{"product_id":"the-man-who-wasnt-there-isbn-9781101984321","title":"The Man Who Wasn't There","description":"\u003cp\u003e\u003cb\u003eIn the tradition of Oliver Sacks, science journalist Anil Ananthaswamy skillfully inspects the bewildering connections among brain, body, mind, self, and society by examining a range of neuropsychological ailments from autism and Alzheimer’s to out-of-body experiences and body integrity identity disorder\u003cbr\u003e\u003c\/b\u003e\u003cbr\u003e Award-winning science writer Anil Ananthaswamy smartly explores the concept of self by way of several mental conditions that eat away at patients’ identities, showing we learn a lot about being human from people with a fragmented or altered sense of self. Ananthaswamy travelled the world to meet those who suffer from “maladies of the self” interviewing patients, psychiatrists, philosophers and neuroscientists along the way. He charts how the self is affected by Asperger’s, autism, Alzheimer’s, epilepsy, schizophrenia, among many other mental conditions, revealing how the brain constructs our sense of self. Each chapter is anchored with stories of people who experience themselves differently from the norm. Readers meet individuals in various stages of Alzheimer’s disease where the loss of memory and cognition results in the loss of some aspects of the self. We meet a woman who recalls the feeling of her first major encounter with schizophrenia which she describes as an outside force controlling her.  Ananthaswamy also looks at several less­ familiar conditions, such as Cotard’s syndrome, in which patients believe they are dead, and those with body integrity identity disorder, where the patient seeks to have a body part amputated because it “doesn’t belong to them.” \u003cbr\u003e\u003cbr\u003eMoving nimbly back and forth from the individual stories to scientific analysis \u003ci\u003eThe Man Who Wasn’t There\u003c\/i\u003e is a wholly original exploration of the human self which raises fascinating questions about the mind-body connection. \u003cbr\u003e  \u003cbr\u003e\u003c\/p\u003e | \u003cb\u003ePraise for \u003ci\u003eThe Man Who Wasn't There\u003c\/i\u003e\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e“If you simply want to read a great science book, I can’t recommend any more highly than this one.”\u003cbr\u003e—\u003ci\u003eForbes\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e\"An agreeably written travelogue through this mysterious landscape at the frontiers of knowledge.\"\u003cbr\u003e—\u003ci\u003eThe Wall Street Journal \u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“You’ll never see yourself—or others—the same way again.”\u003cbr\u003e—\u003ci\u003ePeople\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“The gallery of personal, often tender, portraits of patients is impressive and reminiscent of the writings of Oliver Sacks… A skilled science journalist, Ananthaswamy excels at making theoretical concepts and experimental procedures both comprehensible and compelling.”\u003cbr\u003e—\u003ci\u003eScience\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“In \u003ci\u003eThe Man Who Wasn’t There\u003c\/i\u003e, science writer Anil Ananthaswamy smartly explores the nature of the self by way of several mental conditions that eat away at patients’ identities… Following in the steps of Oliver Sacks’s “The Man Who Mistook His Wife for a Hat” (1985) and V. S. Ramachandran and Sandra Blakeslee’s “Phantoms in the Brain” (1999), Ananthaswamy uses neuropsychology and narrative to take us inside the heads of people experiencing realities very different from our own.”\u003cbr\u003e—\u003ci\u003eWashington Post\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“Anil Ananthaswamy’s exploration of the human ‘self’ is a blazingly original excursion through the brain—as well as a fascinating catalog of bizarre disorders.”\u003cbr\u003e—\u003ci\u003eEntertainment Weekly\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e\"Autobiographies hinging on conditions such as Asperger's syndrome and schizophrenia are proliferating, but there is little to fill the void between such accounts and the scientific literature. Linking experiences with experiments, and individuals with numbers, Ananthaswamy bridges that gap convincingly.\"\u003cbr\u003e\u003ci\u003e—Nature \u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“When you think 'beach read,\" you probably don't think \"neuroscience.\" But science journalist Ananthaswamy has a knack for making difficult topics accessible to everyone.” \u003cbr\u003e\u003ci\u003e—Men’s Journal \u003cbr\u003e\u003cbr\u003e \u003c\/i\u003e“It is an astonishing journey and an ambitious book, bringing together cutting-edge science and philosophy from West and East. You will not be quite the same self after reading it.”\u003cbr\u003e\u003ci\u003e—New Scientist\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e\"An excellent if unnerving book: 'you' turn out to be more fluid than 'you' thought.\"\u003cbr\u003e\u003ci\u003e—New Scientist, CultureLab\u003cbr\u003e\u003cbr\u003e“\u003c\/i\u003eA thought-provoking read… Ananthaswamy relays many interesting advances and, at the same time, challenges us to contemplate who we really are\u003ci\u003e.”\u003cbr\u003e—Scientific American Mind\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“[\u003ci\u003eThe Man Who Wasn’t There\u003c\/i\u003e] illuminates some of the most provocative questions at the boundary of science and philosophy.”\u003cbr\u003e—\u003ci\u003eColumbus Dispatch\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“Sophisticated science, sensitive storytelling and Nancy Drew-like curiosity are at the heart of science author and journalist Anil Ananthaswamy's \u003ci\u003eThe Man Who Wasn't There\u003c\/i\u003e.\"\u003cbr\u003e\u003ci\u003e—San Jose Mercury News\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Science journalist Ananthaswamy skillfully inspects the bewildering connections among brain, body, mind, self, and society… Readers will be fascinated by Ananthaswamy's chronicles as he explores, with kindness and keen intelligence, the uncomfortable aberrations that reveal what it is to be human.”\u003cbr\u003e—\u003ci\u003ePublishers Weekly \u003c\/i\u003e(starred review)\u003cbr\u003e\u003cbr\u003e“A provocative examination of deep questions.”\u003cbr\u003e—\u003ci\u003eKirkus\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e“If you like Oliver Sacks, you’ll love this new work by Ananthaswamy…..”\u003cbr\u003e —\u003ci\u003eLibrary Journal\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“A faint-of-heart hypochondriac might wish to give Ananthaswamy’s book a wide berth, but others should find it quite fascinating. From the man who insisted that he was brain dead (despite walking, talking, eating, and taking the bus) to autism, Alzheimer’s, something called body integrity identity disorder (read the book), and more, Ananthaswamy demonstrates how what is perceived as the self can wiggle all over the map.” \u003cbr\u003e—\u003ci\u003eBooklist\u003cbr\u003e\u003cbr\u003e\u003c\/i\u003e“Despite the depth of scientific knowledge plumbed in the book, the language is simple and accessible in the tradition of the late, great neuroscientist Oliver Sacks (The Man Who Mistook His Wife for a Hat). The series of stories that illustrate the complexity of the brain and its creation of selfhood are imbued with emotion and compassion for the sufferers, even as their conditions are explained in scientific terms.”\u003cbr\u003e—\u003ci\u003eIndia Currents\u003c\/i\u003e\u003cbr\u003e  \u003cbr\u003e “A compelling and entertaining look at the last untapped mystery, the true final frontier: the nature of our selves. Science journalism at its best.”\u003cbr\u003e —Daniel J. Levitin, author of \u003ci\u003eThe Organized Mind\u003c\/i\u003e and \u003ci\u003eThis Is Your Brain on Music\u003c\/i\u003e\u003cbr\u003e  \u003cbr\u003e “Stunning… poetic and incisive.  Each of the patients is unique, special and incredible in revealing something special about the mind, whether healthy or fragile.  Ananthaswamy discovers the elusive nature of the very idea of self and makes sense out of it.  It is a remarkable achievement.” \u003cbr\u003e —Michael Gazzaniga, author of \u003ci\u003eWho’s in Charge?\u003c\/i\u003e and \u003ci\u003eTales from Both Sides of the Brain\u003c\/i\u003e\u003cbr\u003e  \u003cbr\u003e “Ananthaswamy’s remarkable achievement is to make sense of these unhappy individuals’ otherness, while holding on to their human sameness. You’ll come away enlightened and chastened, asking searching questions about who you are.”\u003cbr\u003e —Nicholas Humphrey, Cambridge University, author of \u003ci\u003eA History of the Mind\u003c\/i\u003e\u003cbr\u003e  \u003cbr\u003e “Like Oliver Sacks, Ananthaswamy brings both erudition and sensitivity to his narrative so that we learn as much, and maybe more, from his subjects as we do from the scientists we meet along the way…. You’ll emerge with renewed wonder about the simple experience of being you.”\u003cbr\u003e —Anil Seth, University of Sussex, Editor-in-Chief, Neuroscience of Consciousness\u003cbr\u003e  \u003cbr\u003e “A wide range of engrossing (and many just plain weird) stories elegantly weaving together insights from psychology, psychiatry, and neuroscience. An informative, exciting, and slightly creepy tour of some profound questions about human nature.”\u003cbr\u003e —David Poeppel, Director, Max-Planck Institute and Professor of Psychology and Neural Science, NYU\u003cbr\u003e  \u003cbr\u003e “In this lucid and personable analysis by Ananthaswamy, the self appears an illusion, which nevertheless feels very real to most of us. Since no organism can do without this mental anchor, nature has found a way to concoct one for us.” \u003cbr\u003e —Frans de Waal, author of \u003ci\u003eThe Bonobo and The Atheist\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“It is an astonishing journey and an ambitious book, bringing together cutting-edge science and philosophy from West and East. You will not be quite the same self after reading it.”\u003cbr\u003e—Alun Anderson, \u003ci\u003eNew Scientist\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003ePraise of Anil Ananthaswamy's \u003ci\u003eThe Edge of Physics\u003c\/i\u003e:\u003cbr\u003e\u003cbr\u003e“A thrilling ride!” —Sean Carroll, author of \u003ci\u003eThe Particle at the End of the Universe\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Displays a writer’s touch for fascinating detail.” —\u003ci\u003eThe Washington Post\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“A wonder-steeped page-turner.” —\u003ci\u003eSeed \u003c\/i\u003e | ANIL ANANTHASWAMY is former deputy news editor and current consultant for \u003ci\u003eNew Scientist\u003c\/i\u003e. He is a guest editor at UC Santa Cruz’s renowned science-writing program and teaches an annual science journalism workshop at the National Centre for Biological Sciences in Bangalore, India. He is a freelance feature editor for the Proceedings of the National Academy of Science’s “Front Matter” and has written for \u003ci\u003eNational Geographic News, Discover\u003c\/i\u003e, and \u003ci\u003eMatter\u003c\/i\u003e. He has been a columnist for PBS NOVA’s \u003ci\u003eThe Nature of Reality\u003c\/i\u003e blog. He won the UK Institute of Physics’ Physics Journalism award and the British Association of Science Writers’ award for Best Investigative Journalism. His first book, \u003ci\u003eThe Edge of Physics\u003c\/i\u003e, was voted book of the year in 2010 by \u003ci\u003ePhysics World\u003c\/i\u003e.  He lives in Bangalore, India, and Berkeley, California. | \u003cp\u003e\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003e \u003c\/p\u003e\u003cp\u003eAn allegory about a man who was devoured by ogres first appears in an ancient Indian Buddhist text of the \u003ci\u003eMadhyamika\u003c\/i\u003e (the middle-way) tradition. It dates from sometime between 150 and 250 CE and is a somewhat gruesome illustration of the Buddhist notion of the true nature of the self.\u003c\/p\u003e\u003cp\u003eA man on a long journey to a distant land finds a deserted house and decides to rest for the night. At midnight, an ogre turns up carrying a corpse. He sets the corpse down next to the man. Soon, another ogre in pursuit of the first arrives at the deserted house. The two ogres begin bickering over the corpse. Each claims to have brought the dead man to the house and wants ownership of it. Unable to resolve their dispute, they turn to the man who saw them come in, and ask him to adjudicate. They want an answer. Who brought the corpse to the house?\u003c\/p\u003e\u003cp\u003eThe man, realizing the futility of lying to the ogres—for if one won’t kill him, the other one will—tells the truth: the first ogre came with the corpse, he says. The angry second ogre retaliates by ripping off the man’s arm. What ensues gives the allegory its macabre twist. The first ogre immediately detaches an arm from the corpse and attaches it to the man. And so it goes: the second ogre rips a body part off the man; the first ogre replaces it by taking the same body part from the corpse and attaching it to the man. They end up swapping everything—arms, legs, the torso, and even the head. Finally, the two ogres make a meal of the corpse, wipe their mouths clean, and leave.\u003c\/p\u003e\u003cp\u003eThe man, whom the ogres have left behind, is extremely disturbed. He is left pondering what he has witnessed. The body that he was born in has been eaten by the ogres. His body now is made up of body parts of someone else entirely. Does he now have a body or doesn’t he? If the answer is yes, is it his body or someone else’s? If the answer is no, then what is he to make of the body that he can see?\u003c\/p\u003e\u003cp\u003eThe next morning, the man sets off on the road, in a state of utter confusion. He finally meets a group of Buddhist monks. He has a burning question for them: does he exist or does he not? The monks throw the question back at him: who are you? The man is not sure how to answer the question. He’s not sure he’s even a person, he says—and tells the monks of his harrowing encounter with the ogres.\u003c\/p\u003e\u003cp\u003eWhat would modern neuroscientists tell the man if he were to ask them \u003ci\u003eWho am I?\u003c\/i\u003e While some would likely point out the near-biological implausibility of what the ogres did, they would nonetheless have some tantalizing answers. These answers, which strive to illuminate the “I,” are the focus of this book.\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003e1\u003c\/p\u003e\u003cp\u003eWHO IS THE ONE WHO SAYS, “I DON’T EXIST”?\u003c\/p\u003e\u003cp\u003eMen ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughters and jests, as well as our sorrows, pains, griefs and tears. . . . These things that we suffer all come from the brain. . . . Madness comes from its moistness.\u003c\/p\u003e\u003cp\u003e—Hippocrates\u003c\/p\u003e\u003cp\u003eIf I try to seize this self of which I feel sure, if I try to define and to summarize it, it is nothing but water slipping through my fingers.\u003c\/p\u003e\u003cp\u003e—Albert Camus\u003c\/p\u003e\u003cp\u003eAdam Zeman will never forget the phone call. It was, as he called it, a “\u003ci\u003eMonty Python–\u003c\/i\u003eesque” summons from a psychiatrist, asking him to come urgently to the psychiatric ward. There was a patient who was claiming to be brain dead. Zeman felt as if he were being called to the intensive care unit, not the psychiatric ward. Yet, “this was very unlike the kind of call you normally receive from the ICU,” Zeman told me.\u003c\/p\u003e\u003cp\u003eThe patient, Graham, was a forty-eight-year-old man. Following a separation from his second wife, Graham had become deeply depressed and had tried to kill himself. He got into his bath and pulled an electric heater into the bathwater, wanting to electrocute himself. Fortunately, the fuse blew and Graham was spared. “It didn’t seem to have done any physical damage to him, but some weeks later he formed the belief that his brain had died,” said Zeman, a neurologist at the University of Exeter in the UK.\u003c\/p\u003e\u003cp\u003eIt was a rather specific belief. And one that led Zeman to have some very strange conversations. “Look, Graham, you are able to hear me, see me, and understand what I’m saying, remember your past, and express yourself, surely your brain must be working,” Zeman would say to Graham.\u003c\/p\u003e\u003cp\u003eGraham would say, “No, no, my brain’s dead. My mind is alive but my brain is dead.”\u003c\/p\u003e\u003cp\u003eWorse yet, Graham was distraught at his unsuccessful attempt at suicide. “He was one of the undead or half-dead,” Zeman told me. “He in fact went and spent quite a bit of his time, for a while, in graveyards, because he felt he was with his own when he was there.”\u003c\/p\u003e\u003cp\u003eZeman quizzed Graham to understand the grounds for this belief. It became clear that something very fundamental had shifted. Graham’s subjective experience of himself and his world had changed. He no longer felt he needed to eat or drink. Things that once used to give him pleasure no longer did. “When he pulled on a cigarette, nothing happened,” Zeman told me. Graham claimed that he never needed to sleep, that he did not feel sleepy. Of course, he was doing all of these things—eating, drinking, sleeping—but his desire for these and the intensity of his feelings had damped down dramatically.\u003c\/p\u003e\u003cp\u003eGraham had lost something we all have: a keen sense of our own appetites and emotions. Patients suffering from depersonalization often report this emotional dulling or flatness. Depression too can bring about similar states of being, where emotions lose their edge. But these patients don’t go on to develop such stark delusions of nonexistence. In Graham’s case, the loss of emotional vividness was so extreme that “he had come to the conclusion, on the basis of that alteration in experience, that his brain must have died,” said Zeman.\u003c\/p\u003e\u003cp\u003eZeman thinks that two key factors play a role in such robust delusions. One is a profound alteration in the quality of one’s sense of oneself and the world—in Graham’s case, the emotional rug had been pulled from under his feet. The second is an alteration in one’s ability to reason about that experience. “Both things seemed to be true in Graham’s case,” said Zeman.\u003c\/p\u003e\u003cp\u003eGraham’s delusion was immune to evidence to the contrary. Zeman, in his conversations, would bring Graham to the point of surrender—to make him see the falseness of his delusion. Graham would acknowledge that a whole range of his mental faculties was intact, that he could see, hear, speak, think, remember, and so on.\u003c\/p\u003e\u003cp\u003eSo Zeman would say to him, “Clearly, Graham, your mind is alive.”\u003c\/p\u003e\u003cp\u003eHe’d say, “Yeah, yeah, the mind is alive.”\u003c\/p\u003e\u003cp\u003e“The mind has a lot to do with the brain; surely your brain is alive,” Zeman would prod him.\u003c\/p\u003e\u003cp\u003eBut Graham would not take the bait. “He’d say, ‘No, my mind is alive, but my brain is dead. It died in that bath,’” Zeman told me. “You could get quite close to producing what you would think was knock-down evidence, but he wouldn’t accept it.” It was intriguing that Graham had developed such an explicit delusion—that of being dead because his brain was dead. Would his delusion have been different in an era when the legal definition of death did not include brain death?\u003c\/p\u003e\u003cp\u003eOver the course of his medical practice, Zeman had only ever seen one other case of someone claiming to be dead. In the mid-1980s, working as a junior doctor in Bath, England, Zeman had to treat a woman who had undergone protracted bowel surgery and was suffering from severe malnourishment. Her body had been ravaged by repeated surgery. “She became very depressed as a result of that and formed a belief that she had died,” Zeman said. “Which in a strange way seemed understandable to me, because the kind of trauma she was undergoing was so awful. She thought she was dead.”\u003c\/p\u003e\u003cp\u003eZeman recognized the symptoms in Graham, and diagnosed him as suffering from Cotard’s syndrome, which was first identified as a distinct disorder by the nineteenth-century French neurologist and psychiatrist Jules Cotard.\u003c\/p\u003e\u003cp\u003eWalk down the rue de l’École-de-Médecine in the Sixth Arrondissement in Paris, and you’ll see a formidable colonnade. A striking example of French neoclassical architecture, the colonnade forms a portico for the Université René Descartes. Designed in the late eighteenth century by architect Jacques Gondouin, the façade, as the architect intended, demands attention and yet feels open and inviting.\u003c\/p\u003e\u003cp\u003eI entered the building to visit the rare manuscript section of the Library of the School of Medicine, to look at a document on the life of Jules Cotard. The document is the text of a eulogy delivered by his friend and colleague Antoine Ritti in 1894, almost five years after Cotard’s death. Cotard had been devotedly nursing his daughter, who was suffering from diphtheria, but then fell ill himself with the disease and died in 1889. Much of what we know of Cotard comes from Ritti’s eulogy, a copy of which exists amid the pages of an old leather-bound volume, whose spine simply reads \u003ci\u003eMÉLANGES BIOGRAPHIQUES\u003c\/i\u003e—a mixture of biographies. I turned the pages to Ritti’s eulogy. Handwritten on the first page was a note to the then head of the faculty of medicine of the university: “\u003ci\u003eHommage de profond respect,\u003c\/i\u003e” the note read. It was signed \u003ci\u003eAnt. Ritti\u003c\/i\u003e.\u003c\/p\u003e\u003cp\u003eCotard is best known for describing what are called nihilistic delusions, or \u003ci\u003edélire des négations\u003c\/i\u003e. But before he came up with that phrase, Cotard first talked of “delirium in a severely melancholic hypochondriac” at a meeting of the Société Médico-Psychologique on June 28, 1880, using as an example the case of a forty-three-year-old woman who claimed “she had ‘no brain, nerves, chest, or entrails, and was just skin and bone,’ that ‘neither God or the devil existed,’ and that she did not need food, for ‘she was eternal and would live forever.’ She had asked to be burned alive and had made various suicidal attempts.”\u003c\/p\u003e\u003cp\u003eSoon afterward, Cotard coined the phrase \u003ci\u003edélire des négations\u003c\/i\u003e, and after his death, other doctors named the syndrome after him. Over time, “Cotard’s delusion” has come to refer to the most striking symptom of the syndrome—the belief that one is dead. However, the syndrome itself refers to a constellation of symptoms, and does not have to include the delusion of being dead or not existing. The other symptoms include the belief that various body parts or organs are missing or putrefying, feelings of guilt, feelings of being damned or condemned, and paradoxically, even feelings of immortality.\u003c\/p\u003e\u003cp\u003eBut it’s the delusion that one does not exist that poses an interesting philosophical challenge. Until recently, the seventeenth-century French philosopher René Descartes’s assertion \u003ci\u003eCogito ergo sum\u003c\/i\u003e (I think, therefore I am) was the bedrock of Western philosophy. Descartes established a clear dualism of mind and body: the body was of the physical world, something that takes up space and exists in time, while the mind’s essence was thought and it did not extend into space. For Descartes, \u003ci\u003ecogito \u003c\/i\u003edid not mean thinking as much as “clear and distinct intellectual perception, independent of the senses.” An implication of Descartes’s philosophy, according to philosopher Thomas Metzinger, was that “one cannot be wrong about the contents of one’s own mind.”\u003c\/p\u003e\u003cp\u003eThis Cartesian idea has been falsified in many disorders, including Alzheimer’s, where patients are often unaware of their own condition. Cotard’s syndrome is also a puzzle. Metzinger argues that we should be paying attention to what it feels like to be suffering from Cotard’s—what philosophers call the \u003ci\u003ephenomenology\u003c\/i\u003e of a disorder. “Patients may explicitly state not only that they are dead, but also that they don’t exist at all.” While this seems logically impossible—an obviously alive individual claiming not to exist—it \u003ci\u003eis \u003c\/i\u003epart of the phenomenology of Cotard’s.\u003c\/p\u003e\u003cp\u003eI left the library, and stepped back out onto the rue de l’École-de-Médecine, and turned around to take another look at the name “Université René Descartes” etched into the stone above the colonnade. There was something intriguing about researching Jules Cotard in a university named after Descartes. What does Cotard’s eponymous delusion say about Cartesian ideas? Is the Cotard’s syndrome patient saying, “I think, therefore\u003ci\u003e I’m not\u003c\/i\u003e”?\u003c\/p\u003e\u003cp\u003e“Who is the I that knows the bodily me, who has an image of myself and a sense of identity over time, who knows that I have propriate strivings? I know all these things, and what is more, I know that I know them. But who is it who has this perspectival grasp?”\u003c\/p\u003e\u003cp\u003eWho, indeed. The American psychologist Gordon Allport’s lyrical musings above capture the central conundrum of being human. We instinctively and intimately know what he’s referring to. It is there when we wake up and slips away when we fall asleep, maybe to reappear in our dreams. It is that feeling we have of being anchored in a body we own and control, and from within which we perceive the world. It is the feeling of personal identity that stretches across time, from our first memories to some imagined future. It is all of these tied into a coherent whole. It is our sense of self. Yet, despite this personal intimacy we have with ourselves, elucidating the nature of the self remains our greatest challenge.\u003c\/p\u003e\u003cp\u003eAll through recorded history, it is clear that humans have been fascinated and confounded by the self. Pausanias, a Greek traveler during Roman rule, wrote about the maxims inscribed at the fore-temple at Delphi by seven wise sages. One maxim said, “Know thyself.” The Kena Upanishad, among the most analytical and metaphysical of Hindu scriptures, begins with these words: “By whom commanded and directed does the mind go towards its objects? . . . At whose will do men utter speech? What power directs the eye and the ear?”\u003c\/p\u003e\u003cp\u003eSaint Augustine said this of the notion of time, but he might as well have been speaking about the self: “If no one asks of me, I know; if I wish to explain to one who asks, I know not.”\u003c\/p\u003e\u003cp\u003eAnd so it is that from the Buddha to the modern neuroscientist and philosopher, humans have pondered the nature of the self. Is it real or an illusion? Is the self in the brain, and if so, where in the brain is it? Neuroscience is telling us that our sense of self is an outcome of complex interactions between brain and body, of neural processes that update the self moment by moment, the moments strung together to give us a seamless feeling of personhood. We often hear of how the self is an illusion, that it is nature’s most sophisticated sleight of hand. But all this talk of tricks and illusions obfuscates a basic truth: remove the self and there is no “I” on whom a trick is being played, no one who is the subject of an illusion.\u003c\/p\u003e\u003cp\u003eFrom the Université Rene Descartes, it’s a thirty-minute walk down rue des Écoles, past the national museum of natural history, to reach the Pitié-Salpêtrière Hospital, where Jules Cotard started his medical career as an intern in 1864. I went there to see David Cohen, the head of the hospital’s infant and adolescent psychiatry unit.\u003c\/p\u003e\u003cp\u003eOver the course of his medical residency and practice, Cohen has seen a few handfuls of patients who have suffered from Cotard’s syndrome. Given the rarity of this disorder, this relatively large sample has given Cohen an intimate look at Cotard’s. We talked of one particular patient, fifteen-year-old May—one of the youngest recorded cases of Cotard’s. Cohen treated her and had extensive discussions with her after she recovered, enabling him to link her delusions with her personal history. He got a peek into how the self, even in a delusional state like Cotard’s, is influenced by one’s personal narrative and even dominant cultural norms.\u003c\/p\u003e\u003cp\u003eAbout a month before May came to Cohen’s clinic, she had started feeling extremely sad and depressed, and eventually began exhibiting delusions about her own existence. By the time she was admitted, she had become severely catatonic—mute and unmoving. “Even the nurses were terrified by her,” Cohen told me. But with a few days of inpatient psychiatric care, May recovered somewhat, just enough to say a few words each day, which the nurses would write down diligently. Between these sporadic intimations from May and discussions with her parents, Cohen pieced together May’s story.\u003c\/p\u003e\u003cp\u003eHer family was middle-class Catholic. May had two siblings, a brother and a sister. The sister, who was ten years older, had married a dentist. The family had a history of depression: their mother had suffered from severe depression before May was born, and one of May’s aunts had undergone electroconvulsive therapy (ECT), which involves delivering mild pulses of electricity to the brain to induce seizures, and is often an effective treatment for severe depression—though almost always of last resort.\u003c\/p\u003e\u003cp\u003eMay’s delusions were classic Cotard’s. “She was telling us that she had no teeth, no uterus, and that she had this feeling of being already dead,” Cohen said. He struggled to describe May’s condition in English. “I don’t know the word in English . . . \u003ci\u003emorts vivants!\u003c\/i\u003e” he said. I looked it up later: the literal translation is \u003ci\u003ethe living dead.\u003c\/i\u003e\u003c\/p\u003e\u003cp\u003e“She was waiting to be buried . . . in a coffin,” said Cohen.\u003c\/p\u003e\u003cp\u003eWhen her condition didn’t improve even after six weeks of therapy and medication, Cohen suggested ECT. Given the family’s experience with depression, her parents immediately agreed. After six treatments, May appeared to recover, so Cohen stopped the ECT—but she relapsed immediately, prompting Cohen to resume the treatment. This time she did recover, except for some headache, mild confusion, and slightly disturbed memory. When she began talking, it was as if she had awakened from a nightmare.\u003c\/p\u003e\u003cp\u003eCohen’s discussions with her—in which he asked May to talk freely of any associations that came to mind when he mentioned her delusions—shed surprising light. For instance, the delusion that she had no teeth seemed to have something to do with her sister’s husband, the dentist. Cohen discerned that she may have had feelings for her brother-in-law. She spoke of never wanting to be treated by him. Again, Cohen struggled for the correct word in English to describe the way she expressed herself. \u003ci\u003ePudique\u003c\/i\u003e, he said in French. “Modest.” She spoke of her brother-in-law in “such a way that you understood that she’ll never be naked in front of him.”\u003c\/p\u003e\u003cp\u003eHer delusions about missing her uterus seemed to be tied to episodes of masturbation. “She felt very guilty about that and she thought that maybe she would be sterile.”\u003c\/p\u003e\u003cp\u003eCohen was making the point that the specificity of the delusions is related to one’s autobiography and the cultural context. To make his case for the latter, he recalled a fifty-five-year-old man who had come to see him in the 1990s. Cohen diagnosed him with Cotard’s. One of his delusions was that he had AIDS—which he didn’t. Cohen figured his delusion was linked to guilt over his hypersexuality during the manic phase of his bipolar disorder, from which he also suffered. Before the 1970s, hypochondriac delusions in Cotard’s patients, if they involved sexually transmitted diseases, were almost always related to syphilis—the cultural scourge of the times. Interestingly, this man had actually contracted syphilis while serving in the military as a young man (Cohen tested him for antibodies to confirm). But his delusions during his Cotard’s episode, which happened decades later, were not about syphilis but HIV\/AIDS—which had supplanted syphilis in the broader culture as “God’s punishment for sins of the flesh” (syphilis almost never shows up anymore during hypochondriac delusions in Cotard’s). “It’s only one case, [but] I think this case is very informative,” Cohen said.\u003c\/p\u003e\u003cp\u003eFor Cohen, Cotard’s syndrome is revealing of the workings of the self. The disorder is a deeply felt disturbance of one’s being, and shows that the self is linked to one’s body, one’s story, and one’s social and cultural milieu. Brain, body, mind, self, and society are inextricably linked.\u003c\/p\u003e\u003cp\u003eBack in Exeter, Adam Zeman had encountered something similar with Graham. The delusion in Graham’s case was that his mind was alive but his brain was dead. “It was an updated, contemporary version of the Cotard’s delusion. To come to the conclusion that your brain has died in isolation, . . . [you need] a concept of brain death, which is a relatively recent medical development.”\u003c\/p\u003e\u003cp\u003eWhat Zeman found even more intriguing was the inherent dualism in Graham’s delusion—that an “immaterial” mind can\u003c\/p\u003e","brand":"Dutton","offers":[{"title":"Default Title","offer_id":48338552291557,"sku":"NP9781101984321","price":24.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9781101984321.jpg?v=1769572657","url":"https:\/\/k12savings.com\/es\/products\/the-man-who-wasnt-there-isbn-9781101984321","provider":"K12savings","version":"1.0","type":"link"}