© 1998 Nature America Inc. • http://neurosci.nature.com

book review

results are usually noted therein. One can Overheated imaginations see why this approach has been taken in a work intended for a general readership, but Phantoms in the Brain: Probing the Mysteries of I wish I felt more confident that the end- notes will indeed be read. With an experi- the Human Mind enced science journalist on board, it should have been possible to find a better solution. by V.S. Ramachandran and Sandra Blakeslee The real joy of the book arises from William Morrow and Company, Inc., 1998. $27.00 hardcover, pp 328 Ramachandran’s determination to explain ISBN 0-688-15247-3 the higher reaches of the human mind with- in the context of neuroscience but without Reviewed by John C. Marshall the pernicious reductionism that disfigures so much current work. Ramachandran seems to work on a Mobius-strip; it is Lay readers, who are the primary audience emotional desolation, as close as anyone impossible to decide which side is mind and for Phantoms in the Brain, could be forgiv- can come to experiencing death”. This which brain. The only failure of imagina- en for thinking that they had wandered account would be consistent with the tion occurs in Oliver Sacks’ foreword. He into an unusually gripping episode of The severe depression that is almost invariably quotes from the passage in Hard Times X-Files. Within the space of a mere three found in Cotard’s syndrome. where Mrs. Gradgrind is asked if she is in hundred pages, Mulder and Scully (alias Ramachandran’s position here is argued pain. Sacks claims that her reply, “There is Ramachandran and the science writer San- by analogy with a well known explanation a pain somewhere in the room, but I can- dra Blakeslee) amputate phantom limbs, of Capgras syndrome. These patients believe not be sure that I have got it”, was either watch zombies mail letters, talk to a that their erstwhile family and friends are “her confusion, or Dickens’s joke, for one woman who sees nonexistent cartoons and really doubles who have been substituted for cannot have a pain except in oneself”. Has a man who only shaves the right side of his the real thing. Don Siegel’s classic movie Sacks forgotten that there are well-docu- face. And that’s just for starters. Later, a Invasion of the Body Snatchers provides the mented reports of exosomaesthesia where woman claims that she could lift a heavy closest approximation to how the delusion stimulation at a point on the body is

http://neurosci.nature.com • mahogany table with her paralyzed arm, a might feel. It is known that Capgras patients referred into extrapersonal space? man is convinced that his parents have fail to show a galvanic skin response to My main criticism of the book, how- been replaced by imposters, and God is dis- familiar faces. This loss of emotional reac- ever, is that Ramachandran’s remarks are covered in the left temporal lobe. In short, tion to previously loved ones leads the sometimes overheated and under-refer- this is vintage Ramachandran. patient, it has been claimed, to interpret the enced. The most egregious examples occur Many of the seemingly bizarre behav- lack of an appropriate ‘warm glow’ as evi- in the chapter entitled God and the Lim- iors and beliefs that can result from brain dence that an imposter is pretending to be bic System. It is hardly a novel observation damage are vividly described and provoca- the vanished original. This very neat theo- that mystical experience must be mediat- tively interpreted. I know of no other vol- ry, first proposed by Andrew Young and ed by the brain, the association of reli- 1998 Nature America Inc.

ume that covers anything like the same Hadyn Ellis, is consistent with neurological giosity with (temporal lobe) epilepsy was © range of odd but (partially) explicable phe- findings, in some Capgras patients, of dis- a commonplace of nineteenth century nomena in the border zones between neu- connection between cortical areas special- neuropsychiatry. For example, the third rology and psychiatry. From blindsight to ized for facial recognition and limbic regions edition of Clouston’s Clinical Lectures on phantom pregnancy by way of autistic implicated in the emotions. Nonetheless, the Mental Diseases (1892) notes that “A cer- savants and wart removal by hypnosis, one full story of the Cotard and Capgras delu- tain religious emotionalism of a strong never quite knows where the magical mys- sions must include other factors. Not every and usually perverted kind is often pre- tery tour will stop next. But the reader can depressed patient with a self-accusatory per- sent in epileptics”. Ramachandran won- rest assured that some attempt (of varying sonality and odd perceptual experiences ders whether stimulation of the left plausibility) will be made to explain even would go so far as to deny his own existence. temporal lobe of a well known atheist the very strangest of signs and symptoms. Likewise, not all people who no longer get (Francis Crick) might induce him to expe- More impressive yet is Ramachandran’s an emotional kick from their spouse con- rience God. That Ramachandran is writ- willingness to offer hostages to fortune by clude that he or she has been replaced by a ing with tongue in cheek causes him to way of empirical prediction. Consider, for double. Adultery or divorce (or both) is lose sight here of the distinction between a example, the nihilistic delusions of Cotard’s surely the more common response. cognitive belief (any belief) and an emo- syndrome where, in extreme cases, patients Be that as it may, emotional blunting is tional state. He discusses how a ‘piety claim to be dead. Ramachandran suggests not characteristic of this book’s style. Phan- index’ could be constructed from the gal- that such patients will have a flat galvanic toms in the Brain is a racy, jocular opus in vanic skin response (GSR) to words and skin response to all stimuli that would nor- which some of the jokes are in refreshingly images of a religious nature. The “absolute mally be emotionally evocative. In conse- dubious taste. Ramachandran claims that zero on the scale”, he suggests, “could be quence, they are “stranded on an island of he will take us “at times to the very limits of set by measuring Francis Crick’s galvanic scientific inquiry”. He keeps his promise skin response”. But the joke is ruined by John C. Marshall is at the Neuropsychology (and sometimes more). The flow of the text Ramachandran’s misinterpretation of the Unit, University Department of Clinical occasionally oversteps the bounds of what GSR; a highly ‘positive’ response can indi- Neurology, Radcliffe Infirmary, is known, although copious endnotes cate a highly ‘negative’ emotion. Absolute Woodstock Road, Oxford OX2 6HE, UK redress the balance a little; qualifications, zero would be set by an agnostic who just email: [email protected] exceptions and preliminary or controversial didn’t care one way or the other.

nature neuroscience • volume 1 no 8 • december 1998 651