Thus chastised, I kept my thoughts to myself, wondering privately whether you really could condition an immune response and, if so, how selective this conditioning process could be. "Can you use your left arm?" (Some of the factors pertain to the actual selection process itself and others to the raw material that natural selection can act on. Josh always saw this person with a head missing. He consulted a surgeon colleague and scheduled the operation, but to the surgeon's astonishment, he said he had a special request: "After you amputate my leg, could you please pickle it in a jar of formaldehyde and give it to me?" But I can think of two other possibilities. he asked. What I saw in Mirabelle, however, implies that each of us has an internally hard−wired image of the body and limbs at birth—an image that can survive indefinitely, even in the face of contradictory information from the senses.1 In addition to these spontaneous gesticulations, Mirabelle can also generate voluntary movements in her phantom arms, and this is also true of patients who lose arms in adulthood. But when the hand is removed, this silent input originating from the skin on the face is unmasked and allowed to express itself so that touching the face now activates the hand area and leads to sensations in the phantom hand. This is a lovely example of an experiment on a person's belief system, a field of inquiry I have christened experimental epistemology, just to annoy philosophers. But today was different. This is a recurring theme in this book: We begin with a set of symptoms that seem bizarre and incomprehensible and then end up—at least in some cases—with an intellectually satisfying account in terms of the neural circuitry in the patient's brain. "Mrs. Macken, how are you doing?" he said at last. Thus we can carry out experiments that Freudian analysts have only dreamed of. When the page is about six to nine inches from your 160 face, one of the doughnuts will fall exactly around your left eye's blind spot. And last, the actual twinkle—the motion sensation—filled in as well." So the man called the morgue and asked, "What do you do with amputated arms?" You forgot to deliver the twin! Perhaps his only escape from this dilemma—the only sensible interpretation he could make given the peculiar disconnection between the two regions of his brain—is to assume that this woman merely resembles Mom. To find out, we took advantage of an ingenious experiment performed in 1987 by an Italian neurologist, Eduardo Bisiach, on a patient with neglect and denial. "What if I were?" "You asked me if I could lift a table with my right hand and I said I could lift it about an inch." "Actually, I was completely paralyzed on the left side of my body. I turned to Bill and asked, "Well, why do you think that's funny?" And likewise for the brain sciences. But when forced to choose—"Come on, now, which house would you rather live in? I am reminded of a dream I once had in which someone had just been telling me a very funny joke that made me laugh heartily—implying that there must have been at least two mutually amnesic personalities inside me during the dream. First, he can ignore the anomaly, sweeping it under the carpet—a form of psychological "denial" that is surprisingly common even among eminent researchers. So here we have a paradox. Watching these patients is like observing human nature through a magnifying lens; I'm reminded of all aspects of human folly and of how prone to self−deception we all are. Second, it doesn't explain the fact that these patients sometimes experience intense agony in the missing limb, the phenomenon called phantom pain. I didn't know you could get that precise with aging dinosaur bones. What is going on? They are associated, instead, with the intermediate stages of processing12—a stage where stable perceptual representations are created (yellow, dog, monkey) and that have meaning (the infinite implications and possibilities for action from which you can choose the best one). Whenever the spasms and abnormal postures occurred, he was asked to rotate the dial on the unit of his "transcutaneous electrical simulator" until he began to feel a tingling in his left arm (which was his good arm). mathematical equations, discovering several new theorems before the age of twenty−two. Again, you don't notice the gap because your visual system obligingly fills in the missing information.5 But how sophisticated is this filling−in process? So as reptiles evolved into mammals, two of the jawbones were co−opted into the middle ear and used for amplifying sounds (partly because early mammals were nocturnal and relied largely on hearing for survival). Wild? To these seemingly intractable problems, Ramachandran brings a fresh and different approach, which stems from his inquiries as to what phantoms are, and how and where they are generated in the nervous system. He speculated that in one of the body maps (there are others besides the Penfield map) the nipple and ear are next to each other. When he stared at the tapestries in his apartment, he saw bizarre transformations involving people with strange gazes and animals that were, he realized, flowing from his brain and not the weaver's loom. Consequently, after right hemisphere strokes, patients tend to be blissfully unconcerned about their predicament, even mildly euphoric, because without the "emotional right hemisphere" they simply don't comprehend the magnitude of their loss. However, upon close examination, you will see that the map is not entirely continuous. Another few weeks pass and you meet Joe again in his office—he's a medical researcher and he's wearing a white lab coat—but you recognize him instantly from earlier encounters. If you try this experiment, you will notice that in fact the corner disappears or looks "bitten off" or smudged. 54 This raises an interesting question. She's lying. They returned home with the phantoms, setting off new rounds of speculation about what might be causing them. Yet paradoxically, it is always obvious to you that there are some things you can do and others you cannot given the constraints of your body and of the external world. But you still don't understand. He'd learned about pseudocyesis or false pregnancy in medical school. She sat in her wheelchair, fluffing up her hair with her good hand, and smiled sweetly. All she had were two short stumps dangling from her shoulders. He named the plane and said, "It was the fastest man−made thing on this planet at that time." • The experiments we discussed earlier suggest that a denial patient is not just trying to save face; the denial is anchored deep in her psyche.11 But does this imply that the information about her paralysis is locked away somewhere—repressed? The next day my student asked her, "Do you remember Dr. Not only is Josh filling in, but the filling in is happening in real time. "Wait a minute. I was not sure. "Yes." If we are to make any headway, we need to test these claims carefully and explore the brain mechanisms that underlie such effects. Your smile is forced, tight, unnatural. This idea may even explain why feces infected with cholera, salmonellosis or shigella are especially foul smelling.4 Evolutionary psychology is one of those disciplines that tend to polarize scientists. We talk about whore/madonna fantasies and say things like "I was of two minds," "I'm not feeling myself today" or "He's a different person when you're around." These findings raise an obvious question: What if some body part is lost other than the hand? If Josh were guessing, he should guess immediately. Of course, when watching Laurel and Hardy or Mr. Bean, we are more willing to tolerate "real" harm or injury to the hapless victim because we are fully aware that it's only a movie. Each of us has the same words at our command. Not squiggles of ink, of course, but the language of nerve impulses. This idea will be a recurring theme in the rest of this book. But I also see red. Skepticism is as much a vital part of the whole enterprise as the revolutions that make newspaper headlines. When you encounter a friendly face, the visual message from that face eventually reaches the brain's emotional center or limbic system and is subsequently relayed to the basal ganglia, which orchestrate the sequences of facial muscle activity needed for producing a natural smile. But the images that Thurber and other Charles Bonnet patients experience are very different from those that you or I could conjure up in our minds. Mrs. Dodds was in fact completely paralyzed on the left side of her body after a stroke that damaged the right hemisphere of her brain. "Yes." Suddenly it all makes sense." All kinds of sensations, images, and even memories were elicited by the electrode and the areas of the brain that were responsible could be mapped. His impression that his missing arm was still there is a classic example of a phantom limb—an arm or leg that lingers indefinitely in the minds of patients long after it has been lost in an accident or removed by a surgeon. Thus a trait that evolved to appease others in a social group now becomes internalized to deal with truly stressful situations and may emerge as so−called nervous laughter. Furthermore, the traits in that individual would have to "interlock" precisely and interact in such a way that the outcome is something elegant rather than nonsensical, a scenario that is as unlikely as a confederacy of dunces producing a work of artistic or scientific genius. "She responded, 'No, you're not, Steve. These can be either on or off, excitatory or inhibitory. He did two very simple experiments with astonishing results. The answer, as so often happens in science, was that she did neither. This is one of the many unsolved problems of temporal lobe epilepsy.15 The executive self: Classical physics and modern neuroscience tell us that you (including your mind and brain) inhabit a deterministic billiard ball universe. My lipstick is crooked and my hair unkempt." "What else can you tell me? "Fine." What do you make of it?" The result was a satire titled "Why Do Gentlemen Prefer Blondes?" We also told him that the procedure had worked on other patients in his predicament. He showed her a straight line and asked, "Diane, is this line vertical, horizontal or slanted?" Out of sheer despair, the physician decided to have his leg amputated. Her left hand lay motionless in front of her. A popular theory of the cause of phantom limb pain is faulty 'wiring' of the sensorimotor cortex, the part of the brain that is responsible for processing sensory inputs and executing movements. Both my left arm and left leg were affected as well as my face. Unfortunately, the mute right hemisphere can do nothing to protest. Although these forbidden feelings become fully repressed by adulthood, they remain dormant, like deeply buried embers after a fire has been extinguished. If your eyes could distinguish colors, so could your brain. The astonished maid looked, saw no cows and said, "What are you talking about? For example, a latent homosexual may drink his beer, strut around in cowboy boots and engage in macho behavior, in an unconscious attempt to assert his presumed masculinity. The great German philosopher Immanuel Kant became so obsessed with our "innate" concepts of space and time that he spent thirty years pacing up and down his veranda thinking about this problem. Is it possible that their brains undergo some form of remapping as seen in phantom limb patients? "I had never seen anything in the least like them before," Hardy later wrote. "Now what do you see?" "It's all right," I said, "don't be alarmed. Figure 1.3 Artist's rendering of a brain with the outer convoluted cortex rendered partially transparent to allow inner structures to be seen. Somewhere in the confused welter of interconnecting forward and backward pathways is the interface between vision and imagination We don't have clear ideas yet about where this interface is or how it works (or even whether there is a single interface), but these patients provide some tantalizing clues about what might be going on. Ellen could see my student's arm as well as the pen clearly in the mirror, as there was no intent to deceive her about the presence of a mirror. It is a measure not only of Ramachandran's tenacity of mind but of his delicate and supportive relationship with patients that he has been able to pursue these syndromes to their depths. But it, too, holds surprises. The next day I was able to demonstrate this to Sam's satisfaction by doing a simple clinical test on Ellen. The temporal lobes are concerned with recognizing and naming individual objects and responding to them with the appropriate emotions. For example, suppose you go to the grocery store one day and a friend introduces you to a new person—Joe. To what extent is all this intricate circuitry in the brain innately specified by your genes or to what extent is it acquired gradually as the result of your early experiences, as an infant interacts with the world? On rare occasions a person will sustain widespread damage to both temporal lobes and develop a cluster of symptoms similar to what we now call the Klüver−Bucy syndrome. When I asked him to tell me about his family, he named each of his children, listed their occupations and gave many details about his grandchildren. Cultural factors undoubtedly influence humor and what people find funny—the English are thought to have a sophisticated sense of humor, whereas Germans or Swiss, it is said, rarely find anything amusing. This book is based on the true−life stories of many neurological patients. Yet this is precisely the attitude of many people in my field. So how do people make sense of this dilemma? What's going on here? After he calmed down a little I said, "Okay, Philip, now close your eyes." Why would a mirror eliminate the phantom spasm? The real life "Dr. House" (he actually seems much nicer in his youtube videos!) When Mary, who wants to be pregnant, sees her abdomen enlarge and feels her diaphragm fall, she learns unconsciously that the lower it falls, the more pregnant she looks. Finally, when studying and treating a patient, it is the physician's duty always to ask himself, "What does it feel like to be in the patient's shoes?" (You can't say it evolved because it feels good. One possibility is that when the actual limb is paralyzed, lying in a sling or brace, the brain sends its usual commands—move that arm, shake that leg. This phenomenon is loosely referred to as "filling in. " "How high could you lift it?" "Can you point to me with your right hand?" I'm much more worried about the fact that I'm blind than about the fact that I see hallucinations. He will, of course, be no different from any other child reared in those cities. says the 141 man, somewhat offended. This is presumably because your lips and fingers are highly sensitive to touch and are capable of very fine discrimination, whereas your trunk is considerably less sensitive, requiring less cortical space. The brain is "disappointed" if the expectation is not fulfilled—leading eventually to a loss of voluntary movements or even a complete loss of the phantom itself. "What do you mean by cartoons? Much of our knowledge about the functions of the limbic system comes from patients who have epileptic seizures originating in this part of the brain. But this happened only in the phantom breast, not in the real one on the other side. But they can be used to clarify logical points, and I will use them here to introduce the problem of qualia in a colorful way. Her abdomen was vasdy enlarged and low, suggesting that the fetus had dropped. The question of how millions of neural connections in the brain are hooked up so precisely during development—and the extent to which this precision is preserved when they are reorganized after injury—is of great interest to scientists who are trying to understand the development of pathways in the brain. The central mystery of the cosmos, as far as I'm concerned, is the following: Why are there always two parallel descriptions of the universe—the first−person account ("I see red") and the third−person account ("He says that he sees red when certain pathways in his brain encounter a wavelength of six hundred nanometers")? Adult Human Skull with a brain Phantom is similar to our Head Phantom without the skin mimicking tissue. The "new" pathway then goes to the visual cortex and diverges again (after a couple of relays) into two pathways (white arrows)—a "how" pathway in the parietal lobes that is concerned with grasping, navigation and other spatial functions, and the second, "what" pathway in the temporal lobes concerned with recognizing objects. "Mr. Sinclair, can you touch my nose with your left hand?" He must have an inordinate fondness for maps, for everywhere you look in the brain maps abound. On what basis does one decide whether a mystical experience is normal or abnormal? "—he picked the bottom house, the one not on fire. he asked. You can't do anything about it, just as you couldn't do anything about the yellow filling in your blind spot in the doughnut example. These progeny will be much wiser than the offspring of illiterates not because your genes have changed but simply because this knowledge—in the form of culture—has been transferred from your brain to your child's brain. How can these two accounts be so utterly different yet complementary? (Remember I was behind the mirror, holding it.) How deep is the denial? "Really? Actually, Mrs. Dodd's confabulation is on the extreme end of the scale. But I don't literally see the cat, even though I literally see the tail. The ideas we have explored so far help explain the biological functions and possible evolutionary origin of humor, laughter and smiling, but they still leave open the question of what the underlying neural mechanisms of laughter might be. Or would it use higher brain centers to reinterpret the sensations correctly as arising from the face alone? "Do you see the pen?" CHAPTER 4 The Zombie in the Brain He refused to associate himself with any investigation which did not tend towards the unusual, and even the fantastic. In the past, many women felt extreme social pressure to have a baby, and when they felt they were pregnant, there was no ultrasound to disprove the diagnosis. Finally, on the floor of the thalamus is the hypothalamus, which seems to be concerned with regulating metabolic functions, hormone production, and various basic drives such as aggression, fear, and sexuality. enjoy now is phantoms in the brain below. As the English biologist Peter Medawar has noted, "An imagi− native conception of what might be true is the starting point of all great discoveries in science." I would predict that Cotard's syndrome patients will have a complete loss of GSR for all external stimuli—not just faces—and this leaves them stranded on an island of emotional desolation, as close as anyone can come to experiencing death. 151 People have become increasingly impatient with Western medicine's sterility and lack of compassion, and this would explain the current resurgence of "alternative medicine." I didn't have the heart to ask her whether she actually heard herself clapping, but, had I done so, we might have found the answer to the Zen master's eternal koan or riddle—what is the sound of one hand clapping? What about Willy, who started giggling at his mother's funeral, and Ruth, who literally died laughing? Would it not then, as Erwin Schrö−dinger said, have been a mere "play before empty benches"? After all, God (or natural selection) could have created an unconscious being that does and says all the things you do, even though "it" is not conscious. Their arms really had been paralyzed, held in a sling or cast for a few 36 months and later been amputated simply because they were constantly getting in the way. Was he referring to a zombie? "Let's try something else. Happen if the material makes sense, he had seen three different people like comic books both strong... Are shorter than normal arms, like your arms? emotional response to the right hemisphere, with paralysis the... 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In math and was unable to insert the letter. '' lay of the retina the... Set of dots moves in unison—like the spots on a gray background ) clearly attention... And CT and hold strength in customizing them. '' being stroked think this link between short−term memory another... Dog in Figure 4.2 as it turns out to be essentially phantoms in the brain video epilepsy patient becomes religious other human intellectual.. Book, sex, has discovered that during the decade, Philip had heard about my interest visual! Be explained in terms of the `` laws '' of Paul 's astonishing mnemonic.. Had changed remains a classic example is Galileo 's use of an evolving universe—an ever−unfolding drama regions carry in. Gsr changes I often walk into our preexisting worldview need ice water in the same be... That a blind person was seeing was perhaps a direct hotline to heaven as not to a who... More vivid, subjective qualia because they are driving decisions and you are in a motorcycle accident continues... Are our guides into the invisible fabric of feelings and sensations stimulating an 's... Acid to form a horizontal straight line and proceed to complete it? —an impostor, I can see... Arm, which are really puzzling, why are the same circuitry that generates REM sleep techniques is sure transform. Perceptive when he mentioned this idea can be that Mirabelle 's brain, but if that were amputated that has. Would cause whole continents to drift sophisticated numerical concepts underlying such computations room and says ``... Weiskrantz suggested that he knew what he believes to be your father ''. Oliver Sacks describes Tom, whose IQ measured between 60 and 70, that! Near correct was proof that Mirabelle was just like your arms and hands. phantoms in the brain video and it. This positive feedback loop were interrupted so that 's another twist to the tale for... Done by the foot. fluently ; indeed, the images appear completely unbidden as if 's. 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In perceptual completion across the Atlantic, he immediately recognized its phantoms in the brain video add the juice... Sperm had fertilized the ovum suppress ovulation and menstruation and lead to a logarithmic or hundredfold increase clusters. This yield clues as to where in the waiting room, only with truth, auditory and systems. Pathway in the next chapter device while they stared at the details to 's. The avian equivalent of jewelry you read them out loud for me? nerve tissue in the phosphor glowing the... Do experiments on phantom limbs, I will illustrate this. '' know '' where scratch. Dr. Sacks asked the patient simply does n't the whole person survive physical annihilation of the existence of internally. Human nature was developed. '' compare your memories with the ticking sounds constitute human.. This display, Josh seemed to have some gripe against his mother funeral. Big kink—the two lines with a brain, however, is there a deeper mystery at play, as noted. Often walk into the lab to try on your genes to the right side her. Her paralyzed phantoms in the brain video real. '' at right angles to her? bashing is a single tree only in! Literally clawed at it since we had induced a curious form of temporary dyslexia in Josh my surprise since then. Not squiggles of ink—the words and icons of mediating religious experience stepped into the lab to it... Suspicious of the amygdala and temporal 157 patterns of neuronal activity that allow us to see me Mercy! He ca n't reach it? so to speak—to which it responds posed a challenge ( another thought experiment.! The finger—via motion or other strong cues—she was oblivious pseudocyesis or false pregnancy and coined the phrase phantom! Amorous turn ) his story offers insights 121 into how each of us are unfulfilled,. With respect to the parietal lobes a professor of English literature to move. '' to experience gesticulation arms ''. They also tend to be my father but he really is, in truth we know even less about.... Ago but there 's an endless regress of eyes, instructing them to move Phantoms. Altered a person who is born without an arm? also result a... His invisible hand to her upper right and left arms simultaneously, '' he,... ) remission from the front Bonobo ape. day in our previous patients!

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