The Man Who Wasn't There: Investigations into the Strange New Science of the Self (25 page)

According to Elizabeth Torres, in autism the brain’s ability to modify its prior beliefs based on the actual sensory input is impaired, because of the high levels of noise and low levels of useful information in the error feedback signals. So, people with autism may live with a constant element of surprise.

Being prone to continual surprise, an autistic person’s world must appear magical—but not in a good way, argue Pawan Sinha of MIT and his colleagues. Magicians, they point out, rely on being able to surprise their audience. When people are unable to predict a magician’s next move, it leads to wonder and astonishment. But in the real world, if you are unable to predict the causes of things, it can be debilitating. “
A magical world suggests lack of control and impairs one’s ability to take preparatory actions.” Their hypothesis is that an impaired predictive brain might be responsible for the wide range of seemingly disparate symptoms that characterize the autism spectrum disorder, which echoes Torres’s ideas.

Take an autistic child’s insistence on sameness. Being unsure of your environment is a recipe for anxiety even in neurotypicals, and this might be amplified in autism.

Susan provided some additional perspective, having experienced this with her son, Alex, as well as with other kids in his school who have autism. “Change is especially scary for folks on the spectrum. Kids on the spectrum thrive on routine and repetition. Reading the same book over and over again, watching the same movie multiple times, having a narrow repertoire of preferred foods, going to a small number of restaurants, opting for the same item from the menu
every
time, et cetera. They thrive on predictable schedules and firm expectations.”

If an autistic person is constantly confronting an unpredictable environment, then their desire not to veer too far from certain behaviors may be due to their need to increase predictability and reduce anxiety.

Even hypersensitivity to light, sounds, and other stimuli could be explained: impaired mechanisms for the prediction of causes of environmental stimuli, or imperfect updating of prior beliefs, could make stimuli seem endlessly novel.

It’s not just problems with sensory perception that can be explained using this framework. Sinha and his team also hypothesize that an impaired predictive brain could lead to problems with theory of mind. Reading someone else’s mind is akin to predicting the causes for their observed behavior (that is, their intentions and desires), while keeping in mind prior knowledge about the person. “
Theory of mind is inherently a prediction task,” they wrote. In science-speak, an impaired predictive brain is a parsimonious explanation for autism.

From the perspective of the self, some neuroscientists and philosophers argue that the predictive brain could explain even those aspects of the self that are considered basic, prereflective, and pre-narrative.

“The brain has to model everything it encounters, including itself.
It’s a straightforward consequence of thinking of the brain as this statistical machine. In that sense, the self is just a representation maintained in the brain, just like any other representation that we have of objects in the world,” philosopher Jakob Hohwy of Monash University in Melbourne, Australia, told me.

For instance, as we saw in the chapter on schizophrenia, the sense of agency is the product of a predictive brain. We also saw that the vivid connection to our emotions can be lost due to prediction gone wrong, leading to depersonalization, making us strangers to ourselves. And as we will see in the next chapter, even other properties that define the self—the sense of
mineness
, the feeling that I inhabit a body that feels like
mine
—could potentially be explained by thinking of the brain as an inference engine. It certainly takes the air out of the balloon for theories that privilege the self over, say, visual perception. “We have a deflation of the concept [of the self],” said Hohwy. “There is nothing special about the self; it’s just another cause of our own sensory inputs.”

So, anything that constitutes the self-as-object—aspects of the self that are experienced by the self-as-subject—could be thought of as perceptions arising out of the brain’s predictive mechanisms. Whether you are a neurotypical or someone with autism, you may be your brain’s best guess as to causes of all your internal and external sensory signals put together.

This gives me pause. My thoughts wander to Alex as a little boy. I have known him most of his young life. I wonder about Alex as a two-year-old, who insisted on sameness (whether in the food he was eating or the clothes he was wearing), and his penchant for lining up his toy cars, and how it rattled him to see the order disrupted. He shied away from people, not wanting to be held or picked up. Were these behaviors
attempts at avoiding surprise, his way of creating a predictable environment? Alex has overcome some of his fears as he’s entered adolescence. He lets himself be hugged, for example. Understanding why children with autism insist on sameness and predictability can only help social interactions. Maybe those with autism have an altered self-experience and have trouble reading other people’s minds. But one could also argue that neurotypicals have trouble reading autistic minds. Communication, by definition, is a two-way street, even if at times it is between potentially different minds.

WHEN YOU ARE BESIDE YOURSELF

OUT-OF-BODY EXPERIENCES, DOPPELGÄNGERS, AND THE MINIMAL SELF

This proposition [that] . . . I am, I exist, is necessarily true each time that I pronounce it. . . . But I do not yet know clearly enough what I am.

—René Descartes

“
Owning” your body, its sensations, and its various parts is fundamental to the feeling of
being someone.

—Thomas Metzinger

M
y cousin’s son, Ashwin, a youthful thirty-one-year-old, died of brain cancer recently. The first indication of a potential problem came in August 2009. Ashwin had had a major seizure. Neurosurgeons in New Delhi found and removed a benign tumor from the left temporoparietal region. Within months of the operation, he began having seizures again. Scans revealed nothing new, so he was put on anticonvulsant medications. Ashwin learned to recognize the onset
of seizures, usually pins and needles in his right arm and leg. If he was driving, he’d pull over and take some deep breaths (his mother’s instructions), and wait for the seizure to pass. Moments later it would be over. Then, in early 2013, he was driving to work when something very odd happened. He immediately stopped his car on the roadside and called his mother.

“Mom, I had a very strange experience,” he told her. “I saw another Ashwin in front of me.” He was in no doubt as to what he had seen and experienced: his own self facing him. He was even aware of the emotional state of this double. Ashwin told his mother that the second Ashwin was angry, resentful, frustrated (an emotional state that mirrored how he used to be in his twenties, my cousin told me). Thankfully, the double disappeared, and Ashwin could drive again. His neurologist attributed the experience to a seizure and adjusted his medication.

Within a year, however, Ashwin’s condition worsened. His tumor returned, this time with a vengeance. It was malignant, and in the left frontotemporal region, its tentacles spreading into the left insular cortex. Surgery and radiation therapy bought him some time, but not much. Ashwin passed away very suddenly one evening.

What Ashwin experienced that morning in his car is a phenomenon called the doppelgänger effect. It’s a complex hallucination that involves the feeling that there is another illusory body of oneself nearby, as happened in his case. While Ashwin remained in his physical body, often the person hallucinating can find that his or her center of awareness—the sense of being in a body looking out—can shift from the physical body to the illusory body. The person switches perspective, seeing the world either from the physical body or the illusory body, sometimes moving back and forth in rapid succession. Another
distinguishing characteristic of the doppelgänger effect is often the presence of strong emotions. One of the most cited accounts in the medical literature of the doppelgänger experience is of a young man who jumped off a four-story building to reconcile his self with his body.

More than two decades ago, Peter Brugger, as a PhD student in neuropsychology at the University Hospital Zurich in Switzerland, was developing a reputation as someone interested in scientific explanations of so-called paranormal experiences. A fellow neurologist, who had been treating a twenty-one-year-old man for seizures, sent the patient to Brugger. The young man, who worked as a waiter and lived in the canton of Zurich, had very nearly killed himself one day, when he found himself face-to-face with his doppelgänger.

The incident happened when the young man had stopped taking some of his anticonvulsant medication. One morning, instead of going to work, he drank copious amounts of beer and stayed in bed. But it turned out to be a harrowing lie-in. He felt dizzy, stood up, turned around, and saw himself still lying in bed. He was aware that the person in bed was him, and was not willing to get up and would thus make himself late for work. Furious at the prone self, the man shouted at it, shook it, and even jumped on it, all to no avail. To complicate things further, his awareness of being in a body would shift from one body to the other. When he was inhabiting the supine body in bed, he’d see his duplicate bending over and shaking him. That’s when fear and confusion took hold: Who was he? Was he the man standing up or the man lying in bed? Unable to take it,
he jumped out the window.

When I visited Brugger in the autumn of 2011, he showed me a
photograph of the building from which the man had jumped: he had been extremely lucky. He had leapt from a window on the fourth floor and landed on a large hazel bush, which had broken his fall. But he had not really wanted to commit suicide, said Brugger. He had jumped to “find a match between body and self.” After getting treatment for his fall-related injuries, the young man underwent surgery to remove a tumor in his left temporal lobe, and both the seizures and the bizarre experiences stopped.

Doppelgängers are the stuff of literature: from Edgar Allan Poe’s “William Wilson,” in which William, tormented by his double, stabs him, only to realize that he himself is bleeding, to Guy de Maupassant’s short story “Le Horla,” in which the main character murders his double, but laments at the end, “
No . . . no . . . of course not . . . of course he is not dead. . . . So then—it’s me, it’s me I have to kill!,” fictional doubles abound.

Broadly, such hallucinations are classified as
autoscopic phenomena
(from “autoscopy”; in Greek,
autos
means “self” and
skopeo
means “looking at”). The simplest form of an autoscopic phenomenon involves feeling the presence of someone next to you without actually seeing a double—a sensed presence. Olaf Blanke, a neurologist at the Swiss Federal Institute of Technology in Lausanne, Switzerland, told me that a sensed presence is like experiencing a full-body phantom: if a phantom limb is the continued sensation of having a limb that has been amputated, then a sensed presence of a body is its full-body analogue.

T. S. Eliot immortalized such an extracorporeal presence in his poem
The Waste Land
: “Who is the third who walks always beside you? / When I count, there are only you and I together.”

As it turns out,
Eliot was inspired by accounts of the Antarctic explorer Ernest Shackleton, who wrote in his diaries that he and expedition team members Frank Worsley and Tom Crean, on the last leg of an unimaginably dangerous and difficult journey to find help to save the other stranded members of their trans-Antarctic expedition, began feeling the presence of a fourth person. Shackleton wrote, “
I know that during that long and racking march of thirty-six hours over the unnamed mountains and glaciers of South Georgia it seemed to me often that we were four, not three. I said nothing to my companions on the point, but afterwards Worsley said to me, ‘Boss, I had a curious feeling on the march that there was another person with us.’ Crean confessed to the same idea. One feels ‘the dearth of human words, the roughness of mortal speech’ in trying to describe things intangible, but a record of our journeys would be incomplete without a reference to a subject very near to our hearts.” We now know that it’s not uncommon for oxygen-deprived mountaineers to report sensing the presence of another.

Autoscopic phenomena can go beyond just a sensed presence. There is the doppelgänger effect, in which a person may hallucinate that they are actually seeing another “me”—a visual double. Often, the hallucination is very emotional, and the person’s sense of location and identity switches between the real and the illusory bodies, as experienced by Brugger’s twenty-one-year-old patient.

Probably the most widely experienced and best-known form of autoscopic phenomena is the out-of-body experience (OBE). During a classic full-blown OBE, people report leaving their physical body and seeing it from an outside perspective, say from the ceiling looking down at the body lying in bed.

During my discussions with Michaele about her husband Allan’s
battle with Alzheimer’s disease, I mentioned to her that I was also writing about out-of-body experiences. As it happened, well before she met Allan, Michaele had an intense out-of-body experience. She was in her thirties and pregnant with her fourth child. When it came time to have the baby, a son, she chose a home birth, in the presence of a midwife and a physician. Her water broke one night, and the next morning her physician went over to the local abortion clinic to get a tablet of Pitocin, which can be used to induce labor. Michaele put the pill under her tongue and soon went into labor. She had chosen not to take painkillers. At the very peak of the process, just as she had pushed her baby out, the pain became unbearable. Michaele felt herself leave her body. “I literally was up at the corner of the ceiling, looking down at the whole scene, watching everything happen,” she told me. “I just left my body. It got so intense that I went above, and as soon as it was over, I was back, right back in my body again. It was the weirdest thing.” She thinks the whole episode may have lasted just a few seconds, but more than three decades later, the experience is still etched in her mind. “It’s not something I have talked about a lot,” she said. “I have only told a few people that I feel would understand.”

Many people who have such experiences are reluctant to talk about it. OBEs give the person a strong sense of dualism of body and mind: your center of awareness, which is usually anchored in your body, seems to float free of it. We saw earlier how the bodily self is the foundation for our sense of self, and disruptions of the bodily self can cause BIID, schizophrenia, and perhaps even autism. In all these cases, however, the center of awareness remains anchored to the body, however impaired the perception of it may be. OBEs mess with this center of awareness—suggesting a Cartesian duality. But if you examine OBEs closely, it turns out that the duality is an illusion, a product of a
brain that fails to correctly integrate all the signals from the body. Despite their vividness, OBEs are hallucinations caused by malfunctions in brain mechanisms; elucidating these mechanisms gets us closer to understanding how the brain constructs the self.

Back at the University Hospital Zurich, Peter Brugger tried gamely to induce in me an out-of-body illusion. We were wandering the corridors of the hospital. I was wearing virtual-reality goggles. Brugger was walking about three feet behind me, filming me using my notebook computer’s webcam and feeding the video into the goggles I was wearing. So, instead of seeing where I was going, I was seeing myself from behind, walking about three feet in front of me. We must have been a sight as we walked past curious interns and hospital staff. Brugger, looking like an absentminded professor with his white lab coat and wild, graying hair, holding aloft an open notebook computer, and me walking in front, blind but for what I was seeing in the VR goggles.

The setup didn’t quite work. We should have been using a good video camera, which we didn’t have at the time, and longer wires so that Brugger could have been farther behind me. But I did feel weird walking around watching myself from behind.

In 1998, when Brugger first tried the experiment, he wore such goggles for an entire day, and had someone walk about twelve feet behind him, filming him with a video camera. So, if Brugger was picking a flower, or putting a letter in a mailbox, he’d see himself doing the act from an outside perspective. “This was extremely strange. I lost the sense of where I actually was,” he told me. “I was where I saw the action, rather than where I was actually executing the action.” Brugger was having an out-of-body illusion: the sense of where he was located had
shifted several feet, from being in his physical body to being in the virtual body.