Phantoms in the Brain

Authors: V. S. Ramachandran and Sandra Blakeslee

Synopsis

The author of this book, one the leading figures in neuroscience, unapologetically declared that his intention was to write ‘a popular book on the brain’. To accomplish this goal, he recounts seemingly endless ‘true-life stories‘ of fascinating neurological disorders (page xiii). Like a codebreaker, he deciphers countless brain mysteries and many intractable neurological conundrums. He infuses his narrative with humorous and insightful prose, such as when he discusses Paul, his patient with epilepsy, who ‘was intense and self-absorbed and had the arrogance of a believer but none of the humility of the deeply religious’ (page 180). The author is remarkable for his astute ideas, his simple but effective approach to research, and his groundbreaking neuroscience discoveries. 

The author’s methodology is to study singular unusual patients, and this research approach harks back to the origins of neurology. Contrary to the prevailing practice of studying large groups of diverse subjects, the author prefers a detailed observation of exceptional individuals, and his many breakthroughs demonstrate that this is an effective strategy. He defends this method when he pointed out that ‘in neurology, most of the major discoveries that have withstood the test of time were, in fact, based initially on single-case studies and demonstrations‘ (page xiii). He argues that the study of unusual cases ‘can help us solve the mystery of how various parts of the brain create a useful representation of the external world’ (pages 5 and 12). He illustrated this with many historical examples, such as that of Patient HM, the amnesic who almost single-handedly enabled researchers to understand how memory works. He therefore advocated a return to the study of single cases because these ‘are our guides into the inner workings‘ of the brain (page 2).

A striking distinguishing feature of the author’s defining research output is how little collaboration it required. Working almost single-handedly, relying heavily on innovative ideas and deep knowledge, he described new disorders, refined our understanding of how the brain works, and devised original treatments for previously incurable disorders. He used many historical examples to illustrate his belief that a single doctor can make impactful contributions and breakthroughs in their specialties. A prominent precedent is the Australian physician, Barry Marshall, who made the phenomenal discovery that Helicibacter pylori is the cause of stomach ulcers. Using such inspiring examples, the author stressed that ‘a single medical student or resident whose mind is open to new ideas and who works without sophisticated equipment can revolutionize the practice of medicine’ (page xv). More encouragingly, he believes that there are still abundant opportunities today to make such breakthroughs, asserting that ‘even now, amazing discoveries are staring you all the time’ (page xv). 

The author has a unique and unconventional approach to the whole concept of research. His intriguing strategy is to tinker with ideas, ‘without an overarching theory’, but ‘guided by intuition‘ (page 5). This literal ‘out-of-the-box’ method is however a time-honoured way of creative thinking, and this is the basis of many scientific paradigm shifts. The author complements this simple approach to brain exploration with the practice of elementary but elegant experiments, arguing that ‘you don’t necessarily need complicated machines to generate scientific revolutions‘ (page 5). Expressing a ‘permanent distaste for fancy equipment‘, he referred to Michael Faraday‘s ground-breaking physics discoveries which were achieved by simple experiments. He asserts that this method is particularly suited to the study of brain disorders because neuroscience research is still in it’s infancy: he said, ‘despite two hundred years of research … the most basic questions about the human mind…remain unanswered‘ (page xvi). 

The author is perhaps best known for his expertise in phantom limbs, a subject that intrigued him from ‘the very first time I encountered them and have been puzzled by them ever since’ (page 24). He believes that ‘the study of phantom limbs offers fascinating glimpses of the architecture of the brain’ and ‘it’s astonishing capacity for growth and renewal‘ (page 38). He traced the history of phantom limb research, dating back to the contributions of French surgeon Ambroise Pare, and the American civil war physician Silas Weir Mitchell (pages 22-23). He illustrated the curious manifestation of phantom limbs with many anecdotes, such as that of his patient, Tom, who lost his left arm in a car accident but weeks later ‘could still feel its ghostly presence below the elbow’ (page 21). Reviewing the remapping that takes place in the brain following the loss of a limb, he demonstrated how phantom limbs may rapidly emerge when neighbouring brain areas take over the brain representation of the lost limb (pages 29- 31). He also showed how remapping errors, such as when ‘touch input is hooked up accidentally to pain centers’, may result in phantom pain. As a tribute to his creative thinking, he described his ingenious mirror box device which uses visual feedback to override phantom pain (pages 50-54).

Another significant topic the author explored is the complexity of vision. In doing this, he reviewed many fascinating visual system disorders, with particularly emphasis on Charles Bonnet syndrome, a form of blindness that causes hallucinations. He illustrated this disorder with the case of Walter Thurber, the New Yorker cartoonist whose works were inspired by the creative hallucinations he experienced as a result of accidental blindness (pages 85-87). He also speculated that some ghost and UFO sightings may be explained by Charles Bonnet syndrome (page 106). The author however believes that ‘these bizarre visual hallucinations are simply an exaggeration of the processes that occur in your brain and mine every time we let our imagination run free’ (page 111). Amongst other visual disorders he discussed is blindsight, a phenomenon he illustrated with the case of Diana; blind from carbon monoxide poisoning, she could still unconsciously manipulate objects because her primitive orienting visual pathways have been spared (pages 64-76). The book’s discussion of the physiology of the visual system is very interesting, revealing that what we see is essentially a prediction, based on ‘educated guesswork‘, because the visual system is fundamentally inadequate to its task (page 91). 

The breadth of neuroscience subjects the book covers seems inexhaustible. Such subjects include hemineglect; mirror agnosia or ‘the looking glass syndrome’; somatoparaphrenia or the ‘denial of ownership of one’s own body parts’; Capgras delusion or impostor syndrome; Cotard syndrome or death delusion; Fregoli syndrome or delusion of ‘seeing the same person everywhere’; psudocyesis or phantom pregnancy; and Couvade syndrome or sympathetic pregnancy (pages 117,124, 131, 159-162, 167, 171, and 214-218). The author explained his false alarm theory of humour and supplemented this with a detailed discussion of pathological laughter and pain asymbolia (pages 199-208). In the chapter title ‘God and the limbic system‘, he tackled subjects which he admitted were in the ‘twilight zone’ of neurology; these include creativity, the genius of savants, and the basis of religious experiences (pages 188-198). Some of the author’s ideas do push the limits, such as when he muses about the human body itself being a phantom that the brain has ‘temporarily constructed purely for convenience’, and when he speculated whether ‘there is in fact another being inside you that goes about his or her business without your knowledge or awareness’ (pages 58 and 84). 

The book makes many references to eminent neuroscientists and their remarkable contributions to the understanding of the brain. These include Anton Babinski on anosognosia or unawareness of illness; Sigmund Frued on the psychological defenses: denial, rationalisation, reaction formation, repression, humour and projection; Michael Persinger, James Papez and Paul Broca on the role of the limbic system in pleasure and religious experience; Wilder Penfield on the mapping of the somatosensory homonculus; and Larry Weiskrantz on blindsight (pages 128, 152-155, 175-180, 24-27, and 75-76). The book also explored other non-medical concepts such as the theory of evolution and of continental drift.

Opinion

This is a riveting look at how the brain works, and it explores several curious neurological phenomena. Using inspired experiments, the author demonstrates how the human mind creates a map of the body, and how this map adjusts to accommodate bodily injuries. The cases he discussed are profoundly striking, and his down-to-earth approach exceedingly refreshing. The book blends neurology with psychology, and draws from a wide range of specialisms such as philosophy, history, and science. The narrative in some places drifts towards speculation and philosophical musings, but this is something the author clearly makes no apologies for.

Overall assessment

This book is an enlightening look at the brain and a gem of neurological cases. It is a window into the human psyche and it is excellently written. The author inspires doctors to look for opportunities to make key observations or landmark breakthroughs in their day-to-day practice, and I highly recommend it.

Book details

Publisher, Place, Date: Harper Perennial, London, 2005
Number of chapters: 12
Number of pages: 328
ISBN: 978-1-85702-895-9
Price: £9.31
Star rating: 5