Saturday, May 2, 2009

Conjoined twins: One person or two?

May 2, 2009

By Andy Ho

DR KEITH Goh is planning a procedure to separate a pair of twins conjoined at the head. This carries a very high failure rate - so the Health Ministry has twice expressed its unhappiness about the procedure publicly.

Instead of revisiting the pros and cons on either side of this controversy, let me ask a question that has yet been unspoken: Are we freaked out by these people?

We need to ask if these unusual bodies trigger anxieties in us about what we believe to be natural boundaries. For if these twins unnerve us, is the surgery more for their good or ours?

In One Of Us: Conjoined Twins And The Future Of Normal, Professor Alice Dreger gives a sensitive ethnographic account of conjoined twins that shows how our assumptions about them lead us to see them as radically different. We think these unusual bodies imprison them so they can't ever lead normal lives. In fact, 'like almost everyone else...they tend to readily accept, and even prefer, the anatomy with which they were born', she claims.

In a sense, One Of Us is a continuation of Hermaphrodites And The Medical Invention Of Sex, Prof Dreger's study of people who are neither male nor female but both. Indeed, in some ancient cultures, hermaphroditism was likened to being conjoined.

Hermaphrodite also explores the extent to which unusual bodies define our identities. Poring over 300 French and British medical commentaries published mainly between 1860 and 1915, Prof Dreger details how the medical profession treated the intersexed cruelly. Because they transgressed society's gender norms, medicine took to normalising them. In this way, a cultural agenda was fobbed off as science: The surgical remodelling of genitalia may not necessarily be culturally or morally appropriate. The question we need to ask is whether a similar process is going on with efforts to separate conjoined people.

Surely, with two heads, they are two personalities? Some philosophers argue that this need not necessarily mean two persons. The so-called multiple personalities disorder aside, consider 'split brains'. In a procedure used before to treat intractable epilepsy, neurosurgeons would sever a bunch of nerves connecting the two halves of the brain. This left a functionally normal person without a split personality or two selves.

Yet if one brain is shown a cat and the other a dog, say, without permitting either side to know what the other saw, the patient identifies only 'cat' or 'dog' depending on which brain is asked. Amazingly, the patient is not aware of cat and dog together. This means a person can have two distinct streams of consciousness ('minds') simultaneously: In this case, it is clearly possible to be one person with two minds.

Stephen Gould concludes in The Flamingo's Smile: Reflections In Natural History that conjoined twins have neither one nor two minds. Thus we have to rethink if we can actually count minds.

Consider Abby and Britt Hensel, twins conjoined below the neck who lived happy, well-adapted lives in Minnesota. As reported in Life in 1996, each had 'her own private mental life and her own character, each (experienced) sensations only on her own side of the body, and each (had) exclusive control over the limbs on her side'. There were two hearts, two stomachs and three lungs but all organs below the waist were shared.

Yet they synchronised control over the body and moved as one. They seemed like one organism the way 'split brains' are. Neither could be co-extensive and coeval with the whole organism, for if she were, she would also be identical with the other. Together, Abby and Britt made one organism.

Many conjoined twins don't feel like or act as two persons. But how they are separate defies unambiguous description. According to Leslie Fiedler's Freaks, Myth And Images Of The Secret Self, the original Siamese twins, Chang and Eng, had their own wives. But at times, the twins regarded themselves as one person, signing letters and contracts as a single ChangEng, for example.

Conjoined twins seem to have a different sense of self from us without suffering identity problems. Their sense of agency can't be teased apart cleanly. Even with two heads, two streams of consciousness and two personalities, they may be just one person.

But we viscerally reject such an argument. We believe we have singular minds acting on singular bodies. We obviously have our own bodies; and we think that our minds exist was 'proven' by Descartes' famous 'I think, therefore, I am.'

Philosophers and others have thrown doubt on this common-sense notion but we continue to believe that the mind is a non-physical entity that is distinct from but acts upon the physical body through the brain. This notion drives us to count heads. And when we see conjoined twins with two heads/brains, we think 'two minds', hence 'two persons'. And since, obviously, two persons should have two bodies, we believe surgery to 'separate' the conjoined twins is justified.

We know now that the mind is neither 'in the brain' nor distinct from the body - Descartes was just wrong. More importantly, the lived experiences of conjoined twins suggest that they may be indeed be more one person than two. At the very least, they challenge our sense of self, personhood and identity.

Shouldn't we, in humility, just leave them to adapt to their circumstances as best they can?

Daedalus (meaning 'cunning worker' in Greek) was the man who built wings so he and his son Icarus could fly. As Icarus flew too close to the sun, his wings melted and he crashed to earth. Daedalus is a weekly column on the triumphs and challenges of science and technology.

[Interesting perspective which I could agree with in general for "inseparable" conjoined twins like those sharing organs and limbs. In fact, we should probably have distinct terms for such conjoined twins, and more "separable" ones such as the 2 sets that has been separated by Dr Goh. In the case of the Iranian twins, they had asked for the separation and they were aware of the risks so I would say that they should have the final decision as to whether to separate or not. It is clear from their wish that they see themselves as separate individuals; as two persons.]

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