The example of blindsight is suggestive not only because it supports the idea of the unconscious mind (or several unconscious minds). It also demonstrates how neuroscience can marshal evidence about the innermost workings of the brain in order to make its way through the cold-case file, so to speak, addressing some of the unanswered questions about the self that have plagued philosophers and scientists for millennia. By studying patients who have disturbances in self-representation and observing how specific brain areas malfunction, we can better understand how a sense of self arises in the normal human brain. Each disorder becomes a window on a specific aspect of the self.
First, let’s define these aspects of the self, or at the very least, our intuitions about them.
1. Unity: Despite the teeming diversity of sensory experiences that you are deluged with moment to moment, you feel like one person. Moreover, all of your various (and sometimes contradictory) goals, memories, emotions, actions, beliefs, and present awareness seem to cohere to form a single individual.
2. Continuity: Despite the enormous number of distinct events punctuating your life, you feel a sense of continuity of identity through time—moment to moment, decade to decade. And as Endel Tulving has noted, you can engage in mental “time travel,” starting from early childhood and projecting yourself into the future, sliding to and fro effortlessly. This Proustian virtuosity is unique to humans.
3. Embodiment: You feel anchored and at home in your body. It never occurs to you that the hand you just used to pick up your car keys might not belong to you. Nor would you think you’re in any danger of believing the arm of a waiter or a cashier is in fact your own arm. However, scratch the surface and it turns out your sense of embodiment is surprisingly fallible and flexible. Believe it or not, you can be optically tricked into temporarily leaving your body and experiencing yourself in another location. (This happens to some extent when you view a live, real-time video of yourself or stand in a carnival hall of mirrors.) By wearing heavy makeup to disguise yourself and looking at your own video image (which doesn’t have to do a left-right reversal like a mirror), you can get an inkling of an out-of-body experience, especially if you move various body parts and change your expression. Furthermore, as we saw in Chapter 1, your body image is highly malleable; it can be altered in position and size using mirrors. And as we will see later in this chapter, it can be profoundly disturbed in disease.
4. Privacy: Your qualia and mental life are your own, unobservable by others. You can empathize with your neighbor’s pain thanks to mirror neurons, but you can’t literally experience his pain. Yet, as we noted in Chapter 4, there are circumstances under which your brain generates touch sensations that precisely simulate the sensations being experienced by another individual. For instance, if I anesthetize your arm and have you watch me touch my own arm, you begin to feel my touch sensations. So much for the privacy of self.
5. Social embedding: The self maintains an arrogant sense of privacy and autonomy that belies how closely it is linked to other brains. Can it be coincidental that almost all of our emotions make sense only in relation to other people? Pride, arrogance, vanity, ambition, love, fear, mercy, jealousy, anger, hubris, humility, pity, even self-pity—none of these would have any meaning in a social vacuum. It makes perfect evolutionary sense to feel grudges, gratitude, or bonhomie, for example, toward other people based on your shared interpersonal histories. You take intent into account and attribute the faculty of choice, or free will, to fellow social beings and apply your rich palette of social emotions to their actions on that basis. But we are so deeply hardwired for imputing things such as motive, intent, and culpability to the actions of others that we often overextend our social emotions to nonhuman, nonsocial objects, or situations. You can get “angry” with the tree branch that fell on you, or even with the freeways or the stock market. It is worth noting that this is one of the major roots of religion: We tend to imbue nature itself with human-like motives, desire, and will, and hence we feel compelled to supplicate, pray to, bargain with, and look for reasons why God or karma or what have you has seen fit to punish us (individually or collectively) with natural disasters or other hardships. This persistent drive reveals just how much the self needs to feel part of a social environment that it can interact with and understand on its own terms.
6. Free will: You have a sense of being able to consciously choose between alternative courses of action with the full knowledge that you could have chosen otherwise. You normally don’t feel like an automaton or as though your mind is a passive thing buffeted by chance and circumstance—although in some “diseases” such as romantic love, you come close. We don’t yet know how free will works, but, as we shall see later in the chapter, at least two brain regions are crucially involved. The first is the supramarginal gyrus on the left side of the brain, which allows you to conjure up and envisage different potential courses of action. The second is the anterior cingulate, which makes you desire (and helps you choose) one action based on a hierarchy of values dictated by the prefrontal cortex.
7. Self-awareness: This aspect of the self is almost axiomatic; a self that is not aware of itself is an oxymoron. Later in this chapter I will argue that your self-awareness might partly depend on your brain using mirror neurons recursively, allowing you to see yourself from another person’s (allocentric) viewpoint. Hence the use of terms like “self-conscious” (embarrassed), when what you really mean is being conscious of someone else being conscious of you.
These seven aspects, like the legs of a table, work together to hold up what we call the self. However, as you can already see, they are vulnerable to illusions, delusions, and disorders. The table of the self can continue to stand without one of these legs, but if too many are lost then its stability becomes severely compromised.
How did these multiple attributes of self emerge in evolution? What parts of the brain are involved, and what are the underlying neural mechanisms? There are no simple answers to these questions—certainly nothing to rival the simplicity of a statement like “because that is how God made us”—but just because the answers are complicated and counterintuitive is no reason to give up the quest. By exploring several syndromes that straddle the boundary between psychiatry and neurology, I believe we can glean invaluable clues to how the self is created and sustained in normal brains. In this regard my approach is similar to that used elsewhere in the book: considering odd cases to illuminate normal function.5 I do not claim to have “solved” the problem of self (I wish!), but I believe these cases provide very promising ways it can be approached. Overall, I think this is not a bad start for tackling a problem that is not even considered legitimate by many scientists.
Several points are worth noting before we examine particular cases. One is that despite the bizarreness of symptoms, each patient is relatively normal in other respects. A second is that each patient is completely sincere and confident in his belief and this belief is immune from intellectual correction (just like persistent superstitions in otherwise rational people). A patient with panic attacks might agree with you intellectually that his forebodings of doom are not “real,” but during the attack itself, nothing will convince him that he isn’t dying.
One last caveat: We need to be careful when drawing insights from psychiatric syndromes because some of them (none, I hope, that I am examining here) are bogus. Take for example de Clerambault syndrome, which is defined as a young woman developing an obsessive delusion that a much older and famous man is madly in love with her but he is in denial about it. Google it if you don’t believe me. (Ironically there’s no name for the very real and common delusion in which an older gentleman believes that a young hottie is in love with him but doesn’t know it! One reason for this might be that the psychiatrists who “discover” and name syndromes have historically been men.)
Then there is Koro, the alleged disorder said to afflict Asian gentlemen who claim that their penis is shrinking and will eventually wither away. (Again the converse does exist in some elderly Caucasian men—the delusion that the penis is expanding—when it actually isn’t. This was pointed out to me by my colleague Stuart Anstis.) Koro is
