How the Brain Creates the Self Commentary by Todd E. Feinberg, M.D.

In his article, Milrod examines the self and self-representation mainly from the psychoanalytic standpoint. I have taken another approach to the problem of the nature of the self through the study of patients with brain damage who have neurological perturbations of the self—conditions in which a change in the brain transforms the boundaries of the self, the relationship between the self and the world, the self to other people and the self to itself (Feinberg, 1997, 2001). By studying these patients, and relating the area of brain damage to the change in the self, one hopes to learn which areas of the brain contribute to the self, and in what manner they do so.

One condition that alters self-representation is known as asomatognosia (Feinberg, Haber and Leeds, 1990). The patient with asomatognosia fails to recognize a part of his or her own body. Indeed, asomatognosic patients often totally reject and disown the body part. Asomatognosia most commonly occurs as a result of a right hemisphere stroke in which the severely paralyzed and largely insensate left arm is rejected. Asomatognosic patients nearly always have left hemispatial neglect, and they tend to ignore the entire left side of the body and the left hemispace.

Some patients with asomatognosia attribute ownership of the limb to the doctor, claiming it's “your hand” or “the doctor's hand”. There is a tendency on the part of some of these patients to personify their paralyzed limbs. One of my patients called her paralyzed left arm her “pet rock” and would sing the Everly Brothers hit song “Wake Up Little Suzy” to her arm while hugging, petting, and kissing it.

Another neurological condition that affects the self is known as the alien hand syndrome (Feinberg et al., 1992; Feinberg, Roane and Cohen, 1998). In the alien hand syndrome, the patient has a hand that performs actions that seem purposeful and voluntary, but the patient claims that the actions are not consistent with thei