The Man Who Wasn't There: Investigations into the Strange New Science of the Self (15 page)

Even before that happened, Sophie was struggling as a student. She would find herself unable to talk, sometimes for hours on end, despite being perfectly capable of formulating thoughts and sentences in her mind. The words just wouldn’t come out. That was incredibly
inconvenient, given she had office hours as a teaching assistant, or had to attend classes as a doctoral student. Unable to afford good psychiatric care, Sophie went to a psychiatric hospital in Chicago meant to help poor and low-income patients. The experience was scarring. The intake nurse told the friend who had accompanied Sophie, “I’m not the one doing the official assessment, but from what you have told me it seems as plain as day that she’s a schizo.” The comment stung. “I was right there,” Sophie told me, indignation rife in her voice even years later.

The hospital locked her up, in a spartan room, surrounded by others who were suffering from various mental-health problems, including substance abuse. Sitting among patients who were walking around screaming and yelling, Sophie was unnerved at where she found herself. “It was disturbing to me, from that perspective, although I had grown up with my mother and was used to dealing with her,” she said. Her friend, horrified at the way Sophie was being treated, helped her escape from the lockup.

Fortuitously, Sophie discovered a well-funded program that focused on first episodes of psychosis. She called the clinical director. The response was immediate. “She said, ‘I want to see you at seven a.m. in the morning,’” recalled Sophie. “She was incredibly reassuring and nice, and it was just night and day.” Sophie enrolled at the program for intensive treatment. But despite talking with the clinical director a number of times during the week and taking antipsychotic medication, Sophie wasn’t convinced of her psychosis, partly because she thought her altered view of the world made sense, thanks ironically to her training in philosophy. While her mother’s madness had been “profoundly irrational, conspiracies, plots, and things going on,” Sophie’s own perception of the world as insubstantial, where solid boundaries melted away into an amorphous whole, did not seem
unrealistic. Solid objects were illusions. Even the reality of people existing as individuals was tenuous. “That felt entirely in line with the types of questions that philosophers have been asking for centuries,” said Sophie.

Meanwhile, her schizophrenia was having profound effects on her being. Her sense of a barrier between her internal and external worlds had dissolved. “Suddenly, it was as if my entire interior life was exposed to everyone,” she said. During her sessions with a psychiatrist, she was constantly being asked if she was getting messages from, say, the radio, or whether she was hearing voices. While she wasn’t getting messages or hearing voices, Sophie felt compelled to know whether she was psychotic or not. She began fixating on objects to see if they were communicating with her, and started focusing on her own thoughts. “This is what Louis [Sass] would call hyperreflexivity in the most self-conscious sense—the more I concentrated on my thoughts, the more objectified they became, the more I started to hear auditory elements to things,” said Sophie.

Schizophrenia has also changed Sophie’s relationship to her own body. “My hands never look like my own hands,” she said. “There must be some sort of split-second gap between the movement of my hand and me registering that as my own action, or a self-initiated action.”

What Sophie experienced and continues to experience is a disruption of what is called our sense of agency. It’s that part of our sense of self that makes us feel that we are the owners of our actions. If I lift a glass of water, I know that I’m doing the lifting. Can something we take so much for granted go awry? And could it cause psychosis—the perception of a distorted, nonexistent reality? The answers have their roots in experiments with fish, flies, and eyeballs that began in the early nineteenth century.

Move your eyes left to right, back and forth. What happens to the scene that you are looking at? If all’s well with your visual system, then you should see what’s to your left or right, but the scene you are looking at should hold steady despite the fact that your eyeballs are moving. But think about this for a moment. As far as the brain is concerned, the signals falling on your retinas could be due to either the motion of your eyeballs or something moving in your visual field. How does it know which?

Charles Bell and Johannes Purkinje, back in the 1820s, independently figured out that the answer to this question was telling us something very important. When you move your eyes normally, the brain cancels out the expected movement of the image—because it knows it initiated the eye movements, thus keeping the image steady. But when something is moving in the visual field, there is no such cancellation, and we perceive motion.

Then,
in 1950, Erich von Holst and Horst Mittelstaedt carried out an experiment that illustrated this rather more bizarrely. They twisted the neck of the blowfly
Eristalis
, turning its head upside down: “
Eristalis has a slender and flexible neck which can be rotated through 180° about its longitudinal axis. If this is done, and the head glued to the thorax, the positions of the two eyes are reversed,” they wrote. The fly demonstrated truly strange behavior: in darkness, it acted as if nothing was wrong and moved normally, but under lights, it started going around and around, either clockwise or counterclockwise, choosing the direction at random once the lights came on and sticking with it. The same year, and independently, neurobiologist Roger Sperry did something similar. He surgically rotated the left eye by 180° in
southern swellfish (
Sphoeroides spengleri)
, and blinded the right eye (
“Its small size, loose, scaleless integument, and general hardiness make this fish suitable for experiments involving surgery,” wrote Sperry). Once the fish recovered from surgery, it too would circle either to the left or the right.

Von Holst and Mittelstaedt came up with the term
Efferenzkopie
, or
efference copy
, to explain what was going on. Sperry used the term
corollary discharge
. The essence of the idea was the same in both cases. The animal’s brain generated a command to move. A duplicate of this signal was sent to the visual center. The nervous system would use the copy to compare the expected movement with the signal of the actual movement and use this comparison to stabilize the animal’s motion—a kind of feedback mechanism to ensure that it was moving accurately in the intended direction. But if the head or eyes were twisted around, the feedback reinforced errors instead of correcting them, causing the animal to move in circles.

What could this possibly have to do with schizophrenia, psychosis, and the self?

In 1978, Irwin Feinberg of the VA Hospital in San Francisco tackled this question head on. Experiments until then had shown that motor actions could produce a corollary signal or copy, at least in simple animal models. Could such signals be used to distinguish self from non-self? Say your arm moved. Could the brain use the corollary signal to tell whether the arm moved because
you
tried to move it, or whether it moved due to an external cause?

The question is not as weird as it sounds. Before Feinberg published his paper, the Canadian neurosurgeon Wilder Penfield had written about experiments in which he would stimulate the motor cortex of patients who were undergoing exploratory surgery for
treatment of epilepsy. The stimulation would cause the arm to move. But the patient insisted that he had not moved the arm, rather that Penfield had caused the arm to move. Because the patient had not willed the motion, no motor commands were willfully initiated and there would have been no corollary signal; so, the hypothesis goes, the brain attributed the movement not to the self but to an external agency. Feinberg eloquently argued: “
The subjective experience of these discharges [or signals] should correspond to nothing less than the experience of will or intention.”

And Feinberg went further. What if corollary signals were not limited to motor actions but also to thoughts? Could this be the mechanism for making a thought seem as if it belonged to oneself, rather than to someone else? Feinberg suggested this might be the case. He even attributed auditory hallucinations to malfunctions of this “corollary discharge” mechanism. Indeed, he posited that such malfunctions lay behind some of the strange symptoms of schizophrenia, even the blurring of boundaries between self and non-self, the kind experienced by Laurie and Sophie and countless other sufferers of schizophrenia. “
Thus, if corollary discharge, in permitting the distinction of self-generated from environmental movement, thereby contributes to the distinction of self and other, its impairment might produce the extraordinary distortions of body boundaries reported by schizophrenic patients,” wrote Feinberg.

During the depths of her psychosis, Laurie would hear voices a few times a week, women telling her that she was useless, a failure. Her husband, Peter, could tell when she was hearing voices. “She would look vacant and gaze off into space. Or she’d respond to the voices;
she’d say something completely out of the blue,” said Peter. “You would instantly [know] she was responding to the voices.”

Peter would actually engage with the voices through Laurie. She’d tell him that the voices were saying she was a failure. “Why do they think that?” Peter would ask. The voices would respond, “Because you failed to get your degree.” And Peter and the voices would argue back and forth, with Peter pointing out to the voices that Laurie hadn’t failed her degree, she had merely taken a year off from university (which she had, to cope with her illness). These episodes would last for half an hour, sometimes an hour, and eventually the voices would subside.

Laurie comes across as deeply introspective and analytical. These are traits that forced her to question her condition. She wanted answers. Was she crazy? Her inward journey resulted in two papers that she wrote when she was still a student struggling with schizophrenia. In one of the papers, she ends with a plea to psychiatrists to pay heed to what the patient is saying. Her experience with the psychiatrist whom she saw immediately after her attempted jump off the eight-story garage is illuminating. She explained to him that she had watched herself from a detached, third-person perspective as she tried to commit suicide. She had not been herself. Her psychiatrist dismissed her observations by saying, “You certainly communicate your distress clearly.” It’s in response to such indifference that Laurie implored psychiatrists to recognize the “unwanted new reality” that schizophrenia foists on people, which could help “rescue the sufferer from his [or her] isolation.”

A mainstream psychiatric idea for why schizophrenics have to confront this painful reality relies on the notions of self-checking corollary discharges. The idea that an animal might distinguish aspects of
self from non-self via this mechanism has been tested even at the level of single neurons. Singing crickets (
Gryllus bimaculatus
) chirp at an astounding 100 dB SPL. Their chirps are synchronized with their wing movements, with the crickets generating pulses of sound as they close their wings. Amid this cacophony of sound, how does a cricket—whose ears remain sensitive at all times—distinguish between its own chirps and external sounds? It turns out that there’s a single interneuron that manages this task. This corollary discharge interneuron (CDI) fires in synchrony with the motor neuron that’s controlling wing movement; it fires as the wings close. The CDI’s firing then inhibits the auditory neurons responsible for processing sound—so the cricket is deaf to the sounds it generates on the wings’ downbeat. When the CDI doesn’t fire, and there is no corollary discharge, incoming sounds are deemed external or non-self, and
the cricket tunes in.