Phantoms in the Brain by V S Ramachandran

Author:V S Ramachandran [Ramachandran, V S]
Language: eng
Format: epub, mobi
Published: 2011-03-11T18:30:00+00:00

rare.

"Why do you think it's your brother's arm?"

"Because it's big and hairy, doctor, and I don't have hairy arms."

Anosognosia is an extraordinary syndrome about which almost nothing is known. The patient is obviously sane in most respects yet claims to see her lifeless limb springing into action—clapping or touching my nose—and fails to realize the absurdity of it all. What causes this curious disorder? Not surprisingly, there have been dozens of theories2 to explain anosognosia. Most can be classified into two main categories. One is a Freudian view, that the patient simply doesn't want to confront the unpleasantness of his or her paralysis.

The second is a neurological view, that denial is a direct consequence of the neglect syndrome, discussed in the previous chapter—the general indifference to everything on the left side of the world. Both categories of explanation have many problems, but they also contain nuggets of insight that we can use to build a new theory of denial.

One problem with the Freudian view is that it doesn't explain the difference in magnitude of psychological defense mechanisms between patients with anosognosia and what is seen in normal people—why they are generally subtle in you and me and wildly exaggerated in denial patients. For example, if I were to fracture my left arm and damage certain

nerves and you asked me whether I could beat you in a game of tennis, I might tend to play down my injury a little, asserting, "Oh, yes, I can beat you. My arm is getting much better now, you know." But I certainly wouldn't take a bet that I could arm wrestle you. Or if my arm were completely paralyzed, hanging limp at my side, I would not say, "Oh, I can see it touching your nose" or "It belongs to my brother."

The second problem with the Freudian view is that it doesn't explain the asymmetry of this syndrome. The kind of denial seen in Mrs. Dodds and others is almost always associated with damage to the right hemisphere of the brain, resulting in paralysis of the body's left side. When people suffer damage to the left brain hemisphere, with paralysis on the body's right side, they almost never experience denial. Why not? They are as disabled and frustrated as people with right hemisphere damage, and presumably there is just as much

"need" for psychological defense, but in fact they are not only aware of the paralysis, but constantly talk about it. Such asymmetry implies that we must look not to psychology but to neurology for an answer, particularly in the details of how the brain's two hemispheres are specialized for different tasks. Indeed, the syndrome seems to straddle the border between the two disciplines, one reason it is so fascinating.

Neurological theories of denial reject the Freudian view completely. They argue instead that denial is a direct consequence of neglect, which also occurs after right hemisphere damage and leaves patients profoundly indifferent to everything that goes on within the left side of the world, including the left side of their own bodies.

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