Traumatic Brain Injury patient who lost his ability to " feel" his memories of loved ones
|“The Unbearable Resemblances of Being”
by Mark Miller
“ One cannot believe in impossible things.”
“ I dare say you haven't had much practice,” said the Queen
“When I was your age I always did it for an half an hour a day. Why,
sometimes I've believed as many as six impossible things before breakfast.”
-Lewis Carroll, Through the Looking Glass
Arthur, a thirty-year-old man, had been in a near-fatal automobile accident while attending college. His injuries were life threatening, as he crashed through the window of his car head first. He had been in a coma for several weeks and upon awaking out of the coma began intensive rehabilitative therapy. And after sometime recovered completely and seemed to be back to normal. He just had this one incredible delusion about his parents-that they were imposters-and nothing could convince him otherwise.
His parents were overwhelmed with grief and stress, their own son was afraid of them and they had been taken over by some other beings. They received the name of a renowned M.D and professor, and director for the Center of Brain and Cognition studies in California, V.S. Ramachandran, M.D., PhD. He agreed to see their son. After a brief conversation with Arthur to gain his trust the Doctor asked, “ Arthur, who brought you to the hospital?”
“That guy in the waiting room over there in the green shirt.” Arthur replied “ He's the old gentleman taking care of me.”
“You mean your father?”
“No, no doctor. That guy isn't my father. He just looks like him. He's, um...what do you call it? -an imposter, I guess. But I don't' think he means any harm.”
“Arthur, why do you think he's an imposter? What gives you that impression?”
He gave a look of patience and concentration-as if to say, how could I not see the obvious-and said, “ Yes, he looks exactly like my father but he really isn't. He's a nice guy, but certainly not my father.”
While the doctor interviewed him more Arthur interrupted and said, “ This is what is so troubling to me, why would anyone want to pretend to be my father?
“Maybe my real father hired him to take care of me? “As Arthur was searching the recesses of his mind for any viable rationale or reason for this perplexing and
Arthur had no difficulties remembering anyone else. He knew his friends, other family members, and most importantly himself. Only his parents had been taken away as in the movie body snatchers. But this was no movie.
So the Doctor decided on a plan of trickery, as the one in my essay about the phantom arm, and sent Arthur's father in his room the next day to sit next to Arthur and say, “ Arthur, guess what? You were right all this time. The guy who brought you here was an imposter, and I sent him away to China. I am your real father.” Arthur blinked and accepted it as face value. As Arthur believed that the imposter was sent away and his real father returned. But after they had went back home and the Doctor made a call to the father to see how things were going. The father said he calls me father but there is something amiss.
“ I think he accepts me intellectually, doctor ,but not emotionally. When I hug him there is no warmth or love.”
And after a brief period went by he no longer accepted them as his parents anymore intellectually, they were imposters one more. What Arthur was suffering from the doctor concluded was Capgras' delusion, one of the rarest and most colorful syndromes of neurology. A disorder which a person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor gras delusion is classified as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places, or objects (usually not in conjunction). I Cases in which patients hold the belief that time has been "warped" or "substituted" have also been reported.
This is where it gets strange because what had occurred is the connections to facial recognition or patterns must have been severed from sheering effect of the car accident. Facial recognition is necessary for survival as a baby it is the first object which corresponds with life sustaining means. So, your brain has a specific area for facial recognition and is highly specialized. It also has numerous connections to every area in the Limbic system, Prefrontal cortex, visual-spatial areas, and most importantly to all emotional centers. It is these emotional centers which comprise most your brain, without them you would not be able to move as you would not be able to place any value system of grade on anything; objects, actions, or decisions and beliefs.
However, there was something wrong with this theory, why could he still recognize faces of everyone else he knew but not his parents. There was something going one. It occurred to the doctor that there must be two pathway areas ( one concerned with recognition and the other with emotion) Maybe his facial recognition pathway was completely normal, and that was why he could identify everyone , including his mother and father, but the connection between this “ face region' and his amygdala had been selectively damaged.
The Amygdala is extremely important for fight or flight situations. The Amygdala involves arousal, autonomic response with fear, emotion response, memory, hormonal secretions. And assigns emotional significance to what a person sees, hears, feels, etc. It can also shut down the conscious part of your brain without your control. It is boss you could say.
The doctor recognized if that were the case he would recognize his parents but would not experience any emotion when looking at their faces. He would not feel that 'warm glow” when looking at his beloved mother, so when he sees her he says to himself, “ If this is my mother, why doesn't her presence make me feel like I'm with my mother?” And the only way to make sense of this is for him to assume that this woman here only resembles her. She must be an imposter.
All the experiments confirmed the doctor’s theory he had no problem recognizing faces from pictures or themselves directly but there was another issue and this had to do with his emotions. Arthur has still shown the wide array of emotions. He laughed at jokes, expressed frustration, fear, anger, and even cried. So he was experiencing facial recognition and emotional responses with everyone else, except his parents. Why not call the mail man an imposter since he is a familiar face too.
It may be that when a normal person encounters someone who is emotionally very close to him- a parent, spouse, or sibling-he expects an emotional “glow”, a warm fuzzy feeling. The absence of this glow is therefore generating an absurd delusion to rationalize it or to explain it away. On the other hand, when one sees the mailman one doesn't expect a warm fuzzy glow and therefore no incentive for Arthur to generate a delusion to explain his lack of “glow”.
This idea was revolutionary in that it teaches us an important principle about brain function, namely, that all our perceptions-indeed, maybe all aspects of the mind's process of memory reproduction, placement, and retrieval are governed by comparisons and not absolute values. This appears to be true when talking about something as obvious as judging the brightness of print in a newspaper or something as subtle a detecting a blip in your internal emotional landscape.
So there at least was an explanation for Arthur's condition of facial recognition, his emotional pathway had been severed to the amygdala and to other emotional centers, but not the facial recognition pathway itself. He could not assign any emotional variance to the people that in the past lite up the 'glow”. Arthur was not crazy. And they did not reveal this information to Arthur.
However, Arthur's father question the doctor about Arthur's ability to recognize his parents over the telephone with an emotional response. He asked the doctor, “Does that make any sense to you?
“Well”, the doctor replied.' there is a separate pathway from the auditory cortex, the hearing area of the temporal lobes, to the amygdala. One possibility is that this hearing route was not affected by the accident, on the visual centers have been disconnected for Arthur's amygdala.”
This got the doctor thinking about experiments involved with the amygdala that in addition to responding to facial expressions and emotions, the cells also respond to eye gaze. To find out if this was true, the doctor prepared a series of picture slides, each showing the some model either directly at the camera lens or or an inch or two to the right. Arthur's task was simple to let us know when the model was looking straight at him or not. Whereas you or I can detect tiny shifts in gaze, Arthur was hopeless at it. But on the eighth trial Arthur did something unexpected. In his soft, almost apologetic voice, he exclaimed that the model's identity had changed. He was now looking at a new person. This meant that a mere change in in direction of gaze had been enough to provoke Capgras delusion. For Arthur the “second “model was apparently a new person who merely resembled the “first”, even though it was the same model. At the end of the session Arthur had developed three different people out of some model.
This must have to do with the mechanics of how memories are stored. Each time you meet the same person let’s say in different circumstance or events our memories become refined and change or alter slightly based on previous memories of that person. The memories keep on changing the more times you see the same person in different outfits, work settings, or in the supermarket. The memories stack up on each other, higher and higher, which in turn can also enhance or develop an emotional pathway, where once there wasn't one. This is what lead to the new model of memory transfer, collection, and storage. The hippocampus once believed to be the storage center of all memories, now is known as the director of new memories storage and retrieval of older ones to update and put together.
Arthur's most serious problem, however, was his inability to make and contact with people that matter to him the most -his parents- and caused great anguish. One day Arthur turned to his mother and said, “ Mom, if the real Arthur ever returns, do you promise that you will still treat me as a friend and love me?” How can a sane human being who is perfectly intelligent in other respects come to regard himself as two separate people? There seems to be something inherently contradictory about splitting the self, which by its very nature is unitary. If I started to regard myself as several people which one would I plan for? Which one is the real me?
Philosopher have argued force centuries that if there is any one thing about our existence that is completely beyond question, it is the simple fact that “I” exist as a single human being who endures a space and time. But even this basic axiomatic foundation of existence is called into question by Arthur. -By Mark Miller
Resources: Phantoms in the Brain, by V.S. RAMACHANDRAN, M.D..pp 159-173