broach in this book, is what might be called “functional anatomy”—to explain the cluster of symptoms that are unique to a given disorder in terms of functions that are equally unique to certain specialized circuits in the brain. (Here one must distinguish between a vague correlation and an actual explanation.) Given the inherent complexity of the human brain, it is unlikely that there will be a single climactic solution like DNA (although I don’t rule it out). But there may well be many instances where such a synthesis is possible on a smaller scale, leading to testable predictions and novel therapies. These examples may even pave the way for a grand unified theory of the mind—of the kind physicists have been dreaming about for the material universe.
6. The idea of a hardwired genetic scaffolding for one’s body image was also brought home to me vividly when Paul McGeoch and I recently saw a fifty-five-year-old woman with a phantom hand. She had been born with a birth defect called phocomelia; most of her right arm had been missing since birth except for a hand dangling from her shoulder with only two fingers and a tiny thumb. When she was twenty-one, she was in a car crash that entailed amputation of the crushed hand, but much to her surprise she experienced a phantom hand with four fingers instead of two! It was as if her entire hand was hardwired and lying dormant in her brain, being suppressed and refashioned by the abnormal proprioception (joint and muscle sense) and visual image of her deformed hand. Until the age of twenty-one, when removal of the deformed hand allowed her dormant hardwired hand to reemerge into consciousness as a phantom. The thumb did not come back initially, but when she used the mirror box (at age fifty- five) her thumb was resurrected as well.
In 1998, in a paper published in
Findings such as these emphasize the complexity of interactions between nature and nurture in constructing body image.
7. We don’t know where the discrepancy between S2 and the SPL is picked up, but my intuition is that the right insula is involved, given the GSR increase. (The insula is partly involved in generating the GSR signal.) Consistent with this, the insula is also involved in nausea and vomiting due to discrepancies between the vestibular and visual senses (which familiarly produces seasickness, for example).
8. Intriguingly, even some otherwise normal men report having mainly phantom erections rather than real ones, as my colleague Stuart Anstis pointed out to me.
9. This “adopting an objective view” toward oneself is also an essential requirement for discovering and correcting one’s own Freudian defenses, which is partially achieved through psychoanalysis. The defenses are ordinarily unconscious; the concept of “conscious defenses” is an oxymoron. The therapist’s goal, then, is to bring the defenses to the surface of your consciousness so you can deal with them (just as an obese person needs to analyze the source of his obesity to take corrective measures). One wonders whether adopting a
Or perhaps we could mimic the effects of ketamine by using mirrors and video cameras, which can also produce out-of-body experiences. It seems ludicrous to suggest the use of optical tricks for psychoanalysis, but believe me, I have seen stranger things in my career in neurology. (For example, Elizabeth Seckel and I used a combination of multiple reflections, delayed video feedback, and makeup to create a temporary out-of-body experience in a patient with fibromyalgia, a mysterious chronic pain disorder that affects the entire body. The patient reported a substantial reduction in pain during the experience. As for all pain disorders, this requires placebo-controlled evaluation.)
Returning to psychoanalysis: surely, removing psychological defenses raises a dilemma for the analyst; it’s a double-edged sword. If defenses are normally an adaptive response by the organism (mainly by the left hemisphere) to avoid destabilization of behavior, wouldn’t laying bare these defenses be maladaptive, disturbing one’s sense of an internally consistent self along with your inner peace? The way out of this dilemma is to realize that mental illness and neuroses arise from a
And there are two reasons for this. First, chaos may result from “leakage” of improperly suppressed emotions from the right hemisphere, leading to anxiety—a poorly articulated internal feeling of lacking harmony in one’s life. Second, there may be instances in which defenses might be maladaptive for the person in his real life; a little overconfidence is adaptive but too much isn’t; it leads to hubris and to unrealistic delusions about one’s abilities; you start buying Ferraris you can’t afford. There is a fine line between what’s maladaptive and what’s not, but an experienced therapist knows how to correct only the former (by bringing them out) while preserving the latter, so that she avoids causing what Freudians call a catastrophic reaction (a euphemism for “The patient breaks down and starts crying”).
10. Our sense of coherence and unity as a single person may—or may not—require a single brain region, but if it does, reasonable candidates would include the insula and the inferior parietal lobule—each of which receives a convergence of multiple sensory inputs. I mentioned this idea to my colleague Francis Crick just before his death. With a sly conspiratorial wink he told me that a mysterious structure called the claustrum—a sheet of cells buried in the sides of the brain—also receives inputs from many brain regions, and may therefore mediate the unity of conscious experience. (Perhaps we are both right!) He added that he and his colleague Christof Koch had just finished writing a paper on this very topic.
11. This speculation is based on a model proposed by German Berrios and Mauricio Sierra of Cambridge University.
12. The distinction between the “how” and “what” pathways was first made by Leslie Ungerleider and Mortimer Mishkin of the National Institutes of Health; it is based on meticulous anatomy and physiology. The further subdivision of the “what” pathway into pathways 2 (semantics and meaning) and 3 (emotions) is more speculative and based on functional criteria; a combination of neurology and physiology. (For example, cells in the STS respond to changing facial expressions and biological motion, and the STS has connections with the amygdala and the insula—both involved in emotions.) Postulating a functional distinction between pathways 2 and 3 also helps explain Capgras syndrome and prosopagnosia, which are mirror images of each other, in terms of both symptoms and GSR responses. This cannot occur if messages were processed entirely in a sequence from meaning to emotion and there was no parallel output from the fusiform area to the amygdala (either directly or via the STS).
13. Here and elsewhere, although I invoke the mirror-neuron system as a candidate neural system, the logic of the argument doesn’t depend critically on that system. The crux of the argument is that there must be specialized brain circuitry for recursive self-representation and for maintaining a distinction—and reciprocity—between the self and the other in the brain. A dysfunction of this system would contribute to many of the seemingly bizarre syndromes described in this chapter.
14. To complicate matters further, Ali started developing other delusions as well. A psychiatrist diagnosed him as
