Unthinkable

by Helen Thomson

  But if our mirror systems are active in the same way when we see someone touched and when we feel touch ourselves, why don’t we all go around sensing other people’s touch on our own bodies? One of the reasons is that when you see someone touched, tactile receptors in your skin aren’t stimulated, so they send messages to the brain saying, “I’m not being touched.” This signal vetoes some of the activity of the mirror neurons. Sometimes amputees can feel touch on an area of their missing limb when they see others being touched in the same place. They’re not getting any of the normal veto signals from the skin since there’s nothing there to send them. But what’s allowing Joel’s mirror systems to run amok?

  To answer this question, Banissy’s team ignored the mirror system entirely and went in search of strange activity in other areas of the brain. What they found was quite remarkable. Mirror-touch synesthetes seem to have less brain matter in their temporoparietal junction—an area that is said to help us distinguish the self from other.

  “It’s like they have this fuzzy boundary between themselves and other people,” said Banissy. To test this idea further, he got eight mirror-touch synesthetes to take part in a game in which they had to raise one or two fingers while watching others do the same. They had much more difficulty completing the task when the person they were looking at was raising a different number of fingers than they were told to lift.6

  “It was like their brain had some difficulty inhibiting the idea that this other person wasn’t them,” he said.

  Left to its own devices, Joel’s brain activity seems to mirror the world without restraint, crossing the threshold past which other people’s perceptions become his own.

  LATER THAT EVENING, Joel and I brave the cold again to meet for dinner at Clink, a restaurant at the Liberty Hotel. Joel rushes up, just a few minutes late. He explains that on his way over he’d had to work hard on getting rid of an emotion he’d experienced ten minutes earlier from a colleague. It was the worst kind of emotion, he says: passive aggressiveness.

  “That emotion, that kind of malice, really clearly stands out for me,” he explains, as we sit down at our table. “I have to take a step back and remove myself from the moment because I get this knot in my throat. It’s so vivid I’m like ‘Urgh, God, that’s painful!’ and I don’t want it to become confrontational. Mostly my emotions change pretty quickly but then there are occasions like these that it’ll stick and I’ll take on this irritability that I really have to work hard to get rid of.”

  Joel also dislikes it when people deliberately attempt to hide their emotions from him. “If I can see what your actual emotion is below this façade that you’re playing then it really stands out to me. I think it’s really amplified in me.”

  “That must happen a lot in the hospital, no?”

  “Yeah, it can. Sometimes a patient will say they are fine, and I know they’re not because I can really feel some strong negative emotion. Like I know they’re about to cry because I’m about to cry. But most of the time it definitely helps me. I can’t say that I’m feeling exactly the way they are feeling, but I can feel their discomfort and their distress, or if they’re scared or confused or feeling better. Sometimes it’s hard to know where the mirror-touch starts and where it’s just normal human empathy kick-ing in.”

  Within the hospital environment, it’s difficult to understand how Joel keeps his cool. If a person is in pain, coughing and heaving, he can feel his own lungs tightening. When they are intubated, he feels the tension in his own vocal cords as the tube is placed down their throat. When he injects a needle into someone’s spine, he feels the sensation of a needle slowly sliding into his own lower back.

  It’s not just his patients’ physical distress that he feels, but also the emotional anxieties from their family and the nurses. Directing his attention elsewhere is the (very successful) trick he has learned to regulate this sea of emotions.

  “I try to concentrate on the calmest person in the room, or just stare at my sleeve or something,” he says. Although sometimes in the middle of a busy emergency room his synesthesia is unavoidable. “There was this one time in medical school when I saw someone’s amputated arm. I had these vivid physical sensations of my own arm having been ripped apart. It was really difficult. I think it was so vivid because it was something I had never seen before—novelty seems to have more effect on me than things I see a lot.”

  Of course, sometimes this intense empathy comes in handy for diagnosing a patient or finding out what’s going on underneath the surface. The physical sensations that he experiences from others and the heightened attention to micro-movements has made him a much better observer, he thinks. “I can pick up on subtle twitches and movements of the eyes and mouth that others might not pick up on. It can help lead me to a quicker diagnosis or understand a bit more about the complexity behind what’s going on.”

  “Are there moments in which you particularly utilize your hyper-empathy?” I ask.

  “I do when I see patients in really tough situations. It’s something most patients are starving for—to feel that there’s a connection between them and the person who is caring for them. I also rely on it when you have to tell people they have a terminal diagnosis, like Alzheimer’s. It’s never an easy conversation, but it’s made harder by the fact that the person affected may have a bit of insight into their disease to know something’s wrong but not enough brain capacity to really understand what’s happening. So I use it then to try to get in tune with as much of the person beneath the disease as possible.”

  He says it’s a bit like windows on a computer desktop. “I can choose to maximize certain windows to really hone in on a feeling and make it all the more vivid, but there’s always this wash of emotions being processed underneath that affects everything that I do.”

  “So can you ever turn it off completely?” I ask. “Ignore other people’s emotions around you?”

  “No, there’s always this white noise, a haze of things going on. I’m almost a fool to believe that any of the emotions I’m feeling are completely my own.”

  It suddenly occurs to me that Joel must have seen plenty of people die. I ask him what he feels in those moments.

  “To put it simply,” he says, “it’s as if I’m dying as well. There’s this very powerful moment just before death of letting go. It’s not so much the presence of a feeling but the absence of one. It’s kind of like when you’re in a room with an air-conditioning unit in the background and suddenly it just shuts off. There’s this disquieting stillness.”

  The first time Joel ever saw someone die, it was unexpected—a man lying on a bed near to him, waiting to be taken elsewhere in the hospital. Joel’s body mirrored the man’s. Suddenly, he felt his own breathing slowing. It wasn’t Joel imagining what death must be like, but his body physically imitating the process. “I needed to start having to be more voluntary about my own breathing, otherwise I felt like it would just stop as well.”

  On hearing this, I wonder why Joel was drawn to this career in the first place. In some ways it seemed a natural fit, in others a complete nightmare.

  He says one inspiration to becoming a doctor came about after a stint as a medical assistant with his uncle in a rural Louisiana clinic. “I saw how important it was to the community, and I’d always known that I wanted to help others. I thought about all the things that make me happy and give my life energy and purpose, and it ended up being a collage of things that were compatible with medicine.”

  He says he watches horror movies and psychological thrillers at home to help him cope with the unexpected at work.

  “I know it sounds strange and I know other mirror-touch synesthetes would be burdened by it, but I see it as part of my education. It helps me learn more about others, and manage crises. What good is a physician who shuts down at the sight of blood or violence? The more novel and surprising an experience is, the more vivid the synesthetic experience is for me, so I expose myself to it so that it’s less novel when I see
it in real life.”

  “Do you think you’d do the same if you weren’t a doctor?”

  “Yeah, I think I’d still see it as part of the development of my character. It’s almost like a way of experiencing the world and living a full life. I wouldn’t want to short-change myself.”

  IT’S NOT JUST JOEL who can overdose on other’s feelings—all of us can risk becoming infected with other people’s pain. It’s something known as emotional contagion. Our emotions can spread like a virus—with some truly awful consequences.

  Our capacity to understand others’ feelings through empathy is crucial for successful social interactions—it was this empathy that may have given us a giant kick in our evolution as a social, collaborative and moral species—yet empathize too much and you can actually make yourself sick. Nurses, in particular, are at high risk of this kind of emotional burnout. The consequences are bad for their health: they experience increased levels of anxiety and stress, but also anger, aggression and overall lower levels of empathy.

  You might think you’re immune to such social contagion but several experiments suggest otherwise. In 2014, researchers played with our emotions by tweaking Facebook’s algorithms so that certain people were presented with more negative or positive posts. They showed that these people became more negative or positive themselves as a result.7 Experiments on Twitter users have shown a similar effect.

  While some people are naturally better at empathizing than others, it is possible to change your natural state. In 2013, Christian Keysers from the Netherlands Institute for Neuroscience and his colleagues tested this theory in twenty-two male offenders diagnosed with psychopathy and who were thought to have low levels of empathy. He showed his volunteers videos representing people in love, in pain or experiencing social exclusion, while scanning their brains. The results showed that people with psychopathy had much lower activity in areas of the brain responsible for empathy compared with a control group that had no history of psychopathy. Activity was particularly low in the insula, which as we’ve seen in previous chapters is vital for coordinating signals from the brain and body. However, when Keysers’s team instructed their subjects to try consciously to empathize with the people in the pictures, the brain scans of those with psychopathy matched those of the healthy control group.8 It suggests we may all have a whole spectrum of empathy within us that we can choose to ignore or ignite.

  So how do we empathize without burning out? A series of studies, many by Tania Singer at the Max Planck Institute for Human Cognitive and Brain Sciences, in Leipzig, Germany, suggests we should transform empathy into compassion.9 We often use these words interchangeably, but they mean different things. “Compassion” can be described as having caring thoughts for another person—for instance, when a mother reaches out to a screaming child. “Empathy” is putting yourself in another person’s shoes and vicariously experiencing their emotions. When Buddhist monks are asked to engage in a form of compassionate meditation while listening to distressing sounds such as a woman screaming, areas of the brain involved in empathy, such as the insula, decrease in activity. When people who are not trained in compassionate meditation are asked to listen to the woman screaming, pain networks light up in the brain.

  Singer wondered whether short-term compassion training could help people to think more like monks. After just a few days of lessons, their brains began to look more like the meditating monks’ in response to hearing other people in pain. They are still able to feel for them, but no longer feel with them, and early results suggest this leads to an overall sense of increased well-being.

  If you’d like to try it for yourself, compassion training simply involves spending time thinking about extending warmth and caring feelings—like those you would usually experience toward a much-loved person—to everyone around you. By concentrating on compassion, rather than empathy, you could protect yourself from emotional burnout.

  * * *

  Over dinner, Joel tells me about a couple of times that he has been a patient himself. One time was after a terrible car accident, in which his car rolled and left him in intensive care with lacerations and a cervical collar around his neck. Now, whenever he sees someone his age with a cervical collar, his sensations are at their most vivid because he knows exactly what they feel like. His second experience of being in a hospital was even more dramatic. It was 2005, and Joel was in Haiti working with the local government, providing medical services to hard-to-reach areas of the country. During the trip, Joel developed a sudden headache. “It was different to a migraine—it was really specific to the right side of my head,” he says.

  Luckily, there was a neurosurgeon on the trip.

  “What does it mean if you develop a sudden headache?” Joel asked him, casually.

  The surgeon joked, “Oh, it usually means you’re going to die.”

  “I was like, ‘Oh right, ’cause I have that.’”

  When he got back to Boston, the neurosurgeon had two of his assistants give Joel a full examination. They found what looked like a tumor embedded above the brain, eating away at the skull. It wasn’t clear whether it was attached to the brain or not. It needed to be removed.

  In the operating room, a surgeon peeled back Joel’s skull to find a pulsating mass of blood vessels. They pulled it out, cauterised the bleeding and filled in his skull with bone cement. Thankfully, the tumor wasn’t malignant. When Joel came around from the anesthetic, the first thing he did was search for a letter. He wanted to know whether his surgery had affected his synesthesia.

  “I looked for a letter to see if it still had a color or not—I was really thankful that it did.”

  Whether Joel’s brain tumor had anything to do with triggering his mirror-touch synesthesia is unclear. But the tumor was near to his temporoparietal junction. If he’d had a bundle of abnormal blood vessels growing there since birth then there’s a chance that he might have had greater vascular supply to that part of his brain, making it develop abnormally and perhaps resulting in this unusual blurring of his self and others.

  As we eat, Joel tells me that he has been having an especially difficult week. He’s been leading a Tourette’s clinic. One of his patients has a self-mutilating tic, which involves biting the side of his cheek, pushing on his face and grinding his teeth.

  “It is a massive challenge for me,” he says. “Most of these tics are very surprising so it’s a perfect recipe for me to feel them. I have to be really conscientious not to start copying the tics. Every now and then I have to take some time out and stare at the computer screen or the floor and remove myself from the situation.”

  A few days ago, Joel’s patient was continuously pushing on his face with his knuckles, creating cuts so damaging that he’d had to have surgery on his mouth. It was a particularly tough session because there was a lot going on in the room.

  “Every time the guy would tic, I’d feel like there was a fist mashing my face,” says Joel. “I could feel my lip up against my teeth almost like it was being cut.”

  Then there was a moment where he was completely caught off guard. “The patient pushed on his face and ground his teeth in this way that was so loud, and as he did so I felt this vibration across my face that was so extreme. It really exited the realm of an internal perception and became this very real experience.”

  I wonder what Joel does to get away from it all—to relax. He says he exercises a lot. I’m amazed to hear that even here his mirror-touch synesthesia helps him out. “I tend to learn new physical skills easier than most people,” he says. If he’s watching a tennis instructor demonstrate a serve, for example, he can feel the movements in his own body, meaning that when he repeats the movement for himself he can tell if it matched or not, and if not, where he went wrong.

  He runs every day that he can. He often watches Japanese manga while he’s on the treadmill because there’s a lot of running in it. “If I’m running, and they’re running, there’s no mismatch, and for that short time everything makes sense
in the world.”

  SPEND ENOUGH TIME WITH JOEL and it’s hard to ignore the strange sensation that he knows you like a best friend. He finishes your sentences and immediately senses when you’re confused or troubled. But sometimes this can make relationships difficult. Over the past year, he’s been going through a divorce—a difficult situation at the best of times, but if you’re a mirror-touch synesthete it’s all the more complex. That’s because in an argument Joel takes on board the emotions of the other person. And when you’re trying to iron out your difficulties, too much empathy for another person’s feelings makes it difficult to keep your own feelings straight.

  His ex-husband lives in Seattle and at the worst point of the divorce they talked by FaceTime. It helped, says Joel, to have an image of his own face in the corner of the screen in an argument.

  “The minute I’d feel that I was putting myself way too far into his perspective on things, I would look at myself and get back to how I really felt.”

  “It sounds complicated.”

  “Yeah, it was. The minute that I did something, it was affecting him, which was then affecting me and it turns into this really turbulent spiral.”

  I wonder how Joel’s life would have turned out had he not been so bright, so willing to understand his strange brain. He says that if he didn’t have the intelligence to understand and manage these experiences, his world could easily have come crashing down around him. “All these experiences could be really anxiety provoking,” he says. “My world could be ruled by them. And that would be interpreted by the medical profession as schizophrenia, psychosis or mania of some kind.”

  Someone suddenly laughs loudly on one side of us. I wonder if it had made Joel slightly happier for a second. But then the couple on the other side were looking serious, deep in conversation—perhaps theirs was the emotion he was feeling.