The Man Who Wasn't There: Investigations into the Strange New Science of the Self (18 page)

Sarah is a slim, small woman—wired, energetic, in her early thirties, and already running an online start-up in New York. We met in her office and walked over to a nearby café to discuss an experience that she was still trying to understand. “What the hell just happened?” she asked rhetorically.

Three weeks before we met, she had been visiting a friend in the East Village. It was Saturday evening. Her friend liked to smoke pot recreationally. She joined in too, though she could count on her fingers the number of times she had smoked pot before. Sunday morning her friend suggested they try Adderall. Usually prescribed as a stimulant to treat attention deficit hyperactivity disorder (ADHD), Adderall has become a drug of choice among those working in the intense environments of tech start-ups as a way to focus and enhance performance. Sarah’s friend, an undergraduate, was taking Adderall to study harder and longer. Sarah had never tried it before. They split a pill. But their day of stimulation wasn’t done yet. That evening they had some pot again, smoked a hookah, and had a drink.

Sarah woke up Monday morning in a bit of a haze. “You feel hazy after you have a fun weekend, so I didn’t think much of it,” she told me.

Tuesday morning she went for a six a.m. yoga class. She was still feeling hazy, disconnected. “It felt like I was dreaming,” she said. “I was questioning whether I was alive.” Still, she kept her work appointments, made phone calls, had meetings.

By Wednesday morning, things hadn’t improved. In fact, they felt
worse. She started crying. “Shit, did I die? Am I looking at my life now?” she recalled thinking. “I kept saying, ‘I need to get out of this. I am in something I don’t understand.’ I was panicking. The thing that kept bothering me was that I didn’t believe anything.”

She doubted herself and the reality of her environment. She kept feeling she was in a dream. She got on the train to go to midtown for a meeting, and found herself spooked. She looked at her fellow passengers and wondered, “Are they here? Am I here?”

Wednesday evening—it was the night of a new moon—Sarah went to pray at her liberal Jewish synagogue, something she had grown up doing. On the way, she stopped at a taco stand and ordered tacos, fully convinced that the tacos wouldn’t show up. Standing on the New York City sidewalk, she said to herself, “They are not going to show up; there’s no way I ordered these tacos. I’m going to wake up, and it’s going to be a dream.” But the tacos were soon handed to her, of course. “I literally said, ‘Oh my God, I’m alive. Phew!’”

Sarah was likely doing what psychologists call “reality testing”—there was an awareness of objective reality, but her subjective sense of it was messed up, and she kept trying to reconcile the two. The momentary confirmation of getting real tacos, however, was of little help. Throughout the evening prayer, she remained anxious, her head churning with an internal dialogue seeking confirmation that she existed—because she felt disconnected from herself. When the prayer ended, she avoided eye contact with anyone and rushed back home. She started crying again. “I’m dead. I have died. I have absolutely died,” she thought.

Thursday, she called her nurse practitioner, who said, “Look, there is no way the drugs are [still] in your body.” The nurse advised fluids and rest. It didn’t help. Friday morning, a friend—whom I know well
also—came to meet Sarah. As soon as our mutual friend saw her, Sarah blurted out, “I’m afraid that I just died.” They sat for a few moments together before deciding to go to a nearby ER—a short, six-block walk away. Sarah sobbed all the way to the ER, and continued sobbing in the ER. “A really strange sob,” she recalled.

She continued asking her friend, “Are you sure I’m alive, am I here? Are you here right now?” Her friend would reassure her, “yes, yes, we are alive.” The ER doctor put it all down to a reaction to the drugs (even though he said it was odd that it had continued for so long after Sarah had taken them), prescribed her Ativan for anxiety, and sent her home.

But Sarah’s feelings of unreality continued. Life continued to feel dreamlike—a bit untethered, as if she were floating; she struggled to describe her state in everyday parlance. She’s not sure why it eventually all cleared up about three weeks later. The passage of time, or maybe the massage she got from a massage therapist, who was also an “energy-healer.” “Listen, I am fucked up right now,” Sarah told the masseuse, and explained how she was feeling. The woman replied reassuringly, “Oh, happens to me too. You have to learn to manage it.” She told Sarah that energy was flowing in and out of her body from the top of her head, and she had to stop the flow using a twisting motion of her hand, as if closing an imaginary bottle. Sarah was ready to believe her. The masseuse also gave her some less esoteric advice: “Do yoga; you need to feel back in your body. Stomp your feet, do whatever you need to feel back in your body, and you’ll be fine.”

Sarah did feel a tiny bit better when she left the masseuse. It was time to do more yoga, which she had been doing regularly anyway each morning for the past six years. The day after the massage, she did something extreme even by her standards—two hour-long sessions of yoga back-to-back. “I did one class and I was going to leave, and one of
the teachers said, ‘You should stay.’ I was like, ‘I’m still dreamy, what else am I going to do?’ so I stayed. I felt a little bit better.”

The recovery continued and by the time we met about three weeks after the onset of her experience, she was fine.

—

“You need to feel back in your body. . . . Stomp your feet, do whatever you need to feel back in your body.”

There’s wisdom in that seemingly woolly advice. Neuroscientists may cringe at counsel from a New Age healer, but if you unpack much of what neuroscientists themselves are saying about the self, it’s clear that feeling embodied—being in and of our body—is a key aspect of who we are.

One of the strongest advocates of the notion that the body underpins the self is neuroscientist Antonio Damasio. In his latest book,
Self Comes to Mind
, he writes, “
Of the ideas advanced in the book, none is more central than the notion that the body is a foundation of the conscious mind.” Damasio believes that a conscious mind needs the appearance of a self. His framework begins with the idea of mental images forming in the brain. By this, he does not mean images in our conscious awareness. Rather, he means patterns of activity of neural circuits. Depending on the pattern of activity, a given neural circuit within the brain can be in one of many, many states. Each state, writes Damasio, is the equivalent of a mental image. A succession of such mental images is the mind. At this stage, Damasio is not talking about anyone or anything being conscious of the mind. This is not hard to accept. It’s well known that much of our brain’s activity is subconscious—we are not, and will likely never be, aware of it.

The brain’s basic job is to take care of the organism as the organism
eats, drinks, moves, and sleeps. An organism can survive only if its internal biochemistry remains within acceptable limits. These are so-called homeostatic limits, and the process that keeps the body within these limits is called homeostasis (
a term defined by American physiologist Walter Cannon). The exact homeostatic process differs from organism to organism. For instance, cold-blooded animals (such as reptiles) take on the temperature of their surroundings—so in order to be active, they have to seek warmth—whereas the bodies of warm-blooded animals (just about all mammals and birds) need to be at a near-constant internal temperature, which entails eating a lot when cold to generate the necessary energy or sweating to lose excess heat. The brain performs its duties of maintaining homeostasis admirably. But the brain is part of the organism too, not something distinct sitting outside the body like a puppeteer pulling strings. In order to do its job, the brain has to keep track of—create representations or maps of—what’s happening in the body, in the environment outside, and within itself. The patterns of activity of neural circuits are these maps. These maps are the contents of (the still unconscious) mind.

The next step in his hypothetical framework is the appearance of what Damasio calls the
protoself
, “
which foreshadows the self to be.” The protoself is made up of mental images of the more stable aspects of our body (such as the state of the viscera). Damasio implicates the upper brain stem as the region most responsible for creating maps and generating such images. The structures in the upper brain stem are inextricably linked to the body parts they map—a tight two-way interaction that is “
broken only by brain disease or death.”

The other key function of the protoself is the generation of
primordial feelings
, which “
provide a direct experience of one’s own living body, wordless, unadorned, and connected to nothing but sheer
existence.” Primordial feelings, in Damasio’s framework, “
reflect the current state of the body.”

The next layer, structured on top of the protoself, is the
core self
. The core self is constituted of representations in the brain that capture the relationship between the protoself and its interaction with an object. The representations also capture changes to the protoself and the resultant primordial feelings. For example, if the protoself were to encounter a snake, the core self would be the representation of this interaction and the representation would include the changes to the body state (a state of utter fear for someone like me).

Damasio thinks that with the appearance of the core self in our evolutionary history, the self as we know it entered the picture. The core self is the first intimation of subjectivity (note, however, that Damasio does not satisfactorily explain how neural activity turns into subjectivity—no surprise, since that’s the stuff of the hard problem of consciousness). The core self is living in the moment—it is a sequence of mental images of interactions of the protoself’s dealings with an object, and the ensuing modifications to the protoself and primordial feelings. If all we had was a core self, and many animals likely do, then all we’d be aware of are these moments of subjective experience.

It’s when the brain evolved further and developed autobiographical memory that the next stage came about—the
autobiographical self
. Damasio hypothesizes that there is brain circuitry that is capable of grouping together autobiographical memories into an object (one can think of this object as a story), letting that object interact with and modify the protoself, which then produces a moment of subjectivity. But this time the subjective experience is not just of the body, but of a more complex entity, the person. The autobiographical self would be
a rapid sequence of such moments of subjectivity. This fully formed self would be the basis of one’s personality.

Regardless of whether one agrees entirely with Damasio’s framework, there’s widespread agreement in neuroscience about the body’s central role in giving rise to the self. This role is manifest in emotions and feelings. In Damasio’s view, the self begins with primordial feelings—body states represented in the upper brain stem, the insular cortex, and the somatosensory cortices—which form the building blocks for more complex emotions and feelings.

Damasio also proposes an “as-if body loop”—roughly translated, the ability of the brain to simulate body states. Why would a brain want to do this? Because, at times, simulating an anticipated state can speed up the brain’s capacity to control the body’s physiological state and thus save energy. It can make the brain more efficient and effective. It’s not unlike the idea of the brain generating an efference copy of a motor command, using it to predict the sensory consequences, and being prepared for it.

If the body and primordial feelings form the basis for our sense of self, depersonalization—given that it involves disembodiment and the numbing of emotional feelings—can be viewed as a fundamental impairment of self-awareness. Mauricio Sierra and Anthony David of the Depersonalization Research Unit at King’s College London write that “
the condition manifests as a pervasive disruption of self-awareness at its most basic, preverbal level (i.e. what it feels like to be an entity, to exist).”

Depersonalization will mostly induce some or all of these experiences:
“(1) feelings of disembodiment, which refers to the sense of detachment or disconnection from the body; (2) subjective emotional numbing, an inability to experience emotions and empathy; (3)
anomalous subjective recall, a lack of ownership when remembering personal information or imagining things; and (4) derealization, an experience of feeling estranged or alienated from surroundings.”

People with depersonalization find it hard to put their experience into words, resorting mainly to metaphors. “The actual disconnect itself is very challenging to describe,” Nicholas told me. “It feels like your physical body is not you.”

It almost sounds like an out-of-body experience, but it’s not. There are some key differences between the experience of feeling disembodied in the context of depersonalization and the disembodiment of out-of-body experiences (which we’ll examine in detail in a later chapter). Depersonalization does not usually involve a shift in perspective, in which the observing self somehow ends up outside the body. This shift in perspective is common in out-of-body experiences, however, and is
suggestive of different neural mechanisms that work to keep the self anchored in the body. In depersonalization, one is (usually) still located within the body, but the vividness of being embodied is compromised.