The Man Who Wasn't There: Investigations into the Strange New Science of the Self (34 page)

Coming to terms with the self’s mostly fictitious nature (the unresolved issue of subjectivity notwithstanding) may help rein ourselves in. It’s unclear, though, whether mere intellectual understanding will do. In fact, the Buddhists developed the notion of no-self not as an
intellectual argument but to give philosophical heft to an experience that arises out of meditation. “No question that no-self is a very important idea,” said Georges Dreyfus, who is in the no-self camp. “But it’s trying to capture an experience which happens to people mostly through meditation. It’s an experience which has profound transformative effects, in terms of diminishing self-centeredness, making oneself more open to others, and so on.”

In Buddhism and Advaita, the no-self idea arises out of concern for the suffering of people. Mistakenly identifying with
me
and
mine
is at the root of suffering, they say. Realizing this and losing one’s attachment to the self is liberation, the end of suffering. “The core Buddhist thought is that cognitive attachments to self are itself a kind of pathology, a kind of a source of dysfunction,” said Jonardon Ganeri.

The malady
is
the self.

This book begins with an ancient Buddhist allegory from about 200 CE—sincere thanks to Jonardon Ganeri for alerting me to the allegory and for letting me use the English translation from his book
The Self.

My book would have been impossible to write without the extraordinary kindness and openness of the many people who shared their stories with me. Some of you I have to thank using pseudonyms, but you know who you are.

Thanks to Michaele and Allan for inviting me into their home and spending time talking about Allan’s Alzheimer’s—Allan, sadly, passed away soon after I met him. To Clare for sharing her father’s story and letting me visit him at his long-term care home. Unfortunately, Clare’s father is in the late stages of Alzheimer’s, and I can only wonder about what he understood when Clare introduced us. My thanks to him.

Thanks to Patrick and David—two men who let me into their lives and put their trust in me, despite the risks of do so. I’m extremely grateful to both of them for letting me join them on their journey to
see Dr. Lee, who let me witness the process of David getting his leg amputated (short of being in the OR). The story first appeared in
MATTER
magazine in October 2012; thanks to Jim Giles, Bobbie Johnson, and Roger Hodge for their part in making it happen.

Thanks to Laurie and Sophie for sharing their very personal—often harrowing—experiences of schizophrenia; their keen insight into their own condition proved invaluable to someone like me, who was trying to make sense of another’s altered sense of reality. And to Laurie’s husband, Peter, for providing a partner’s perspective.

I’m grateful to Nicholas and his fiancée, Jasmine, for helping me understand Nicholas’s depersonalization, and to Nick’s foster mother, Tammy, and his physician for sharing their side of things. Thanks to Jeff Abugel for his insights into his own condition and for connecting me to Nicholas. And to Sarah for taking the time to sit down and talk about her transient, but nonetheless scary, encounter with depersonalization, and to Ellen Petry Leanse for the introduction.

James Fahey, an articulate advocate for those with Asperger’s syndrome, helped me understand what it means to be an adult with his condition and yet live without being constrained by psychiatric definitions and socially imposed boundaries. My sincere thanks to him. And to my friends Susan and Roy, and their son Alex, for letting me into their lives in so many ways and for being open about Alex’s and their struggles.

My heartfelt thanks to my cousin Shobha and her husband, Ashok, for talking about Ashwin so soon after he passed away—it must have been hard, as parents—and for letting me write about his doppelgänger experience. Thanks to Chris and Sonia for taking an emotional trip back in time; talking about Chris’s brother, who died too young, wasn’t easy for them. To Thomas Metzinger for being open about his
out-of-body experiences and for patiently explaining his philosophy of the self, over and over.

I’m grateful to Zachary Ernst for an insightful take on his ecstatic seizures; his philosopher’s acumen helped me make sense of a seemingly mystical experience. To Catherine and Albéric, mother and son, for welcoming me to Romont, where, amid staggeringly beautiful Swiss alpine scenery, Albéric spoke in French about his ecstatic epilepsy and Catherine translated.

Thanks also to many of the aforementioned people for reading and checking what I wrote about them.

My gratitude to the many scientists, doctors, and philosophers whom I quote in the book (and some whom I don’t): they gave generously of their time and energy and shared their expertise—in person and by phone or email; many of them read parts of the book and made valuable suggestions and corrections. I’m grateful to (in the order of chapters): Adam Zeman, David Cohen, Steven Laureys, William de Carvalho, Athena Demertzi, Lionel Naccache, Shaun Gallagher, Pia Kontos, Robin Morris, William Jagust, Suzanne Corkin, Bruce Miller, Giovanna Zamboni, Paul McGeoch, Michael First, Judith Ford, Ralph Hoffman, Gottfried Vosgerau, Martin Voss, Nick Medford, Hugo Critchley, Sanjeev Jain, R. Raguram, Alison Gopnik, Uta Frith, Elizabeth Torres, Francesca Happé, Peter Hobson, Philippe Rochat, Jakob Hohwy, Peter Enticott, Olaf Blanke, Lukas Heydrich, Bigna Lenggenhager, Henrik Ehrsson, Arvid Guterstam, Manos Tsakiris, Thomas Grunwald (who arranged for me to witness a neurosurgery), Fabrice Bartolomei, Bud Craig, Antoine Bechara, Jonardon Ganeri, Dan Zahavi, Georges Dreyfus, and Geshe Ngawang Samten.

And I am especially grateful to Peter Brugger, Louis Sass, Anil Seth, Thomas Metzinger, and Fabienne Picard, all of whom went far
beyond what could be reasonably expected, endured endless emails and phone calls, hosted my visits to their offices and labs and even homes, and vetted parts of the book, all with boundless generosity.

Thanks to my friends: Caroline Sidi for help with all things French; Srinath Perur for reading and commenting on the whole book; Rajesh Kasturirangan and Vikramajit Ram for invaluable inputs; Venu Narayan for being a sounding board from start to finish. C. S. Aravinda translated “Nirvana Shaktam” from Sanskrit to English—my thanks to him.

Needless to say, any errors that remain are my sole responsibility.

The book proposal took shape with the help of my agent, Peter Tallack, at the Science Factory. Thanks, as always, Peter. Thanks also to my editor, Stephen Morrow, for being an astute and attentive listener, for seeing what I saw in these stories, and for gently guiding the book to its finish.

My friends and colleagues at
New Scientist
—thanks for doing what you do. I learned my craft there, and I continue to do so.

Also, a warm thanks to my friends who made me feel at home in their homes during my peregrinations as I researched this book: Caroline Sidi, Alok Jha, Banu and Ramesh, Vijay and Hema, Maithili and Prasad, Rao and Kinkini, Anjali and Kiran, and Suruchi and Biraj.

I got through the final three months of frenetic writing because my mother and father took care of everything else—from the regular cups of coffee to nourishing vegetable stews. So, finally, to my parents and sisters, brothers-in-law, and niece and nephews, a big thank-you for being family, for all your support and love.

“It seems outlandish”
:
Thomas Nagel,
The View from Nowhere
(Oxford: Oxford University Press, 1986), 55.

PROLOGUE

An allegory about a man
:
Parable adapted with permission from Jonardon Ganeri. The English translation appears in Jonardon Ganeri,
The Self: Naturalism, Consciousness and the First-Person Stance
(Oxford: Oxford University Press, 2012), 115.

CHAPTER 1: THE LIVING DEAD

“Men ought to know”
:
Quoted in Adam Zeman, “What in the World Is Consciousness?,”
Progress in Brain Research
150 (2005): 1–10.

“If I try to seize”
:
Albert Camus,
The Myth of Sisyphus and Other Essays
(New York: Vintage, 1991), 19.

the façade, as the architect intended
:
Michel Delon, ed.,
Encyclopedia of the Enlightenment
(London, New York: Routledge, 2013), 258.

Cotard had been devotedly
:
J. Pearn and C. Gardner-Thorpe, “Jules
Cotard (1840–1889): His Life and the Unique Syndrome Which Bears His Name,”
Neurology
58 (May 2002): 1400–03.

the case of a forty-three-year-old woman
:
G. E. Berrios and R. Luque, “Cotard’s Delusion or Syndrome?: A Conceptual History,”
Comprehensive Psychiatry
36, no. 3 (May/June, 1995): 218–23.

“clear and distinct intellectual”
:
“René Descartes,”
Stanford Encyclopedia of Philosophy
, http://plato.stanford.edu/entries/descartes.

“one cannot be wrong”
:
Thomas Metzinger, “Why Are Identity Disorders Interesting for Philosophers?,” in
Philosophy and Psychiatry
, Thomas Schramme and Johannes Thome, eds. (Berlin: Walter de Gruyter GmBH & Co, 2004), 311–25.

“Patients may explicitly”
:
Ibid.

“Who is the I”
:
Gordon Allport, quoted in Stanley B. Klein and Cynthia E. Gangi, “The Multiplicity of Self: Neuropsychological Evidence and Its Implications for the Self as a Construct in Psychological Research,”
Annals of the New York Academy of Sciences
1191 (March 2010): 1–15.

We instinctively and intimately
:
Anil Ananthaswamy, “Am I the Same Person I Was Yesterday?”
New Scientist
, July 23, 2011.

“Know thyself”
:
Pausanias,
Description of Greece,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0160:book=10:chapter=24.

“By whom commanded and”
:
Swami Paramananda,
The Upanishads
(The Floating Press, 2011), 69.

“If no one asks”
:
Saint Augustine quoted in Klein and Gangi, “The Multiplicity of Self.”

fifteen-year-old May
:
David Cohen et al., “Cotard’s Syndrome in a 15-Year-Old Girl,”
Acta Psychiatrica Scandinavica
95 (February 1997): 164–65.

often an effective treatment
:
For an eloquent defense of this seemingly barbaric procedure, see Sherwin Nuland’s TED talk titled “How Electroshock Therapy Changed Me,” http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy?language=en.

a fifty-five-year-old man
:
David Cohen and Angèle Consoli, “Production of Supernatural Beliefs during Cotard’s Syndrome, a Rare Psychotic Depression,”
Behavioral and Brain Sciences
29, no. 5 (October 2006): 468–70.

“God’s punishment for sins”
:
Ibid.

“a facial expression involving”
:
Edward Shorter, “Darwin’s Contribution to Psychiatry,”
The British Journal of Psychiatry
195, no. 6 (2009): 473–74.

“grief muscles”
:
Ibid.

“melancholic omega”
:
Ibid.

the French philosopher Louis
:
“Louis Althusser,”
Stanford Encyclopedia of Philosophy,
http://plato.stanford.edu/entries/althusser.

the frontoparietal network
:
Audrey Vanhaudenhuyse et al., “Two Distinct Neuronal Networks Mediate the Awareness of Environment and of Self,”
Journal of Cognitive Neuroscience
23, no. 3 (March 2011): 570–78.

the dubious field of phrenology
:
“Franz Joseph Gall,”
Encyclopedia Britannica
, http://www.britannica.com/EBchecked/topic/224182/Franz-Joseph-Gall.

the extent of the lowered metabolism
:
Vanessa Charland-Verville et al., “Brain Dead Yet Mind Alive: A Positron Emission Tomography Case Study of Brain Metabolism in Cotard’s Syndrome,”
Cortex
49 (2013): 1997–999.

some regions that are
:
In Graham’s case, these were the dorso-lateral prefrontal regions.

a sixty-five-year-old woman with dementia
:
Seshadri Sekhar Chatterjee and Sayantanava Mitra, “‘I Do Not Exist’: Cotard Syndrome in Insular Cortex Atrophy,”
Biological Psychiatry
(November 2014).

the immunity principle
:
Shaun Gallagher, “Philosophical Conceptions of the Self: Implications for Cognitive Science,”
Trends in Cognitive Sciences
4, no. 1 (January 2000): 14–21.

at least three such facets
:
William James,
The Principles of Psychology
, https://ebooks.adelaide.edu.au/j/james/william/principles/chapter10.html.

“a man has as many”
:
Ibid.

“a man’s inner or subjective”
:
Ibid.

the
mineness
:
Thomas Metzinger,
Being No One: The Self-Model Theory of Subjectivity
(Cambridge, MA: MIT Press, 2003), 267.

“Something has happened to me”
:
Quoted in Sue E. Estroff, “Self, Identity, and Subjective Experiences of Schizophrenia: In Search of the Subject,”
Schizophrenia Bulletin
15, no. 2 (1989): 189.

Emerson was curiously indifferent
:
Elizabeth Arledge,
The Forgetting: A Portrait of Alzheimer’s
, PBS, 2004, http://www.pbs.org/theforgetting/experience/first_person.html.

he could still conduct
:
Ibid.

CHAPTER 2: THE UNMAKING OF YOUR STORY

“Memory, connecting inconceivable mystery”
:
Ralph Waldo Emerson,
The Later Lectures of Ralph Waldo Emerson, 1843–1871,
vol .2, Ronald A. Bosco and Joel Myerson, eds. (Athens and London: University of Georgia Press, 2010), 102.

A handwritten note
:
Konrad Maurer et al. “Auguste D and Alzheimer’s Disease,”
Lancet
349, no. 9064 (May 1997): 1546–549.

“
She sits on the bed”
:
Ibid.

“
On what street”
:
Ibid.

“sampled thin slices”
:
“History Module: Dr. Alois Alzheimer’s First Cases,” http://thebrain.mcgill.ca/flash/capsules/histoire_jaune03.html.

“Alzheimer put down”
:
David Shenk, “The Memory Hole,”
New York Times
, November 3, 2006.

“progressive cognitive impairment”
:
Maurer et al., “Auguste D.”

“A Characteristic Serious Disease”
:
Ibid.

“In the centre of”
:
Ibid.

“miliary foci”
:
Ibid.

“The clinical interpretation”
:
Ibid.

“Alzheimer’s disease robs you”
:
Elizabeth Arledge,
The Forgetting
, 1.40 sec. Italics mine.

Clare, a sixty-year-old woman
:
Some identifying details about Clare and her father have been changed upon Clare’s request, including her name.

Consider the phrases used
:
For a critique, see Pia C. Kontos, “Embodied Selfhood in Alzheimer’s Disease: Rethinking Person-Centred Care,”
Dementia
4, no. 4: 553–70.

“Individuals construct private”
:
Donald E. Polkinghorne, “Narrative and Self-Concept,”
Journal of Narrative and Life History
1, nos. 2–3 (1991): 135–53.

“the self is ultimately”
:
Joel W. Krueger, “The Who and the How of Experience,” in
Self, No Self? Perspectives from Analytical, Phenomenological, & Indian Traditions
, Mark Siderits et al., eds. (Oxford: Oxford University Press, 2011), 37.

“It is by no means”
:
Dan Zahavi, “Self and Other: The Limits of Narrative Understanding,”
Royal Institute of Philosophy Supplement
60 (May 2007), 179–202.

the causation was unclear
:
Suzanne Corkin, “Lasting Consequences of Bilateral Medial Temporal Lobectomy: Clinical Course and Experimental Findings in H.M.,”
Seminars in Neurology
4, no. 2 (June 1984): 249–59.

“could no longer recognize”
:
William Beecher Scoville and Brenda Milner, “Loss of Recent Memory after Bilateral Hippocampal Lesions,”
Journal of Neurology, Neurosurgery & Psychiatry
20 (1957): 11–21.

“This was performed on April 26”
:
Ibid.

“A striking feature of H.M.”
:
Corkin, “Lasting Consequences.”

the back half of
:
Suzanne Corkin et al., “H. M.’s Medial Temporal Lobe Lesion: Findings from Magnetic Resonance Imaging,”
The Journal of Neuroscience
17, no. 10 (May 1997): 3964–979.

“It is the most heavily”
:
Gary W. Van Hoesen et al., “Entorhinal Cortex Pathology in Alzheimer’s Disease,”
Hippocampus
1, no. 1 (January 1991): 1–8.

“unforgettable amnesiac”
:
Benedict Carey, “H. M., an Unforgettable Amnesiac, Dies at 82,”
New York Times
, December 4, 2008.

the same brain networks that
:
Daniel L. Schacter et al., “The Future of Memory: Remembering, Imagining, and the Brain,”
Neuron
76, no. 4 (November 2012): 677–94.

“I want to draw attention”
:
Quoted in Errol Morris, “The Anosognosic’s Dilemma: Something’s Wrong but You’ll Never Know What It Is (Part 2),”
New York Times
, June 21, 2010, http://opinionator.blogs.nytimes.com/2010/06/21/the-anosognosics-dilemma-somethings-wrong-but-youll-never-know-what-it-is-part-2.

“If she was asked”
:
Quoted in Ibid.

the medial prefrontal cortex
:
Giovanna Zamboni et al., “Neuroanatomy of Impaired Self-Awareness in Alzheimer’s Disease and Mild Cognitive Impairment,”
Cortex
49, no. 3 (March 2013): 668–78.

“What is your favorite”
:
Suzanne Corkin, “What’s New with the Amnesic Patient H.M.?,”
Nature Reviews Neuroscience
3 (February 2002), 153–60.

reminiscence bump
:
Clare J. Rathbone et al., “Self-Centered Memories: The Reminiscence Bump and the Self,”
Memory & Cognition
36, no. 8 (2008): 1403–414.

“constrains what the self”
:
Martin A. Conway, “Memory and the Self,”
Journal of Memory and Language
53 (2005): 594–628.

memories of those experiences
:
Ibid.

“the idea that bodily habits”
:
Pia C. Kontos, “Alzheimer Expressions or Expressions Despite Alzheimer’s?: Philosophical Reflections on Selfhood and Embodiment,”
Occasion: Interdisciplinary Studies in the Humanities
4 (May 2012): 1–12.

“Nothing human is altogether”
:
Quoted in
The Embodied Self: Dimensions, Coherence and Disorders
, Thomas Fuchs et al., eds. (Stuttgart: Schattauer GmbH, 2010), v.

“Knowledge of typing”
:
Kontos, “Embodied Selfhood.”

“Habitus comprises dispositions”
:
Pia C. Kontos, “Ethnographic Reflections on Selfhood, Embodiment and Alzheimer’s Disease,”
Ageing & Society
24, no. 6 (2004): 829–49.

“a way of being”
:
Pia C. Kontos, “Habitus: An Incomplete Account of Human Agency,”
The American Journal of Semiotics
22, no. 1/4 (2006): 67–83.