The Man Who Wasn't There: Investigations into the Strange New Science of the Self (30 page)

Picard was intrigued by Craig’s hypothesis. Her patients’ explanations of how they felt during their ecstatic seizures suggested that the symptoms may have to do with a dysfunctional insula, specifically the anterior insula. And one of her patients provided preliminary evidence that this could be the case. The patient, the thirty-seven-year-old man who described his ecstatic aura as a “sensation of velvet,” had been operated on in 1996 for a tumor in the right temporal region. He was free of seizures until 2002, when they began again, but less frequently. While closely monitoring him during one of his seizures, neurologists managed to get a SPECT image of his brain. This involves injecting a nuclear tracer as the patient is having a seizure (something the patient agrees to in advance). In about thirty seconds, this tracer is absorbed by brain regions with greater blood flow, a proxy for greater brain activity. Thirty minutes later, the patient is wheeled into a scanner and brain scans can reveal the region that was most active during the seizure. In this man’s case, it was the right anterior insula.

Two other patients enriched Picard’s understanding. One was Zachary Ernst, who provided Picard with insightful descriptions of his ecstatic seizures. The other was a seventeen-year-old farmer from Romont, Switzerland, who came to Geneva to be closely monitored during his seizures. Picard asked him for a detailed explanation of his experiences, and he wrote a report for her, in which he mentioned what he called his “absences.” There were big absences, with loss of consciousness. And there were small ones, when he remained aware, and time seemed to slow down: those around him at the time would
tell him that his seizure had lasted one or two seconds, but he felt immersed in them for longer, much longer. It was hard for him to tell how long. And these seizures would be triggered by something pleasant in his environment, “a nice car going by, pictures, a color, a flower, a landscape, animals grazing, a bird singing, branches moving in the wind, a person smiling, a beautiful woman, a kiss, a caress, a thought about someone, a hope . . .”

Picard’s neurological examination of the teenage farmer would further implicate the anterior insula as the source of such magical feelings.

The train from Geneva to Romont sped along the northern shore of Lake Geneva (or Lac Léman in French), until it reached Lausanne, and soon after, it veered away from the lake into mountainous terrain. When I got off at Romont, I was met by Catherine. It was her son Albéric, the young farmer, who had written a report for Picard. Catherine drove me to a farm to meet Albéric. During that short drive, she told me that Albéric was the third of six children and that though he had been the heaviest at birth, his delivery had been the most harmonious. It had been a water birth, as with all her children. And she had named him Albéric (Celtic for “king of bears”) because he had been “very strong in [her] body . . . very virile.”

Albéric had been an uncomplicated, happy kid. He loved nature (which, I’d discover, was in staggering abundance around their three-hundred-year-old farmhouse near Romont), walked around barefoot, loved the company of their cows, and by age three was clambering onto his godfather’s tractor. He also began speaking at age three, much later than his sisters.

We met Albéric at the farm where he was working. The images I had built up of a cherubic kid vanished; here was a strapping nineteen-year-old, slightly disheveled from working on the farm, with a gentle, easy smile. He had cut himself while working; his finger was bleeding. But he nonchalantly got into the car and we drove back to Romont to talk about his epilepsy; he spoke in French and his mother translated.

The first seizure came when he was fifteen. Just one week before it happened, Albéric had an experience that subtly echoed elements of my first meeting with him. He and his godfather were at a mountain farm, some five thousand feet in altitude, when his godfather badly cut three of his fingers while using a woodworking machine. He asked Albéric to stay at the farm and care for the cows, which were being specially tended to before they had their first calves, and he drove off to the hospital. Albéric called his mother, and she said, “You shouldn’t have let him go.” When she arrived at the farm, Catherine found Albéric crying and in shock. He was traumatized, by the accident and because he had let his godfather drive away alone. “One week later it began, the seizures,” Catherine told me.

It happened at the same mountain chalet. This time Albéric was with his father. They had finished cleaning the stalls for the cows and were sitting by the fireplace. Suddenly he felt a strange, unfamiliar taste in his mouth. Then he lost consciousness and soon thereafter the convulsions began, which he could not recollect. It was the first of his big “absences.” His parents, unaware of what exactly had happened, brought him back down to their farmhouse. At home, Catherine realized that Albéric was still confused. She was bathing him with running hot water when he remarked at how strange it was that the chalet had hot water (up in the mountains they had to boil water). “He didn’t realize he was home,” recalled Catherine. That night his father slept
near him. “We thought, He’ll be never the same. . . . Something is broken in his person,” said Catherine.

Albéric’s big seizures continued, mainly at night, signs of which would be evident in the morning, in the form of extreme tiredness or even a bitten tongue. But he began having smaller seizures too, during which he remained aware. These he found to be an entirely different experience. The triggers were usually something pleasant, such as—unsurprisingly for a farmer—the sight of a tractor during harvest season. Nature had a great effect too. At times, he would feel as if the cows were speaking to him just before the seizure. The seizures themselves were pleasant as well. “He told me once it is just like a drug, these seizures,” said Catherine. “When he doesn’t have any, he waits, thinking it’ll come. He thinks perhaps he’ll never [be able to] live without them.”

Unfortunately, Albéric continued to suffer from the more dangerous absences. One came when he was working as an apprentice at a farm. He woke up at four a.m. and walked over to his boss’s house—wearing only his underwear. The boss asked, “What are you doing here?” and Albéric left. Soon, his boss noticed a light in the barn, so he walked over and found Albéric clambering barefoot onto a combine harvester. The key was in the machine. Albéric does not remember the incident.

Around the time he turned seventeen, he became Picard’s patient. An MRI scan showed a benign tumor in the right temporal pole. When I went to see Picard in Geneva in March 2013, she showed me the room where Albéric had been monitored during one of his seizures. A technician sat in a room with monitors, which showed the EEG signals from patients in each of four rooms. Each screen was filled with rows and rows of squiggles—each squiggle a signal from one EEG
electrode. They looked like the tracings of a seismograph. Only a trained neurologist or technician could spot the signature of a seizure. For instance, a focal seizure would generate spikes in one electrode or in a cluster of nearby electrodes. Inset among those electrical waveforms on each screen was the feed from a camera that was trained on the patient, lying in bed with an EEG skullcap covering his head. Albéric had been in one of those rooms when he had an eighty-second seizure. The EEG showed the seizure beginning in the right anterior temporal region. Upon onset of the seizure, Albéric was injected with a nuclear tracer. And subsequent SPECT imaging revealed that the seizure had involved increased blood flow (or activity) in the right insula, and also close to the tumor. Neurosurgeons operated on Albéric and removed his tumor.

Before his surgery, Albéric had to see a psychiatrist, because there was the danger of depression after brain surgery. Unflustered by the thought of depression, Albéric had told the doctors, “No problem; when it’s not good,
cartouche
!” In other words, there was always the choice of ending one’s life with a gun if things took a turn for the worse. He was joking, of course. “They were very shocked,” recalled Catherine. But she knew what her son meant and had clarified that he was joking. “I was laughing. It’s the way of thinking of the farmer; if a cow is not good, they shoot it. In the farm, it’s totally normal to speak so. When we live in nature, we see this in life.”

After his surgery, Albéric’s condition improved for a while, but the more serious seizures returned, especially at night. The seizures are potentially dangerous when he’s working on the farm, especially if one comes when he’s on a tractor or a combine harvester. The family’s response to his situation is typically earthy. They are researching the use of a dog that could alert Albéric of an imminent seizure. And he
might undergo another surgery. Whatever the eventuality, “he’ll have to live with it,” says Catherine. “We’ll be always his parents. We will always be here for him. That’s no discussion.”

Sadly, the one part of his epilepsy that he cherished—the ecstatic seizures—ceased after his surgery. Even so, in the brief period when Albéric allowed himself to be studied, Picard’s intuition about the role of the insula in ecstatic seizures received strong support. Albéric’s descriptions corroborated those of Zachary Ernst. There is something about an ecstatic seizure that changes one’s self-awareness and relationship to the world. Picard wrote this in her case report about Albéric: “He felt a deepening awareness of the situation or conversation going on around him, a sudden clarity. It was as if he clearly understood everything, especially if he happened to be in the midst of a discussion with several people. He grasped it all simultaneously. Things suddenly seemed self-evident, almost predictable (yet without the feeling of knowing the future).”

Again, the strains of a mystical experience: the slowing of time; hyperawareness of one’s environment; and a sense of certainty that all that’s being perceived is as it should be. Another of Picard’s patients that I met in Geneva, a forty-one-year-old Spanish architect, had this to say about her episodes of ecstatic seizures: “You are just feeling energy and all your senses. You take in everything that is around; you get a fusion. You forget yourself.”

Picard acknowledged the seeming paradox here: the seizures made the person both extremely self-aware while simultaneously blurring the boundaries between one’s self and the world, the result of which, as Dostoevsky wrote, is to be “in perfect harmony with myself and the entire universe,” a sense of oneness with everything.

During our conversation in March 2013, Picard said she couldn’t
shake off the intuition that the insula is involved in these extraordinary experiences. “I am more and more convinced that there is something affecting the insula,” she said. “But I don’t have proof for any patient.” The only bits of evidence she had were the nuclear-imaging studies, but such studies are not precise enough to pinpoint the brain regions involved in the seizures. A seizure is a dynamic, rapidly evolving neural process, and the tracer can take up to thirty seconds to become “fixed” in the brain—enough of a lag to cause a blurry image; it’s as if you are trying to photograph a fast-moving car, but your camera’s shutter speed is too slow. Picard wanted something unambiguous.

She got news of one such study the very next day. I was in her office when she received an email from Fabrice Bartolomei, a neurologist at the Hôpital de la Timone in Marseille, France. Bartolomei’s surgical team had implanted electrodes deep inside the brain of a young woman suffering from ecstatic seizures. His email to Picard read, “We have explored the patient . . . The stimulations in the anterior insula trigger a pleasant sensation of floating and chills.”

Picard shot off a reply: “I’m so happy!”

The connection between ecstatic epilepsy and Bud Craig’s hypothesis of the insula as the seat of the sentient self had just become stronger.

“
I don’t believe the brain is a mystical place,” said Craig in a talk he gave in Sweden in October 2009. “When René Descartes came to Sweden three hundred years ago and taught that humans know that they exist because they think . . . he left our brains somewhere off in this metaphysical space, but they really belong in our bodies, because that’s
what we are. We are biological organisms and our bodies are what our brains are designed to take care of.”