Psychosomatic Medicine 18:133-142 (1956)
© 1956 American Psychosomatic Society

Psychological Significance of Visual Auras

Study of Three Cases with Brain Damage and Seizures

¹ Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pa.
² Department of Neurology, Cornell University Medical College, New York, N. Y.

Three patients with vivid visual auras and grand mal seizures were the subjects of an investigation of the psychological significance of visual auras. Each patient showed evidence of gross structural disease of the brain in the paraoccipital area. Among the techniques utilized in the clinical study were psychological testing, hypnosis, detailed psychiatric interviewing, and free association. In 2 cases it was possible to reproduce the aura experimentally under hypnosis and to elicit directly the hallucinatory expression of the underlying fantasy.

From the data, we have concluded that the visual aura, while one manifestation of cerebral encephalopathy, expresses certain crucial emotions of the individual and plays a definite role in the psychic economy. By tracing the fantasies and chain of ideas evoked in association to the aura, one can interpret its meaning in much the same way as a dream is interpreted. We believe on the basis of our findings that certain specific organizing principles, analogous to the dreamwork, are employed in the formation of the aura. As a result of the activity of these mechanisms the aura presents in visual form a synthesis of crude impulses, emotional configurations, and memories.

Our material suggests that, in addition to being the ideational representation of a drive, the aura also serves to bind some of the energy attached to the drive. When the quantity of excitation associated with the drive is not sufficiently bound by the aura, the convulsive threshold of the brain is exceeded and a grand mal seizure occurs.

The aura can no longer be considered as formed exclusively by a disturbance in a discrete portion of the cortex but is to be regarded as a complex phenomenon resulting from the total integrative activity of the brain.