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V.S. Ramachandran's Tales Of The 'Tell-Tale Brain'

Neurologist V.S. Ramachandran, a pioneer in the field of visual perception, explains how his simple experiments in behavioral neurology have changed the lives of patients suffering from a variety of neurological symptoms in The Tell-Tale Brain.

18:56

Other segments from the episode on February 14, 2011

Fresh Air with Terry Gross, February 14, 2011: Interview with Matthew Alexander; Interview with V.S. Ramachandran.

Transcript

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One Man Says No To Harsh Interrogation Techniques

DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies, filling in for Terry Gross.

Our guest, Matthew Alexander, was a senior military interrogator in Iraq. In
2006 he led an interrogation team that tracked down Abu Musab al-Zarqawi, the
leader of al-Qaida in Iraq.

Alexander is known for rejecting and criticizing harsh interrogation
techniques, such as sleep deprivation, stress positions and waterboarding. He
says his team was able to track down Zarqawi by building trust and rapport with
members of Zarqawi's network held in a prison in Northern Iraq. Alexander
chronicled that experience in his book "How to Break a Terrorist."

His new book describes his experience as part of a Special Forces team that
conducted dozens of raids at homes of suspected al-Qaida members. His role was
primarily to interrogate suspected insurgents and their families in their homes
on those raids.

Matthew Alexander is an 18-year veteran of the Air Force and Air Force
Reserves, a four-time combat veteran of Bosnia, Kosovo and Iraq. He was awarded
a Bronze Star for his service in Iraq. His new book is called "Kill or
Capture."

Well, Matthew Alexander, welcome to FRESH AIR. Now, you worked for a period of
time at a prison, where you were stationary, and detainees were brought in and
you would do interrogations, and then for a period of time you were the lead
interrogator, where you would supervise others. Did you have sort of a standard
way to begin an interrogation?

Mr. MATTHEW ALEXANDER (Author, "Kill or Capture"): There is several ways that I
would begin. Sometimes I would walk in with a copy, my copy of the Quran, and I
would recite a line. Usually I would use the first line of the Quran, which is
praise be to Allah, the most compassionate, the most merciful, which would help
me to show compassion toward my enemy, who's sitting in front of me, but then
also put in place an obligation of reciprocity on their part to show compassion
towards me by reciprocating, by providing information.

Sometimes I just started with questions: What's your name? Where are you from?
Tell me a little bit about your life. Because the first step of any
interrogation is to understand your detainee, understand what uniquely
motivates them as an individual. Why did they join al-Qaida or another
insurgent group? Why did they decide to pick up arms?

And if you can analyze them and figure out those motivations, then you can
craft an appropriate approach and incentive, but not until you've done that.

DAVIES: I noticed that you would often begin by saying: I'm going to treat you
with respect, and I would like you to treat me with respect, by which I mean
you don't lie to me. And it seems in a lot of the prisoner interrogations that
you reconstruct for us in these books, that the detainees quickly lie. Almost
all of them seem to lie initially, or at least you believe they lie. Do you
then confront them?

Mr. ALEXANDER: Sometimes you do, but sometimes you let them get away with the
lie. For instance, I don't really care if anybody ever admits to participating
in terrorist activity. I could have somebody on tape, you know, having prepared
suicide bombers to go out on missions. We had detainees who we had on tape
having cut people's heads off with machetes. But I would let them lie about
that all day, as long as they were telling the truth about the information I
needed to go out and kill or capture the next target.

That's the difference between, you know, law enforcement interrogation -you
know, I was a criminal investigator - and intelligence interrogation.

And some interrogators, even in the military, forgot this, that they're not
there to get a confession. In fact, I believe that the confession hurts you
because it reminds both them and the interrogator that you're opponents. So I
would gladly allow them to lie about their participation in terrorist activity
as long as they were telling me the truth about the information I needed.

DAVIES: A couple of the techniques that you mentioned in the book, one of them
is pride and ego up. Explain what that is.

Mr. ALEXANDER: Well, pride and ego up is an approach where you try to elevate
the pride of the detainee. You stroke their ego. And then you use that in a
spirit to say that they have power, they have what they call in Arabic wasta,
which is power and influence.

And with that power and influence, they can affect their own fate. They can
change their destiny by cooperating with you. Or maybe you can put them in a
position of power, like I offered one senior al-Qaida member a chance to be in
a position in the future of Iraq and to play a role in the future of Iraq, by
which he sold out Abu Musab al-Zarqawi, the leader of al-Qaida.

DAVIES: And were you, in fact, in any position to offer him a role in the
leadership of Iraq?

Mr. ALEXANDER: Well, to me, the role that he did play was to find and kill
Zarqawi, which was a role in the future of Iraq, a very important one.

Unfortunately, when I was in Iraq, and I think this is still true to this day,
interrogators and senior interrogators don't have the power to offer real
incentives and to make them good.

So for instance, I can't walk in and offer a guy $100,000 to provide me the
location of a senior al-Qaida member. I can't walk in and say I'll get your
family members visas out of the country so that you don't face reprisals for
giving us this information.

And that's a real change. You know, in Vietnam we had real incentives that
interrogators could offer captured Vietcong members to get them to turn to our
side. But we didn't do that in Iraq, and it wasn't until General Petraeus got
there and offered the Sunni tribes money and weapons that they turned against
al-Qaida by - with the offering of a real incentive.

DAVIES: But it seems that there were often times in which you would appear to
offer them things or offer things that you couldn't deliver, in one case
something that was actually a forged divorce application. You discovered one
guy was in a financial jam because he had a second wife who had expensive
tastes, and you dummied up a divorce document, convinced him that you could get
him out of this marriage he couldn't handle.

Mr. ALEXANDER: Yeah, and false documents is something, you know, I learned to
use in deception as a criminal interrogator. If you have, if you catch two
young kids down here at the back of Walmart stealing TVs, I guarantee you the
detectives are going to take them back to the station, put them in separate
rooms and use some form of deception.

They might tell one that the other one is giving them information or say the
first person who cooperates is going to get a deal. But they're going to use
deception.

And deception is a legitimate part of warfare. You know, we don't question
deception if infantry fakes an attack on the left and sweeps right. And
interrogators can use deception too, but they must be careful about how they
use that deception.

And the reason why is because somebody else is going to interrogate that
detainee one day. And if you've used deception and you've been found out, then
they're going to have a harder time establishing trust. So what the senior
interrogator has to do is they have to evaluate the gains versus the risk.
What's the risk of losing rapport with this detainee by not following through
on a promise versus the information you're going to get?

DAVIES: Now, when you would be with a detainee, and these were Sunni combatants
that were brought in for your interrogations, and when they would say to you,
you Americans caused this, you deposed the government, you disbanded the army,
you allowed the Shia militias to terrorize our people, destroy our
neighborhoods, remove our employment - how would you respond?

Mr. ALEXANDER: Well, my response is: I agree with you, that the United States
has made mistakes in Iraq. I mean, nobody, at least in 2006, questioned the
fact that some strategic errors were made in disbanding the army in the policy
of de-Baathification, which put many Sunnis out of work who weren't really even
supporters of Saddam; they just joined the Baath Party to get a job.

And so I would admit those mistakes. And almost every detainee that I admitted
those mistakes to, to a T, they all were surprised that I was willing to admit
that.

And it moved many of them to hear that because many of them had lost family
members or friends because of these actions, because of allowing the Shia
militias to run free. And so when they heard that apology, followed by an offer
to work together, it was very appealing to many of them.

I talk about the first guy I interrogated in Iraq, Abu Ali(ph), and the first
thing he ever said to me was: If I had a knife right now, I'd cut your throat.
And three or four days later, he was cooperating, providing us information. In
fact, he provided the house where we captured the detainees that led us to
Zarqawi.

And that type of change happened because we were able to admit our mistakes and
make the Sunnis an offer to work together in the future.

DAVIES: And what did you tell Abu Ali that turned him around?

Mr. ALEXANDER: I talked to Abu Ali, my partner, and I talked to him about his
son. When we initially interrogated him, he didn't admit that he had a son. We
found out later, through another detainee, that he had a son, and we painted
for him a picture of what the future of Iraq would look like with the current
violence just escalating into a civil war between Sunni and Shiite.

And instead, we painted a picture that it couldn't look like, which would be a
secure and safe Iraq, if Americans and Sunnis could learn to work together.

DAVIES: You write in this book that the widespread belief in misguided
stereotypes about Muslims and Arabs was the single most detrimental factor to
effective interrogations in Iraq. What stereotypes are you referring to, and
how did they undermine these interrogations?

Mr. ALEXANDER: Well, the stereotype I'm referring to are things such as a
common parlance that was said by some interrogators and analysts, which is that
Arabs grow up in a culture of violence, so they only understand violence.

We have that documented in an email from a senior interrogator to his commander
at one point in Iraq. And it was that type of stereotype of Arabs and of
Muslims that was very counterproductive to trying to get people to cooperate,
because by not analyzing them and understanding them not as die-hard jihadists
who hate our way of life or want to reestablish a caliphate or believe in
Shariah law, but instead as Sunni Iraqis who had individual motivations for
joining al-Qaida that were a broad variety of reasons, from social, economic
and other reasons, we skipped the first step of every effective interrogation,
which is to know your detainee.

And so those prejudices worked directly in contrast to what we were trying to
accomplish.

DAVIES: And you found that even among the al-Qaida detainees that you spoke to,
that, by and large, they were not driven by religious commitment but more by
practical considerations of their lives?

Mr. ALEXANDER: That's correct, and Iraqi Sunnis are very secular. They're
actually fairly moderate. In fact, they enjoy American movies and culture and
TV and music. Iraqi Sunnis are actually very moderate people. They're very open
to discussing religion and open to new ideas.

I talked at length with several of my detainees about religion and religious
philosophy, about Islam. And I found their interpretations of Islam to always
be very reasonable.

And so I think that by categorizing all the people that we'd interrogated at
the very beginning as being a certain brand of Islam, the Wahhabi version or
the Taliban version, was completely counterproductive to what we were trying to
accomplish, which is to get to know them so we can understand how to work with
them.

DAVIES: Our guest is Matthew Alexander. He was a senior military interrogator
in Iraq and has written a new book about his experiences. It's called "Kill or
Capture." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, we're speaking with Matthew Alexander. He
was a senior military interrogator in Iraq. He was assigned to a special
operations task force there in 2006. He has a new book called "Kill or Capture:
How a Special Operations Task Force Took Down a Notorious al-Qaida Terrorist."

Some of the interrogators that you worked with, I believe, were veterans of
Guantanamo Bay and Abu Ghraib and came from a different, harsher set of
techniques in interrogation. Were there differences and, you know, battles that
played out among the interrogators over how to handle the detainees?

Mr. ALEXANDER: Yeah, there was a lot of battling at the prison when I was
inside the prison, between the old-school interrogators and my new school of
interrogators. And those old-school interrogators, the people who had been at
Guantanamo Bay, been in Iraq and Afghanistan early on, who had been allowed to
use advanced interrogation techniques, which I believe is a euphemism for
abuse, if not torture, believed that those methods should still be used.

But now we had in place, the Detainee Treatment Act. So what they started to do
was manipulate the rules so that they could still do what are basically
advanced interrogation techniques, or use abuse, but try and notionally stay
within the rules. And that created large differences between the ways we wanted
to interrogate certain detainees.

For instance, we caught a guy named Abu Ubaida(ph), who was a high-ranking of
al-Qaida in the north of Iraq, and they immediately wanted to use a pride and
ego down approach. And I had asked, why do we not consider using love of family
approach, and...

DAVIES: Now, when you said a pride and ego down approach, you mean what?

Mr. ALEXANDER: That would mean - their idea was that they needed to insult him,
to humiliate him, to bring down his ego, to bring down his self-respect and
self-worth, to put him lower than them, so they could then force him to
cooperate.

And I suggested that we use love of family, which I had found to be the most
effective approach against members of al-Qaida. And lo and behold, later we
found out that his son was being held in an Iraqi prison. We had him released
and brought to our prison, and we put him face-to-face with his father.

And as soon as Abu Ubaida saw his son, he broke down in tears, and he said to
us what - however I can help, I will. So it was love of family approach that
ultimately got him to cooperate.

DAVIES: Did differences in results matter? I mean, did those of you who used
newer, more flexible methods get more information, and was that, you know,
noticed and observed by commanders and others?

Mr. ALEXANDER: It was. When I showed up on the raid team to do interrogations
out in the battlefield, they were very frustrated with interrogators that were
there before us because they weren't producing as many results.

And if I had to guess - it's always hard to put a number to the success of an
interrogation because you don't know if you've gotten just a small piece of
what a detainee knows, which may be very important, of if you've gotten 100
percent of what they know, all of which may not be important.

But our success rate went up dramatically in the time when I was on the raid
team, working with my partner, who was a former street cop, using non-coercive
techniques, law enforcement techniques, our knowledge of the culture.

And I would say that by the end, by the time I left, our success was up
probably around 80 percent, where we would get people to cooperate. And the
commander came to me and actually said, you know, when you guys first got here,
I had no trust in interrogators. And now I trust you more than any other form
of intelligence.

DAVIES: I want to talk about your work in going out with soldiers in, I guess,
search and capture missions. Is that what they were called?

Mr. ALEXANDER: Kill or capture missions.

DAVIES: Kill or capture missions.

Mr. ALEXANDER: Kill or capture missions.

DAVIES: Kill or capture missions, all right. So you would go out in this
Stryker personnel carrier, and you'd find the house or apartment that was
targeted, and the soldiers would then - would run in to sweep it, to gain entry
and secure it, and then you would be summoned to go in and conduct an
interrogation of people who would there by typically bound by their hands,
right?

Mr. ALEXANDER: That's correct.

DAVIES: It's interesting that you use exactly the same description to describe
the sound of the soldiers breaking in, right, the sound of an explosion, the
sound of metal hitting concrete. What was going on?

Mr. ALEXANDER: Almost every raid started with the same noise, which is we would
shuffle up to the fence or front gate or door, and the soldiers would go up to
the front door and set a charge, some type of explosive , that would blow the
door off its hinges.

Even to this day, when I hear metal falling onto stone, it jogs a memory of me,
of the front door going down on a house that's about to be raided.

And then the soldiers would run into the house, and very swiftly and
efficiently, these guys were fast and professional, they would go in, and they
would capture people, and they would flex-cuff them, you know, behind their
back with flex cuffs, and then would call us, immediately, to try and
interrogate them as soon as we captured them.

And my partner and I would come in, and we've have to decide, you know how many
people are captured, who wants to interrogate the head of household, who wants
to interrogate the wives, and then that's how we would start our approach.

DAVIES: Right. There would be two interrogators, you and your partner. Each of
you would have an Iraqi translator. So then you would confront somebody who has
been rousted from their bed or whatever, and they're there with flexicuffs on,
and you would begin an interrogation.

Now, how is that different in a field, from talking to talking to somebody in a
prison cell?

Mr. ALEXANDER: Well, in the field, you only have 10 or 15 minutes to get
information, because the team doesn't want to stand out there in the open,
where they're at risk of ambush or attack. They want to get the information and
move.

And usually, the objective is to go straight from that target to the next one,
to get information so that we can go do another kill or capture mission before
al-Qaida has a chance to react.

So there's a much larger time pressure on the interrogators in battlefield
interrogation scenarios, but it's much more fun, I think, because you have this
dynamic of the ticking time, you know, counting down on you.

But you also have a lot more moving parts. For instance, the first mission I
went on, we captured these twin brothers who were part of an al-Qaida cell. My
partner and I immediately split the two up into separate rooms.

Initially, we asked all the questions, and all their answers seemed to make
sense. There weren't any discrepancies. But we knew that these guys had to know
where the weapons dealer for the cell was, and they both claimed not to know
who this person was.

So we took a chance. We used an old cop technique where we went back in and
told both brothers that the other one had told us where this weapons dealer
lived, that it was two blocks over.

And the guy I was interrogating said no, that I didn't know what I was talking
about. But my partner's detainee said he was also wrong. The weapons dealer
didn't live two blocks over, he lived four blocks over. And he took us to the
house.

DAVIES: When you have only a few minutes, can you establish the trust and
rapport? Do you say nice things in Arabic? Do you refer to the Quran? Do you
try and establish friendship?

Mr. ALEXANDER: Yeah, I try to do that. You know, one of the first things I
always did was take my helmet off, put my hand on somebody's shoulder, assure
them that I'm not going to harm their family, allow them to see their family,
to see that they're not being harmed, and ensure them that they're not going to
be mistreated.

And that initial show of compassion towards them goes a long way because it's
not what they're expecting at all. And when you think about it, if you're going
to be captured, your expectation is that right away, you're going to get
beaten. And I think a lot of Iraqis had that impression after the photos of Abu
Ghraib were released, that they were going to be treated harshly upon their
capture.

And so the shell-shock for them was when they were treated nicely, and that's
what threw them off their game. That's what caused them to be quite confused.
You know, and so, we used that to our advantage. And we call that a fear down
approach from the Army field manual. You try to lower somebody's fear, because
not only does fear play against you because it causes people to shut up, to be
careful about what they say, but it also affects memory.

And as an interrogator, you want accurate and timely intelligence information.
And as we like to say, if they tell you the location of a house, that's great,
but it would be better if they tell you if the house is booby-trapped.

DAVIES: Matthew Alexander was a senior military interrogator in Iraq. His new
book is called "Kill or Capture." He'll be back in the second half of the show.
I'm Dave Davies, and this is FRESH AIR.

(Soundbite of music)

DAVIES: This is FRESH AIR. I'm Dave Davies filling in for Terry Gross.

Back with Matthew Alexander. His new book, "Kill or Capture" is about his
experiences as a senior military interrogator in Iraq in 2006. He relied on
building trust and rapport to get information, and he's become known as a
critic of harsh interrogation methods.

Alexander spent months in Iraq traveling with a Special Forces team that
conducted raids on the homes of suspected al-Qaida members and supports. After
soldiers would blow the door of a home off its hinges and cuff everyone inside,
Alexander had to question suspected insurgents and their families.

How often did the team go to an address and then discover it was actually the
wrong place, or the people were there that you were looking for, but it turned
out you had bad information and they really weren't doing anything wrong or
didn't know anything?

Mr. ALEXANDER: I'd say at least half the time when we went into a house it
ended up being the wrong house. And that's not the fault of Army.
Countersurgency is complex and it is difficult, and good accurate intelligence
information is difficult.

I mean, it's not like the houses have numbers on them that there's even type of
civil order that makes it easy, and the enemy is hiding within the civilian
populace. It's extremely difficult to get good information that gets you
directly to the right house.

But what I say is that what's important is how you treat people in the wrong
house. You can raid the wrong house, and you can leave with somebody having a
better impression of us, even prior to us coming. And that might sound like
it's quite impossible, but it's not.

We raided a house twice, three times. Brought an uncle back to the prison and
released him, brought a father of the guy we were looking for back to the
prison, and then released him, and later had that father help us capture our
target even though we had raided his house three times, because we had treated
him with respect. We had paid him compensation. We had apologized for the
inconvenience, restoring his respect and his honor.

DAVIES: You know, it's interesting because if half the time you went to the
wrong place, you never knock on the door, you blow the door off its hinges. You
go in, you roust people out, soldiers empty contents of drawers onto the floor.
I mean, you make a mess and you damage property and you humiliate them. You
cuff them in front of their families. How do you make it right when you
apologize?

Mr. ALEXANDER: Well, first of all, I mean, the Iraqis themselves, many of them
were opposed to the violence that was being imposed by al-Qaida, especially
suicide bombings, even if they didn't support the American occupation. They did
oppose al-Qaida violence.

So many of them were quite understanding about why were conducting the raids.
They believe that we should be. They were disheartened that we came to their
house, but they understood that our job was difficult. And they understood that
if we treated them correctly, if we apologized.

Yeah, you might dump things out on the floor, but you might help pick them back
up. You might leave them with cash that more than compensates them for the
damage to their front door. But most important, the most important part of all
of that is the apology. An earnest apology that says, hey, we made a mistake
here. We're sorry, but we want to work with you. We're trying to make Iraq
safer. And most Iraqis understood that.

DAVIES: And was it important to apologize to the men of the house in front of
their families?

Mr. ALEXANDER: Very important. Because this is a matter of respect and honor.
You know, and this isn't some type of Arab cultural nuance, this would be the
same way here in the United States. You know, we take pride in our houses and
our ability to defend our homes, and when you come in there, you erode that
pride and that self-respect for a head of household. So to apologize for them
in front of their families restores that pride and that honor in their family's
eyes, and goes a long way.

DAVIES: You've written in a book and you've spoken about the harm that's done
with enhanced interrogation techniques, you know, harsh techniques like water
boarding and stress positions and sleep deprivation, torture abuse. And you
believe that a lot more information comes when you get to know the detainee,
you build trust, and elicit information that way.

There is, of course, those who argue strongly that the particular demands of
the war on terror mitigate against that argument, that you need to get tough
with people, you can't be nice to these committed terrorists. I mean, there
were, of course, the CIA reports that Khalid Sheikh Mohammed broke down and
cooperated after he was water boarded. Do you put any stock in that story or
those arguments?

Mr. ALEXANDER: Well, I won't be one to tell you that torture never works. I've
had friends who have given me examples of when torture did work, but I don't
care because to me this isn't about efficacy. We have other things that work a
hundred percent of the time like chemical weapons and flamethrowers. We don't
use them.

And the reason we don't use them isn't an efficacy argument, it's because it's
against our morality, or because the laws of war have determined that they
cause unnecessary human suffering, and we've outlawed them. And there's no
exceptions to that.

I think my big disappointment is the shift in priorities from an America that
stands for principles to an America that stands for security. My oath of
office, when I took it as an officer in the United States military, didn't
mention security. It mentioned allegiance and defending the Constitution, which
prohibited torture when we ratified the convention against torture and other
provisions within the Constitution.

So to me, I don't care if torture works a hundred percent of the time. I'm not
going to use it because it goes against the very principles that I signed up to
defend.

DAVIES: And what's your sense of how interrogators in Iraq and Afghanistan
today are approaching their jobs? Have things really changed?

Mr. ALEXANDER: I think it has changed. And my friends who are still in the
field and still interrogating tell me that there is not torture and abuse going
on, that it has stopped. But I recently, last year, had a senior Army
interrogations instructor tell me that you still have to slap people around
once in a while because it's all the understand.

And that - I believe that you can't talk about torture unless you talk about
the prejudice that led to the torture, that the two things are intertwined. And
it was that prejudice against Arabs and Muslims and the stereotypes that were
used against them, that lead to the torture.

And so I think you can make rules that prohibit torture, but if you don't also
make improvements to the way that we train and educate soldiers, that we'll
still have incidents of torture and abuse. They might be much more rare, but
the underlying conditions will still be there.

DAVIES: Well, Matthew Alexander, thanks so much for speaking with us.

Mr. ALEXANDER: You're welcome.

DAVIES: Matthew Alexander was a senior military interrogator in Iraq. His new
book is called "Kill or Capture."
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V.S. Ramachandran's Tales Of The 'Tell-Tale Brain'

DAVE DAVIES, host:

Our next guest, V.M.(ph) Ramachandran, is known for thinking about the
mysteries of the human brain in creative ways. In his new book for example, he
seeks to understand why a man in the hospital with a brain injury could speak
to his father on the telephone, but was unable to recognize him or speak when
his father entered the room.

Ramachandran's research combines modern advances in neuroscience with low tech
common sense approaches as you'll soon hear. His new book looks at unusual
cases of brain dysfunction for clues about how the brain works, and he explores
evolutionary explorations for the brain's complex wiring in what he calls a
quest for what makes us human.

V.M. Ramachandran is the director of the Center for Brain and Cognition, and
distinguished professor with the psychology department and neurosciences
program at the University of California San Diego. He's the author of "Phantoms
in the Brain." His new book is called "The Tell-Tale Brain."

Well, V.S. Ramachandran, welcome to FRESH AIR. Let's begin by talking about
some of this amazing work you've done with mirror visual feedback, and this
involves people who have had an amputation, but who feel a phantom limb. First
of all, explain that phenomenon, what happens to people sometimes - when
they're sometimes missing a limb and they feel these things.

Dr. V.S. RAMACHANDRAN (Author, "The Tell-Tale Brain"): Well, when an arm in
amputated following a crash injury in a car accident, or there's a cancer or
malignant tumor or a cancer in the arm, or there's a gangrene and the arm is
amputated, typically for diabetes, and when that's done, 98 percent of the time
the patient continues to vividly feel the presence of that missing arm. We call
this a phantom limb.

So typically the patient goes under general anesthesia and you've already told
him that you're going to amputate his arm, unfortunately. And then you proceed
with the amputation and he comes out of anesthesia, and he's surprised
initially because under the sheets he continues to feel the arm, and he says
when are you going to do surgery?

Then you remove the sheets him and show him that the arm is gone, and he's
often shocked to see this because he continues to feel the presence of the arm
even upon seeing that it's not there.

This has been known for a couple of hundred years, but studied systematically
over the last hundred years, and there have been dozens of case studies, but
nobody really understood what was going on in the brain. Why would these people
be haunted by these phantom appendages? And you get a phantom with almost any
part of the body.

DAVIES: Yeah. And it was fascinating to read that some people will feel an itch
in the palm of a hand that isn't there, or feel chronic pain, right?

Dr. RAMACHANDRAN: Yes. Chronic phantom pain is a serious clinical problem.
About two-thirds of them, they have very severe pain. Sometimes so excruciating
the patient becomes very depressed, sometimes - often loses his job. Sometimes
even contemplates suicide.

DAVIES: Yeah. And before we talk about some of the work you did with mirrors to
alleviate this, tell the story of the gentleman who you were able to discover
regions of his face that would affect his sensory perceptions of his missing
limb.

Dr. RAMACHANDRAN: Well, there are nerves which used to supply the fingers and
hand which now supply the stump. But those nerves get irritated and misinform
the brain that the hand is still there and surviving, and the nerves are
painful. You get pain referred to the missing phantom hand. And based on this,
therapies were devised where you remove the nerves or the terminals of the
nerves which are curled up and painful. This often provides partial relief, but
is usually notoriously ineffective.

What we did was a simple experiment based on an idea that there's a complete
map of the body surface on the surface of the brain. So every point in the body
surface has a corresponding point in the brain, and there's a systematic map.

Now, the curious thing about this map is, even though it's continuous, all
parts are represented, the face area of the map is right next to the hand area.
It's dislocated, instead of being near the neck where it should be, and nobody
knows why. So our reasoning was, when the arm was amputated, the hand
representation in the cortex is devoid of sensory input. It's deprived of
sensory input. It becomes hungry for new sensory input.

So the sensory input from the face skin sprouts terminals or invades the
territory corresponding to the missing hand. So when you now touch the face,
the hand area of the brain is activated, not just the face area.

So the result of all this is very simple. You blindfold the patient so he
doesn't know where you're touching him and you touch his leg and his abdomen
and his chest and he accurately reports where you're touching him, obviously.
But when you touch his face on the same side as the amputation, the patient
says oh, I feel that in my phantom missing thumb, and expresses considerable
surprise.

DAVIES: Right. So this person might feel an itch in his palm which he could
scratch by touching the right spot on his face. And I guess one of the things
this tells us is that the brain is growing new tissue as even - it doesn't just
happen in embryo. I mean, it's - new things are happening, the brain is sort of
remapping itself a bit as we grow older?

Dr. RAMACHANDRAN: Yes. I mean, what we were all taught as medical students say
a decade or two ago was that connections in the fetal brain, or an infant
brain, are fixed during infancy or fetal life by the genome - by genes. And
then as you grow into adulthood, the maps crystallize and are there
permanently. And you can't do anything but change these - alter these maps. And
if there's injury to the brain, the injury is permanent and there's very little
recovery or function after tissue damage to the brain.

So we - our findings suggest that this is not true. The map - even the basic
sensory map in the brain gets completely reorganized in a matter of weeks. And
more recently we have shown that if this happens in just a couple of days, you
get some reorganization taking place. This challenges the dogma that all
medical students are raised with, and all neurologists are raised with, that no
new connections or new pathways can emerge in the adult brain. That was news 10
or 15 years ago. Now, it's widely accepted.

DAVIES: OK. Let's talk about this remarkable treatment that you developed for
people who have had amputations and may have terrible pain in their phantom
limb, and a treatment that you did with a simple mirror. Explain what you had
your subject do.

Dr. RAMACHANDRAN: Well, in simple terms, the patient has a phantom limb, and
very often, for reasons that are not entirely clear, the phantom is clenched in
an excruciating position, like the fingers are clenched into the fist with the
nails digging into the palm - the phantom nails digging into the phantom palm.

And they will often say things like well, if I could only open my phantom hand
or move my phantom arm, it might relieve this cramping sensation. But I can't
do that, my phantom is paralyzed. I should backtrack a little bit and say that
many patients with a phantom can move the phantom. They'll say it's waving
goodbye, it's patting my little brother on the shoulder, it's reaching out for
the phone when the phone rings.

These are very vivid sensory impressions for the patient. But in about a third
to half the cases, the phantom is paralyzed as I just said. It sounds like an
oxymoron. How can a phantom be paralyzed?

What we found when we looked at the case history, many of these people had a
real paralysis of the arm where the arm was intact. For example, nerves going
from the spinal cord into the arm were yanked off the spinal cord in a
motorcycle accident so the entire arm is paralyzed and lying in a sling and
excruciatingly painful and paralyzed for years.

And then, in a misguided attempt to get rid of the pain, sometimes the arm is
amputated. And the irony is the patient is then left with a phantom arm in a
phantom sling when the pain persists with a vengeance in the phantom. And we
call this phenomenon learned pain or learned paralysis. The question is can you
unlearn the learned pain or learned paralysis by allowing the brain to send a
command to the phantom and have the phantom move in response to the command or
appear to move. How do you do that? The guy doesn't have an arm so how do you
make his phantom appear to move?

DAVIES: You have to trick the brain, in a way?

Dr. RAMACHANDRAN: To trick the brain. How do you trick the brain? So then I hit
on a technique of just using a five-dollar mirror which you prop up on the
table in front of you, put some bricks or take a cardboard box and remove the
top of the box and remove the front of the box, prop up a vertical mirror. And
then, the mirror is sort of parallel to your nose and sitting in front of you
on the table. Sorry, I should say standing up in front of you on the table.
Then, the patient puts his phantom limb, let's say his phantom left arm, on the
left side of the mirror, which is the non-reflecting side, puts the normal
right arm on the right side of the mirror, which is the reflecting side, and
looks into the mirror at the reflection of the normal hand.

Now, if he then starts moving his two hands, well, he can't move his phantom.
He can pretend it's moving. Clapping his hand or conducting an orchestra or
waving goodbye, while looking in the mirror, he's going see the mirror
reflection of the right hand super-imposed on the phantom, moving in command -
moving in perfect synchrony with the command sent to the left hand, to the
command sent to the phantom arm. So you give the visual illusion that the
phantom, in fact, is obeying the command.

DAVIES: When you've done that, do patients say, oh, my God, I can actually see
my phantom limb now?

Dr. RAMACHANDRAN: Yes, absolutely. They get spooked out by it or they get
intrigued. They'll say, my God, my phantom. I see my phantom. Of course, I know
it's not there. Some people will look behind the mirror and chuckle. I know
it's not there, but it feels like it's there. It not only looks like it's
there, it feels like it's there. And when I move my normal hand, the phantom
arm looks like it's moving. When I open the normal fist of the right hand, the
phantom limb, whose fist I could not open for months, now suddenly feels like
the fist is opening as a result of the visual feedback and the painful cramp
goes away. So this is a striking example of modulation of pain signals by
vision.

DAVIES: You know, one of the fascinating things about the story that you just
told is that modern medicine involves so many advances in sophisticated high-
tech tests and treatments, and you're using a $5 mirror. And I have to note
that you have quite a varied intellectual background. You think of these
problems differently, don't you?

Dr. RAMACHANDRAN: Well, that is correct. I mean, I think that - I was raised in
India and I was raised in Thailand, but the emphasis was on low-tech by
necessity. And I think that emphasis actually is beneficial because it makes
you think more creatively and it makes you more resourceful and rely on your
ingenuity, so to speak. And this spills over into your research, this attitude
and this technophobia.

But I want to emphasize that often, you know, we're not Luddites. We don't shun
technology, but the initial experiments are often very simple and the
simplicity of the experiment is often deceptive and often, in spite of being
simple, the results can be quite stunning.

But more recently we've studied an extraordinary syndrome where a patient says
he - we were just talking about phantom limbs earlier. But even more
extraordinary and much more rare is a syndrome where a patient, who is
otherwise completely normal - in fact, you can't even call them patients, in
normal people out there - who want their arm amputated at a specific level.

DAVIES: Right. This is apotemophilia(ph), right? This is somebody who...

Dr. RAMACHANDRAN: Apotemnophilia.

DAVIES: OK. They think that a part of their own body is foreign to them, right?

Dr. RAMACHANDRAN: Well, not exactly. No, it's very interesting. Because in
clinical medicine, it's very important to talk really carefully to the patient
and often you can clinch the diagnosis 90 percent of the time, figure out
what's going on by just talking to the guy, which is not fashionable these
days.

So for example, this patient says, my arm - I want my arm removed. That's why
he's there. I want my arm removed. I know I'll be happier if it's removed. And
he takes a felt pen and draws a line along which he wants the amputation, maybe
just above the elbow, just below the elbow. It's different for different
patients. Or below the knee, right? And then, he says, I want it amputated and
about a third of them will get it amputated.

DAVIES: Seriously? People will do that?

Dr. RAMACHANDRAN: Oh, absolutely. They will get it amputated and they feel much
happier. Their depression goes away and they feel like more of a complete
person, paradoxically. Well, they say, it's not like I don't - it's not like
the arm doesn't belong to me. I know it belongs to me. It's not like it feels
like it doesn't belong to me. In fact, it feels like it belongs too much to me.
It feels intrusive, right, which is slightly different from saying, it doesn't
belong to me. Now, why the difference?

DAVIES: Yeah, what's going on?

Dr. RAMACHANDRAN: OK. You see, there are two stages. First of all, the signals
from the arm, skin, muscles, tendons and all of that go first to the sensory
area in the brain, the vertical strip I told you about earlier when talking
about phantom limbs. So there's a complete map of the skin surface and the
muscles and all of that just on the side of the brain. That's where all the
sensory processing occurs. And then, the signals are relayed around to the body
image center, which then gets signals from vision and from your inner ear and
all of that. So there is a more abstract representation of your body in the
body image center, which is more dynamic.

So there are two stages. The sensation is processed from the skin and ligaments
and tendons and muscle and then, after that, it's sent to the superior parietal
lobule where you construct the body image, OK? So the sensory input going from
the skin of the hand, from the muscles, from the tendons, goes to the sensory
area and it's processed normally. That's not damaged because there's no stroke.
But in his superior parietal lobule, in the body image center, the arm is
congenitally missing so there is no place in the brain for the signals to be
relayed to. And it gets there and there is an acute discrepancy between his
body image and what the sensory signals are telling him.

DAVIES: And what might cause that? Is that a - would that be a congenital
defect or...

Dr. RAMACHANDRAN: It's a congenital defect, is what we think. And we've filmed
this using brain imaging techniques, where these people have a congenital
defect in that region of the brain. And we're still not 100 percent sure of
this, but we're 90 percent sure that that's what's going on. And therefore, the
signals come in from the arm, sensory representation is normal, but there is
nowhere for the signal to go and the brain is faced with a discrepancy. And the
brain abhors discrepancy.

It's constantly trying to produce a sort of coherency of information to produce
stability of behavior. And when there is a discrepancy, the discrepancy is
picked up by another region of the brain called the insular, which then
generates the fight/flight response, generates acute anxiety and the patient
says I want the arm removed. It feels over-present and he senses the
discrepancy. So that is what's going on.

DAVIES: V.S. Ramachandran's book is called "The Tell-Tale Brain." More after a
short break. This is Fresh Air.

(Soundbite of music)

If you're just joining us, we're speaking with V.S. Ramachandran. He is a
behavioral neurologist and author of the new book "The Tell-Tale Brain: A
Neural Scientist's Quest for What Makes Us Human."

You write a lot about mirror neurons and the role that they played on our
evolution. You want to just tell us a little bit about that?

Dr. RAMACHANDRAN: Well, mirror neurons were not discovered by us, obviously.
They were discovered by Giacomo Rizzolatti in Parma, Italy, and his colleagues.
And what they refer to is in the front of the brain, the motor and pre-motor
cortex, there are neurons that issue commands to your hands and other parts of
your body to perform specific actions, semi-skilled actions, skilled actions or
even non-skilled actions. So these are motor-command neurons which orchestrate
specific sequence of muscle twitches for you to reach out and grab a peanut,
for example, or put it in your mouth.

What Rizzolatti and his colleagues found was some of these neurons, as many as
20 percent or 30 percent, will fire not only when - let's say I'm measuring
mirror neuron activity in your brain. So when you reach for a peanut, these
neurons fire. But the astonishing thing is these neurons will also fire when
you watch me reaching for a peanut so these are promptly dubbed mirror neurons
for obvious reasons. So it's as though your brain is performing a virtual
reality simulation of what's going on in my brain, saying, hey, the same neuron
is firing now when he's doing that as would fire when I reach out and grab a
peanut, therefore, that's what that guy's up to.

He's about to reach out and grab a peanut. So it's a mind-reading neuron. It's
essential for you seeing other people as intentional beings who are about to
perform certain specific intended actions.

DAVIES: And that might have helped us learn from one another and thereby
advanced culturally far beyond our...

Dr. RAMACHANDRAN: That's correct. That's the stuff - that's kind of an obvious
behind-site, but that's the claim I made, oh, about 10 years ago in a website
run by Brockman called "Edge." And what I pointed out was - and others have
pointed this out, too, is that mirror neurons obviously are required for
imitation and emulation. So if I want to do something complicated that you're
doing and I want to imitate it, I have to put myself in your shoes and view the
world from your standpoint. And this is extremely important.

It seems like something trivial, you know, mimicry, but it's not. It's
extremely important because imitation is vital for certain types of learning,
rudimentary types of learning. These days you learn from books and other
things, but in the early, early days when hominids were evolving, we learned
largely from imitation. And there's a tremendous acceleration of evolution
illusionary process. What I'm saying is maybe there are some outliers in the
population who are especially smart simply because of genetic variation, who
have stumbled, say, accidentally on an invention, like fire or skinning a bear.

Without the mirror neuron system being sophisticated, it would have died out,
fizzled out immediately. But with a sophisticated mirror neuron system, your
offsprings can learn that technique by imitation so it spreads like wild fire
horizontally across a population and vertically across generations. And that's
the dawn of what we call culture and therefore, of civilization.

DAVIES: Well, V.S. Ramachandran, it's been really interesting. Thanks so much
for speaking with us.

Dr. RAMACHANDRAN: Thank you. Enjoyed that.

DAVIES: V.S. Ramachandran is director of The Center for Brain And Cognition at
the University of California, San Diego. His new book is called "The Tell-Tale
Brain." You can join us on Facebook and follow us on Twitter @nprfreshair. And
you can download podcasts of our show @freshair.npr.org.

For Terry Gross, I'm Dave Davies.
..COST:
$00.00
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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