Before I started writing my post, I read Tina’s, and her closing questions got me started on a train of thought traveling back through the landscapes of The Echo Maker and other portions of this course’s material, and I came upon an idea that took me by surprise: In neurological medicine, there is no such thing as going back to normal.
In class discussions, we’ve made an effort to avoid the implied value judgment of the word “normal” by using “neuro-typical” or its synonyms. I think that the difficulty we have experienced of cutting this bias out of our language reveals how deeply ingrained that assumption of the superiority of normalcy is. The goal of normalcy applies to several levels of human organization. Culturally, the norm is the status quo, and any group that follows the biological imperative of self-preservation will probably recognize maintaining the norm as necessary for its survival. We can see this in our own governmental process: setting Liberal and Conservative labels aside, all but the furthest fringe elements of our political system take the preservation of the vast majority of the Constitution for granted; we trustingly follow the traditions of law and procedure that have accumulated for two centuries – and why not? To abandon the norm would be to take on unknowable risks. The same instinctual fear of the unknown that helps sitting politicians remain in office - sometimes regardless of popularity and competence compared to their competition – is part of what inspires the infamously impenetrable social unit, the clique. People group together with others that remind them of themselves, and in those groups, surrounded by friends more identical than family, they are normal. They cling to each other as naturally as drops of oil in water. Types and genres (goth, geek, jock, prep, mods, rockers…) of people are coagulated from a sea of formerly solitary uncategorized persons, allowing for each group to establish its own us-against-them dichotomy and to create a localized sense of normality, of sameness, coexisting simultaneously with an expression of rebellion, individuation, or exclusivity. On a personal level, it is natural to distinguish what is familiar or relatable from what is alien or surprising as normal and abnormal, respectively. Neurologically and psychologically (these two fields seem to be on a collision course towards unification), the normal brain can appear almost indistinguishable from the ideal brain. If we allow the easy layman’s conflation of brain and identity, it follows that to be normal is ideal. If normal is best, shouldn’t everyone want a normal brain, and isn’t it medicine’s responsibility to strive to give the gift of normalcy to all?
Of course this issue is much more complicated. Two problematic variables that immediately spring to mind are the issues of degree of abnormality and its danger to the patient, and whether a condition is damaged-induced or inborn. Regarding the first, if the condition is life-threatening, medical intervention is not going to encounter nearly as many moral hang-ups. But under physically non-threatening circumstances, as Tina suggests, the right path is increasingly difficult to discern. And whose choice is it to make whether a surgical or pharmaceutical measure is to be taken? As with a lethal abnormality, a lucid patient able to understand her condition and step outside of its influence to make an informed decision on whether to normalize herself, as with Sister John of the Cross, is a moral Get Out of Jail Free card from the medical perspective. But what about Mark, who understands that something is wrong, but is unable to step outside his delusion, or Weber’s “David,” who, like so many of the people we’ve read about, has incorporated the products of gradual brain damage into his personality (Powers 363)? For me, it is becoming increasingly difficult to differentiate self and personality from neurology and brain structure. A change to one is a change to the other, and neither is ever constant. There is no "true" self for each brain, only a multitude of ever-changing potentialities for what that self might be.
What I am realizing, and what I learned from The Echo Maker, is that there is no going back to normal neurologically. We cannot approach the health of the brain like we do the health of the rest of our bodies. There are some overt parallels, but also important distinctions. We could think about purely psychological dysfunction (although I am starting to think it doesn’t exist in isolation) as physical fitness. By thinking the right way and following the right routines, we can work ourselves out of a bad mood much like we can exercise ourselves into better shape. But neurosurgery and neurochemical medication are much more complex and dynamic than putting a scalpel to another part of the body or taking a fiber pill to help with digestion. The brain is not a machine that can have parts replaced. To borrow from the principles of physics, we cannot modify one aspect of the brain without inspiring an unpredictable change in the brain as a whole. Weber muses, “Always the water changed, but the river stood still. The self was a painting, traced on that liquid surface” (Powers 382). If a neurosurgeon takes out a piece of the brain, a bucketful of the water, how can he control the shifting of the surface where the self is manifested? Or if a nurse gives an injection of a neurotransmitter, drops in a pebble for the sake of the ripples, how can the change be reversed, the ripples recollected or the pebble plucked from the bottom without greater disruption? The pebble, the chemical addition, is incorporated into the river. Deliberate changes evolve, and the brain outpaces us in our ability to modify it. The water of the river is always new, and the surfaces that patterned the self yesterday cannot be recreated by modification just as a person with a bucket can reverse the direction of the river. So when we try to restore some kind of familiarity to the deep and wildly dynamic structures upon which the ever-changing self is borne, we cannot hope to recreate what was, only to guide what is in the right direction, and even that is uncertain.
Karen had to come to terms with this principle regarding her brother’s condition. We all know that experiences change us, but the profundity of structural changes that occur on a daily basis is hard to comprehend. Karen learns that she must approach neurological change seeking not restoration but reconciliation and adaptation. Mark could not return to the same person he was before his accident, but he could, with the right pebbles tossed in the river, move toward a more recognizable pattern of self less muddled by delusion.
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