The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human

It would also explain the paradoxical finding (not proven, but suggestive) that some severely depressed patients commit suicide when first put on antidepressant drugs such as Prozac. It is arguable that in extreme Cotard cases suicide would be redundant, since the self is already “dead” there is no one there who can or should be put out of her suffering. On the other hand, an antidepressant drug may restore just enough self-awareness for the patient to recognize that her life and world are meaningless; now that it matters that the world is meaningless, suicide may seem the only escape. In this scheme, Cotard syndrome is apotemnophilia for one’s entire self, rather than just one arm or leg, and suicide is its successful amputation.¹⁵

DOCTOR, IAMONE WITH GOD

Now consider what would happen if the extreme opposite were to occur—if there were a tremendously overactivation of pathway 3 caused by the kind of kindling one sees in temporal lobe epilepsy (TLE). The result would be an extreme heightening of empathy for others, for the self, and even for the inanimate world. The universe and everything in it become deeply significant. It would feel like union with God. This, too, is frequently reported in TLE.

Now, as in Cotard syndrome, imagine adding into this cocktail some damage to the system in the frontal lobes that inhibits mirror-neuron activity. Ordinarily this system preserves empathy while preventing “overempathy,” thus preserving your sense of identity. The result of damaging this system would be a second, even deeper sense of merging with everything.

This sense of transcending your body and achieving union with some immortal, timeless essence is also unique to humans. To their credit, apes are not preoccupied with theology and religion.

DOCTOR, I’M ABOUT TO DIE

Incorrect “attribution” of our internal mental states to the wrong trigger in the external world is very much a part of the complex web of interactions that lead to mental illness in general. Cotard syndrome and “merging with God” are extreme forms of this.¹⁶ A far more common form is the syndrome of panic attacks.

A certain proportion of otherwise normal people are seized for forty to sixty seconds by a sudden feeling of impending doom—a sort of transient Cotard syndrome (combined with a strong emotional component). The heart starts beating faster (felt as palpitations, an intensification of heartbeats), palms sweat, and there is an extreme sense of helplessness. Such attacks can occur several times a week.

One possible source of panic attacks might be brief miniseizures affecting pathway 3, especially the amygdala and its emotional and autonomic arousal outflow through the hypothalamus. In such a case, a powerful fight-or-flight reaction would be triggered, but since there is nothing external you can ascribe the changes to, you internalize it and start to feel as if you’re dying. It’s the brain’s aversion to discrepancy again—this time between the neutral external input and the far-from-neutral internal physiological feelings. The only way your brain can account for this combination is to ascribe the changes to some indecipherable and terrifying internal source. The brain finds free-floating (inexplicable) anxiety less tolerable than anxiety which can be clearly attributed to a source.

If this is correct, one wonders if it might be possible to “cure” panic attacks by taking advantage of the fact that the patient often knows a few seconds ahead of time that an attack is about to occur. If you are the patient, then as soon as you sense the attack coming on, you could quickly start watching a horror movie on your iPhone, for example. This might abort the attack by allowing your brain to ascribe the physiological arousal to the external horror, rather than to some terrifying but intangible inner cause. The fact that you “know” that it’s only a movie at some higher intellectual level doesn’t necessarily rule out this treatment; after all, you do feel fear when watching a horror movie even while recognizing that it’s “only a movie.” Belief is not monolithic; it exists in many layers whose interactions one can manipulate clinically using the right trick.

Continuity