Self Comes to Mind

or fear, as well as the responses of freezing or running in situations of fear are all triggered from the PAG. The to-and-fro of connections among these nuclei is well suited to producing complex representations. The basic wiring diagram of these regions qualifies them for an image-making role, and the kind of image these nuclei make is feelings. Also, because these feelings are early and foundational steps in the construction of the mind and are critical for the maintenance of life, it makes good engineering sense (by which I mean evolutionary sense) for the supportive machinery to be based on structures that are housed literally next door to those that regulate life. 9

     
Figure 3.2: Panel A shows the MR scan of a patient with complete damage to the insular cortices, in both the left and right hemispheres. A three-dimensional reconstruction of the patient’s brain is shown on the left. On the right, there are two sections taken through the brain (marked 1 and 2), along the vertical and horizontal black lines shown on the left and marked respectively 1 and 2. The area shown in black corresponds to brain tissue destroyed by the disease. The white arrows point to locations where the insula should have been. Panel B shows a normal brain in 3-D and in two sections taken at the same levels. The black arrows point to the normal insular cortex.
THE STRANGE SITUATION OF CHILDREN
DEPRIVED OF THE CEREBRAL CORTEX
    For a variety of reasons, children can be born with intact brain-stem structures but largely absent telencephalic structures, namely, the cerebral cortex, the thalamus, and the basal ganglia. This unfortunate condition is commonly due to a major stroke, occurring in utero, as a result of which all or most of the cerebral cortex is damaged and reabsorbed, leaving the skull cavity filled with cerebrospinal fluid. This is known as hydranencephaly, to distinguish it from developmental defects, generally known as anencephaly, that compromise other structures beside the cerebral cortex. 10 The affected children can survive for many years, even past adolescence, and are often dismissed as “vegetative.” They are commonly institutionalized.
    These children, however, are anything but vegetative. On the contrary, they are awake and behaving. To a limited but by no means negligible extent, they can communicate with their caregivers and interact with the world. They are patently minded in a way that patients in vegetative state or akinetic mutism are not. Their misfortune provides a rare window into the sort of mind that can still be engendered when the cerebral cortex is absent.
    What do these unfortunate children look like? Their motions are quite limited by the lack of muscular tone in their spine and the spasticity of their limbs. But they move their heads and eyes freely, they have expressions of emotion in their faces, they can smile at stimuli that one would expect a normal child to smile at—a toy, a certain sound—and they can even laugh and express normal joy when they are tickled. They can frown and withdraw from painful stimuli. They can move toward an object or situation they crave—for example, crawl toward a spot on the floor where sunlight is falling and where the child will bask in the sun and obviously draw benefit from the warmth. The children look pleased, in an external manifestation of the kind of feelings one would predict they would have following an emotional response appropriate to the stimulus.
    These children can orient head and eyes, albeit inconsistently, to the person addressing them or touching them and reveal preferences for distinct people. They tend to be fearful of strangers and appear happiest near their habitual mother/caregiver. Likes and dislikes are apparent, none so striking as in examples of music. The children tend to like some musical pieces more than others; they can respond to different instrumental sounds and different human voices. They also can respond to different tempi and different composition styles. Their faces are a good reflection of their states of emotion. In brief, they are most joyful when they are touched and tickled, when preferred music pieces are played, and when certain toys are shown in front of their eyes. Obviously they hear and they see, although we have no way of knowing how well. Their hearing seems superior to their sight.
    Of necessity, whatever they see and hear is achieved subcortically, in all likelihood in the colliculi, which are intact.