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... in his own ego and that ought to be acknowledged by it. Thus even the feeling of our own ego is subject to disturbances and the boundaries of the ego are not constant. (1)
For the past twenty years, my colleagues and have studied patients with acquired brain damage who have undergone a transformation in the most intimate aspects of their personal identities. I call these conditions neurological perturbations of the self. (2)
We study these cases to discover, among other things, the neurological structures necessary for a self, and the manner in which these structures are wired together to create a unified human mind. To that end, our analysis of these patients focuses on how the self, the ego, one's personal identity, adapts in response to damage to critical neurological structures.
In these cases, I rely in large measure upon the patients' verbal descriptions of how they view themselves after a neurological injury. Although these narratives are acquired within a medical context, and the patients are expressing what they believe to be the truth in the context of a medical or neurological exam, my analysis of their reports more closely resembles a psychoanalyst's reading of a patient's dream, or a reader's interpretation of a movie or novel. I take this approach because, while these patients are communicating what they believe are the actual facts of their circumstances, I actually find most intriguing what the patients reveal about those aspects of their self-concepts and motivations of which they are unaware.
Perhaps the best known, and certainly one of the most fascinating, neurological perturbations of the self is asomatognosia, a disorder in which a patient denies ownership of a part of his or her body. A patient with asomatognosia typically has damage to the nondominant, usually right, hemisphere of the brain; and the side of the body opposite the brain lesion, in this case the left, is paralyzed and has impaired sensation.
These patients also demonstrate a condition called hemispatial neglect, in which they ignore, as if nonexistent, the half of space opposite the brain lesion. Patients with large right-hemisphere strokes might not clothe their left sides, shave the left side of the face, eat food placed on the left side of the plate, or speak to people who address them from the left side of their hospital beds.
In order to demonstrate asomatognosia, the examiner grasps the patient's paralyzed left arm and brings it into the patient's right, non-neglected side. The patient is then asked a series of questions, such as "What is this?" "Who does this belong to?" "Do you have a name for this?" etc. Some patients with asomatognosia appear simply confused as to whose arm it is and respond that they are not sure, perhaps it belongs to the doctor. This confusion is understandable, and not terribly interesting from a neuropsychological point of view, given that the patient has profound hemispatial neglect, cannot move or feel the arm, and may have some degree of generalized confusion common after an acute stroke. Many of these patients will readily admit their error if it is pointed out to them.
But there are also those patients who exhibit a more profound disturbance in their sense of ownership of or personal relatedness to the limb. Such a patient adamantly denies the limb belongs to him even when he traces its attachment to his shoulder. He treats the arm as if it is dissociated from his self--as if it belonged to someone else or as if it were an inanimate object.
The British neurologist Macdonald Critchley pointed out the remarkable tendency of some of these patients to personify their paralyzed limbs as if they possessed completely independent identities. He observed that these patients would make up nicknames for their arms such as "George," "Toby," or "Silly Billy." Critchley described the striking behavior of one of his patients toward his paralyzed left arm:
Asked to open his fist,...
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More articles from Daedalus
The convictions of Peter Debye.(Biography), September 22, 2006
Genetics, biosocial groups & the future of identity., September 22, 2006
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