Blurring the Definition of Self, Agency, and Identity

Two-year-olds Tatiana and Krista Hogan are craniopagus conjoined twins. They are one of only 6 sets of twins in the world who were born conjoined at the head. Only 2% of conjoined twin births are craniopagus (1). Because the craniopagus twinning is so rare, there is a limited supply of observations that have been made about their condition. There is also a general lack of research looking at the condition of being a conjoined twin. Conjoined twinning presents profound physical differences. The physical immobility, health risks, and unconventional lifestyle that result from conjoined twinning motivate parents and doctors to separate twins if possible, and as early as possible. The majority of advances in scientific observations of conjoined twinning, therefore, have focused on surgical separation of conjoined twins and these results (1) (2) (3).  I would like to suggest, however, that the condition of a conjoined twin is not that different from individual bodies. Their condition and ability to cooperate indicates more about the human mind and body. It seems to present a crisis, however, because it challenges the authority we put in constructions we have made, primarily the construction of the agency of the self.
Tatiana and Krista present a unique situation because of the way they are connected, which makes them ineligible for separation (4). While most sources would classify conjoined twinning as a congenital misfortune (1), there is also a great deal that can be learned from their resilience and adaptability. The idea of not being able to separate conjoined twins threatens their own well-being, but more importantly it pushes the boundaries we have constructed about ourselves. The observations that have been made about conjoined twins, and Tatiana and Krista in particular, challenge our assumptions about the nature of our subjectivity. How do we define a personal boundary if there is an area of shared sensation with another person? How do we affirm a sense of agency in our behavior if it is possible for two people to make cooperative or independent movements of a shared appendage?
Like most craniopagus conjoined twins, Tatina and Krista Hogan share a percentage of their brain matter (5). However, Tatiana and Krista’s brain connection provides evidence of communication between one another about the things they perceive and their sense of consciousness (6). Tatiana and Krista are not the first twins to show evidence of nervous system communication. Certainly when twins share organs or appendages there are unconscious overlaps in brain activity. For Tatiana and Krista, there is evidence that their nervous systems connect in conscious ways (6) (7) (8).
CT Scans of the twins’ brains reveal that their brains are connected via a “tissue bridge” at the top of their brain stem. The bridge is believed to link the thalamus of both girls’ brains (6) (7) (8). What is known about the thalamus suggests that it processes and relays sensory information to different parts of the cerebral cortex.  The thalamus is central to regulating states of sleep and wakefulness, regulating arousal, level of awareness, and activity.  More generally, the thalamus is credited for regulating our motor system. Our sensory systems for hearing, touch, taste and sight are supposed to be localized and relayed from the thalamus to corresponding areas of the cerebral cortex.  The thalamus’ role as a hub for sensory inputs is evidenced by case studies where the patient’s brain suffered lesions in various parts of the thalamus that caused specific sensory deficits (9). In class, we have used sensory inputs as an example of which processes go through the I-function.  In fact, observation about the thalamus have indicated that these neurons may be crucially linked to the rest of the brain in a way that allows for self-awareness. (9) (11)
Observations of Tatiana and Krista reflect that the thalamus may in fact be the crucial link. Tatiana and Krista’s mom describes the twins’ process of “tuning in”. She says, we know when they’re ‘tuning in’ because Tatiana’s eyes will twitch a little bit and Krista’s eyes will look straight forward…if Krista’s looking at something on the TV and Tatiana can’t see it, she can just tune in to what her sister’s looking at” (5). If one the twins are crying, a pacifier in one’s mouth will sooth both of them (8). If one twin’s leg is stimulated, the other twin’s leg will also respond.  The twins’ ability to “tune into” what the other is seeing or feeling seems intimately linked to the role the thalamus has been found to play in the brain. If they are able to communicate with one another via sensory inputs, there is a strong implication that the twins are co-conscious.
The twins’ possible shared consciousness or shared awareness has no medical precedent (5). However, some work has been done to make observations about different types of conjoined twins. These studies focus on the interaction between embodiment and cognition and work to reexamine our notion of experience and body boundaries. Conjoined twins force us to reexamine our notion of the body being a definite physical boundary containing the self (12) (13). To begin, our examination of Christopher Reeves and amputees indicates that the definition of the self as defined through the body is variable and subject to change. There are indeed varying degrees of shared consciousness, where Tatiana and Krista now seem to position themselves at one end of a spectrum.
In the case of Tatiana and Krista, there is the question of how far their co-consciousness goes. Studies of the thalamus’ role in the brain provide neurological observations that help explain behavioral observations in the twins. The thalamus is thought to be central to our sense of consciousness. There seems to be an extremely crucial connection between the central role the thalamus plays in determining when we are aware of our actions and its supposed role as the nexus of our consciousness.
Thalamo-cortico-thalamic circuits are the looped neural pathways that connect the thalamus to the cerebral cortex, and the cerebral cortex back to the thalamus. One study of persistent vegetative states—when the patient is awake but not conscious—indicates that cortical activity on its own is not conscious, and that thalamo-cortico-thalamic circuits, and the thalamus itself are site of conscious experience (9) (11). Because the thalamus allows the brain to obtain data on its own activity, these circuits may be what makes self-awareness possible (9).  In class, we have discussed reafferent loops, which operate on a similar principle as the thalamus-cortex circuits. Reafferant loops are constantly regulating outputs based on ever-changing inputs. Another study of the reaffirms that the thalamus does not operate on a yes/no or on/off basis, but is a sort of facilitator of conversations between parts of the brain. The researcher explained, “Instead of vision being a process going straight from eye to cortex, its more of a loop” (10). It is important to realize that there are conversations going on within and amongst Tatiana and Krista’s brains. More revealing than this is the knowledge that there are conscious and unconscious processes in the nervous system. Quadripalegics are able to move parts of their body that they don't have access to. Similarly, Tatiana and Krista respond to stimuli the other twin is experiencing. There is a strong indication that a great deal of Tatiana and Krista's coordination is happening unconsciously. This is not unique to their condition, however. There are a host of physical actions and responses that an individual person has no control over because these processes are taking place unconsciously. We may feel that we are more in control that Tatiana and Krista, but the only real difference between them and myself is that their condition makes this lack of control immediately apparent.
At the neuronal level of thalamic activity, it is important to emphasize the “nobody in charge” principal we have discussed previously in class. At the level of neurons and communication between various parts of the brain, coordination occurs in the absence of a coordinator. The thalamus receives and relays information via reciprocal loops between the thalamus and areas of the cerebral cortex, but one does not have more authority over the other. The thalamus does not receive and send out information as a chain reaction. This point is extremely important to interpreting Tatiana and Krista’s shared signals.  In fact, the brain’s ability to operate via loops and circuits rather than a chain of command is likely what allows Tatiana and Krista’s brains to cooperate so efficiently. They are not simply sending signals together, they must be constantly in check with one another from a neuronal level.
The thalamus’ is at the center of the process of self-awareness, which on the level of neurons is a synthesizing or synchronizing of information (10).  We are not capable of being aware of everything at once, and our brains are receiving many more inputs than we consciously perceive. Constant dialogue within the brain allows for a synchronization of events (10), so that what our “I” recognizes as conscious experience seems like a unified product, a filtered impression of the world.  This notion of synchronizing information is extremely important to understanding what is happening as Tatiana and Krista share consciousness. Again, the central question is how far their co-consciousness goes. When Tatiana’s leg reacts to someone tickling Krista’s leg, does Tatiana have any control over whether she moves her leg (does she know she feels it) or does it function as an unconscious reflex? Where can we draw the line between bodily coordination and shared consciousness?
Psychologists have done the most work on explorations of states of shared consciousness.
In one study researchers tried to reconcile the difference between bodily ownership and authorship. They emphasize that for an individual, involuntary actions do not exist.  This is true for a quadriplegic, who would not attribute a reflex in response to a stimulus in his foot as his own individual action because he is not in control of it.  This same study finds that for conjoined twins, their connection to one another is comparable to appendages. The researchers came to this conclusion by observing a twin’s reaction if the second twin dies; when one twin dies, or when twins are separated; it is as if the other twin has lost a part of his or her body. The study concludes that “the bodies of Siamese twins overlap in varying degrees; they are physically, sentiently, and psychologically merged” (13).
One source was interested, theoretically, in the relationship between the body and our sense of self. They conclude that surgical separation of conjoined twins represents a process by which surgeons are constructing, rather than separating, bodies. They write, “there are no natural ways of making two bodies out of one that preserve each twin’s self-identity and self-body relationship” (p. 24) (12). Tatiana and Krista present a case that pushes the boundaries on this issue of defining the self when one is denied agency over a certain part of one’s body, or when agency is cooperative between two loci of control.
Their unique situation presents many more questions. For Tatiana and Krista there is an implication that they are constantly perceiving a reacting for one another. The question remains, however, whether each of them has agency to actually “tune in or out” to one another’s signals, or whether this process happens involuntarily.  If they register information from one another involuntarily, is the process conscious or unconscious. Are they aware that they are communicating with one another, retaining a sense of dual agency, or do their two bodies operate more as one?
Exploring these questions for Tatiana and Krista’s situation has implications for a single person’s sense of self and agency as well.  Their ability to relay information back and forth to one through a shared thalamus reaffirms observations that suggest that the majority of what we perceive is just that, a perception created in our mind. Tatiana and Krista suggests that the brain is extremely adaptable and it literalizes the idea that our sense of self is dynamic, a constant dialogue that is always blurring the boundaries.

Works Cited

1. Editorial. Brain: A Journal of Neuroscience. 129(5):1075-1077.  2006. http://brain.oxfordjournals.org/cgi/content/full/129/5/1075

2. “Formerly Conjoined Twins Continue to Thrive”. Montefiore Medical Center. 2009. http://www.montefiore.org/newsreleases/2008/July/twins/

3. “Brain Swelling Halts Conjoined Twin Surgery”. Bio-Medicine. http://www.bio-medicine.org/medicine-news/Brain-Swelling-Halts-Conjoined-Twin-Surgery-20868-1/

4. “Extreme Bodies; Separating Cranial Conjoined Twins”. How Stuff Works.  http://videos.howstuffworks.com/discovery/32215-extreme-bodies-separating-cranial-conjoined-twins-video.htm

5. “Extreme Bodies: Sharing One Brain”. How Stuff Works. http://videos.howstuffworks.com/discovery/32216-extreme-bodies-sharing-one-brain-video.htm

6. “Extreme Bodies: Two Infants With One Brain”. How Stuff Works http://videos.howstuffworks.com/discovery/32218-extreme-bodies-two-infants-with-one-brain-video.htm

7.  Armstrong, Jane. “Tissue ‘Bridge’ Joins Twins’ Brain”. December 2006. http://www.theglobeandmail.com/servlet/story/RTGAM.20070423.wbctwinsspecialreport14/BNStory/conjoinedTwins/feature-topic

8. “First Look At Conjoined Twins”. Canwest News Service. October 2006. http://www.canada.com/topics/bodyandhealth/story.html?id=0e49832c-7a4f-4ab7-a804-e7cc03c9978f

9. http://en.wikipedia.org/wiki/Thalamus

10. Leonard, Abigail. “Your Brain Boots Up Like A Computer”. August 2006. http://www.livescience.com/health/060817_brain_boot.html

11. “The Neuroscience of Consciousness”. http://www.users.globalnet.co.uk/~lka/conz3a2.htm

12. Gibbs, Raymond W. Embodiment and Cognitive Science. Cambridge University Press. 2006. http://books.google.com/books?id=BqnF3PqyvygC&pg=PA23&lpg=PA23&dq=conjoined+brain,+sense+of+self&source=bl&ots=6s-GAKg-_R&sig=XHkt9c5j_hbvtiUbPv2NuaT2euE&hl=en&ei=fx3kSfC7NJXslQeSv7DgDg&sa=X&oi=book_result&ct=result&resnum=1#PPA24,M1

13. Murray, Craig D. “The Experience of Body Boundaries by Siamese Twins”. May 2001.  http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VD4-430WWNR-2&_user=400777&_coverDate=08%2F31%2F2001&_rdoc=1&_fmt=full&_orig=search&_cdi=5972&_sort=d&_docanchor=&view=c&_acct=C000018819&_version=1&_urlVersion=0&_userid=400777&md5=9378da14f059b14733152219d10db773#sec5

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