Please visit Amazon Author Page at

Sunday, June 19, 2011

Consciousness, Empathy, Self and Wisom - 3

More recently the term Self has also come under scrutiny. The idea of self is both physical and philosophical. William James is credited with showing that the so-called “self” (he called it the me self) has three components: the material self, the physical self dealing with one’s care of one’s own body with clothing etc, the social self that is recognized as a consistently predictable individual and the spiritual self which determines one’s internal philosophical values.

I will leave out for the present, the “self” as defined by philosophers and religious scholars who suggest that there is a non-material entity called self or atma or spirit which activates the functions of the human body, including that of the brain and independent of the body. I am also leaving out the study of “self” by neuroscientists such as Antonio Damasio who suggests that there is a proto-self, core self and autobiographical self.

Based on the suggestions of William James, one group of neurologists defined self as “temporally stable, trans-situational consistencies in behavior, dress, or political or religious ideologies”. Since patients with dysfunction in frontal lobe functions have been shown to exhibit dramatic changes in their beliefs and self-care, these neurologists studied 72 patients with fronto-temporal dementia. The studies included documentation of change in the core aspects of “self” as defined above, such as changes in style of dress, social presentation, political and religious ideologies and self-concept related to their work.Imaging studies (MRI and SPECT) were also completed on these patients.

Seven patients showed dramatic changes in “self” as defined above. Six of those with change in their “self” showed clear structural abnormalities on fMRI with asymmetric loss of function in the non-dominant frontal lobe.
In other words, some of the components of what we call “self” in our daily, practical usage are represented in specific areas of the brain.That is not surprising at all.It is surprising that it took so long to figure that out.

The reason I am summarizing all of this is because with an increase in aging population, we see many patients with loss of mental functions including awareness, a personal self and judgment. In addition, patients with several types of neurological diseases based on organ pathology manifest behavioral problems and mental illness in which they have lost or have exaggerated mental functions. I believe neuroscience can help our patients based on solid evidence. It is obvious that these studies are important in understanding mental illness with objective data and are essential to developing reliable treatment modalities.

In addition, compassion, empathy, altruism, wisdom are important in the making of a physician. If we understand what wisdom is and what empthy is, we may be able to train our future physicians better.

Further reading:

Singer T, Lamm C. Social neuroscience of empathy in The Year in Cognitive Neuroscience 2009: Ann. N.Y. Acad. Sci. 2009; 1156: 81–96.

Budson AE, Price BH. Memory dysfunction. New Eng J Med 2005; 352: 692-699.

T R Insel . Faulty circuits. Scientific American April 2010 pages 44-51.

J W Buckholtz et al. Dopaminergic network differences in human impulsivity. Science 2010; 329: 532-534.

Mohammadreza Hojat, PhD, Michael J. Vergare, MD, Kaye Maxwell, George Brainard, PhD, Steven K. Herrine, MD, Gerald A. Isenberg, MD, Jon Veloski, MS, and Joseph S. Gonnella, MD.The Devil is in the Third Year:A Longitudinal Study of Erosion of Empathy in MedicalSchool. Academic Medicine 2009;84(9):1182-1191.

Steve Twomey. Phineas Gage: Neuroscience's Most Famous Patient - An accident with a tamping iron made Phineas Gage history's most famous brain-injury survivor., Smithsonian Magazine, January 2010.

Damasio A. The Feeling of what happens. Harcourt Brace. 1999

No comments: