Self Comes to Mind

knows that he was married and is the father of two sons, but he knows almost nothing concrete about his family members, whom he cannot recognize, in photographs or in person. His autobiographical self is severely compromised. On the other hand, another well-known amnesic patient, Clive Wearing, has far more preserved recall of his biography. He has not only a normal core self but a robust autobiographical self. A passage from a letter his wife, Deborah Wearing, wrote to me, explains why I think so:
     
He can describe the approximate layout of his childhood bedroom, he knows that he sang in Erdington Parish Choir from an early age, he says he remembers being in the bomb shelter during the war and the sound of bombs in Birmingham. He knows a number of stubs of facts about his childhood and about his parents and siblings, he can sketch his adult autobiography—his Cambridge college where he was choral scholar; where he worked; the London Sinfonietta, the BBC Music Department, his career as a conductor, musicologist and music producer (and earlier as a singer). But as Clive will tell you, although he knows the vague outline, he has “lost all the details.”
Clive has been more capable of real and significant conversations in recent years than in the days when he was very scared and angry in the first ten years. He has some awareness of the passage of time as he speaks of his uncle and parents in the past tense (his uncle died in 2003 and after my giving him the news, which upset him as they were close, I don’t remember him speaking of Uncle Geoff in the present tense again). Also, if asked to guess how long since his illness, he will guess at least 20 years (in fact 25) and he has always had a rough idea. Again, he has no feeling of knowing, but if asked to guess he is usually spot on.
    One other pathological instance that can be attributed to a selective compromise of the autobiographical self is a condition known as anosognosia. Following damage to a region of the right cerebral hemisphere that includes the somatosensory cortices and the motor cortices, usually caused by stroke, the patients exhibit a blatant paralysis of the left limb, especially the arm. Yet they repeatedly “forget” that they are paralyzed. No matter how many times they are told that their left arm does not move, when asked, they will still claim, quite sincerely, that it does move. They fail to integrate the information corresponding to the paralysis in the ongoing process of their life history. Their biography is not updated for such facts, even if they do know, for example, that they have suffered a stroke and are admitted to a hospital. This literal oblivion to such blatant realities is responsible for the apparent indifference toward their health condition and for their lack of motivation to participate in the rehabilitation they so need.
    I must add that when patients suffer equivalent damage to the left cerebral hemisphere, there never is anosognosia. In other words, the mechanism by which we update our biographies relative to the aspects of our body having to do with the musculoskeletal system require the aggregate of somatosensory cortices located in the right cerebral hemisphere .
    Seizures arising within this same system can cause a bizarre and fortunately temporary condition: asomatognosia. The patients maintain a sense of self and retain aspects of visceral perception but suddenly and for a brief period are not able to perceive the musculoskeletal aspects of their bodies.
    One last comment regarding the pathologies of consciousness. It has recently been suggested that the insular cortices would be the basis for conscious awareness of feeling states and, by extension, of consciousness. 20 It would follow from such a hypothesis that bilateral damage to the insular cortices would cause a devastating disturbance of consciousness. We know from direct observation that this is not true and that patients with bilateral insular damage have normal core self and perfectly active conscious minds.

10
Putting It Together
     
By Way of Summary
     
    It is time to put together the seemingly disparate facts and hypotheses about brain and consciousness introduced in the previous three chapters. I propose to begin by addressing a number of questions that are likely to have been raised in readers’ minds.
     
1. Granted that consciousness does not reside in a brain center, is it the case that conscious mental states are predominantly based in