Using hundreds of these operations, Penfield was able to create a cortical map of the “body in the brain.” In doing so, he discovered that the body is mapped within these strips of tissue in a familiar order, meaning body parts that are adjacent in real life were adjacent in the brain. So an area of the somatosensory cortex that provoked the sensation of touch on the upper leg would be close to an area of the brain that provoked the sensation of touch on the lower leg. This in turn would be next to an area responsible for the ankle, the foot, the toes and so on.
Penfield illustrated these body maps using what is now known as a homunculus—an image of a grotesquely squat man with extraordinarily large hands, fingers, lips and tongue. The homunculus is disfigured because it represents the size of the brain area devoted to a given body part—and each area is proportional not to the body part’s physical size, but to how richly innervated it is by muscles or sensory nerve endings. For instance, the sensory homunculus has disproportionately huge lips and hands because they are extremely sensitive to touch and therefore take up a lot of room in the brain. Areas such as the torso and upper arms are tiny on the homunculus because they have fewer nerve endings and therefore take up less room.
These maps are important in giving us a sense of what our body looks like and where each part of it is at any given moment. This may sound strange—perhaps you think you know what your body looks like because you can see it—but visual stimuli are not the only way you sense your body.
Close your eyes and stretch out your hand. Now touch your nose. You can do it despite not being able to see any of your body. And that’s because embedded within the brain is a model of what your body should look like—an internally generated image that scientists sometimes call our sense of bodily self. In order to create this image, Penfield’s motor and sensory maps work together with what’s called a proprioceptive map, which processes information about your joints and movements. These maps aren’t static—every second of the day they are being updated to give you a fluid sense of where your body is, what it feels like and what it is doing. If you start to put on weight, for instance, your visual sensations of a bulging midline and internal sensations from the skin and muscles both contribute to update your brain’s internal body schema. It’s not clear exactly where your final body image is produced, although there is some evidence to suggest that the superior parietal lobe is involved (stroke patients who damage this area sometimes fail to recognize their limbs as their own). What we do know is that when all these body maps are communicating with one another, it produces the feeling of owning a body that matches the physical reality. The problem is that sometimes this system goes awry, and that’s when we start to feel a little out of sorts.
Take, for example, the phantom limb—a phrase introduced in 1871 by the American neurologist Silas Weir Mitchell. People with a phantom limb experience an amputated limb as still present and sometimes painful. After Lord Nelson lost his right arm during the Battle of Santa Cruz de Tenerife he referred to the subsequent sensation of pain in his missing limb as “proof of the existence of the soul”—for if an arm can survive physical destruction, he said, then why not an entire person?
We now know that this is not proof of a soul, but of something else quite extraordinary—neural plasticity, or the brain’s ability to reshape itself throughout our life. When someone has their limb amputated, areas of the brain that once received input from the amputated limb are now neglected. The brain doesn’t like to waste precious real estate, so when one limb is erased, the rest of our body image quickly expands to take its place. This is why phantom limbs occur—brain areas that once processed touch to the arm, might now be taken over by neurons that process information about touch to the face. This can lead to the sensation that an amputated arm is being touched when in fact it is the face that is being touched.
Often these phantom limbs become painful; a phantom arm might feel like it is frozen or clenched in a fist. It’s likely that motor regions of the brain are still attempting to send commands to the missing limb but are getting nothing back. These mixed messages make it seem as if the phantom limb is paralyzed. A simple trick can help relieve this pain almost instantaneously. The person sits with a mirror between their remaining limb and their phantom limb. Looking in the mirror provides an exact replica of the limb where the phantom is felt. Unclenching the fist, or moving the real limb, gives the impression that the phantom limb is making the same action. In this way, people can soothe pain or even make their phantom limbs disappear altogether.
You don’t need to have lost a limb to discover what it’s like to incorporate a phantom limb into your body image. Take a blown-up rubber glove and two small brushes and place the rubber hand on the table in front of you. Conceal your own hand with a piece of wood or cardboard. Now get a friend to brush the rubber hand repeatedly at the same time as brushing your real hand. Once the illusion kicks in you should start to feel like the rubber hand belongs to you, and that you can feel the brushstrokes directly on it.
This is the most famous example of how easily our body image can be altered, but there are many others. In 2011, Vilayanur Ramachandran at the University of California and his colleagues wrote about a new condition that they called xenomelia, in which otherwise rational individuals are overcome with the desire to amputate a healthy limb. Ramachandran’s first subject was a twenty-nine-year-old man who recalled a strong desire to amputate his right leg from around the age of twelve. He said the leg made him feel “over-complete” and he simply wanted it gone. He readily acknowledged that these feelings were not normal. A month after first visiting Ramachandran, he poured dry ice over his lower leg, forcing surgeons to perform an amputation.
Many doctors claimed this was just a cry for attention or a result of psychological trauma from early exposure to an amputee. But Ramachandran argued that it was much more likely to have an identifiable biological mechanism in the brain.
“When we ask these patients to draw a line across their limb for where they wish it to be amputated, then ask them to draw it again a month later, the line is in the exact same place,” he told me at the time. “It was just too specific to be down to an obsession of some kind.”
To prove his point, he worked with the neuroscientist Paul McGeoch, also at the University of California, to analyze four people with xenomelia who wished to have one of their legs amputated. The experiment was simple: they scanned each patient’s brain while touching their legs.
The results were startling: When subjects were touched on their “normal” leg or above the line of amputation on their unwanted leg, there was a significant burst of activity in their right superior parietal lobe. When they were touched on their unwanted limb, activity in this area didn’t change. The team say that the right superior parietal lobe is an area of the brain that is ideally positioned to unify disparate sensory inputs to create a coherent sense of having a body. They propose that xenomelia occurs when someone finds themselves in the unnatural situation in which they can feel their limb being touched, but that sense of touch is not incorporated into their body image. The result is a desire to amputate the seemingly alien limb.10
Interestingly, something similar might explain why transgender people often feel at odds with their anatomy. Recently, Laura Case at the University of California and her colleagues recruited eight people who were anatomically female but identified as male with the strong desire to have male anatomy. They also recruited a group of non–trans women as a control. To find out if there were any significant differences in the way their brains processed information about sexualized body parts, Case and her team scanned each participant’s brain while they were tapped on the hand or breast. As you would expect, stimulation of the hand and breast caused the corresponding areas of the parietal lobe to light up with activity. But in the trans group this activity was significantly lower when their breast was touched compared with when their hand was.11
We have a chicken-and-egg problem with both these studies
—it’s impossible to tell whether the brain differences are a cause or a consequence of a lifetime’s aversion to a specific body part. Nevertheless, both experiments clearly demonstrate the importance of our internally generated body image, and specifically the parietal lobe, in helping us achieve that image. But can it also help to explain the presence of lycanthropy?
There’s one early sign that it might. In 1999, Hamdy came across a fifty-three-year-old patient who suffered from epilepsy and severe depression. For some time, she found it difficult to escape the belief that she had claws growing out of her feet. A brain scan showed a loss of tissue in one side of her parietal lobe. It was the first hint that, when people with lycanthropy report their bodies changing shape, they may be genuinely perceiving those feelings.
We also know that people with schizophrenia show a higher susceptibility to body illusions such as the rubber-hand trick mentioned earlier. Brain scans suggest that this might be explained by a stronger reliance on sensory information from vision and movement over weaker stored body representations. It could suggest that in some extreme cases a visual hallucination of claws or an animal’s face may be more easily incorporated into one’s sense of body image.
Unfortunately, Matar’s brain scans have not yet pinpointed any abnormalities. That’s not to say there aren’t any. Several doctors I have spoken to about the condition think that the unexplained nature of lycanthropy, as well as schizophrenia in general, might be revealed with better neuroimaging techniques with higher resolution than currently available.
“There are many hypotheses and partial solutions, but we need to scan more patients and do bigger studies before we can make any conclusions,” says Hamdy. “So for now we continue to treat Matar’s schizophrenia and hope that this also helps his belief that he can turn into a tiger.”
* * *
Back in Al Ain, Rafia comes into the room followed by Matar and three young doctors. During his cigarette break, she had learned that Matar’s mother was away with his sister in India. His sister had started to show signs of schizophrenia, and was being tested at a specialist hospital. Rafia seemed to think that Matar had stopped taking his medication, and his anxiety about his mother being away had exacerbated his symptoms.
Matar walks across the room, seemingly in better spirits. He sits in one of the front seats. “I’d like to carry on,” he says, looking at me.
I smile, thank him and ask again if he could tell me how he knows he is a tiger when he gets these feelings, rather than any other animal.
This time he answers immediately and fluently.
“I don’t know why I’m a tiger, I just know I am. I hear lots of voices around me, telling me I’m no good. They laugh at me. They tell me I’m rubbish, that I’m not good enough to be human. Some days it feels like there is a lion around me. Sometimes it is attacking me, grabbing the back of my neck. I can’t move from the pain. I can see the blood coming from my body where I’ve been attacked.”
“Do you ever feel like you can defend yourself?”
“No.” He shakes his head. “I can’t defend myself from the lion as it’s much stronger than me so I feel like I have to attack first.”
“How long does it last?”
“Sometimes only a few minutes, sometimes hours.”
Hamdy interrupts. “Have you been feeling like this recently, or has it just happened today?” he asks.
“It started last night,” says Matar. He looks upset. “I was in bed and I felt it coming on, so I locked the door, put a towel over my head and wrapped myself up in my sheets so that I couldn’t move my arms or get free.”
He says that once, when he could no longer resist acting out his urges, he attached cement blocks to his shoes to make his feet too heavy to move.
“I just want to stop myself from hurting anyone.”
“Have you ever looked in the mirror when you’ve felt like a tiger?” I ask.
“Yes,” he says. “I’ve looked at my reflection when I’ve felt like a tiger and I see two things. I see myself as a tiger and I see a lion that’s catching hold of my head and my neck. I can’t rationalize it. It’s very frightening.”
Despite his behavior today, Matar is not thought to be a danger to anyone. His medications generally allow him to function well in society and live safely in his local community.
“We’re happy to have him live at home. He has his family and a community nurse to look out for him,” says Hamdy. “It’s different here than in the UK—there’s a big emphasis on family helping care for people who are ill.”
I turn back to Matar. “Is there anything you can do to help prevent your delusions from occurring, other than take your medication?”
“I always wear white,” he says, pointing at his white long-sleeved robe and headdress. “It’s calming. White feels like a peaceful color to wear, it helps when I have these weird feelings.”
Suddenly the atmosphere changes again as Matar laughs out loud. He stretches his fingers out wide and bends them at the knuckle. He lowers his head and slips off his shoe. Then he grabs his left leg and grimaces in pain.
Suddenly, the snarling starts again.
“I think we should leave,” says one of the doctors sitting beside me. Another asks Matar if he would like some medicine to help with his anxiety. He nods and with barely a glance walks out of the room and is gone.
* * *
This is the point where I’d love to add that Matar is now well, that a mixture of drugs and psychotherapy has helped him banish his delusions. Unfortunately, that’s not the case. A few months after I returned home, I emailed Rafia and asked her to translate a note from me to Matar, thanking him for coming to meet me. I wanted to know how he was feeling. Rafia replied quickly. She said that Matar’s behavior on the day of my interview suggested a fairly severe relapse and that he continued to have repeated admissions to the hospital. So far, she said, he has not returned to an acceptable level of functioning.
Matar’s brain may be unique, but there are many lessons we can learn from such extreme cases, not least the incredible power of family in ensuring the health of those who may otherwise find themselves in permanent care. If you place people with lycanthropy side by side with others who experience perceived body alterations, though, what emerges is a picture of the brain working tirelessly to create a sense of something that most of us take for granted every day: a body that feels like our own.
Louise
Becoming Unreal
I think it’s time to ask you a question.
Who are you?
It seems simple enough. There are many ways that you could answer. When we think about who we are, it’s often from the perspective of others. I might think about myself as a journalist, a daughter, a friend, a wife, a James Bond fan. But what else constitutes “me”? As Matar showed us, part of “me” is my body. Mine is fairly tall and slim. It has big feet.
But another aspect of me is also present inside that body. I am made up of emotions, memories, thoughts, opinions and bodily sensations that all carry a feeling of “being mine.” The body I see in the mirror changes day by day, but the person inside that body is constant. Scientists like to call this our sense of self. This attachment to our thoughts and sensations seems like something that should be fairly permanent. Yet that is not always the case.
In his diary, the Swiss philosopher Henri Frédéric Amiel describes a peculiar feeling: “I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalised, detached, cut adrift. Is this madness?”1
These feelings were later defined as depersonalization disorder—a condition in which a person feels detached from themselves, as if their external and inner worlds have become unreal, as if, as Amiel put it, they are no longer tied to their own mental experiences. Some people describe it as feeling like they are watching a movie of themselves, or that their perception of the world has decreased in qualit
y.
You might have had some experience of this yourself—it’s thought that brief episodes of mild depersonalization are common among the general public, typically at moments of high stress or fatigue. That spaced-out feeling you get when jet-lagged or hungover could be seen as a transient experience of depersonalization, for instance. A number of drugs, including ecstasy, have also been associated with the onset of such feelings.
Depersonalization can appear suddenly without any apparent trigger, or after severe stress or childhood trauma. There are some theories that it is a protective mechanism, that in the face of extreme danger our sense of self can detach itself from what’s happening in the world, in order to remove itself from the stressful nature of what’s going on. This idea struck a chord with me because it brought back memories of a fleeting feeling of depersonalization that I had experienced, one morning driving to the dentist.
The road was wet and the gravel and fallen leaves had washed to the bottom of a T junction near my house. As I braked to meet the end of the road, my wheels skidded and I drove full speed into the oncoming traffic, spun and crashed into a lamppost. The entire episode not only felt as though it was happening in slow motion, but also felt like it was happening to someone else. As soon as the brakes stopped working, I remember a distinct feeling of detachment from my body, like it didn’t quite belong to me. I remember thinking back to my driving lessons and whether my driving instructor had told me anything about what to do in this situation. I decided he hadn’t, and then proceeded to feel angry about his lack of foresight. Then I recollected someone pumping the pedals during a skid in a film I had once watched, so I tried that. After that didn’t gain me any traction, I remember searching the oncoming traffic to work out which car I was likely to hit. I felt like I was watching myself get closer to the end of the road. I remember thinking about whether there was any way I might warn them and tried to look apologetic as I neared the unsuspecting driver. After hitting the first car and spinning 180 degrees I remember thinking it was strange that the air bag hadn’t worked, and then trying to figure out how best to position myself to minimize the damage for the second impact. It was almost as if my physical body was not quite “me.” Like I was watching it all happen from somewhere inside my own head. This slow-motion catastrophe ended as my car eventually came to a halt across the road. If these were feelings of depersonalization, they were short-lived: as soon as the lamppost buckled the front of the car, the pain down my shoulders dragged me back into myself. But for some this feeling of depersonalization, this detachment from your sense of self, is a permanent way of life.
Unthinkable Page 16