Automatism (medicine)

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Automatism
Specialty Neurology

Automatism is a set of brief unconscious or automatic behaviors, [1] typically at least several seconds or minutes, while the subject is unaware of actions. This type of automatic behavior often occurs in certain types of epilepsy, such as complex partial seizures in those with temporal lobe epilepsy, [2] or as a side effect of particular medications such as zolpidem. [3]

Contents

Automatic behaviors involve the spontaneous production of purposeless verbal or motor behavior without conscious self-control or self-censorship. This condition can be observed in a variety of contexts, including schizophrenia, psychogenic fugue, Tourette syndrome, epilepsy (in complex partial seizures and Jacksonian seizures), narcolepsy, or in response to a traumatic event.

Automatic behavior can also be exhibited in REM sleep, during which a higher amount of brain stimulus increases dreaming patterns. In such circumstances, subjects can hold conversations, sit up, and even open their eyes. [4] These acts are considered subconscious as most of the time the events cannot be recalled by the subject. [4]

Automatic behavior may also manifest while performing well-learned actions. In this case, the behavior becomes automatic because it does not require conscious monitoring. The seemingly purposeful task is performed with no clear memory of it happening. [5]

Variations

Varying degrees of automatism may include simple gestures, such as finger rubbing, lip smacking, chewing, or swallowing, or more complex actions, such as sleepwalking behaviors. [6] [7] Others may include speech, which may or may not be coherent or sensible. [8] The subject may or may not remain conscious otherwise throughout the episode. Conscious subjects may be fully aware of their other actions at the time, but unaware of their automatism.

In some more complex automatisms, the subject enters into the behaviors of sleepwalking while fully awake until it starts. In these episodes, which can last for longer periods of time, the subject proceeds to engage in routine activities such as cooking, showering, driving a familiar route, or even conversation. Following the episode, the subject regains consciousness, often feeling disoriented, and has no memory of the incident. [9]

Early automatism

The interest in automatic behavior started in the 19th century after a vast spiritual movement was associated with uncontrollable body movements. [10] Many people believed that uncontrollable movements such as table-turning, tilting, and screaming were signs of spirit possessions or that outside forces were taking over human bodies. [10]

Many individuals started focusing on automatic behavior, such as the psychotherapist and psychologists Pierre Janet. [11] Pierre Janet played an important role in studying the condition of dissociation related to automatic behaviors. Janet collected abnormal cases of automatisms and studied these cases with the idea that the patient's consciousness and unconsciousness were separated, causing behavioral changes and automatism. [11] This approach to automatisms and the study of the conscious and unconscious part of the brain was inspired by the work of Sigmund Freud and William James; two investigators of hypnosis and hysteria. [11]

At that time, automatism was a condition that many people faked. [10] Indeed, scam artists use confidence tricks to depict fake spiritual possessions by making it seem like they weren't in control of their bodies. Interest in the spiritual movement eventually dropped in the early 20th century. However, scientists were always skeptical of the idea of automatism. [11] There wasn't a concrete way to know if the sensation of losing control of the body felt by the individuals was real. [11]

Conditions of automatism

There are many conditions for automatism. One example is dissociation, where consciousness and unconsciousness can be separated and change behavioral patterns. [12] Dissociative symptoms, prevalent in many cases can be seen in people who have experienced blindness, deafness, anesthesia of various parts of the body, convulsions, possession, odd voices or sudden new habits, physical illness, and others. [12] Dissociation can be connected to hypnosis, where involuntary actions are produced as a result. [12] Hypnosis was closely related to dissociation because people were vulnerable to hypnosis while experiencing dissociative symptoms. [12] Dissociation leads people to lose control over their actions as their consciousness and unconsciousness separate. [12]

Another condition of automatism is the expectation of attention, where someone has expectations that an action will be produced. [12] For example, the use of a pendulum, during which the person holding the pendulum is attempting not to move it, the thought of it moving still crosses the mind. [12] Expectation attention can therefore be described as expecting an action to occur, [12] where our thought process is based on a movement we believe is bound to happen, creating this expectation. [12] As our thoughts and actions are connected, focusing on the expectation of such action is likely bound to happen. [12] We can also see the "trolling for consistent action" affecting expectation attention. [12] For example, when thinking of a specific feeling, such as coughing, as the thought lingers for a while we suddenly feel the urge to cough, clearing our throat and then eliminating such sensation. [12] As this process plays out, we do not feel that we coughed due to the thought of doing so, as we aren't as aware of the thought in the first place. [12] Expectation attention allows us to focus on our thought about action, even though our consciousness does not perceive us focusing on it, and so thought and behavior are separated. [12]

Movement confusion is another condition of automatism, and is defined as one's belief that an action must be seen to believe that they are producing that action. [12] For example, with the use of a pendulum, pushing a pendulum in a certain direction or pulling it in the opposite direction can contradict the original thought of the specific movement of the pendulum. [12] As we can see the result of such action that we produce, it is harder to continue producing such action if it is opposite from our original idea of how the action will be produced. [12] As it becomes harder to see the initial perceived action, the consistency of such action is being seen less, and the consciousness will soon become the unconsciousness of performing this action. [12]

An outside agent can also be a condition of automatism. People subject to automatism will produce involuntary actions that were not controlled by their mental causation. To explain that phenomenon many will believe an outside factor is responsible for the action. [13] Since the individuals don't have a conscious feeling of doing the automatic behavior, they automatically doubt that their mind could be responsible for it, pushing them to believe someone else, or something else, is causing their behavior. [13] Many people link automatism with spirit possession for that reason. [13]

Automatic behavior in seizures

According to the book Brainstorm: Detective Stories From the World of Neurology by Suzanne O'Sullivan, a side effect of focal seizures are uncontrollable movements, also known as automatism. [14] O'Sullivan observed many automatisms in her patients such as purposeless swearing, spitting, uncontrollable clicking fingers, fumbling movements, and more. [14] According to O'Sullivan, these symptoms are "an automatic release phenomenon that occurs because brain inhibition has been lost." [14] The release of inhibition causes automatic behavior in other cases such as after a cingulotomy or even in the postictal phase of a seizure. [15] In those cases, the patients having an epileptic seizure aren't in control of their bodies.

Usually, focal seizures from the temporal lobe or extratemporal seizure with cingulate cortex will generate automatic movements. [15] The automatic behavior happens around five seconds after the seizure starts. It results from the spread of the seizure past its starting point. [15] During a seizure, the cortical region of the brain can be activated, generating an automatic behavior. [15]

Different automatic behavior can occur depending on what part of the brain is affected during the seizures. For instance, the electric stimulation of the cingulate, part of the cortex involved in behavior regulation, can create an automatic movement to the contralateral leg, lip, and face. [15] If the patient has an effective automatism such as facial expressions that exhibit fear, the limbic motor region of the cingulate cortex is most likely impacted by the seizure. [15] If the patient has an automatic behavior involving oral-alimentary like chewing or the movement of the appendicular skeleton such as picking up an object, this means the seizure activated the temporal lobe of the patient. [15] Seizures can also impact the anterior cingulate causing the patient to have an uncontrollable ictal pouting also known as an inverted smile. [15]

Spirit possession automatism

The Ouija Board, is a flat board marked with the letters of the alphabet, the words "yes and no", numbers 0-9 as well as other graphics. [16] The board uses a small heart-shaped piece of plastic or wood which is called a planchette. [16] To use this board correctly, participants must place their fingers on the planchette and see which direction it points. The action of the board can be explained by a psychophysiological phenomenon known as the ideomotor effect. [16] The ideomotor effect, also known as the "Automatism Theory", is the idea that even though a person may not know they are controlling the message indicator, they are. [16] Most proponents of the Automatism Theory undertake the fact that it is probable to move the planchette unconsciously and declare that the Ouija board opens up a shortcut from the conscious to the subconscious mind. [16]

The pendulum is a hand-held device usually containing a crystal and a chain. [17] Crystals are often used as the weight stone, as the user could connect with them spiritually and cleanse them as needed. [17] When using a pendulum, individuals begin to think about what questions they want to ask the pendulum, usually being yes or no questions. Usually, the pendulum will start moving in a specific pattern. [17] The pendulum is linked to automatism as it is often believed to be caused by automatic behavior. Indeed, slight movement can make the pendulum move. [17] In addition, thinking about the pendulum moving can subconsciously push someone to move the pendulum and blame it on spirits. This is another case of the ideomotor effect [16] as the individual is not aware of moving the pendulum.

Dowsing is a technique used to locate ground water, minerals, ores, gemstones, and many more by using a divining/dowsing rod. [18] A divining rod usually consists of either tree branches or a forked rod, normally being hazelwood and V/Y/L shaped. With these rods, it is believed that when standing over a water source or minerals, the rods will spontaneously cross, or stick downwards. [18] The scientific community criticizes this belief as they think dowsing is caused by an automatic behavior from the person dowsing. [18] Indeed, subconsciously, the rods getting pushed together might be caused by the individual. This could be explained by the Ideomotor Effect [16] as the individual is not aware they are causing the rods to move.

Tourette's Syndrome

Tourette's syndrome is a neurodevelopmental condition with primary indicators being vocal and motor tics. To be classified as Tourette's syndrome, the individual must have a minimum of one vocal tic and two motor tics that have been chronically present. A tic is defined as a sudden, recurring, automatic, movement or vocalization. [19] The cause has been widely disputed since its discovery in 1885 by George Giles de la Tourette. Causal theories have ranged widely from repressed sexual conflict to oppressive parents. Modern day research leans more towards both environmental and genetic factors and triggers. [20]

Alien hand syndrome

Alien hand syndrome is an automatic behavior, first discovered in 1908, in which the person has uncontrolled behavior and observes his limbs moving without consciously having the capacity to control it. Often, it happens to be the left hand, since the right hemisphere is affected. There are a few different versions of alien hand syndrome that can occur, which are the Frontal Lobe version, the Callosal version, and the Posterior version. The frontal lobe version is the only version that affects the right hand of the individual. The callosal version involves the corpus callosum area of the brain. The posterior version involves the parietal lobe. [21] The frontal, occipital, and parietal areas of the brain are also associated to this syndrome. It can occur after brain surgery, stroke, infection, tumor, aneurysm, migraine, having the two hemispheres surgically separated, Alzheimer's disease, Corticobasal degeneration, and Creutzfeldt--Jakob disease. Although anyone can fall victim to this, alien hand syndrome is a very rare side effect.

Dreams

Statue of a sleepwalker on top of a house in Austria Statue of sleepwalker.jpg
Statue of a sleepwalker on top of a house in Austria

While the human body is sleeping, we are considered to be unconscious, but what happens to us when we are dreaming? Automatism can be illustrated within dreams, as the human brain does not need to think about dreaming, it simply happens. The brain is active during the REM (rapid eye movement) stage of sleep, when dreams occur, [22] however this is only to portray the images we see in our dreams. Further analysis of this ideology can be seen in nightmares. Most humans do not want to have frightening dreams, still, we as individuals have no control over what we dream about. This is a prime example of why dreaming is considered an automatic behavior. Sleepwalking also comes around as a thought of automatic behavior found within the subcategory of dreams. What is happening to our bodies when we sleepwalk? Sleepwalking occurs in the frontal cortex responsible for rationality and the hippocampus used for memory. [23] Scientists know this information from performing various tests on sleepwalking patients, such as EEG's and brain scans. It has been shown that sleepwalking relates to the natural human behavior of sleeping, although the frontal cortex is awake and ready to go. This can be seen in a lot of animal species, as this form of sleep where the frontal cortex is partially awake stems from an adaptation of enhanced survival. This is because the animals are ready to rise and defend against predators, and are less vulnerable while sleeping. [24] While sleepwalking can be rather daunting and dangerous, it is something nobody can control, therefore considered a subclass of automatic behavior in dreams.

Everyday automatism

Everyday automatism is how someone can be affected in their everyday life due to the automatism they are experiencing. Even the most basic things done daily becomes extremely difficult—for example, showering, eating, and even breathing. Showering becomes difficult with the effects of nausea, paleness, and oral automatisms which can be triggered by the shower, through this automatism it is affected in the left temporal lobe. When the shower triggers this automatism, it triggers the left temporal lobe and causes these effects to happen to the individual experiencing these automatisms. [25]

Eating is another aspect of one's life that happens daily. Automatisms that are attached to eating can be triggered or caused by eating which can cause dizziness, impaired speech, jerking, and lip-smacking, without loss of awareness. All of those effects are provoked by eating or the mere thought of eating. [26] Something so simple as breathing is affected due to automatisms, and the effects it can cause are shortness of breath, changes in respiratory rate and pattern, and reflexes such as coughing are triggered through automatisms. [27] These are all examples of things someone does daily and possible side effects they can experience due to their epilepsy.

See also

Related Research Articles

<span class="mw-page-title-main">Unconsciousness</span> Loss of awareness of self and environment

Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an awareness of self and environment or to respond to any human or environmental stimulus. Unconsciousness may occur as the result of traumatic brain injury, brain hypoxia, severe intoxication with drugs that depress the activity of the central nervous system, severe fatigue, pain, anaesthesia, and other causes.

In psychoanalysis and other psychological theories, the unconscious mind is the part of the psyche that is not available to introspection. Although these processes exist beneath the surface of conscious awareness, they are thought to exert an effect on conscious thought processes and behavior. Empirical evidence suggests that unconscious phenomena include repressed feelings and desires, memories, automatic skills, subliminal perceptions, and automatic reactions. The term was coined by the 18th-century German Romantic philosopher Friedrich Schelling and later introduced into English by the poet and essayist Samuel Taylor Coleridge.

<span class="mw-page-title-main">Hallucination</span> Perception that only seems real

A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. Hallucination is a combination of two conscious states of brain wakefulness and REM sleep. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

<span class="mw-page-title-main">Sleepwalking</span> Sleeping phenomenon combined with wakefulness

Sleepwalking, also known as somnambulism or noctambulism, is a phenomenon of combined sleep and wakefulness. It is classified as a sleep disorder belonging to the parasomnia family. It occurs during slow wave stage of sleep, in a state of low consciousness, with performance of activities that are usually performed during a state of full consciousness. These activities can be as benign as talking, sitting up in bed, walking to a bathroom, consuming food, and cleaning, or as hazardous as cooking, driving a motor vehicle, violent gestures and grabbing at hallucinated objects.

Alien hand syndrome (AHS) or Dr. Strangelove syndrome is a category of conditions in which a person experiences their limbs acting seemingly on their own, without conscious control over the actions. There are a variety of clinical conditions that fall under this category, which most commonly affects the left hand. There are many similar terms for the various forms of the condition, but they are often used inappropriately. The affected person may sometimes reach for objects and manipulate them without wanting to do so, even to the point of having to use the controllable hand to restrain the alien hand. Under normal circumstances however, given that intent and action can be assumed to be deeply mutually entangled, the occurrence of alien hand syndrome can be usefully conceptualized as a phenomenon reflecting a functional "disentanglement" between thought and action.

<span class="mw-page-title-main">Occipital lobe</span> Part of the brain at the back of the head

The occipital lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The name derives from its position at the back of the head, from the Latin ob, 'behind', and caput, 'head'.

<span class="mw-page-title-main">Hypergraphia</span> Psychological condition wherein a person is compelled to write or draw

Hypergraphia is a behavioral condition characterized by the intense desire to write or draw. Forms of hypergraphia can vary in writing style and content. It is a symptom associated with temporal lobe changes in epilepsy and in Geschwind syndrome. Structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the hippocampus and Wernicke's area. Aside from temporal lobe epilepsy, chemical causes may be responsible for inducing hypergraphia.

<span class="mw-page-title-main">Myoclonus</span> Involuntary, irregular muscle twitch

Myoclonus is a brief, involuntary, irregular twitching of a muscle, a joint, or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus describes a medical sign and, generally, is not a diagnosis of a disease. It belongs to the hyperkinetic movement disorders, among tremor and chorea for example. These myoclonic twitches, jerks, or seizures are usually caused by sudden muscle contractions or brief lapses of contraction. The most common circumstance under which they occur is while falling asleep. Myoclonic jerks occur in healthy people and are experienced occasionally by everyone. However, when they appear with more persistence and become more widespread they can be a sign of various neurological disorders. Hiccups are a kind of myoclonic jerk specifically affecting the diaphragm. When a spasm is caused by another person it is known as a provoked spasm. Shuddering attacks in babies fall in this category.

In criminal law, automatism is a rarely used criminal defence. It is one of the mental condition defences that relate to the mental state of the defendant. Automatism can be seen variously as lack of voluntariness, lack of culpability (unconsciousness) or excuse. Automatism means that the defendant was not aware of his or her actions when making the particular movements that constituted the illegal act.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.

Focal seizures are seizures that affect initially only one hemisphere of the brain. The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parietal and occipital lobes. A focal seizure is generated in and affects just one part of the brain – a whole hemisphere or part of a lobe. Symptoms will vary according to where the seizure occurs. When seizures occur in the frontal lobe, the patient may experience a wave-like sensation in the head. When seizures occur in the temporal lobe, a feeling of déjà vu may be experienced. When seizures are localized to the parietal lobe, a numbness or tingling may occur. With seizures occurring in the occipital lobe, visual disturbances or hallucinations have been reported.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Echopraxia is the involuntary repetition or imitation of another person's actions. Similar to echolalia, the involuntary repetition of sounds and language, it is one of the echophenomena. It has long been recognized as a core feature of Tourette syndrome, and is considered a complex tic, but it also occurs in autism spectrum disorders, schizophrenia and catatonia, aphasia, and disorders involving the startle reflex such as latah. Echopraxia has also been observed in individuals with epilepsy, dementia and autoimmune disorders; the causes of and the link between echopraxia and these disorders is undetermined.

<span class="mw-page-title-main">Ring chromosome 20 syndrome</span> Medical condition

Ring chromosome 20, ring-shaped chromosome 20 or r(20) syndrome is a rare human chromosome abnormality where the two arms of chromosome 20 fuse to form a ring chromosome. The syndrome is associated with epileptic seizures, behaviour disorders and intellectual disability.

Primary consciousness is a term the American biologist Gerald Edelman coined to describe the ability, found in humans and some animals, to integrate observed events with memory to create an awareness of the present and immediate past of the world around them. This form of consciousness is also sometimes called "sensory consciousness". Put another way, primary consciousness is the presence of various subjective sensory contents of consciousness such as sensations, perceptions, and mental images. For example, primary consciousness includes a person's experience of the blueness of the ocean, a bird's song, and the feeling of pain. Thus, primary consciousness refers to being mentally aware of things in the world in the present without any sense of past and future; it is composed of mental images bound to a time around the measurable present.

<span class="mw-page-title-main">Neural correlates of consciousness</span> Neuronal events sufficient for a specific conscious percept

The neural correlates of consciousness (NCC) are the minimal set of neuronal events and mechanisms sufficient for the occurrence of the mental states to which they are related. Neuroscientists use empirical approaches to discover neural correlates of subjective phenomena; that is, neural changes which necessarily and regularly correlate with a specific experience. The set should be minimal because, under the materialist assumption that the brain is sufficient to give rise to any given conscious experience, the question is which of its components are necessary to produce it.

Unconscious fraud is fraud committed by somebody who does not consciously realise that they are deceiving others. Examples could be a hypnotised person or perhaps a medium in a trance, neither of whom would consciously realise that they are engaging in acts which make others believe – such as that a 'spirit' has moved an object.

<span class="mw-page-title-main">Ideomotor phenomenon</span> Concept in hypnosis and psychological research

The ideomotor phenomenon is a psychological phenomenon wherein a subject makes motions unconsciously. Also called ideomotor response and abbreviated to IMR, it is a concept in hypnosis and psychological research. It is derived from the terms "ideo" and "motor". The phrase is most commonly used in reference to the process whereby a thought or mental image brings about a seemingly "reflexive" or automatic muscular reaction, often of minuscule degree, and potentially outside of the awareness of the subject. As in responses to pain, the body sometimes reacts reflexively with an ideomotor effect to ideas alone without the person consciously deciding to take action. The effects of automatic writing, dowsing, facilitated communication, applied kinesiology, and ouija boards have been attributed to the phenomenon.

<span class="mw-page-title-main">Occipital epilepsy</span> Medical condition

Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.

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Further reading