizing information to facilitate a response. This includes working memory, conceptual reasoning, developing and acting on plans, and directing and maintaining attention. In short, it is responsible for selecting and directing behavior, which is supported by its dense interconnectivity with the basal ganglia (McNamara, 2001). The medial frontal circuit, which is also known as the anterior cingulate circuit, is necessary for motivated behavior, error detection, and reward anticipation (Cummings, 2003). The third, orbitofrontal circuit allows for the integration of limbic and emotional information with behavioral responses (Bonelli & Cummings, 2007; Cummings, 2003). It is involved in stimulus acquisition, associating stimuli with rewards, complex decision making, and behavioral self-regulation. One of the special roles of the orbitofrontal circuit is the mediation of social and interpersonal behavior (Cummings, 2003), such as behaving according to cultural norms, contemplating what others are thinking, and even responding to our own autonoetic awareness, or self-knowing. Because this region is highly interconnected with limbic sites (McNamara, 2001), damage can result in poor inhibition of behavior, emotional disturbance, and loss of the ability to self-regulate behavior, both because there is lost awareness of the constancy of self and also because there is compromised sensitivity to reward and punishment. Individuals with damage to this orbitofrontal region are described as impulsive, displaying both financial imprudence and obsessive behavior, such as hoarding or compulsive worrying.
Not surprisingly, the prefrontal region has become appreciated as the seat for much of what we know as personality. In fact, the prefrontal region has been implicated in many of the features of antisocial personality disorder and psychopathy (Bassarth, 2001; Pridmore, Chambers, & McArthur, 2005). Among those with antisocial personality disorder, there is an 11 percent reduction in prefrontal gray matter volume (Raine, Lencz, Bihrle, LaCasse, & Colletti, 2000), as well as reduced prefrontal perfusion and metabolism (Pridmore et al., 2005). This suggests that the low arousal, poor fear conditioning, lack of conscientiousness, and decision-making deficits that characterize antisocial behavior may actually be related to prefrontal structural and metabolic deficits. This may account for the historical targeting of this region for transorbital lobotomies, where a mallet is used to pound and force a surgical instrument through the thin layer of skull at the top of the eye socket. Historically, the pick was then wiggled to damage the orbitofrontal lobe, subsequently leaving the patient emotionally flat, lethargic, mentally dulled, and often more amenable to cooperation with treatment providers.
Perhaps one of the most striking examples of the emotional and personality disturbances that can result from frontal damage is the well-known case of Phineas Gage, made famous by the physician Harlow. Gage was a railway workman who survived an explosion that blasted an iron bar about four feet long and one inch wide through his frontal lobe. Although Gage retained intact cognitive abilities and made a remarkable physical recovery, his personality underwent a dramatic change after the accident. His previous disposition, which was described by acquaintances as calm and responsible, was replaced by irascibility, impulsivity, and social inappropriateness. He could no longer control his emotions, make good judgments, or execute planned behaviors. His language became profane and his behavior capricious, resulting in the loss of his job and social relationships. In short, it seems like Gage’s self changed, at least in terms of his personality and his self-awareness as a calm and responsible person. When Damasio and colleagues (Damasio, Grabowski, Frank, Galaburda, & Damasio, 1994) later examined Gage’s skull, they found that the regions most affected by the tamping iron were the orbitofrontal and medial frontal cortices. This finding has driven much of the current thinking about the role of these regions in personality, social behavior, and the awareness of self and others.
The prefrontal cortex is also the region that is probably most implicated in the process of miracle interpretation. In addition to mediating planning, goal-directed behavior, social inhibition, and insight, the PFC is responsible for agency detection and attributing independent mental states to oneself and others. As Atran and Norenzayan (2004) suggest, the brain is wired with an agency detection mechanism that is ready to be triggered by ambiguous information as a way of imputing causality to events. This agency detection mechanism is likely dependent on the neurocognitive networks in the frontal lobes, particularly the prefrontal cortex (McNamara, 2001). It is this area that likely seeks an explanation, cause, or originating source when individuals are confronted with counterintuitive information.
In similar fashion, these networks also control our theory of mind, namely the process by which we attribute complex mental representations of intentional mental states to other agents and ourselves. Theory of mind, sometimes known as social cognition, essentially refers to our ability to deduce the mental states and intentions of others (Gallagher & Frith, 2003; Leslie, 1987). It is a cross-cultural cognitive activity that involves constructing representations of mental states, like thinking, deceiving, and believing, and then attributing these mental states to other agents or people. It is this ability that normally allows us to appreciate novels and movies as fiction, as well as comprehend and interact with others’ minds, including inferring the intentions of the divine or the supernatural. As a result, it is heavily involved in the way we attribute counterintuitive events and experiences to the intentions of the miraculous, to powers outside oneself or contrary to the laws of nature.
Therefore, to the extent that agency detection and theory of mind are both dependent on the cognitive networks in the frontal lobes, much of the process involved in miracle ascription can be traced to frontal lobe activity. This is readily apparent among those with frontotemporal dementia and obsessive-compulsive disorder, where frontal lobe deficits result in damage or perseveration of agency and theory of mind in a way that makes afflicted individuals more amenable to miracle attributions.
Frontotemporal dementia (FTD) is the second most common form of primary degenerative dementia after Alzheimer’s disease (AD), accounting for up to 20 percent of presenile cases of dementia (Mendez & Perryman, 2002; Snowden, Neary, & Mann, 2002). It is equally common in men and women, and it is considered an early-onset dementia because it starts insidiously and occurs earlier than AD, typically between the ages of 45 and 65 (Ratnavalli, Brayne, Dawson, & Hodges, 2002; Snowden et al., 2002). It is one of three neurobehavioral disorders that fall under a constellation of syndromes called frontotemporal lobar degeneration. FTD is the frontal variant of this syndrome, whereas the other two disorders, semantic dementia and primary nonfluent aphasia, are temporal variants that are defined by greater disturbances in speech and language. The core diagnostic features of FTD include an insidious onset and gradual progression, an early decline in interpersonal decorum, disinhibition in personal conduct, and both emotional blunting and a loss of insight (Neary et al., 1998).
Although the exact cause of FTD has yet to be identified, the responsible neuropathological changes have been narrowed to a loss of large cortical nerve cells, microvacuolation, and gliosis associated with abnormalities in tau metabolism (Cairns et al., 2007; Cummings, 2003), sometimes with spongiform degeneration. This leads to disproportionate atrophy and hypometabolism of the frontal and temporal structures. Structural neuroimaging, such as MRI procedures, often reveal prominent bilateral atrophy and white matter signal intensity in the frontal and anterior temporal lobes, with slightly disproportionate right- relative to left-hemisphere degeneration (Cummings, 2003; Mendez & Perryman, 2002; Neary et al., 1998; Rosen et al., 2002; Snowden, Neary, & Mann, 2007). Recent estimates by Snowden and colleagues (2007) suggest 54 percent of those with FTD have bilateral atrophy of the frontal and anterior temporal lobes, with 20 percent showing atrophy confined to the frontal lobes and 14 percent with bilateral atrophy isolated to the temporal lobes. On functional neuroimaging, FTD often appears as significantly reduced cerebral blood flow in the dorsolateral and orbital frontal regions bilaterally (Grossman, 2002).
In light of these structural and metabolic changes, it is not surprising that the cognitive deficits experienced by those with FTD are largely circumscribed to frontal and temporal deficits. In general, patients with FTD demonstrate a dysexecutive syndrome characterized by deficits in attention, abstraction, planning, and problem solving. Reduced verbal production is sometimes common, as well as mental rigidity, poor abstraction, difficulty shifting mental set, and perseverative tendencies (Craft, Cholerton, & Reger, 2003; Kramer et al., 2003; Neary et al., 1998; Twamley & Bondi, 2003). Although there is little idiopathic decline in memory and perception, at least early in the disease process, these executive deficits may occasionally interfere with encoding, organization, and learning (Snowden et al., 2002).
Perhaps the most salient features of FTD, however, are profound changes in character and disordered social conduct. In fact, it is these neuropsychiatric and behavioral symptoms that frequently lead patients to treatment, not because patients themselves perceive any problems (they are often anosognosic for their deficits), but because family members are overtly concerned by the alteration in personality and social conduct. It is these behavioral and psychiatric disturbances, rather than cognitive problems, that lead to greater caregiver stress and institutionalization (Mourik et al., 2004; Srikanth, Nagaraja, & Ratnavalli, 2005).
Central to these disturbances is a decline in social conduct, which often emerges in the form of disinhibition and loss of self-control (Mendez & Perryman, 2002), such as making lewd remarks, violating others’ interpersonal space, or making inappropriate gestures. This behavior is not antisocial, but rather asocial (Srikanth et al., 2005), largely due to damage to the orbitofrontal regions responsible for linking internal or external cues with positive or negative outcomes. Their own personal conduct can also be impaired, such that they become more passive in caring for themselves. They lose interest in personal hygiene, failing to wash or groom appropriately and sometimes defecating unconcernedly in front of others. Emotionally, they are often blunted and stifled in their capacity to demonstrate joy, sadness, or empathy for others. Utilization behavior is also common, where patients grasp and use any nearby objects, even when it might be inappropriate, such as indiscriminately grabbing someone else’s food or drink. This is more likely to appear later in the disease course and may be related to their mandatory exploration of the environment.
In some persons with FTD, behavioral excesses emerge, perhaps related to the prefrontal loss of inhibition. Many become hyperoral, developing substantial elevations in appetite, a preference for sweeter foods, and increased oral behavior, like smoking (Ikeda, Brown, Holland, Fukuhara, & Hodges, 2002; Srikanth et al., 2005). Hypersexuality can emerge in the form of sexual jokes or compulsive masturbation, just as antisocial forms of hypervisuality can result in shoplifting or playing with fire (Grossman, 2002). Over 60 percent of those with FTD also develop repetitive, ritualistic, and stereotyped behaviors, like humming, counting aloud, and hoarding objects (Rosso et al., 2001). They may pace the room, repeat certain catch phrases, and engage in superstitious and compulsive behaviors. It is not uncommon to hear of these patients engaging in compulsive counting or becoming distressed when prevented from eating the same foods at exactly the same time each day. Despite the compulsive nature of these symptoms, they are qualitatively different than those in obsessive-compulsive disorder because they are not linked to intrusive thoughts or overt anxiety (Mendez & Perryman, 2002). Many of these socially undesirable traits and behavioral excesses are more common when the right hemisphere is differentially affected and may reflect the dysregulation of the frontal lobes in regulating control over their behavior (Mendez & Perryman, 2002).
Another way researchers (Darvesh, 2005; Hodges, 2001; Rosen et al., 2002; Rosso et al., 2001; Snowden et al., 2002) have conceptualized the symptoms of FTD is to categorize them according to the frontal regions involved. The disinhibition, impulsivity, asocial tendencies, and compulsive and stereotypical behaviors have been linked to orbitofrontal involvement. Many of the cognitive problems, such as deficits in planning, organization, and executive functioning, may reflect the spread of the disease to the dorsolateral prefrontal cortex, whereas apathy, aspontaneity in speech, and social withdrawal may be related to medial frontal/anterior cingulate involvement. These groupings may actually represent three distinct subgroups of FTD.
Frontotemporal Dementia and Hyper-religiousness
Interestingly, part of the symptomatology of those with FTD also appears to be hyperreligiosity. This area of research is relatively new, but several studies have found increased levels of religiousness among those with FTD (Rossor, Revesz, Lantos, & Warrington, 2000; Saver & Rabin, 1997; Twamley & Bondi, 2003). In particular, many of those with FTD score high on tests of religiousness, report increased devotion to religious beliefs, become preoccupied with religious ideas (Rosso et al., 2001), and engage in a greater number of religious behaviors and report a stronger belief in God. Although little has been done to determine the prevalence of miracle attributions in this population, it seems likely that this hyperreligiousness extends to a greater tendency to rely on supernatural explanations for unusual and counterintuitive experiences. The precise cause for this increased religiousness is not known, but it may be related to some of the co-occurring changes in the brains of those with FTD.
One possibility is that this hyperreligiousness is related to the loss of inhibition and increased impulsivity experienced by those with FTD. Deterioration of the orbitofrontal regions appears to result in a reduced ability to inhibit competing responses (Snowden et al., 2002), so there may be a spontaneous release of compulsive and stereotyped behavior, such as hyperorality, hypersexuality, and hyperreligiousness. This is evident in the new interest in painting experienced by some patients with FTD (Miller & Hou, 2004). Remarkably, Miller and Hou suggest that artistic productivity can actually increase in FTD, despite the progressive and degenerative nature of the disease. They have noticed that there may be a spontaneous burst of visual creativity triggered by the illness, where many of the visual scenes absorbed and internally represented over a patient’s lifetime are released. Consistent with the other features of the disease, the paintings that emerge are often approached compulsively, frequently in realistic or surrealistic styles. It may be that these individuals have a compulsive need to paint, or there may be a releasing of artistic inhibition related to the sparing of the parietal regions responsible for visuospatial activities (Miller & Hou, 2004). In a sense, the hypometabolism in the frontal regions may stimulate the release of hypermetabolism in the parietal and occipital regions not affected by the illness.
In the same way, it may be that hyperreligiousness, which includes a propensity toward interpreting counterintuitive information as a miracle, is released when the barrier of inhibition is dropped. The compulsive thoughts and behaviors in FTD have been linked to disruptions in the individual’s normal ability to engage in suppression (Rosso et al., 2001), suggesting that this loss of suppression may release an abnormal level of behaviors, including religious thought, activity, and attribution. Paired with this, orbitofrontal atrophy promotes impulsivity, so there may be a greater willingness to accept and proclaim religious explanations for positive, harmonious phenomena (Saver & Rabin, 1997). This seems particularly likely considering that many of those with hyperreligiousness come from families with strong religious tendencies (Darvesh, 2005), so the lowering of one’s inhibitory threshold may stimulate the release of religious thinking, explanation, and experience that has been internally absorbed over one’s lifetime.
Added to this is the heightened significance of spirituality and religion for this population. Many of those with dementia rely on their personal spirituality as an important resource for coping, improving their quality of life, and sustaining meaning and purpose in the face of their illness (Katsuno, 2003). Higher levels of spirituality and engagement in private religious practices have been associated with slower progression of the disease (Kaufman, Anaki, Binns, & Freedman, 2007), which suggests that it may even be helpful and adaptive for some of those with FTD to examine events from a religious/ spiritual perspective. When this is paired with their growing difficulties in set shifting and abandoning previous opinions and strategies, they may become more rigid and inflexible in their religious beliefs, making them more predisposed to preoccupation with religious ideas or the use of miracle language to explain counterintuitive information.
In contrast, those with AD often experience a progressive loss of religious interests and behaviors, perhaps related to the decreased pursuit of lifelong interests, which may extend into religious concerns (Saver & Rabin, 1997). This may be related to the greater passivity and decreased spontaneity associated with AD, compromising an individual’s ability to construct religious cognitions.
Another possibility, or perhaps an interacting element, is that increased religiousness and miracle ascription is a by-product of the altered ability to infer one’s own and others’ mental states. Along with impaired social awareness and loss of insight, those with FTD have impaired metacognitive abilities, such as theory of mind, that interfere with their ability to infer others’ mental states, thoughts, and feelings (Eslinger et al., 2005). Those with FTD are impaired on tests of theory of mind (Lough et al., 2006), which seems particularly related to the degeneration of the ventromedial prefrontal cortex (Frith & Frith, 2003). They may be aware of social rules and norms, but they cannot recognize when they violate these norms or integrate this social knowledge with the affective connotations (Lough et al., 2006). This leads them to struggle to take another’s perspective or accurately impute the effect of their actions on the thoughts and feelings of others. In part, this may be related to their reduced capacity for set shifting and adopting a perspective outside their own, which is mediated by atrophy and hypometabolism in the dorsolateral prefrontal cortex (Snowden et al., 2002). Therefore, when they are confronted with events or experiences that do not conform to known natural processes, their hyperreligiousness may lead them to fall back on an attribution to miraculous intervention, rather than being able to consider alternative explanations.
But their difficulties are not limited to representing mental states in others. They also have difficulty representing theirown mental states, or their own autonoetic awareness (Eslinger et al., 2005). In addition to deficits in their theory of mind about others, they also have problems with metacognition about themselves. They have little self-awareness, self-monitoring, and self-regulation that can promote adaptive behavior in changing environments. In a sense, they do not have a working sense of self because they lack a persistent perception of their behavior and a synthesis of their experiences over time and space (Eslinger et al., 2005). Miller and colleagues (2001) found that a majority of those with FTD undergo significant changes in their concept of self, in their ability to perceive those essential qualities that distinguish themselves from others. Despite having intact memory and language, the authors found that patients often exhibited a diminished maintenance of previously learned self-concepts. Put simply, they demonstrated a distinct change of self, an alteration of their temporally stable sense of their core features. Very few areas seem to be immune to this change. Eating habits, food preferences, weight levels, dress styles, and political and religious ideology can all change with FTD, particularly among those with reduced activity in the right frontal lobe (Assal & Cummings, 2002).
For example, Miller and colleagues (2001) report on a case where a woman, in the course of FTD, changed from wearing expensive designer apparel and eating at fine French restaurants to wearing cheap clothing and developing a love for fast food. In another example, they mention a man who went from being scrupulous, tight with money, and short-tempered to being relaxed and easygoing, with his views on sex changing from conservative to tolerant and experimental. In fact, it appears that those with FTD show significantly less self-awareness about their personality than even those with AD, with a tendency to exaggerate positive qualities, minimize negative qualities, and a failure to update their self-image after the onset of the disease (Rankin, Baldwin, Pace-Savitsky, Kramer, & Miller, 2005). In some cases, this change in self involves a loosening of inhibition and increased devotion to religious beliefs, preoccupation with religious ideas, and a greater number of religious behaviors and attributions. There are even cases of those with FTD who change from being vegetarian prior to diagnosis to consuming large amounts of meat after the onset of the disease. In all cases, these are distinct changes in religious, social, and political beliefs, all of which are things that we might associate with core features of the self. Most of these changes can be traced to abnormalities in the right frontal lobe, suggesting that normal functioning of the right frontal lobe is necessary for the maintenance of self (Miller, Chang, Mena, Boone, & Lesser, 1993).
As a result, there is something askew in the representational ability of those with FTD, both to represent the constancy of self and to accurately assign intentionality and agency to others. One by-product appears to be a new or a more vigorous pattern of using religious thinking to assign causality and intentionality, which may translate into a greater proclivity to rely on miracle attributions. Considering the heavy involvement of the frontal lobes in FTD pathology, metacognition, and agency detection (Eslinger et al., 2005), it seems likely that they have a strong role in the human tendency to assign miracle explanations to counterintuitive information. Similar processes may be at play among those with obsesssive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a persistent anxiety disorder that affects 1-3 percent of the population (Graybiel & Rauch, 2000). It typically has an early onset, usually peaking in the twenties, and it occurs with similar prevalence rates across cultures and between men and women (Brune, 2006). The name rises from the hallmark signs and symptoms, which affect both cognition and motor behavior. Obsessions typically refer to unwanted but insistent and recurrent thoughts, urges, doubts, or images that evoke anxiety. Fears about dirt and contamination are common examples. Compulsions are ritualistic, stereotyped urges and behaviors that are repeated in response to the obsessions, often to defuse or neutralize the anxiety associated with the obsession. Among the more typical compulsions are cleaning, checking, and seeking symmetry and order.
These symptoms are different than the habits and mannerisms or the senseless thoughts that many of us share, like songs that repeat through our mind or a strict routine when showering in the morning. These more typical thoughts and behaviors can even be helpful because they release tension and calm us, but the obsessions and compulsions associated with OCD are excessive, intrusive, and out of the individual’s control. They are intrusive and ego-dystonic because the afflicted individual recognizes them as excessive and unreasonable, but believes something terrible will happen unless he or she acts on them. Any attempt to ignore the symptoms simply arouses more anxiety. In a sense, the relatively normal thoughts and fears that most of us experience are misappraised by those with OCD as overly significant and catastrophic in consequence, producing anxiety and motivating efforts to reduce the distress (Abramowitz, Deacon, Woods, & Tolin, 2004).
Interestingly, many of the obsessions of those with OCD have religious themes or imagery. The actual prevalence of religious obsessions ranges from 20 percent (Karadag, Oguzhanoglu, Ozdel, Atesci, & Amuk, 2006) to 42 percent of patients with OCD (Tek & Ulug, 2001). It appears that religious obsessions may actually keep company within a primary symptom cluster of taboo social topics that include sexual, somatic, and perhaps aggressive obsessions (Denys, de Geus, van Megen, & Westenberg, 2004). The taboo content of these obsessions may reflect the heightened anxiety associated with social concerns, and the particular sensitivity of teenagers to these social concerns may account for the early, adolescent onset among those whose OCD involves religious themes (Grant et al., 2006).
The actual content of these religious obsessions and compulsions may vary with the individual and culture. Hindus reportedly have more symptoms related to contamination and washing, largely because these are themes that are important to Indian culture of purity and cleanliness (Khanna & Channabasavanna, 1998). In the same way, the religious themes of obsessions and compulsions likely reflect one’s cultural and religious background. One common pattern across cultures or traditions is increased levels of scrupulosity among those with OCD (Nelson, Abramowitz, Whiteside, & Deacon, 2006), including obsessions related to a fear of God and compulsions of washing and hoarding related to a fear of sin (Olatunji, Abramowitz, Williams, Connolly, & Lohr, 2007).
Moreover, the actual number of these religious obsessions and compulsions appears to vary according to the degree of one’s religiousness. Abramowitz and colleagues (2004) discovered that those who are more religious generally report greater obsessional symptoms, compulsive washing, and beliefs about the importance of their religious thoughts. They also report a greater need to control their thoughts and an inflated sense of responsibility for controlling their actions. Even within denominations, Protestants who report greater religiousness score higher than Catholics, Jews, and less religious Protestants on measures assessing obsessionality, overimportance of thoughts, control of thoughts, and perfectionism and responsibility (Abramowitz, Huppert, Cohen, Tolin, & Cahill, 2002). Some of this might be related to their greater fear of God and their heightened fear of sinful thoughts. This relationship does not appear to be exclusive to Protestants, since Catholics with high or moderate degrees of religiousness also showed higher scores on measures of OCD-related cognitions than less religious Catholics (Sica, Novara, & Sanavio, 2002). This includes greater obsessionality, perfectionism, responsibility, and perceived overimportance of thoughts and control of thoughts. Therefore, religious obsessions and compulsions appear in many of those with OCD, but may be particularly prevalent in those with greater levels of religiousness.
Why would those with religious beliefs be more prone to obsessions and compulsions than those with more moderate, mitigated, or absent religious beliefs? Some of it might be related to the intrinsic value placed on religious thought and ritual, as well as their control. If you are taught that certain thoughts are sinful, as with many Protestant doctrines, then you may be likely to assume you can, and should, control these thoughts due to a fear of potentially disastrous consequences. To uphold these tenants, parents and religious leaders may encourage the suppression of these unwanted thoughts, which only leads to a cycle involving the greater urgency of the unwanted thoughts and more preoccupation toward neutralizing them through compulsive behavior. In many ways, thoughts and behaviors become indistinguishable, making the mere thought equivalent to the feared action (Nelson et al., 2006). This can be found even in non-Protestant religions where strong emphasis is given to moral behavior, purity of mind, and responsibility for one’s actions. This may be why obsessive traits are more common in highly religious and spiritual persons, with correlations ranging from +.15 to +.40 (Previc, 2005).
Furthermore, many of the rituals inherent to most religions are characterized by repetitive and exaggerated behavior. These rituals share many features with the compulsions of OCD, including a common goal for achieving order, regularity, and predictability. They both serve social purposes to contain fear and stave off perceived threats. OCD may just represent an exaggeration of these behavior strategies aimed at harm and risk minimization. Considering these similarities, as well as the value placed on thought and ritual by most forms of religion and spirituality, those with OCD may be particularly predisposed to adopt religious obsessions and compulsions. They may also be more inclined to ascribe miracle status to events that do not fit known physical or natural laws. High levels of magical ideation and perceptual distortions are reported by those with OCD (Tolin, Abramowitz, Kozak, & Foa, 2001), including a greater tendency to believe in God and miracles. Examining the pathology and brains of those with OCD may help us better understand this increased tendency toward miracle ascription.
OCD, the Frontal Lobes, and Miracle Ascription
Although there is no overt locus of neuronal degeneration in OCD, the prevailing hypothesis for its pathogenesis is a defective or hypertonic striatum that disturbs the frontosubcortical balance in striatal loops (Pujol et al., 2004). Functional imaging on those with OCD shows abnormal metabolic activity, usually hypermetabolism, in the corticobasal ganglia circuitry that links the orbitofrontal and medial frontal regions of the prefrontal cortex with the caudate nucleus (Anderson & Savage, 2004; Graybiel & Rauch, 2000; Saxena & Rauch, 2000). On MRI scans, OCD typically emerges as reduced gray matter volume in the medial frontal gyrus, medial orbitofrontal cortex, and left insuloopercular regions (Pujol et al., 2004). These deficits largely account for the cardinal features of OCD. For example, the frontostriatal system modulates behavioral responses, and the dorsolateral and orbitofrontal cortices contribute to the execution of flexible behavior, so that damage or overactivity in these regions can result in difficulty switching between tasks, behaviors, and beliefs (Brune, 2006).
Dysregulation in each of these systems can also contribute to the emergence of stereotyped, recurrent, and persistent obsessions and compulsions. The orbitofrontal and medial prefrontal cortices have been implicated in the way we evaluate rewards and punishments, which is compromised in OCD (Graybiel & Rauch, 2000). Both of these prefrontal cortices are strongly interconnected with the limbic system and are therefore implicated in motivation and our ability to perceive the emotional value of stimuli and select behavioral responses based on our expectations about the outcome. In the case of OCD, disruption to these areas likely results in the overvaluing of stimuli and inaccurate anticipation of rewards and punishments, both of which can foster obsessive thinking and compulsive behavior.
When it comes to miracle attributions in particular, part of the tendency for those with OCD to be more likely to engage in miraculous explanations may be related to an excess theory of mind. Again, there is no research showing the explicit processes involved in religious obsessions and compulsions, but they may stem from an overactive metacognitive system that is inclined toward attributing events to miraculous intervention. In the case of those with FTD, we stated that there is an alteration, most likely a deficit, in their ability to assign intentionality, infer one’s own constant mental state, and maintain earlier and perhaps more inhibited methods of agency detection. In the case of OCD, there may be an overactivity of metacognitive mechanisms and agency detection.
Considering the responsibility of the prefrontal cortex for cognitive flexibility, concern over one’s existence, and theory of mind, the hyperactivation of this region may result in hyperreligiousness, including a tendency to look for religious or miraculous explanations for counterintuitive information (Muramoto, 2004). It may be that individuals with OCD are more likely to look for both internal and external explanations for events that do not conform to natural, known processes. In a sense, elevated prefrontal activity may widen the scope of the agency detector, making those with OCD more susceptible to assigning intentional states, such as goals, thoughts, and intentions, to objects or agents, including agents outside the self and outside natural law. This seems particularly true among those primed with religious or spiritual backgrounds.
Similar to those with FTD, the reduced prefrontal inhibition of those with OCD may promote a release from internal and external cognitive anchors (Previc, 2005). This can lead to the loosening of associations and unusual attributions of causality, including incorrect attributions to self, which can reinforce the perceived control gained by compulsions. It can also reinforce unsubstantiated associations between external events, like superstitions about one’s behavior and the agents behind counterintuitive events. With the lowering of inhibition in the prefrontal system, exaggerated attention may also be devoted to extrapersonal space and extrapersonal sources of agency (Previc, 2005), particularly among those with preexisting neural networks primed toward religion or the supernatural. This is consistent with studies showing greater activation in the frontal relative to the occipital and parietal systems during meditation, religious reading, and other transcendental and spiritual experiences (Herzog et al., 1990-1991; Newberg et al., 2001; Newberg, Pourdehnad, Alavi, & d’Aquili, 2003). Put differently, the impact of frontal pathology on abstraction may lead those with OCD toward a different method of abstract reasoning. Their release from inhibition, paired with their greater penchant for religious themes, may result in the abstraction of meaning from nonnatural and miraculous sources.
This predilection for miracle attributions may also be supported by the unusual level of belief fixation experienced by those with OCD. Intrinsic to the overactivation of the frontal systems may be a clinging to one’s belief structure, even when confronted by evidence to the contrary. This belief fixation likely contributes to the maintenance of obsessions despite the disproportion between the obsession and the actual threat involved. In the same way, this belief fixation may also lead those who have OCD and a religious background to become even more open to, and entrenched within, their religious beliefs, rituals, and explanations, making them more firmly convinced of the reality of miracles and external sources of control.
Regardless of the mechanisms involved, the reliance on miracle explanations for counterintuitive events may be adaptive for those with OCD. The brains of individuals with OCD are overinvolved in anticipating possible consequences to their thoughts and actions. Their obsessions and compulsions help them in turn to predict and control both current and future events. Miracle attributions, like superstitious beliefs and obsessions, may represent methods for anticipating the outcome of future scenarios (Brune, 2006). They may serve as metarepresentations designed to impute meaning and controllability to events, thereby staving off real and perceived danger. Even among those without OCD, a tendency to interpret anomalous experiences as miracles can impart purpose and meaning to past and current events, as well as control and predictability to future events. In fact, Atran & Noren-zayan (2004) suggest that omniscient agents may be more attractive sources of attribution than nonomnicient agents because they do not succumb to false beliefs and because they provide an unassailable explanation that can be conformed to any need. This may make miracle explanations all the more appealing to those with OCD because they can be invoked to deal with any anxiety and uncertainty, be it commonplace or unnatural.
Toward a Unified Understanding of Miracle Attribution
Having considered the pathology underlying FTD and OCD, it may be possible to abstract a somewhat unified, albeit tentative, understanding of the neuropsychological processes involved in miracle attribution. Insights from both neurological disorders suggests that the impact of perceived miraculous events is not universally preconceptual or immediately affective (Azari et al., 2001), as many might think. Instead, there is a heavy cognitive and attributional component, where there is a causal claim regarding the mysterious and nonnatural source for the experience. It seems likely that this causal attribution is predominantly mediated by frontal lobe processes.
In particular, when we are confronted with anomalous or counterintuitive situations, we seek a solution, a satisfactory explanation that involves an active agent. We postulate the existence of agents because agents are primary sources of meaning and teleology, even when they cannot be directly observed (Pyysiainen, 2001). This search for a solution likely activates the frontal regions responsible for agency detection, theory of mind, and metarepresentations that have specifications about the causal relations between counterintuitive events. In the case of those with disordered frontal lobes, this activation might follow from a release of inhibition or a diminishing of one’s stability of self (as in the case of FTD), or it can be secondary to an excess theory of mind or even belief fixation (as with OCD). In both cases, there is a disruption in normal metacognitive and agency detection mechanisms.
Activation of these cognitive mechanisms, both in intact and disordered systems, likely stimulates the release of personally salient mental representations or cognitive schema that are housed in the prefrontal cortex, each of which has distinct specifications about causal relations. Although there are multiple ways of dealing with counterintuitive information, those who are religious, spiritual, or simply inclined to see a world beyond our explanation and hidden from our senses may have more distinctly extrapersonal, spiritual, or supernatural representational systems. They may be more prepared to make miracle attributions in accordance with their religious or spiritual representations, including how they causally experience events. Azari, Missimer, and Seitz (2005) describe it as an assumption about a relationship between the body and a conscious agent, be it the world, space, or the divine. Put simply, counterintuitive information may activate miracle representations in accordance with preexisting assumptions about the extraordinary and supernatural origin, agency, and intentionality of anomalous events.
The prefrontal cortices are critical for each stage of this process, from agency detection and mentalizing to selecting from available representations, so they are intimately involved in the way we explain counterintuitive information as miraculous. This is consistent with much of the research on the neurobiology underlying spiritual and religious experiences. The spiritual experiences of those with temporal lobe epilepsy are related to increased cerebral blood flow in the frontal regions that control how we attribute mental states to self and others (Azari et al., 2001; Newberg et al., 2001). During meditation, there appears to be increased frontal activity on PET imaging (Herzog et al., 1990-1991), and SPECT imaging with Franciscan nuns and Tibetan monks has revealed increased activity and blood flow in the dorsolateral and dorsomedial prefrontal cortex (Newberg et al., 2001, 2003). Even the simple recitation of religious texts activates dorsolateral and dorsomedial frontal cortices on PET imaging (Azari et al., 2001). Therefore, the increased activity of the frontal lobe during spiritual and religious experiences, paired with its role in agency detection and causal attribution, supports a strong role for frontal processes in the attribution to miraculous processes.
Undoubtedly, there are limitations to this approach. Methodologically, there are inherent difficulties in trying to discern the operation of a cognitive process by examining how it goes awry in disordered systems like FTD and OCD. By all accounts, the use of miracle language and miracle representations to explain counterintuitive information is a common and arguably normal process that has been evolutionarily selected; otherwise it would be much less prevalent. However, there is nothing concrete to suggest that miracle attributions work precisely the same way among unafflicted individuals and those with FTD and OCD. In fact, the processes leading to miracle attribution in FTD and OCD may be an artifact of the dysregulated frontal systems associated with these conditions, with little corollary to normal mechanisms for miracle ascription. The risk is that something will get missed by examining dysregulated systems, such as intact functions that are also operating in miracle ascription, but that are easily overlooked because they are not part of FTD or OCD pathology.
It is also likely that miracle ascription is not isolated to the frontal lobes. Multiple other areas may also be involved. As argued elsewhere in this series (Paloutzian, Rogers, Swenson, & Lowe, in press), it may be more accurate to say that miracles are made along a frontal-parietal circuit, where counterintuitive information is first perceived as sensory input and later constructed using a meaningful miracle schema. The medial temporal lobe has also been heavily implicated in religious and paranormal activity (see Previc, 2005, for a review), probably related to the affective valence experienced with these events. While it is true that many of the events deemed as miraculous are given this designation due to their strong emotional loading, it is equally important not to diminish frontal lobe involvement in the actual process of defining something as a miracle. Although limbic and temporal involvements likely play a precursory role in how we define a miracle, this focus on the immediate, eye-catching emotional element may minimize the larger, cognitive process involved in the way we interpret events to be miracles.
It seems safe to say that many people want to believe in miracles. There is a strong human appeal to be awed, to find wonder, and to be held captive to the extraordinary. Hume calls it a “propensity of mankind toward the marvelous” (as cited in Pojman, 2001, 85). This intimates that many individuals are primed toward seeing or experiencing miracles, particularly if they have a spiritual or religious worldview. In this light, it would seem easy to argue that studying the neural substrates involved in miracle attribution only cheapens the miracle, removing the mystery from something meant to be appreciated on its own merit and taken on faith. But it seems important to acknowledge that calling something a miracle is a decision, an overt cognitive process that is likely mediated by frontal-subcortical activity, predominantly involving prefrontal regions that control agency detection, theory of mind, inhibitory processes, and the flexibility or rigidity of thought. This does not remove or threaten the highly affective or mysterious nature of these events, but simply suggests that the process for experiencing and perceiving a miracle is more than an emotional response or a mysterious feeling. It is a very cognitive process, which is most likely governed by the frontal lobes.
It should also come as no surprise that this process for miracle interpretation is brain-based. It is akin to the conversation reported by Nasar (1998) between Harvard professor George Mackey and John Nash, the mathematical genius afflicted with schizophrenia. Professor Mackey posed the question to John, “How could you, a mathematician, a man devoted to reason and logical proof … how could you believe that extraterrestrials are sending you messages? How could you believe that you are being recruited by aliens from outer space to save the world?” Nash quietly replied, “Because the ideas I had about supernatural beings came to me the same way that my mathematical ideas did” (11). Hallucinations and mathematics, attributions to miracles and attribution to chance—each of these alike can be traced to distinct neural substrates. In the case of miracles, these attributions seem preferentially localized to frontal lobe activity.
Some people might ask why we do not see more miracles in modern times. Perhaps the advance of science has increased our knowledge about natural processes, thereby reducing occasions of counterintuition, where events do not fit known natural laws. Perhaps individuals have exchanged miracle explanations for other agents, like luck or good fortune. Perhaps our use of the term miracle has been so watered down that we have become desensitized to true miracles. Either way, maybe our understanding of miracles is limited because we have been looking in the wrong place. Maybe more attention needs to be given to unlocking the secrets of the frontal lobe, where miracle attributions are made.