The Anosognosic’s Dilemma: Something’s Wrong but You’ll Never Know What It Is (Part 4)

By ERROL MORRIS
NYT
(This is the fourth part of a five-part series. Page down this blog for the rest.)

4. BELIEF IS NOT A MONOLITHIC THING

V.S. Ramachandran has written about anosognosia in a number of journal articles and in his extraordinary book with Sandra Blakeslee, “Phantoms in the Brain.” Ramachandran rarely settles for the status quo. If there is something unexplained, he pursues it, trying to provide an answer, if not the answer. He has made a number of spectacular discoveries, most famous among them his innovative use of mirror-boxes to treat phantom limb syndrome. Rather than devise complex experiments, he prefers simple intuitive questions and answers. His work on anosognosia is a perfect example.

Ramachandran was taken in by a question that haunts Babinski’s original work on anosognosia — the question of whether the anosognosic knows (on some level) about the paralysis. What is going on in an anosognosic brain? (Babinski’s original question: Is it real?) Almost any deficit can be explained as volitional. How do you know that an anosognosic patient is really in denial, or oblivious, or indifferent to his/her paralysis? How do you know that the patient is not feigning illness? This was a critical question during World War I, when neurologists had to deal with a flood of injured soldiers and had to discriminate between the truly damaged and those just malingering.

ERROL MORRIS: As I understand it, from the earliest descriptions of anosognosia, there were two things that people had fixed in their heads: one was, of course, the organic illness, the hemiplegia, the other was the lack of awareness.

(More here.)

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