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Book Reviews

Personal Identity and Fractured Selves: Perspectives From Philosophy, Ethics, and Neuroscience

Personal Identity and Fractured Selves: Perspectives From Philosophy, Ethics, and Neuroscience

edited by Debra J. H. Mathews, PhD, MA; Hilary Bok, PhD; and Peter V. Rabins, MD, MPH. Johns Hopkins University Press, Baltimore, MD, 2009, 193 pages, $55.00.

What is a person? That is the fundamental question asked in this short (193-page) book. It is a product of a symposium convened (no date given) by the Johns Hopkins Berman Institute of Bioethics Program in Ethics and Brain Sciences in conjunction with the Brain Sciences Institute. Apart from the introduction and conclusion, 8 chapters present philosophical, neural, and psychiatric discussions of what constitutes personhood, identity, and self. These are woven around 4 hypothetical case studies of individuals who underwent major behavioral change as a result of Alzheimer’s disease, frontotemporal dementia, deep brain stimulation for Parkinson disease (projected to 2012), and steroid psychosis (in a professional athlete who surreptitiously took steroids to improve performance, with 2 alternative endings to the case report). The chapter authors do not confine themselves to these cases but do refer to them to illustrate their thinking.

Although the authors reach no unanimity on the definition of person, there is a considerable convergence on themes of self-awareness (consciousness), a personal narrative over time, rationality, responsibility (commitment), and coherence in relationship to others and reality.

In applying their view of personhood to the 4 cases, the contributors come to startlingly different conclusions. Most of the philosophers see major changes in (or loss of) the capacities that define a person as a loss of personhood, possibly with the assumption of a new identity. The neuroscientists and psychiatrists shy away from such a view and regard the profound changes seen in the 4 cases as part of a clinical transformation (temporary or permanent) within the same person. Some quotes will give the flavor of the discourse.

Marya Schechtman, a philosopher, writes, "To be a person in the forensic sense (a forensic person) [a term taken from Locke] is to have the psychological capacities to act as moral agents and to enter into binding contracts and commitments. This means that not all human beings will be forensic persons [for example, fetuses, children, the severely retarded, and those with advanced dementia], nor will all forensic persons necessarily be human beings" (p 68). She sees the cases as illustrating a loss of forensic personhood.

Similarly, Carol Rovane, a philosopher, writes, "Nor should we make the mistake of supposing the life of the person as extending through an entire life span, to times when the capacity for interpersonal engagement has been lost. Those who have Alzheimer’s disease or other dementias may have rights, and we have obligations to them, as long as they live. But these are rights we award to them as human beings, not as persons" (p 117). Later, Rovane writes, "On my account of personal identity, if patients chose to undergo medical treatment in the expectation that profound changes in their other commitments will follow, they will be choosing to bring about their own non-biological death, to be followed by the non-biological birth of another person whom no one yet knows" (p 126).

John Perry, a philosopher, is less certain. He writes movingly of his father, a victim of Alzheimer’s disease, who ended up in a nursing home thinking of himself as being in Italy, where he served in World War II, "with attractive and attentive Italian nurses. It was not an unpleasant life, but it was one he would have looked forward to with horror had he known in advance." Consolingly, he adds, "Perhaps one should consider one’s future as a person with Alzheimer’s disease similarly [to Hume’s thoughts about years before one was born]. It wasn’ t so bad being a child, with the diminished self and lack of autonomy that small children have" (p 152).

Michael Gazzaniga, a neuroscientist, writes about mirror neurons discovered in chimpanzees and split brain studies and concludes,

What makes us persons, rather than merely creatures, is our ability to create a story about ourselves, and we want that story to hang together, to make some kind of coherent sense, even if our brains have to distort our perceptions to do so. Neuroscientific research has identified a mechanism, which I will call the interpreter, in the left hemisphere of the human brain that generates such a narrative [narrative center is the alternative term]. No other species can sit around the campfire weaving experiences into a saga of personal or cultural identity (p 175).

Reading this book is a heady experience, at times frustrating and often exciting. The conclusions are often surprising and stimulating without always being illuminating. It is a good read.

John C. Racy, MD

racy@email.arizona.edu

Author affiliation: University of Arizona College of Medicine, Tucson.

Potential conflicts of interest: None reported.

Volume: 71

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