http://opinionator.blogs.nytimes.com/2010/06/23/the-anosognosics-dilemma-somethings-wrong-but-youll-never-know-what-it-is-part-4/

*V.S. RAMACHANDRAN: * Denial that a body part, in this instance, an arm,
belongs to her.  It’s part of the same spectrum of disorders.  So the
wonderful thing about her is that she has a great sense of humor and was
really articulate and intelligent.  So I asked her, “Can you move your right
arm?” and the usual list of questions, and she said “Yes, of course.”  I
said, “Can you move your left arm?”  She said, “Yes.”  “Can you touch my
nose?”  “Yes, I can touch your nose, sir.”  “Can you see it?” “Yes, it’s
almost there.”  The usual thing, O.K.?  So far, nothing new.  Her left arm
is lying limp in her lap; it’s not moving at all; it’s on her lap, on her
left side, O.K.?   I left the room, waited for a few minutes, then I went
back to the room and said, “Can you use your right arm?”  She said, “Yes.”
Then I grabbed her left arm and raised it towards her nose and I said,
“Whose arm is this?”  She said, “That’s my mother’s arm.”  Again, typical,
right?  And I said, “Well, if that’s your mother’s arm, where’s your
mother?”  And she looks around, completely perplexed, and she said, “Well,
she’s hiding under the table.”  So this sort of confabulatory thing is very
common, but it’s just a very striking manifestation of it.  No normal person
would dream of making up a story like that.  But here is the best part.  I
said, “Please touch your nose with your left hand.”  She immediately takes
her right hand, goes and reaches for the left hand, raising it, passively
raising it, right?  Using it as a tool to touch my nose or touch her nose.
What does this imply?  She claims her left arm is not paralyzed, right?  Why
does she spontaneously reach for it and grab her left arm with her right
hand and take her left hand to her nose?  That means she knows it is
paralyzed at some level.  Is that clear?
[53]<http://opinionator.blogs.nytimes.com/2010/06/23/the-anosognosics-dilemma-somethings-wrong-but-youll-never-know-what-it-is-part-4/#ftn53>

*ERROL MORRIS: * Yes.  Presumably, if she didn’t know it was paralyzed, she
wouldn’t try to lift it with her right hand.

*V.S. RAMACHANDRAN: * And it gets even better, she’s just now told me that
it’s not her left arm, it is her mother’s arm, so why is she pulling up her
mother’s arm and pointing it at my nose?  What we call belief is not a
monolithic thing; it has many layers.

*ERROL MORRIS:* Like a deck of cards.  But it again raises the question of
whether this phenomenon is real?  Isn’t that Babinski’s question?  This is
true of your work on anosognosia — the idea of trying to devise a set of
experiments to determine whether someone is pretending to not-know
something.  Are they feigning a lack of awareness?  Are they truly
oblivious?  Or is that knowledge buried somewhere in the brain?  Do we live
in a cloud of belief that is separate from the reality of our circumstances?

*V.S. RAMACHANDRAN: * Absolutely, and overall, fortunately, it’s a positive
cloud in most of us. If we knew about the real facts and statistics of
mortality, we’d be terrified.

*ERROL MORRIS:* Indeed.

*V.S. RAMACHANDRAN: *It may well be our brains are wired up to be slightly
more optimistic than they should be.
------------------------------

Ramachandran has used the notion of layered belief — the idea that some part
of the brain can believe something and some other part of the brain can
believe the opposite (or deny that belief) — to help explain anosognosia. In
a 1996 paper 
[54]<http://opinionator.blogs.nytimes.com/2010/06/23/the-anosognosics-dilemma-somethings-wrong-but-youll-never-know-what-it-is-part-4/#ftn54>,
he speculated that the left and right hemispheres react differently when
they are confronted with unexpected information. The left brain seeks to
maintain continuity of belief, using denial, rationalization, confabulation
and other tricks to keep one’s mental model of the world intact; the right
brain, the “anomaly detector” or “devil’s advocate,” picks up on
inconsistencies and challenges the left brain’s model in turn. When the
right brain’s ability to detect anomalies and challenge the left is somehow
damaged or lost (e.g., from a stroke), anosognosia results.

In Ramachandran’s account, then, we are treated to the spectacle of
different parts of the brain — perhaps even different selves — arguing with
one another.

We are overshadowed by a nimbus of ideas. There is our physical reality and
then there is our conception of ourselves, our conception of self — one that
is as powerful as, perhaps even more powerful than, the physical reality we
inhabit. A version of self that can survive even the greatest bodily
tragedies. We are creatures of our beliefs. This is at the heart of
Ramachandran’s ideas about anosognosia — that the preservation of our
fantasy selves demands that we often must deny our physical reality.
Self-deception is not enough. Something stronger is needed. Confabulation
triumphs over organic disease. The hemiplegiac’s anosognosia is a stark
example, but we all engage in the same basic process. But what are we to
make of this? Is the glass half-full or half-empty? For Dunning, anosognosia
masks our incompetence; for Ramachandran, it makes existence palatable,
perhaps even possible.
------------------------------

[53] Oliver Sacks provides (also from “A Leg to Stand On”) a particularly
dramatic example of a patient trying to throw his arm out of bed.  “. . .
the patient at Mount Carmel who ‘discovered’ his long-lost brother in his
bed.  ‘He’s still attached to me!’ he said indignantly.  ‘The cheek of it!
Here’s his arm!’ holding up, with his right hand, his own left arm.”

[54] See V.S. Ramachandran, The evolutionary biology of self-deception,
laughter, dreaming and depression: some clues from anosognosia, Medical
Hypotheses, November 1996, 47(5):347-62. This idea of the right brain as the
“devil’s advocate” is further discussed in Ramachandran’s Phantoms in the
Brain. I hope to return to these fascinating ideas in a forthcoming essay.

-- 


You cannot build anything on the foundations of caste. You cannot build up a
nation, you cannot build up a morality. Anything that you will build on the
foundations of caste will crack and will never be a whole.
-AMBEDKAR



http://venukm.blogspot.com

http://www.shelfari.com/kmvenuannur

http://kmvenuannur.livejournal.com

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