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

6. The idea of a hardwired genetic scaffolding for one’s body image was also brought home to me vividly when Paul McGeoch and I recently saw a fifty-five-year-old woman with a phantom hand. She had been born with a birth defect called phocomelia; most of her right arm had been missing since birth except for a hand dangling from her shoulder with only two fingers and a tiny thumb. When she was twenty-one, she was in a car crash that entailed amputation of the crushed hand, but much to her surprise she experienced a phantom hand with four fingers instead of two! It was as if her entire hand was hardwired and lying dormant in her brain, being suppressed and refashioned by the abnormal proprioception (joint and muscle sense) and visual image of her deformed hand. Until the age of twenty-one, when removal of the deformed hand allowed her dormant hardwired hand to reemerge into consciousness as a phantom. The thumb did not come back initially, but when she used the mirror box (at age fifty-five) her thumb was resurrected as well.

     In 1998, in a paper published in Brain, I reported that by using visual feedback with mirrors positioned in the right manner, one could make the phantom hand adopt anatomically impossible positions (such as fingers bending backward)—despite the fact that the brain had never previously computed or experienced that before. The observation has since then been confirmed by others.

     Findings such as these emphasize the complexity of interactions between nature and nurture in constructing body image.

7. We don’t know where the discrepancy between S2 and the SPL is picked up, but my intuition is that the right insula is involved, given the GSR increase. (The insula is partly involved in generating the GSR signal.) Consistent with this, the insula is also involved in nausea and vomiting due to discrepancies between the vestibular and visual senses (which familiarly produces seasickness, for example).

8. Intriguingly, even some otherwise normal men report having mainly phantom erections rather than real ones, as my colleague Stuart Anstis pointed out to me.

9. This “adopting an objective view” toward oneself is also an essential requirement for discovering and correcting one’s own Freudian defenses, which is partially achieved through psychoanalysis. The defenses are ordinarily unconscious; the concept of “conscious defenses” is an oxymoron. The therapist’s goal, then, is to bring the defenses to the surface of your consciousness so you can deal with them (just as an obese person needs to analyze the source of his obesity to take corrective measures). One wonders whether adopting a conceptual allocentric stance (in plain English: encouraging the patient to adopt a realistic detached view of herself and her follies) for psychoanalysis could be aided by encouraging the patient to adopt a perceptual allocentric stance (such as pretending she is someone else watching her own lecture). This in turn could, in theory, be facilitated by ketamine anesthesia. Ketamine generates out-of-body experiences, making you see yourself from outside.

     Or perhaps we could mimic the effects of ketamine by using mirrors and video cameras, which can also produce out-of-body experiences. It seems ludicrous to suggest the use of optical tricks for psychoanalysis, but believe me, I have seen stranger things in my career in neurology. (For example, Elizabeth Seckel and I used a combination of multiple reflections, delayed video feedback, and makeup to create a temporary out-of-body experience in a patient with fibromyalgia, a mysterious chronic pain disorder that affects the entire body. The patient reported a substantial reduction in pain during the experience. As for all pain disorders, this requires placebo-controlled evaluation.)

     Returning to psychoanalysis: surely, removing psychological defenses raises a dilemma for the analyst; it’s a double-edged sword. If defenses are normally an adaptive response by the organism (mainly by the left hemisphere) to avoid destabilization of behavior, wouldn’t laying bare these defenses be maladaptive, disturbing one’s sense of an internally consistent self along with your inner peace? The way out of this dilemma is to realize that mental illness and neuroses arise from a misapplication of defenses—no biological system is perfect. Such a misapplication would, if anything, lead to additional chaos rather than restoring coherence.