The Man Who Wasn't There: Investigations into the Strange New Science of the Self Read Online Free Page A

otherwise might have. He became convinced he was brain dead.
    A more recent case study, published in November 2014, also supports this hypothesis. Two Indian doctors were treatinga sixty-five-year-old woman with dementia, when she began to show signs of classic Cotard’s. “Our patient presented to us with beliefs like ‘I think I am dead and what I am is not me,’ ‘I do not exist,’ ‘there is nothing in my brain, just vacuum,’ and ‘it is infectious and I’m infecting my close relatives and I am responsible for all their suffering,’” SayantanavaMitra of the Sarojini Naidu Medical College, Agra, India, wrote to me in an email.
    Mitra’s team scanned her and the MRI scan revealed that the frontotemporal brain regions had atrophied. They noted, in particular, that a deep-brain region called the insula was heavily damaged in both hemispheres. There’s growing evidence that the insula is responsible for the subjective perception of our body states, a crucial aspect of our conscious experience of selfhood. So, a damaged insula was likely hampering the woman’s sense of her own body, and her dementia made it difficult for her to correct false perceptions, leading to claims of being dead.
    The doctors started her on mild doses of antipsychotic and antidepressant medications. She recovered enough to take part in psychotherapy, with the therapist using her MRI scans as “evidence against her belief that her head was rotten,” Mitra said. The therapist was able to shake her out of her false beliefs. She was eventually discharged, and continues to get better on her medication.
    Graham, too, eventually recovered. Cotard’s syndrome is, thankfully, transient in most people, even though the treatment at times might involve electroconvulsive therapy.
    “I think Cotard’s delusion is a victory of metaphor over simile,” Zeman told me. “There are mornings when most of us get up and feel as if we are half-dead. So alterations of your experience which you might express using that kind of simile are not so uncommon. But the bizarre thing about Cotard’s is that people begin to treat this simile as if it were literally true. And for that to happen, there surely has to be some disturbance of reason.”

    The paucity of patients with Cotard’s syndrome means that the neural underpinnings of their delusions are yet to be fully understood, but it’s clear that Cotard’s syndrome is giving us a glimpse into the nature of the self.
    Take, for instance, something philosopher Shaun Gallagher callsthe immunity principle, an idea that goes back to Austrian philosopher Ludwig Wittgenstein. It refers to the fact that when we make a statement like “I think the Earth is flat,” we can be wrong about Earth’s flatness, but we cannot be wrong about the “I,” the subjective self that is making the assertion. When we use the pronoun “I,” the word refers to the one who is the subject of an experience, not someone else. I cannot be wrong about that. Or can I?
    Cotard’s delusion certainly gets philosophers thinking (if they need any further enticement), as do various other conditions, such as schizophrenia. In Cotard’s delusion, the firm belief that “I don’t exist” seemingly challenges the immunity principle. But even though the delusional person is wrong about the nature of his existence (which is analogous to Earth’s flatness), the immunity principle holds because there is still an “I” making the claim, and that “I” cannot refer to anyone else but the person experiencing nonexistence.
    What or who is that “I”? The question permeates this book. Whoever or whatever the “I,” it manifests itself as a subject of experiences.
    But how does the brain, with its physical, material processes, give rise to a seemingly immaterial, private mental life (at the core of which seems to be the “I,” the subjectivity)? This is the so-called hard problem of consciousness. Neuroscience doesn’t have an answer so