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The Out-Of-Body Experience: Disturbed Self-Processing at the Temporo-Parietal Junction OLAF BLANKE and SHAHAR ARZY

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The Out-Of-Body Experience: Disturbed Self-Processing at the Temporo-Parietal Junction OLAF BLANKE and SHAHAR ARZY NEUROSCIENCE UPDATE I The Out-of-Body Experience: Disturbed Self-Processing at the Temporo-Parietal Junction OLAF BLANKE and SHAHAR ARZY Folk psychology postulates a spatial unity of self and body, a “real me” that resides in one’s body and is the subject of experience. The spatial unity of self and body has been challenged by various philosophical considerations but also by several phenomena, perhaps most notoriously the “out-of-body experience” (OBE) during which one’s visuo-spatial perspective and one’s self are experienced to have departed from their habitual position within one’s body. Here the authors marshal evidence from neurology, cognitive neu- roscience, and neuroimaging that suggests that OBEs are related to a failure to integrate multisensory infor- mation from one’s own body at the temporo-parietal junction (TPJ). It is argued that this multisensory dis- integration at the TPJ leads to the disruption of several phenomenological and cognitive aspects of self- processing, causing illusory reduplication, illusory self-location, illusory perspective, and illusory agency that are experienced as an OBE. NEUROSCIENTIST 11(1):16–24, 2005. DOI: 10.1177/1073858404270885 KEY WORDS Illusion, Autoscopic phenomena, Temporo-parietal junction, Neurology, Neuroimaging Self and the Out-of-Body Experience OBEs has notoriously questioned (and continues to put into question) folk psychological notions of humans In an out-of-body experience (OBE), people seem to be about their self and body. OBEs challenge the experi- awake and feel that their “self,” or center of experience, enced spatial unity of self and body that has been is located outside of the physical body. It is from an ele- described as the existence of a “real me” that resides in vated extrapersonal location that the subjects who under- one’s body and is the subject of experience (Neisser go an OBE (OBErs) experience seeing their body and 1988). Psychologists (Palmer 1978; Blackmore 1982; the world. The following example from Irwin (1985; Irwin 1985), neurologists (Devinsky and others 1989; case 1) may illustrate what subjects experience during an Grüsser and Landis 1991; Brugger and others 1997; OBE: Blanke and others 2004), and philosophers (Metzinger 2003) suggested that OBEs are culturally invariant neu- I was in bed and about to fall asleep when I had the dis- ropsychological phenomena. In addition, some of these tinct impression that “I” was at the ceiling level looking authors suggested that OBEs are deviant self models due down at my body in the bed. I was very startled and to abnormal brain activation patterns whose scientific frightened; immediately [afterward] I felt that, I was investigation might lead to a better understanding of the consciously back in the bed again. processes mediating the self under normal conditions.* Understanding how the brain generates the abnormal An OBE is defined by the presence of three phenome- self during OBEs is particularly interesting because nological characteristics: disembodiment (location of OBEs not only are found in clinical populations the self outside one’s body), the impression of seeing the (Devinsky and others 1989; Grüsser and Landis 1991; world from a distant and elevated visuo-spatial perspec- Brugger and others 1997; Blanke and others 2004) but tive (extracorporeal egocentric perspective), and the also appear in approximately 10% of the healthy popula- impression of seeing one’s own body (or autoscopy) tion (Blackmore 1982; Irwin 1985). Moreover, OBEs from this elevated perspective (Green 1968; Blackmore have been described in the majority of the world’s cul- 1982; Blanke and others 2004). This is shown in Figure tures (Sheils 1978). Yet there are to date only a few sci- 1. This threefold deviance from the normal self during entific investigations on OBEs, probably because they generally occur spontaneously, are of short duration, and happen only once or twice in a lifetime (Green 1968; The authors are supported by the Leenaards Foundation. From the Functional Brain Mapping Laboratory, Department of *There have been many other theories of out-of-body experiences Neurology, University Hospital, Geneva, Switzerland (O.B., S.A.), and (OBEs). For example, some have considered the phenomenological the Laboratory of Cognitive Neuroscience, Brain-Mind Institute, data during OBEs as factual evidence that OBEs reflect the actual pro- Lausanne, Switzerland (O.B.). jection of a subtle, nonphysical aspect of one’s personality in extraper- sonal space. These authors suggested that OBEs reflect an actual sepa- Address correspondence to: Olaf Blanke, MD, PhD, Laboratory of ration of the self from the body and that OBEs provide evidence for Cognitive Neuroscience, Brain-Mind Institute, 1015 Lausanne, human survival after death. See Irwin (1985, p 219–59), Blackmore Switzerland (e-mail: [email protected]). (1982, p 200–39), and Alvarado (1992) for a critical discussion of these as well as other accounts. 16 THE NEUROSCIENTIST Out-of-Body Experience Copyright © 2005 Sage Publications ISSN 1073-8584 ing that the phenomenology of OBEs in neurological and healthy subjects is very similar: Suddenly it was as if he saw himself in the bed in front of him. He felt as if he were at the other end of the room, as if he were floating in space below the ceiling in the corner facing the bed from where he could observe his own body in the bed. he saw his own completely immobile body in the bed; the eyes were closed. (Lunn 1970, case 1) Etiology. OBEs have been observed predominantly in patients with epilepsy and migraine. Thus, Lippman (1953) reported two migraine patients with OBEs, and Green (1968) reported that 11% of the OBE subjects that participated in her survey suffered from migraine headaches. Devinsky and others (1989) described the largest study of neurological OBE patients and described patients whose OBE was associated with nonlesional epilepsy (cases 6 and 10), with epilepsy due to an arteri- ovenous malformation (cases 2 and 3) or to posttraumat- Fig. 1. Phenomenology of out-of-body experience (OBE). ic brain damage (case 1). In Blanke and others’ study During an OBE, the subject appears to “see” himself (bottom) and the world from a location above his physical body (extra- (2004), OBEs were due to a dysembryoplastic tumor corporeal location and visuo-spatial perspective; top). The self (cases 1 and 2a) and in one patient induced by focal elec- is localized outside one’s physical body (disembodiment). The trical stimulation (case 3). direction of the subject’s visuo-spatial perspective during an OBE is indicated by an arrow. Modified from Blanke (2004). Autoscopic Phenomena. Authors in the field of neu- rology have classified OBEs among autoscopic phenom- Blackmore 1982). This sparseness of scientific investi- ena, which are defined as a group of illusory visual gations is astonishing because other body illusions such experiences during which the subject has the impression as supernumerary phantom limbs or the transformation of seeing a second own body in extrapersonal space of an extremity (i.e., visual illusions of body parts) have (Devinsky and others 1989; Brugger and others 1997). been systematically investigated by many basic and clin- Next to OBEs, two other forms of autoscopic phenome- ical neuroscientists (for review, see Ramachandran and na have been described. Devinsky and others (1989) Hirstein 1998; Halligan 2002). Importantly, these latter explicitly compared OBEs to phenomenon of autoscop- studies have led to the description of neurophysiological ic hallucination, which is defined as the experience of and neuroanatomical mechanisms of visual illusions of seeing a double of oneself in extrapersonal space with- body parts and to the development of more efficient out leaving one’s body. Autoscopic hallucination is illus- treatments for neurological patients. This is not the case trated in the following example: for visual illusions of the entire body such as OBEs, which continue to occupy a neglected position between The patient suddenly noticed a seated figure on the left. neuroscience and mysticism. Although several authors in “It wasn’t hard to realize that it was I myself who was the field of psychology have experimentally investigated sitting there. I looked younger and fresher than I do now. OBEs (for review, see Alvarado 2000), the present My double smiled at me in a friendly way.” (Kölmel review will focus on recent neurological and neuroimag- 1985, case 6) ing findings with respect to OBEs. The third autoscopic phenomenon is heautoscopy, OBEs of Neurological Origin which is an intermediate form between autoscopic hallu- cination and OBE. During heautoscopy, the subject also Authors in the field of neurology have described several sees his double in extrapersonal space, but it may be dif- patients with OBEs due to brain damage. This has result- ficult for the subject to decide whether he is disembod- ed in descriptions of the etiology, associated phenome- ied or not. In fact, subjects may state that they experi- nology (such as autoscopic phenomena, vestibular dis- ence seeing the world from two simultaneous or alter- turbances, and visual body part illusions), and anatomy nating visuo-spatial perspectives (Brugger and others of OBEs. This is described in detail below. 1994; Blanke and others 2004): Early reports were by Lippman (1953, case 1 and 2), Hécaen and Green (1957, case 3), Daly (1958, case 5), [The patient] awakens from sleep and has the immediate and Lunn (1970, case 1). More recently, Devinsky and impression as if she were seeing herself from behind others (1989, case 1, 2, 3, 6, and 10) and Blanke and oth- herself. She felt as if she were “standing at the foot of ers (2004, case 1, 2a, and 3) reported further cases show- my bed and looking down at myself.” Yet . the patient Volume 11, Number 1, 2005 THE NEUROSCIENTIST 17 also has the impression to “see” from her physical [or In addition to vestibular disturbances, it has been bodily] visuo-spatial perspective, which looked at the reported that OBE patients may also experience parox- wall immediately in front of her.
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