Biol Theory

DOI 10.1007/s13752-015-0219-x

ORIGINAL ARTICLE

Wittgenstein’s Certainty is Uncertain: Brain Scans of Cured

Hydrocephalics Challenge Cherished Assumptions
Donald R. Forsdyke1

Received: 29 April 2015 / Accepted: 30 June 2015

 Konrad Lorenz Institute for Evolution and Cognition Research 2015

Abstract The philosopher Ludwig Wittgenstein chose as Introduction

his prime exemplar of certainty the fact that the skulls of
normal people are filled with neural tissue, not sawdust. In Death and taxes are vernacular designations for ultimate
1980 the British pediatrician John Lorber reported that certainty. However, for Ludwig Wittgenstein, the ultimate
some normal adults, apparently cured of childhood certainty was the presence of brain tissue. In his seminal text
hydrocephaly, had no more than 5 % of the volume of On Certainty (1969, p. 18e) he declared: ‘‘Now would it be
normal brain tissue. While initially disbelieved, Lorber’s correct to say: So far no one has opened my skull in order to
observations have since been independently confirmed by see whether there is a brain inside; but everything speaks for,
clinicians in France and Brazil. Thus Wittgenstein’s cer- and nothing against, its being what they would find there?’’
tainty has become uncertain. Furthermore, the paradox that And this was more than an introspective I-have-a-brain-
the human brain’s information content (memory) appears therefore-I-am. It also applied to others:
to exceed the storage capacity of even normal-sized brains,
I … am sure, that my friend hasn’t sawdust in his …
requires resolution. This article is one of a series on dis-
head, even though I have no direct evidence of my
parities between brain size and its assumed information
senses to the contrary. I am sure, by reason of what
content, as seen in cases of savant syndrome, micro-
has been said to me, or what I have read, and of my
cephaly, and hydrocephaly, and with special reference to
experience. To have doubts about it would seem to
the Victorian era views of Conan Doyle, Samuel Butler,
me madness. (Wittgenstein 1969, p. 36e)
and Darwin’s research associate, George Romanes. The
articles argue that, albeit unlikely, the scope of explana- Thus the great 20th century philosopher admitted to a
tions must not exclude extracorporeal information storage. certainty so great that a person might justifiably, in his own
words, ‘‘throw away the ladder after he has climbed up on it.’’
Keywords Female brain
Head size
Information As far as the brain was concerned there could be no dilemma.
storage capacity
Long-term memory
John Lorber
Yet he could still aver that, ‘‘what we cannot speak about we
Neuronal reductionism
Plasticity limits
Redundancy
must pass over in silence’’ (Wittgenstein 1922, p. 189). Here
Supernatural explanations
Ventricle size we return the ladder and break the silence.
There is a dilemma, and it comes from neuroscience
itself. Some years ago there was a TV series—‘‘Candid
Camera’’—where unsuspecting people monitored by hid-
den cameras were put in preposterous positions. In one set-
up, a car without an engine was discretely pushed into a gas
station. An attendant emerged to fill it up. On being asked
& Donald R. Forsdyke to check the oil, he duly opened the bonnet and began to
forsdyke@queensu.ca
scratch his head. The hilarious altercation that followed,
1
Department of Biomedical and Molecular Sciences, with the driver angrily remonstrating that the car would
Queen’s University, Kingston, ON, Canada have needed an engine to get to the station, and the

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 D. R. Forsdyke

attendant declaring that one was not present, encapsulates Shocking enough. But now for what really rocked the
the dilemma now facing neuroscientists worldwide. There neuroscientists. Half of Lorber’s 60 cases were of above-
are a few people on this planet—for most intents and normal intelligence (as determined by standard IQ tests).
purposes just like you and me—whose ‘‘bonnets’’ (their The central scans in the figure—virtually indistinguishable
skulls), when ‘‘opened’’ (x-rayed), reveal, at best, only 5 % from the severely impaired case on the right—are repre-
of the expected amount of brain tissue! sentative of this group. And doubtless a candid camera
It doesn’t take a neuroscientist to appreciate the would have caught Lorber’s jaw dropping when, among
dilemma. The logic is simple. A neuroscientist may find them, he found a student who was ‘‘socially completely
abundant neural tissue in a thousand skulls of normal normal’’ and had a first class honors degree in mathematics
individuals, thus certifying the close correlation between (Lewin 1980, p. 1232):
presence of tissue and normality. But the entire house of
Instead of the normal 4.5 cm thickness of brain tissue
cards tumbles to the ground when individual one thousand
between the ventricles and the cortical surface, there
and one is normal, yet has no tissue! Admittedly, in prac-
was just a thin layer of mantle measuring a millimeter
tice the distinction is not so stark. Individual one thousand
or so. The cranium is filled mainly with cerebrospinal
and one is found to have approximately 5 % of the brain
fluid. … I can’t say whether the mathematics student
tissue volume that is characteristic of each of the one
has a brain weighing 50 or 150 g, but it’s clear that it
thousand others. But we suspect that Ludwig would be no
is nowhere near the normal 1.5 kg.
less surprised by 5 %, than by 0 %.
Of course, when Lorber presented his findings at a con-
ference in 1980—under the title ‘‘Is Your Brain Really
Recovered Hydrocephalics Necessary?’’—he met with much scepticism. Journalist
Roger Lewin related in Science how experts had pointed to
In the 1970s a British pediatrician, John Lorber, reexam- difficulties in the interpretation of brain scans, and had even
ined, in adult life, the brains of people who had been declared that ‘‘Lorber’s style is less scientific than it might
treated as children for hydrocephaly, or ‘‘water on the be.’’ To the accusation that he was being ‘‘overdramatic,’’
brain’’ (Lewin 1980). In these children the circulation of Lorber replied, ‘‘Of course these results are dramatic, but
fluid in the ventricles of the brain is blocked. Yet fluid they’re not overdramatic. One would not make the claim if
continues to enter the brain, so the ventricles expand and one did not have the evidence’’ (Lewin 1980, p. 1232).
brain volume increases. In early life the skull bones allow But the ripples cast on the neurobiological pond soon
this expansion, and an enlarged head may be the first sign faded. Lorber disappeared from view. He died in 1996 at
that all is not well. By inserting a small tube (shunt), sur- the age of 82. Nevertheless, his results were considered
geons are able to drain off the excessive fluid, so relieving dramatic enough to warrant a TV documentary. Barry
the pressure. If successful, the ventricular expansion is Beyerstein of the Brain Behavior Laboratory at Simon
reversed and head size returns to normal. When the oper- Fraser University quipped (Beyerstein 1999, p. 17):
ation is carried out early, before the skull bones begin to
The telecast employs the ever-popular theme of a
fuse, a child can expect a normal life.
brave outsider struggling against a mulish establish-
Taking advantage of new brain-scanning technology,
ment to suggest that, once again, the so-called ‘ex-
Lorber anticipated that the adult brains of treated hydro-
perts’ aren’t as bright as they think they are. Along
cephalics would appear normal. For an example of a nor-
the way, the program encourages the misapprehen-
mal brain, see the scans at the left in Fig. 1 (de Oliveira
sion that there is a huge reserve of unnecessary brain
et al. 2012). Here brain tissue, encased within the outer
mass that can be casually dispensed with.
skull bones (white), is seen as the usual ‘‘gray matter’’
(gray) and ‘‘white matter’’ (pale gray), and there are small And in the ‘‘Ask the Experts’’ section of Scientific
black central areas (labeled ‘‘LV’’). These are the fluid- American, he attacked what he called ‘‘the 10 % myth,’’
containing ventricles. On the far right are the correspond- which implied that ‘‘90 % of the average brain lies
ing scans of a hydrocephalic whose surgery had failed and perpetually fallow’’ (Beyerstein 2004).
who remained severely impaired neurologically. Almost
the entire skull is filled with ventricular fluid (black) and
there remains only a small surrounding rim of actual brain Lorber Confirmed
tissue. Given the extent of tissue loss, it is astonishing that
he is alive. Yet 60 of the 600 cases Lorber studied dis- Nearly three decades after Lorber’s initial claim, no
played such extreme brain scans. Ventricular fluid occu- respectable neuroscientist had risen to his defense and
pied at least 95 % of cranial capacity! Lorber was still an easy target. In January 2007 the

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Wittgenstein’s Certainty is Uncertain

Fig. 1 Brain scans. Normal adult appearance (left). Enlarged ventricles (middle and right). Reproduced under Creative Commons License from
Frontiers in Human Neuroscience (Forsdyke 2014)

anthropologist John Hawks—with dual interests in Sher- obviously incredible’’ and that Lorber had really been on a
lock Holmes and human skulls—set out to dissect Lorber’s well-intentioned publicity-binge ‘‘to show that hydro-
claim ‘‘part by part’’ (Hawks 2007). In A Study in Scarlet cephalus is a condition that can be successfully overcome’’
the great detective had opined that a brain should scale (Hawks 2007).
with the amount of information it contained (i.e., memory), A few months later, however, there appeared in The
and could easily become overloaded (Doyle 1887, Lancet the first of two independent confirmations sug-
Chap. 2): gesting that Lorber should not have been so lightly dis-
missed. Under the title, ‘‘Brain of a White-Collar Worker,’’
I consider that a man’s brain originally is like a little
French neurologists reported a ‘‘massive ventricular
empty attic, and you have to stock it with such fur-
enlargement’’ (like the central subject in the above figure)
niture as you choose. A fool takes in all the lumber of
in the brain scan of a civil servant who was married with
every sort that he comes across, so that the knowl-
two children and had come to them with relatively mild
edge which might be useful to him gets crowded out,
neurological symptoms that responded to treatment
or at best is jumbled up with a lot of other things, so
(Feuillet et al. 2007). And Brazilian neurosurgeons later
that he has a difficulty in laying his hands upon it.
reported a similar case (figured centrally in Fig. 1; de
Now the skillful workman is very careful indeed as to
Oliveira et al. 2012).
what he takes into his brain-attic. He will have
nothing but the tools which may help him in doing his
work, but of these he has a large assortment, and all
Female Brains Don’t Scale
in the most perfect order. It is a mistake to think that
that little room has elastic walls and can distend to
For me, these hydrocephalic cases provided welcome
any extent. Depend upon it, there comes a time when
support for the argument that the size of a human brain
for every addition of knowledge you forget some-
scales neither with its information content—specifically,
thing that you knew before. It is of the highest
with what the experts call ‘‘long-term memory’’—nor with
importance, therefore, not to have useless facts
intelligence. When gathering material for a biography of
elbowing out the useful ones.
the neurophysiologist George Romanes, who, with Charles
Thus, Hawks was highly sceptical of Lorber, concluding Darwin, was a founder of the science of evolutionary
that the story of the mathematics student was ‘‘quite psychology, I had been entertained by an article—‘‘Mental

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Differences between Men and Women.’’ Here ‘‘the missing Again, presumed information-content does not match head
five ounces’’ was of much concern: size.
These arguments were supported, albeit indirectly, by
Seeing that the average brain-weight of women is
some frank admissions of ignorance by neuroscientists at
about five ounces less than that of men, on merely
New York’s Columbia University. Nobelist Eric Kandel
anatomical grounds we should be prepared to expect
(2006, p. 423) declared that ‘‘in the study of memory
a marked inferiority of intellectual power in the for-
storage, we are now at the foothills of a great mountain
mer. … The disabilities under which women have
range. … To cross the threshold from where we are to
laboured with regard to education, social opinion, and
where we want to be, major conceptual shifts must take
so forth, have certainly not been sufficient to explain
place.’’ Fusi and Abbott (2007) called for ‘‘radical modi-
this. (Romanes 1887, pp. 654–656)
fication of the standard model of memory storage,’’ and
Apologizing for the ‘‘almost brutal frankness’’ of his Firestein (2012) echoed this in his book—Ignorance. How
remarks, there followed a litany of what seemed to be the It Drives Science. Furthermore, our brain’s storage capac-
self-evident intellectual deficiencies of women, including ity for visual detail is now seen as enormously greater than
in the ‘‘power of amassing knowledge.’’ But when previously estimated. This led researchers at MIT (Brady
Romanes compared men and women in a reading test: et al. 2008) to challenge the standard ‘‘neural models of
memory storage and retrieval.’’
The palm was usually carried off by the ladies.
Moreover, besides being able to read quicker, they
were better able to remember what they had just
Why Doesn’t Size Matter?
read—that is to give a better account of the paragraph
as a whole. One lady, for example, could read exactly
Given the doubts of these neuroscientists and the growing
four times as fast as her husband, and could then give
appreciation that brain size does not scale with information
a better account. (1887, p. 657)
quantity, it would seem timely to look anew at possible
Shortly thereafter a woman, Philippa Fawcett, beat the ways our brains might store their information. Broadly,
top man, known as the ‘‘Senior Wrangler,’’ in the Cam- three hypotheses exist:
bridge Mathematics Tripos. But alas, when it came to
1. Information relating to long-term memory is held
women’s ‘‘unnatural, and therefore impossible, rivalry with
within the brain in some chemical or physical form
men in the struggles of practical life,’’ Romanes, like most
consistent with current knowledge of brain chemistry
of his fellow Victorians, was not to be moved by such facts:
and physiology. This ‘‘standard model’’ has many
How long it may take the woman of the future to versions (e.g., Tsien 2013) that need not detain us.
recover the ground which has been lost … it is 2. Information relating to long-term memory is held
impossible to say; but we may predict with confi- within the brain in some extremely minute, subatomic,
dence that, even under the most favourable conditions form, as yet unknown to biochemists and physiolo-
as to culture, … it must take many centuries for gists. Those who have witnessed in recent decades the
heredity to produce the missing five ounces of the vast increase in the power of computers to store large
female brain. (1887, p. 666) quantities of information in progressively smaller
spaces should not be surprised if evidence for this
alternative eventually emerges.
3. Information relating to long-term memory is held
Savants and Microcephalics Don’t Scale
outside the brain. Since most nonneural tissues and
organs appear unsuited for this task, this extrapolates
Unaware of the hydrocephalic work, I used studies of rare
to long-term memory being outside the body—extra-
individuals with exceptional memory (savant syndrome),
corporeal! Amazingly, this startling alternative has
and with exceptionally small heads (microcephalics), to
been on the table for at least two decades. A George-
argue against the scaling of human head size with brain
town University professor of computing science has
information-content (Forsdyke 2009). With one prominent
sketched out how it might work (Berkovich 1993,
exception, those with savant syndrome tend to have nor-
2014). A 10th century Arabic philosopher-physician
mal-size heads. The presumed high information-content of
even had a version (Avicenna 1631).
their heads does not match their head size (Treffert 2010).
On the other hand, while most microcephalics are intel- Only with hypotheses two and three, which seem so
lectually impaired, there are a few cases where intelligence improbable, do we really confront the dilemma posed by
is normal; hence, long-term memory is likely to be normal. the brain scans of hydrocephalics. Yet some neuroscientists

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still seek to reconcile the scans with standard models.

Indeed, Lorber originally suggested that the ‘‘primitive
deep structures that are relatively spared in hydrocephalus’’
may have allowed his subjects to live normal lives, so that
‘‘there must be a tremendous amount of redundancy or
spare capacity in the brain’’ (Lewin 1980, p. 1233). This
implied that normally much of the brain is simply idling,
ready to act as a backup should the need arise.
Somewhat more convincing was a ‘‘plasticity’’ expla-
nation advanced by Bateson and Gluckman (2011). In
similar fashion, the Brazilian neurosurgeons invoked the
‘‘resilient adaptation of brain networks’’ associated with
‘‘the ability of neuronal tissue to reassume and reorganize
its functions’’ (de Oliveira et al. 2012). These plasticity
explanations imply that, in keeping with the sometimes
amazing recoveries reported for severe brain injuries—U.S. Fig. 2 Brain scan of a seven-year-old girl who led a normal life with
Congresswoman Gabrielle Giffords may be a recent minimal impairment after removal of her dominant cerebral hemi-
example—an otherwise-occupied part of the brain can sphere at age three to relieve the symptoms of chronic focal
encephalitis (Rasmussen syndrome). Reproduced with permission
change to compensate for a defective part. from The Lancet (2002; see Majorek 2012)
However, there must be rules for redundancy and
plasticity. There must be limits. It is a matter of elementary
logic that, at some stage of brain shrinkage, these expla- taken two decades for cloud computing to become estab-
nations must fail. The drastic reduction in brain mass in the lished. With respect to long-term memory, a stand-alone
hydrocephalic cases seems to demand unimaginable levels computer can be regarded merely as a terminal for
of redundancy and/or plasticity—superplasticity. How manipulating data, and one retrieves from, and store files
much brain must be absent before we abandon these at, some remote location by way of the Internet. There are
explanations and admit that the standard model, however imaginative attempts to relate this to the workings of
incarnated, will not work? individual brains (Al Shargi and Berkovich 2009). The
The philosopher Marek Majorek was surprised at the lack brain is seen as a receptor/transmitter of some form of
of astonishment—the seeming cognitive dissonance—of electromagnetic wave/particle for which no obvious
clinicians ‘‘dryly’’ reporting both the hydrocephalic cases external structure (e.g., an eye) would be needed. Consid-
and others where individuals functioned well with only half a ering the universe as a holographic information storage
brain (hereditary or surgical loss of one cerebral hemisphere; device, and invoking the ‘‘spooky’’ physical principle of
Fig. 2). On a report in The Lancet entitled ‘‘Clinical Picture: ‘‘non-locality’’ (Rudolph 2008), a ‘‘possible ‘hardware’
Half a Brain,’’ he commented (Majorek 2012, p. 124): implementation’’ has been described (Berkovich 1993).
While various versions are considered in more detail
Yet it seems that the report should have been supplied
elsewhere (Clark 2008; Noë 2009; Forsdyke 2011), they all
with a large red title stating something to the effect
fall far short on evidence. However, the rare hydrocephalic
‘‘A major medical miracle: normal life with half a
cases described here suggest that we should be cautious
brain!’’, published not only in an academic journal
when tempted to cast aside the astonishing idea of personal
but on the first pages of every major newspaper in the
information—long-term memory—being stored elsewhere.
world, and extensively discussed in professional
There are those, like Berkovich and Majorek, who urge us
journals.
to lift our eyes to new horizons (Pribram 1991; Talbot
For Majorek, such reports ‘‘radically challenge’’ the 1991). Although some may lack a formal training in neu-
assumption that the brain alone provides the basis of our roscience, we should listen carefully. After all, Nature is
conscious experience (‘‘neuronal reductionism’’). not obliged to conform to our preconceptions. And, to
return to Sherlock Holmes: ‘‘How often have I said to you
that when you have eliminated the impossible, whatever
Cloud Computing remains, however improbable, must be the truth?’’ (Doyle
1890, p. 93).
A modern metaphor for information relating to long-term The importance of this extends beyond neuroscience and
memory being held outside the brain is ‘‘cloud comput- into the clinic. Perhaps in these terms we will someday be
ing.’’ Even though the Internet emerged in the 1990s, it has able to explain the strange ‘‘voices’’ experienced by

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schizophrenics, and the bizarre condition described by the deem plasticity and redundancy explanations as more
American Psychiatric Association (manual of psychiatric plausible.
conditions; DSM-5) as ‘‘disassociative identity disorder’’
(otherwise ‘‘multiple personality syndrome’’)? And, of
course, when speaking of extracorporeal memory we enter
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