Ecstatic epilepsy is a rare form of focal epilepsy where seizures begin with ecstatic or mystical experiences, including feelings of enhanced self-awareness, mental clarity, unity with everything, bliss, and physical well-being. This perspective article describes the phenomenology and historical context of these seizures, identifying the anterior insula as the primary brain structure involved. The authors propose that temporary disruptions to anterior insula activity may interrupt interoceptive prediction errors, leading to an absence of uncertainty and a sense of bliss, as perfect prediction of the body's physiological state is mimicked. An alternative hypothesis suggests the anterior insula processes surprise, and epileptic discharge may interrupt unexpected events, producing a sense of complete control and oneness with the environment.
The noetic (insightful) quality of mystical-type experiences in psychedelic-assisted therapy may arise from changes in metacognition—the ability to monitor and evaluate one's own thoughts. Drawing on existing metacognition models, the authors propose that psychedelics activate procedural, performance-based metacognitive feelings, producing an 'Aha!' experience interpreted as a feeling of epistemic gain. This framework could help explain therapeutic mechanisms such as intention setting, music's role, traumatic memory recall, and spiritual bypassing. The paper reviews theoretical links between metacognition and altered states like meditation and lucid dreaming, then outlines future research directions.