Altered Egos: How the Brain Creates the Self

216 Pages·2001·7.58 MB·English

by  Todd E. Feinberg

Altered Egos
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Altered Egos
How the Brain Creates the Self
Todd E. Feinberg, M.D.
OXFORD
UNIVERSITY PRESS
OXFORD
UNIVERSITY PRESS
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Copyright © 2001 Oxford University Press, Inc.
First published by Oxford University Press, Inc., 2001
198 Madison Avenue, New York, NY 10016
First issued as an Oxford University Press paperback, 2002
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Feinberg, Todd E.
Altered Egos: how the brain creates the self/Todd E. Feinberg
p. cm.
Includes bibliographic references and index.
ISBN 0-19-513625-X (cloth); ISBN 0-19-515242-5 (pbk)
1. Neuropsychology. 2. Brain. 3. Self.
I. Title.
[DNLM: 1. Brain-physiology. 2. Ego. WL 103.5 F299a 2001]
QP360 .F45 2000 612.8'2-dc2.1 99-086181
987654321
Printed in the United States of America
on acid-free paper
Contents
Acknowledgments vii
Chapter 1
Introduction: Soul Searching 1
Dissecting the Self 1 The Patients 1 John 2
The Perplexing "Inner I" 4
Chapter 2
Deconstructing the Self 8
Asomatognosia 8
Mima 8 Sonya 14
Personification of the
Limb 15 Shirley 18
Anosognosia 21 Jack 21
Chapter 3
Patsy 24 Daryl 26
Missing Pieces; Familiar Places 30
Explaining
The Margins of the Ego 30 Capgras
Asomatognosia 27
Syndrome 32 Emma 34 Louise 35
Lizzy 28
Oliver 37 Marianne 38 The Family
Romance 38 Fregoli Syndrome 41
Fannie 43 Bart 44 JP 44
Environmental Reduplication 47
The Capgras-Fregoli Dichotomy 49
Disorders of Personal Relatedness
and the Anatomy of the Self 51
Chapter 4
Mything Persons 55
What Is Confabulation? 55 Linda 56 Personal Confabulation 58
Sick Willie 59 Sam 60 Linda 63 Walter 65 Explaining Personal
Confabulation 67 Personal Confabulation and the Anatomy
of the Self 68
Chapter 5
Auto-Bodies 72
Minor Misidentification 72
Susan 73 Rosamond 75
The Self as Known and
Knower 78 Double
Indemnity 80 Autoscopia 80
The Vision of the Self and the
Soul 83 Imaginary
Companions and Guardian
Angels 84 Florence 88
V
Contents
Chapter 6
Keeping It All Together 90
Splitting the Brain 90 The Alien Hand Syndrome 93
Stevie 95 The Self Finds a Way to Remain Whole 99
Sonia 103 Seymour 104
Chapter 7
Journey to the Center
of the Mind 106
How Does A Distributed
Brain Create a Unified
Self? 106 Descartes'
Dilemma 107 Sherrington
Ponders the Mind's Eye 109
Chapter 8
Mental Unity and the Visual
The Nested Hierarchy of
System 112 The Cartesian
the Self and Mind 121
Theater and the Binding
Emergence and the
Problem 114 The Ghost in
Brain 121 Roger Sperry
the Machine 117
Argues for the Emergence
of an Immaterial Mind 125
Non-Nested and Nested
Hierarchies 127 The
Nested Hierarchy of the
Brain 129 Meaning and
the "Inner I" 131 Purpose
Is the "Ghost in the
Machine" 132
Chapter 9
Being and Brain 139
The Subjective and Objective Points of
View 139 The Neurological Basis of
Meaning 141 Meaning, Qualia, and the
Mind-Body Problem 144 The Brain Is
Not About Itself 147
Chapter 10
The Living Mind 149
The What, Where, and How of the Self 149
Beings and Brains 150
Notes 153
Glossary 167
Bibliography 179
Index 193
vi
I Acknowledgments
I first wish to thank my patients and their families who have agreed to
be interviewed on medical rounds, videotaped for lectures, or have par-
ticipated in research protocols. As a physician who is involved in research
and teaching, I frequently ask patients to take part in these activities. The
majority agree in the hope that their participation will help somebody
else in the future.
In preparing this book, Jim Morgan helped edit early versions of parts
of the manuscript. My colleague Elizabeth Ochoa reviewed the entire
manuscript and made numerous and invaluable suggestions regarding
the organization and presentation of the material. I am in her debt. My
editor at Oxford University Press, Fiona Stevens, believed from the start
that I could write this book. Always just an e-mail away, Fiona has been
a friend, supporter, and master editor throughout and this book is far
better thanks to her efforts. Thanks as well to the other wonderful peo-
ple at Oxford who helped make this book a reality, including Edith Barry
for editorial assistance, Rosemary Wellner for expert copyediting, and
Helen Mules, Trade Production Editor. My appreciation also goes to
Lynn Cooper for her illustrations, and Norma Kaman and Allaya
Jitsomwung for help with manuscript preparation. Permission to quote
from Vladimir Nabokov's Despair was kindly provided by Vintage
Books, a Division of Random House, Inc. Thanks to Tom Roberts for his
help in obtaining permissions to quote from the Talking Heads' song,
ONCE IN A LIFETIME, by David Byrne, Chris Frantz, Jerry Harrison,
Tina Weymouth and Brian Eno © 1981 Index Music, Inc. (ASCAP) Bleu
Disque Music Co., Inc. (ASCAP) & E.G. Music Ltd. (PRS) All Rights
o/b/o Index Music, Inc. & Bleu Disque Music Co., Inc. administered by
WB Music Corp. (ASCAP) All Rights Reserved. Used by Permission
WARNER BROS. PUBLICATIONS U.S. INC., Miami, FL. 33014.
I have been enriched through discussions with many colleagues and
collaborators over the years. First thanks are owed to the late Dr. Edwin
Weinstein. I corresponded with Dr. Weinstein over many years about
interesting neurological patients whom I had examined, and his insights
never failed to illuminate the underlying dynamic of these cases. Dr.
Weinstein was a great man and the influence of his ideas can be seen
vii
Acknowledgments
throughout. I also wish to thank David Roane, my collaborater on some
of the research discussed in this book; Joe Giacino, for lively debates on
the nature of anosognosia and for sharing important clinical material
with me; and Richard Rosenthal for insightful discussions. Martha Farah,
a dear friend and colleague, is a constant source of support and inspira-
tion, and Larry Miller encouraged and advised.
I wish to express my gratitude to my many friends and colleagues at
Beth Israel Medical Center, including Arnold Winston, Chairman of
Psychiatry; Susan Bressman, Chairman of Neurology; and Mathew Fink,
President of Beth Israel Medical Center. Special thanks to Betty and
Morton Yarmon after whom our center is named. Their generosity of
spirit and philanthropy make projects like this book possible.
Finally, I thank my parents Gloria and Mort, my wife Marlene, and my
kids Joshua and Rachel. I love you all.
viii
Altered Egos