The Changing Self

As a neurosurgeon who treats epilepsy, I occasionally have to tell a patient that he or she is legally prohibited from driving a car once they’ve had a seizure. Their responses vary. Some are angry, some bargain, several are non-compliant, but most of them are left with a certain muted depression by the loss of independence. They are similar to another population that I occasionally see – spinal cord injury patients who have just lost the function of their legs. Interestingly, while deeply shocked and despondent at first, the paraplegics often bounce back. They learn to use their wheel chair; they get specially equipped cars and often get on with life. The epileptic patients don’t do that. They often seem stuck. The question is why? Why does one group who has the use of their legs seem dependent, while the other group who can’t walk is able to engage with the world?

The difference – the car.

This difference speaks to our fundamental neurobiology of how we engage with technology. The primate brain, ours and our monkey cousins, is built to incorporate tools not simply into its behavior, but quite literally into its sense of self. Put another way, our brains are configured to perceive a tool as a part of our body. There is an elegant experiment that highlights this phenomenon. Atsushi Iriki's lab, at the Riken Brain Science Institute in Japan, did some interesting experiments in which he trained monkeys to use rakes to pull a morsel of food toward themselves while recording their brain activity. The electrodes were in the sensory cortex – the part of the brain that enables one to perceive touch. Iriki identified neurons that would start to fire when they touched the monkey’s hands. Once trained to pull in food, the researchers again tested the monkey’s brain activity. When they would touch the rake that the monkey was holding, his sensory cortex would activate just as it had when the hand had been touched previously. Thus, according to that monkey’s brain, in a very real way that tool became a part of his body.

What does that have to do with epileptics driving cars? From monkeys to humans, the tools we use quite literally become a part of who we are. We perceive them as a part of our body. One of the most fundamental tools in modern society is the automobile. It is our new legs in a modern society that is geographically spread out. Actually, its probably more than that – in addition to mobility we associate cars with our lifestyles, economic class, and personalities (someone who owns a Hummer is usually quite different from someone with a Prius). Thus, when a patient with epilepsy looses the ability to use a car, he or she has lost a part of their extended body. Essentially, they have lost a physical expression of their persona and, more importantly, they have lost their ability to navigate a specialized world where most resources are beyond shoes-and-knees-walking distance. From a personal standpoint as a neurosurgeon, whenever I am able to intervene and recover leg function or cure seizures, the patient’s psychology of being returned to independence is almost exactly the same.

Please don’t confuse my praise of a car as materialistic. Rather, the point here is to show that the boundary of what we call our bodies (according to our brain’s physiology) is more fuzzy than what we would typically believe. How many people today feel handicapped without their smart phones? Doesn’t it hurt when our tire grates up against a curb? More than a desire for things, the adoption of ever increasing capability is part of how we as humans are built. There is an innate cortical plasticity to take on new functionalities and incorporate those elements into our cognitive model of “me.” It is this cognitive flexibility that allowed our ancestors to first use tools (such as a rake) to advance our ability to survive and proliferate.

Going into the future, new “body extensions” will be cropping up with increasing speed and diversity. The next question is how far does this go? How flexible are our brains to incorporate very very novel types of tools? There is some very provocative evidence in my lab that implies some pretty extraordinary plasticity. Over the past decade we have been working on creating brain computer interfaces. Devices that decode the user’s brain signals to enable them to control a device by using their thoughts alone. Early into these experiments we would use “surrogate thoughts” to enable a patient to control a cursor on a computer screen. As an example, if they wanted the cursor to go right they would think about moving their thumb, if they wanted it to go up they would imagine moving their middle finger, and so forth. Clumsy at first, after about ten minutes they would start doing really well – hitting better than ninety percent of their targets. When they were done we would always ask – “what were you thinking about when you were getting control?” The response tended to be pretty uniform. To paraphrase a sixteen year old who quickly became a master (he not only did the task, but used his control to play video games) said it best –“at first I imagined moving my fingers, but then I just wanted it to go up or down, left or right.” When we are controlling a computer mouse or tying our shoelaces, we don’t have to consciously think about moving the individual muscles. Similarly, for that sixteen year old the cursor became a natural extension of his intentions – he just wanted to go up or down – then his brain executed. In the lab we would refer to this as “cursor cortex.” That teen’s brain took on that completely non-biologic functionality – controlling a cursor – as naturally as he would using his own hand.

Thus the idea that we can change our selves, is not simply a modern social phenomenon that we see with the emergence of tattoos and plastics surgery, it is part and parcel to our very biology. Moreover, with advent of Jawbone headsets, Google Glasses, and FitBits, not only is technology getting more advanced it is getting more intimate with our bodies. In certain instances they are even leading to surgery. Today we already see people alter their eyes to get better than perfect vision. And why not? Its easy, low risk, and it improves the convenience of your life. Simple, right? As technology continues to evolve and makes functional modification of our capacities a low surgical risk with clear benefits, people will be more inclined to adopt the changes.

So what could we modify? One could imagine that if brain computer interfaces become small, negligible in terms of surgical risk (like getting an ear pierced), and gave you the ability to manipulate your environment with your thoughts alone, that wide spread adoption would become inevitable. If you could have a small implant that could allow you to access the web with your thoughts alone, would you? If you’re a lawyer and other lawyers have the ability to access any legal file with the speed of their thoughts, would you feel pressured to also get one? With technology moving at an exponential pace these are possibilities that are no longer fancies of the imagination. Whether it is years or decades, the issue is no longer if these will become a reality, it is when. Once realized, just like Lasik today, the question will not be a grand consideration, it will simply be “and why not?” Interestingly, with the advent of novel human machine interfaces we will see the emergence of new and more impressive capabilities and the emergence of new disabilities when those capabilities are taken away. Thus, you never get a free lunch – even if you get it with a rake.