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 conceptual allocentric stance (in plain English: encouraging the patient to adopt a realistic detached view of herself and her follies) for psychoanalysis could be aided by encouraging the patient to adopt a perceptual allocentric stance (such as pretending she is someone else watching her own lecture). This in turn could, in theory, be facilitated by ketamine anesthesia. Ketamine generates out-of-body experiences, making you see yourself from outside.
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 misapplication of defenses—no biological system is perfect. Such a misapplication would, if anything, lead to additional chaos rather than restoring coherence.
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 having schizophrenia or “schizoid traits” (in addition to his epilepsy) and prescribed him antipsychotic medication. The last time I saw Ali, in 2009, he was claiming that in addition to being dead he had grown to enormous size, reaching out into the cosmos to touch the moon, becoming one with the Universe—as if nonexistence and union with the cosmos were synonymous. I began to wonder if his seizure activity had spread into his right parietal lobe, where body image is constructed, which might explain why he had lost his sense of scale, but I have not yet had a chance to investigate this hunch.
15. One might expect, therefore, that in Cotard syndrome there would initially be no GSR whatsoever, but it should be partially restored with SSRIs (selective serotonin reuptake inhibitors). This can be tested experimentally.
16. When I make remarks of this nature about God (or use the word “delusion”), I do not wish to imply that God doesn’t exist; the fact that some patients develop such delusions doesn’t disprove God—certainly not the abstract God of Spinoza or Shankara. Science has to remain silent on such maters. I would argue, like Erwin Schrödinger and Stephen Jay Gould, that science and religion (in the nondoctrinaire philosophical sense) belong to different realms of discourse and one cannot negate the other. My own view, for what it is worth, is best exemplified by the poetry of the bronze Nataraja (The Dancing Shiva), which I described in Chapter 8.
17. There has long been a tension in biology between those who advocate a purely functional, or black-box approach, and those who champion reductionism, or understanding how component parts interact to generate complex functions. The two groups are often contemptuous of each other.