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

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Copyright © 2015 by Anil Ananthaswamy

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Portions of chapters 1, 7, and 8 appeared in
New Scientist
magazine. Most of chapter 3 was first published as a feature in the online magazine
Matter.
The parable narrated in the prologue is adapted with permission from Jonardon Ganeri. The English translation of the parable appears in his book
The Self.

DUTTON—EST. 1852 (Stylized) and DUTTON are registered trademarks of Penguin Random House LLC.

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Ananthaswamy, Anil.

The man who wasn’t there : investigations into the strange new science of the self / Anil Ananthaswamy.

pages cm

Includes index.

ISBN 978-0-698-19081-8

1. Neuropsychology. 2. Identity (Psychology) 3. Mind and body. I. Title.

QP360.A48 2015

616.80092'2—dc23 2015003576

While the author has made every effort to provide accurate telephone numbers, Internet addresses, and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

to

those of us who want to let go

but wonder,
who
is letting go of
what
?

TITLE PAGE

COPYRIGHT

DEDICATION

EPIGRAPH

PROLOGUE

1. THE LIVING DEAD

WHO IS THE ONE WHO SAYS, “I DON’T EXIST”?

2. THE UNMAKING OF YOUR STORY

MEMORIES, A PERSON, A NARRATIVE—AND ITS UNRAVELING

3. THE MAN WHO DIDN’T WANT HIS LEG

IS THE FEELING THAT YOU OWN YOUR BODY AND ITS VARIOUS PARTS BASED ON REALITY?

4. TELL ME I’M HERE

WHEN YOUR ACTIONS DON’T FEEL LIKE YOUR OWN AND WHAT IT DOES TO THE SELF

5. I AM AS IF A DREAM

THE ROLE OF EMOTIONS IN THE MAKING OF THE SELF

6. THE SELF’S BABY STEPS

WHAT AUTISM TELLS US ABOUT THE DEVELOPING SELF

7. WHEN YOU ARE BESIDE YOURSELF

OUT-OF-BODY EXPERIENCES, DOPPELGÄNGERS, AND THE MINIMAL SELF

8. BEING NO ONE, HERE AND NOW

ECSTATIC EPILEPSY AND THE UNBOUNDED SELF

EPILOGUE

ACKNOWLEDGMENTS

NOTES

INDEX

ABOUT THE AUTHOR

It seems outlandish that the centerless universe, in all its spatiotemporal immensity, should have produced me, of all people . . . There was no such thing as me for ages, but with the formation of a particular physical organism at a particular place and time, suddenly there
is
me, for as long as the organism survives. . . . How can the existence of one member of one species have this remarkable consequence?

—Thomas Nagel

PROLOGUE

A
n allegory about a man who was devoured by ogres first appears in an ancient Indian Buddhist text of the
Madhyamika
(the middle-way) tradition. It dates from sometime between 150 and 250 CE and is a somewhat gruesome illustration of the Buddhist notion of the true nature of the self.

A man on a long journey to a distant land finds a deserted house and decides to rest for the night. At midnight, an ogre turns up carrying a corpse. He sets the corpse down next to the man. Soon, another ogre in pursuit of the first arrives at the deserted house. The two ogres begin bickering over the corpse. Each claims to have brought the dead man to the house and wants ownership of it. Unable to resolve their dispute, they turn to the man who saw them come in, and ask him to adjudicate. They want an answer. Who brought the corpse to the house?

The man, realizing the futility of lying to the ogres—for if one won’t kill him, the other one will—tells the truth: the first ogre came
with the corpse, he says. The angry second ogre retaliates by ripping off the man’s arm. What ensues gives the allegory its macabre twist. The first ogre immediately detaches an arm from the corpse and attaches it to the man. And so it goes: the second ogre rips a body part off the man; the first ogre replaces it by taking the same body part from the corpse and attaching it to the man. They end up swapping everything—arms, legs, the torso, and even the head. Finally, the two ogres make a meal of the corpse, wipe their mouths clean, and leave.

The man, whom the ogres have left behind, is extremely disturbed. He is left pondering what he has witnessed. The body that he was born in has been eaten by the ogres. His body now is made up of body parts of someone else entirely. Does he now have a body or doesn’t he? If the answer is yes, is it his body or someone else’s? If the answer is no, then what is he to make of the body that he can see?

The next morning, the man sets off on the road, in a state of utter confusion. He finally meets a group of Buddhist monks. He has a burning question for them: does he exist or does he not? The monks throw the question back at him: who are you? The man is not sure how to answer the question. He’s not sure he’s even a person, he says—and tells the monks of his harrowing encounter with the ogres.

What would modern neuroscientists tell the man if he were to ask them
Who am I?
While some would likely point out the near-biological implausibility of what the ogres did, they would nonetheless have some tantalizing answers. These answers, which strive to illuminate the “I,” are the focus of this book.

THE LIVING DEAD

WHO IS THE ONE WHO SAYS, “I DON’T EXIST”?

Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughters and jests, as well as our sorrows, pains, griefs and tears. . . . These things that we suffer all come from the brain. . . . Madness comes from its moistness.

—Hippocrates

If I try to seize this self of which I feel sure, if I try to define and to summarize it, it is nothing but water slipping through my fingers.

—Albert Camus

A
dam Zeman will never forget the phone call. It was, as he called it, a “
Monty Python–
esque” summons from a psychiatrist, asking him to come urgently to the psychiatric ward. There was a patient who was claiming to be brain dead. Zeman felt as if he were being called to the intensive care unit, not the psychiatric ward. Yet, “this
was very unlike the kind of call you normally receive from the ICU,” Zeman told me.

The patient, Graham, was a forty-eight-year-old man. Following a separation from his second wife, Graham had become deeply depressed and had tried to kill himself. He got into his bath and pulled an electric heater into the bathwater, wanting to electrocute himself. Fortunately, the fuse blew and Graham was spared. “It didn’t seem to have done any physical damage to him, but some weeks later he formed the belief that his brain had died,” said Zeman, a neurologist at the University of Exeter in the UK.

It was a rather specific belief. And one that led Zeman to have some very strange conversations. “Look, Graham, you are able to hear me, see me, and understand what I’m saying, remember your past, and express yourself, surely your brain must be working,” Zeman would say to Graham.

Graham would say, “No, no, my brain’s dead. My mind is alive but my brain is dead.”

Worse yet, Graham was distraught at his unsuccessful attempt at suicide. “He was one of the undead or half-dead,” Zeman told me. “He in fact went and spent quite a bit of his time, for a while, in graveyards, because he felt he was with his own when he was there.”

Zeman quizzed Graham to understand the grounds for this belief. It became clear that something very fundamental had shifted. Graham’s subjective experience of himself and his world had changed. He no longer felt he needed to eat or drink. Things that once used to give him pleasure no longer did. “When he pulled on a cigarette, nothing happened,” Zeman told me. Graham claimed that he never needed to sleep, that he did not feel sleepy. Of course, he was doing all of these
things—eating, drinking, sleeping—but his desire for these and the intensity of his feelings had damped down dramatically.

Graham had lost something we all have: a keen sense of our own appetites and emotions. Patients suffering from depersonalization often report this emotional dulling or flatness. Depression too can bring about similar states of being, where emotions lose their edge. But these patients don’t go on to develop such stark delusions of nonexistence. In Graham’s case, the loss of emotional vividness was so extreme that “he had come to the conclusion, on the basis of that alteration in experience, that his brain must have died,” said Zeman.

Zeman thinks that two key factors play a role in such robust delusions. One is a profound alteration in the quality of one’s sense of oneself and the world—in Graham’s case, the emotional rug had been pulled from under his feet. The second is an alteration in one’s ability to reason about that experience. “Both things seemed to be true in Graham’s case,” said Zeman.

Graham’s delusion was immune to evidence to the contrary. Zeman, in his conversations, would bring Graham to the point of surrender—to make him see the falseness of his delusion. Graham would acknowledge that a whole range of his mental faculties was intact, that he could see, hear, speak, think, remember, and so on.

So Zeman would say to him, “Clearly, Graham, your mind is alive.”

He’d say, “Yeah, yeah, the mind is alive.”

“The mind has a lot to do with the brain; surely your brain is alive,” Zeman would prod him.

But Graham would not take the bait. “He’d say, ‘No, my mind is alive, but my brain is dead. It died in that bath,’” Zeman told me. “You
could get quite close to producing what you would think was knock-down evidence, but he wouldn’t accept it.” It was intriguing that Graham had developed such an explicit delusion—that of being dead because his brain was dead. Would his delusion have been different in an era when the legal definition of death did not include brain death?

Over the course of his medical practice, Zeman had only ever seen one other case of someone claiming to be dead. In the mid-1980s, working as a junior doctor in Bath, England, Zeman had to treat a woman who had undergone protracted bowel surgery and was suffering from severe malnourishment. Her body had been ravaged by repeated surgery. “She became very depressed as a result of that and formed a belief that she had died,” Zeman said. “Which in a strange way seemed understandable to me, because the kind of trauma she was undergoing was so awful. She thought she was dead.”

Zeman recognized the symptoms in Graham, and diagnosed him as suffering from Cotard’s syndrome, which was first identified as a distinct disorder by the nineteenth-century French neurologist and psychiatrist Jules Cotard.

Walk down the rue de l’École-de-Médecine in the Sixth Arrondissement in Paris, and you’ll see a formidable colonnade. A striking example of French neoclassical architecture, the colonnade forms a portico for the Université René Descartes. Designed in the late eighteenth century by architect Jacques Gondouin,
the façade, as the architect intended, demands attention and yet feels open and inviting.

I entered the building to visit the rare manuscript section of the Library of the School of Medicine, to look at a document on the life of Jules Cotard. The document is the text of a eulogy delivered by his
friend and colleague Antoine Ritti in 1894, almost five years after Cotard’s death.
Cotard had been devotedly nursing his daughter, who was suffering from diphtheria, but then fell ill himself with the disease and died in 1889. Much of what we know of Cotard comes from Ritti’s eulogy, a copy of which exists amid the pages of an old leather-bound volume, whose spine simply reads
MÉLANGES BIOGRAPHIQUES
—a mixture of biographies. I turned the pages to Ritti’s eulogy. Handwritten on the first page was a note to the then head of the faculty of medicine of the university: “
Hommage de profond respect,
” the note read. It was signed
Ant. Ritti
.

Cotard is best known for describing what are called nihilistic delusions, or
délire des négations
. But before he came up with that phrase, Cotard first talked of “delirium in a severely melancholic hypochondriac” at a meeting of the Société Médico-Psychologique on June 28, 1880, using as an example
the case of a forty-three-year-old woman who claimed “she had ‘no brain, nerves, chest, or entrails, and was just skin and bone,’ that ‘neither God or the devil existed,’ and that she did not need food, for ‘she was eternal and would live forever.’ She had asked to be burned alive and had made various suicidal attempts.”

Soon afterward, Cotard coined the phrase
délire des négations
, and after his death, other doctors named the syndrome after him. Over time, “Cotard’s delusion” has come to refer to the most striking symptom of the syndrome—the belief that one is dead. However, the syndrome itself refers to a constellation of symptoms, and does not have to include the delusion of being dead or not existing. The other symptoms include the belief that various body parts or organs are missing or putrefying, feelings of guilt, feelings of being damned or condemned, and paradoxically, even feelings of immortality.

But it’s the delusion that one does not exist that poses an
interesting philosophical challenge. Until recently, the seventeenth-century French philosopher René Descartes’s assertion
Cogito ergo sum
(I think, therefore I am) was the bedrock of Western philosophy. Descartes established a clear dualism of mind and body: the body was of the physical world, something that takes up space and exists in time, while the mind’s essence was thought and it did not extend into space. For Descartes,
cogito
did not mean thinking as much as “
clear and distinct intellectual perception, independent of the senses.” An implication of Descartes’s philosophy, according to philosopher Thomas Metzinger, was that “
one cannot be wrong about the contents of one’s own mind.”

This Cartesian idea has been falsified in many disorders, including Alzheimer’s, where patients are often unaware of their own condition. Cotard’s syndrome is also a puzzle. Metzinger argues that we should be paying attention to what it feels like to be suffering from Cotard’s—what philosophers call the
phenomenology
of a disorder. “
Patients may explicitly state not only that they are dead, but also that they don’t exist at all.” While this seems logically impossible—an obviously alive individual claiming not to exist—it
is
part of the phenomenology of Cotard’s.

I left the library, and stepped back out onto the rue de l’École-de-Médecine, and turned around to take another look at the name “Université René Descartes” etched into the stone above the colonnade. There was something intriguing about researching Jules Cotard in a university named after Descartes. What does Cotard’s eponymous delusion say about Cartesian ideas? Is the Cotard’s syndrome patient saying, “I think, therefore
I’m not
”?

“
Who is the I that knows the bodily me, who has an image of myself and a sense of identity over time, who knows that I have propriate strivings? I know all these things, and what is more, I know that I know them. But who is it who has this perspectival grasp?”

Who, indeed. The American psychologist Gordon Allport’s lyrical musings above capture the central conundrum of being human.
We instinctively and intimately know what he’s referring to. It is there when we wake up and slips away when we fall asleep, maybe to reappear in our dreams. It is that feeling we have of being anchored in a body we own and control, and from within which we perceive the world. It is the feeling of personal identity that stretches across time, from our first memories to some imagined future. It is all of these tied into a coherent whole. It is our sense of self. Yet, despite this personal intimacy we have with ourselves, elucidating the nature of the self remains our greatest challenge.

All through recorded history, it is clear that humans have been fascinated and confounded by the self. Pausanias, a Greek traveler during Roman rule, wrote about the maxims inscribed at the fore-temple at Delphi by seven wise sages. One maxim said, “
Know thyself.” The Kena Upanishad, among the most analytical and metaphysical of Hindu scriptures, begins with these words: “
By whom commanded and directed does the mind go towards its objects? . . . At whose will do men utter speech? What power directs the eye and the ear?”

Saint Augustine said this of the notion of time, but he might as well have been speaking about the self: “
If no one asks of me, I know; if I wish to explain to one who asks, I know not.”

And so it is that from the Buddha to the modern neuroscientist and philosopher, humans have pondered the nature of the self. Is it real or an illusion? Is the self in the brain, and if so, where in the brain
is it? Neuroscience is telling us that our sense of self is an outcome of complex interactions between brain and body, of neural processes that update the self moment by moment, the moments strung together to give us a seamless feeling of personhood. We often hear of how the self is an illusion, that it is nature’s most sophisticated sleight of hand. But all this talk of tricks and illusions obfuscates a basic truth: remove the self and there is no “I” on whom a trick is being played, no one who is the subject of an illusion.