Sensing another’s self

Here is a report (NYT 8/21/15: “Your Brain, Your Disease, Your Self”) of some half-way interesting research recently published in Psychological Science. I say half-way because this is the type of study the validity of which I question because it relies on questionnaires, though these researchers used them in a well constructed context with plenty of ancillary data. I also say half-way because of a recent study out of the University of Virginia in which they tried to replicate 100 psychological studies and could only do so for about a third of them, which to me suggests the original methodology was inadequate to the task, the topic poorly understood, or the supposed phenomena was too trivial to matter.

Anyway, this study looked at how family members perceived personality changes in patients with 3 different neurological diseases. One was ALS (amyotropic lateral sclerosis) which affects lower motor centers and not higher centers, one was Alzheimer’s with diffuse effects throughout the cortex and midbrain, and the third one was fronto-temporal dementia where specific cells are effected so as to disrupt systems in both frontal and temporal lobes. They used a variety of data to show overall neuropsychological status, e.g., memory, IQ subtests, etc. and then they asked family members to rate in a variety of ways if and when they thought their sick member had changed in personality, i.e., was not their old self. Little change was noted in the ALS patients, which makes sense because this disease affects motor control until the end stage. More effects (memory loss, slowed mental faculties, etc.) were noted in Alzheimer’s patients but family members did not report a change in the self (personality) even as memory failed and the patients themselves failed to recognize or recall who they were. The most change in others’ perceptions of self came with fronto-temporal dementia when this disease affected the patients’ treatment of others, i.e., their ethical or moral behaviors, e.g., stealing, lying, tricking others, etc. Family members reported that these patients had lost or changed their selves. A curious finding that gratifies my humanist longings.

Yet somehow this seems to me misconstrued. Of course we do not want to think that someone we love has become capable of immoral actions, so we must attribute some basic change in their self, as opposed to their inability to move or remember or think, which we attribute to the disease debilitating key functions but leaves the self intact. But in fact, one postulate of psychology since Freud, Jung, even Nietzsche is that we all have within ourselves darker impulses that most of us control or repress in the service of healthier, prosocial activity. We do generally ignore this aspect and vary our attributions according to the disability, e.g., memory, motoric, impulse control, inter-personal relationships, in-group/out-group, etc.

Sensing another’s self is basic; we empathically follow another’s intents, moods, etc. Sensing a change in self is not basic because such a change violates expectations. Our selves are embodied and we maintain expectations of identity based upon that body. Sort of, anyway. A few months ago I went with my wife to her 50th high school reunion. She recognized some of her classmates and not others. Some recognized her but not others. Many people came up to me, peering in my face and trying to place who I was. I took up the joke of saying, “You don’t remember me, do you? And after all that time we spent together in English class.” Later I disclosed I was actually a spouse and not a classmate. Some laughed at the joke and some did not. Could we have predicted from their high school selves who would enjoy the joke and who not? Maybe. I think sense of humor is a stable trait. And the people we liked or didn’t like back then are about the same as now.

Of course, this study above focused on a marked change in neuropsychological status due to disease. I think we experience some difficulty in understanding and dealing with people with neurological/psychiatric disease. There are many sorts of rapid changes seen ecologically, including patients with bipolar illness, borderline personality disorder, traumatized patients, dissociative identity disorder, etc. I have worked with the last a few times and the personalities assumed at any one moment were difficult to tell apart unless one was adult and the other child or male-female or unless you knew the physical cues marking the transition.   A different self? In some sense. Some adolescents change their moral stances through large swings before settling in an enduring adult pattern.

We make different attributions for different selves. I have worked with teachers who called a problem child, e.g., severe ADHD, a devil, some literally and some close enough. The mentally ill person who commits mass murders are generally not recognized as being the same youthful self by their family members. One example of this was Charles Whitman, who shot and killed 16 (?) people from a tower at a college in Texas. He had sought help several times in the period before the incident, complaining that his mind was changing and going out of control.   The response of the mental health system was clearly inadequate in part because his symptoms were unusual.   Later his autopsy revealed a large tumor had grown in a lower temporal lobe and impinged on the amygdala, a cancer consistent with his reported symptoms.

A famous college basketball coach when dying of cancer famously said that the cancer could not touch his mind or take away his soul. Ouch! Cancer certainly touched Charles Whitman’s mind (and he is only one dramatic example out of many). I won’t say anything about souls, though I think murdering others comes close enough to merit the question.