Loss of Will,
Against the Will,
Rhawn Gabriel Joseph, Ph.D.
Reprinted from: Consciousness and the Universe,
Edited by Sir Roger Penrose, FRS, Ph.D., & Stuart Hameroff, Ph.D.
Cosmology Science Publishers, Cambridge, 2011
KEY WORDS: Consciousness, Free Will, Frontal Lobes, Medial Frontal Lobes, Supplementary Motor Area, Catatonia, Alien Hand, Split-Brain
1. FREE WILL & FUNCTIONAL LOCALIZATION
If the brain and mind are synonymous, is unknown. However, if the brain is damaged, the mind too is effected. Disturbances in brain functioning, be it due to drugs, alcohol, injury, tumor, stroke, emotional trauma, seizures, or electrode stimulation, directly affect consciousness (Joseph 1982, 1986a, 1988a, 1996, 1998, 1999a, 2001, 2003). Often specific aspects of the conscious mind are directly impacted (Joseph 1988a,b) including what has been referred to as "free will" (Joseph 1996, 1999b). This is because specific functions are localized to specific regions of the brain.
For example, in most humans, severe injury to the left frontal lobe can abolish the ability to speak words or intelligible sentences, a condition classically referred to as Broca's expressive aphasia (Joseph 1982, 1996, 1999b). Although the "Will" to speak remains intact, those afflicted may be capable only of expressing their frustrations by cursing which is mediated by the right frontal lobe, as is the ability to sing (Joseph 1982, 1988a, 1996, 1999b). Hence, patients can curse and may be able to sing words they can't say.
If, however, the damage to the left frontal lobe is widespread and extremely deep, penetrating into the medial (middle) portions of the anterior cerebral hemispheres, not just the "will to speak", but "free will" may be abolished and those afflicted may be forced to act "against their will" (Joseph 1986, 1988a, 1999b). What we call "free will" appears to be localized to the frontal lobes, the medial most portions in particular.
2. DISCONNECTION SYNDROMES
No region of the brain functions in isolation, unless isolated following a very circumscribed lesion thereby disconnecting it from other areas of the cerebrum; a condition classically referred to as "disconnection syndrome" (Geschwind 1981; Joseph 1982, 2009). For example, whereas Broca's area subserves the capacity to speak, the grammatical and denotative aspects of language (the words which will be spoken) are organized and assimilated by a multi-modal association area in the angular gyrus of the inferior parietal lobe (IPL) immediately adjacent to Wernicke's receptive language area in the superior temporal lobe (Joseph 1982, 1986, 1988a, 1996, 2000). The IPL and Wernicke's and Broca's areas are linked together by a rope of nerve fibers, the arcuate fasciculus.
However if the arcuate fasciculus is damaged such as due to stroke, those afflicted will know what they want to say, but will be unable to say it and will suffer severe word finding difficulty (Joseph 1982). Temporary functional disconnections occur even in the normal brain, where the missing word is known but can't be found, and this condition is experienced as "tip of the tongue" phenomenon. Thus one part of the mind is disconnected from another (Geschwind 1981; Joseph 1982, 2009). The "will to speak" remains intact (due to preservation of the frontal language areas), whereas the missing words are locked away in the posterior regions of the forebrain.
One rather severe form of of disconnection is "locked-in syndrome" which is due to destruction of the pyramidal (cortico-spinal) nerve fiber pathways linking the brainstem pontine area with the forebrain (Smith and Delargy 2005). Although completely paralyzed and seemingly comatose or "brain dead", patients are believed to be fully conscious and aware, and maintain the "will" to move and speak, but are unable with the exception of, in some cases, the capacity to blink and thus communicate through the eyes (Allain et al., 1998; Smith and Delargy 2005). Consciousness is maintained and cognitive functions are preserved because the forebrain is intact and completely functional with only mild reductions in cerebral metabolism noted (Allain et al., 1998; Zeman 2003).
Parisian journalist Jean-Dominique Bauby suffered a stroke in December 1995, which severely damaged the neural pathways leading to and from the frontal lobes and brainstem. He was completely paralyzed and was initially believed to be in a vegetative state (Bauby 1998). However, when he began to cry, and by blinking his left eye, his caretakers realized he was in fact fully conscious. Over the next two years he learned to communicate by blinking a code for different letters of the alphabet, and dictated his memoir, The Diving Bell and the Butterfly (Bauby 1998). He died of pneumonia two days after it was published.
Consciousness is maintained in locked-in syndrome, because the forebrain which includes the frontal lobes, remains intact, and the inferior pons and the medulla of the brainstem which mediates vital life-sustaining functions are undamaged. However, because the motor areas in the forebrain are disconnected from the motor centers in the brainstem, the patient can't move their body and may appear to be in a vegetative state (Smith and Delargy 2005; Zeman 2003). They are no longer able to act according to their free will, which is locked-in.
3. FREE WILL AND THE FRONTAL LOBES
Various aspects of personality, memory, attention, perception, emotion, the body image, and consciousness may be variably compromised with damage to different regions of the forebrain (Joseph 1982; 1986a,b; 1988a, 1992, 1994, 1998, 1999a,b, 2001, 2003, 2009), e.g. amygdala (emotion), hippocampus (memory), temporal lobe (memory, language, personality), parietal lobe (body image, hand-in-space). Certainly damage to these and other brain areas may limit and restrict what we call "free will". However, insofar as "free will" is defined as the ability to make plans, consider alternatives, and chose among and act upon them, if the frontal lobes remain intact and consciousness and movement are preserved, patients can still make choices and act on them, and they do not lose their free will.
By contrast, if the frontal lobes are damaged, or if the neural pathways between and within different frontal areas are compromised or disconnected, patients may not only lose their "free will" but other brain areas may act against their "will" and engage in behaviors which the patient cannot willfully resist (Joseph 1986a, 1988a, 1996, 1999b). Free will is localized to the frontal lobes, the medial frontal areas in particular.
The frontal lobes are not a homologous tissue but serve myriad functions, and are "interlocked" via converging and reciprocal connections, with the brainstem, midbrain, thalamus, limbic system, striatum, anterior cingulate, and throughout the neocortex including the primary and secondary sensory receiving areas (Fuster 1997; Jones and Powell 1970; Miller & Cummings 2006 Pandya & Yeterian 1990; Petrides & Kuypers 1969; Pandya & Vignolo 1969; Risberg & Grafman 2006). Different areas of the frontal lobe are continually informed about activity in other areas of the brain, and in this way can direct attention, control behavior, and act according to their free will. In consequence, different aspects of "free will" can be compromised if neuronal pathways from the frontal lobes to other brain areas have been severed and "disconnected" and depending on which regions of the frontal lobe have been injured (Joseph 1986, 1988a, 1999b). For example, injuries to the right frontal lobe can result in a loss of control over free will.
4. THE RIGHT FRONTAL LOBE: FREE WILL UNRESTRAINED
Depending on the degree of damage, individual with right frontal lobe injuries may become unrestrained, overtalkative, and tactless, saying whatever "pops into their head", with little or no concern as to the effect their behavior has on others or what personal consequences may result. They may become inordinantly disinhibited and influenced by the immediacy of a situation, buying things they cannot afford, lending money when they themselves are in need, and acting and speaking "without thinking" (Fuster 1997; Joseph 1986a, 1988a, 1999b; Miller & Cummings 2006; Risberg & Grafman 2006). Seeing someone who is overweight or obese they may begin making sounds like a hog ("oink oink") or laughingly call the person a "a fat pig." If they enter a room and detect a faint odor, its: "Hey, who farted?" If they see food they like, they may grab it off another person's plate.
Following severe right frontal lobe injuries there may be periods of gross disinhibition which may consist of loud, boisterous, and grandiose speech, singing, yelling, and beating on walls. The destruction of furniture and the tearing of clothes is not uncommon. Some patients may impulsively strike doctors, nurses, or relatives, or sexually proposition family members or complete strangers, and thus behave in a thoroughly labile, aggressive, callous and irresponsible manner.
One patient, with a tumor involving the right frontal area, threw a fellow patient's radio out the window because he did not like the music. He also loudly sang opera in the halls. Indeed, during the course of his examination he would frequently sing his answers to various questions (Joseph 1986a, 1988a, 1999b).
D.F. tried to commit suicide by sticking a gun in his mouth, but aimed it wrong and blew out his right frontal lobe. After he had been discharged from the hospital, he returned for his doctor's appointment laughing, making ridiculous remarks, and dressed inappropriately with a toothbrush, toothpaste, hair brush, and wash rag sticking out of his shirt pocket (Joseph 1988a).
When asked, pointing at his pocket, "Why the toothbrush?" he replied with a laugh, "That's just in case I want to brush my teeth," and in so saying he quickly drew the toothbrush from his pocket, climbed up on top of the doctor's desk, and began to brush his teeth. Then he began to dance on the desk and wanted to demonstrate how the skin flap which covered the hole in his head (from the craniotomy and bullet wound) could bulge in or out when he held his breath or held his head upside down (Joseph 1988a).
Nevertheless, despite his bizarre and inappropriate behavior, D.F.'s overall IQ was above 130 (98% rank: "Very Superior"). Unfortunately, although he had a high IQ, he could no longer control or employ that intelligence, intelligently. He had lost control over his "free will." During one lucid moment, he stated that "I don't know why I act this way. I just can't control it."
One frontal patient described as formerly very stable, and a happily married family man, became excessively talkative, restless, grossly disinhibited, sexually preoccupied and would approach complete strangers and proposition them for sex. He also extravagantly spent money and recklessly purchased a business which soon went bankrupt.
In another case, a 46-year old woman with a right frontal lobe tumor began walking around outside in just a slip and bra and then stripping naked in front of neighbors. She claimed she was descended from queens, was fabulously wealthy, and that many men wanted to divorce their wives and marry her (Joseph 1996).
A 19-year old man with seizure activity in the right frontal lobe, felt compelled to take his penis out of his pants, in public, and to masturbate. He was subsequently arrested for exposing himself in public. He claimed to have no control over his behavior. When interviewed he suddenly exposed his penis and urinated in the direction of his doctor who by grace of very fast reflexes moved aside just in time to avoid getting drenched (Joseph 1996).
A very conservative, highly reserved, successful, brilliant , happily married engineer with over 20 patents to his name suffered a right frontal injury when he fell from a ladder. He became sexually indiscriminate and began patronizing up to 3 prostitutes a day, whereas before his injury his sexual activity was limited to once weekly with his wife. He spent money lavishly, depleted his considerable savings, suffered delusions of grandeur where he thought he was a senator and a billionaire, and camped out at Disney Land and attempted to convince personnel to fund his ideas for a theme park on top of a mountain (Joseph 1986a, 1996). At night had dreams where President Kennedy and Senator Kennedy would appear and offer him advice --and he was a republican!
Even with "mild" to moderate right frontal lobe injuries patients may initially demonstrate periods of tangentiality, grandiosity, irresponsibility, laziness, hyperexcitability, promiscuity, silliness, childishness, lability, personal untidiness and dirtiness, poor judgment, irritability, fatuous jocularity, and tendencies to spend funds extravagantly. Unconcern about consequences, tactlessness, and changes in sex drive and even hunger and appetite (usually accompanied by weight gain) may occur (Fuster 1997; Joseph 1986a, 1988a, 1999b; Miller & Cummings 2006; Passingham, 1997; Risberg & Grafman 2006).
These individuals, however, are not acting according to their free will, but often against their will. A janitor, who following his frontal lobe injury, suddenly believed he was a multi-millionaire congressman, quit his job, tried to take over the local congressman's office, stood on corners making speeches, and made extravagant purchases of items he could not afford or pay for. Later he explained that "I know its not true, but I believe its true and can't stop myself" (Joseph 1996).
Essentially, with right frontal lobe injuries, that aspect of the brain which serves and controls free will becomes disconnected from those brain areas which act on free will.
5. MOVEMENT AND THE FRONTAL MOTOR AREAS
To exercise one's free will requires access to and control over the motor systems of the brain and the body musculature. Motor control and movement are controlled, at the level of the frontal lobes, by the primary, secondary, and supplementary motor areas. These forebrain neocortical tissues are interconnected and communicate with other motor centers, such as the brainstem via a thick ropes of neurons known as the pyramidal (cortico-spinal) tracts (Fuster 1997; Joseph 1986a, 1988a, 1999a; Miller & Cummings 2006; Passingham, 1997; Risberg & Grafman 2006).
There is a one-to-one correspondence between single neurons in the primary motor area and single muscles such that the musculature of the entire body surface is represented according to their importance (Chouinard & Paus 2006; Dum & Strick 2005; Verstynen, et al. 2011). For example, the hands, fingers, face and mouth, have a greater representation than the musculature of the back. It is the primary motor areas which control fine motor functioning (such as when typing or writing).
The representation of the musculature is more diffuse in the secondary premotor area. The premotor transmits its motor impulses to the primary motor areas and subcortical regions of the brain but receives its marching orders from the supplementary motor area (Joseph 1999b; Nachev et al. 2008).
6. FREE WILL AND THE MEDIAL, SUPPLEMENTARY MOTOR AREAS
The SMA is more concerned with the general problem of guiding and coordinating the movements of the extremities through space (Andres, et al., 1999; Nachev et al. 2008; Passingham, 1997; Stephan, et al., 1999). However, it is the SMA which programs and exerts executive control over the secondary and primary motor areas, and it is the SMA and medial frontal lobes which are more closely linked with "free will."
The SMA is especially concerned with preparing the hands, arms, and body to move, and becomes active simultaneously with the intention to move, but before movement and prior to activation of the secondary and primary motor areas. Single cell recordings (Brinkman & Porter, 1979; Tanji & Kurata, 1982) and studies of blood flow studies (Orgogozo & Larsen, 1979; Shibasaki et al. 1993), movement related evoked potentials (Ikeda et al. 1992) and other functional indices (Nachev et al., 2008) indicate increased activity in the SMA prior to moving, and when just thinking about moving the body, hand, arm, or leg. Thus activity begins in the SMA well before movements are initiated and prior to activation within the premotor and primary motor areas.
For example, when anticipating or preparing to make a movement, but prior to the actual movement, neuronal activity will first begin and then dramatically increase in the SMA, followed by activity in the premotor and then the primary motor area, and then the subcortical striatum (caudate, putamen, globus pallidus) and finally the brainstem (Alexander & Crutcher, 1990; Mink & Thach, 1991; Nachev et al., 2008). This indicates that the "will" to move begins in the SMA and medial frontal lobes and exert executive control over the secondary, primary, and subcortical motor areas which then perform these "willed" actions.
The SMA in fact exerts executive control over the arms and hands, and can willfully direct the extremities towards items of interest (e.g. coffee cups, tools, pens, keys, breasts) which are then grasped, manipulated and utilized (Andres et al., 1999; Passingham, 1997; Stephan et al., 1999). Direct electrical stimulation of the SMA will also trigger complex semipurposeful movements of the hands, arms, legs, and feet (Penfield & Jasper, 1954). The same is not true of the primary or secondary motor areas which, if activated by electrode, may only trigger the twitching of single muscles. Although guiding fine motor movements of the hands, the pre- and primary motor areas are under the control of the SMA and medial frontal lobes.
7. DISCONNECTION: ACTING AGAINST THE WILL
If the neural pathways linking the SMA / medial frontal lobes to the secondary and primary area are severed or grossly injured, the disconnected primary and secondary motor areas may act against the patient's will. Behavior will be controlled, deterministically, by external stimuli (Joseph 1996, 1999b).
Patients will involuntarily engage in complex coordinated movements involving their arms and hands, and may reach out and grasp and manipulate or even use various objects even though they don't want to, and try to willfully resist. Patients will lose control over their arms, hands and legs, and compulsively pick up and use tools, pens, cups, or other objects, such that in the extreme the right or left hand may act completely independently of the "conscious" mind (Denny-Brown, 1958; Gasquoine 1993; Goldberg & Bloom 1990; Lhermitte, 1983). Instead of acting voluntarily according to their "free will", behavior is determined and controlled by their environment.
In fact, the mere visual presence of a cup, pen, hammer, saw or scissors near the hand may trigger groping movements as well as grasping and involuntary use of the object. For example, they may compulsively reach out and take the examiner's pen or swipe their glasses from their face and put them on. One patient put three pair of spectacles on and wore them simultaneously.
If a hammer is placed on the testing table the patient may involuntarily pick it up and begin hammering on the table or walls, even when told not to, and will continue even after told to stop. If a glass of water is placed on the table, they may pick it up and drink from it, although they are not thirsty and despite their efforts to willfully oppose these actions (Gasquoine 1993; Goldberg and Bloom 1990; Lhermitte 1983; McNabb et al. 1988). Denny-Brown (1958) has referred to this condition as "magnetic apraxia" and "complusive exploration".
Sometimes just the presence of a pencil and a piece of paper may cause a patient to pick up the pencil and begin writing an endless letter that might include the mechanical repitition of the same word line after line and even page after page.
Not only do they act against their will, but once they take hold of a pen, cup, or other object, they may be unable to let go and cannot release their grip. In fact, the entire arm and hand may become increasingly stiff and rigid, such that the hand will become frozen and seemingly "stuck" to the pen, paper, cup, or whatever they were holding or touching. While walking they may move more and more slowly until they seem unable to move, as if their feet are stuck to the floor as if glued (Denny-Brown, 1958).
Gegenhalthen (counterpull), i.e. involuntary resistance to movement of the extemities, appears to be exclusively associated with medial frontal lobe/SMA abnormalities (Joseph 1996, 1999b). If the patient raises an affected arm, it will stiffen and become increasingly rigid as the will to move it increases. If the patient tries to resist or to relax the arm, it instead becomes frozen in place.
The same condition also results if a nurse or physician attempts to move the arm; it becomes increasingly rigid and patients are forced, against their will, to maintain their afflicted arm even in uncomfortable postures, frozen in place, for long time periods. However, over time, the affected limb may slowly return to a resting posture--a condition referred to as "waxy flexibility."
Likewise, if they are presented with yet another cup, pen, or tool, the frozen state may slowly disappear and they may reach out and compulsively take hold of the new object.
Naturally, individuals so afflicted become quite upset, frustrated and embarrassed by the misbehavior of their body, and will complain these actions occur against their will.
8. THE ALIEN HAND
With injury or damage to the medial frontal lobes, SMA, and their interconnections with the other motor areas, one or both hands may take on a "life of their own"; a condition referred to as the "alien hand" (Joseph 1986a, 1988a,b, 1996, 1999b). In fact, with damage to or disconnection of these medial frontal tissues, involuntary uncontrolled movements may become so purposeful and complex that they appear to be directed not by the external environment, but by a consciousness with its own free; an alien consciousness that is disconnected from another aspect of consciousness which can speak but which cannot willfully oppose these alien behaviors by an alien hand (Joseph 1986a, 1988a,b, 1996, 1999b).
McNabb et al. (1988, pp. 219, 221) describe one woman with extensive damage involving the medial left frontal lobe and anterior corpus callosum, who was forced to punish her misbehaving right hand by slapping it with the left. However, sometimes the right hand would fight back and interfere with actions performed by the left. She complained that her right hand showed an uncontrollable tendency to reach out and take hold of objects and then be unable to relese them. When the right hand behaved mischievously she attempted to restrain it by wedging it between her legs or by holding or slapping it with her left hand. She repeatedly express astonishment at these actions by her hand. A second patient frequently experienced similar difficulties. When "attempting to write with her left hand the right hand would reach over and attempt to take the pencil. The left hand would respond by grasping the right hand to restrain it."
Problems of an even more severe nature have plagued patients following complete (surgical) destruction of the corpus callosum and thus the neural pathways linking the two medial motor areas of the frontal lobes (Joseph, 1988ab). These independent "alien" behaviors usually involve the left hand and the half of the body, and were purposeful, intentional, complex and obviously directed by an awareness maintained by the disconnected right hemisphere (which controls the left hand). These alien actions were often completely against the "will" of the consciousness maintained in the left hemisphere.
These "alien" disturbances were so purposeful, and often so well thought out, it was as if these "split-brain" patients had developed two independent "free wills" maintained by independent minds housed in the right and left half of the brain (Joseph, 1986b, 1988a,b); two free wills and two minds which were unable to communicate, and each of which had a "mind of its own."
As originally described by Nobel Lauriate Roger Sperry (1966, p. 299), "Everything we have seen indicates that the surgery has left these people with two separate minds, that is, two separate spheres of consciousness. What is experienced in the right hemisphere seems to lie entirely outside the realm of awareness of the left hemisphere. This mental division has been demonstrated in regard to perception, cognition, volition, learning and memory."
For example, one patient's left hand would not allow him to smoke and would pluck lit cigarrettes from his mouth. He reported that he had been trying to quit, unsuccessfully, for years, but it was only after the surgery that he found he couldn't smoke, because the left hand wouldn't let him (Joseph, 1988a).
Each frontal lobe has its own primary, secondary, and supplementary motor areas and medial (and lateral) tissues. Since free will is associated with the SMA and medial frontal lobe, disconnecting the connections between the right and left created two "free wills" one maintained by the right the other by the left frontal lobe.
Akelaitis (1945, p. 597) describes two patients with complete corpus callosotomies who experienced extreme difficulties making the two halves of their bodies cooperate. "In tasks requiring bimanual activity the left hand would frequently perform oppositely to what she desired to do with the right hand. For example, she would be putting on clothes with her right and pulling them off with her left, opening a door or drawer with her right hand and simultaneously pushing it shut with the left. These uncontrollable acts made her increasingly irritated and depressed."
Another patient experienced difficulty while shopping, the right hand would place something in the cart and the left hand would put it right back again. Yet another had the same problem when trying to decide what to eat, first picking one item, and the other hand putting it back and picking another. Of course, similar difficulties in "making up one's mind" also plague those who have not undergone split-brain surgery.
A recently divorced split-brain patient reported that on several occasions while walking about town he was forced to go some distance in another direction by the left half of this body. He resisted with the right half of the body and essentially engaged in a battle of the wills. As it turned out, the left half of the body was trying to take him to the home of his ex-wife, but the right half of his body refused to have anything to do with her.
Another split-brain patient who had recently broken up with his girlfriend voiced considerable anger toward her and stated an intention to never see her again. He also admitted that they had broken up several times, but always got back together. This time, however, he was adamant: He never wanted to see her again. When asked to indicate with "thumbs up" or "thumbs down" if he still liked her, the right hand gave a "thumbs down" and the left hand a "thumbs up."
Geschwind (1981) reports a callosal patient who complained that his left hand on several occasions suddenly struck his wife--much to the embarrassment of his left (speaking) hemisphere. In another case, a patient's left hand attempted to choke the patient himself and had to be wrestled away.
Bogen (1979) indicates that almost all of his "complete commissurotomy patients manifested some degree of intermanual conflict in the early postoperative period." One patient, Rocky, experienced situations in which his hands were uncooperative; the right would button up a shirt and the left would follow right behind and undo the buttons. For years, he complained of difficulty getting his left leg to go in the direction he (or rather his left hemisphere) desired. Another patient often referred to the left half of her body as "my little sister" when she was complaining of its peculiar and independent actions.
A split-brain patient described by Dimond (1980, p. 434) reported that once when she had overslept "my left hand slapped me awake." This same patient, in fact, complained of several instances where her left hand had acted violently toward other people, and this caused her considerable distress and embarrassment.
Yet another split brain patient, "2-C" complained of instances in which his left hand tried to strike a relative (Joseph 1988a,b). Once, after he had retrieved something from the refrigerator with his right hand, his left took the food, put it back on the shelf and retrieved a completely different item "Even though that's not what I wanted to eat!" he complained. Once while watching and enjoying a program TV, the left half of his body dragged him from his seat, and then changed the channels and then returned to his seat to watch a different program, even though: "That's not what I wanted to watch!" On several occasions, his left leg refused to continue "going for a walk" and would only allow him to return home.
9. MIRROR NEURONS, ALIEN HANDS, SPLIT-BRAINS & FREE WILL
In 1996 Rizzolatti et al., reported the discovery of "mirror" neurons which were most densely concentrated in the SMA. According to Rizzollati et al. (1998) "mirror neurons appear to form a system that allows individuals to recognize motor actions made by others by matching them with an internal motor copy," thus enabling them to perform and mimic the actions of others (Rizzolatti & Craighero 2004, Rizzollati et al. 2009).
Since the SMA and medial frontal lobes are implicated in the expression of all "alien" actions, is it possible these "alien behaviors" are merely reflexive, and that the "alien" hand is merely mimicking and mirroring the behavior it is observing, and thus doing the opposite?
The answer was provided in 1988 when it was conclusively demonstrated that these "alien" behaviors are purposeful, goal directed, and under the control of a "free will" and a mind separate from the dominant stream of consciousness which has access to language (Joseph 1988ab). In one test, both hands of split-brain patients were provided information and given multiple choices so as to make a choice which precluded mimicry. Specifically, the patient sat before a box with two separate holes (on the right and the left) in which he inserted his hands. Above each hole, in plain sight, were small patches of textured material, one above the other, i.e. sandpaper, wire mesh, smooth metal, velvet. While in the hole and out of sight, both hands were stimulated simultaneously, but with completely different materials, e.g. velvet to the right, sand paper to the left. They were then required to point to the material they experienced. On every test the right and left hands made the correct responses. The "alien" left hand did not mimic the right and did not interfere with its choices.
However, these patients (that is, the language dominant left hemispheres) had not been told they would be experiencing two different fabrics, and then expressed shock and dismay when the alien left hand chose a different material. In one case, the patient's normal right hand, repeatedly reached over and tried to force the left (alien) hand to make a different choice, that is, to chose the same material experienced by the right hand, although the left hand responded correctly! However, in this case, the alien hand resisted and refused to make a different choice, even when the patient (his left hemisphere) vocalized: "Thats wrong!" Repeatedly, he reached over and grabbed his left hand with his right but it refused to point at the wrong item. He became so angry with his left hand that he yelled at it, said "I hate this hand" and then began punching and hitting it. Finally the two hands began to fight!
In this and in other instances, it was demonstrated that the alien hand was not misbehaving, but acting purposefully and making rational choices according to its own free will - and which was opposed by the free will residing in the other, disconnected half of the brain.
10. CATATONIA, THE SMA / MEDIAL FRONTAL LOBES & FREE WILL
Different regions of the brain are specialized for performing specific functions, and interact with yet other regions to coordinate and make possible complex cognitive and behavioral activity. The frontal lobes serve as the senior executive of the brain and personality and the MFL and SMA provide the neuroanatomical substrate which executes what has been traditionally described as "free will."
If other areas of the brain are disconnected from the SMA / MFL the patient may feel compelled to act against their will. However, if the MFL and SMA are destroyed, "free will" is abolished. Ideas and thoughts are no longer generated, and the "will" to speak or to initiate or complete a voluntary movement may become completely attenuated and abolished (Hassler 1980; Laplane et al. 1977; Luria 1980; Penfield and Jasper 1954; Penfield and Welch 1951). Patients may lose even the will to speak and become mute, unresponsive, stiff, frozen, unmoving, motionless, and catatonic (Hassler 1980; Joseph, 1999b; Laplane et al. 1977; Luria 1980; McNabb et al. 1988; Penfield and Jasper 1954; Penfield and Welch 1951).
In one case, a soldier developed gegenhalten, waxy flexibility, mutism, and catatonia after a gunshot wound that passed completely through the frontal lobes, destroying much of the SMA and MFL and disconnecting these regions from other brain tissue. For two months he laid in a catatonic-like stupor, always upon one side with slightly flexed arms and legs, never changing his uncomfortable position. He did not obey commands, was incontinent, made no complaints, gazed steadily forward and showed no interest in anything. However, over the ensuing weeks, he periodically showed signs of lucidity, and could be persuaded to talk, and would answer quite correctly about his personal affairs. When questioned he explained that during his catatonic periods, although he was aware of his surroundings, his mind was empty, devoid of thoughts, and it just did not occur to him to move, speak, or eat. So he did nothing. Incredibly, the patient "was eventually returned to active duty" (Freeman and Watts 1942).
In another case, a 42 year old male with no previous psychiatric history, developed gegenhalten, mutism, and catatonia after a beating and suffering frontal and midline subdural hematomas (which later required the drilling of burr holes for evacuation). He resisted the efforts of others to move him, and would sit motionless and unresponsive for hours in odd and uncomfortable positions. The patient's symptoms seemed to wax and wane such that he demonstrated some periods of seeming normality (Joseph 1996). When he was in one of his "normal" periods, and was asked about his behavior he replied: "Its not that I don't want to move, its that I don't feel the want". During another "normal" period he explained his catatonic state thusly: "I feel nothing. No thoughts. Everything is going on outside my head, but nothing is going on inside my head. Like I am a rock. I am just there." Thus, while in his catatonic state his mind was a blank and there was simply no reason to even move.
It is not uncommon with SMA / MFL injuries for patients to become catatonic, mute, and remain in odd, uncomfortable postures for long time periods (Joseph 1996, 1999b). Upon recovery many patients may later remark they had completely lost the will to speak, that thoughts did not enter their head, that they were unable to think or generate ideas, and instead experienced a motivational-ideational void, a complete emptiness without feelings, which left them without any reason to move or function (Brutkowski 1965; Hassler 1980; Laplane et al. 1977; Luria 1980; Mishkin 1964). As those afflicted have no interest in eating, drinking, or even moving, essentially they had also lost the will to live.
With massive SMA MFL injuries, free will is abolished, and this is because, free will is localize to the frontal lobes.
11. CONCLUSIONS: THE NEUROANATOMY OF FREE WILL
The frontal lobes serve as the "Senior Executive" of the brain and personality, acting to process, integrate, inhibit, assimilate, and remember perceptions and impulses received from the limbic system, striatum, temporal parietal and occipital lobes, and neocortical sensory receiving areas. Through the assimilation and fusion of perceptual, volitional, cognitive, and emotional processes, the frontal lobes engages in decision making and goal formation, modulates and shapes character and personality and directs attention, maintains concentration, and participates in information storage and memory retrieval. Further, the frontal lobes, the SMA and medial regions in particular, can direct behavior by controlling movement and the musculature of the body, and in this manner, it serves what is best described as "free will."
Because "free will" is localized to the right and left frontal medial motor areas, surgical destruction of the neural pathways linking the right and left SMAs and medial frontal lobes will result in two independent streams of mental activity which act according to their own "free will."
Destruction and disconnection of the pathways leading from the SMA and medial frontal lobes to the secondary and primary motor areas leads to difficulties where the patient's body will act "against their will", and perform actions they are unable to prevent or control. Compulsive utilization, and forced groping and grasping, are obviously compulsive in nature, and reminiscent of obsessive-compulsive disorders, which are also associated with frontal lobe abnormalities (Joseph 1996), especially of the orbital-medial frontal lobes and the striatum /anterior cingulate which are buried within the depths of the frontal lobes.
Patients may experience unwanted, recurrent, perseverative ideas, or compulsions to repetitively perform certain acts, e.g. hand washing. They may also experience intrusive recurring thoughts, feelings, or impulses to perform certain actions against their will. Motorically obsessive compulsions may involve repetitive, stereotyped acts including the perseverative manipulation and touching of objects.
Moreover, abnormal or electrical activation of the medial-orbital frontal lobes has been reported to trigger recurrent and intrusive ideational activity ("forced thinking"), as well as compulsive urges to perform aberrant actions, e.g. shouting or the manifestations of various motor tics (Penfield and Jasper 1954; Ward 1988). Similar disturbance have been reported for those who are afflicted with Tourretts syndrome (Singer 2005; Walkup et al., 2006). Those with Tourretts may involuntarily shout out obscenities, and inappropriate remarks, or engage in spontaneous, but repeptitive and stereotyped movements which are experienced as "unvoluntary" (Tourette Syndrome Classification Study Group, 1993). Although the exact etiology is unknown, abnormalities in deep medial frontal lobe structures have been reported (Walkup et al., 2006).
Damage to the neural pathways to and from the medial frontal lobes often simultaneously disrupt the orbital, lateral, and inferior frontal lobes, and can produce a unique constellation of compulsive, perseverative symptomology, including "forced thinking" and uncontrolled obsessive compulsions. That is, a patient may suffer from a difficulty suppressing or inhibiting previous thoughts or behaviors, which then occur again and again.
However, with massive damage to the medial frontal lobes and supplementary motor areas, instead of acting against their will, they lose the ability to will; free will is abolished, and this is because what has been called "free will" is localized to the frontal lobes, the medial frontal lobes in particular.
Alexander, G. E., & Crutcher, M. D. (1990). Preparation for movement. Neural representations of intended direction in three motor areas of monkey. J. Neurophysiology, 64, 164-178.
Allain P, Joseph PA, Isambert JL, Le Gall D, Emile J. Cognitive functions in chronic locked-in syndrome: a report of two cases. Cortex 1998;34: 629-34.
Akelaitis, A. J. (1945). Studies on the corpus callosum. American Journal of Psychiatry, 101, 594-599.
Bauby, J.-D., (1998), The Diving Bell and the Butterfly: A Memoir of Life in Death, Vintage.
Bogen, J. (1979). The other side of the brain. Bulletin of the Los Angeles Neurological Society. 34, 135-162.
Brinkman, C., & Porter, R. (1979). Supplementary motor area. Journal of Neurophysiology, 42, 681-709.
Brutkowski, S. (1965) Functions of the prefrontal cortex. Physiological Review, 45, 721-746.
Chouinard, P. A., Paus, T. (2006). The Primary Motor and Premotor Areas of the Human Cerebral Cortex, Neuroscientist April 2006 vol. 12 no. 2 143-152.
Denny-Brown, D. (1958). The nature of apraxia. Journal of Nervous and Mental Disease, 15-56.
Dimond, S. J (1980). Neuropsychology. Buttersworth.
Dum, R. P., Strick, P. L. (2005). Frontal Lobe Inputs to the Digit Representations of the Motor Areas on the Lateral Surface of the Hemisphere The Journal of Neuroscience,25(6):1375-1386.
Freeman, W., & Watts, J. W. (1942). Psychosurgery. Springfield, IL: Charles C. Thomas.
Fuster, J.M. (1997). The prefrontal cortex. Anatomy, physiology, and neuropsychology of the frontal lobes. New York: Ravens-Lippincott.
Fuster, J. M. (1995). Neuropsychiatry of frontal lobe lesions. In B.S. Fogel & R. B. Schiffer (Eds). Neuropsychiatry. Baltimore, Williams & Wilkins.
Gasquoine, P. G. (1993). Bilateral alien hand signs following destruction of the medial frontal cortices. Neuropsychiatry, Neuropsychology & Behavioral Neurology, 6, 49-53.
Geschwind N (1965) Disconnection syndromes in animals and man. Brain. 882, 237-274, 585-644.
Geschwind, N. (1981). The perverseness of the right hemisphere. Behavioral Brain Research, 4, 106-107.
Goldberg, G., & Bloom, K. K. (1990). The alien hand sign. American Journal of Physical Medicine & Rehabilitation. 69, 228-38.
Hassler, R. (1980). Brain mechanisms of intention and attention with introductory remarks on other volitional processes. Progress in Brain Research, 54, 585-614.
Ikeda, A., Luders, H. O., Burgess, R. C., and Shibasaki, H. (1992) Movement-related potentials recorded from supplementary motor area and primary motor area. Brain, 115, 1017-1043.
Jones, E. G., & Powell, T. P. S. (1970). An antomical study of converging sensory pathways within the cerebral cortex of the monkey. Brain, 93, 793-820.
Joseph, R. (1982). The Neuropsychology of Development. Hemispheric Laterality, Limbic Language, the Origin of Thought. Journal of Clinical Psychology, 44 4-33.
Joseph, R. (1986a). Confabulation and delusional denial: Frontal lobe and lateralized influences. Journal of Clinical Psychology, 42, 845-860.
Joseph, R. (1986b). Reversal of language and emotion in a corpus callosotomy patient. Journal of Neurology, Neurosurgery, & Psychiatry, 49, 628-634.
Joseph, R. (1988a) The Right Cerebral Hemisphere: Emotion, Music, Visual-Spatial Skills, Body Image, Dreams, and Awareness. Journal of Clinical Psychology, 44, 630-673.
Joseph, R. (1988b). Dual mental functioning in a split-brain patient. Journal of Clinical Psychology, 44, 770-779.
Joseph, R. (1992) The Limbic System: Emotion, Laterality, and Unconscious Mind. The Psychoanalytic Review, 79, 405-455.
Joseph, R. (1994) The limbic system and the foundations of emotional experience. In V. S. Ramachandran (Ed). Encyclopedia of Human Behavior. San Diego, Academic Press.
Joseph, R. (1996). Neuropsychiatry, Neuropsychology, Clinical Neuroscience, 2nd Edition. Williams & Wilkins, Baltimore.
Joseph, R. (1998). Traumatic amnesia, repression, and hippocampal injury due to corticosteroid and enkephalin secretion. Child Psychiatry and Human Development. 29, 169-186.
Joseph, R. (1999a). The neurology of traumatic "dissociative" amnesia. Commentary and literature review. Child Abuse & Neglect. 23, 71-80.
Joseph, R. (1999b). Frontal lobe psychopathology: Mania, depression, aphasia, confabulation, catatonia, perseveration, obsessive compulsions, schizophrenia. Psychiatry, 62, 138-172.
Joseph, R. (2000). Limbic language/language axis theory of speech. Behavioral and Brain Sciences. 23, 439-441.
Joseph, R. (2001). The Limbic System and the Soul: Evolution and the Neuroanatomy of Religious Experience. Zygon, the Journal of Religion & Science, 36, 105-136.
Joseph, R. (2003). Emotional Trauma and Childhood Amnesia. journal of Consciousness & Emotion, 4, 151-178.
Joseph, R. (2009). Quantum Physics and the Multiplicity of Mind: Split-Brains, Fragmented Minds, Dissociation, Quantum Consciousness, Journal of Cosmology, 3, 600-640.
Joseph, R., Forrest, N., Fiducia, N., Como, P., & Siegel, J. (1981). Electrophysiological and behavioral correlates of arousal. Physiological Psychology, 1981, 9, 90-95.
Laplane, D., Talairach, J., Meininger, V., Bancaud, J., & Orgogozo, J. M. (1977). Clinical consequences of cortisectomies involving the supplementary motor area in man. Journal of the Neurological Sciences, 34, 301-314.
Lhermitte, F. (1983). "Utilization behaviour" and its relation to lesions of the frontal lobes. Brain, 106, 237-255.
Luria, A. (1980). Higher cortical functions in man. New York: Basic Books.
McNabb, A. W., Caroll, W. M., & Mastaglia, F. L. (1988). "Alien hand" and loss of bimanual coordination after dominant anterior cerebral artery territory infaction. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 218-222.
Miller, B. L., & Cummings, J. L. (2006). The Human Frontal Lobes. Guilford Press.
Mink, J. W., & Thach, W. T. (1991). Basal ganglia motor control. I, II, & III. Journal of Neurophysiology, 65, 273-351.
Mishkin, M. (1964). Perseveration of central sets after frontal lesions in monkeys. In J. M. Warren & K. Akert (Eds.), The frontal granular cortex and behavior. (pp 219-241). New York: McGraw-Hill.
Nachev, P., Kennard, C., & Husain, M. (2008). Functional role of the supplementary and pre-supplementary motor areas Nature Reviews Neuroscience 9, 856-869.
Orgogozo, J. M., & Larsen, B. (1979). Activation of the suplementary motor area during voluntary movement in man suggest it works as a supramodal motor area. Science, 206, 847-850.
Pandya, D. N. & Yeterian, E. H. (1990) Architecture and connectivity of cerebral cortex: Implications for brain evolution and function. In: Neurobiology of higher cognitive function. eds. A. B. Scheibel & A. F. Wechsler. Guilford.
Pandya, D. N., & Kuypers, H. G. J. M. (1969). Corticocortical connections in the rhesus monkey. Brain Research, 13, 13-36.
Pandya, D. N., & Vignolo, L. A. (1969). Corticocortial connections in the rhesus monkey. Brain Research, 13, 13-16.
Passingham, R. (1997). Functional organization of the motor system. In Frackowiak, R. S. J., et al., (Eds.,) Human Brain Function. Academic Press, San Diego.
Penfield, W. (1952) Memory Mechanisms. Archives of Neurology and Psychiatry, 67, 178-191.
Penfield, W., & Jasper, H. (1954). Epilepsy and the functional anatomy of the human brain. Boston: Little-Brown & Co.
Penfield, W., & Perot, P. (1963) The brains record of auditory and visual experience. Brain, 86, 595-695.
Penfield, W., & Welch, K. (1951). Supplementary motor area of cerebral cortex. Clinical and experimental study. Archives of Neurology & Psychiatry, 66, 289-317.
Petrides, M. & Pandya, D. N.. (1988) Association fiber pathways to the frontal cortex from the superior temporal region in rhesus monkey. Journal of Comparative Neurology 273:52-66.
Risberg J., Grafman, J. (2006). The Frontal Lobes: Development, Function and Pathology, Cambridge University Press
Rizzolatti, G., Craighero, L. (2004). THE MIRROR-NEURON SYSTEM, Annu. Rev. Neurosci. 27, 169–92.
Rizzolatti G, Fadiga L, Fogassi L, Gallese V. (1996). Premotor cortex and the recognition of motor actions. Cogn. Brain Res. 3:131– 141.
Rizzolatti G, Luppino G, Matelli M. (1998). The organization of the cortical motor system: new concepts. Electroencephalogr. Clin. Neurophysiol. 106:283–296.
Rizzolatti, G., Fabbri-Destro, M., Cattaneo, L. (2009). Mirror neurons and their clinical relevance. Nat Clin Pract Neurol 5 (1): 24–34.
Smith , E., and Delargy, M. (2005). Locked-in syndrome, BMJ. 330, 406-408.
Shibasaki, H., Sadato, N., Lyshkow, H., et al. (1993). Both primary motor cortex and supplementary motor area play an important role in complex finger movement. Brain, 116, 1387-1298.
Singer, H.S. (2005). Tourette's syndrome: from behaviour to biology". Lancet, 4, 149–59.
Sperry, R. (1966). Brain bisection and the neurology of consciousness. In F. O. Schmitt and F. G. Worden (eds). The Neurosciences. MIT press.
Stephan, K. M., Binkofski, F., Halsband, U., et al., (1999). The role of ventral medial wall motor areas in bimanual coordination. Brain, 122, 351-368.
Tanji, J., & Kurata, K. (1982). Comparison of movement-related neurons in two cortical motor areas of primates. Journal of Neurophysiology, 40, 644-653.
Tourette Syndrome Classification Study Group (1993). "Definitions and classification of tic disorders". Arch Neurol. 50, 1013–16.
Verstynen, T., et al. (2011). In Vivo Mapping of Microstructural Somatotopies in the Human Corticospinal Pathways. Journal of Neurophysiology, 105, 336-346
Walkup JT, Mink JW, Hollenback PJ, (2006). Advances in Neurology, Vol. 99, Tourette Syndrome. Lippincott, Williams & Wilkins. .
Ward, C.D. (1988). Transient feelings of compulsion caused by hemispheric lesions: Three cases. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 266-268.
Zeman A. (2003). What is consciousness and what does it mean for the persistent vegetative state? Adv Clin Neurosci Rehabil, 3, 12-4.