I don't expect anyone to read this in its entirety

As I read The Man With a Shattered World, I was consistently baffled by Zasetsky’s unabated and insurmountable will to survive. I found myself (as I’m sure other readers did) questioning whether, were I in such a situation, would I be just as dedicated to a daily relearning of facts, thoughts, and ideas that once came easily and automatically to me? I found it unfathomable that Zasetsky did not give up and persisted in the mentally and physically excruciating attempts at approximating some conception of normalcy – or functioning. Another, perhaps less expected, dilemma came to mind as well: I began wondering why exactly it is so terrifying to lose one’s memory. Other than the fact that one would not be able to properly serve (or be an integral part of) a functioning society, why else is the notion of losing one’s self so horrifying?

This, however, would come back to the definition of the often amorphous term—which, I’m sure, varies among every individual. The term “self” to a person sharing the perspective of LeDoux, for instance, might connote the agglomeration of synaptic connections within different regions of the brain and how these correspond to the environmental and genetic influences a person is endowed with. To someone with a more philosophical mindset, like Descartes (granted, his theories are centuries old), the word might mean something like “that which lives on after death; that which supersedes the physical.” What, however, would Zasetsky have proffered as a definition? And how would this (or how did this) change with his injury?

Though only speculations can be offered, several instances described both by Luria and Zasetsky give insight into the possible answers he might have provided. As Luria notes during a description of Zasetsky’s “former self” (i.e. when his parieto-occipital regions were intact), “Before he was wounded, words had distinct meanings which readily occurred to him. Each word was part of a vital world to which it was linked by thousands of associations; each aroused a flood of vivid and graphic recollections. To be in command of a word meant he was able to evoke almost any impression of the past, to understand relationships between things, conceive ideas, and be in control of his life. And now all this has been obliterated” (Luria 101). Inherent in this statement is the sense of agency, that the person described here (Zasetsky) experienced a sense of control of his memory, could willfully bring to mind specific notions, thoughts, ideas, and sentences. The description implies a freedom of will, an ability to choose that which to focus on and that which to ignore. This ability was consistent; it was stable, concrete, reliable, and could be counted upon not to fail. Thus it was a strong component of Zasetsky’s self-concept. In general, concepts of oneself (as well as the selves of others) seem to be fairly concrete, consistent, and to a certain degree, predictable...or, at least, this is the goal. Striving towards an identity (I believe) means striving towards a concrete, tangible representation of what you think you are, what you want to be, and what you think you’re capable of. (Of course, this concept is malleable: often identities change with time, or evolve—i.e. I no longer feel the need to die my hair blue and wear black lipstick—but while they are favored or worked towards, they seem to be rather fixed—i.e. I thought I was oh so cool for being a “goth;” strove to solidify that identity in my appearance, attitudes, and tastes; maintained this effort until I…well, challenged the conviction that this was really my identity.) In short, identity confirms (sometimes fictitiously) that you are a self, separate from others, distinct and unique.

So, what happens when this disappears? What if I truly still believed that I was, at my core, supposed to dress in back and listen to metal music all the time (yes, I know this is superficial, but bear with me!) and suddenly, my wardrobe was destroyed, my CDs were smashed, I forgot how to put on eyeliner, and I lost that generally depressed composure that so consistently characterized every photo taken of me at the age of thirteen? Well, I would certainly lose my “self” (or, at least, what I had assumed the self to be). But I would also lose my general purpose for being/existing: my M.O. would dissolve right before my eyes. Hopefully, I would recover – and find another identity (cheerleader…or…A student!), since such an example is of minor and superficial concern. In the case of someone who loses a greater portion of his/her sense of self, however, such reconstruction would not seem as easily accessibly.

Which brings us back to Zasetsky: this man, who “graduated with honors from middle school, completed three years of courses at the Tula Polytechnic Institute, [and] did advanced work in chemistry…” (141), who incorporated the information, the knowledge he had thus far accumulated, into a concrete sense of self, was suddenly robbed of all such information which had constituted his identity. He was constantly aware, as he makes numerous notes of, that the words, images and ideas presented to him had once been accessible to him (at least, when he got to the point of being able to recognize them), but was always plagued by the inability to explicitly define and understand them: “I know a particular word exists, except that it has lost its meaning. I don’t understand it as I did before I was wounded. This means that if I hear the word ‘table’ I can’t figure out what it is right away, what it is related to. I just have a feeling that the word is somewhat familiar, but that’s all” (105).

Zasetsky was never capable of recovering the sense of self he had once possessed, the identity he had perhaps even taken for granted at the time. Such a sense had now been overwritten with feelings of failure, a “sense of just how abnormal I am when I talk to people…that idiotic smile on my face, that silly, nervous laugh…I’ve become a very peculiar sort of person…sickly, but…a kind of newborn creature” (100). Normally, such a concept of self wouldn’t be too encouraging (at least I wouldn’t assume so), and might detract someone from wanting to go on. Zasetsky, however, circumvented the disappointment of such perceptions by endowing himself with a purpose to live, and thus creating a new self. By beginning to write, Zasetsky arguably saved himself from that terrible forfeiting of existence that occurs when individuals succumb to their illnesses, such as some of Sacks’ post-encephalitic patients when their illnesses became incompossible with normal life (i.e. Lucy K’s health being incompossible with the relationship she had with her mother). Though, as Luria admits, “…he was not fit for anything…could not help around the house, got lost when he went for walks, and often failed to understand what he read or heard on the radio…” (83), Zasetsky recreated a purpose to live in writing: “…writing his journal, the story of his life, gave him some reason to live. It was essential in that it was his only link with life…he could be useful, make something…to ensure a future” (84). The (nearly obsessive) consistency with which Zasetsky sat at his desk, agonizing over each word for twenty five years (and over 3,000 pages!) gave him a concreteness that perhaps compensated for the now inconsistent self. In other words, he established a stability and reliability through writing that mirrored that found in a striven-for identity (or self-concept). He navigated around his now unpredictable world by finding something tangible to hold on to. The “world as broken into thousands of separate parts” that “made no sense” to him, and which “he feared…for it lacked stability” (61) was now slightly more manageable, inasmuch as he established his own grasp (originating from his new self) upon it [which goes back to the question in the first paragraph: why is it so terrifying? well, because it’s unmanageable/unpredictable/unstable, and therefore is threatening].

It is no wonder, then, that he was so motivated to never give up. That drive to maintain an identity, to maintain a history of himself, to maintain a reason to live is evident in each sentence he so methodically records.

I did it again

I appreciate the attention given, in The Man Who Mistook His Wife for a Hat, to surprising and complex dynamics among phenomena such as deficit and giftedness, illness/pathology and creativity, disability and difference.

I feel a certain reluctance when I use words like “disability” and “deficit,” particularly when referring to neurological or psychiatric issues. On one hand, I don’t suggest dropping the terms for reasons of political correctness; that would seem reactive and finicky to me. On the other hand, those terms convey, at best, only half of the pertinent information. Sacks is alert to the brain’s amazing resilience and resourcefulness, its plasticity, its ingenious capacities for adaptation and compensation. Sacks understands, too, that often a limitation of some sort in the brain is accompanied by a corresponding and proportionate (though sometimes disproportionate) strength in another faculty. Similarly, he’s aware of how a pathology can be made generative and useful, how a deficit can become a resource, how a disability can occasion an exceptional capability of another kind. He speaks rather explicitly about the ways in which pathology and creativity are in dynamic relationship--or in collusion. For instance, any student of literature can attest to the remarkable frequency with which genius and madness appear side by side (while we have to be wary of romanticizing disease). I find increasingly that the distinctions among disabilities, benign differences, capabilities, gifts, deficits, illnesses, pathologies, blessings are really very murky, even as they have to be taken seriously.

A personal note. When I was in elementary school, I was diagnosed with a mild nonverbal learning disorder. It’s hard to explain concisely what this entailed--Google it if you’re truly interested--but my instinct is to describe it in positive terms, steering away from deficiencies and focusing on--strange to say--benefits. What characterizes the condition for me is an atypical reliance on language as a means for understanding and expression. Put differently--I am emphatically not a visual learner; I need stuff explained in language if I’m going to get it. This manifested (and manifests) itself as difficulty in math and science, clumsiness in sports, illegible handwriting, and ineptitude in visual arts--but also as early speech, early reading, a sophisticated vocabulary, good spelling, a better-than-average verbal memory, ease in writing. I’ve perused ancient report cards and been amused by their schizoid quality--disabled there, gifted here: a pattern that showed itself, as well, on every standardized test I have ever taken. There are, in addition, indifferent effects, more aptly characterized as differences. I tend to perceive things in a more piecemeal, less global way--I wish I could provide a better description, but it’s a slippery thing--and this for the most part hasn’t presented any problems, and most people don’t pick up on it. All the above came as a unit; it was never just an isolated lack.

How do these subtleties complicate and/or enrich our sense of these case subjects’ experiences? How about our own experiences?

Down, But Not Out.

I was thoroughly intrigued by The Man Who Mistook His Wife For A Hat, to say the very least. Never in my life have I ever considered that recognition was such a process or that it was possible to lose that ability. I still cannot fathom looking at a hat and not knowing what it is, or seeing a person -- especially a loved one -- and not really knowing that it is a person at all. Perhaps what is most intriguing was that Dr. P was still very adept with music and actually became unable to function completely without finding the rhythm and music to whatever he was doing. I think too often people assume that one disability means that you are a disabled person, which is not necessarily true. To have a disability is not to be disabled, merely to have a setback of sorts, be it extreme or bearable. It is especially important to consider the good things that come out of a disability -- just because one thing has quit working properly, doesn't mean something might not work better now, as we see when Sacks views Dr. P's paintings. We will never know whether it was a stroke of artistic genius or simply the progression of his prosopagnosia that caused the change from natural to abstract, but at any rate, does it matter?

Another case in which we see a benefit arising from the sickness is that of Witty, Ticcy Ray. Ray, though he recognized that something was severely wrong, was unable to enjoy life and function without his Tourette’s. The idea that medicine meant to make something better actually makes one’s quality of life worse is unthinkable for most. To accept and appreciate a disease as not only part of life but a good part of oneself is very unusual. Upon reading Ray’s case, I am brought back to the patients on the L-Dopa regime from Awakenings. It is curious to me that most of those patients, even after having had one bad experience with L-Dopa, were eager to retry the drug, while Ray was very hesitant to have such control over his disease. I have only had the opportunity to interact with three people with Tourette’s, but with all three there was always a sort of reluctant acceptance – they understand that this is what they must live with, and do their best to make it better. However, every single one of them expressed to me that there is not a day gone by that they did not wish to be “normal”. This is the reaction I would expect out of most people with any disease, but especially with one so blatantly obvious as Tourette’s. Even more curious is the fact that two out of three of those patients had much, much milder forms of Tourette's Syndrome than Ray's -- is it simply difference in personality that make them see their diseases so differently?

The way Ray embraced his disease and indeed could not live properly without it was, in a way, refreshing. I’m not sure if it’s better to know and love your disease or to not know it at all, as with Mr. Thompson, who has a severe case of Korsakov’s Disease but does not feel the impact. This, to me, was the most heart-wrenching of the cases. I am also forced to wonder whether it is better for people to understand that one is sick, and still be able to enjoy it, as with Ray, or for them to think you are simply a funny person who simply seems to be constantly going. In keeping with the idea that not all disabilities are disabling, I have to ask whether or not Mr. Thompson’s problem was wholly a problem at all – clearly, it is debilitating in the fact that he cannot recognize anyone and so must constantly form an identity for them, but the very idea that his brain can so quickly fabricate a person, even an entire past, is utterly awesome. Seeing what qualities these diseases amplify or bring about in a person is just as interesting in studying the disease itself. Physically, these diseases are terrible, but at the same time, they are wonderful expressions of the true power of the brain. I am left contemplating what the word ‘acute’ really means in reference to these cases.

Living With The Enemy

"Judgement and identity may be casualties---but neuropsychology never speaks of them (pg.19, 20)." 

Sack's seems to immerse himself in the exploration of human perception, judgement and comprehension within The Man Who Mistook His Wife For a Hat more extensively that in Awakenings. He is focused, in many cases, upon patient's 'normal' functioning using their abnormal perceptive skills notably in the case of Dr. P. Dr. P is an amazingly talented music teacher who occasionally mistakes objects (fire hydrants in some cases) for human beings due to his lack of ability to identify the "whole" of the items around him. He can not visualize anything but schematic concepts because there is no "real visual self" (pg. 15). There is nothing in his mind that he could visually imagine to explain things verbally and a lack of familiarity to comprehend the most common items (ex. gloves). He is at a loss, concerning his perception (yet, he doesn't consciously realize this), in the body he inhabits, the space he inhabits, and the people that surround him (pg. 15). Being such a visually oriented "thinker" the loss of any form of visual perception is very disconcerting and intriguing to me. I was compelled by Sack's description of Dr.P's tendency to "itemize" features on people's faces (recognition of his brother Paul: "... the square jaw, those big teeth" (pg.13)). He uses his vision to dissect people's specific features to remember them. The reason I found this interesting was because this seems to be the way my memory, and I think most people's memory works. Your brain remember the strangest, yet, most specific details, from a moment in time in order to trigger your brain to the larger "whole" of the memory. Dr. P can remember someone's nose, or mustache, and is, eventually, reminded of who that person is through the details. 

Witty Ticcy Ray, another case study of Sack's was that of Ray, a man with severe Tourettes syndrome. Here, the concept of "living with the enemy" arose. Ray identified his disease as "a fight between it and I", an internal struggle with something you've grown to accept and almost appreciate within yourself (pg. 93). This idea that a sort of disease can be a benefit to you is very interesting. I know personally, that for me, the effects of mild OCD and anxiety are completely beneficial. I can't imagine a life without my "craze"---I do feel that it is most definitely a large part of my personality---my idiosyncrasies, my obsessions, my quirks, allow for my specific tempo. Ray seems to have this same personal attachment to certain aspects of his disease. He is drawn to what he feels his Tourettes gives him; a "spunk", an edge that makes him witty and exciting. But, with so many negative effects, Ray decided to begin on Hadol, a medication to eliminate his tics and in fill counteract the effects of Tourettes. After three months of psychologically preparing himself to, in part, disassociate himself from his 'Tourettes persona', Ray was able to successfully take Hadol. But, he complained of feeling dull and unenthusiastic. He decided to take Hadol during the weekdays and let his Tourettes emerge on weekends. This balance between disease and medication, especially in Ray's double existence is very compelling. What is the divide between personality and disease? How much of your personality and temperament lie within your disease? Is Ray still Ray when he is on Hadol? 

Methods of Understanding

What I find intriguing in comparing the perspectives of Heilman and Sacks is how their slightly different views are just more specific manifestations of an overriding theme of opinion. Generally speaking, this theme is the one mentioned by Sacks as the holistic versus topistic mindset, wherein the former find truth in overall functioning of a given entity (i.e. the brain) and the latter find truth in the compartmentalized sections of that entity. Though Sacks advocates for a combination of the two (an integrative mindset), he does seem to focus more on the holistic end of the analytical spectrum. By contrast, Heilman is an obvious proponent of more distinct separation of parts (what with his numerous schemas of functional pathways in the brain that explain aphasia, agnosia, and the memory systems). The categories to which these individuals side, however, seem to be just another echo of an overarching pattern in human thought: one side arguing for a unilateral perspective, the other upholding a multilateral one. An immediate concept that comes to mind is the various divisions of religious thought, which either conceive of a higher power as embodied in one, ultimate form (i.e. the Christian “God”) or conceive of a higher power as embodied in many different forms (i.e. the myriad Hindi deities). Another concept that can be filed into this form of categorization is, perhaps not as apparently, the Nature-Nurture debate, where Nature would seem to be the overall fatalistic force that governs all human personality or behavior, and Nurture would seem to be the many different influences that shape an individual bit by bit. Perspectives in Medicine, of course (i.e. holistic versus…well…Western) are other illustrations of such cognitive sectors.
Perhaps what is the most interesting about these forms of analysis and understanding (the “all” versus the “parts” perspectives) is the notion that we, as humans, may be constrained to such patterns of thought, and that this fact underlies our constant exhibitions of it in its different forms. In other words, the question might be asked: are our powers of understanding only achievable through a set number of mechanisms, such as the opposite poles of all-or-nothing and the modular? Does this translate into some innate capacity we are endowed with (and thus cannot escape) of comprehending one entity only in its opposition to another? Yes, it is a useful mechanism to dichotomize and contrast, but might doing so remove the essence of that which we are observing?
I understand that this might be a bit too much of a philosophical rambling; but I am very intrigued by the manner in which humans come to understand things, and also why certain individuals are drawn to one end of the spectrum (i.e. the specific) and not the other (i.e. the broad)—or even what leads an individual to adopt a conjoining of both mindsets. The possibility, too, that patients experiencing an onset of aphasia or agnosia in their lives become all the more frustrated because they are aware of that they’ve lost something, to me, confirms this notion that an entity’s opposite contributes greatly to it’s meaning, or how we understand it. Such patients, for instance, are markedly more distressed than their amnesiac counterparts who, though they often suspect something is missing, are generally unaware that anything has been lost (and therefore are not in a constant state of frustration…at least to the eye of the observer). In the first instance, a part of someone’s functioning is lost (i.e. there is damage to the left temporal lobes encompassing Wenicke’s and/or Broca’s area); whereas in the second instance, often an entire structure spanning both lobes (i.e. the hippocampus or the ability of acetylcholine to reach this area) is affected. (In viewing it from anatomical terms, however, both instances seem to fall under the category of compartmentalization, so this example may just prove more confusing).
Regardless, I am very curious to view other methods of understanding the brain and the self, aside from the holistic and topistic views. Perhaps if I find another method, I might produce a more coherent and translatable explanation of what I’m puzzling over…

Right Brain vs. Left Brain

As an aspiring artist myself, I was particularly struck by the subjects of visual agnosia presented in the readings for this week. In particular, I was awestruck by the right brain limitations of Dr. P in The Man Who Mistook His Wife for a Hat. The “judgment,” as Dr. Sacks calls it, was completely comatose in Dr. P’s brain, essentially making him a computer. Recognizing only the strong schemata that objects have, (while describing the glove, Dr. P poured over the details of the glove: “A continuous surface…infolded upon itself. It appears to have…five outpouchings…a container of some sort?”) Dr. P could not name anything presented in front of him unless he was able to deduce the meaning from his observations. Dr. Sacks notes that when it comes to vision, Dr. P was “lost in a world of visual abstractions,” thus explaining the progression of paintings hanging in Dr. P’s home (Sacks 15).  Whether or not this was truly artistic development or visual agnosia, we will never know, but it still hard to fathom a world without the influence of the right hemisphere of the brain.

Reading this story, coupled with the work of Kenneth Heilman, I was reminded of the lessons of one of my drawing instructors from a few years ago. His entire class was based on the mechanics of the brain, and how to truly learn to observe and create a drawing that is natural, one must remove all “influence” of the left brain on one’s work. In almost every one of his classes, he stressed the fact that the left side of the brain has schemata like images of everything in our lives. For every hand, the left brain has an image of a hand that affects the pure observation of drawing a hand. The same is true for the shape of eyes, or of how the nose looks. Our right brain is the side of the brain that can distinguish the differences in the left brain images “provided” in our mind, as well as make them apparent in our visual re-construction of them on paper.

Dr. P no longer had the influence of the right brain in his life, losing his “judgment,” and ultimately turning him into a computer. It is hard to imagine a life without being able to judge the natural and recognize the differences between objects we have known all our life.

Above all, the most intriguing aspect of Dr. P’s impairment was his “life music;” the only thing keeping him going. Dr. Sacks points out that music is very mechanical and can drive one in a way that visual roadblocks cannot inhibit. Therefore, Dr. P was able to live his life to some normality. However, Music, although mechanical, is also very artistic and creative, something that could arguably emanate from the right side of the brain.