SCIENCE en q PHANTOMS IN THE BRAIN This a splendid VS. RAMACHANDRAN, M.D., PH.D., AND SANDRA BLAKESLEE VS. RaMAcraNoRaN, MD. PAD. of California, San opal Seuies in La Jolla. Named important people to watch in the FOREWORD BY OLIVER SACKS, M.D PROBING Sata hayes Ont) Marriage. Shelves in Santa Fe, New Me fo) muases PROVEN IED DD (NN thCHAPTER 1 The Phantom Within (fall es eee ores [lem sf ey A man weising an enormous bejeweled cross dangling on god chain ‘sin ny ofr, cling me about his conversations with God, the "real ‘meaning of the cosmos and the deeper tt behind al surice appear ances. The univer i safle with spttal messages, he a, yOu jus allow yours to rane in. I glance at his medial cart, noting that fhe has salered fom eripoal lobe epilepsy sine early alesence, and that i when "God began talking” to him, Do hs eigow expences Jane anything to do with bis tempor lobe siure “Anam alt les am ina motor accident ba conics to fel 3 "phantom arm” wth vivid sensations of motement. He can ‘wave the mining am in id, “toc” things and even reach and “rab” coffe cup. IFT pl the cup away fom hin sudden he ylps in pin, “Ouch! I can fc being wrenched om my agers," he as, 120 / Phanvous 18 THE BRATS [Avourse developed lage blind spt in her eld of von, which is woubling enough But to her dismay she offen secs cartoon characters ‘orang within the bind spor tae When she looks at me seated cross {dom he, she ses Buge Bunny ia my lp, or Emer Fudd or the Road annes, Or somesimes she ses eatoon versions of real people she's always known. wy cootcacher sre» stroke that paralyzed the lef sie of her bod bat abe ini that her Rt arm is a paralyzed. Once, when T See ace ehose amas hing the bed nex to he, se explained hat the limb belong tober brother “albranan fom Pada who ha diferent Kind of stoke began to hgh uncontrollably. This went on fora fll day, wl she erally tied aushing. “Kn ten ere is Anhur, a young man who sustained teil head injury ivan automobile cash and oom aerward chimed that his father TTR anther had been replaced by dupicaes who looked exact lik is | purent He recognized thei fces bat they seemed of, wnfamiiar ‘Tnclonly way Arthur could make any sense out ofthe situation was 0 tisume tha his parent wer impostor ‘Non of these peope crazy" sending them to pyc would be hme oftime. Rather cach them ses fom damage 13 speci pt ofthe bran that lends to bizare but highly characteristic changes Tetchavor They hear voices, fet missing limbs, se things that noone does deny the obvious and make wo, extaoeinary claims about ‘ther people and the world we al ven. Yer forthe mow part hey are fed, foal and no more insane shan you oI. Altougl enigmatic sondes ke thee ave inigued and perplexed phoscans tcoughout history they ae wally chalked up cuiosties— rare stale ico deer abled le and forget.” Mest new ‘Ribgns ho tret such patients are not parulty Interested in ex Thing these oad behavior. Their goal so alia symptoms and Puke people well apuin, not necessary co dig deper of 0 am how (pe bein mks, Puehinits offen snvent a hoc theories for curious ‘Jahon a fa lea condition eequtes an equally bare explana cee Dad spams are blamed on the patents upbsinging (at ‘hughes om childhood) or ven onthe pasen's mother (a ba mur wees Phntoa te Bruin takes the opposite viewpoint. These pu tent, whone res you wil hearin detail, are our guides int dhe inner tte ofthe human brain--youre and mine. Far from bing cus cite syndeomesilastrate fundamental principles of how the normal Tue Puawrom Wirwiw / 3 human mind nd in wrk sling ght ome mare ft im se nga hr a, oo sn wh le tien mates Hine you ce weadre y ome es ay cnr a noth you snaps cued en youth oy Souci wo dein Go why yo ac fn wo pris soca sno 1 te ket tome of oe quinn Ince by siching thse pats, we cn nen ade ty po. dope” quedonesout te nae ofthe scl Why do you cadre 2 tee person trough san and me sad what ng sb he ade, ef in eps! Wd men aes che towian ston Ad more general, how doth acy oy ‘of protoplasm in the brain lead to conscious experience? aemanee Filo lone t dete quero ike tac xt ony now scroming er tha chines can eed eerincaly. By monn thse ps oto tec andno he brsto, ec cond “cnet hat ep eel he ep archer os rnd Secon pop wi Fea of ng wh mg aed scr of experientl epee i how he rain ep se tntlge ind bc) sn cpa cep ens Berwcen mental and physic ors of he Wr), and sa erper renin on beet sytem, coines, mindy inaction and (ther hier of human tear Tele that Being medal en nt al ht difiens ome gash nn Io teed eth my thar hrs te het ofall wire pts and wpe chance tease main ning dtd oa awe mind ach oy begins with cher an account of pale dplyng ening ince {NC ympeome or boat queso abou human are such hy ‘te laugh or why wea 9 prone secon. We ten go sep ‘ep though the sme sqene fest owe nyo 221 ead woe tac cc In some nance, a ith puto ib ican chim ro hive gency ned the mtr era the ‘Sac on Cc th al ner tems case cen hough we ome stingy ow bu wc tc sc ced or Reet {ey the op of eect aes that compart prs ad tate neatly the most cing of din. Av Shock Holes old Waton, “The game aoe” Comer he ef Ar wh chogh hs pets wring Most pss would be teed 0 cola ta he as ae,40 Prasroms IN THE BRATS this pe of dis and, ined, that is the most common explanation fo this 9p Rika found in many textbooks Bat, By simply showing him photo toa of ifeene pope and meaung the een 0 whic Bes ng (asing 2 oie sar tothe he detector et) 1 was abe co re out exactly wha ad gone wrong in bean (ce chaser9). Tht ‘eecoring theme in ths book: We begin with ae of snproms that ‘com hee and ncompechesle and shen end opt es i 305 Te ih an intlecrany sctfhing account i ers ofthe acu ‘Gieuay inthe patent Brain. And in doing 0, we ave often not only “Ghconced something ew about how the bain works bu smultancosty honed the door toa whole new dection of esearch acre mani npr ou ound ny eet alappont we ience and why {am dawn ocariogs ses, When {preety sens ound the omy, oe guston ome cere ee ein shen ae you bran scents eer Eng COE se inde theory for bow the mind wok? Ther’ Hist’ ener Te cay and Neweons univer aw of grsston in psc ‘Wy nor oe forthe bain” yar iar we oxy ate ag wer we cn frat Mt theories of ind a bri. Every sense his 10 80 ‘Foti a nal eaperment” or phenomena-dvenat-—in which {epeeoer a stl dcovering the base Lvs —befe reaches 2 resented ther diven sage, Conse the eon of eas ca esa magactam. Akhough peopl had vagte tons Ro Unione and'magoco for conve and wed hem ork for whe compe the Victorian pe Michael Furay was he it nly snngnet tenancy He two wer simple experiments wt ‘eimtthine eke, In one experinentstich any chook ane seers pi cd bar age hind shee of opt sil Peace om ings onthe re of he opr and fund that hey aay aligned hemscles log te magetc Hoes of re (8 POTN time anyone fa demons the exitence of els Wisma in th second experiment, Fray moved ar magnet to se ee in eer oft cl of wiry and, 10 and behold ation eel an lets cent i the wire These informal demonte see ths Bonk ful of exampc Fis soxt—had deep ic ay ele magne and lec for the is ine, Faraday’ aan epcaton of tee ee femsined qualita, bat exper Tae PHanrom Winnie / rents set the stage for James Clerk Manvel’ famous electromagnetic wave equations several decades hter—the mathematical formals that foxm the bass of ll moder physic, ‘My pine is simply that neuronience today is inthe Faraday sag, notin the Manel ge, and tere so point in trying to jump ahead would love to be proved wrong, of coun, and thee is crtinly no har in uving to constact formal theories abou the brain ven if one ‘als (and there ino shoctage of people who ae tying) Bit forme, the best research statepy might be characterized a “tikering” Whenever [use this word, many people look rather shocked, a fone could't possibly do sophisticated science by jus playing around with ideas and ‘without an overarching theory to ide ots hunches. But that's exactly ‘what Tmean (although thee hunches ae far fom random; they are ays guided by into). ‘Pee been iteened in cence along a can remember. When Twas ight oe nine years od, sarted collecting fis and sesh, becoming ‘bsesed with taxonomy and evolution. A lite later | setup a smal ‘emis lab under the stairway in our house and enjoyed watching on Slings "ia" im hydrochloric aid and iteing to the hydrogen “pop” when I set re wo st (The eo displaced the Hoge from the hyo Chlocc acid to form ion ehloie and hyogen.) The ides that yo ould leam so much from a simple experiment and that everything in the universe is based on sich interactions wis fining. Tremember that when a teacher tld me about Faraday simple experiments, 1 wat intrigued by the notion that you could accomplish so much wth o litle ‘These experiences let me with a permanent distaste for cy equipment and the realization that you don neces need complicated machines to generate sientic revolutions; ll you need are some good hunches? [Another peresesteakof mine that ve away been dn to the ‘excepion eater than to the rule in every scence that Ive ste. In igh schoo I wondered why iodine i he only element that tums fom 2 Sold to vapor directly when hested, without fst melting ad gn through a liquid stage. Why docs Saturn have rings and not the other planet Why does water alone expand When i euras oe, whereas every ‘ther guid shrinks when isles? Why do some animals a have Se? Why can tadpoles regener los ibs though anal frog anno? Isic because the tadpole younger, o is i because ts 2 eadpoie? What ‘would happen if you delayed metamorphosis by blocking the action of| {yroid hormones (you could puta fw deope of tiourc into the guar) so that you ended up with 2 very old tadpole? Would the6 / PuawroMs 1x THE BRAIN irc tadpole beable 1 regenerate a misng mb? (AS a schoolboy nae ume fcbe atempe to anger thi, but, 20 my knowledge, we Adon’ know the anger eve 0 this da)" ‘Ofcourse, looking at such odd cases snot he only way—or even the best way doing science slo of fan bu i's not eveyone’ cup Chace Buritsan escent that as remained with me nce childhood, Sat fonatelyT hae been blero ara i ino an advantage, Cliieal ‘earolgy, i pauls, sul of sch example hat have Been ignored by the “establishment” because they don't realy received wisdom. f Rive liconered, omy delight, that many’ of them are diamonds in the rough Tor cxample, those who are suspcious of the claims of mind-body medicine shoul consider alle personality disorders Some cnans ‘Sy thar patients an acualy "change" their eye sce whes assuming “Herne peronss—a nearsighted perio becomes farsighted abiveeyed perm Hecomes brown-yed-—oF that dhe patient's blood chemistry Efanges along with pesonality (high blood glucose level with one and ‘Soemat gia level with another), There ae abo ease descriptions of| people's hi earning white, ely overight ater a severe pycholog atshock and of pws nun” developing stigmata cn cei palms ine he union wth Jesus. find it surprising eat despite three decades of| Tscarch, we ie not even sure whether these phenomena are rel oF ‘opus Given al the bint that there s something iterexing going on, ep not emamine these chime in greater deta? Are they ike alien ab Utction and spoon bending o are they genuine anomalis—IkeX ays fr bacterial transformation’ that may someday deve paradigm shifts nt scenic revetons Twas penonaly dawn into medicine, 2 dspline fll f ambiguities, because fs Sherlock Holmes tle of inguiry gay appealed to me Diagnosing 2 paven’ problem rains as much ah a 38 a siete, Calin ino play poe oberon, eas andl he human senses T recall one profewor, Dr. KV. Thinwengadar, instructing How to identify eseve by ast smling the patent—the unmistakable swesth ‘hl posh breath of dabeie Hers the fehly baked bread odor of ‘phe ve, thestal-bee stench of cof che newly plucked chicken {eathers atoma of rel the foul smell fa hung abscess and the a tmoniate Winder oor ofa paint i ver fae (And today a psi trlan might ad the grape juice smell of Padomonas infection i Children and the sweater sll of soaerie acidemia.) Inspect the Singers carefily, Dr Thirwvengadam told us, because a sll change in THe Has fom Wernttx / 7 the angle ewcen the mile andthe Sgr cn ald he sto satu lng cnc lng ttre more omic gn me emetic grceng conyers anyon the op ‘tng Bla the argcen removes the cnc, bt even fo th iy, Shure no ea why iocus Anobe xe of min» poor ot ‘erly, wold inst om aurdagrosng Paki’ dese wth at ‘ecb syeing otheptn onp pet wth SE eke a chscrr sfing gai) Ths deectele apet ‘cin edn hing ae in thi = igh sech medina ‘panel sedi my mid By ccf in. eingouchng oc yes ren neling the tet one Cn ave st reo a Son nd merle ibrtory te 0 confirm wit sendy Ee Final hen sing and eng pte en te pa’ ty sips tnt hms "hat docs ee ho ben the poe “vn if were tm In ing th tae never ceed to eared zh courage ud fide of ay of my paseo by eB at ona wiped ican omen earch» pens and new meting Fe th eon, eventhough many fhe cn ks You wl he ae tinged itr cy chy fen they ne neo EE champh of the taman pct ont sven, nd het arg coder of pina For eam, oe pater ats erg fram New Yorke a he geo ty waned epg its vcue ing Gow fe ight tempo be. Tie es ve tring. of court hs anarent and phe ound hime tecoming finely poe. fr the itn nis He Tn fhe tcgantnkng vere, pring voles toe time He sso ha och pct vow ge Bi a ow ene on i Gh ae it when fe wat sing to fla uk Bos flow fom it inl tha al oe ae fd port as many new ae gS ‘nis uer Do we cath hve at sapped pretal or eau wee {ntryme hidden nth ces our ight here there iy ony enn eke is be shy ew fang met Before we meet the patents, cack mysteries nd speculate about brain organization, lite to take you ona dor guided vou of the human bein. These anatomical signposts, which I promis to Kep simple, wil help you understand the many new explanations for why neuralgia patients atthe way they do W's almost a che these days to saytha the human brain is the most8 / PHANTOMS IN THE BRAIN complet organize fem of materia the nies ar thereat sae en I you sip say svn of bein, fm te Sloe nee mcr and pe ade ae Sst tha composed of heron o ere ele SRE i ofthe nero ten, where information i a Arr the epi tn protaly contains ver ne handed {te nos, whose number slow diminishes wth Meee pars el body and fers af howsans fy ranches cated aon, whch receae mfoemaon fom other ners. Each sc as primary non (2 projeion chat can tel Hog ds a en sein cout Othe cl arn tom trials {ercommunicon with ote el. Ta a a gue 1, you noice that neurons make cones wi enero a poins llednynapes, Each neroa makes any sects mound to tem thowndsjapes with ter news. Wes Sot eer on ore exon or nb That some cum onthe jc oir ings op, wheres oes eles jes Seng dwn, an ongoing dance of aggesog complex ie aE yu ban the sine of gn of sand woul! conan one Fe rns nears, evo nln sons and one lion sures A her Gen toe en en aad eae pombe brain sater=te number of pemutscons and arama of acy Unc are tore poseesceds the sane cary parses nthe ave: Given thi compe ‘THe PHANTOM Wits / 9 ic 12 Gn nto oman rt, oS i of te Impetus, tpn and etal The ‘rat etd fr the pera a eral rand nds rm oF ‘found te spr am separa the ina ri lure) Sine we of mic er cnn om i (et) ed hsm ee) te made Te ope elec gr {ht mee () Sion het hope of the bas Ned do tae ‘Ramachandran by ad) redeem Ze 1998 how do we begin to unestand dhe functions ofthe brain? Obvious, understanding the fracture of the nervous tem sil to understand ing its funcion*—and oI wil bein with abi vary ofthe anatomy ‘ofthe bain, which, for our purposes here, begins a the top of the pial ‘ond, This rion, called the meds oblongata, connects the spinal cord fo the brain and contains casters of cele or null that contol cal Functions ike bod prenire, hear at and breathing The medals com ects to the pons (akin of bulge), which sen bers into the cerebel fm, a ft sizedstructore atthe back ofthe rin that hepe you carry tout coordinated movements. Atop these are the exo enormous cereal Iemisphres—the fan walt shaped habs of the Baim. Each half i dived ino four loder font, temporal, pavital and oxcptl—that you wil learn much more about incoming chapters (Figure 1.2), “ch hemiphere contol the movement ofthe mies or example, ‘hose in your arm and leg) on the opposite sie of your body. Your right ‘ia makes your let arm wave and your le brain allows your ight le10 / PuastoMs 18 THE BRAIN to ck s al. The two hes of he ein connected 2 Ban of ae ke cos ellos. cnt band i eat, te 0 des vee Sanger commaniate te ress ayaome that oy eh Se eae Sera asin copion. The outer pat of ech He see es composed of ere core: si, conoid sh fel week har iscrnched to gs and farows ks olilower hd packed desl ie he sl ‘ais ceer of he rain ac he wo than. The hin i heath 0 be conay me pie than the cers cone and when dere cy aor” cue allem feraion 2 ach pes dough before reaching the one col mane IeeTSS Kec he hams athe cones ae roe sc lle ree win mame he putamen and austen) Fal, See Thor othe tame he Hyodbalamas, which seems 0 Be auninad wth regulating mceabobc ncn, homane prostin, SSaTsanue tsi esac agazesion, ay nd xl Sree smi cs ave been not fr og in, bat we a dear eso ow he ban ora Many de thoi fino nee ee tapecmexlany at hoard the penal bat STeag Eat teenen hs oo eee poms ven the eye NT med yeas Arone end of the spect are modi, Ueber rent prs of the bra are high speci Or lnc Thus ees moe forgo, ne fr eo, mere ig ne for fe ogntn and me oe fe sreee ine cheat acon ey ange, te models oF Sere tet autonomous, ach docs town jo, st of com SEOO EAB ccint mene » bce rate —pases up inode ne, no “aking” mich fer exons Rr de oder end of te specu we have “hols,” » hort appouch teers with what hee dy aed “connection * Fee top ares ta he Bran anc a whole a Tee nc pur go many oer part. The hls vew de nic yy he tte many ne, epee rpm, cn Be se forme Even connected to vein ch, eR lta and wo the ea for dtint modules ia wate fine Ss stn psn spate hat these te pine ew ae on tay ccna he bran dyn ctr hte iy bach nnd ina marcy compere. The gander ae rea prea sae oa when we Xe all he posses conc Reng the venetian C0 al ino polasized cmp Tue PuaNtom WirHiN / 11 Ask whether a given funtion is Iclzed or aot localized” As we shall See, i's much more user tacle each problem ast comes along and or get bung up taking ide "Ech view i ts extreme form is infact ater absurd. Asan analogy, suppose you ae watching the program Raymatchon television. Where aynaih localized? Ts icin the phosphor glowing onthe TV screen in the dancing electrons inside the cathode-ray tube? Is in the rr ‘magnedic waves being wansmited Uough at? Ori itn the clot fim or video tape in thesia fom which the show is ing tans ted? Or enybe its inthe camera that's looking at the ators in he seme? "Mot people recognize right aay tht thi is meanings question, You mighe Be tempted to conciae therefore that Baywatch not Io calze (there no Baywatch “module”) in any one pace—that it per ‘eats the whole universe—but that, t00, is absurd. For we know tu localized onthe moon or in my pet cat orn the chai Pm siting fon (even though sore of the electromag wares may rach these locations). Clealy the phosphor, the cathode-y tbe, the ecromag netic waves andthe celluloid or tape ae allmuch more dec involved {hi scenario we call Baywatch than the moon, 3 hai or my et This example states thar once you understand what tevison program reali the question “Is i loi not laze?” recedes {uo the background, replaced with the question "How does work” Bur is ao clear that tookiag tthe cthode-ay tube and electron gun ‘may eventually give you hints about how the tleiion sc works and chs up the Baywatch program a i aed, whereas eamiing the ‘Shir you ae sting on never wil So ocalzaton is nota bad plac 10 stare, 0 long as we avoid the pitll of thinking that it holds all she So iis with many of the curently debated issues concerning brain faction. 1 langage localized I colo vision? Laughter? Once we ws derstand these functions better, the question of where” becomes lest Imporane than the queston of “how.” Ast now stands, «wealth of fempicl evidence support the idea thar there are indeed specialized farts or modules ofthe brain for various mental expats. Bu the real fecrec to understanding the brain es nr nly in uneven the sacar and faction of each module but in discovering how they interact with {ach ater to generat the whole spectrum of ales that me cal aman ler ix where the patients with bizarre acurologiclconons come imo the picure. Like the anomalous behavior of the dog that dl not12 / PHANTOMS IN THE BRAIN turk when the crime wat being committed providing Sherlock Holmes aa ae aco who might have entered the house onthe night ofthe a ce eld Behavior of thee patents can lp us sols he myaery ers parts of the bran create 2 us represenaton of the ce td and genette the ison ofa "sl" hat endures in Pass ad time “To help you get el for this way of dong scence, consider these coer a Set de lesions drawn fom them—taken frm che oder euroogicl eer, ity eas ago a middle-aged woman walked into the le one Satine,» worl-enowned neurologist with Ken diagnostic eee Tyc woman appeared norma and convened Buen indeed. pot seis Truly wrong th her, Bu he bad one exon com var ee Son ow and then Bere and wou By up 0 Be hoa 2nd at Gung et She ote had o we er ght Rando wrest he a ec conte, pushing it down to het aide—much Eke Peter eat ceaing Dr. Srngelove. She somtimes even had osc on the sercttows hand, so inten aston ying to ere i Siang, dh womans primary physician decided se was men ath see or bytes and en ert cera poychitis fr teat La ee pc auld help she was dispatched co De. Goldstein, a ene pain for dagtosing dificul aes, Aer Goldstein ex iho her fe eased to hie station thar she was noe protic aon cred er hyena She Rad no obvious neurologic des ay tyr or cxggerated rns. But he soon came op ith an Balada for ber behavior ke you atid me, the woman Bad oe srr tre cach of whichis speciale for diferent mental sre and conte naerents.on the oposite sie ofthe bos. The cara ice ae connected by a band of ib ald the corpus eas he two ses to commoniate and say “in 6” eee oF ou, this woman's right Remisphere (which £m aa aes le and) cee o have some ate sual tendencies 2 wo ge ot nl nal hse res aye een Bed Fe eBeagcs™—innbicoryenesmges sent acros the compos calls Sc oe ational let hemisphere. Bur ia had suffer as Gold sea roe, damage to the coxpus callosum asthe rss of 2 aks ei at would be renewed, The ight sie of her bran an is waa eros et hand were now eto temp to strane he. ‘Tue PHANTOM Wires / 13 “Ths explaton sot fr col ace ine been well norm me ne nthe igh emp be ea ona ee han i rans wb ne sok ea Ire ten ano depend or mo shat ther prec for er pT season sens to bet wh he et ined th he Rin let oe a et shoe sing In con ope a fe damage tote sh hep ed obey nics Seo pecan Tee pir fs do etal a op te (Merson tts Chae 7) Whe cnr Sno mo Ne weed scene ton or oon se Ste ie woman eda Sy, pohly om cod ook (on nn om srnging Nene. ‘tras conte Glin’ peso: ro er Stangoean chao ie hn fled 2 mae ot nh ope ea 0 thr he to fr ten couldn “re a ck cn deed a of is ancion, ring tha So nigh se ned pe {for different tasks. * es Sn Gomis ne the singe a of ning, meting We al doo dyn scala You tt» god fc a you gi. Bat what iSpy nen hat cd in nena you fot ae a ou Son commant ned os ant apn You prod a {un pace, Pandey, a ot a jou prs eric ons Se each dy ocoes xen i petem when crane ml a ou wo do Tou might hk is Kes of Saranrcn Bit ca be he smer hea if yu na nt tar mirr ca ry ming Ts yo tha ttm ps lp “The sexs thet tuo Kinds of ames eri hat dient brain scons hand them, sal only on hc onan pied “se “Set” A spmtncou tle is poduced y the bs angi, cen cals und tence the bas higher Cex (where eng and eng ie pi) se ney lr amas Wh yo Treo edly ft, the vial menage rm hat face cena troche te brs ocala bbc sc ae seen tryed tothe ts eangla, which cchexte the nguenct ffi trace actiny meee for pding ntl aie When this et acc your sme pene Te ent ead eens one in moton, hope in 2 faction of sond without he ning pars ‘of your cortex ever being involved. me14 / Puawroms 1 Tite BRAIN ‘But what happens wen someone asks you tse while taking your photograph The verbal insrtion fom the photographer i received tnd understood by the higher tisking centers in the bri, inlading the auditory core and language centers. From there i relayed tothe motor cores inthe front ofthe brain, which specializes in prodacing ‘olen shld movement, lke playing » piano or combing your hat Despite appaten simpli, sang valves the cael orchestration of dozens of tny muscles inthe appropriate sequence. As fara te motor ones Gehich i not specialized Tor generating natal smiles) i con eared hiss comple eta plying Rachmaninof though ic never Thad Tewons, and therfore it fai uty. Your smile is forced tight semnaru vidence for wo diferent “nile ict comes rom brain-damaged pints When» person sere stoke ia the right motor corex—the {pcciized brain fegon that Helps orchesrate complex movements on the left ie of the boay—peoblems crop up on the let Asked osm, the patient proce that forced, nesta gn, but now i's even more hideous i shall smile onthe right se ofthe face alone, Bat when this sume patient ses bowed fend or lative walkthrough the door, he face erupt into a Boa, natarl sue wing both sides oF the mous tru face. The ean i that er bas gang ave or ben damage by te stoke 0 the spect ect for aking symmetrical sess ita” "Very acy, one encounters patent who has apparently had sal stroke, wich neither enor anyone else nies unt e res o mie All ofa sudden, his loved ones ar astonished tose that only one half Of his face nning. And yet when the neurologist instruct him to Sie, hepeeduces 2 symmetial albeit natural gria—the exact con {se of the previous pate. Thi fellow tars oat, had tiny stroke that only affected his baal ganglia selectively on one se of the bn “awning provides further proof for specialized cicuuy. AS noted, many stoke vicims ae pase on the ight of seo their ods, “pending on whore the brain injury occurs. Voluntary movements on the opposte side are permanatly gone. And yet when sucha paint {wns he suetches both am spontaneously. Mach to his amaze nent, his paayaed arm siden spins to lie! Tt docs so becase « Circa bain pathway conto the arm movement dung the yawn— {pathway closely linked tothe respiratory enters in the Bra tem, ‘Sometimes ny brain lesion damage ta mere speck of cells among, tillons ean produce far-reaching problems that seem grossly out of proportion to the sizeof the injury. For example, you may think tat ‘THe PHawrom WitHiN / 15 memory inves the entire brain. When Tsay the word ose" it evokes I sora of asocinons:peshps images of rose garden, the fist ime Someone ever gave you # rose the sell, the softness of petals» persion famed! Rose pd 50 on. Even the simpie concept of “ose has many Fat sssocitons suggesting tht the whole brain must surely be involved {laying down every memory te Bt the unfortunate story of patient known as H.ML sugges oth cervse? Beease H.M. suffered fom & paiculay intractable form of ilps, his donors cided to remove ick tise from both ies of Hs bran, inclading two ny seahorse shaped stacares (one on each Sie) cad the hippocampus, a stratore eat contos the yng down ff new memories, We only Know this becuse after the surgery, H.M. ould no longer form new memories, yet he could eal everything that Inappened before the operon. Doctors now tet the hippocampus with, irener resect and would never knowingly remove i fom both ides of the bein (Figure 13) “Although Ihave never worked decay with HM, Ihave olen ses pints wth similar Forms of amnesia esling fo chronic alcool Erle (omgen starvation in the bain following surgery). Taking 0 hems an ancy experience. For example, when T zee the patent, he seems intelgent and anticulae, alls orally and may even discuss Plosophy with me. LT sk him toad or suber, he can do so without trouble. He's noc emotionally o pchologicalydscured an can ds ‘sis iy and thei various acts with xe. “Phen T excuse myself to go 0 the reseoom, When I come back, these isnot a gimmer of recogaon, no hin Gat he's ever seen me before in is ie "De you remember who Tam?" ee 1 show him a pen, “What shi ounain pen” “via coor 30" ae {pur the pen under 2 pillow om 3 nesthy chai and ask him, id Tjust do" te answers prompey, “You put the pen under that pillow.” ‘hen I chat some more, perhaps asking about his fay. One inte ‘goes by and I ak, “I Jas showed you Something. Do you remember whet a" He looks puzzled. "No, hat16 / Puawrous 16 rite BRAws Figure 1.3. Arti nadeing of bran with hotrod carccrndered Wien he ude, and ivr ben i and thse are dtr oes bs gang fe een) bd theft pr of eter ira of mab ons ond miriam! ote ipa bee ‘Do yu remember tha I showed you an object? Do you remember where I put it -No." He has absolutly ‘Such pti are, nef, zen inte in the sense dey remember recollection of my hiding the pen sey Tue Panton Wernis / 17 only events thut rok place before the acide that injured thee new tology. Thy may real thee ist baseball game, is dat and ole {raduation in elaborate deta, but nothing after the injury seems to Be FReonded For example, pow acide thy come upon st weeks news popes they read i every day av if were a brandnew paper each ime “They can ead a detective nove again and again, each Hime exjving the plot and dhe arprie ending, Tan tell them the same joke bala dozen times and each time I come ro the panch lise, ehey laugh Rear 2c tualy my graduate siden do this 00) “Those patent are tling us somthing very imporent—that a day brain strate alle the hippocampi absotely ial for bing down ‘ew memory tact inthe brain (even though the actual memory traces fe nor sored in the hippocampus). They ilusrate the power ofthe modular approach in elping to narow the cope of nguiy, you wane fo understand memory, look 3 the hippocampus. Al yet, a we shall see, stihing the hippocimpas alone wil never explain al aspects of tmeinony. To understand how memories are retrieved a2 moments n> tice, how they ate edited, pigeonhole (sometimes even censored), we ee to lok st how the hippocampus interacts with other brn ste {ures ach a dhe froma fe, the limbic stem (concered with emo {ns} and the structures in the brainstem (which allow you eo attend selectively o specie memories). The role of he hippocampus informing, memories is cleay estab lsh, but ae there brn region specazed in move esoteric ables like the “number sens” that unigueto humans? Noe long ago Y met 2 genteman, Bill Marl, who ad seed a sroke 2 week cater, CCheerfl and om his way 10 recovery, he was ony too happy to discuss his ie and medical condition. When Late him to tll me about his family, he names each of his chldren, lined thir occupations and gave ‘many deta about his grandchildren. He ws fsa, eligent and a ‘eulite—and not everyone i 50 000 fer a sre ‘What was your occupation?” Taked il Bil replied,“ we o bean A Force pt “What kind of plane id you Oy He named the plane and sid, “Te was the fastest man-made thing on this planet at that ime.” Then he tld me how fst ew and sa hat it had been made before the introduction of engines. ‘At one point I asd, “Okay, Bl can you sobre seven from one hundred Wat's one hundred mines seven? "He sad, “Oh, One hundred minis seven?”18 / PHAWTOMS IN THLE BRAIN yeah.” mmm one hundred minus seven.” ‘rye one hundred minus seven.” sai Bil. "One hundred. You want mero ake avay seven from ‘one hundred. One hundred minus eve.” eee "Niney se" ane On." he sid. “Let's ty something ee, What's seventeen minus thee" “Seventeen mins thre? You knos Pm not very good a this Kind of thing.” id Bal Bil” Td is the answer ging o be a smaller number ora bigger umber?” "Oh a smaller number,” he sid showing that he Knew what sub 4° seventeen minus three” esi as T sureed wondering wheter Bil hada problem uadeesanding what 4 number fo the nature of number, Indeed, the question of numbers Iso and deep, going back o Pythagoras. asked him, "What i ify?” "Oh hat’ the langest mabe thee i” “Which number i bigger one hundred and one or ninety sven? He answered immediately: "One hundeed and one i ger.” cee ‘specame there are more digs.” ‘his ean that Bl sell understood, a least tacit, sophisticated merical concept ike place vale. Aso, eventhough he coulda subtract Chee fom seventeen, his anwcr wasn't completely absurd. He sid fwelves" ot sevent-ve or two Funded, inhi that he was sill, capable of making ballpark estimates. "Ten decied ol hi tle story: “The ober day a man walked inwo the new dinostor exhibit fll atthe American Museum of Natural story in New York ands huge skeleton on dplay. He wanted 10 Snow how old ics, 40 he went ep tan olf cursor sting in the Commer and suid" 9, ol chap, how of are these dinosaur bones” Ste curtor looked atthe man and sid “Oh chey'e sary milion and thee eats ol se? Sy milion and three years Od dda’ know you could get that Tue Paaxtom Wirmts / 19 rece with aging dino hones, What do you mean, sixy milion and three years ol" "Oh, well e sid, “they gave me this jo three years ago and at that time thy told me the bones wer sae malion years od" Bil lughed ot loud the punch ine. Obviously he understood fx more about nurbers than one might have gucted. Ie equi Sophis tiated mind wo understand that ok, given that ic involves what pos ‘phe al the “alley of misplaced concreteness.” T ened to Bll and asked, "Wel, why do you think has Fane?” ‘sve yut know," he sd the Teel of cca 8 appropiate” Bl understands the joke ar the idea ft, yet he ean suburact twee fom seventeen, Does this ean tha cach of sha number ceter Jn the sogion ofthe left anlar gyro (where B's stoke injury was Toxated) of our bran for adding, subricting, mutpyng and dividing? "hi not. But leat ths pion —the angular gprs somehow nee ‘eaury for numerical computational tis but & not needed for other Sts suchas short-term memory, inguage or humor. Nor, paradox ically et needed for understanding the namencalconcepsunderyng tsch computations, We do not yet know how this “arithmetic circast inthe angular gyrus works, but a least we now kno" where ro Took ‘Many patents, bike Bil, with dsclculia ao have an associated brain ison dled finger agnosia: They can no longer nate which finger the ‘neurologists ponting to or touching. Init a complete coincidence that both arthmene operations and finger naming occupy adjacent bein regions, or docs ive something todo with the fact that weal lear to count by using our fingers in early ehldbood? The observation that in some ofthese patients one function can be retained (naming Bags) Isle the other (adding and subtracting) is gone docsa’s negate the a fzument tha these two might be clnly linked and occupy the sme fratomical niche inthe bein. Tes posible, for instance, that te 660 Fantions ar aid down in close proximity and were dependent on each other during the lering phe, but in the aul each funtion can sur ‘re without the other. In other words, acid may need vo wigee his ‘rhe fingers sulbonsciotnly while counting, wheres you and T my ROC ‘eed to do so “These storia examples ad casestudies leaned rom my notes sup por the view tht speci cicuts a moles do ext nd we shall Encounter sever addtional example in this ook, But other equally Interesting questions remain and we'llexplore thee aswel How do the modules actualy work ad how do ey “alk to” eachother to generate20. / PHANTOMS IN THE BRAIN conscious experience? To what exten is allthis nicatecicuty inthe train innaey specie by your genes ort what extent i it acquired gradually asthe result of your early experiences, a an if interacts Sith the work? (This the ancent “nature venus narere™ debate, Ihc hau been going on for hundreds of years yet we bave barly {entched the sure in formolaing an answer) Even if eran eis fe hardwired from bi, docs follow tht they cannot be altered? How much ofthe adult rani modifiable? To nd out, t's meet Tom, ‘one ofthe Bist people who helped me explore these lnger questions CHAPTER & “Knowing Where to Scratch Ft mgd 1 on Sanne pr eatin, ‘sr mr cane "Torn Sorenson vividly recalls the horifing circumstances that led tothe Togs of his arm. He was diving home fom soccer practice, tired and hungry fom the exert, when a car ia the opposite Ine swerved in front of him Brakes squealed, Tom's car spun ou of contol and he was thvown fom the driver's seat ont the ice lane bordering the fceway. Is he was hurd through the ar, Tom looked back and sw chat his fan! was sil in the cary "sping the seat casion severed from his ‘by like a pro in Fredy Krueger hoor lm "As esl of hi gruesome mishap, Tom lst his ft arm just above the elbow. He wae seventeen Yea oi, with jas three months to go tnt igh schoo! graduation. Ih the week aflervard, eventhough he knew that his am was gone, Tom could sll fc ghostly presence teow the elbow, He could "each out” and “grab” objets that were within a22, / PHaNroMs IN THE Beats arms each, Indeed is phantom arm semed 9 be ale to do anything thatthe real arm would ave done automaticly, such as warding of bows, breaking flo patting his lite brother onthe back. Since Tom had bce lef-hande, his phantom would reach forthe reser when ‘oe the telephone rag. “Tom was noe eazy. Hisimpresion tat his mising am was stil thee isa ease example of a phantom limb—an arm or leg tha inges in efi the minds of patents long afer ithe ben loti an eset ‘or removed by a surgeon, Some wake up fom ancxbesa and ae in ‘redulous when old hat their arm had o be saree, becase they ll ‘vil ets presence. Only when they look under the shets do they ‘ome io the shocking realization thatthe ib is really gone. Moreover, Some of thee pens expenence exerting pin inthe phantom 2, hand or fingers, so much so that they contemplate suicide. The pain not only unrelenting i also unereatble; no one has the ogi idea ‘of how earns or how to deal with Asa physician Iwas aware that phantom Kinb pain poss 2 serous linia problem. Chronic pai in eal body part such ste joint aches ‘of atts or lower backache dificult enough fo tet, but how do {you teat pain ia a nonestene limb? As ascents, I was alo curious shout why the phenomenon occur in the fireplace: Why would aay penis in the patients mind long after had been remo Why doesnt ‘the mind simply accept the lve and "reshape the body image? To be sure, this docs happen in few patients, ut itll ake years or ecades. Why decades—Why aot jst a week or 2 ay? study of thi ‘Phenomenon, | realized, might not ony help us understand the question ‘of how the bain copes wth a sen and masve loss, but alvo help ‘dre the more fundamental debate over ature verct surcure—the ‘extent to which ur body image, 26 well other aspects of our minds, 2c Ind down by genes an the extent 10 which they are moxie by experience “The perience of sensation i ibs long aler amputation had been notice as fr back a che sixteenth century by the French surgcon Am broise Fare, and, not surprising, here isan elaborate folklore surround Ing this phenomenon. fier Lord Nelson lost his ght arm dar an sunsaccetfil aac on Santa Cruz de Tenet, he experienced compe. ling panwom lim pains, nclading the unmistakable semation of fingers igang inco his phantom pam. The emergence of these phew sens ‘on his missing mb led thes ond to procaim tat his phantoms was dec evidence for dhe extene ofthe tol.” For ian aem can “Kxowise Witenes To Sexarew"” / 23 cs afer is removed, why can't the whole person survive physical Snnition of the body? IC proof, Ld Nelson claimed, forthe ex fence ofthe spit lng afer thas east of its ate. “The eminent Padi ply Sas Wer Michel? fn eoined the ps “panto ib afer the Chl War. In hoe preantoe {fps gangrene wa common rest fn nd trons medi feed ts of howsnds of wounded sods Thoy tered hore trite phantoms sting of nw ron f sprain about wit Tight be cousing them, Weir Mic Reni ws so surpise by the Phenomenon tha he publ the few aie on the wet unde 3 FPcudonye in popularmapacine ced Lipo owe ee than x cing the cle foe hi collages that night have coed id fe publthed 2 potainal dial Journ Phantom, when yo thik about ate eather spooky phenomenon. Since Wet ich’ time there have been al Rind fspeclions ou phantoms, ang om the inet the clos. A rcely 2 itera yen agora pape inthe Canaan Jooral of Phar aed Thar phantom imps ae mercy he elt of wat hiking. The thors raved that the pent desperatly wants his arm ack and therefore ‘Spenencl 2 phanonr—in uch hese way thi peson may hae tearing dco ay creme “hoo erly decd pret ‘Ts egomene os we dal ec, er eons second sore popu explanation for phantoms i tht the Fayed ant cuevap nene eins Inthe snp (ncuron) ht gal Sipe he hand eto come famed an tated, hry ong tiger bran conten ito thik ta he mining ib sl ere “Though thee are a to many problems wath hs eve nation hey, tecue ifs simple and convenient explanation, most psn hing "Pare lterlyhudrdsof facinating ce se, which appear in the ede metic oun Some ofthe dened phomena ae ‘cn confirmed epeaey an ily ot fran explanation, whereas ‘hr sce ke rfc product of the writer's own imagination (Onc of ny voc abouts patent who sae experencing aid anc am soon fr smpstionnothing srs ofr ait ifaw weeks developed spel, gniingsenton inhi phantom ‘analy he waste puted by the aden emergees ofthese ne SSmsatons, but when he ned hs pycan wy thi as Rapening, he24 / PHANTOMS IN THE BRAIN doctor ide’ know and coulda’hep. Fly, out of curios, ‘se “Whatever happened to my am afer you removed 1 {Gueton,” replied the doctor, "you need! to ask the surgcon.” So the ‘Bow ced the surgeon, who sid, "Oh, we wualy snd the Hnbs to the morgue.” So the man called the morgue and asked, “What do you {So with amputated arms?” They replied, "We send them either v0 the incinerator o to pathology Unaaly we incinerate them “el, dl you do with this parca arr? With arm?” They looked at thei ecord and sid "You know, is funny We dein ‘Sherate it We sent patholo.” "The man called the pathology nb, “Where is my arm?” he asked again ‘They sd, "Well, we fad too many ams, so we just buen the tanden, ou Bind the hospital” "They took him to the gasden and showed him where the arm was tued, When he exhumed the found was crawling with maggoO tn cxcsimed, “Wel, maybe thas why Tm feeling hese bizare se ‘Shion in my arm" Soe took dhe fim and incinerated it. And fom {hat day on is phantom pain disappeared. ‘Sch stories ae fan to tell, expecaly around a campfire 2 igh, but they do very lie to dpl the ea mystery of phantom ims. Although pent with this syndrome have been studied extensively since the rum fe comry, here's been a tendency among pisiians to regard them SS enigmatic, clinal cuter and almost no experimental work has teen dane on them, One reason fo dhs that clinical newoogy his ‘Soc his been descriptive rather than an experimental science. New ‘Rlogits ofthe ineteemth and ary oeenith cenuses were astute ‘Sina observes and many valle lessons can be leaned from eaing their ee reports, Ody enough, however, they di not take the nex hwo step of doing experiments to diconer what might be going on {ene bra of these patents tei scence was Ansotelian rather than CGllean Ginen how immensely successl the experimental method has trem amon every other cence, ae high ewe imported ceo eurolgy? Tike owe pyians, 1 as inrgued by phantoms the very fst sme «encountered ther and have been pzzed by them ever since, In ad ‘sion to phantom aris and legr—vhich ae common among. 3m {ter ha ao encountered women with phantom breast fer raat {mauccomy and even patient witha phastom appendix: The char: {esc apamodic pain of appendicis cid not abate afer srg mova, so much so shat the patent refsed fo belive that the surgeon “Knowine Wine To SexateH™ / 25 had cuit ut! Asa medial ten, Iss at halle asthe pints themselves, andthe textbooks I onsued only deepened the mystery real about & patent who experenced phantom erections afer his penis fad been amputated, a woman with phantom menstal camps follow: {ng hyserectony, and 3 gerdeman who hada phastom nose and face After the trigeminal nerve innenating his ice had been severed in an seein "All these clinical experiences lay tucked away in my bran, dormant, ntl about si year ago, when my iteest was rekindled bya seme paper published in 1991 by Dr. Tims Pons ofthe Navonal Insts of [real apaper that propelled me ito a whole aew direction af esearch and eventually brought Tor into my laboratory But before 1 continue ‘th this part ofthe stony, we aed 0 look closely tte anatomy ofthe Train—particlry at how various body pars sch a Ems ae mapped fmt the cerebral somes, the gre convoluted mail on the surface of the brain This will help you understand what Dr. Tons covered and, inturn how phantom limbs emerge Of the many strange images that have remained with me fom my rel school days, peraps none i more vivid than that of the de Formed line man you sean igure 2.) raped across the surace ofthe {ercbrl corer scaled Penfield homunculus. The homencals is the arts’ whimsial depiction ofthe manner in which diferent points to the boxy surface ate mapped onto the srace ofthe brain—te go ‘esque deformed features are an atemp to indicate that cen body prt uch athe lip and ronguc are grossly overrepresented, “The map was drawn fog) information gleaned from fat human ‘bins. During the 1940s and 1950s, the brillant Canadian neurosur- igson Wider Ped performed extensive bri surges on patients un tks local anesthetic (there ae no pain receptors in he brain, even though | itisa mas of mere tise), Offa, mich ofthe brain was exposed during the operation and Peni size hs oppoetniy vo do experiments that fad never toon tried before. He stimulated specific repons of the pa ‘len brain wth an electrode and imply asked them what they fe ll end of semations imagen and even memories were ted by the ee trode and the arcs ofthe bain hat were respon could be mapped. “Among other things, Penfield found arrow sup runing fom top to bottom down both sides ofthe ran where his electrode produced Senstion localized in various pats ofthe body. Up atthe top of the bain inthe crevice tha separates the evo hemispheres, letra si ‘hon elite senstions inthe ger. Nearby stimuli evoked sense26. / Puantoms IN THE BRAIN Der 2 tt te ar ae hd ml a ia ie hoe core ieee cmt lantt col hat ued Sg ith re mined te ed yet chat henna, tions inthe fect. As Peni followed thi sip down fom the wp of ela he dicovered rea tha eve sessions fom the gs and ITS ee ad (ange eaion with very prominent represen ra tee bth ces he pe snd Sally he hors and vosebon ‘Phu uaa homoncals:* ath cle fom» gent dtoed selon ofthe boy om the rice of the bry wth the Shor pari inporan ling ap dprporoniy Is en Ese thc are oe wi the hs or withthe ge tke uP ares he ae inane wth he emie tank of he bo Thiet ntannsbly becuse your ian ger are highly sent Tae Ri caput of eye acrminaton, whecus your nk cerca Koei rein le cortical ce Fr the most ut Seana icy though ups down: The Kot epeented at he vee me) inc onsetchel a ae the bottom. However, op coe “Knowine Wine To Sexaen™ / 27 ‘raminason, you wll ce tha the map i noe entirely continuous. The fice & not near the neck, where it shouldbe, bat below the hand “The genial instead of boing between the thighs, are leated below the "Those acas can be mapped outwith even greater preision in other animals porary in monkey, The researcher ners long thin eee ‘made of ce or tungsten int the monkeys somatosensory cortex—the "ip of bain tise dexribed care If the needle tip comes tle right text tothe cel body of neuron ad if that neuron i ative, 3 Will generate ny eka trent that ae picked up by the nee electrode {Ent ampli, The signal an be displayed on an osciloscope, making posse to monitor the acuviy of tha neuron. or example iyo puta electro int the monkey's somatosensory ‘conten and tach the monkey of 3 specie part of ts body che ell will Fe. Each cell has is tertory onthe boy surfeit on smal patch tf skin, oo speak-to which traponds, Weel his the cls receptive fed. Amp ofthe entire body surface exis the rain, with each half fhe body mapped onto the oppoite side ofthe bran. While animals ae logical experimental subject in which to examine the detailed structure an function ofthe bras sensory regions, they have one obvious problen: Monkey can't talk, Therefore, they cant tel the esprimenter, a Pens patients could, what they ar eling. "Thus lage and important dimension lost when animal re wed 30 such experiments But despite this obvious imitation, 2 great deal can be leaned by doing the Fight Kinds of experimen For instance, as we'e noted, one important question conccrs nature versus nurtare Are these body maps fomthe surface ofthe brain Raed, or cn they change with experience as tre grow fom neworns to infancy, through adolescence and into ok {ge And even if the maps ae already dere at bith, to what exten cn ‘hey be molied i the ale” Tt ws these questions that prompted Tie Pons and his colegues to cibarh on their esearch, The satey was t0 record signal from the brain of monkeys who had undergone dor shiztomy-—a procedure in which all the nerve fibers caring sensor infomation fom one am inc the spinal card are compleey severed.” Eleven yar afer the su fen they anctetzed the animal, opened their sally and recorded from the somatosensory map. Since the monkey's paralyzed arm was not sending mesages to the etn, you would no exec 0 cord 2 Sig