My soul is a hidden orchestra; I know not what instruments, what fiddle strings and harps, drums and tambours I sound and clash inside myself. All I hear is the symphony.
Fernando Pessoa
I once met a young man who was convinced his head was full of water and contained a fish rather than a brain: something like a trout. It unsettled him to think of it living in such cramped conditions. He no longer had need of a brain since his thoughts and behaviour were under the control of the CIA. Most of us believe that the head contains not a fish but a person: a self. Here's one, at the front of a lecture hall, spilling words that seem to come from nowhere, spinning a story. This is the self I refer to as "me." There in the auditorium are 200 other selves. All I see are rows of heads. For each head to represent the location of a conscious self requires a further, inferential step. We create our own selves by inference too, automatically and irresistibly. In doing so we ride the rails of the deepest human convention. But, at root, it is just that: a convention. The self is not an intrinsic feature of the brain, and it is possible to become derailed-through psychosis, like the man with the fish in his head, or as a result of damage to the brain. The degradation of personality is a neurological commonplace.
Mary had suffered a brain haemorrhage, a burst aneurysm. The arterial wall had always been defective (though she was not to know) and now, in her fiftieth year, the sac had punctured, pouring blood into the frontal lobes. The surgeons opened up her head and fixed a clip to stem the flow. She had been close to death. Three weeks later, sitting in my office, it was difficult to stem the flow of words. She didn't seem to pause for breath.
"I've got a poem I wrote it yesterday well I haven't written it down it just came to me when I was sitting looking out the window at the lawn and these magpies came vicious things you wouldn't want to leave a baby outside they'd peck its eyes out like they do the sheep they attack in pairs they swoop down and confuse the sheep one then the other we had a kitten climbed a tree it did they flapped around her poor thing was terrified I threw a stone we shook the biscuit box to get her down."
And then she did pause. She had forgotten the poem.
"Where was I?" she said. I wasn't going to remind her. I didn't say a word as I reached behind for the black case containing my test equipment. I avoided eye contact. If you didn't speak, and you didn't look, Mary would stay silent. Without the trigger of a word or a glance to open the verbal sluice-gate she sat, if not exactly still (she was always fidgeting with the buttons on her blouse) then at least quiet. I quickly took some clean history sheets from a tray on my desk. Mary froze. I wondered how long we could sit there like that, motionless. The silence didn't trouble her.
She seemed absorbed by a picture postcard pinned to the board behind my desk. It showed a Mediterranean scene, a seaside town with a pine-fringed golden beach, blue sea and a seafront promenade with shops and restaurants. "Majorca" blazed diagonally, upper left, in curly yellow letters. It had been there since the summer and now looked incongruous beneath the seasonal tinsel and holly my secretary had stuck about the place.
We began with questions about orientation: time, place and person. It is important to exercise discretion. You don't want to insult your patient by asking overly simplistic questions. But, with Mary, it was appropriate to start at the bottom. Personal orientation was one of her problems.
"What day is it?"
"Wednesday"
"And the date?"
"Is it the twenty-fourth?"
"Actually it's the sixteenth."
"What month is it?"
"July."
"What makes you think it's July?"
"It's warm in here."
She undoes a button on her blouse, then another. "I should keep your blouse on, Mary," I tell her. We move on.
"Where are we now?"
"At the hotel."
"And what is the name of the town we are in?"
"I don't know," she says. "Majorca, somewhere."
I ask her name. She gives me a pitying look. "Me? I'm Mary Magpie. Who did you think I was?"
I'm projecting images of the brain. The hall is full and the students are attentive. They seem to enjoy watching the shapes and words glide across the screen, falling into place with Powerpoint precision as the brain assembles itself. I am pleased with my picture. It is like a work of art. In the shadows, on a table nearby, I have another exhibit. Later, I shall take it from its container and hold it up for the audience to admire. For now, we contemplate the colourful diagram. It is a standard representation of the major anatomical divisions (hindbrain, midbrain, forebrain) and some of the subcomponents (cerebellum, thalamus, basal ganglia, neocortex). The neural substructures float beneath the rippled surface of the cortex like fishes in a rock pool.
"How old are you, Mary?"
"Twenty-four."
"And your children?"
"Emma's twenty-two, Tom's nineteen."
It is an introductory lecture. I keep it simple, moving swiftly through the lower structures like a child ascending a climbing frame, eager to reach the top. I am most interested in what goes on in the higher reaches, the zones containing the interlinked systems of perception and thought, memory and emotion. Consequently, my account of the hindbrain and midbrain structures is crisp. I encourage the students to imagine that we are crawling through the base of a gargantuan skull and clambering up the brainstem. It has the girth of an oak. We proceed under the shadow of the great lobes of the cerebral hemispheres which loom like thunderclouds. It's the higher branches we aspire to, way up in the gloom. I ask them what they think they would see. Nothing, one of them says correctly, it's pitch dark. Shine a light, I say.
I explained to Mary that we were in a hospital. Did she know why? Yes, she told me. She'd had an aneurysm. But they'd put it right. She would be going home soon. It was a pity her sister had to stay behind. Her sister? Yes, she'd had an aneurysm too, but she wasn't doing so well.
Mary was becoming agitated now. She stood up and made for the door. "Got to go," she said. "I left the baby." "What baby?" "My baby," she said. "I left it in the garden. Those magpies will have its eyes out." The baby was born last month. They opened Mary's head, and then they delivered her baby. It was a beautiful little girl but there was a problem with her brain. It could be an aneurysm.
Shine that light at the glossy underside of the temporal lobe, directly above, and you will see that the outer surface is wrapped in a sheet woven from an exquisite material. Next slide. This is the "grey matter." It covers all of the major lobes. In reality, the colour would be a dull grey-brown, but here we'll give it a silver sheen. Dissolve into the fibres of this material. Look about. See what makes it glisten. Picture an exotic, illuminated garden. The objects all around ("neurons") are certainly plant-like-spherical pods with slender, branching tendrils (the "dendrites") and a longer process (the "axon") extending from one end.
Where is the mind in this tangled wood of neurons and nerve fibres? It isn't anywhere. And the self? What did you expect? A genie in a bottle? In his essay, "Sorry, But Your Soul Just Died," Tom Wolfe imagines an apocalyptic near future where advanced methods of brain imaging will strip away the illusion of self. People will realise that all they are looking at is a piece of machinery, devoid of self, mind or soul. At this point, he says, "some new Nietzsche" will step forward to announce the death of the soul and, "the lurid carnival that will ensue may make the phrase, 'the total eclipse of all values,' seem tame."
It is true. Neuroscience is fast developing the wherewithal to reveal in fine, bare detail the neurobiological substrates of the mind. Perhaps it will despoil the last refuge of the myth of selfhood. Our ethics and systems of justice, our entire moral order, are founded on the notion of society as a collective of individual selves-autonomous, introspective, accountable agents. If this moral agent is revealed to be illusory, what then? Perhaps by using the weapons of neuroscience to explode the self we run the risk of splitting a social atom and releasing forces beyond our present comprehension. Could "the century of neuroscience" really signify the collapse of all values? No, Wolfe honours neuroscience unduly. He is seduced by the gadgetry. You don't need futuristic new technologies to expose the brute fact that there's nothing but meat inside our heads. We have known this down the ages.
It dawned on me some time ago, having been a diligent student of neuroanatomy and after spending ten years as a practising clinician, that I was no longer especially interested in the brain. Or rather, that my interest was moving outwards. It was as if I had been in a congested city, gawping at the crowds and the architecture and the traffic from ground level. Now I was rising above the buildings. I could see suburbs and fields and rivers beyond and in the distance other towns and cities. Cities don't float in a vacuum and nor do brains. No brain is an island.
When Mary's husband came to visit, he had a calming effect. They seemed to function as a unit. Her behaviour meshed into the networks of partnership and so became more coherent. In any relationship, one person is partly defined by the other. For Mary, her husband was a guide to self-definition. He provided a template. He drew from her a behavioural repertoire and a mental structure to complement his own. The centre of gravity lay between them. There was a kind of equilibrium. This effect was not of his deliberate doing. That's just the way it happens.
If Mary's heart, or lungs or liver had been diseased, rather than her brain, it would be possible to describe the pathology in terms of its effects on that particular organ system in relation to the overall functioning of her body. The heart pumps blood, the liver secretes bile, the lungs enable the supply of oxygen to the blood and in each case the frame of reference is the individual organism. In defining brain function we have to think beyond the body. The brain evolved as a means of orchestrating interaction between the organism and the world. To achieve this it must maintain both an inward and an outward orientation, monitoring the state of internal systems, while responding to the flow of events outside.
According to western intellectual tradition, which emphasises a distinction between nature and culture, we have a curious, duplex kind of existence. We move in a natural realm of time, space and matter and, concurrently, through a socio-cultural dimension of people and ideas, a world saturated with customs and beliefs, traditions, laws, language, arts and science. First, we are subject to the laws of physics; second, to the influence of customs, beliefs, traditions and so on. An emerging theme in neuropsychology is that, just as it has functional systems devoted to perception of, and interaction with, the physical environment, so the brain has evolved systems dedicated to social cognition and action. It constructs a model of the organism of which it is a part and, beyond this, a representation of that organism's place in relation to other, similar organisms: people. As part of this process it assembles a "self," the device we employ to negotiate the social environment.
Beyond accounting for Mary's illness in terms of physical pathology and appreciating its consequences at the personal level, we must try to understand what mechanisms might be operating at the intersection of the biological (brain) and the social (self) domains. That is the challenge for neuroscience: to find a way of fitting the brain and the self into a common framework of understanding.
We are all fictional characters. We build a story of ourselves from the raw materials of language, memory and experience. The idea of the "narrative self" has a long history, with roots in Anattavada, the Buddhist doctrine of "no soul" or "no self." This holds that the self is only a bundle of fleeting impressions. David Hume took a similar line. For him, the extension of the self beyond such momentary impressions was fiction. Daniel Dennett offers a modern version, emphasising the power of language in giving coherence to our experience over extended periods. Dennett says that it is not so much that, through language, we spin stories as that the stories spin us. The self is best understood as a "centre of narrative gravity."
Confabulation is the inadvertent construction of an erroneous self-story, signifying the neurological breakdown of the storyteller. It takes different forms, sometimes mundane, sometimes fantastic. As in Mary's case, it is typically associated with damage to the frontal lobes and is due to a combination of things. Memory disorder is one ingredient. In particular, confabulators have problems with contextual memory. They may retain the kernel of some autobiographical event or episode, but fail to anchor it in a specific time or place. Memories drift loose, images collide. Then there is disinhibition of associations. Thoughts reach the spotlight of awareness through a process of filtering and exclusion. But the confabulator's theatre of consciousness is crowded with gatecrashers (imaginary babies, magpies, the number 24). The reduplication of relatives, or the creation of imaginary children is a common theme. Finally, there is a disturbance of the neuropsychological mechanisms responsible for maintaining a distinction between external stimuli and internally generated thoughts (falling into the frame of a picture postcard, you are transported to Majorca).
I reach into the shadows behind the screen and retrieve a small plastic bucket. I fish out a human brain. I don't know whose. Perhaps I've passed this person on the street. In its natural state, encased within the skull, brain matter is gelatinous. This brain, fixed in formalin, has a solid, rubbery feel and would carve like a tender tuna steak. After the bright pictures filling the screen, it looks small and lacklustre. But it holds the interest of my audience. All eyes turn towards the object as I point out the landmarks. In terms of imparting knowledge, this little coda adds nothing. Yet the students leave with something they wouldn't otherwise have had. They take with them a clearer sense of the brain as a biological object; a physical mass as well as a textbook concoction of bright colours and neat abstractions. It will help them distinguish between the brain and the self.
When the Apollo astronauts brought back pictures of our planet, it changed the way we saw ourselves. We knew already that we inhabited the surface of a small sphere at the edge of an unremarkable galaxy, one of indeterminate billions. But now we saw our home in its true colours. It was precious and vulnerable, a thing we should take care of. Something similar happens when you see the brain. Imagination infiltrates intellect. You get a sense of location and vulnerability.
A few students want a closer look. They want to touch. A young woman asks if she can hold the brain. She dons rubber gloves and takes the specimen in her hands. There is wonder and apprehension on her face. A young man turns the brain over to examine its underside. He picks at the stump of a severed artery. Another tests the weight, feeling the drop of the object first in the left hand then the right. He says it's odd but your head doesn't feel this heavy.
Six months later, Mary came to the out-patients clinic. It was a routine follow-up. Although her memory was still poor she had made good progress in other areas. There was no longer the prolixity of speech or the fragmented attention that had characterised her earlier behaviour. In particular, over a period of two hours of interviewing and testing, I had detected no signs of confabulation. Then, work done, idly chatting as we waited for her husband to collect her, I asked what plans she had for the weekend. "Oh," she said. "I'd like to watch the badgers again." "Really?" "Yes, in the field over the back wall. You can see them from the garden shed." She was looking at my name-tag. "Brock the badger," she said. Mary's husband arrived and they left together. I never saw them again. I didn't ask him about the badgers at the bottom of the garden.
Like the surface of the earth, the brain is pretty much mapped. There are no secret compartments inaccessible to the surgeon's knife or the gaze of the brain scanner; no mysterious humours pervading the cerebral ventricles, no soul in the pineal gland, no spirits in the tangled wood. There is nothing you can't touch or squeeze, weigh and measure in ways we measure the physical properties of other objects. There is no ghost in the machine. It is time to grow up and accept this. But, somehow, we are the product of the operation of this machinery and its progress through the physical and social world. Minds emerge from process and interaction, not substance. We inhabit the spaces between things. We subsist in emptiness: a beautiful, liberating thought and nothing to be afraid of. The notion of a tethered soul is crude by comparison. Shine a light, it's obvious.
