HYPOTHESIS

NEURAL AND COGNITIVE BASIS OF SPIRITUAL EXPERIENCE: BIOPSYCHOSOCIAL AND

ETHICAL IMPLICATIONS FOR CLINICAL MEDICINE
James Giordano, PhD,1# and Joan Engebretson, DrPH2

The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable
equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating
biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed
and what types of neural events may be occurring. We posit that
existing evidence suggests that SE can induce both intermediate
level processing (ILP) to generate attentional awareness (ie, consciousness of) effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, state of) consciousness effects. Recognition of neural and cognitive

mechanisms is important to clinicians understanding of the

biological basis of noetic, salutogenic, and putative physiologic
effects. We posit that neurocognitive mechanisms, fortified by
anthropologic and social contexts, led to the incorporation of
SE-evoked behaviors into health-based ritual(s) and religious
practice(s). Thus, these experiences not only exert biological
effects but may provide important means for enhancing patients locus of control. By recognizing these variables, we advocate clinicians to act within an ethical scope of practice as therapeutic and moral agents to afford patients resources to
accommodate their specific desire(s) and/or need(s) for spiritual
experiences, in acknowledgement of the underlying mechanisms
and potential outcomes that may be health promotional.

INTRODUCTION
Over the past decade, there has been considerable multidisciplinary interest in spiritual experience and its possible role in
human health.1 In mainstream and many complementary medical approaches, secular, and in certain instances, nonsecular
spiritual practices are being viewed as potentially positive influences on patients (at very least, subjective) wellness.2
However, there is considerable equivocality regarding the importance and/or degree of enfranchisement that clinical medicine should maintain toward spirituality. These range across
diametrically opposing viewpoints, from advocacy of clinicians
complete acceptance and participatory involvement in their patients spirituality3,4 to a more pragmatic stance that disregards or
negates the importance of spiritual issues or effect(s) in the clinical scenario.5 Poised somewhere in between is an ambiguous
neutrality that is somewhat polarized at its borders; on one end,
such neutrality confers benign acceptance, whereas, on the
other, it may represent implicit rejection.6 Hall and Curlin7
maintain that even such neutrality regarding patients spirituality (and by extension, religiosity) is, in practicality, impossible
and intellectually undesirable.

In this paper, we argue that it is important for clinicians to

recognize patients spirituality as an important biological, psychological, and social variable that can potentially affect the
noetic (ie, cognitive) experience and perhaps physiological aspects of well-being. We attempt to illustrate the putative neural
substrates of spiritual experiences and frame these within anthropologic contexts to demonstrate the salutogenic role such neurocognitive events manifest within individuals, societies, and
cultures. Last, we argue that the ethical foundations of medical
practice obligate the clinician to acknowledge the basis and effect(s) of these variables. In recognizing this, we advocate that
the clinician, as a steward of knowledge and therapeutic and
moral agent, act prudently to enable their patients access to
those resources that best serve the good of their spiritual needs.

1 Center for Clinical Bioethics, Georgetown University Medical Center,

Washington, DC
2 School of Nursing, University of Texas-Houston Health Science Center, Houston, TX
Supported in part by a Hunt-Travis foundation grant (to J.G.).
# Corresponding author. Address:
4000 Reservoir Rd, Washington, DC 20057.
e-mail: jgiordano@neurobioethics.org or Gsynapse22@aol.com

216

(Explore 2006; 2:216-225. Elsevier Inc. 2006)

CONTEXTS OF SPIRITUAL EXPERIENCE(S)

Spirituality and religion are not inherently identical, and the
(incorrect) semantic interchangeability of these terms may be a
source of philosophical and practical difficulty for many clinicians. Establishing more appropriate definitions of spirituality
and religion thus becomes an important step in helping to clarify
how these may play a role in patients experience and thereby
identify how clinicians may potentially address these domains to
facilitate positive clinical outcomes.
A number of definitions of spirituality exist; however, all address a universal aspect of the human condition. With etymological roots in the Hebrew word for breath, it implies something intrinsic to life.8 Connelly and Light examined several
definitions of spirituality, finding several common attributes
including the following: the essential; the core; and the central,

2006 by Elsevier Inc. Printed in the United States. All Rights Reserved
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EXPLORE May 2006, Vol. 2, No. 3

doi:10.1016/j.explore.2006.02.002

integrating dimension or domain of life or that which brings

significance, purpose, meaning, and direction to peoples lives.9
An additional aspect, with relevance for healthcare is the
concept of the spiritual experience. Spiritual experiences are
frequently associated with religious events and/or circumstances. However, the phenomenon itself is definable in secular contexts, and terms such as liminal or transliminal and
sublime and/or ecstatic occurrences could be used instead,
thereby preventing any overt religious connotations when
circumstantially inappropriate. Irrespective of the term(s)
used to describe the occurrence, such experiences are an altered state of consciousness that may be the result of activation of distinct neural mechanisms by external and/or internal stimuli. Phenomenologically, they generally consist of an
extraordinary conscious experience with both strongly perceived subjectivity and intentionality (although frank objectification may not occur, as in the sublime experiences induced through certain Buddhist meditative practices10).
These experiences often assume ineffable and somewhat subjectively metaphysical characteristics. It is not uncommon for
people to have such experiences around birth and death and
during illness, trauma, and extreme emotions or suffering;
thus, health problems often precipitate their occurrence.11
Although such experiences may be interpreted through religious beliefs, this interpretation may be more confusing if the
individual is not a member of a religious group that has
semiotics to provide adequately context or meaning to the
event.
The word religion stems from the meaning to bind together.12
Thus, religion, by definition, refers to a community aggregate, to
which an individual maintains a sense of belonging through ideas
of beliefs, practices, ethical teachings, and cosmologies within specific sociocultural institutions and traditions. Spiritual issues may
find expression through and be codified by social institutions that
bring together groups of people to share collectively a belief system
and practice its disciplines. As a salutory social practice, this process
also serves to form a unifying connection among its members.13
Terminology, at least in part, may indirectly affect social and
medical attitudes toward the nature and value of these experiences and practices. For the clinician, an understanding of the
phenomenology, neural correlates of spiritual experience and
the relation to the social, cultural, and psychological domains of
religion, may be helpful in depicting these variables in contexts
more resonant to medical practice(s).

Terms such as intentionality, desire, and will are not used in

the folk psychological sense to connote some specific contextual
meaning that implies adherence to a particular theoretical orientation to
a concept of mind. Rather, these terms are used to explain the cognitive dimension(s) and effect(s) of neural events in ways that are resonant
to familiar concepts and constructs of brain-mind function(s). See
Wundt W. Elements of Folk Psychology: Outlines of a Psychological History of
Mankind. Schaub EL, trans. London: George Allen and Unwin; 1916,
and Churchill, Paul. Eliminative materialism and the propositional atittudes. In: Lyons W, ed. The Disappearance of Intropsection. Cambridge,
MA: MIT Press; 1986.

Neural Basis of Spiritual Experience

TAXONOMY AND PHENOMENOLOGY OF SPIRITUAL

EXPERIENCE
We have recently evaluated spiritual experiences from a database
of over 300 reports (Wardell D, Engebretson J. Taxonomy of a
spiritual experience: a qualitative analysis of healers. Journal of
Religion and Health. 2006, in press). Through a taxonomic analysis, three domains were identified: the circumstances under
which the experience occurred, the manifestations of the experience itself, and the interpretation of the experience. The circumstances include both external and internal contexts. The
experiences were manifested through various modes of awareness, and both observable as well as symbolic phenomena were
described. The cognitive interpretation reflects individuals prior
and current circumstance and resonance to sociocultural orientation. Thus, the spiritual experience assumes qualitative meaning by virtue of its circumstance and manifestation. The qualitative nature of the spiritual experience is based on conditions of
manifestation that influence both the actual subjectivity and
subsequent levels of interpretation of the subjective event.

THE NEUROBIOLOGY OF SPIRITUAL EXPERIENCE

The emergent field, known somewhat provocatively as neurotheology, explores the relationship between spirituality, spiritual experience(s), and neurological processes.14 A rapidly expanding area, the neural substrates putatively mediating spiritual
experiences have been elucidated by brain-stimulation experiments, neuroimaging studies, and evaluation of the neuroanatomy of pathologic conditions in which spiritual experiences are
prominent. Early experiments by Persinger15,16 and Cook and
Persinger17 induced conscious experiences with strongly spiritual feeling and contexts through transcranial electromagnetic
stimulation of the (left and right) temporal lobes. More recently,
Newberg et al have used single photon emissions computerized
tomography (SPECT) to examine regional brain activation in
meditative and religious states.18 These studies have revealed
that differential activity in several structures including the temporal lobes, cingulate gyrus, superior parietal cortices, and right
lateral prefrontal cortex (RLPFC) appear to subserve spiritual
experience(s).18-23

THE HIERARCHICAL PROCESSING MODEL

Before discussion can delve into the postulated neuroscience of
spiritual experience, it is important to define operationally those
neural mechanisms involved in consciousness. The contempo-

The reader should draw their own conclusions about the meaning
of this circuitry relevant to spiritual experience(s). Such meaning will
reflect cultural, social, and spiritual and/or religious orientations and
beliefs. We do not intend or desire to superimpose on or oppugn any
such individual beliefs. Rather, we maintain that the theoretical models
and concepts presented herein do not refute any particular orientation
but, instead, serve to enhance further speculation, inquiry, and discourse.
The understanding of how the physical substrate that is the brain
generates consciousness represents what David Chalmers calls the hard

EXPLORE May 2006, Vol. 2, No. 3 217

rary notion of conscious processing is built on the work of

Jackendoff from the late 1980s.24 Based upon the psychological
processes and the function of sensory and perceptual systems,
Jackendoff developed a general model that constructed a theoretical conceptualization of tiered neural activity through
which discrete psychological (ie, cognitive) events were assembled. Although the specifics of the Jackendoff model have been
debated, and some refuted entirely, the conceptual model of
hierarchical processing has remained valid and, as matter of fact,
has been considerably substantiated by recent advances in neuroscience.25
Using the Jackendoff model as a basic pediment, there is
considerable evidence to demonstrate that lower levels of neural
processing (ie, extero- and interoceptive sensory data) primarily
encode first-stage sense data that define discrete, local characteristics about the stimulus but do not impart perceptual or
cognitive valence to it. Such mechanisms primarily occur at
the level of the brainstem. At the intermediate level, these inputs
are combined and conjoined to larger field representations both
within the brain and to those brain areas that are activated by
changes in bodily state. Thus, at the intermediate level, neural
processing involves a more global activation of neural substrates
to produce an identifiable brain-mind state, engage attentional
focus, and feed these inputs toward working memory so as to
encode their effect. This intermediate level of processing is subserved by a number of brain areas, including the anterior and
medial cingulate, associative cortex, insula, and regions of the
parietal and temporal cortices. Prinz,25,26 Crick and Koch,27 and
Rees et al28 support that such intermediate level processing
(ILP), coupled to attentional focus, is the basis for directed
consciousness (ie, consciousness of an event and/or its internal effect[s]). Higher, tertiary-tier processing involves recognition of pattern similarity, matching to sample and advanced
discrimination. These functions are mediated by the rostral an-

problem of both neuroscience and neurophilosophy (see Chalmers62).

Thus, although consciousness can be operationally defined to some
extent, the nature of what is being defined and how this is produced
by or within the brain remains the focus of considerable debate. Theoretical and philosophical positions range from the dualist perspectives
(eg, complementarity of mind and brain, property dualism) to a monist,
materialism (eg, eliminativism, absolute physicalism), with perspectives
that are somewhat in between (eg, emergentism, nonreductive physicalism). In addition, there is considerable debate whether this hard
problem can be solved. Daniel Dennett contends that consciousness
represents an as yet unresolved property of neural function and views an
expanding epistemic capitol as being the step stone to solving the consciousness problem. In contrast, Colin McGinn believes that we have
reached a point of cognitive closure in attempting to understand the
mystery of consciousness, and, thus, it will interminably remain incomprehensible. A complete discussion of this topic is beyond the scope
of this paper. For a concise review, see Lyons W. Matters of the Mind NY:
Routledge; 2001. For more detailed discussion of particular perspectives,
see Dennett D. Sweet Dreams: Philosophical Obstacles to a Science of Consciousness. Cambridge, MA: MIT Press; 2005; McGinn C. The Problem of
Consciousness: Essays Towards a Resolution. Oxford: Blackwell; 1991.

218 EXPLORE May 2006, Vol. 2, No. 3

terior cingulate gyrus, ventromedial prefrontal cortex and may

also involve regions of the inferior and/or medial temporal cortices. Although these areas may contribute to perceptual abilities
that facilitate object and stimulus distinction and are participatory in sharpening memory formation, they do not seem to be
directly involved with attentive focus and consciousness of
but, rather, just add distinguishable elements to the neural
network effects.25,26,29
How might spiritual experiences engage and/or be the result
of these neural mechanisms? External and/or internal environmental input to (first tier) ascending sensory and reticular pathways can engage the thalamus to activate the cingulate and insula
and stimulate the amygdala. This second-tier activation can occur without engaging attentional focus, thus producing a subliminal conscious state of the sense data and of some basal
emotional content that reflects differential neurochemical activity in distinct amygdalar regions.25 Recent studies have suggested that the left amygdala subserves positive emotions and
drive states, whereas the right amygdala appears to mediate more
connotatively negative states.30 However, with continued right
amygdalar activation, the left amygdala may become collaterally
engaged, thereby producing pleasurable emotions, feelings, and
drives31-33 that are often consequential to periods of intense
distress and (physical or emotional) suffering.
Robust stimulation of this system engages attentional focus
and activates the deep temporal lobe(s) and/or their input to the
posterior prefrontal cortex, parahippocampal gyri, and hippocampus to engage working memory and appears to subserve
consciousness of an internal or external event or condition.25-28 The amygdalar-septohippocampal neuraxis is important in linking consciousness of emotions and drive states to
preextant memories and new memory formation34 (with some
difference in positive and negative memory consolidation to
right and left hippocampi, respectively33). This may be the basis
of situational objectification34 and may contribute to the involvement of declarative memory in emotionally contextual belief states.34,35
The differential activation of left or right temporal cortices
also appears to contribute to components of the spiritual experience. In the majority of individuals, the left temporal cortex is
operative in establishing the representational sense of self-awareness. In addition, communicative and primary linguistic capacity is localized within this region, thereby establishing neural
connectivities that may subserve both the ideative and communicative components of self-representation.36,37 In contrast, the
right temporal lobe functions in nonprimary communication
abilities (eg, prosody, linguistic intent),38 and basal (38-40 Hz)
electrical activity within the right temporal field has been hypothesized to be contributory to the subjective awareness of the
internal brain-mind state.39-41 The temporal lobes appear to
function in concert with left and right superior parietal cortices
to establish the boundary between contained, somatic self-perception and the external environment.42
In summary, external (and internal) environmental events are
selectively attended to stimulate differentially the cingulated
and either the left amygdala (to produce positive emotions) or
right amygdala (to produce strongly negative emotions that may,
with continued and durable activation, subsequently engage the

Neural Basis of Spiritual Experience

contralateral amygdala to evoke feelings of elation). Amygdalar

output engages the parahippocampal and hippocampal regions,
linking the emotional response to both declarative and emotive
memory and framing it within the current circumstance(s). Differential activation of the temporal lobes may produce enhanced
linguistic outflow or facilitate a linguistic component to the
experience. Discontinuity in the coordination of the left and
right medial temporal cortices may produce sensations of a physical (or nonphysical) presence that, through concomitant
amygdalar-hippocampal activation, is often cognitively conjoined to emotional and/or memory states and may be construed in personal (eg, presence of relatives or conspecifics),
cultural (eg, presence of archetypal figures/characters), and/or
religious (eg, deific presence) contexts. Such strong limbic activation, together with the focal activity of the RLPFC appears to
engage selectively the temporal lobe(s) and reduce the activity of
the superior parietal cortical fields, leading to a distortion in
both somatosensation and perceived relation to the external
environment (eg, feelings of detachment or infinity). This tentative neuraxis, summarized by Table 1, is schematically depicted
in Figure 1.
It is of interest to note that individuals suffering from temporal lobe epilepsy (TLE) may experience many of these same
subjective phenomena, including feelings of presence of an
existential other, situational detachment, altered sensorium,
and change in subjective consciousness.43,44 Spread and diffusion of the ictal discharge to adjacent brain areas lead to progressive involvement of brain loci subserving somatosensation, linguistic capacity, and flow.45 In addition, many patients with TLE
and temporal lobe lesions manifest excessive spirituality or religiosity.46,47 Taken together, these convergent lines of evidence
strongly suggest that a discrete neuroanatomical pathway is involved or may directly subserve many of the components of
spiritual experiences.
Apart from such pathologic examples as patients suffering
TLE, the activation of these neurobiological substrates seems to
be capable of producing beneficial physiologic effects.48,49 The
longitudinal work of Benson50,51 and Benson and Dusek52 has
demonstrated the efficacy of liminal, meditative states (with concomitant subjectively spiritual experience) and the contribution
of these events to the placebo response. The recent studies of
Stefano et al53 and Lazar et al54 have indicated that downstream
pathways are likely activated by these neuraxes. Interestingly,
an important variable in the induction of neurophysiologic
mechanisms subserving both spiritual events and placebo response(s) seems to be the relative enfranchisement, or belief,
of the patient.55,56 Studies have shown that the RLPFC plays a
crucial role in the expectational and belief processes crucial to
the induction and magnitude of particular patient-centered and
placebo-type effects.21-23,56 This is consistent with the work of
18
and dAquili and Newberg23 that demonstrated
strong RLPFC involvement in the attentional dimension(s) spiritual responses. Thus, it appears that these neural systems are
capable both of producing/subserving the cognitive dimensions
of spiritual experiences and engaging top-down physiologic
mechanisms. Such proverbial mind-body interactions have
long been known57-59 and, more recently, have been the basis of

Neural Basis of Spiritual Experience

Table 1. Neuroanatomical Substrates Putatively Subserving Spiritual/

Liminal Experiences
Neural Substrate

Putative Function

Brainstem reticular formation Initial arousal

Subsequent suppression during
liminal state
Midbrain grey region(s)
Opioid-mediated effects:
Emotionality, euphoria, and pain
suppression
Subcortical regions
Anterior/medial cingulate Perceptual domains of processing
Insula
Cortical regions
Specific sensory cortices
Sensory attendance during inductive
phase
Superior parietal cortex
Somesthetic awareness; suppression
may produce alterations in sense
of boundary
Temporal cortex
Left temporal cortex
Primary communicative areas
May subserve linguistic outflow
during liminal events/experiences
Representational sense of selfawareness
Right temporal cortex
Secondary communicative region
Putative source of 38-40 Hz
component hypothesized to be
contributory to conscious state
Medial temporal cortex
Discontinuity between L/R temporal
cortices may produce sensations
of physical or nonphysical
others. or nonphysical others.
RLPFC
Attentiveness, focus
Expectation, belief
Limbic structures
Amygdala
Left amygdala
Emotionality: putative positive noesis
Right amygdala
Emotionality: putative negative noesis
Hippocampus
Memory induction
Emotional content/construct of
memory
Differential engagement of
declarative or emotional memory
(ie, belief)
Refer to text for detailed description; refer to references 10,14-40.

studies in psychoneuroendocrinology and psychoneuroimmunology.

From such findings, we are inclined to say that the mind event
(ie, the spiritual experience) is representative of a brain event (ie, the
activation of specific neural pathways and mechanisms by external
and/or internal means), thereby assuming that mind is in some way
a direct process of the neurological activity of the brain.60,61 Although a viable enough position, there are two issues that have been

EXPLORE May 2006, Vol. 2, No. 3 219

Figure 1. Schematic diagram of neural structures putatively subserving sensory, cognitive, and physiologic sequelae of spiritual experience(s).
As explained in text, provocative input may include external and/or internal sensory stimuli that are produced by specific behaviors (meditation,
and others) and/or rituals (eg, prayer). These may serve as bottom-up, body-brain/mind events. At the intermediate level of neural processing
(ILP), cognitive awareness of the summative effects of engagement of this neuraxis produces distinct conscious experience(s) by engaging
attentional mechanisms (to evoke consciousness of the event) and may engage higher level, nonattentional mechanisms (to evoke state of
consciousness events) as well. Perception of these neural events may be responsible for the qualia of conscious experience. These events appear
to exert positive salutogenic effects and may be important for the induction of hierarchical neural processes and physiologic manifestations. Such
top-down processes are illustrated in bold arrows in the Figure (see text for details, refer to Table 1 for summary of proposed functions of neural
substrates with demonstrated involvement in spiritual experience(s); refer to references 10,14-40). ILP, Intermediate level processing; HLP, higher
level processing; RLPFC, right lateral prefrontal cortex.

considered to complicate this philosophically materialist/physicalist approach. First is that it appears that actual subjective (spiritual)
experience is, on some level, necessary for the induction of the subsequent (physiological) effects. This consideration then leads to the
second, which is that the brain-mind condition(s) induced by expe-

220 EXPLORE May 2006, Vol. 2, No. 3

rience itself appears to represent a distinct state of consciousness,

as well as an event that we can be conscious of. Certainly, the
spiritual experience fulfills many of the requisite criteria for a conscious event and/or state. It is subjective; it has structure; it is familiar and transparent to the subject as an internal event; it possesses a

Neural Basis of Spiritual Experience

range of attention; and it has self-situatedness, possesses varying

degrees of unified form, and manifests some dimension of pleasure
or unpleasantness.62
We argue that these proposed complications can be reconciled to the neurobiological model as processes that reflect progressive activation of bottom-up, collateral, and top-down
neural networks. These generate distinct patterns of neurological
activity (which produce distinct sense data and perceptual states
to feed forward and bridge the biological event(s) (ie, the brain
event) to a psychological effect (ie, a mind effect). According to
Searle,63 the unity of consciousness involves an integration of
multiple brain-mind events into a singular field of subjectively
apprehensible experience(s) relative to processes of both memory and thought. Spiritual experiences appear to engage hierarchical levels of brain function, from acquisition of purely sense
data to the more extrapolative cognitive events of linking emotions and memories to expectation and/or contextual objectification(s). The cognitive and emotional characteristics of this
experience both solidify such objectification (ie, places the experience within the framework of relating the perceived self to an
environment or other agent) and organize this objectification
within cognitive and linguistic domains that are consistent with
the epistemic and cultural orientation of the subjective
self.64,65
Last, the experience has definable, subjective conscious characteristics, its qualia. Although there is ongoing neurophilosophical debate about the existence/nonexistence and relative
meaningfulness of qualia,66-69 it is the qualia of the spiritual
experience that are reported to contribute to individuals concomitant subjective feeling of well-being.23,49-52 Whether epiphenomenal or a direct mental process, this may in some way
reflect the perception of the neurally evoked, conscious experience itself as being pleasant (or not). In this light, the spiritual
experience can assume contextually noetic value. When considered in this perspective, even if considered as a solely neural
event, its role as a fundamental, patient-centered response and
its importance to perceptions of well-being and, therefore, selfattribution of subjective health (ie, feeling good) become
more readily apparent.

ANTHROPOLOGICAL PERSPECTIVES
However, an important unresolved issue remains: how did such
experiences come to be such a fundamental part of the cultural
repertoire of diverse social groups? We maintain that these experiences represent consciously recognizable events with subjectively
relevant and potentially objective effects and salutogenic benefits
(in certain instances). Humans may have recognized that particular

We do not intend to make any suppositions or presumptions about

the possible purpose of the spiritual experience, even as a neural event.
Certainly, it is a matter of personal orientation and belief whether such
events, and the neural circuitry that subserves them, are extero- or interoceptively derived and what the derivational source of these events
may be. For an interesting and provocative discussion of such possibilities, see Newberg A, DAquili E, and Rause V. Why God Wont Go Away:
Brain Science and the Biology of Belief. New York: Ballantine Books; 2001.

Neural Basis of Spiritual Experience

external events (eg, circumstances, behaviors) may be capable of

provoking positively noetic experiences (by engaging particular
neuroanatomical substrates to induce mechanisms that are subjectively appreciable). In addition, such mechanisms may engage a
cascade of physiological events that may be both internally (ie, self)
perceptible (eg, changes in metabolic state, relaxation, and others)
and produce changes in neurochemistry to elicit feelings of reinforcement and reward.15-19,30-33 The sum of these hierarchical
events could be a considerable change in multiple domains of consciousness (eg, attentional and nonattentional mental states), in
which the relation of the conscious state (ie, the neural events) and
its qualia to an identifiable object or other might be framed within
the environmental, sociocultural, and/or circumstantial context(s)
of the subject.
It has been suggested that the phylogenic development of the
human brain has resulted in a predisposition for a fundamental
set of cognitive drives and desires as well as cognitive actions or
needs.70,71 These fundamental cognitive need states can be
summarized as the need for knowing, need for meaning, and
need to relate.71 Such cognitive needs may have had considerable influence on the complexity of both individual human
consciousness and the dynamic nature of human sociocultural
interaction.72
Implicit to this viewpoint is that the neurological complexity
of the brain predicates ongoing interpretive analysis (of both
external events and internal conditions) versus simple behaviorism.73 If we approach human existence relative to ecological
survivability, the need to know and the need to relate, coupled
with the advanced communicative capacity rendered by the
structure of the brain, afforded the human species a considerable
advantage.74 If the spiritual experience can be considered an
event of consciousness, then its relative benefit to individuals in
a community could only be relevant if it were describable. This
is wholly consistent with the relationship of consciousness to
language.62-64 Developing the linguistic capability to communicate what is good from what is bad in the environment
would have been a significant attribute to evolutionary success.74 Equally important would be the ability to linguistically
communicate the first-person experience of subjective states,
especially those with profound (positive or negative) noetic
value. Early recognition of particular behaviors or exposure to
environmental events that were capable of eliciting neurological
mechanisms that subserve definable, positive conscious (ie,
spiritual) experiences may have had powerful influence in light
of their strongly subjective effects.75 The need to communicate
such feelings would have been relatively imperative on both an
individual and social level.76
However, even the most modern, sophisticated brain is not capable of describing the qualia of conscious experience in completely
materialist or physical terms (only the most ardent eliminativist
would describe their subjective conscious state in neurobiological
referents). Thus, the social need to develop linguistic ability to
describe an event that is as phenomenologically meaningful as that
produced by such neurobiological events within the context of the
spiritual experience would almost naturally manifest a sense of intentionality, be perceived as objectifiable, and thereby described in
terms of its circumstance and manifestation. The human need to
create rational sense of such internal experiences would lead to the

EXPLORE May 2006, Vol. 2, No. 3 221

development of interpretive frameworks that were consistent with

both the epistemic scope and cultural bias of that time. Such epistemologic measure was limited, and the level of explanation could
be seen as consistent with both the common understanding of the
world and a relative desire to manifest some operational level of
control over that environment. According to Kuhn, the human
need for explanatory models is often satisfied even if explanations
are inadequate or incorrect.77 Thus, practices (such as rituals)
evolved to induce and preserve these (positively) noetic experiences
within a level of meaning that was resonant within particular cultures.78 Equally consistent is the hypothesis that the expressive
vector of consciousness, language, is by its nature symbolic.73 A
strong relationship exists between the state and foci of consciousness, the language used to describe these states and foci, and the
social reality in which these events occur.72-74 The nature of language to be symbolic is important in that it satisfies the human need
to provide meaning, objectify the environment, and relate (both to
others as well as to construed superlative forces through which
desires for environmental control might be effected72,79). The conceptualization of this may have changed over time and may reflect
humanitys interaction with, and susceptibility to, both positive
and negative environmental factors. Although there were certain
aspects of the environment that may have been controllable, many
others (plight, famine, disease, death) were not. Furthermore, a
fundamental negative experience is fear of the unknown.72,73 The
development of culturally symbolic archetypes is often built on
societally resonant explanations for and attempts to control unknown domains of environment or existence.73,74 As such, these
explanations satisfy the desire for intentional causation, in which
conscious representation and the reality of the external world are in
some way consistently and meaningfully unified.63,64
With an increased need both to make sense of and to control
the environment, there develops recognition that certain behaviors and rituals may be able to invoke internal feelings of positivity. This could produce an internalized locus of control
against an external environment that may have been viewed as
relatively refractory to understanding or controllability. Discrete
sociocultural groups may have established disciplines to practice
techniques that were provocative for such noetically positive
experiences. The linguistics that supported these practices would
naturally reflect common archetypes that were resonant to the
epistemic framework of these respective groups. Therefore, we
posit that organized religion(s) developed as a cultural framework for the linguistic transfer of behaviors that would incur
positive spiritual experiences and afford them interpretive meaning.
In an abstract sense, this could be considered to be a rudimentary approach to public health practice, in that it conferred
behaviors that could produce wellness experiences within a
group of individuals. Uniform practice of these behaviors would
reduce perceived health disparity by conjoining all members of
the group in salutogenic activity and would serve a preventive
role in health practices (by reducing feelings of negativity that
were ascribed to bad or evil archetypes). The question arises,

See also Wittgenstein L. Tractatus Logico-Philosophicus. Pears DF,

McGuinness BF, trans. London: Routledge and Keegan Paul; 1961.

222 EXPLORE May 2006, Vol. 2, No. 3

then, of whether religion may serve a similar role in the modern

medical setting.
Further research is needed to derive a viable answer to this question. However, an equally important question is the type and nature of studies that could best address this issue. Seemingly, the
best fit would be a mixed methods approach. Built on a range and
diversity of evidentiary frameworks that acknowledge both multiple
end points and contributory processes in health and healing, such
studies permit more complete assessment of both quantitative and
qualitative variables. This would allow for appreciation of patientcentered effects in observed outcomes, the knowledge of which
could potentially enhance the ability of the clinician to act more
fully in the role of therapeutic agent.80

PRACTICAL APPLICATIONS
For many patients, declining health and/or confronting disease
represent events that both strip away an internal locus of control
(ie, produce a sense of victimization) and often expose them to
an environment that may elude their linguistic capacity and
basis of understanding (ie, medicalization). This perceived loss
of control and increased level of unpredictable unknowns might
be contributory to the enhanced religiosity of the gravely ill,
chronically diseased and aged.1,11 However, as discussed, religion is just one means to incur spiritual experiences. It is important to recognize that the role of religious belief and practices to
evoke the noetically (and perhaps physically) positive effects of
the spiritual phenomenon may be assumed by a variety of other
behaviors and experiences by more secular patients.
Irrespective of whether secular or nonsecular in orientation,
the spiritual experience is essentially composed of circumstance,
interpretation, and manifestation. As presented in Table 2, these
reflect biopsychosocial frameworks that exist in each particular
patient and may provide insight into meaningful cognitive and
social contexts that affect individuals relative construct(s) of
wellness and illness.81
Often, the basis and interactive nature of these factors are not
familiar to many clinicians, and such an applied approach may
require a revision in medical scholarship, both in academia and
at the bedside. How might this be accomplished? First, it is
critical to acknowledge that spiritual experiences exist as neurocognitive phenomena and that these can potentially exert salutogenic and physiologic effect(s). This can help to establish explanatory models that are bilaterally relevant to patient and
clinician. This bilaterality enhances the patient-clinician interaction and may facilitate a more positive healing environment.
Second, the clinician need not be an agent for the spiritual
experience9; however, in recognizing these effects as a possibly
relevant clinical variable in patients health, the clinician should
be participatory in making resources available (and/or supporting patients use of such resources). This further enhances the
therapeutic relationship by promoting the patient as being a
reciprocal partner in their own care. In addition, this avoids
neutrality, which can often be a blind to trivialize the role of
explanatory models and may contribute to nocebo effects.82,83
Such blinds may also allow the clinician to infuse subtly their
beliefs on the patient.84 This may occur implicitly, connotatively, or explicitly but can exert profound paternalistic influ-

Neural Basis of Spiritual Experience

Table 2. Biopsychosocial Domains Encompassed by Spiritual Experience(s)

Biological Domains
Neural mechanisms/ substrates of spiritual experience (see Table
1, Figure 1)
Extra neural substrates:
Neuroendocrine regulation
Neuroimmune regulation
Top-down-mediated physiological processes
Psychological Domains
Noetic properties of spiritual experience
Emotional effects
Meaningfulness (contextual and symbolic)
Resonance with explanatory knowledge/ models
Enhanced internal locus of control
Properties of consciousness
Subjectivity
Intentionality
Transparency to self
Social Domains
Cultural influences/expression
Secular/nonsecular orientation
Group/community connectedness
Environmental influence(s)

biomedically good; (2) acknowledge the good for the specific

choices of the patient; (3) satisfy the humanitarian good of treating the patient as a dignified human being; and (4) should, on
some level, accommodate that good that defines the patients
ultimate and more deeply existential needs.86 Clearly then, the
clinician is both a therapeutic and moral agent. Thus, we argue
that, to meet these four-fold obligations of beneficence, it is
important (and perhaps imperative) that the clinician take an
active role in assessing the importance of their patients spirituality in recognition of its biopsychosocial influence on their
health. This does not imply that the clinician should participate
in spiritual domains of their patients care.84 To the contrary, we
view this as imprudent and believe that the clinician should not
partake in their patients spiritually inductive practices because
the deeply personal and individually unique nature of these
experiences may be beyond the scope and tenor of the medical
relationship.9,87 However, the acknowledgment of patients spiritual needs, understanding of the physiologic basis of spiritual
experience, and accommodation of patients desires for spiritual
resources permit the clinician to assume an accepting stance and,
in so doing, may fortify the clinician-patient relationship as a
fundamental domain of healing.
Acknowledgments
The authors thank Sherry Loveless for assistance on graphic
artistry.

Refer to text for complete description; see references 48-55, 57-59, 81-83.

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