The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human

3. Confabulation—The tendency to make things up to protect your self image: This is done unconsciously; there is no deliberate intention to deceive. “I can see my hand moving, Doctor. It’s an inch from your nose.”

4. Reaction formation—The tendency to assert the opposite of what you unconsciously know to be true about yourself, or, to paraphrase Hamlet, the tendency to protest too much. An example of this is closeted homosexuals engaging in vehement disapproval of same-sex marriages.

Another example: I remember pointing to a heavy table in a stroke clinic and asking a patient whose left arm was paralyzed, “Can you lift that table with your right hand?”

“Yes.”

“How high can you lift it?”

“By about an inch.”

“Can you lift the table with your left hand?”

“Yes, by two inches.”

Clearly “someone” in there knew she was paralyzed for, if not, why would she exaggerate the arm’s ability?

5. Projection—Ascribing your own deficiencies to another person. In the clinic: “The [paralyzed] arm belongs to my mother.” In ordinary life: “He is a racist.”

6. Intellectualization—Transforming an emotionally threatening fact into an intellectual problem, thereby deflecting attention from and blunting its emotional impact. Many a person with a terminally ill spouse or family member, unable to face the potential loss, starts treating the illness as a purely intellectual challenge. This could be regarded as a combination of denial and intellectualization, though the terminology is unimportant.

7. Repression—The tendency to block the retrieval of painful memories, which if dredged up would be “painful to the ego.” Although the word has made it into pop psychology, memory researchers have long been suspicious of repression. I lean toward thinking that the phenomenon is real, for I have seen many clear instances of it in my patients, providing what mathematicians call an “existence proof.”

For example, most patients recover from anosognosia after having been in denial for a few days. I had been seeing one such patient who insisted for nine days in a row that his paralyzed arm was “working fine,” even with repeated questioning. Then on the tenth day he recovered completely from his denial.

When I questioned him about his condition, he immediately stated, “My left arm is paralyzed.”

“How long has it been paralyzed?” I asked, surprised.

He replied, “Why, for the last several days that you have been seeing me.”

“What did you tell me when I asked about your arm yesterday?”

“I told you it was paralyzed, of course.”

Clearly he was “repressing” his denials!

Anosognosia is a striking illustration of what I have repeatedly stressed in this book—that “belief” is not a single thing. It has many layers that can be peeled away one at a time until the “true” self becomes nothing more than an airy abstraction. As the philosopher Daniel Dennett once said, the self is more akin conceptually to the “center of gravity” of a complicated object, its many vectors intersecting at a single imaginary point.

Thus anosognosia, far from being just another odd syndrome, gives us fresh insights into the human mind. Each time I see a patient with this disorder, I feel like I am looking at human nature through a magnifying glass. I can’t help thinking that if Freud had known about anosognosia, he would have taken great delight in studying it. He might ask, for example, what determines which particular defense you use; why use rationalization in some cases and outright denial for others? Does it depend entirely on the particular circumstances or on the patient’s personality? Would Charlie always use rationalization and Joe use denial?

Apart from explaining Freudian psychology in evolutionary terms, my model may also be relevant to bipolar disorder (manic-depressive illness). There is an analogy between the coping styles of the left and right hemispheres—manic or delusional for the left, anxious devil’s advocate for the right—and the mood swings of bipolar illness. If so, is it possible that such mood swings may actually result from alternation between the hemispheres? As my former teachers Dr. K. C. Nambiar and Jack Pettigrew have shown, even in normal individuals there may be some spontaneous “flipping” between the hemispheres and their corresponding cognitive styles. An extreme exaggeration of this oscillation may be regarded as “dysfunctional” or “bipolar illness” by psychiatrists even though I have known some patients who are willing to tolerate the bouts of depression in order to (for example) continue their brief euphoric communions with God.

OUT OF BODY EXPERIENCE: DOCTOR, I LEFT MY BODY BEHIND