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Book Forum: Mind and Brain   |    
Phantoms in the Brain: Probing the Mysteries of the Human Mind
Am J Psychiatry 2000;157:841-842. doi:10.1176/appi.ajp.157.5.841
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By V.S. Ramachandran, M.D., Ph.D., and Sandra Blakeslee. New York, William Morrow, 1998, 328 pp., $27.00.

In the preface, Ramachandran defends his writing this popular science book by citing the popular tradition of Galileo, Huxley, Faraday, Sagan, Sacks, and Pinker. Even in that company, this book does not disappoint. Ramachandran further argues that most of the discoveries of neurology that have withstood the test of time were based on single case studies. So listen up, especially you editors.

In the chapter "Chasing the Phantom," the authors present Ramachandran’s astonishingly creative experiments with patients who experience phantom limb phenomena. Armed with a genius for unaided visual observation and inductive reasoning in an era of fine pixel (voxel) resolution and gross computer subtractions, Ramachandran has been able to make significant contributions to the understanding of how the brain represents the body self. He has shown that the body image is a malleable internal construct and that perception extracts statistical correlations to create a temporarily useful model (p. 59).

With simple tricks, Ramachandran suggests that body image is not anchored (or "loyal") to one’s own body and can even involve inanimate objects. Ramachandran feels that this "may give us a handle on elusive psychological phenomena such as the empathy and love that you feel for a child or a spouse" (p. 61). The body image is "merely a shell that you’ve temporarily created for successfully passing on your genes to your offspring" (p. 62). The implications of this are far-reaching for psychoanalysis. The rapidly fluctuating representations of the body are no less than a neurology of object relations.

Along the way, Ramachandran accounts for many phenomena, such as foot fetishism, by sensory homuncular propinquity. He draws on his wide neuropsychiatric experience to find illustrations; for example, a woman with phocomelia who "experienced phantom hands six inches below her stumps frequently used her phantom fingers to calculate and solve arithmetic problems" (p. 57). Ramachandran concludes that in this case there was "no learned dependence on sensory feedback" (p. 57) that would lead to the usual loss of movement in phantom limbs following amputation.

In "The Zombie in the Brain," Ramachandran approaches the so-called binding problem of a unified perception of (in his example) a ball—whether there is "some later place in the brain where all this information is put together"—as involving "logically flawed assumptions about the visual process" (pp. 80–81). In sports, we "release [the] zombie" (p. 83) of our "how" pathway. In contrast, a patient with Balint’s syndrome from bilateral parietal damage (p. 80), with only the "what" pathway intact, focuses on and recognizes only the small object that is in her foveal vision. A patient with dissociation between her what and how pathways (p. 79) can interact with the world spatially but is "unaware of the shapes, locations and sizes of most objects around her" (p. 79), and Kluver-Bucy animals and patients, who lack bilateral temporal lobe function, are indiscriminate about objects yet move about without bumping into walls (p. 78). Because there are a "multitude [of zombies] inhabiting your brain" (p. 84), it follows that "your concept of a single ‘I’ or ‘self’ inhabiting your brain may be simply an illusion—albeit one that allows you to organize your life more efficiently, gives you a sense of purpose and helps you interact with others" (p. 84). The authors state that this will be a recurring theme in the book. The choice of the term "zombie" for these very lively agencies is infelicitous.

In "The Secret Life of James Thurber," whose blindness led to Charles Bonnet syndrome—"[super]vivid visual hallucinations to ‘replace’ the reality that is missing from their lives" (p. 87)—the syndrome helps us understand how we neuromentally "see" things: how vision fills in gaps to make a seamless world and why so many of us "see" unidentified flying objects and angels. The startling conclusion is that we hallucinate all the time and that what we call perception is matching "which hallucination best conforms to the current sensory input" (p. 112), unless, as in Charles Bonnet syndrome, the lack of confirming visual stimulation allows the brain "to make up its own reality" with "apparently no limit to its creativity" (p. 112).

The chapter "Through the Looking Glass" returns to the how pathway in the parietal lobe and the what pathway in the temporal lobe to examine hemineglect. It is caused by right parietal injuries only because, after Mesulam, Ramachandran sees the right hemisphere as a broad "searchlight" of attention that encompasses both right and left visual fields in entirety (p. 117), whereas the left hemisphere, busy with language, has a smaller searchlight for the right side of the world only. Left damage can be compensated for by the right, but right damage leaves loss and neglect on the left side of the body and the world (p. 117). Clever arguments show that there is unconscious perception on the left side (p. 118). Using a mirror on the patient’s right side, Ramachandran demonstrates what he terms "mirror agnosia, or the looking glass syndrome" (p. 124): the patient believes objects reflected in the mirror from the neglected side are real and inside the mirror. This may be a new test for right parietal lesions. The knowledge base of these patients becomes "twisted to accommodate the strange new world they inhabit," raising "philosophical questions about how sure we can be that our own grasp on reality is all that secure" (p. 126). It is also like a Freudian defense mechanism (p. viii).

"The Sound of One Hand Clapping" tackles anosognosia and contrasts the Freudian view that the denial is a defense with the neurological view that the denial is a direct consequence of the neglect syndrome. Ramachandran confesses that when he began this research 5 years ago he had no interest in Freud but thinks now that "even though Freud wrote a great deal of nonsense, there is no denying that he was a genius" (p. 152). He runs down a list of Freudian defenses (pp. 153–155), identifying them with the neurological phenomena of anosognosia. Ramachandran’s astonishing and widely reported experiments countering the denial of patients with this disorder are recounted. He caused a vestibular disruption by squirting ice water in the left ear canal. Typical of Ramachandran’s imaginative extrapolations is his suggestion to irrigate the ear canals of patients with anorexia.

"The Unbearable Likeness of Being" considers the misidentification syndromes like Capgras syndrome, in which there is no loss of recognition of faces or of the ability to experience emotion but there is an inability to link the two. Cotard’s syndrome is construed as an exaggerated form of Capgras syndrome. There is an inability to assess the direction of gaze as well in Capgras (p. 168). In Fregoli syndrome (p. 171), the patient keeps seeing the same person everywhere, and it is attributed to excess connections from face recognitions to the amygdala. I have proposed Fregoli as a model for transference phenomena and have found that misidentification syndromes in general dissect object relations (1), but Ramachandran and Blakeslee here propose that a similar confusion in normal brains may be the basis of racist stereotypes.

In "God and the Limbic System," the authors lead us from transcranial magnetic stimulation of small brain regions, which has produced visual experiences in the blind and orgiastic pleasure, to a discussion of the legitimacy of the religious experiences produced by temporal lobe stimulation or limbic seizures in what they call "the God module" (p. 175) in our heads. Four possibilities are considered: 1) God visits these people, which is untestable; 2) the emotions stimulated are so inexplicable that religion is sought for their explanation; 3) the "salience" (p. 182) pathways are kindled between the visual and auditory sensory centers and the emotion-recognizing amygdala; and 4) humans have actually evolved specialized neural circuitry for the sole purpose of mediating religious experience (p. 183). Admitting that this is the "twilight zone of neurology" (p. 188), the authors discuss Alfred Russell Wallace’s ideas about the problems for evolution theory posed by potential intelligence, such as latent math ability in an aboriginal tribesman. Ideas of "general intelligence" (p. 192) founder on the specialized talents of savants and the fact that 10% of autistic children, compared with 1%–2% of the general population, have perfect pitch. It seems that the left angular gyrus is good at math and the right angular gyrus is good at art.

In "The Woman Who Died Laughing," the authors reject Freud’s escape valve idea and discuss laughter as a contagious social false alarm signal. A neurological substrate for laughter is the pain asymbolia that arises from insular cortical damage, disconnecting it from the cingulate gyrus (p. 208).

"You Forgot to Deliver the Twin" examines the physical basis of pseudocyesis and concludes that the indivisibility of mind and body "preached by physicians like Deepak Chopra and Andrew Weil is not just New Age psychobabble" (p. 221).

Finally, "Do Martians See Red?" argues, in harmony with Ramachandran’s own Hindu rearing, that the idea of a self inhabiting the brain and loftily inspecting the world is an illusion. We create our own reality from fragments; we see a reliable but inaccurate representation of the world; and we are unaware of most of our actions carried out by a host of unconscious zombies in harmony with the self, which, far from the insurmountable metaphysical riddle of philosophers, is now "ripe for scientific inquiry" (p. 228). For example, the irrevocability of qualia, or subjective sensations, present in the what but not in the how system, lends stability to our input system, even in our blind spots, whereas we have flexibility in our output of choices and in our time-delayed memory system, which is involved at an intermediate level in making choices. The temporal lobes play a central role in consciousness and awareness. In conclusion, Ramachandran and William Hirstein compile and elaborate a list of characteristics of the self: embodied, passionate, executive, mnemonic, unified, vigilant, conceptual, and social. Clearly, the self is also now neuropsychiatrically self-studying.

Many psychiatrists may share Silvano Arieti’s prejudice against most academic philosophy (2) because of its aridity, uselessness, and lack of empirical grounding. They will find that this book spares much effort spent on the supposedly unanswerable imponderables of that discipline by simply offering answers based on cases.

Forrest DV: Mind, brain and machine: object recognition. J Am Acad Psychoanal  1991; 19:555–576
Arieti S: Philosophy and general system theory, in Creativity: The Magic Synthesis. New York, Basic Books, 1976, pp 283–290


Forrest DV: Mind, brain and machine: object recognition. J Am Acad Psychoanal  1991; 19:555–576
Arieti S: Philosophy and general system theory, in Creativity: The Magic Synthesis. New York, Basic Books, 1976, pp 283–290

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