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How to pronounce Anil Ananthaswamy: uh-NEEL uh-nahn-thuh-SWAH-mee
The author of The Man Who Wasn't There discusses his research into the meaning of the self and how technology is helping us probe this concept further.
What inspired you to examine the self by way of neurological disorders?
I have been interested in the self since my late 20s. It might have something to do with growing up in India, where many major religions (Hinduism, Buddhism, Jainism, for example) have strong philosophical underpinnings that tackle the question "Who am I?" It's part of my cultural DNA, I guess.
As a writer, I wanted to address the self in a way that was both instructive and novel—for there are already so many good books on the subject. What could I say that hadn't been said before? As I did my research, I found that the debate over whether there is a self or not still persists, but it's a very subtle one. And there are, of course, books talking about the self as an illusion, that it's not real, etc. It's hard for the lay person to get a handle on the crux of the debate. I realized that one could examine the nature of the self—and hence the nature of the debate—by looking at disorders that disturb the self (and some neuroscientists like Todd Feinberg have done just that in their work and writings). Just like we have learned a lot about how the brain functions by studying people who have had strokes and tumors and have lost some functionality (say speech, or movement in one arm), we can learn a lot about the self by taking seriously the experiences of people who have lost some aspect of their self.
Of the many conditions discussed in this book, was there one you found most captivating or surprising?
I think the most surprising was Cotard's syndrome, in which patients claim they don't exist. The condition is not terribly well-studied, and while neuroscientists have some inkling of what's happening in the brain in Cotard's, the exact neurocognitive mechanisms are unclear. Given that those suffering from Cotard's are certain of not existing, and no amount of rationalization can shake them off their delusion, it does make you wonder about all the other things we seem so certain about (for example, most of us are certain we exist).
The most captivating condition that I encountered was ecstatic epilepsy, which leads to this paradoxical state where individuals have heightened self-awareness of their body and their surroundings, and yet feel that certain boundaries have dissolved, giving them a feeling of unity with something larger than themselves. Their sense of time slows down—a second seems to last much, much longer. They report feelings of bliss and well-being. It's almost mystical. It's fascinating that neuroscience is beginning to provide some answers as to what might be happening in the brain during such seizures—and why that might result in ecstatic experiences.
Neuroimaging technologies have allowed the brain to become a more visible and tangible entity. Broadly speaking, what do these advances in technology mean for scientists in their evolving understanding of the "self"?
Neuroimaging techniques such as PET scans and fMRI have indeed become very sophisticated. They are allowing neuroscientists to identify regions of the brain that are associated with various aspects of the self, such as the bodily self or the narrative self. It's becoming clear that there is no one brain region that is the exclusive domain of the self; the self, as some neuroscientists have eloquently said, is "nowhere and everywhere" in the brain.
But it's very, very important to point out these imaging studies only give us correlations, not causation. Just because we see differences in the brains of people, say, with schizophrenia when compared with controls, it doesn't mean that those differences are the cause of schizophrenia. All we can say, scientifically speaking, is that those differences are correlated with schizophrenia.
Because of the power of these technologies, sometimes there is a tendency within neuroscience to view the brain-mind relationship as a one-way street, with the brain influencing mental activity, and not the other way around. But there are psychiatrists and neuroscientists who argue for caution. For instance, could extreme social withdrawal during one's teenage years lead to schizophrenia? These are complicated questions of nature versus nurture, and are not easy to answer. And simply using advanced imaging technologies will not be enough.
How does social culture impact the prevalence and treatment of mental disorders?
It's not a question I researched or tackled in the book—but there is evidence that culture impacts the prevalence and treatment of mental disorders. The classic case is depression. Given a certain genetic predisposition to depression, an individual is more likely to become depressed in an individualistic culture than in one that is more collectivist.
And yes, cultures can impact the treatment options too. While it's getting increasingly common worldwide to treat mental disorders with pills, there still exist small groups in places like India and Africa where the community takes responsibility for caring and treating an individual, not by using drugs, but by giving them ample social support and interaction. And there's evidence that just six weeks of such an intervention has the same effect as taking Prozac for a month. This is not to romanticize traditional societies, because elsewhere in these societies, people with mental disorders are sometimes shunned, their condition unacknowledged, thus increasing their suffering. Also, globalization is breaking down existing social support structures everywhere.
Nonetheless, it's clear that the broader culture has a vital role to play—for better or for worse—in the incidence rates and treatment options for mental disorders.
Do you hope readers will come away with a different way of thinking about mental disorders after reading your book?
I think the first thing I realized during the writing of the book is that one should be careful with the use of the phrase "mental disorders". Cultures across the world treat disorders of the mind differently from disorders of the body: there is still stigma associated with the phrase "mental disorder". And until the stigma goes away, it's best to avoid using that phrase; but our language gives us few alternatives.
After interacting with so many people who so kindly shared their life stories with me—I was left feeling that each of us falls somewhere on a spectrum of physical and mental abilities. Each of us is a self that has formed during childhood and early adulthood—and the self is the result of a complex interplay between body, brain, mind, society and culture. There's genetic predisposition, there's upbringing and there's ongoing social interactions.
This is not to underplay the seriousness of some conditions. Severe autism, or schizophrenia, or depression is not something you can wish away by saying "we are all the same". But it behooves us to acknowledge that there is someone who is experiencing severe schizophrenia rather than saying someone is a severe schizophrenic. It's a subtle difference, but I think it's important.
And, I hope readers also come away with the message that the usually stark distinction we make between the body and the mind is hardly so. Saying something is a mental disorder makes it the domain of the mind, and all that that implies (for example, we are supposed to 'get over' something just because it is mental). Neuroscience (and often folk wisdom) tells us that it's not so black-and-white. Attending to the body influences the mind and vice-versa.
Schizophrenia typically does not emerge until young adulthood, while Alzheimer's can start as early as one's forties. Does meditation—a practice that you mention in the epilogue—have the capacity to delay or even prevent symptoms of these disorders from emerging?
Whether meditation can delay or prevent the emergence of such symptoms is an open question. But, there are some studies that suggest that mindfulness meditation can help people already suffering from mental health disorders. There was a recent study published in the British Journal of Psychiatry that claimed that in a population of Chinese patients with schizophrenia, who were followed for 2 years, mindfulness reduced the severity of symptoms, increased their own insight into the illness and reduced the frequency of readmission to the hospital.
But one has to be very careful not to imply that meditation is a panacea. It's not. Meditation, when done without supervision, can itself lead to dissociation –and can cause problems. And you want to be especially careful doing intense meditation without supervision if have suffered from schizophrenia or depersonalization, or other dissociative conditions.
Given those caveats, there are eminent philosophers like Thomas Metzinger who have argued that schools should teach children a few secular techniques for meditation and relaxation, as a way to equip them for a world in which our attention is getting increasingly fragmented.
Where do you envision mental health interventions going in the future? Are we moving towards a society that will eventually rely less heavily on pills and other forms of medication?
It's really hard to predict where we are going. I'm not against pills and medication—there are situations (severe depression and schizophrenia come to mind) when medication is undeniably needed. But a society that relies solely on pills is falling prey to the same problem of neurobiological reductionism: influence the brain chemistry to influence the state of mind. Any holistic approach to mental health must take into account the social and cultural factors that bring individuals to the brink of bad mental health—and push those of us who are susceptible over the edge.
Many individuals have a strong sense of selfhood. Did researching and writing this book change the way you view or think about yourself personally? How would you recommend we all think about the "self" based on the latest science you discuss in the book?
When philosophers and neuroscientists talk about the self being an illusion—they are not talking about the "phenomenal self", the self as subjectively experienced by each one of us. The phenomenal self is very real: there's no denying we experience it, we are it. And it's also in the nature of the self that we feel threatened when the self is disturbed, when its boundaries are transgressed. We have evolved to be so, and it's fair to say that this is a normal response.
But what the science is telling us is that aspects of this phenomenal self are constructed by the brain—it's an ongoing neural process. The boundaries that we take as rigid are not actually so. They are malleable. So, in situations where the sense of our own self is too strong, or too rigid, or too grandiose, when our cognitive attachment to everything we consider to be "me" or "mine" is so strong that even the slightest snub causes grief, then maybe it's time to pay heed to the new science of the self (and indeed, the old philosophies of the self).
Given such insights from neuroscience and philosophy, getting to know the "constructed" nature of the self—and finding non-pathological ways of loosening the ties that bind the self—may help us better deal with the knocks of life.
Of course, it's all easier said than done.
As for me personally, this book is part of an ongoing journey of enquiry. On good days, I feel I can see through the self's shenanigans, on bad days, I am the self's shenanigans.
Unless otherwise stated, this interview was conducted at the time the book was first published, and is reproduced with permission of the publisher. This interview may not be reproduced or reprinted without permission in writing from the copyright holder.
Prof Edward Bullmore, MB PhD FRCP FRCPsych FMedSci, trained in medicine at the University of Oxford and St. Bartholomew’s Hospital, London; then in psychiatry at the Bethlem Royal & Maudsley Hospital, London. He moved ... (more)
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