A Head Injury Really Could Alter Your Self-Perception

By
A scene from I Feel Pretty.

Amy Schumer’s newest movie, I Feel Pretty, has a hell of a premise: Schumer’s character, Renee, wants to be “undeniably pretty.” She wants it so badly she leaves her apartment in the middle of thunderstorm to throw a wish-laden quarter into a fountain. But this isn’t a movie about magic, and so Renee continues to look like Renee. Until the next day, after she falls in spectacular fashion at SoulCycle and knocks herself out; when she comes to, she sees herself as a svelte, sculpted starlet.

As it turns out, this is a movie about head trauma.

The concept is (obviously!) far-fetched, a la 13 Going on 30 and Big. And yet … it’s maybe not that far-fetched. There really are plenty of documented cases of personality changes and altered perception following head trauma, and while Renee’s experience is unrealistic, it is grounded in fact. Sort of. “I think the reality is the writers took an amalgamation of things that have been described after traumatic brain injury and put them together in a plot,” says Douglas H. Smith, director of the Center for Brain Injury and Repair at the University of Pennsylvania.

Let’s assume Renee’s head injury is moderate to severe — you know, for science. After she whacks her head, she sees someone completely new in the mirror, and assumes her friends and co-workers won’t recognize the new Renee. Improbable, yes. But it isn’t necessarily impossible, said neuroscientist and author Dean Burnett.

“There are lots of ways the brain gets injured and distorts perception,” said Burnett, author of Idiot Brain and the forthcoming Happy Brain. Consider, for example, the neurological phenomenon called “blindsight,” a type of conscious blindness common in sufferers of a stroke. “It’s really weird,” he said. “The eye still works, and the signal from the eye is still there, but when it enters the brain it’s like a green screen.” Patients completely lose the ability to see one side of their visual field, but they can still guess what they should be seeing with an accuracy that suggests the brain is still receiving the visual stimuli, but just encountering a processing error.

“It shows how much the brain creates the visual world, rather than being a passive receptor of it,” Burnett said. “The idea that you could see yourself looking completely different from what you do — that’s not ridiculous. People with anorexia look in the mirror and genuinely see an overweight person. It’s not a completely unknown concept.”

There are also neurological conditions that affect the way we see other people. Take Capgras delusion, a condition in which people become convinced that their friends and family have been replaced by imposters. “There’s been a disruption in the brain between their face and your emotional connection to it,” Burnett says. “You think, ‘I recognize that person, that’s my wife, but I feel nothing toward them so it must be an imposter.’” It’s not unreasonable to think that something similar could happen to the way a person with a brain injury sees him or herself.

Emotion and desire can play a significant role in self-perception, even if you don’t have brain damage or a neurological condition, which further strengthens the argument for I Feel Pretty’s sorta-scientific validity. “If you are convinced you want to look like something, you end up seeing yourself looking somewhat different,” Burnett says. “Studies show people constantly perceive themselves as being thinner or fatter than they actually are. The idea that we only ever see the actual physical properties of what’s in front of us isn’t correct. The brain isn’t a camera. That’s not how it works.”

That said, Renee’s altered self-perception isn’t exactly typical. “It actually is common to see a change in people’s body image after this type of injury,” Smith says. “It’s just that it’s usually the other way around. Right after the injury, people are dysfunctional, and usually in a neuro-ICU.” Long periods of hospitalization and the loss of independence and mobility often have a significant negative impact on self-esteem. “It’s rare for someone to look in the mirror after a traumatic brain injury and think, Heeeyyy,” Smith added.

Renee, in contrast, overnight gains the kind of confidence necessary to enter a bikini contest and — more impressively — lose with grace. Smith says he actually has seen patients become more confident than they were before their injury, but their confidence isn’t a symptom, and it definitely doesn’t develop overnight. “We’ve seen incredibly inspirational cases, where patients claim that because of their need to overcome a traumatic brain injury they’re much more self-confident in their recovery,” Smith says. “They’ve really had to struggle and suffer and test their inner strength, and they get over themselves as far as being shy and demure.”

But in terms of measurable changes people can experience after traumatic brain injury, one of the most surprising is a boost to the libido. “There’s often a change in libido after severe traumatic brain injury,” Smith says. “It’s typically a lowered libido, but in some cases there is an increased libido.”

That’s because it’s common, in these situations, to damage the frontal lobe — specifically, the orbital frontal cortex, which, Burnett explains, keeps our sexual whims in check. “It’s the part of the brain that keeps a leash on the impulsive part,” he says. “The part that says, ‘Right, I’m currently experiencing arousal. Is that appropriate in this situation?’ These are the most vulnerable parts [of the brain] and can be easily damaged, so your libido can run a bit more wild when it’s not being curtailed by the higher thinking part of the brain.”

I Feel Pretty doesn’t touch much on whether Renee’s libido has changed or not (though there is a mildly funny sex scene). But what does change, a lot, is Renee’s willingness to take risks — personally and professionally — when she thinks she’s supermodel-hot. That, too, could be a damaged frontal cortex at work.

“When you think, ‘Should I ask this person out? No, they’ll just reject me,’ that’s your brain making deductions based on outcomes you expect,” Burnett says. “It makes these calculations and inhibits you based on what you think will happen. If your perception changes to, ‘I’m a beautiful person, people will want to have sex with me,’ then your brain doesn’t stop you from doing or trying things. There’s no need to curtail the impulse if you think you’re beautiful.”

So: Could a brain injury really alter your body image? Yes. Kind of. “This specific scenario is extremely unlikely or impossible, yes,” Burnett says. “But the principles at work truly aren’t that far-fetched.”

How a Head Injury Really Could Alter Your Self-Perception