David Lynch music video: 70 violations of guidelines for reducing seizures

This warning is shown briefly before the video begins showing an onslaught of flashing images.

This warning is shown briefly before the video begins showing an onslaught of flashing images. This is just a screen shot, not the video itself.

David Lynch’s just-released music video for Nine Inch Nails’ “Came Back Haunted” provides more than 4 minutes of nearly constant seizure-provoking flashes and images. When analyzed for seizure safety, the video fails in 70 instances to adhere to international safety guidelines for flash, including the intermittent use of saturated red images.

Before the barrage of flashes begins, the official release on the Vevo music video website is accompanied by the following message: “WARNING: This video has been identified by Epilepsy Action to potentially trigger seizures for people with photosensitive epilepsy. Viewer discretion is advised.”

Two very big problems with this:

1. There’s a disturbing, no doubt intentional, consequence of highlighting the risk of seizures. Emphasizing that viewers are flirting with danger seems to be a marketing move. Unfortunately, this tactic does attract attention, but it trivializes the actual health risks.

2. Contrary to the claim that the UK Epilepsy Action organization determined that there was a photosensitive seizure risk in the video, Epilepsy Action’s website states that the organization was not consulted about the video. The organization is investigating and plans to continue reporting on it. A news item on the website quite correctly states, “It appears conscientious to show a warning before the video. However, many people with photosensitive epilepsy do not know they have it until something like this triggers their first seizure.” If filmmaker Lynch is conscientious, why not remove the seizure risk in the first place?

Trivializing seizures by using them for marketing

Here’s what happens when the seizure risk is used for marketing purposes. People who know nothing about epilepsy are charmed by the video’s association with seizures and use it to spice up their commentary:

“…before getting into the fact it comes with a STERN WARNING THAT IT HAS BEEN KNOWN TO CAUSE SEIZURES one must take into account it was directed by David Lynch, the man responsible for Twin PeaksEraserhead and Blue Velvet…. I know you’ll all click on the video below to see if I’m just being outlandish and overreactive (what I like to call Glenn-Beck-ish), but remember, you were warned. Also, if you’re rendered comatose (or worse), I call dibs on your watch.”

“Came Back Haunted” packs in a myriad of flashing, distorted clips interspersed with Renzor singing as the camera captures the footage in a near-epileptic state of jitter.”

I found one reasoned commentary. Instead of swallowing the seizures-as-marketing bait, Rachel at bangs.com, to her credit, sees through it:

“…who wants to just hang out and watch a dumb boring music video anyway? I want a bit of DANGER in my viewing experience!”

Safely see for yourself how seizure-inducing it is!

I recorded what happened when I tested “Came Back Haunted” with the program I use to test images for seizure safety, the Harding Flash and Pattern Analyzer. If you view the testing session, you can see what it looks like when a clip is chock full of violations of seizure safety guidelines. When viewing the clip below of the Harding Flash and Pattern Analyzer test session, seizures are very unlikely unless you stare at the upper left-hand corner of the screen at very, very close range. (Smaller images affect a smaller area of the brain’s visual cortex, making it harder to generate the requisite number of neurons misfiring to get a seizure going.)

 

In this clip the video itself runs at twice its normal speed in the upper left corner of the screen. The rest of the screen shows the analyzer’s findings, in a large line graph and a table that tracks the number of frames that fail the safety test. This is not a borderline case! 

Note: If you’re curious to see the offending video on YouTube in its official form, do keep in mind that since the flashing is downright nasty, the smaller you make the image on your screen, the less danger there is of triggering a seizure.

About Epilepsy Action’s role

Apart from the unauthorized and false statement that Epilepsy Action was consulted, there’s yet another problem with the claim. David Lynch is an American filmmaker, Nine Inch Nails is an American band, and the epilepsy warning refers to a British epilepsy advocacy organization that is vigilant and outspoken in monitoring photosensitive seizure triggers in popular media. Epilepsy Action has drawn the public’s attention to photosensitive seizure-provoking material in visuals broadcast on UK TV, in music videos (Kanye West) and in movies (Twilight: Breaking Dawn).

The American epilepsy advocacy community should be much more proactive and visible to the public, explaining the dangers of seizure-provoking media–including the fact that many people without “regular” epilepsy who have just photosensitive epilepsy are unaware they have the condition. If the epilepsy organizations are concerned about stigma–and they are–they need to advocate against seizure-provoking media and against demeaning portrayals of seizures that stem from photosensitivity. A whole generation of young people is forming opinions about seizures and epilepsy by reading the relentlessly insensitive stuff like David Lynch and Nine Inch Nails making “seizure-inducing magic together.”

Hat tip to John Ledford for making me aware of the video!


Would you know if you just had a seizure?

No, not necessarily. You might have no idea it happened, even. Multiple studies have shown that people often aren’t aware of their own seizures. When you consider that altered consciousness is characteristic of many seizures, it’s not so surprising. People who aren’t “all there” during the seizure may have no memory of it.

And if you have a seizure with subtle symptoms, anyone who’s with you may not realize it’s happening, either. This is a key reason many people haven’t heard much about video game seizures–many just go undetected.

The big seizures, of course, get noticed. Anyone nearby can clearly see a person who has fallen and is having convulsions. Individuals emerging from a grand mal seizure (what doctors now refer to as a tonic-clonic seizure) won’t remember the event itself, but will realize they’re not where they were before (perhaps finding themselves on the floor or in an ambulance), and may have bruises from uncontrolled movements.

Although studies show that photosensitive epilepsy can cause any type of seizure, a lot of clinicians still assume the condition produces only grand mal/tonic-clonic seizures. They may not know that partial and absence seizures are associated with photosensitivity, too. Click here for a list of some typical signs you may have had a seizure.

What are partial and absence seizures?

Partial and absence seizures can act like stealth attacks on the brain. They cause unusual behaviors and sensations, and may be followed by additional symptoms, but they often escape notice while the seizure is in progress.

Simple partial seizures produce temporary symptoms such as distorted vision or unexpected movement or tingling in one limb. Because they affect a small area of the brain, awareness and memory are not affected.

Complex partial seizures occur in 35 percent of people with seizures. Many types of behavior can take place during the seizure, depending on which parts of the brain are affected. Sometimes people may seem to continue whatever they had been doing, including talking with others. Sometimes during one of these events people are conscious enough to allow them to hear what’s going on around them–perhaps feeling everything  is happening far away–but they aren’t able to speak. Because consciousness is altered, it’s not uncommon to have either no memory of what happened during the seizure or just a vague idea. The event can be over in 30 seconds, or it may last for a few minutes.

The seizures are typically followed by headache, temporary confusion, memory loss, and/or other neurological dysfunction, as well as fatigue and “brain fog” that gradually dissipate over a period lasting up to a few days. Lingering after-effects of complex partials can easily be more of a disruption to everyday life than the seizures themselves.

Absence seizures, where a person briefly stares and “zones out,” may be very hard to notice and can be mistaken for attention problems. Learning, memory, and social interaction are often affected by the gaps resulting from interruptions in awareness, but absence seizures are not followed by after-effects.

Research shows people often don’t detect their own seizures 

In a study published in 2007 by Christian Hoppe and colleagues, 91 seizure patients were asked to record all of their seizures in a diary during the time they were being monitored on EEG. In instances where patients activated a reporting alarm just prior to or during a seizure, only two-thirds of the seizures were documented afterwards by the patients. The reliability of patient reporting was lowest when documenting complex partial seizures and seizures experienced during sleep. Of 150 complex partial seizures (verified on EEG) while subjects were awake, only 52.7 percent of the events were reported, even though subjects were periodically reminded to report all their seizures.

The study authors state, “Seizure-induced seizure unawareness is a frequent, but rather unrecognized, postictal [post-seizure] symptom particularly associated with seizures from sleeping and with CPS [complex partial seizures].”  Now consider, what are the chances that a person who has never had a seizure before, or whose seizures have never been identified, will remember after the event that something unusual happened?

In the 2004 review article “Visual Stimuli in Daily Life,” Kasteleijn-Nolst Trenité and colleagues note that during photic stimulation testing many patients do not notice brief seizures that are detected on the EEG but have no clinical signs. “The question must be raised,” they continue, “whether asymptomatic individuals might have unnoticed reflex seizures triggered by daily-life stimuli and become overtly symptomatic only when a critical age is reached (early adolescence), in combination with lifestyle-related factors.” In other words, after adolescence, photosensitive seizures that were already happening but nobody was aware of may become more visible, possibly when the nervous system is affected by additional circumstances (lack of sleep, alcohol consumption, etc.).

Need more data? In a 1996 study of 27 seizure patients by Blum and colleagues, patients were not aware of 61 percent of their seizures detected on EEG! Seven patients didn’t recall any of their seizures. Patients were questioned periodically throughout the day as to whether they’d had a seizure or if anything unusual had occurred, so the seizures would be expected to be fresh in their minds.

Can an EEG help determine whether you had a seizure? 

Let’s say something suddenly felt very weird yesterday, and you’re wondering if it was a seizure. An EEG conducted today can’t tell you if yesterday’s event was a seizure. That’s because EEGs can’t provide data on any period other than the time the electrodes are in place and recording brain activity. An initial EEG usually lasts for 20 to 30 minutes and can be thought of as an extended “snapshot” of brain wave patterns. If you have a seizure during an EEG, the EEG can confirm that it was a seizure–but only if electrodes pick up the brain waves that typically signify a seizure.

Usually at some point during the EEG you’re exposed to a strobe light to see if your brain has an abnormal response to flash. If that part of the EEG is abnormal, it can indicate that you have photosensitive epilepsy and should avoid flashing lights. The test is done in a way that doesn’t provoke an actual seizure, but it can show an abnormal “firing” of neurons that is consistent with seizures. Note that strobe lights may not create that EEG response even if a video game does–the flashing white light doesn’t make the same impact on the visual cortex that a colorful screen with lots of action. Some people don’t respond to the strobe but do have an abnormal EEG response to certain sharply defined patterns. Video games and TV may include some of these patterns, but little testing is done for pattern sensitivity in the US.

EEGs done with scalp electrodes miss a lot of seizure activity that involves a small area and/or lies deep inside the brain, far from electrodes on the surface. I’ve written about this before, but I can’t resist adding that this point was acknowledged in the above study by Blum et al. “…there are seizure types that often do not manifest on surface EEG. The most important of these is frontal lobe epilepsy, but this also occurs with complex partial seizures of temporal lobe origin.”

In fact, “it is crucial to recognize that a normal EEG does not exclude epilepsy, as around 10% of patients with epilepsy never show epileptiform discharges,” according to a 2005 paper in the Journal of Neurology, Neurosurgury & Psychiatry.

Seizures are more common and frequent than current technology and human memory can demonstrate.


“Twilight” cautions issued in US and UK

Epilepsy organizations in the US and UK have issued warnings about seizures during the birthing scene in the film Twilight: Breaking Dawn. Because of the warnings, the seizures have received additional press attention.

Unfortunately, the warning in the US did not address consumers outside the epilepsy community. It released a warning last week on its website, addressed only to people who know they have photosensitive epilepsy:

“If you have photosensitive seizures, please take this information into consideration when deciding whether to see this movie. Around 3 percent of the nearly 3 million Americans with epilepsy have photosensitive epilepsy.”

The Epilepsy Foundation missed a major opportunity to explain that those most at risk for visually triggered seizures are those who have  a genetic vulnerability but haven’t yet experienced a seizure. So while the Epilepsy Foundation is to be commended for responding to early reports of seizures provoked by flashing light in the scene, it downplayed the extent of the seizure risk.

As of today, 15 individuals have provided information about their Twilight seizures to a website tracking them, and only three had experienced prior seizures. What about the remaining 12 people? Would they have avoided the movie on the basis of a warning aimed at people who know they photosensitive epilepsy?

Not surprisingly, media coverage relied on information provided in the Epilepsy Foundation’s statement. For example, the Baltimore Sun’s story, which was picked up by a number of other newspapers, stated,

“While epilepsy is relatively uncommon in the population — about 3 million Americans have it — photosensitivity is even rarer, occurring in just 3 percent of those with epilepsy.”

To its credit, the Epilepsy Foundation warning provided links to excellent information on its site about visually induced seizures. Next time the organization should point out that anyone might have these seizures, not only people with epilepsy. When balancing the desire to protect those with epilepsy from unnecessary restrictions on daily activities against the greater public’s need to know about visually induced seizures, the Foundation favors the sensitivity of its own membership.

Over in the UK, in response to reports of seizures among American movie-goers, the advocacy group Epilepsy Action did indeed take action, even without reports of seizures in British viewers.

For its part, Epilepsy Action made clear in its own news release about the film that photosensitive seizures can also affect people with no prior connection to epilepsy.

“Many people with photosensitive epilepsy, especially young people, do not know they have it until something triggers their first seizure.  In 1997, an episode of Pokemon shown on Japanese television caused almost 600 people to have seizures. Of these, 76 per cent had no previous history of epilepsy.”

According to Epilepsy Action’s news release, the group contacted Breaking Dawn’s UK distributor and requested confirmation that the birthing scene had been checked for photosensitivity. The distributor (which did not confirm the photosensitivity check) then issued a seizure warning that will be displayed for movie audiences.

 


Photosensitivity shares the Twilight spotlight

One of the biggest challenges of spreading awareness about video games causing seizures is that many video game seizures take place when people are alone. With nobody else around to witness and document these events, people assume these are very rare. Along comes a blockbuster movie with a graphic scene that triggers seizures, and photosensitive seizures are suddenly in the spotlight, as it were.

I’ve held off writing about the seizures triggered by a scene in the movie Twilight: Breaking Dawn, because I keep waiting to hear whether it’s in fact causing “epileptic seizures in filmgoers across America,” as described in the Guardian. Although the story has been picked up by many news outlets, it is based on just a handful of reported events. There are still not many people who have publicly reported seizures. (If you want to report one, you can share your experience at https://www.facebook.com/breakingdawnseizures and
https://sites.google.com/site/breakingdawnseizures/home.)

The Twilight seizures are getting widely publicized because, in addition to the high profile of the movie, the seizures that have been reported were convulsive events occurring in a crowded movie theater. A theater inDedham,Massachusettsstopped the film while the stricken viewer was given emergency assistance. In a way these people are fortunate that their sensitivity to flashing light became so evident that they can take precautions in the future. It’s possible other audience members had seizures that didn’t involve convulsions and weren’t recognized as seizures.

The birthing scene is described as graphic. In addition to the visual stress of the flashing, viewers are probably stressed by what they’re seeing. Some of the news stories remind readers of graphic scenes in other movies, such as 127 Hours provoking visceral, physical reactions in certain viewers. Stress lowers the seizure threshold, meaning that the same degree of flashing in a context that’s not so tense might not result in a seizure.

The excitement of playing video games probably has this same effect of lowering the seizure threshold. Also, while playing alone it may be easier to enter an altered state of awareness of one’s surroundings that lowers the seizure threshold. My daughter preferred to play with nobody else in the room so that she could get into a “zone” she found very pleasant. Unfortunately, once in the zone, seizures were more likely and she was less likely to have the awareness to sense them coming and prevent them by stopping or covering one eye.

I contacted the British Board of Film Classification, which screens movies prior to their release, to check for objectionable content and rate the  maturity level of the content. In the UK film makers and distributors are responsible for identifying material that could provoke seizures and other adverse reactions in audiences, and provideing the appropriate warnings to audiences. If BBFC examiners notice sequences they think could affect a large number of viewers, they may require that audience warnings be added. For example, the review board noted last year that Enter the Void “includes a number of sequences of flashing and flickering lights that are likely to trigger a physical reaction in vulnerable viewers. It also contains extended sequences featuring rotating and handheld camerawork that may induce motion sickness in some viewers.”

In the UK, according to a BBFC spokesperson, no reports of Twilight: Breaking Dawn seizures have been received, nor did the BBFC identify any material likely to provoke seizures in those with light sensitivity.