by Anil Ananthaswamy
“But in the devastation are clues to what makes us who we are. These maladies are to the study of the self what brain lesions are to the study of the brain: They are cracks in the façade of the self that let us examine an otherwise almost impenetrable, ongoing, unceasing neural process.”
What is the self? This is an old and difficult question at the intersection of religion, philosophy, psychology, and neuroscience. By investigating Alzheimer’s disease, autism, body integrity identity disorder, Cotard’s syndrome, and schizophrenia in turn, Anil Ananthaswamy is able to show how the disruptions these conditions cause can illuminate the illusive concept of self, which can be so difficult to examine when it is functioning seamlessly. Through interviews with patients as well as their caregivers, Ananthaswamy offers insight into the phenomenology of these conditions, interspersed with lucid explanations of the most current scientific thinking.
The Man Who Wasn’t There explores neuroscience of the most fascinating and mind-bending sort. Ananthaswamy does begin with the most dramatic of the conditions he is exploring, Cotard’s syndrome, in which the patient believes herself to be dead. But in general this is a very sober and analytic investigation. Ananthaswamy is delving deep, and his explanations are detailed; he is willing to dig into nuance rather than oversimplifying matters. He has a tendency to interleave explanations and examples, which can make for some circular reading, since the science is often best understood once the example is in hand.
The crucial thing about this book may be that it doesn’t assume we have all the answers about what the self is and how it works. Instead, it is about questioning our assumptions. Again and again, it asks, what does this condition tell us about what we currently believe to be true? How does this affirm or challenge our current thinking or our intuitions about the self? For example, why is it that people with schizophrenia can tickle themselves? On the surface, this would seem to be an unusual but not particularly noteworthy phenomenon. But The Man Who Wasn’t There digs into such little quirks, and shows how they might connect to a larger impairment of the sense of agency, which can lead patients to feel that they are not the source of their self-generated thoughts or sensations.
One of the things I appreciated about this book was the focus on phenomenology, or the lived experience of the people who experienced the conditions Ananthaswamy is investigating. There are, of course, limits to this approach. He is necessarily speaking with people who have recovered—or never entirely lost—their ability to articulate their experiences. He also speaks with doctors, researchers, and caregivers, but does not rely on them exclusively when he can talk to the patients themselves. And in the new afterword to the paperback edition, Ananthaswamy speaks powerfully against the stigma we tend to attach to “illnesses that seem to be of the mind more than the body.” The Man Who Wasn’t There is integrative, fundamentally challenging this common sense of duality by showing how deeply the mind and body are connected.