Phantoms in the Brain: Probing the Mysteries of the Human Mind (27 page)

"No," she replied, "it doesn't seem to want to do anything. It's not moving." Apparently my mock injection had worked, for she was now able to accept the fact that her left arm was indeed paralyzed.

But how could I be sure that this was not simply the result of my persuasive charm? Maybe I was just

"hypnotizing" Nancy into accepting that her arm was paralyzed. So I did the obvious control: I repeated the same procedure with her right arm. After ten minutes, I went back into the room and, after chatting briefly about various topics, said, "As part of the neurological exam, I'm going to inject your right arm with this local anesthetic, and after I give you the shot, your right arm will be paralyzed for a few minutes." I then gave her the injection, with the same syringe containing saline solution, waited a bit and asked, "Can you move your right arm?" Nancy looked down, lifted her right hand to her chin and said, "Yes, it's moving.

See for yourself." I feigned surprise. "How could that be possible? I just injected you with the same anesthetic that we used on your left arm!" She shook her head with disbelief and replied, "Well, I don't know, doctor. I guess it's mind over matter. I have always believed that."15

What we call rational grounds for our beliefs are often extremely irrational attempts to justify our instincts.

—
Thomas Henry Huxley

When I began this research about five years ago, I had no interest whatsoever in Sigmund Freud. (He might have said I was in denial.) And like most of my colleagues I was very skeptical of his ideas. The entire neuroscience community is deeply suspicious of him because he touted elusive aspects of human nature that ring true but that cannot be empirically tested. But after I had worked with these patients, it soon became clear to me that even though Freud wrote a great deal of nonsense, there is no denying that he was a genius, especially when you consider the social and intellectual climate of Vienna at the turn of the century. Freud was one of the first people to emphasize that human nature could be subjected to systematic scientific scrutiny, that one could actually look for laws of mental life in much the same way that a cardiologist might study the heart or an astronomer study planetary motion. We take all this for granted now, but at that time it was a revolutionary insight. No wonder his name became a household word.

Freud's most valuable contribution was his discovery that your conscious mind is simply a facade and that you are completely unaware of 90 percent of what really goes on in your brain. (A striking example is the zombie in Chapter 4.) And with regard to psychological defenses, Freud was right on the mark. Can anyone doubt the reality of the "nervous laugh" or "rationalizations"? Remarkably, although you are engaging in these mental 109

tricks all the time, you are completely unaware of doing so and you'd probably deny it if it were pointed out to you. Yet when you watch someone else doing it, it is comically conspicuous— often embarrassingly so. Of course, all this is quite well known to any good playwright or novelist (try reading Shakespeare or Jane Austen), but Freud surely deserves credit for pointing out the pivotal role of psy−

chological defenses in helping us organize our mental life. Unfortunately, the theoretical schemes he constructed to explain them were nebulous and untestable. He relied all too often on an obscure terminology and on an obsession with sex to explain the human condition. Furthermore, he never did any experiments to validate his theories.

But in denial patients you can witness these mechanisms evolving before your very eyes, caught in flagrante delicto. One can make a list of the many kinds of self−deception that Sigmund and Anna Freud described and see clear−cut, amplified examples of each of them in our patients. It was seeing this list that convinced me for the first time of the reality of psychological defenses and the central role that they play in human nature.

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Denial:
The most obvious one, of course, is outright denial. "My arm is working fine." "I can move my left arm—it's not paralyzed."

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Repression:
As we have seen, the patient will sometimes admit with repeated questioning that she is in fact paralyzed, only to revert soon afterward to denial—apparently "repressing" the memory of the confession she made just a few minutes earlier. Many cognitive psychologists argue that repressed memories, such as sudden recollections of child abuse, are inherently bogus—the harvest of psychological seeds implanted by the therapist and brought to flower by the patient. But here we have proof that something like repression is going on, albeit on a smaller time scale, with no possibility that the patient's behavior was unduly influenced by the experimenter.

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Reaction formation:
This is the propensity to assert the exact opposite of what one suspects to be true of oneself. For example, a latent homosexual may drink his beer, strut around in cowboy boots and engage in macho behavior, in an unconscious attempt to assert his presumed masculinity. There is even a recent study showing that, when viewing X−rated film clips of male pornography, men who are overt gay bashers paradoxically get bigger erections than men who are not prejudiced. (If you're wondering how the erections were measured, the researchers used a device called a penile Plethysmograph.) I am reminded of Jean—the woman who said she could lift a large table an inch off the ground with her right hand and then added, when questioned, that her paralyzed left hand was actually stronger than the right; that she could use it to lift the table an inch

and a half. Also recall Mrs. Dodds, who when asked whether she tied her shoelaces, replied, "Yes, I did it with
both
my hands." These are striking examples of reaction formation.

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Rationalization:
We have seen many examples of this in this chapter. "Oh, doctor, I didn't move my arm because I have arthritis in my shoulder and it hurts." Or this from another patient: "Oh, the medical students have been prodding me all day and I don't really feel like moving my arm just now."

When asked to raise both hands, one man raised his right hand high into the air and said, when he detected my gaze locked onto his motionless left hand, "Urn, as you can see, I'm steadying myself with my left hand in order to raise my right."

More rarely, we see frank confabulation:

"I am touching your nose with my left hand."

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"Yes, of course I'm clapping."

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Humor:
Even humor can come to the rescue—not just in these patients but in all of us—as Freud well knew. Just think of the so−called nervous laugh or of all those times when you've used humor to deflate a tense situation. Can it be a coincidence, moreover, that so many jokes deal with potentially threatening topics like death or sex? Indeed, after seeing these patients, I am convinced that the most effective antidote to the absurdity of the human condition may be humor rather than art.

I remember asking a patient who was a professor of English literature to move his paralyzed left arm. "Mr.

Sinclair, can you touch my nose with your left hand?"

"Yes."

"Okay, show me. Please go ahead and touch it."

"I'm not accustomed to taking orders, doctor."

Taken aback, I asked him whether he was being humorous or sarcastic.

"No, I'm perfectly serious. I'm not being humorous. Why do you ask?"

So it would seem that although the patient's remarks are often tinged with a perverse sense of humor, they themselves are unaware that they're being funny.

Another example: "Mrs. Franco, can you touch my nose with your left hand?"

"Yes, but watch out. I might poke your eye out."

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Projection:
This is a tactic used when, wanting to avoid confronting a malady or disability, we conveniently attribute it to someone else. "This paralyzed arm belongs to my brother, for I know perfectly well that my own arm is fine." I leave it for psychoanalysts to decide whether this is a true case of projection. But as far as I'm concerned, it's close enough.

So here we have patients engaging in precisely the same types of Freudian defense mechanisms—denial, rationalization, confabulation, repression, reaction formation and so forth—that all of us use every day of our lives. I've come to realize that they present us with a fantastic opportunity to test Freudian theories scientifically for the first time. The patients are a microcosm of you and me but "better," in that their defense mechanisms occur on a compressed time scale and are amplified tenfold. Thus we can carry out experiments that Freudian analysts have only dreamed of. For example, what determines which particular defense you use in a given situation? Why would you use an outright denial in one case and a rationalization or reaction formation in another? Is it your (or the patient's) personality type that determines which defense mechanisms you use? Or does the social context determine which one you muster? Do you use one strategy with a superior and another with social inferiors? In other words, what are the "laws" of psychological defense mechanisms?

We still have a long way to go before we can address these questions,16 but, for me, it's exciting to contemplate that we scientists can begin encroaching on territory that until now was reserved for novelists and philosophers.

Meanwhile, is it possible that some of these discoveries may have practical implications in the clinic? Using cold water to correct someone's delusion about body image is fascinating to watch, but could it also be useful to the patients? Would repeated irrigation permanently "cure" Mrs. Macken of denial and make her willing to 111

participate in rehabilitation? I also started wondering about anorexia nervosa. These patients have disturbances in appetite but are also delusional about their body image—claiming actually to "see" that they are fat when looking in a mirror, even though they are grotesquely thin. Is the disorder of appetite (linked to feeding and satiety centers in the hypothalamus) primary, or does the body image distortion cause the appetite problem? We saw in the last chapter that some neglect patients actually start believing that the object in the mirror is "real"—their sensory disturbances actually cause changes in their belief system. And in denial or anosognosia pa−

tients, you often notice a similar warping of their beliefs to accommodate their distorted body image. Could some such mechanisms be involved in anorexia? We know that certain parts of the limbic system such as the insular cortex are connected to the hypothalamic "appetite" centers and also to parts of the parietal lobes concerned with body image. Is it conceivable that how much you eat over a long period of time, your intellectual beliefs about whether you are too fat or thin, your perception of your body image and your appetite are all more closely linked in your brain than you realize—so that a distortion of one of these systems can lead to a pervasive disturbance in the others as well? This idea can be tested directly by doing the cold−water irrigation on a patient with anorexia (to see whether it would temporarily correct her delusion about her body image). This is a far−fetched possibility but it's still worth trying, given the ease of the procedure and the lack of an effective treatment for anorexia. Indeed, the disorder is fatal in about 10 percent of cases.

Freud bashing is a popular intellectual pastime these days (although he still has his fans in New York and London). But, as we have seen in this chapter, he did have some valuable insights into the human condition, and, when talking about psychological defenses, he was right on target, although he had no idea why they evolved or what neural mechanisms might mediate them. A less well known, but equally interesting idea put forward by Freud was his claim that he had discerned the single common denominator of all great scientific revolutions: Rather surprisingly, all of them humiliate or dethrone "man" as the central figure in the cosmos.

The first of these, he said, was the Copernican revolution, in which a geocentric or earth−centered view of the universe was replaced with the idea that earth is just a speck of dust in the cosmos.

The second was the Darwinian revolution, which holds that we are puny, hairless neotenous apes that accidentally evolved certain characteristics that have made us successful, at least temporarily.

The third great scientific revolution, he claimed (modestly), was his own discovery of the unconscious and the corollary notion that the human sense of "being in charge" is illusory. He claimed that everything we do in life is governed by a cauldron of unconscious emotions, drives and motives and that what we call consciousness is just the tip of the iceberg, an elaborate post hoc rationalization of all our actions.

I believe Freud correctly identified the common denominator of great scientific revolutions. But he doesn't explain why this is so—why would human beings actually enjoy being "humiliated" or dethroned? What do they get in return for accepting the new worldview that belittles humankind?

Here we can turn things around and provide a Freudian interpretation of why cosmology, evolution and brain science are so appealing, not just to specialists but to everyone. Unlike other animals, humans are acutely aware of their own mortality and are terrified of death. But the study of cosmology gives us a sense of timelessness, of being part of something much larger. The fact that your own personal life is finite is less frightening when you know you are part of an evolving universe—an ever−unfolding drama. This is probably the closest a scientist can come to having a religious experience.

The same goes for the study of evolution, for it gives you a sense of time and place, allowing you to see yourself as part of a great journey. And likewise for the brain sciences. In this revolution, we have given up 112

the idea that there is a soul separate from our minds and bodies. Far from being terrifying, this idea is very liberating. If you think you're something special in this world, engaging in a lofty inspection of the cosmos from a unique vantage point, your annihilation becomes unacceptable. But if you're really part of the great cosmic dance of Shiva, rather than a mere spectator, then your inevitable death should be seen as a joyous reunion with nature rather than as a tragedy.