narrative-neuro-09

Sacks and Ethics

2009-04-29T00:30:00.001-07:00

As I did the reading for this week, I found myself feeling very protective of Sacks. I remember, early in the semester, when we were reading Awakenings, my cursory Google search of Sacks revealed that there was great hostility toward him, among book reviewers and medical professionals, and their criticism always had a weird personal quality to it, a whiff of undignified animosity. Alexander Cockburn is an example of this, and so is Tom Shakespeare. Although--to be honest--I find their criticism thoughtless and hard to take seriously, I do want to be sensitive to the real ethical complications and questions of Sacks’s work (notably, these are not the issues that Cockburn and Shakespeare address; they are dismissive rather than critical).

There are basically three ethical concerns that Sacks has raised for me personally. The most significant difficulty I’ve had with Sacks--and this is something I’ve spent a lot of time thinking about--is the fact that he consistently chooses the most extreme and rare cases, rather than trying to elucidate the more common varieties of neurological difference and/or damage with his warmth and erudition and depth of insight, so as to make his work of practical benefit. It’s the deliberate seeking out of impressive and unusual cases that, to me, has a faint suggestion of freak show. Another thing I find problematic about later Sacks is the ambiguity of his role: I felt much more comfortable with the cases in which Sacks was present primarily as a doctor, the best example of this being Awakenings. There, his presence is clearly justified. But with Temple Grandin I was very unclear about what exactly his stated reasons for being with her were. I was curious how he had explained the situation to her, since she didn’t seem to find his presence strange. With Temple Grandin, as with several others, he was in the role of voyeur, primarily. My third concern has to do with his films specifically. I sort of tense up when I notice that Sacks is talking about the patient or subject as if he or she weren’t in the room. That feels like a kind of dehumanization, when you talk about people like museum pieces. But the matter Sack’s ethics is trickier than my criticisms suggest. A lot of what I’ve highlighted is defensible.

As we’ve discussed, there can be some benefit to looking at the extreme cases. They have a way of revealing general principles about the brain. I can see how his writing about Parkinson’s could really alter, for the better, how physicians and lay people understand the condition. Moreover, he is to some degree a creative writer; he is to some degree an entertainer, he is to some degree an educator; he is a public intellectual. A former fiction teacher of mine would ask of a story the Passover Seder question: Why is this night different from all other nights? Or, what is the conflict here? Why is this story of all possible stories worth telling? Why should we care? This is to say, stories are about exceptional happenings. Even stories that claim not to be--like Mrs. Dalloway--can’t help transcending the mundane. If we view Sacks as a short story writer, as I most certainly do, it is perfectly understandable that he would choose the extreme cases.

The ambiguity of his role is problematic, not because I think he ought to take on an especially rigid role for its own sake, but because I think it creates confusion for the person about whom he is writing. I would feel awkward for that reason if he were writing about me. I wouldn’t know how to relate to him or what to expect from him. I wouldn’t be sure whether he was there to help me, or whether he was there to look at me and study me for someone else’s benefit or his own. When he puts on his doctor cap, this problem mostly goes away. A lot of the ethical muddiness dries up. But, on the other hand, stepping out of the doctor role gives him a little more latitude, which can reveal aspects of a condition that are otherwise hard to get at. He can be more flexible in the way he interacts with his subjects. He can see them in a wider variety of contexts. He can elicit different reactions. We can learn some subtle things if he isn’t strictly in the doctor role.

What I don’t find defensible is his habit--albeit occasional--of talking about subjects and patients as though they are not there or cannot hear or cannot understand. Some of his commentary, even if it’s astute, is painful to hear directly and could be better received in final essay form, with necessary qualification. It’s not that the content of his remarks is wrong; it’s that he, in these instances, treats people like objects, and this goes against his project.

Okay, I’m tired.

Boundaries, eh?

2009-04-28T18:11:00.001-07:00

I found the articles dissecting Oliver Sacks’ anthropo-literary style very intriguing. Throughout this semester, I have been struck by the boundaries I would normally assume to exist between patient and doctor being blurred and, in some instances, nonexistent as regards Sacks and his subjects. For the most part, I was happily surprised at the manner by which Sacks seeps into the lives of his patients and, comparatively, he he allows them to seep into his life. This reaction was especially prominent when reading sections from An Anthropologist on Mars, wherein he traveled to Pontito with his eidetic memory patient, Franco. In turn, seeing Sacks zonked out (for lack of a more apt term) on kava juice (?) as he explored Micronesia during The Island of the Colorblind. Indeed, Sacks provides his readers not only with a portrayal of his subjects, but also (as Couser points out in reference to Sacks’ films) “Sacks himself enters the frame; he, too, is available for visual inspection, as is his interaction with his subjects.” His presence is also repeatedly felt throughout his writing, wherein he continually analyzes how he feels about his patients, their dispositions, and his philosophical ideations.
There is also a part of me, however, that wonders about how much blurring of the boundaries between a patient and a doctor is appropriate. Should there be fine lines of demarcation? I know, in situations I’ve been involved in, there has always seemed to be somewhat of a dichotomy (involving power levels) between my status as a patient, seeking “treatment,” and the doctor’s status as the treatment provider. [I have, however, been known to foster somewhat dichotic views, and so perhaps more of my own perception may account for these ostensibly clear-cut delineations].
I wonder also, however, especially in light of all our readings for this semester (especially Joseph LeDoux’s), whether it is indeed better to have less rigid boundaries. In fact, when I call the Echo Maker to mind, it seems that conceiving of boundaries as fixed and inflexible entities is absolutely false—and one would be pathological to assume this as truth.
Indeed, as LeDoux asserts in our final reading of his “Synaptic Self,” though different brain regions are distinct in a cytoarchitectonic and organizational sense, to conceive of our neural structures as distinct, isolated entities is inaccurate. Each depends upon another to carry out its function, and thus illustrates the fluidity of perceived distinction.
Overall, then, it’s difficult to decide what my stance is on Sacks and his dealings with his patients. In no way do I agree with the authors who deem his interactions violating or reminiscent of freak shows. However, I think that his style of patient-doctor relationship certainly transgresses conventional lines. That said, I do believe this method helps bridge the gap between the pathological and the non-pathological. So much of Sacks’ work, I feel, results in a clearer image of what it might be like to be one of his patients. Indeed, a more integrative and holistic perspective is provided by all of his publications, wherein the reader (unless, like Cockburn, s/he decides to hate the man for no good reason) gleans a novel perspective, free from typically binary modes of thought (i.e. seeing a disorder only for its diagnostic criteria). And so, in conclusion, I would say that there’s a great deal of ambiguity here, which parallels the ambiguity Sacks introduces into his work. In turn, I feel that this ambiguity is a more accurate reflection of reality, in that conceived boundaries are, well, conceived. Changing. In flux. Not entirely solid or stable.
I appreciate this perspective, and recognize that it is not one to which I have generally adhered. Thus, as a result of reading Sacks, Powers, Skloot, LeDoux, and others (who have, in particular, seemed to promote the notion of flexibility rather than rigidity in their perspectives) my synapses seem to have done a little readjusting. Thanks, guys!

Shakespeare the Ideologue & Sacks' Ethics

2009-04-26T23:25:00.000-07:00

I began this week’s readings feeling unsure about the moral purity of Sacks’ work, but the three critiques — coupled with “A Surgeon’s Life” — have helped me toward a clearer position in favor of Sacks, though not necessarily because I agreed with what I read.

My most significant disagreement is not with an arguement we read directly, but with one that was paraphrased and deconstructed for us: Tom Shakespeare’s. I do not know much at all about Tom Shakespeare*, yet the (what seemed to me) strangely misdirected ire that he targeted at Sacks immediately placed him in an unfortunate category for me. He became akin to Michael Moore and Ann Coulter: an ideologue who makes exaggerated, misleading, or even deliberately false statements in order to further a cause. To my mind, this behavior undermines rather than supports the cause in question because it presents a detrimentally simplistic perspective. My impression from reading Couser’s quotations and paraphrases is that Shakespeare is more interested in drawing focus to the persistent marginalization of the disabled by the medical community than in the ethical strength of Sacks’ writing. He makes accusations that seem to have no bearing on Sacks’ actual writing. Shakespeare asserts that Sacks is interested primarily in profiting from his patients’ stories (qtd. in Couser 7), which, if sincere, seems like shallow guesswork made by a poor judge of character.

Sacks is clearly a kind-hearted and generous doctor. Nearly everything in Sacks’ writing has pointed toward a patient-first attitude that is not only willing but eager to find a living, relatable person in even the most severely disabled patients and subjects. In spite of Shakespeare's accusation that he writes to make us "marvel" at his "expertise," Sacks humbly admits his mistakes where he sees them: “Some things, one might think, would be completely out of the question [for someone with Tourette’s] — above all, perhaps, the intricate, precise, and steady work of a surgeon. This would have been my belief not so long ago” (Sacks 79). Admittedly, he is not always successful: his dismissal of Heidi's complaint in the department store shows some methodological coldness (Couser 5).

Fortunately, Sacks is constantly examining and re-evaluating his own perspective and assumptions about disease, and this is perhaps no more apparent than in the chapter from the book that we read for today, the same book that Shakespeare supposedly reviews. I agree with Couser that Shakespeare quite possibly “formed a negative opinion of Sacks on the basis of the earlier volume [The Man Who Mistook His Wife for a Hat] and was unable or unwilling to qualify it in reviewing a subsequent book that is far more ambitious and accomplished” (Couser 8). Shakespeare judges Sacks only on his most sensationalist book, which would not look so much like that "high-brow freak show" (Couser 2) for which the likes of Alexander Cockburn despise him. This hollow attempt at an argument, which Couser generously calls "succinct" (Couser 2) is so glib and moronic that I am tempted to make fun of the Nation columnist's name in like fashion.

Shakespeare also complains that Sacks is monological in his presentation and fails to give the patient perspective sufficient space on the page. But I am more inclined to agree with Anne Hunsaker who says, “To compare Awakenings to the conventional [monological] medical history is to trace a movement away from "authoritative discourse" and toward dialogism.” Shakespeare’s complaint presumes an niche perspective of a general-audience writing; that is, he is preoccupied with his own idea of how many personal testimonials he would have liked to see. He is interested in the unfiltered perspective of the sick, not their doctor's attempt to synthesize patient and physician. Perhaps in Sacks, Shakespeare was looking more for direct quotations, but it seems that more generally he wanted a journalist to document the diseased or disabled perspective, not a neurological interpreter to weave a narrative case study, however humanist the tone.

* I do know that Tom Shakespeare is himself disabled, and I guiltily wonder if his own sense of marginalization (probably not a real word) or his affinity for the chronically ill gives him a distorted or instinctively confrontational perspective on the work of a doctor writing about his patients. I am guessing that this is an offensive idea to some, especially since I am presuming to psychoanalyze a person I have never met, but it is the only explanation I can think of for such a respected voice in the scientific community (I did a little internet research) voicing such irrational outrage against a man who has done much for a cause he also promotes (that being the social acceptance of the neurologically atypical or handicapped).

P.S. I have noticed that I have a habit of misspelling “Sacks” as “Sachs.” Perhaps this is from seeing “Goldman Sachs” in the news too many times. Please forgive the error.

A Retraction of my "wrong", and further thoughts

2009-04-26T20:35:00.001-07:00

At the end of our last class I threw around the word "wrong" a lot. I'd like to further clarify what I meant. I don't think of what Sacks does as "wrong", explicitly--rather something about reading narrative case studies feels wrong to me personally. Voyeurism and exploitation of others are things I try ardently to avoid, as a scholar, artist, and human being in the world; and I know that the work of Sacks is sometimes read for those purposes.

I found Cassuto's analysis of Sacks' work thoughtful and fascinating, though I also discovered some holes in his argument. In his metaphor of the freak show, Cassuto neglects to reflect on the charlatanism rampant in that tradition. Of course, of course, many of the "ringmasters" did travel the country, seeking out (and even trading amongst themselves) people with medical oddities. But they also would use makeup, props, and sleights of hand to create the illusion of a freak where there was really only an out-of-work actor. Somehow this knowledge shifts Cassuto's metaphor for me, and slightly invalidates it, though I understand his use.

Secondly, I objected to a specific evaluation he made: "Sacks is writing narratives of wonder at a time when wonder is hard to come by. These wonder narratives wind up creating a uniquely collaborative space within which disabled people can express themselves--rather than closing one off" (329).

Now, I would argue that the people represented in Sacks' narratives are not "express[ing] themselves". What is expressed is Sacks' own perception of their self, which is an entirely different beast. I also think the degree to which this process is "collaborative" necessarily depends a great deal on the abilities/lucidity of the individual patients. Someone like Temple Grandin, for instance, has a deep understanding of how she is being portrayed and is participating actively in shaping Sacks' narrative of her (as well as writing her own, of course). Someone like Jessy Park, on the other hand, doesn't have the same kind of grasp on what it means for her to be in Sacks' documentary. I wouldn't call her a "collaborator". This is a term Cassuto returns to often, and I question his choice.

To go back to this idea of "wrong". I really appreciated Hawkins' comments on Sacks' project--and I agree wholeheartedly that his approach is novel and commendable. To be as a doctor a "traveler into the world of the patient" is brave, difficult, and compassionate. I do support the work. Sacks clearly comes across, both as a writer and a man, as a compassionate, thoughtful, respectful, curious, engaging individual. I understand how his work has broadened the public's mind to ideas of difference/the neurotypical, living with disease, etc... and honestly, his work also entertains, titillates, and provides scintillating stories. The problem for me only lies in the extremely public display of other people's lives, because you can't control how it will be received. As someone who has lived through an array of medical emergencies and strange conditions, I personally am concurrently very open and very protective of those details. I feel no shame when relating a story from my medical history, but at the same time, *I* want to be in control of that information, *I* want to be able to present it and myself. Therefore, I feel a sense of guilt when reading Sacks' work, alongside the intellectual interest and pleasure in his writing style. This is what feels "wrong". Does anyone else feel this way, or is it particular to me?

Studying the relationship between emotion, memory, and perception in Autism

2009-04-21T22:04:00.000-07:00

Losh and Capps' paper brought to my attention many ideas about the relationship between emotion, memory, and perception.

In one instance, they cite other studies that suggest "experiences rendered through narrative are more likely to be consolidated in memory". Typical children developed the narrative form of response when recounting emotional incidents, and L&C believe that this supports the "prospect that narrative activities may be integrally involved in emotional appraisal and that autistic individuals' noted difficulties with narrative, could, in part, inhibit their capacity for appraising emotional experiences and constructing emotion concepts and memoryies"

This presents an interesting relationship between formation of a narrative, and appraisal of emotions. It suggests that emotions are determined after the formation of a narrative, rather than the reverse. Yet we often address other individuals' emotions and seek reasons / create a narrative afterward.

L&C address this, and acknowledge that autistic individuals certainly posess less elaborate memories of emotions, (as Grandin suggested), and that formation of narrative is not cognitive bottleneck. They believe that memories of emotional events create a "knowledge base... on the causes, consequences and subjective meaning of affectively charged happenings, and that Lacking such a repository could render autistic individuals disadvantaged"

Still, the question remains as to why this knowledge base is not created. This leads me to believe that a core question in autism is studying the relationship between perception and emotion, or perception and creation of narratives. L&C point out the autistic group's tendency to point out the visual elements of emotions (angry faces, sad faces, etc). This leads us to believe that the understanding of emotion that this individuals have, is based more in visual-word association than some 'deeper' emotional understanding or empathy.

It seems that understanding social interaction, requires the need to process emotional information, which seems to be a consolidation or 'essentialized' form of information. As was emphasized in the Rage for Order film, the brain of an autistic individual is structured in such a way that it appears to prefer processing closed, predictable, and physical systems.

This reminds me of a hypothesis for Autism called, The Intense World Syndrome. As it proposes: "...the core pathology of the autistic brain is hyper-reactivity and hyper-plasticity of local neuronal circuits. Such excessive neuronal processing in circumscribed circuits is suggested to lead to hyper-perception, hyper-attention, and hyper-memory, which may lie at the heart of most autistic symptoms. In this view, the autistic spectrum are disorders of hyper-functionality, which turns debilitating, as opposed to disorders of hypo-functionality, as is often assumed."

This in does seem compatible with what the University of California researcher in the Rage for Order film was talking about --a deficit in that kind of coordinating ability that is apparent in the cerebellum. It may be that a dysfunction in this area is what allows hyper-sensitivity to perceptual information., or that hyper-activation of those circuits is what causes disfunction in the cerebellum, as researchers of that theory might propose.

As a side note, I just wanted to say/complain:

Reading Understanding of Emotional Experience in Autism: Insights From the Personal Accounts of High-Functioning Children With Autism, gave me a new found appreciation for the writing of Oliver Sacks and other narrative-neuro writers.

Take for example, this idea of understanding autism through a "discourse analytic framework", or, the great phrase, "personalized causal-explanatory narrative frameworks". I can't imagine anyone who doesn't have an hour to read the paper understanding this. Thankfully, we have writers who address the general public, letting us know that what the authors really mean to describe are, "recorded conversations" and "personal stories" respectively. Some fields are much worse, but this paper reminded me of the great need for popular science writers who can convey specific ideas in more accessible ways.

Nothing new under the sun

2009-04-21T21:50:00.000-07:00

Sachs' investigation of Stephen Wiltshire's drawing and Temple Grandin's discussion of her visualization-based drafting process challenge the conventional understanding of what it means to be an artist. We take for granted that an artist (I will, for the sake of simplicity, stick to visual art) renders an image from his imagination, and that art, therefore, is a product of imagination. Certainly, most of the art that fills the world's galleries is taken from life, inspired by or modeled on a scene that took place in reality. But art is not an automatic reproduction. It is created with style and intention. Art speaks; it has a message. Even photography can be more than pure journalistic record-keeping. A photographer frames an image and makes it his own. He manipulates his instrument to emphasize what he judges to be the salient features of a scene. Through the enumerable choices made in shooting and developing, a photographer communicates, and documentation is turned into art. But is Stephen capable of more than documentation? Is he an artist?

I argue he is on both counts, and there are a couple of reasons for this. First of all, he is driven to draw. His compulsion seems to stem, in the most general terms, from a need to make order out of what he perceives and, in rendering it, to communicate that order. I don't mean that Stephen is trying to reach out to the larger public — Emily Dickinson wrote the vast majority of her poems without any apparent intention to publish them; they were a way of communicating with herself — but he is solidifying his perception of the outer world into something tangible. Second, he interprets. He adds details and ornamentation to buildings for both aesthetic (the chimney on Sachs' house) and symbolic (the flagpole in his yard) purposes. Jessy Park's psychedelic coloration is similarly interpretive and has an individualized style that parallels the warm lines of Stephen's later drawings.

The additional perspective we get from Grandin is problematic. Her mode of piecing visual images together to make something new seems to be echoed in Stephen's creative alterations and additions. Is it truly art if he is only mechanically stacking visual images like building blocks? I think this is a false distinction. Grandin's process merely literalizes the common method of all human creative output. Nothing comes from nothing. An artist takes in what is pre-existing and makes a new pattern out of the old pieces. The pieces themselves are eternal, though we add new meanings to them as our memory of associations grows. So to strip Stephen of his artistic mantle would be an act of supreme arrogance on the part of the neurotypical. It would require belief that the neurotypical artist can make something out of nothing in a manner beyond the ken of an autistic one.

"a scientist trying to figure out the ways of the natives"

2009-04-20T01:12:00.000-07:00

I'm going to start, if I may, with a personal anecdote. Trying to write this response has been uncommonly difficult for me, because the subject matter is so personal and so difficult for me to relate to people. I was diagnosed with high-functioning Asperger's syndrome when I was sixteen and, despite the fact that there has been a good deal of research demystifying Asperger's and the autism spectrum, it really something isn't something that I like talking about. Immediately following my diagnosis, my mom reacted very negatively, trying to find any alternate diagnosis to explain the experiences and symptoms that I described and that were noted to my psychiatrist, maybe because she was a concerned parent still operating with a set of beliefs like the "views" noted by Capps and Losh "that individuals with autism do not experience or express emotions (e.g., Bettelheim, 1967)" or "that autism involves an absence of emotional expression and indifference to others (e.g., American Psychiatric Association, 1994; Bettelheim, 1967; Kanner, 1943; 1971)".

Of the conditions we've studied, the disorders on the autism spectrum strike me as being among the most subjected to negative social stigma, along with epileptic disorders, which I also had the privilege to write about. I feel a bit hypocritical for this, but while I find the stigma surrounding epilepsy to be rather outdated and highly motivated by superstition -- the experiences of epileptics are such a radical break from neurotypical people that one of the most logical ways to explain them without using neuroscience are through falling into the realms of the unscientific and unrealistic -- I honestly can understand the stigma against autism spectrum disorders. As LeDoux made a point of discussing in last week's reading, emotions are exceedingly difficult to explain through the same methods in which neuropsychologists describe other phenomena, but they are too inherent to the human experience to ignore.

Considering this, the notion of someone's brain being so neurologically atypical that they have marked difficulty understanding and relating to their own emotions and those of other people, experiencing deep a 'disconnection' between themselves and the rest of the world, naturally seems foreign, strange, and even impossible to understand. Even living with it myself, I don't understand much of my own experiences and my family has even greater difficulty doing so, though having the context of Asperger's gives us a framework within which to work. Reading the selections for this week has been difficult for me to sort through and, thus, respond to because so much of it is simultaneously familiar and alien. For example, while, I could empathize with Temple Grandin on many counts -- her experiences with finding the right course of medications, for example, struck a chord, albeit for different reasons -- other parts of her descriptions of her experiences were so far removed from how I understand things. Her early notion of "thinking in pictures," for example, was strikingly other.

The otherness of autism spectrum disorders is, though, what I think makes them inherently essential to an understanding of the human mind and the neurotypical experience. As we've come back to time and time again during the course, understanding how a neurologically atypical brain works highlights the functioning of the brain in general, so that we can better learn how a neurotypical brain crafts and contributes to our experiences. In our readings about autistic spectrum disorders, we've had the perspectives of the neurotypical (Clara Claiborne-Park, Lisa Capps and Molly Losh, and our friend Oliver Sacks, in both An Anthropologist on Mars and his introduction to Exiting Nirvana), the autistic (Temple Grandin), the Asperger's (Tim Page), and the neurotypical writing as autistic (The Curious Incident of the Dog in the Nighttime), and this synthesis, this meeting different aspects of similar experiences, even more than the experiences themselves, is where we can really find an understanding of the material. The relationship between a neurotypical brain and an autistic one could be seen as this idea, written in synapses and chemicals rather than in words.

A jumble of thoughts

2009-04-19T23:18:00.000-07:00

Oliver Sacks is one of my favorite writers, in general, and certainly my favorite among the authors we’ve read for this class. I was pleasantly surprised (though not actually surprised) to find Sacks’ forwards in some of our recent readings. In Exiting Nirvana he perfectly sets up the following text, and provides a historical context in terms of prior research on the autism spectrum, and an emotional context by providing certain details of the family portrayed in this book that the author did not provide. Additionally, I appreciate how he sees the benefits, as well as drawbacks of each disorder he studies. He includes some of this insight in his forwards. As we’ve discovered, especially after reading “Prodigies,” among other chapters from our reading, and watching films such as Rain Man, etc., there are many remarkable individuals with autism. The level of artistic and other skills in the cases we’ve encountered are staggering- not simply considered in the realm of individuals with certain deficits, but among “healthy” children and adults.

Exiting Nirvana discusses “theory of mind” at length, and how people with autism are characterized as not being able to see from another person’s perspective. Immediately upon reading the first few pages of Thinking in Pictures, I was stunned by Grandin’s ability to create such effective designs mostly due to her ability to see through the eyes of the livestock (both emotionally and literally- creating humane ways to move these animals by thinking about their emotions and physical comfort, and literally seeing through their eyes with the aid of her vivid visual mind). This raises a lot of questions for me. First, if humans are animals, why then can certain individuals with autism see from only certain animals’ perspective, and not humans? Why is there a disconnect here? If a person with autism possesses an innate ability to empathize with livestock, can this person learn to empathize with other humans easily? Additionally, as Katie mentions in her post, is there a link between autism and sociopathy (“given that a lack of empathy is also a hallmark of the antisocial personality disorders, the connotation feels a bit negative.”)?

A picture is worth a thousand words...

2009-04-19T22:25:00.000-07:00

Cliche, I know, but after reading "Thinking In Pictures? that saying is so much more powerful. The thought of thinking in pictures is mind-boggling to me. I am an extremely verbal thinker -- everything I imagine comes up as a series of words strung together, or placed in its representative spot. For example, I once was asked to describe my favorite place to be in the world. This happens to be my best friend's bedroom, since I virtually grew up there -- we've known each other for sixteen years and her bedroom has hardly changed. She has a queen sized bed with no frame in the left upper corner, a dresser about three feet in front of that with a tv and a dvd player. To the right of the dresser is a brown book shelf stacked completely with CD's, and to the left is the door. n the adjacent wall, another brown bookshelf, a tall white floor lamp, and her coral colored closet doors. On the wall directly behind her bed, a large window with white sills and mini blinds. When I visualize this picture, however, I don't see those things. I see the word bed, and clumped around it I see 'green, white, purple' for the colors of her bed sheets. The word 'dresser' is in front of that, with the words 't.v.' and 'DVD player' stacked on top of it. The shelf shows as 'shelf' in very large letters, and the word 'CD' is packed over and over very tightly in between the letters. It is impressive and amazing that someone can not only fully visualize an object, but even rotate and see it from all sides. I have never once visualized an object in its entirety.

Grandin addresses the fact that being a visual thinker has the downside of not being able to comprehend words with which there is no concrete image to associate. But what I am curious about is what happens for words that have multiple meanings. I imagine that the first image associated with the word would be the most widely recalled, but is it possible to file the word away again with a second image? For example, the word 'leech'. From older days it means physician or surgeon, and it's also a blood sucking annelid. As a verb it is the act of using an annelid to suck blood, or more generally to drain or exhaust something. Is there such a way for a visual thinker such at Grandin to remember each of these definitions in conjunction with the same word? Can slight alterations to the word affect how she visualizes? I'm reminded of some of the work I do as a computer technician. Occasionally, work orders are lost before they can be completed and I have to create new ones. however, the system won't allow me to create multiple work orders for the same serial number. I avoid that situation by putting in the serial number with a period behind it. I wonder if the same concept could be applied to Grandin's visualization process.

To better understand the mind of the visual thinker, I took Grandin's suggestion and used Google Images. I typed in a few random nouns that came to mind and sorted through he first few pages of results. Simple nouns such as 'leech' yielded pictures of the animal, but after a few pages I started to see boots, which are worn to prevent leeches from attaching to the ankles or getting into pant legs, and vials of blood because that's what leeches eat. Upon searching 'liberty', I got a plethora of pictures of the Statue of Liberty, the Liberty Bell, and a Jeep Liberty. My final word was 'symbiotic' for which I received a bunch of pictures of different animals that have symbiotic relationships with other organisms. It was a great representation of the associative way people on the autistic spectrum think.

I am fascinated by this system and have many questions. Do all of the visual thinkers have memories that are inexhaustible? if only a percentage of visual thinkers have Grandin's ability to modify information, is there a point where those without that skill are "maxed out" on their ability to associate a word with something? Do visual speakers excel at word games such as anagrams and scrambled words? Grandin offers a lot of insight on the visual mind but I suspect that she is right when she says that it works in ways forever incomprehensible to the non-visual person.

The Uncertainty of Autism

2009-04-19T21:00:00.000-07:00

Apart from the obvious separation between fiction and memoir, Exiting Nirvana and The Curious Incident of a Dog in the Night-Time are two books about autism, separated by view points. Haddon gives the perspective of Christopher, an autistic boy whereas Park gives her own, neurotypical perspective on her autistic daughter, Jessy. Something that struck me after reading Park’s memoir was the constant and very detailed search for an answer to her daughter’s differences and the
realizations and perceptions that come from the perspective of an outsider.

Exiting Nirvana is written in such a way that allows the reader to work through the same process that Clara experienced when trying to understand or at least grapple with her daughter’s autism. The anecdotes are usually coupled with Clara’s attempts to reason and come to grips with the fact that Jessy meant to ask a question rather than make a statement, or that she has a sudden obsession with clichés, or that the sky suddenly has so much power over her emotions. Through deduction and reasoning, much like the way Jessy solves math problems, Clara comes to the conclusions that Jessy’s “clichés help her express herself, but their real advantage is far more fundamental. They help her give structure to chaos” (37) and “ ‘Jane’s house is in New Jersey.’ It sounds like a statement…Yet she doesn’t know where Jane’s house is, and the statement is false. But she has no reason to mislead me, and she is incapable of a convincing lie, so I’m able to guess: this is one of her odd assertions that function as a question” (55). These efforts to understand do not always end in success, however.

Jessy’s need to keep everything constant and in perfect order and her inability to comprehend change and abstraction is difficult for any outsider, including her mother, to decipher. “Jessy loves charts: they too reduce an untidy world to order” ( 36). In spite of all her efforts to understand Jessy, for Clara, there will always be a void. When recalling the anecdote where Jessy had eight pieces of bacon, Clara states, “Though it would make for a neater narrative, I won’t reinvent the words of the question I didn’t record. My question mark, floating in the blankness, is a truer rendition” (26).

The math that Jessy employed as a child didn’t have any real rhyme or reason to an observer and although it seemed that “gradually, numbers lost their magic” and Jessy’s “emotions seemed independent of the weather” (82), a meeting with Oliver Sacks twenty years later proved these theories to be only somewhat true. Something that I was very taken with after reading both, Mark Haddon’s novel, and Clara Claiborne Park’s memoir, is the world of total “bewilderment” that comes with autism. Not only does it come from the observers of the autistic, like Clara Claiborne Park, but it most certainly comes from the person housing the illness, like Jessy and Christopher.

Bridging the Gap (With Empathy).

2009-04-19T17:22:00.000-07:00

Losh and Capps point to a critical and widely accepted notion in proper emotional and social development. In a neuro-typical individual, “advances in emotional understanding occur as children are increasingly able and inclined to locate emotions within causal–explanatory frameworks and evaluate their significance in relation to self and other.” The authors go on to argue that “the development of such evaluative skills has been argued to be a key factor in the enabling of children to penetrate the psychological and sociocultural dimensions of complex affective encounters.” Thus it is the acquisition of these increasingly complex abilities that is lacking in autistic individuals.
Though this would seem to encompass the lack of empathy long assumed to be a hallmark of both Kanner’s and Asperger’s autism, such a definition circumvents the slightly caustic ring of former classifications. I use the word caustic here, because to claim another individual lacks empathy sounds (at least to me) somewhat accusatory.
Perhaps this is a case of cue distortion on my party, but given that a lack of empathy is also a hallmark of the antisocial personality disorders, the connotation feels a bit negative.
I find it preferable, therefore, to conceive of the undeniable emotional barriers faced by autistic individuals not as an absence of the very emotion that renders us human, but as a snag in his or her emotional development. Or, as Temple Grandin might put it, a short-circuit in the computer wires.
In reference to this, I think the work of Martin Hoffman is an appropriate parallel. In Hoffman’s view, empathetic ability increases as a direct function of developing cognitive awareness of others (Hoffman 1984). In simpler terms, as more complex mental capacities develop, so too does the capacity to engage in and experience empathy. In infancy (0-1 years of age), for example, only a rudimentary form of empathy exists, wherein a basic imitation of adult gestures—or, motor mimicry— is observed (Meltzoff 1977), as well as what Hoffman terms the “primary circular reaction” wherein newborns reactively cry upon exposure to other crying infants (Sagi and Hoffman, 1976). By contrast, in later childhood and early adolescence, “person identity” (the realization that others’ identities, opinions, personal experiences and emotions are not solely dependent upon oneself—and that they exist outside of immediate, observable situations) enables a more advanced (and abstract) understanding of others. Only when person identity is acquired, Hoffman argues, can individuals “take the other’s role and asses their reactions in particular situations [while] also generaliz[ing] from these situations and construct[ing] a concept of the other’s general life experience” (Hoffman 1984). By transcending early childhood fusions of self and other, and by refining the resulting perceptions of separate entities, a more complex and mature form of empathy is engendered.
In its entirety, Hoffman’s model of empathy comprises four distinct stages (of which primary circular reactions and person identity acquisition are associated with the first and last, respectively). As for the second stage (1-2 years of life), sympathy (in absence of the ability to put oneself in another’s shoes, as mandated by empathy) is made possible by the attainment of person permanence (the notion that people do not disappear when, say, they leave the room). Following this is the stage lasting from 3 to 10 years of age, wherein role taking (the ability to assume another’s perspective) develops, and thus empathy takes its first roots.
If this model is to be applied to autistic individuals, one might argue that—dependent upon the severity of their symptoms—they are prevented from progressing to the third and fourth stages of empathy acquisition, based on neurological hindrances. In other words, from a developmental standpoint that carries a hint of psychoanalytic theory (inasmuch as this might be mistaken to parallel Freud’s psychosexual stages—and this is by no means my intention), autistic individuals may be neurobiologically incapable of engaging in role taking, which is necessary for the more complex forms of empathy.
To me, this correlates with the “complex attributional processes hinging on later developmental achievements, such as the capacity for reflecting upon experiences
and evaluating them in relation to sociocultural norms and expectations, as well as the appraisals of others” that Losh and Capps refer to. In that sense, though it may seem somewhat tangential, Hoffman’s approach to empathy development might shed a more humanistic light on cases of autism. Not that I find them to elicit the negative connotations associated with antisocial personality disorder. But I do believe that there is a want of empathy in the neuro-typical population and their reactions to autism.
Not only is there a disconnection on the autistic individual’s part—as they can engage only limitedly in the emotional currency upon which otherwise normal individuals rely. There is also a critical lack of understanding on the parts of non-autistic individuals who, say, observe their neuro-developmentally impaired counterparts and cast them off as retarded or burdensome. Perhaps, then, if empathic connections are fostered on more basic, more rudimentary or earlier forms of empathy (as one would attempt to cultivate in youngsters who have not yet developed a person permanence or person identity), a greater communication between the two seemingly opposite worlds could be achieved.

To Take Away What is Unnecessary, You Must First Define What Is Necessary

2009-04-14T13:50:00.001-07:00

Through the fictional autistic narrator, Christopher, author Mark Haddon introduces a vital theme, not only apparent throughout The Curious Incident of the Dog in Night-time, but also evident in the non-fictional accounts of autism provided by Oliver Sacks (throughout his Anthropologist on Mars). The theme is that of Occam’s razor, which (in Christopher’s translation from latin) states, “no more things should be presumed to exist than are absolutely necessary” (Haddon 90).
There is certainly evidence enough to argue that Christopher’s mental state is an illustration of this tenet. For one, he (like other autistic individuals) considers the non-goal-oriented chit-chat that so greatly comprises human interaction as unnecessary: “I didn’t reply to this either because Mrs. Alexander was doing what it called chatting, where people say things to each other which aren’t questions and answers and aren’t connected” (Haddon 40). [As Feinberg describes this phenomenon, albeit rather bluntly: individuals with Asperger’s (the less-severe and more functional form of autism), “…cannot see the point in social chit-chat. They do not ming having a discussion…on a particular issue in order to establish the truth of the matter…But just a casual, superficial chat? Why bother? And what on earth about? How?...it is both too hard and pointless” (Feinberg 172). Perhaps a more neutral and reflective tone is found in Oliver Sacks’ description of the same sentiments (or lack there of) in Temple Grandlin: “By professional standards, she is extraordinarily successful, but other human interactions—social, sexual—she cannot ‘get’” (Sacks 260). Indeed, the emotional understanding and communication that serves as the basis for such social interactions (be it chit-chat or deep empathic exchange) rests on an individual’s ability to share the emotions of the other person, an ability that is also lacking in Sacks’ other true-life character, Stephen: “He seemed not to understand different emotions and would laugh if one of the children had a temper tantrum or screamed” (201).
In turn, Christopher’s direct, simplistic thinking is another example of the reductionist motif. He does not waste time in mincing words or thoughts, but states and attends to things without the presumed prefrontal cortical inhibition that causes otherwise neuro-normative individuals to hold their tongues: i.e. when Christopher explains to Mrs. Alexander why he does not feel sad about his mother’s (supposed) death: “I don’t feel sad…because mother is dead. And because Mr. Shears isn’t around anymore. So I would be feeling sad about something that isn’t real and doesn’t ecist. And that would be stupid” (Haddon 75). Or, when Christopher shows up at his mother’s house and genuinely asserts to Mr. Shears that “I’m going to live with you because Father killed Wellington with a garden fork and I’m frightened of him” (192). Likewise, Oliver Sacks’ depiction of Temple’s lack of “…diffidence or embarrassment (emotions unknown to her)” (Sacks 262) while displaying her bedroom and squeeze-machine “…with a complete absence of inhibition or hesitation” (265). Thus the regular tentativeness, humbleness, or self-consciousness that might be expected of a non-autistic individual is not apparent. Such is the case, as well, with Steven Wiltshire who “…seemed to have no sense of either vanity or modesty, but showed [Oliver Sacks] his drawings, commented on them, in an ingenuous way and with total absence of self-consciousness” (Sacks 205).
A further embodiment of the theme present in Occam’s razor is the presumed “hypertrophy of a single mental faculty” (Sacks 193) to the exclusion of all others that characterize savant talents. Inherent in this distinction is a cleavage of all (or most) other mental faculties that unrelated (and thus unnecessary to) the hypertrophized faculty—i.e. verbal/communicative skills, emotional competence, etc. Christopher compares this to the otherwise normative state of mind, wherein “most people are almost blind and they don’t see most things and there is lots of spare capacity in their heads and it is filled with things which aren’t connected and are silly, like ‘I’m worried that I might have left the gas cooker on” (Haddon 144). Thus, at least to Christopher, such non-autistic minds to not cleave the unnecessary or surperfluous.
It is crucial to note, however, that to define “necessary” or its counterpart, “superfluous” is entirely subjective. Indeed, Christopher sees what others may deem necessary as silly, or stupid (in his words); while most non-autistic individuals would deem his retention of every detail when looking at a farm field, for instance, as equally unnecessary—disadvantageous, in fact. Thus it can be argued that perspective is inherently correct.
This, of course, leads into the discrepancy over whether savantism is a deficit or a gift. Most would see it as a disadvantage, if it is to be accompanied by social deficits and interpersonal dysfunctional; however, as Temple asserts, “If I could snap my fingers and be nonautistic, I would not…Autism is par of who I am” (Sacks 291); “It is possible that persons with bits of these [autistic] traits are more creative, or possible even geniuses…If science eliminated these genes, maybe the whole world would be taken over by accountants” (292).
In summation, then, one individual’s take on Occam’s razor may be entirely different than another’s: unnecessary and necessary (and the removal of and/or implementation of each) are highly dependant upon perspective—which, itself, is colored by an individual’s predisposition, emotional interior, exterior, and cognitive capacities. The very insistence that deficits such as autism are unnecessary can even be lumped into this discrepancy.

Welcome to My World

2009-04-14T08:37:00.000-07:00

What strikes me the most about Mark Haddon’s The Curious Incident of the Dog in the Nighttime is how evidently blunt the writing it is and where the bluntness comes from. Because we are reading the story from the perspective of a young boy with Asperger syndrome, we receive a very straightforward narrative with very little description or speculation. Christopher, because of his condition, is extremely deliberate in anything that comes across his mind. He doesn’t like yellow and brown. He likes red. Different types of food on the same plate cannot touch one another. There is no real designation for why he likes these things those ways. There is even a chapter about why Christopher doesn’t like yellow and brown, but it provides no true reason for why he hates yellow and brown, but creates more of a list of yellow and brown things. The idea behind this is that Christopher believes that when the reader notices his “list” they will automatically realize why yellow and brown are terrible.

The clear-cut decisions and thoughts bring up an interesting style of narrative. Some would argue that it waters down the true quality of the prose, but in the case of Mark Haddon, that fact is almost the idea behind the novel. Everything is very frank to Christopher, thus making things like finding out about his mother and Mr. Shears just seem to be something that happened, instead of the horrible affair that is truly behind the discovery. The lack of adjectives helps to make frightening sections of the novel, like Christopher’s father becoming very angry unfold in a slow motion style. They are occurring with no real emotion and because of the lack of emotion, the narrative becomes extremely powerful.

Although the subject matter is entirely different, I couldn’t help being reminded of The Road by Cormac McCarthy. The same style of writing is employed, giving the narrative a blunt side that takes away from the beauty of writing but enhances the experience of the novel. Horrible moments become that much more terrible because of their exposure to the reader. Each sentence is naked, creating a strong piece of writing.

I believe that the experience that the reader has when moving through the narrative of The Curious Incident is the important part of the novel, and the idea that Mark Haddon is looking for. He presents it to the reader very obviously in Christopher’s perspective, but also through his actions and thoughts because he forces the reader not only into seeing the way Christopher sees, but also the way he thinks, and the affect that it has on the reader. One cannot help reading The Curious Incident and being shocked at some points in the novel, and if you are shocked then Mark Haddon has achieved his goal.

On Part One: I am No One

2009-04-07T18:39:00.000-07:00

On page 59 Mark has his first post-accident recognition of another patient’s sadness when he overhears someone sobbing in a room near his. This “feat of intellect” as Karin calls it seemed to be so much more to me at that moment. Every now and then while reading Powers’s novel I stop and have that moment of questioning: is he the echo-maker? Is he simply echoing what his interrupted mind grasps, words or actions that instigate a connection, a memory? It cannot be this simple. Mark recognizing sadness seemed pivotal to me in the unorganized, time-warped narrative. So much of him seems to still be present and what is missing is baffling because it seems to be so little he is not capable off. He shoots the shit with his two buddies and they recognize his progress but he gets overwhelmed. “When they’re near, he can’t hear himself think. Too much happening at once for him to see what’s wrong.” (67). He receives necessary, pseudo-romantic attention from Bonnie and then becomes captivated, infatuated by Barbara. He is able. He can walk and talk. Tracking his progress is confusing because of the parallel narrative of his sister, that at times overshadows his deficits and puts the reader’s focus on Karin. The self—our self, knowing who one is through memory and self-preservation—is not only taken from Mark but to an extent more so from Karin by her brother’s Capgras syndrome. “You think I’m just a symptom?” (92), she asks Daniel. Her sense of self, the idea of the life she has created and thought she knew and could hold on to, is taken away by the accident and Mark’s recovery and misidentification delusions send Karin deeper and deeper into the chase, the struggle. I cannot imagine what it must be like to be talking to your sibling, the closest genetic organism to you, knowing that they do not recognize who you are. I ask a completely unanswerable question: Why does Capgras manifest itself in this way? Why do patients not recognize loved ones especially? The mysterious note only adds to the delusion and shattering of the self. I am No One. To bring back someone else? Is Karin the one who needed bringing back? The obvious answer seems to me to be Mark but it is his challenge to bring back that other.
The pages are filled with cryptic lines about identity, life and death. Mark realizes on page 64 that he doesn’t even know where the dead are. For some reason this line and so many others seemed to make my mind pause and think and then blank. On the next page, he has another realization that seems so wise, so natural for someone who has had their world flipped inside out and upside down from one millisecond to the next. While asking his sister/actress to get him some sort of identification Mark seems to grasp something that at this very moment seems beyond me. They can operate on your brain without you even knowing it. In this thought Mark at once comes to terms with his accident and current situation and surrenders his body to the technology that, without his consent, has kept him alive.
I found myself struggling with the unannounced switch from Karin’s point of view to Mark’s. I definitely enjoyed reading the Mark sections more. Knowing his thoughts, the way they are presented and the way they expose his personality, made me understand the entire narrative better. “Nobody’s quite what they say they are, and he’s just supposed to laugh and play along.”

Capgras + Our Sense of Self

2009-04-07T14:55:00.000-07:00

For me the most intriguing part of Capgras syndrome is the profound implications this disorder has with regard to how we define our sense of self. The Hirstein and Ramachandran article details the multiple brain functions that are involved in the process of recognizing a face. Part of our neurology allows us to consciously interpret what we see in front of us as another person, while another part is responsible for triggering the emotional arousal that results from our associations with a face that is familiar to us. The authors suggest that in the case of Capgras patients, the limbic section of the brain fails to enact this emotional response to the faces of loved ones, thus forcing the patient to conclude that the person they are encountering is not the really the relative they know and love, but an imposter.
In The Echo Maker, Richard Powers creates a vivid picture of the impact this kind of neurological disconnect can have on the lives and relationships of an affected person and his loved ones. Our sense of self is defined by our connection to others. The relationships we create anchor us in our surroundings and give meaning to our place in the world. In the novel, Mark’s conception of one of his most important relationships becomes wrapped in distrust and suspicion. Once he no longer has the grounding link to the person he loves most, his sense of self is profoundly shaken. The syndrome deeply impacts Karin as well, since much of her understanding of herself relies on the role she once inhabited in Mark’s life. She knows herself as his protector, his caretaker, his sister, and she has shaped a significant part of her identity around this version of herself. Mark’s accident changes all of this. His brain can process her face intellectually, but can no longer elicit the warm emotional reaction that would allow him to accept Karin as his sister. She is stripped of a role that she has long relied on to define herself.
In his interview with Terry Gross, Powers suggests that although Capgras is a rare phenomenon, the theme of the novel may resonate with readers because we may experience this “decoupling of intellectual recognition and emotional recognition” in small ways in our everyday lives. He gives the example of someone professing their love to another person, only to later admit that they no longer have those passionate feelings toward them. In that example, the person would recognize their lover as the same familiar face, but no longer feel the emotional arousal that their partner used to bring forth. In neuro-typical people, this decoupling would lead the person to conclude not that their lover is a fake, but that some change has taken place within themselves or the other that has caused the initial feelings to fade. Powers also emphasizes that the self is a kind of novelist, in that it has an amazing ability to revise its view of the world. Our environment, our relationships, our place in society – all these factors that make up our lives are constantly shifting, and as a result we must constantly reconstruct the narrative of our experience. Whether it’s a brain malfunction like Mark’s that interrupts our understanding of a relationship, or the more common reality of falling out of love, life demands that we are flexible in how we view ourselves and organize the world around us.

To Take Away What Is Unnecessary, You Must First Define What is Necessary

2009-04-07T12:46:00.000-07:00

I'm glad I don't have Capgras.

2009-04-06T11:36:00.000-07:00

In Kim Ferguson’s Intro to Cognitive Science class last semester, we watched a documentary about a man suffering from accidental Capgras, that is, arising from physical injury to the brain. I believe it was a car accident, making his case very similar to Mark’s. In the short video, the man (whose name escapes me) is living with his parents in his old house, and has been for several months. He says that although he is not convinced that the people living with him are his real parents, he is no longer difficult or hostile to them because they seem like good people and they take good care of him. He says the same of his house, which he no longer recognizes as his own. His parents say they are taking baby steps, and that their relationship has much improved from the earlier days. This video was extremely haunting, in a way that was different from the coldness exhibited by Mark towards Karin, in that this man was simply coexisting with his parents because it was convenient and posed no threat to him. All of his past relationships and memories with his parents had evaporated on his end, and he had simply accepted that. While Mark often puts up some sort of fight towards Karin, acknowledging her presence and significance if not as her sister as a caretaker, the other man does not even feel the need to do that. He lives in his fake house because it is shelter, and cohabitates with his fake parents because they cook for him. And while the omnipresent narrator of the video insists that he is making progress and that there is hope that his emotional connections will be restored, it is hard to believe when watching the video.

In the same class, we briefly covered what happens in the brain that causes Capgras. It is speculated that the reason Capgras sufferers may recognize loved ones and simultaneously not recognize them is that connection between emotion and face recognition and memory is damaged (Please tell me if this is not right…my poor memory has suffered over the many months). Therefore, when Mark looks at Karin, he recognizes her face but does not feel the flood of emotion one might feel towards one’s sister; love, affection, irritation, etc. Mark’s brain then rationalizes that since it doesn’t emotionally react towards his sister, then she cannot logically be his actual sister. It is this reason also that Capgras patients hardly ever believe it is themselves who are the cause of it. This is a prime example of both the fragility of the brain and it’s amazing prowess, in this case occurring at the same time.

I enjoyed The Echo Maker. Powers is obviously a very skilled writer; utilizing many literary tools and layered narrative to tell the story. The balance between fiction and disorder was even, in that though the plot was centered around Mark’s Capgras, there were other elements interwoven into it that made it an interesting read without relying solely on the disorder. Powers was informed and respectful and chose a syndrome that lent itself well to fiction writing. While the book itself could have been a more exciting read--the smoothness of the flow became a bit tiring--I think Powers successfully relayed both a story and a course on Capgras.

The Echo Maker

2009-04-06T01:37:00.000-07:00

I want to apologize, first, for this tardy write-up. The truth is, I’ve been struggling to think of anything very insightful to say about The Echo Maker. But, after a lot of hemming and hawing, I think I may have something at least vaguely interesting. It has to do with the omnipresence of the brain and brain science and how some of the material, including The Echo Maker, has proposed implicitly, thrown into doubt, reconfigured, or destabilized fundamental notions of who we are. Explaining how I got onto this line of thinking will require some anecdotes.

There’s an odd experience we have when we’re reading about a topic that is novel to us, as much of neuroscience is novel to me. It’s the same thing we experience when we learn a new word. We start to see it everywhere. Now that I know a bit more about Parkinson’s, now that I know a bit more about autism, now that I know a bit more about epilepsy, synaesthesia, Capgras syndrome, agnosia, etc., examples of atypical brain development and of brain damage appear in news stories constantly; they come up in my conversations with friends and relatives; books relating to them seem to materialize out of nowhere; the reading assignments in other academic courses bring them up; my own short stories begin to swirl around related themes. In the past two or three weeks, this has been uncannily true for me, and it’s gotten me to think in new ways about some of what we’ve read.

An acquaintance--Jeremy--who’s becoming a friend and whom I met through another acquaintance had, I noticed shortly after we’d been introduced, some habits in his conversation and in his Web correspondence (e-mail and instant messages) that could be construed as rude or, at the least, bizarre. For instance, in the middle of an IM conversation, he would disappear abruptly, while still ostensibly signed on, and come back forty minutes later, saying he’d gotten so involved in his music (he’s a composer) that he’d forgotten we were talking. This happened more than once. I also noticed, while I was with him in person, that, if I said anything ironic or sarcastic, he would pause and look blankly at the floor for a moment, then register the joke and laugh. He wasn’t big on prolonged eye contact either--which was fine by me, initially, since I think intense eye contact can easily become more creepy than polite. But his eye contact was so brief and so rare that I started to think something in this social situation was awry. I was beginning to take some offense, privately, to these various gestures, but didn’t say anything because I knew I was construing them as rude when, conceivably, no disrespect was intended. Then one time he mentioned in passing “having A.S.,” but didn’t elaborate, either assuming I knew what he was referring to, or testing whether I did, and the context gave me no clues, other than that it was a medical issue. The only “A.S.” I could think of on the spot was Ankylosing spondylitis, a rare form of arthritis--how I know of that A.S., I couldn’t say. Anyway, when I responded with something about Ankylosing spondylitis, he looked at me as though I had just broken into a foreign language that sounded funny to uninitiated ears. “No,” he said, “Asperger’s syndrome”--which I did in fact know some rudimentary information about. Suddenly, all the potentially offensive ambiguities in our interactions were explained. And of course I felt like a serious, serious idiot. A psychology student in neuropsychology class, I should have known. And Ankylosing spondylitis was a comically absurd guess. It struck me how much and how concretely our everyday interactions are shaped by the vicissitudes of the brain, and how a knowledge of the brain casts a different and brighter light on those interactions, bringing clarity as well as new questions when previously indistinct details are revealed, as in a picture moved to a different and better lit setting. And not just our everyday interactions but the big stuff too. We can see a similar phenomenon in The Echo Maker, where an alteration in a single brain has amazingly widespread effects, altering in turn whole sensibilities, whole relationships and families, whole lives.

Not long after the awkward and embarrassing incident above, it was announced on the news that the actress Natasha Richardson--daughter of Vanessa Redgrave, wife of Liam Neeson--had died because of a seemingly--but really only seemingly--minor head injury, which she sustained when she fell during a skiing lesson, after which she was talking and laughing and refused medical help. She died of apparently serious brain damage, which I won’t bother to explain here, two days later. That evening, when two American parents heard of her death and the circumstances surrounding it, they thought of their seven-year-old daughter, who had had a head injury, seemed to be fine at first, but had after two days, when they went to see her to bed, begun to complain of a headache--a pattern almost exactly like Richardson’s last days. Making the connection, the parents called their pediatrician, the girl was transported by helicopter to a hospital equipped to deal with the injury--which was the same as Richardson’s after all--and she survived basically unscathed. Then I heard on the news about a lawyer in the Midwest who was using the possibility that his client had Asperger syndrome as a defense in a murder case, claiming that his client was “laboring under it” so that he “didn’t know the nature of his actions or that they were wrong.” Wisely, the judge rejected this defense. Still, knowing what I know about Asperger’s, I found the lawyer’s attempt outrageous. When I mentioned the story to Jeremy, he explained much more precisely that such a defense wouldn’t make sense with this particular form of autism, but could make more sense--he said this with an air of caution--with other forms, although it would be a controversial argument even then. He spoke, moreover, about the dangers of conflating neurological and psychiatric phenomena and the misuse of neuroscience--this surely rings a bell with members of our class. The brain, with both its power and its vulnerability, shapes our lives in real ways, on the individual level, and our world, on a societal level.

These coincidences and parallels reached a peak this afternoon when I was having lunch with a friend, who’s a novelist and professor. He mentioned, apropos of something else, having been on the committee that voted to give the National Book Award to Richard Powers for The Echo Maker. My friend, however, was the only person not to vote in favor of Powers’s book, which he said he hated. He said, furthermore, that he sees psychology currently and increasingly replacing philosophy and making it irrelevant, and he sees neuroscience replacing psychology; and this made him nervous, deeply nervous. When you study literature, it is sometimes said, philosophy is always right around the corner; but more and more it is psychology and neuropsychology that are around the corner, as Richard Powers unquestionably knows. Given my friend’s age and education, I should think that The Echo Maker violates fundamental ideas he holds about what literature is and ought to be. My friend, when we were discussing another thing entirely, mentioned that he’d recently met Oliver Sacks at a lecture and that they’d been e-mailing since, planning eventually to get together. They’d been talking about what “apprehension” means, from the perspective of a writer and that of a neuropsychologist. My friend said, fittingly, “I think I may be afraid of Oliver Sacks.” The brain, brain damage, brain science--they are omnipresent and to some people a major threat, a threat to aesthetic, intellectual, moral, legal, and philosophical views. I will admit, I felt a twinge of anxiety when reading The Echo Maker, because it gets at such visceral and deeply embedded fears and destabilizes some of our smug sense of safety, constancy, comfort, and so on.

Inherent Instability

2009-03-31T18:05:00.001-07:00

One of the major themes throughout Richard Powers’ Echo Maker is that of “the self” as a fluid and constantly changing entity. Each character challenges the assumption that members of our species—biologically endowed, as we are, with the prefrontal cortical advantage of self-concepts and self-awareness—are inherently coherent, consistent, or predictable. In Mark’s case, his very disorder (Capgras) is a direct reversal of such supposition, as are the unravelings of Karin’s and Weber’s respective personalities, David’s stoic and tolerant perspective, and Barbara Gillespie’s personal history (morphing from high-functioning journalist to mysterious nurse’s aid). Frequently, in fact, Powers addresses the notion that it may be delusional to believe in the constancy of self, or the qualities that define us as individuals. As Weber reflects, “our sense of physical embodiment [does] not come from the body itself. Several layers of brain [stands] in between, cobbling up from raw signals the reassuring illusion of solidity” (Powers 258). Or, as Karin sums it up: “the whole race suffer[s] from Capgras” (Powers 347).
Interestingly, each character’s “self” seems to be primarily determined by its relation to others (either another person or another thing). Mark, for instance, gains his identity as his sister’s brother, as his father’s son, as an accident victim, as a sufferer of Capgras, as an employee at IBP, as a buddy of Rupp and Cain, etc. Karin, likewise, gains her identity as Mark’s sister, as the daughter of Marks’ parents (her parents), as a caretaker, as someone who has been unfaithful in relationships, as a former smoker, and so on. Weber’s, in turn, is based upon his research, his publications, his relation to his wife (Sylvie), his holistic stance in neuroscience, and his role as a father (amongst other things). Thus whenever any of these external or “other” entities change, so the “self” that is reliant upon them for its definition changes. In the broadest and most apparent situation, Mark’s accident alters not only his perception of reality and his functional capabilities, but also alters his sister’s perception of reality and her functional capabilities. The latter alteration is a direct byproduct of Mark’s personal alteration—which, ultimately (as the reader discovers) has been precipitated by the entrance of Barbara Gillespie (an “other”) into an element of Mark’s self (in this case, his extended peripersonal space, just beyond his car on a highway in Nebraska). Simply put, the “self” is interdependent upon the “other.”
This notion fits in quite well with Nancy Cantor’s and Hazel Markus’s concept of a “working self,” as outlined by Ledoux in Synaptic Self. As the author summarizes, the working self is “…a subset of the universe of possible self-concepts that can occur at any one time—it is the subset that is available to the thinking conscious person at a particular moment, and is determined in part by memory and expectation, and in part by the immediate situation” (Ledoux 256). In turn, the manner by which certain motives are acted upon (and the manner by which certain goals are pursued) contribute to this sense of self, inasmuch as they endow a person with agency—or the free will to direct his/her actions. (As a mundane example, a person with a preference for dark chocolate is a separate individual from a person who dislikes dark chocolate and prefers hard candy, inasmuch as each—when a craving arises—pursues a different entity: the one with the relative incentive salience. Given some conditioning, however, such tastes are surely subject to change: if the dark chocolate, say, is mixed with ipecac, a taste aversion may develop that steers the former chocolate-lover in the opposite direction. Likewise for the hard candy fan)
Another similarity between Ledoux’s and Powers’ takes on the self is the acknowledgment of innate mechanisms that seem to underlie the more fluid and changeable personal identity. As Ledoux explains, one neural correlate of behavior is rooted in the dopaminergic pathways that exist in organisms whose brains possess an amygdala, tegmentum, accumbens, pallidum, and motor cortex. At the presentation of a novel conditioned stimulus (in this case, one that seems threatening—i.e. a tone associated with a painful shock), the lateral nucleus of the amygdala is activated, “…which, in turn, activates the central nucleus of the amygdala…[whose outputs] initiate the expression of species-typical defense responses (like freezing and associated autonomic changes) as well as activate arousal systems in the brain stem” (Ledoux 248). These structures, and their neurotransmitters (dopamine being the most important here) are universal, much like the postulated primary incentives and the respective drives to acquire them (i.e. food, sex, water—in no particular order). Thus, in contrast with the inconsistency of the less concrete self (i.e. the personality, labels one adopts, one’s individual preferences or secondary incentives like fame, money, or dark chocolate), the system that gives rise to basic responses and evolutionarily conserved functions (i.e. defensive reactions or defensive actions is quite consistent. Thanks to the central and basal amygdalar nuclei (amongst other structures), there exists an innate, unchanging response system, regardless of the personality built on top of, in reaction to, or as a byproduct of its functioning.
This notion of an inherent sameness or consistency as the basis upon which fluidity is constructed is also apparent in Powers’ writing. Most obviously, it is evident in his depiction of the Cranes’ migratory patterns: “Something in the birds retraces a route laid down centuries before” (Powers 4), wherein he underlines the innate (yet unconscious) tendency to return to some sort of root or home base. This is also apparent in his human characters, as Karin (for one) constantly complains of Nebraska’s inescapability and her futile efforts to escape her homeland (while also acknowledging her repeatedly unfaithful endeavors with David and Robert). In fact, Powers seems to point out benefits of a slight reversion to this earlier, ingrained, and unconscious behavior, frequently noting the advantage of losing the gauze of identity. Often, he casts Mark’s ostensible reversion in a positive light: “with an animal precision [Karin’s] had lost, his ears picked up stray pieces of surrounding conversations and wove them together” (Powers 37); “Damage had somehow unblocked him, removing the mental categories that interfered with truly seeing. Assumption no longer smoothed out observation…The lower the brain, the slower the fade. Love, in an earthworm, might never extinguish at all” (Powers 198). Perhaps this viewpoint is best expressed in Weber’s conclusion that “older creatures still inhabited us, and would never vacate” (Powers 231).
Both Ledoux and Powers point to several aspects of personhood: the malleability of the self, its inexistence without an “other,” and the innate, implicit basis upon which this fragile structure is seated. Thus individuation, in the human sense of personal identity, is not negated; rather, our uniqueness—our senses of self—seem to rest upon a firm and consistent base. This base, our innate evolutionarily conserved mechanisms (i.e. fear reaction and action, incentive sensitization, etc.) provides us with a secure jumping off point from which we can construct the less reliable and inherently unstable (yet explicit) selves—selves that we strive to establish continuity in, against all odds (even if that means confabulating from time to time).

The Illusion of Normalcy and the Mercurial Self

2009-03-29T22:27:00.000-07:00

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.

Personal Melodies in Dissonance

2009-03-29T15:47:00.001-07:00

How was everyone's break? I hope you all had a good rest and got some work done and traveled safely and all that. My break went a little awry right at the top--I was greatly enjoying the Echo Maker. I started reading it before break, and in the first week took it on my plane ride back home--and promptly left it in the seat pouch after I'd landed in Austin. Over the next couple of days, as I waited for my dad to pick up another copy at the bookstore, I found myself thinking a lot about recognition and homecomings, some of the themes in the book, if only because I no longer spend a lot of time in my hometown (which, being somewhat sheltered from the recession, is still vibrantly and rapidly changing all the time). I was struck by niggling feelings that something was wrong as I drove down the street where I lived after high school--and then realized the new owner of my old studio apartment had the door open, and she'd painted, and the color was different. Or I'd I find myself searching for an old friend in one of the enormous crowds sweeping the city for South by Southwest, and recognizing her from afar by the way she flicked her cigarette. As Karin does in the novel, I was instantly "at home" again both physically and psychologically, in an emotional and geographical place I'd left long ago--and it reminded me that mapping is still ever-present in my mind.

I'm not sure I ever wrote about this, but I was captivated a few weeks ago when we read a Sacks article online and someone referred to a patient's "motor melody" being disturbed. I think that is one of the most comprehensible metaphors I've come across to explain these altered states of being, altered relationships of mind to body. In the novel, the entire melody of Mark's life had been disrupted by the accident, and yet he didn't see himself as different, but the whole world, and most specifically, his sister, or her impersonator.

Because there's simply no way to comprehend inhabiting a Capgras mind, I kept reaching for strange metaphors to explain it to myself. For instance, when Richard Powers was talking to Terri Gross about the artificiality of typing and composing at once, I turned that into a way to understand the artificiality--or mechanicalness, I suppose is more correct--of how we recognize and represent the outer world to ourselves. I tried to imagine what it would be like to not simply know my sister, but to have most of the elements there and then have others ask me to convince myself that she was really the one. This problem that Capgras patients simply don't "feel" like the person is their loved one is awful. Few people, in other circumstances, have to consciously construct their most intimate relationships, they simply are.

Powers eloquently describes the effects of this emotional brain-damage on the bystanders. It seems that Mark makes everyone doubt themselves (except perhaps Barbara, who is in her own way shaping a double identity)--or perhaps not doubt, but re-examine the way they are positioned against other people. As Dr. Weber's mid-life crisis (for lack of a better term) creeps over him, he has the added uncertainty of this young man who for all intensive purposes seems functional--and yet is very, very damaged. Karin slowly becomes convinced, and begins to voice her belief, that Mark is right, that she can't be his real sister. Her pain in dealing with this disconnect is haunting. We've seen other spouses, siblings, and parents dealing with a loved one who is taken from them by a malady or condition--but never before someone who loses *themselves* because of another's illness.

Reading this novel just after Lying Awake brings us again to the issue of a patient's role and involvement in their treatment. Sister John, though she went through turmoil in the process, was actively involved in planning the course of action and had a great deal of input into how her illness was going to be viewed. Mark, on the other hand, because of the very nature of his deficit, was unable to productively participate in treatment and actually effectively blocked people from helping him. So would it have been right or wrong of Karin to have left him to his own devices, to wash her hands of the matter because this new, strange brother before her believed he was fine and the rest of the world was crazy? It's hard to say, especially because she needed him to "recover" to regain her own sense of self, so in a way her actions were almost as selfish as those Dr. Weber was punishing himself for. How do you treat someone who thinks they don't need treatment? And who is to say that a nonlife-threatening condition must be corrected?

Becoming a Part of Her

2009-03-09T20:20:00.000-07:00

A theme that has surfaced in our readings and discussions has been, in some cases, the concept of a mental illness becoming an all-consuming, self changing part of the affected human being. It has the potential to become an actual part of the person rather than something outside of them. It can make a person who they are. There is no longer a differentiation between the self and the disease. In Mark Salzman’s Lying Awake, Sister John lived years with migraine-like headaches that gave her “a wonderful experience, but it’s spiritual, not physical” (47).

I found that the decision to place this story in a cloister with a nun who is affected by epilepsy is a very deliberate decision. Epilepsy is a disorder which can make the patient feel that they are “becoming so drawn into the altered world created by the disorder that one loses interest in everything else” (68). The days spent in the cloister are used for the purpose of becoming closer to God. The goals are to be as selfless as possible and to put oneself “in [God’s] hands completely” (125). In the cloister, the nuns are meant to lose themselves in religion. There no longer is a material world. Epilepsy, just like religion, is impalpable. Sister John experiences her epilepsy so that her spiritual world and physical world become undifferentiated. According to Sister John, Epilepsy is a disease of the will of God. She gives God full power over this illness and loses her will to cure her epilepsy. She questions her surgery because surgery used to cure epilepsy would mean questioning God. The narrator states that for Sister John, “leaving the enclosure made her feel uneasy, like being caught in an open field with a storm approaching” (38). The cloister and her place in it has been what defines Sister John. Everything that she experiences within the cloister whether it be physical or emotional becomes entangled within her identity as a whole.

Something that was quite striking in Lying Awake, was Sister John’s reaction to her diagnosis. It seems as though she was very much aware of her life, pre-epilepsy. She knew there was difference between her pre and post epileptic life and must have believed that it was due to some sort of religious awakening rather than a physical cause. The epilepsy actually improved Sister John’s emotional life. She states that “if the surgery were to take my dream away, everything I’ve gone through up to now would seem meaningless. I wouldn’t even be able to draw inspiration from the memory of it…” (138). In this moment sister John begins to separate her illness from her religious life, admitting that the epilepsy has made her religious self, a more meaningful self. She comes to the conclusion that the medical world and the religious world might be separated and that her doctor may not understand her “take” on her condition.

To Sister John, epilepsy is something that was given to her by God, a condition that was designed for her. To the medical world, her way of life seems like “hyperreligiousity” and “the choice to live as a celibate: hyposexuality. Control of the will through control of the body, achieved through regular fasting: anorexia. Keeping a detailed spiritual journal: hypergraphia” (153). Many of the mental illness that we have studied in class so far have seemed like an exaggeration of a neurotypical mind. In this case,however, Sister John contradicts the idea that what she experiences is “hypertypical”. She sees her epilepsy and her way of life as being normal and different from the material world, but not an extension of the “norm”. To Sister John, epilepsy is who she is, her conception of “neurotypical”.

The time has come, the Walrus said, to talk of many things

2009-03-08T23:46:00.000-07:00

The obvious place to go with this week’s reading is in the direction of neuroethics, specifically into the realm of what a diagnosis of temporal-lobe epilepsy (or other conditions, as in the reading in Heilman) means for different people in a practical sense, which is to say “how a diagnosis of TLE can have an ultimately positive or negative, singularly extraordinary effect on a patient’s life.” Lying Awake sets the topic up in the framework of Sister John’s religious faith, and later brings in references to famous cases (e.g., Fyodor Dostoevsky) and posthumous diagnoses of “likely candidates” (e.g., Vincent Van Gogh, Saint Paul of Tarsus); Sadi Ranson-Polizzotti addresses it repeatedly, if indirectly, in her references to how “in the Victorian era, epilepsy was a disease of ‘idiots’ and ‘madmen’” and “the stigma of the condition”; and the chapter of Heilman, for all its intense discussion of regions of the brain, inherently includes a human element because of the constant demonstration of concepts through case examples.

The most apparent issue at hand, most notably in Lying Awake, is how wildly a diagnosis can alter the fabric of someone’s life. On the one hand, we have two cases of epilepsy in this week’s reading where the diagnosis, ultimately, altered the sufferer’s life for the better. The easier of the two to discuss is Portia, Heilman’s epilepsy patient at Northeastern University: her “frequent and disabling” (Heilman, 75) grand mal seizures (big bad seizures; also called tonic clonic or major motor seizures, these seizures present with the convulsions typically associated with seizures in general) clearly and significantly upset her life, and the failure of drugs to regulate and control them leads to the conclusion that surgery may be the best option. She receives surgery, has the right amygdale removed, and her life returns to “normal” (Heilman, 76).

Sister John’s case sees the same eventual end, but takes the long way of getting there, no doubt due to the difference in the presentations of her epilepsy and Portia’s. The first marked difference is that, unlike Portia’s grand mal seizures, Sister John’s TLE seizures, with their prominent headaches, disturbances of vision (“the left side of her vision got blurry,” pg. 114), distortion of perception (c.f., pgs. 116 & 135), and the one fit of losing conscious awareness and “wandering around the choir, staring at the ceiling and humming to herself” (pg. 136), would be classified as complex partial seizures. Although they have the potential to be incredibly disruptive, complex partial seizures are often not as readily visible as the convulsions of grand-mal attacks, which complicates things: on one hand, the accompanying headaches and symptoms can be misdiagnosed as migraines (as they are with Sister John); on the other, the visions and altered states that usually typify a complex partial seizure can be seen as a benefit or a sign from God.

Further complicating the matter are the emotions Sister John experiences before and after her seizures. In contrast to the “normal” presentations of epilepsy, which, like Portia, are typified by fear preceding the onset of a seizure, Sister John’s TLE manifests with feelings of intense euphoria before she seizes, followed by the hypergraphia that leads to her impassioned spiritual writings. What afflicts her is known as Interictal, or Dostoevsky, Syndrome (the model Dostoevsky “followed so closely that the syndrome was eventually named after him”, pg. 120), “A condition sometimes observed in people with temporal lobe epilepsy, characterized by intense productiveness, often in writing or artistic work, between convulsions” (encyclopedia.com). Indeed, the most fear that we see Sister John suffering from during the course of the novel comes after her diagnosis, when she agonizes over whether to sacrifice her current understanding of God and her faith by accepting the surgery and losing her seizures, or to consider that she hasn’t been blessed and is, instead, just suffering from a neuropsychological disorder.

Although making the decision takes her some time, her choice is eventually shown to be a positive one, most overtly in the final scene, when her new “understanding” (pg. 181) opens the opportunity of being the novice mistress to the former actress, Claire Bours, and even in small details, such as Dr. Sheppard (aptly named, given his function of leading Sister John out of epilepsy and towards her true faith), whose “expression chilled her” (pg. 45) in their first meeting, giving her a box of discarded medical scissors to take back to the monastery.

Despite these two cases, though, we are also given one major case where the diagnosis of epilepsy is so powerfully stigmatizing that the sufferer no doubt denied it vehemently, and most biographers would rather make allusions of pedophilia than deal with it. The case of Lewis Carroll/Rev. Charles Lutwidge Dodgson is an interesting one, made more so by the presentation in Sadi Ranson-Polizzotti’s article. Throughout her extensive case, she expertly weaves back and forth between discussing Carroll/Dodgson’s epilepsy, its effects on his life, and how it influenced the creation of his stories (and, by extension, all of children’s literature), the accusations of pedophilia and why they’re so enticing, and how a good deal of the “evidence” used to condemn Carroll/Dodgson as a pedophile is either suspicious (e.g., the series of books that all reference each other, making claims about Carroll/Dodgson based on “gossip”) or able to be interpreted as a symptom of his epilepsy. The picture that Ranson-Polizzotti gives us is a rather bleak one; her interpretation of Carroll studies and of society in general doesn’t suggest that epilepsy is horribly misunderstood and unfairly stigmatized by most of the Western world, but only because she’s too busy clubbing the reader upside the head with the idea.

Regardless of where, exactly, the different materials for this week’s readings fall on the matter of what sort of effect a diagnosis can have on a person’s life, they offer us something even greater: a wealth of material with which to discuss the relationship between brain and behavior. If I may go on two brief tangents, the first regarding epilepsy, but away from this week’s reading, and the second within this week’s reading, but away from the topic of epilepsy: TLE and mood disorders are, actually, quite ideal for discussing the links between form and function in neuropsychology.

On the first tangent: in the opening chapter of her book Seized: Temporal Lobe Epilepsy as a Medical, Historical, and Artistic Phenomenon, author Eve LaPlante discusses Vincent Van Gogh as a “classic case” of TLE and shows the effect that the disease had on his life and personality, from prompting him to drink (unwittingly exacerbating his condition), prompting unprecedented fits of rage, and keeping him hospitalized for most of the last two years of his life. LaPLante begins with the extended fit that called for Van Gogh’s hospitalization on Christmas Day, 1888 – said fit involved threatening fellow artist Paul Gaugin with a knife, the infamous ear-hacking incident, and leaving aforementioned ear as a “‘keepsake’ for a prostitute who once posed for him” (LaPlante, 5) – and then traces Van Gogh’s personal history, family history, and medical history before concluding with how, in broad terms, the “more than a hundred alternative [posthumous] diagnoses” (LaPlante, 9) were wrong and it is a great disservice to ignore the fact that, in his lifetime, he was pegged as “[suffering] from a form of epilepsy” (LaPlante, 1). Clearly, even though Van Gogh’s diagnosis didn’t “save” him as Sister John’s (debatably) did, it is likely an important factor in examining his behavior.

On the second: the last case presented in Heilman’s chapter is that of Mary Jackson, the motivated inner-city Valedictorian who went to the Ivy League, succeeded for two years, and then underwent a rapid personality shift, the details of which take up most of the story. Heilman tells us quite expertly how she went from a high-achieving member of the Dean’s List to sleeping around, sleeping through classes, partying hard, and even contracting HIV, most likely as a result of her sex life. Although the eventual diagnosis of a pituitary tumor and its subsequent removal did not fix everything that the personality shift had altered – c.f., “Her mother thinks that she still loses her temper more rapidly than she did before the tumor developed” (Heilman, 85) – Mary still returns to “her old self” (Heilman, 85). In discussing Mary’s “old self,” Heilman is notably sparse with the details, but the effect is still clear: because of the brain tumor, Mary’s entire personality was upended and the course of her life had to be adapted to suit a virus she picked up on account of the tumor-induced personality changes.

We see the same notion in the rest of this week’s readings. From the sudden resurgence of faith that Sister John has because of her seizures, which is so overpowering that she can hardly stand to let them go until she sees their effects on her fellow sisters, to the altered states that Carroll/Dodgson committed to paper in the Alice books, we see fruitful examples of how the brain can have an overpowering effect on personality, behavior, and life itself. Naturally, it is dangerous to do all of our inferring based on atypical brains, but, as Heilman notes in his chapter, this is how a good deal of the work in this field gets done.

Exemption versus Accountability: to Rescind or Not to Rescind the self

2009-03-08T15:28:00.000-07:00

I found one of the most salient topics addressed throughout Salzman’s Lying Awake to be the rescinding of the self—or, at least, the grappling with choosing to do so. Most evident in Sister John’s dilemma towards the end of the novel regarding whether her choosing to undergo surgery is an inherently selfish or inherently self-less act, the consideration that the self as a hindrance spiritual achievement is quite evident. As Sister John conceives of it, “[t]he foundation of religious life…is a commitment to look beyond oneself”(Salzman 142)—and to strip oneself “…of self-will and self-love…[is] a means of clearing away all obstructions to the love of [what is conceived of/believed to be] God” (139). Indeed, the very act of sacrificing one’s self to some higher entity (be it a god, another corporeal person, an idea/doctrine, etc.) implies that the existence of that self was/would otherwise be an obstacle to whatever devotion one is attempting to engage in. In other words, to rescind the self implies it is in some way, not entirely facilitating to whatever aim one has in mind. This is very similar to the yogic concept of the universal Self (purusha) versus the manifested self (prakriti): the upper case version is supposedly the non-physical “seer” or “true self;” whereas the lower-case version is the physical, tangible “self” that is tied to identity, body, and labels. The former is supposedly the basis of all consciousness, existence, etc., the latter is the individual manipulation of such life-stuff. Here, too, the latter (the lower case self) is seen as a hindrance to accessing/being in communion with the former (upper case Self). [In fact, the lower case self is said to be a delusion—inasmuch as the idea that one is individual and separate is a fallacy that humans maintain by seeking individuation and identity—a concept paralleled by Sister John’s acknowledgment, albeit during petit-mal temporal lobe seizure, that “self had been an illusion, a dream” (18).]

Granted, letting go of one’s self-concept—of one’s identity—grants anyone a certain degree of freedom, in that he/she is no longer tied down to a set script of how to function; however, is this rescinding-of-self truly the most ideal outcome? Of course, spiritually speaking, it is one of the ultimate goals—indeed, one of the necessities in order to “merge with” or “access” a higher state of consciousness (or, at least, to believe that such a process is occurring). Is this, as religious-devotees would have the world believe, the most advantageous pursuit or activity when day-to-day survival and optimal functionality is considered?

I think not. On many different levels.

For one, to rescind the self—to sacrifice all that pertains to one’s individual personhood—is to rescind one’s agency (or one’s sense of it, at least). Without agency (or a sense of it), there is no accountability. One—in the absence of a self—becomes not only powerless but exempt. Take, for instance, a newborn baby: it does not yet have a self; its very role in maturity is individuation: the formation of identity that separates it (gradually) from other objects (both other people and other things). A newborn baby is not chastised for soiling its diaper, vomiting in public, crying at the drop of a dime as it has not yet required the personal accountability inherent in a self. It is still exempt. Likewise, teenager is not expected to pay taxes, rent an apartment, or hold a steady job: he/she, though having formulated more of a “self” than a newborn baby, is still not fully individuated from his/her caregivers (at least, in typical instances) and thus remains exempt from that which fully individuated persons are expected to be accountable for. With self comes personal responsibility (including care for self and others); without self comes lack there of (take sickness, for example, wherein one is not “fully his/herself” and thus is exempt from activities which he/she would normally undertake until he/she is back to his/her normal self-state). Giving up everything you are to something outside yourself (i.e. Sister Joseph’s—along with the other nuns’—cataloguing every adversity as “God’s plan”) is rescinding your own free will and agency in the matter: it is rendering your effort inexistent. Personally, I see this as an easy way out.

This is not to say, however, that it is not noble to give yourself over to another entity. Indeed, self-sacrifice in its non-extreme form is rather enlightening and irrefutably helpful to the world at large: who can deny that the altruistic efforts of doctors without borders, or other such volunteer programs have reaped immense benefits for others’ survival (or that cliché “common good” we are all moralistically supposed to be striving for)? The problem does not lie in letting go of the self in order to acknowledge and assist others; it is extant in the inflexible and rigid fixation upon a total abolition of individuality—a complete and total refusal to be accountable to the world at large.

In fact, it is my (perhaps controversial) opinion that sequestering oneself in a cloister, away from the world at large is an inherently selfish act—a refusal to use one’s human capacities (i.e. communication), a forced ignorance of realities other than one’s own, and, ultimately, contradiction to survival itself (one person alone, devoid of other humans can only survive up to a point—indeed the human race cannot survive if there are not multiple persons, some of whom are propagating future generations).

Not only is it (ironically) selfish, but it is also (again, my biased opinion) pathological. Just as the exaggeration of any other natural human tendency to a non-adaptable and non-functional extreme renders such a tendency injurious, the exaggeration of the natural human tendency to be self-less mirrors the symptoms of psychosis: the false-attribution of agency to external sources (such as in paranoid schizophrenia), the notion that one has no self/is not inherently “real” and/or that the self is inextricably merged with and bound to external entities—and thus has no stability of its own (as in borderline personality disorder).

Of course, the counterpart to this, the exaggeration of the natural human tendency to foster a self (to be self-focused), also drifts into pathology. Examples of this extreme are narcissistic personality disorder, anorexia (the obsessive self-centered drive to remain thin at all costs—though, arguably also attributable to external influence in many cases), as well as, say, anal-retentiveness as postulated by Freud.

Yet again, then, the theme of balance arises, when the necessity of both selflessness and selfishness (or, in this case, rescinding of self and maintaining of self) is contrasted with the over-expression of one leading to the extreme disregard of the other.

Nevertheless, the caveat remains that a person’s identity inextricably lies within his/her degree of self-sacrifice or self-focus—just as that same identity may be colored by varying degrees of quirks along a normalcy-pathology spectrum. Balance may be optimal, but it may not be achievable—as Sacks addresses in his furtive seeking of the ideal titration of L-Dopa for his post-encephalitic patients. Indeed, if it was—and we all achieved it—the world would be quite a monotonous environment. Thus not only a balance of both opposites are necessary, but so too is a gradation of their display.

Essentially, what it boils down to is this: I don’t consider it admirable to forgo one’s life and live in a cloister, exempting oneself from all worldly obligations (at least not at this stage at my life). I do not, however, have any right to deem this choice wrong. I find solitude to be extremely self-centered—necessary, at times, but self-centered. [Note: I am extremely guilty of this self-centeredness…especially during conference time]. But hey, that’s just an opinion generated from the self I personally choose to cling to in an act of non-exemption—the self I have formulated and adhere to in my (sometimes unsuccessful) attempts to be “accountable.”

Types of Memory: When is 'Amnesia' Applicable?

2009-03-04T03:00:00.000-08:00

"Clive's passionate relationship with his wife Deborah, a relationship that began before his encephalitis, and one that centers in part on their shared love for music, has engraved itself in him—in areas of his brain unaffected by the encephalitis—so deeply that his amnesia, the most severe amnesia ever recorded, cannot eradicate it."

- A Neurologist's Notebook: The Abyss

I found the passage above to best exemplify some of the strengths and weaknesses of Oliver Sacks' writing. The main goal of this line is seems to be to evoke a thought in the reader's head: "not even most severe form of amnesia ever recorded can deny this man love for his wife and for music --how beautiful." (That's the strength)

It is important and interesting to note that Sacks does mention between the dashes that the Clive's encephalitis did not affect those areas any of those areas of his brain, yet he deliberately maintains this characterization for the sake of the narrative. Logically, the sentence is like saying that Clive miraculously maintained the sort of memory of love for his wife through the most severe of ear infections, or really, any unrelated condition. --The reason I find this worth noting as a weakness is because rather than imply a undescriptive quantitative ('deepest') aspect of memory for the sake of the narrative, Sacks could emphasize the qualitative one, and we would end up with a more faithful perspective on what is going on in the brain and why the memory of their relationship was not forgotten along with other aspects of his life. He does this by mentioning the experiment with the needle-handshake and distinguishing emotional memory from other types of memory, but doesn't give us the same coherent idea of neurological underpinnings as he does in other writings. I'm looking forward to LeDoux's upcoming chapter on emotion, which will likely shed more light and detail on this aspect of memory.

Another topic I found interesting was Sacks' discussion of procedural memory with regard to Clive's retained ability to retain piano-playing skills:

"The basis of procedural or implicit memory is less easy to define, but it certainly involves larger and more primitive parts of the brain—subcortical structures like the basal ganglia and cerebellum and their many connections to each other and to the cerebral cortex. The size and variety of these systems guarantee the robustness of procedural memory and the fact that, unlike episodic memory, procedural memory can remain largely intact even in the face of extensive damage to the hippocampi and medial temporal-lobe structures."

I was glad Sacks added this much into the reading, but it left me with a lot more questions. We know that working memory proccesses are different from long-term memory processes which involve conversion via the hippocampi and also the 'reconstruction' process involved in retrieving episodic memories. We've seen in the case of patients like H.M., working memory is stable enough so they can partake in short tasks or have short conversations (like the Lost Mariner, but unlike Clive repeatedly thinking "I'm wake. Now I'm awake. No, now i'm awake").

Are there case-studies that show examples of 'procedural memory amnesia'? Is this because procedural memory completely different in that it does not require a highly specialized system for the reconstruction process? Or is there a way to produce amnesia of procedural memory? I look forward to gaining a better idea of this system...

One point I am unclear on is to what degree procedural memories are not physical. I think cracking an egg into a pan involves procedural memory, but remembering a routinely used omlet recipe might also be immune from retrograde amnesia, though it is difficult to measure since a person with retrograde amnesia typically will still know what an 'omlet' is. No one would argue that knowledge of vocabulary would fall into the same system as the procedural memories assumed to be in subcortical structures such as the cerebrellum, but on a theoretical basis, their coding or representation may be similar, or at least both different from episodic memory in that the content of the past memories cannot simply be split from the ability to learn new memories... Again, looking forward to reading about studies on language disorders and whether or not cases have been found where a patient has retrograde amnesia of vocabulary, or retains loses ability to learn new words, but maintains the past words. This at first thought appears unlikely, though it would help us further divide types of memory and gain clarity on how memories are represented through the brain.

another longish one

2009-03-04T00:11:00.000-08:00

Alice Munro is easily my favorite contemporary writer--the Nobel people should hang their heads low for snubbing her as they do, year after year--and I was delighted to see her on the syllabus. She’s a particularly apt choice, given the subject of the class. Sacks, Luria, Skloot--perhaps Nabokov and even LeDoux, though less so, and others--they all write to enlarge our view of the world, to heighten our sensitivity, to wake us up to a certain kind of diversity, and that’s cognitive diversity. One common trait of these writers is empathy; they seek to increase ours and their own. What makes me love Alice Munro is her empathy, her ability to see through another’s eyes, to be sympathetic but impartial, to accept the subtle shifts and interchanges among our strengths and weaknesses and quirks. She’s the ideal writer to tell this particular story.

Alice Munro--very much like Sacks, I think--is aware of our contradictions, of the push and pull of personality. A classic Munro touch: “She looked just like herself on this day--direct and vague as in fact she was, sweet and ironic.” Who better to capture the convolutions of neurological disorder, the constellations of gifts and deficits and sensibilities and disabilities that we’ve been discussing?

When I think back on my own grandmother’s unraveling--she had Alzheimer’s--I remember some of the weird contraries in her behavior. She did the goofy things Fiona does (placing a book in the refrigerator), and the dangerous things (attempting to drive her car over train tracks), and the maddening things (losing a valuable ring, a family heirloom), and the sad things (failing to recognize her own children, whom she saw weekly till the end). But--like Fiona with her “little yellow notes” or like the “motor genius” that Sacks describes--she had unexpected brightenings, flashes of energy and focus and capability, with a slight compulsive quality. She could recall trivia from decades before, even when she forgot to put pants on. She could read the newspaper from front to back, really read it and understand it, although she couldn’t retain the information for long. She could beat almost anyone in almost any card game. Strange contradictions.

It’s interesting that Fiona so obviously holds on to the ability to fall in love, feel great attachment, and show great affection and devotion. Many people, watching relatives succumb to Alzheimer’s, note an emotional unresponsiveness, affective deadness--at least outwardly, as with the “masking” Sacks talks about--and presumably parts of the brain implicated in those emotional functions are vulnerable to decay as well. But this wasn’t the case with Fiona--and to some extent I buy it. I remember feeling vaguely that, even as my grandmother didn’t recognize us or really respond to us, there was some warming-up, some rise in her emotional temperature, when we were present--something of her old self remained. Some part of her remembered us.

And an even older self, hidden before, may now get the chance to emerge from the depths of Fiona’s unconscious, as layer upon layer of her higher mental functioning is stripped away, “pulling everything to rags. All rags and loose threads.” She must have had some dim awareness, if not full awareness, of her husband’s infidelity, and in a sense, in her earlier life, she was always protecting him from his own folly, but the unconscious often stands in a compensatory relation to the ego, taking the exact opposite attitude. Naturally, when she’s ill, she adopts her husband’s particular vice--a vice that isn’t entirely bad, the narrator suggests: “Nowhere had there been any acknowledgment that the life of a philanderer . . . involved acts of generosity, and even sacrifice”--and there is that element in her behavior towards Aubrey.

All right. I’m tired. Time for bed. Sorry for the abrupt ending.

Memento: A keepsake; an object kept as a reminder of a place or event.

2009-03-03T17:51:00.000-08:00

I want to explore the connections between Memento and the amnesia case studies that we have read. I am particularly curious as to what everyone has to say about Leonard's anterograde amnesia and his conscious choices in dealing with this state. In Oliver Sacks “The Abyss” he describes the severe retrograde amnesia of Clive, a man who constantly lives in a confused and displaced state. He does not consciously remember how to describe how is wife looks, the lay out of his home, or his favorite musicians. While Clive shares the same disease as Sacks, Mr. T from The Man who Mistook His Wife For A Hat, Clive greatly differs in his approach to his disease. Mr. T is in a constant state of ‘chatter’ in attempts to fuse himself with a narrative, some form of self reference and understanding. While Clive is often talking and joking he does not confabulate as severely and fantastically as Mr. T does. While Leonard suffers from a different kind of amnesia, not effecting his past memories, he still deals with this idea of conscious confabulation Versus Sub-conscious Confabulation. Sacks describes Clive’s memory reconstructions or communications saying that “This sort of confabulation was not one of conscious fabrication. It was, rather, a strategy, a desperate attempt—unconscious and almost automatic—to provide a sort of continuity, a narrative continuity, when memory, and thus experience, was being snatched away every instant.” Leonard's confabulations differ from Clive and Mr. T in that they are conscious decisions at the times when he alters his physical documentations of his life (i.e. polaroids, notes, tattoos). Leonard's confabulations are actually self inflicted manipulations. They are conscious yet, he would forget about his choice in one moment to change his puzzle pieces. He makes these alterations to continue his investigation much like Mr.T would create this “inner narrative” at every moment of the day to continue his story; the one thing that connects a person to themselves, the world around them. What does it mean that Leonard's method of “remembering” is not that at all? It is in fact quite the opposite. Not only does he forget the truth, his version of the truth is self created, skewed to continue to keep himself from actually remembering what actually happened to his wife.
Leonard manipulates himself because he feels that this unsolvable puzzle he has created is the only means to his happiness; his worth. He struggles to find meaning and identity in his life much like many other memory loss patients of Sacks and Luria. There is this sense of struggle to find identity and connection in Leonard's existence.

Aesthetically, I think that this is shown through the choices of setting in the film. Christopher Nolan has purposefully created a Film Noir feel throughout the entire film. Film Noir is stylistically linked to German expressionist films which highlight the concept of physical confusion in one’s environment in relation to the unrealistic sets designed to represent shadow and light. Memento fits in with the idea of being a film noir in a lot of ways--there is moral ambiguity, the concept that the world is inherently corrupt, and certain character types such as the “femme fatal.” The black and white high contrasted hotel shots are the most blatant visual cue to Memento’s alikeness to a Film Noir. Leonard serves as the sinister and dark character who is never pleased, always in a state of loneliness and despair while Natalie serves as the “femme fatal” who uses Leonard to get what she wants. There is also very apparent moral ambiguity regarding Leonard's motives as well as all the other characters in the film. We, along with Leonard, are stuck in this mystery case. We have no understanding or reference to any of Leonard's past except for the “facts” that he has supplied...and he has a memory problem. This unreliable narration is the audience’s window into the film. The scenery surrounding the film is bleak and unrecognizable. We are never told where the film is taking place or given any sort of visual understanding as to where Leonard actually is or has been. We only know that he has been staying in a motel for an undeclared amount of time. Our very idea of what was going on in the movie, or the motives that were supposed to justify Leonard's actions are shattered at the end of the movie, forcing the audience to then do an active re-evaluation of all the previous actions just like Leonard has to do each day .. or every ten minutes. The audience is put into the mind and situation of a person with short term memory loss. We have to take the clips and bits of information that are completely out of order and try to make sense of them. How does Sammy Jankis fit into the story? Wait, who was Natalie again? Her boyfriend ? You are left with all of the questions and seemingly loose ends, but if you are able to piece the story back together in it’s completeness it still doesn’t make complete sense. We are forced to infer just like Clive, or just like anyone with memory loss has to do. You infer what you’ve just done or where you’ve just been.

Lastly, I wanted to comment on the quick editing that Nolan used in small portions of the film. It is actually really hard to catch if you aren’t paying attention but, there are parts of the film when Leonard will be talking about Sammy--for instance, when Leonard is describing Sammy in sitting in the hospital, Sammy is shown sitting in a chair. Very quickly the film cuts for a split second revealing Leonard sitting in the chair instead of Sammy. With this quick edit it becomes apparent, very early in the film, that there is a strong comparison between the two---or as we come to find out that he is Sammy Jankis. This happens again when Leonard is sitting on the couch in Natalie’s house with the TV remote. In a quick edit Nolan reveals an insulin shot in his hand instead of the remote. I think that Nolan has used this quick editing technique to portray the way in which Leonard possibly gets these quick glimpses of reality---The reason I think this could possibly be true is because it seems that when Leonard writes something in cursive either in a tattoo or on his polaroid he doesn’t intend to remember it. Or believe it at least. His tattoo of the “Remember Sammy Jankis” on his hand is in cursive. When he writes down what Teddy is telling him about Natalie he writes it in cursive...just to later cross it out. It is like Leonard is using this technique to ensure that he won’t remember these things or when he does that they are not valid.

Shifting Truths

2009-03-03T16:39:00.001-08:00

This week I thought about some of the fiction stories we read in light of a topic that we’ve been discussing in one of my other classes: the concept of truth. In that seminar we’ve been reconsidering the role our idea of truth plays as we interact with others and form relationships. The truths we know are always particular to our won experience and must therefore be considered in context. We are able to have relationships with others because our versions of the truth overlap in such a way that allows us to interact and share common perspectives with regard to experiences. Conflict within relationships takes place when the two people have opposing versions of the truth. It can be resolved if each person presents their perspective and the two eventually come to a consensual new version of the truth. But to engage in conflict there must be enough mutual understanding to allow the two parties to communicate. If there is no overlap in versions of truth, conflict will carry no meaning and the relationship will be empty.
As it relates to our readings, memory is elemental in the way we shape our perspective and develop the truths with which we structure our knowledge and understanding of the world around us. It is our memory of past experiences that allows us to agree upon certain realities, and therefore communicate with others. When a person’s memory starts to break down, these realities deteriorate leading that person to become increasingly detached from the relationships that were once of great importance in their lives. In the Alice Munro story, Fiona and Grant lived together and shared a rich and rewarding marriage for many years, but once her memory starts to go all the life and meaning of their previous relationship is deflated. When he visits her in the home for the first time he is baffled to find that her version of the truth with regard to their relationship has completely shifted. She greets him not as her husband but instead with a vague and formal courtesy. Munro says, “He could not throw his arms around her. Something about her voice and smile, familiar as they were, something about the way she seemed to be guarding the players from him – as well as him from their displeasure – made that impossible” (5). Without her memory of their connection and all their shared experiences, Grant’s implicit understanding of how they should relate to each other in rendered valueless. Their shared version of truth is lost, and thus he senses a new distance between them that he cannot bridge with affection. Since she is living with new truths she is in a new world, and he knows that in this new world she would not recognize the affectionate gestures of her own husband.
The story demonstrates how shifting versions of truth brought on by memory loss can be particularly painful for the people close to the amnesic person when some consensual truths remain in tact. Munro shows this in the scene when Grant is driving to Fiona to the home, and they share the enjoyment of a memory of skiing in the moonlight. Grant thinks, “If she could remember that, so vividly and correctly, could there really be so much the matter with her? It was all he could do not to turn around and drive home” (3). The overlap in understanding that still exists makes the discrepancies all the more hard to bear for the people close to the victim of memory loss.
The issue of truth comes into play in the Walker Percy story, “The Second Coming.” Written from the perspective of someone with an unreliable memory, the narration give the reader the sense of a shifting sea of truths were nothing is solid or certain. In the opening scene we are brought into this bewildering world, where each new circumstance brings old realities into question. Percy says, “As her mind cast about for who or what he might be – a new kind of runner? masquerader from country club party? Halloween trick-or-treater? – she realized she did not yet know the world well enough to know what to be scared of” (Lethem 102). Although she has the capacity to list different possible explanations for her strange visitor, she also recognizes that knowledge of reality and what defines a useful version of the truth is too limited to allow her to understand the situation. She cannot attribute her trouble to amnesia, but instead to a general confusion as to what exactly she has learned from her past experiences. The issue reveals itself in another form when the main character contemplates love and happiness. She thinks, “Is one supposed to do such-and-so with another person in order to be happy? Must one have a plan for the pursuit of happiness? If so, is there a place where one looks up what one is supposed to do or is there perhaps an agency where one consults?” (110). In this part of the story the reader senses the failure of the main character’s mind to do what comes naturally to most people with working memories – that is, construct versions of truth based on experience. While most of us are able to develop ideas about love and happiness simply by remembering our feelings with regard to certain events in our lives, this story lets us consider the perspective of a person who cannot rely on her memory of the past to help her define truths to live by.

Blissful Ignorance? I Think Not...

2009-03-03T10:50:00.000-08:00

While reading Oliver Sacks’s “The Last Hippie,” I found myself questioning some of the precepts of yoga. Particularly, the Yoga Sutras-—which, prior to my having taken any cognitive science classes, seemed (to me) to be the ultimate answer to everything-—as it was, apparently for Greg F. and his fellow Krishna Consciousness comrades. [The Yoga Sutras are the ancient Sanskrit notes taken by students of Patanjli—the assumed first ever yoga teacher (who may in fact be several people; this is highly debated by yogic philosophers)—compiled around 200 B.C. The sutras provide the basis for the practice of yoga, of which the physical postures widely known in the western world comprise only one eighth—i.e. only one of the proposed eight limbs of yoga, which catalogue all aspects of leading a yogic lifestyle. Think of it as the bible of yoga]. Granted, I was slightly more naïve at the time, but I have always thought that such scriptures—and I say scriptures without the least intent of sounding religious—contained in them a vast amount of knowledge that was simple, but applicable to the world at large. Of course, the concept of enlightenment—or, Samadhi, in Patanjli’s words—was always well beyond my grasp. However, much of the wisdom contained in the sutras seemed to be validated by (and more clearly illustrated/proven) by the knowledge I acquired in psychology classes, cognitive science classes, and even biology classes.
Concepts concerning being in the present moment, stilling the mind, letting go of material attachments (including attachment to one’s own body), and more have certainly colored my interpretation of the psycho-physiological aberrations we have read about thus far. For example, I believed that Skloot’s mental deficiencies were, in part (though not entirely) a gift: a forced embrace of simplicity that would have been otherwise impossible for him. There also seemed to be a kind of deliverance from the norm in other cases of memory loss, often referred to as a forced existence in an “eternal present” which, I found, strikingly similar to the goals of many meditative practices.
When, however, Sacks compared the symptoms of Greg F’s frontal lobe damage with the assumptions of Swami Bhaktivedanta and his followers, the latter’s opinion seemed utterly…stupid. Thus there was a huge discordance now between something I had very much thought was informative, true (an ambiguous term in itself, but that’s fodder for another post), and accurate. I wondered if I was indeed ignorant or naïve in agreeing with the yoga sutras for so long, and I began reevaluating their importance to me. So I read through them again, especially focusing on the sections discussing Samadhi (a gradation of enlightenment), definitions of serenity and explanations of how one achieves such states.
Thankfully, I was well assured that the sutras did not seem to advocate frontal lobe deficiencies, nor did they seem to propone that any particular cerebral structure would promote a more advantageous mental state. Though, given the era of his writings, Patanjali was probably not well versed in neuroscience, it was clear that what he had to say was obviously not called into working memory by those individuals who deemed Greg “an illuminate…[with] the ‘inner light growing’” (Lethem 197) or one “having achieved ‘detachment,’ and Enlightened One” (Lethem 200).
To these individuals’ credit, it is easy to see where they would have been mistaken. The twenty-seventh sutra (of the second book of the Yoga Sutras) asserts that the wisdom gained en route to enlightenment is “sevenfold [interestingly, enough, Ledoux’s “magic number” of working memory]…One experiences the end of 1) desire to know anything more; 2) desire to stay away from any thing; 3) desire to gain anything new; 4) desire to do anything; 5) sorrow; 6) fear; 7) delusion” (Satchidananda 199). Greg’s reluctance and refusal to learn Braille would seem to match the first qualification; while his reaction to everything with jokes might seem to fulfill the second [indeed, “virtually every object, every person, every sensation, every word, every thought, every emotion, every nuance and tone[,]” as Sacks asserts, elicited a pun from Greg (Lethem 208)]. In turn, qualifications three and four are ostensibly satisfied by Greg’s overall passivity, his “unnatural serenity that his Krishna brethren had percieved, apparently, as ‘bliss’” (Lethem 199). What with his lack of emotion (for the most part) [as Sacks describes, “there was no furious defiance, no raling at Fate, no sense, apparently, of indignity or despair” (Lethem 203)], qualifications five and six are also satisfied. Of course, it would be impossible to misconceive of the seventh entity: delusion. The fact that Greg firmly believed he was not blind, despite the fact that “his eyes showed complete optic atrophy” implies the he was clinging to the delusion of being able to see.
As regards instance, one (Greg’s refusal to learn Braille) it would be impossible to correlate this with a yogic state of achievement, since the very next qualification (that the desire to stay away from anything is supposed to end when one gains wisdom) discounts it as a possibility. (In other words: by refusing to learn Braille, Greg is not adhering to the second tenet of wisdom acquisition, and thus does not qualify as being enlightened.) Examining his incontinent wisecracking, the 38th sutra of book two (which emphasizes the necessity of “continence” [brahmacharya] (Satchidananda 137) disqualifies the behavior from any semblance to samadhic ascension. In turn, instances three and four (with which Greg’s passivity is misidentified) are rendered inapplicable by the requirement of non-distraction for true serenity or truly being present—or, what the sutras refer to as “the restraint of the modifications of the mind-stuff” (Satchidananda 3). The very fact that Greg was uncontrollably drawn in by and reactive to “..everything around [him] and everything within [him]” (Lethem 208) proves the inconsistency of his ostensible passivity. Finally, he indeed shows emotions by his reactions to the greatful dead and the sorrow he displays at hearing about the loss of his father—thus demonstrating the fallacy in the false attribution of Greg’s emotionless state to the end of sorrow and fear.
Appropriately, all such qualifications arguably require the prefrontal cortex, inasmuch as this structure gives rise to the higher-order processing capacities that neurotypical humans are capable of. Applicable to all seven byproducts of wisdom (or to the disappearance of all hindrances to wisdom), as per the yoga sutras, are the distinct capacities of top-down processing (a.k.a. executive functions) illustrated by Ledoux. These include attention (giving rise to mental “continence,” control of emotions, and the filtering of unnecessary stimuli); prefrontal cortical influence over what (temporal) and where (parietal) pathways in object recognition (which would prevent against delusion); and working memory (which, LeDoux argues, makes consciousness possible—and, of course, consciousness is a huge component of the awareness that leads to wisdom).
Thus it is not that the yoga sutras are inherently ignorant, wrong, or naïve (in fact, they, again, seem compatible!). Rather it is their misinterpretation that underlies the apparent idiocy of Greg’s Krishna comrades. Sadly, this misinterpretation led to the exacerbation of a tumor that, originally, could have been removed without adverse consequences experienced by Greg in its overdue extrication.
In this manner, Greg’s story disproves the very notion that ignorance is bliss. Though it may seem, irrefutably, to be just that (as Greg seemed to be blissful, and his symptoms seemed to be embodiments of enlightenment) it is just the opposite: ignorance is by no means bliss. To believe that it is, is to avoid taking full advantage of your prefrontal cortical capacities. (Or, more simply, to avoid the higher order thought processing that distinguishes us as human).

A Glimmer of Hope through Sadness

2009-03-01T22:50:00.000-08:00

Much like the case of William Thompson in The Man Who Mistook His Wife for a Hat, I was very intrigued in the case of Clive Wearing. Both suffer from severe amnesia, and both have trouble creating their own identity. However, the case of Clive Wearing becomes almost a hopeful message in Sacks’ article, at least compared to the case study devoted to Willie Thompson. Both patients suffer from retrograde amnesia, leaving no presence of their past lives in their mind, but with Clive, there is an interesting aspect of his illness. Even though Sacks refers to his case as “the worst case” of retrograde amnesia “ever recorded,” Clive is still able to take some emotional baggage with his disease. He remembers his wife, Deborah, and is much more animated and happy when she is around, and also is capable retaining the entirety of his musical prowess he had before his encephalitis. Sacks constantly states that retrograde amnesiacs are unable to retain any true memories, but are capable of picking up on things told to them as stories, thus explaining Clive’s WWII bunker stories. However, Clive’s musical ability, as well as the knowledge and love of his wife, does not come from his procedural memory, but from something more abstract which Sacks calls emotional memory. Thus brings up the question of Clive’s soul: does he have one? When Sacks asked the sisters at the hospital about Thompson’s soul, they were not eager to answer too quickly. Willie’s memory was so shot that he had to keep a constant narrative running in his head; a vague attempt at memory. Although troublesome to analyze because I do not have retrograde amnesia, I must argue that Willie’s, as well as Clive’s “souls” are intact. Although Willie’s predicament seems far worse, as he is unable to remember anything at all, and has no wife or activity to bring him to himself, the mere fact that he keeps his constant guessing-game narrative is a sign that there is some sense of loss. Sacks notes in “The Abyss” that retrograde amnesiacs have no idea that they suffer from amnesia. I would argue with some smidgen of hope that this statement is not true. It is very apparent in Willie’s case study that his narratives always begin with a strong sense of who the person standing in front of him is, but as he continues to guess their identity, and get it wrong, he becomes more and more frustrated and aware of the fact that he cannot remember. Granted, after this goes on for a certain period of time, Willie relapses and goes back to his strong assertions. In the case of Clive, he is unaware that he has no episodic memory, but he is aware that something is wrong. Clive’s wife Deborah notes that in the earlier stages of Clive’s amnesia, he would slowly seep into a depression like state, a “never-ending agony.” The actions of both of these patients shows that there is some resonating feeling of loss present in their minds. Unfortunately for both, it comes in a sad realization that they are losing their memory. Although they do not know this directly, they are certainly aware that something is wrong. This brings me to my next point, which is where this sense of self comes from. What it is in the nature vs. nurture argument that makes the sense of the self so strong that one can realize, even with retrograde amnesia, that something is wrong. Through Sack’s writing, it is not apparent to the reader the extreme emotions presented by Clive because Sacks is constantly describing his witty antics, but through small snippets from Deborah and Clive’s documentary, we do get a side of Clive that is truly upsetting. But this upsetting and unsettling side of Clive becomes a glimmer of hope because there is a chance that the self is there. This argument is solidified by his love for Deborah and for his music. It is unfortunate that the soul must be realized at such great a cost.

Questions To Which I Can't Remember the Answers.

2009-03-01T21:20:00.000-08:00

I am immediately struck by the different ways that the authors chose to manifest the amnesia in each piece. In many of the pieces, I did not realize until the end who the amnesiac was or what the instance of memory loss was until I got to the end of the piece and had a moment to think about it. This could very well be a reflection of me, but I like to think that it is reminiscent of the many different ways we use memory and how it can be affected.

I was especially intrigued by Philip Dick's "I Hope I Shall Arrive Soon". I certainly, upon first reading it, would not have grouped it as part of literature on amnesia. But, I love the idea that memory, however concrete we all would like to believe it is, is malleable; also, the thought that memory is more about the general feeling than it is the exact event. Kemmings is so overcome with the guilt he felt during each instance that there is nothing strange to him in remembering the cat eating the bird in conjunction with his French wife and their crumbling house. Though the types of guilt are different, he doesn't necessarily remember the specific instances. Instead, he jumbles them all together into one blanket of guilt spanning many many years. I know it's true for myself that if there wasn't some sort of intense feeling, be it excitement, outrage, or something else, I tend to forget the details of an even fairly easily. This is interesting though, because on many of the occasions where such feeling is involved, I am so overcome by the memory of that feeling that I could not, in a million years, accurately describe the events that preceded it.

LeDoux, in Synaptic Self, supports the idea that working memory serves as temporary storage and each memory can be interrupted when another process "bumps" it out of it's spot. So why don't we continuously replace long term memories instead of just pushing older memories deeper into our subconscious? How did Kemmings memories get jumbled? Was it really just because he was so overcome with guilt that he couldn't enjoy a good memory without something in it triggering the bad memories of his past? Or is it something similar to the working memory -- can one memory bump it's way into another? I'm reminded of the way S. remembers things in Mind of Mnemonist -- by placing them in rows along streets and in their respective countries. Clearly that is an extreme form of memory, exacerbated by his synesthesia, but could that same idea be applied to "normal" memory? Who's to say that the reason Kemmings associates all these guilty memories and mixes them all up couldn't be that he has placed them all in the same general area, and his "view" of each of them is over-shadowed by the next memory?

If memory is so malleable, and it is so easy to mix together a group of thoughts no matter how old they are, is it still something to be trusted?I can't imagine that even with the faults memory is not beneficial to humans and animals alike, but I do find myself questioning the authenticity of my memories now more than ever before. With regards to this piece especially, I have a much greater appreciation for the way my brain processes my memories and what "amnesia" actually is, as well as a more prevalent distrust of what I've recorded as fact.

The Necessities and Benefits of Past, Present, and Future

2009-02-24T06:00:00.000-08:00

Most would be quick to argue that author Floyd Skloot is by no means in an advantageous position—at least in regards to his mental and physical functional capacities, as well as his placement in the eye of public opinion and social hierarchy. Indeed, the author himself states that “in this social dimension…I remain a grave cripple and, apparently, a figure of contempt” (Skloot 199). What may not be as apparent, however, is how valuable such a seemingly unfavorable state is/has been for him. Though Skloot admits, “I have lost trust in my body” (46), and underlines his tenuous grasp on both his external and internal environments [“…the least pattern of noises distracts me and shatters concentration” (13); “I sometimes experience myself as disintegrating” (50); “[t]he means I use to compensate for my lack of integration separate me futher from the ‘natural man’” (53)], he emphasizes the many benefits he has reaped from the confines imposed upon him by his brain damage.
Ironic as it may sound, Skloot points time and again to instances wherein the limits established by his neurological degradation have allowed him to discover (and utilize) previously inaccessible depths of his own person. He emphasizes not only a consequential “new freedom to express…emotions” which allowed him to deepen his relationship with his older brother and daughter, but also a liberation in being “forced our of the mind, forced away from my customary cerebral mode of encounter… and into body, into heart…rewoven” (22). Skloot, unlike the majority of neurotypically functioning individuals who do not “have to think about how they work, or concentrate on most their functions” (48), must maintain a deliberate and intentional awareness. Rigorous and exhausting as it is, such awareness of self (even if that self is not entirely trustworthy in its stability) is immediately calls to mind the mechanisms of meditation—designed specifically to call one back to his/her self, to draw the mind away from the constant barrage of complex and incessant thought, to embrace simplicity. Ask anyone who has ever tried and they’ll probably tell you that meditation is not the easiest thing in the world to do. Jumping off to a thought about the future, the past, an idea, a feeling, a distraction is so difficult to avoid that being present is usually not achieved for longer than a few moments in a day. Of course, if one does not have the type of brain damage that Skloot has, he/she can get away with a constant circumvention of the present moment, an avoidance of being aware of oneself and one’s actions, an evasion of self-monitoring procedures. For Skloot, however, for his very physical (and, arguably, psychological) survival, he must be in a constant state of this self-monitoring so rarely entered (and freely overlooked) by others. As he describes, “for me to maintain balance, I must summon consciousness back to the fore in the process of movement” (50), “my balance disorder tends to show itself when I am caught off guard or most relaxed…” (52).
Of course this is still a challenge—as much as it would be for anyone, given the general difficulty of staying in the present or being self-aware; as Skloot is quick to point out, “the vigilance required to manage it is more debilitating than the symptom itself” (52). Yet to see his state only as a hindrance would be to vastly overlook the gift it continuously provides him. Skloot himself points to the “Zen of illness” (198) he has found in the midst of such disorder, a wonderful illustration of Frankl’s concept of spiritual elasticity [as Skloot later quotes: “man must cultivate flexibility to swing over to another value group if…[it] alone offers the possibility of actualizing values…temper[ing] his efforts to the chances that are offered” (198)]. Inherent in Skloot’s development of coping mechanisms is an embrace of simplicity, mandated by his brain-damage and manifested by a focus on the “eternal presence” (239), that would arguably not have been possible for him prior to his viral infection. In his words, “the sense of misalignment also leads to a letting go of many things that were important before. Symbolically, you have to free your hands for other purposes, such as catching yourself when you fall” (51). Thus there are many more advantages to his illness than are probably apparent at first glance.
It is important to remember, though, that either extreme is unfavorable: just as never being able to be present has far reaching advantages and consequences, Skloot’s mother’s absolute mental deterioration, wherein she becomes nothing but the present moment and cannot formulate a past or a future or any form of consistency, is by no means a positive experience for anyone involved—though Skloot does emphasize the softening of her character that had never before been possible. Yet again, then, we have the example of an attempt at striking a critical balance—in this case, between different points in time (past, present, future), all of which contribute a unique vantage point to an individual who accesses them. Yet again, also, there is the echo of Sacks in the notion that no individual parts account for a whole person, but rather the integration of parts lead to the realization of self. Thus it is not a single moment, or a single category of time, that gives a person their temporal awareness/identity; rather, it is the agglomeration of moments (those that have happened, those that are happening, those that will happen) that comprise this chronological perception.

Meditation, Mindfulness

2009-02-23T02:07:00.001-08:00

Many things here. Let’s begin with that wild construction of a new “amnesia genre”! Lethem says,

I had in mind fiction that, moreso than just presenting a character who’d suffered from memory loss, entered into an amnesiac state at some level of the narrative itself—and invited the reader to do the same. Fiction that made something of the white spaces that are fiction’s native habitat or somehow induced a dreamy state of loss of identity’s grip. (xvi)

So: Lethem’s seeking art that merges form with content- a style that evokes the neurological disorders addressed within! What Sacks continually struggles with is conveying to his audience the evocative experience of sensory alteration (no means an easy feat!)- he was moving in the same direction as Lethem’s collected authors- disclosing information until the “proper” time, attempting to somehow bridge that strange gap between the patient and the outsider. How do the various author’s achieve this neurological effect? I certainly felt the same creeping anxiety and unsettling calmness reflected by the patients within the pages.

Here, Lethem’s also stating that there’s something intrinsic to the properties of storytelling, or narratives, that shapes them towards expressing neurological disorders, specifically amnesia. White spaces are “fiction’s native habitat”, Lethem says, as if the writer’s task of summoning something up from nothing (an exaggeration) parallels the patients own clawing for a constructed past. Neurological disorders hint at the strange borders of our perceptions of reality. Is what’s there really there? And should it then be almost expected that illusions should best represent such conditions? After all, in such states, what is an illusion? (Forgive muddled speech here, hopefully the thought is vaguely conveyed?

In some ways, the methods of these authors are almost opposed to Skloot’s own work. They’re attempting to alter language, reality, etc. to attempt to capture that alien, anxious, exhausted sensation that comes with these forms of amnesia. Skloot, conversely, is trying furiously to, if you will, meet us rather than force us to meet him. He battles to construct linear, logically coherent thoughts. The whole book is his exhaustive, laborious attempt at capturing “normative” thought.

It’s interesting. Skloot speaks of the therapeutic benefits that come from constructing his narrative. The book is really another extensive conversation with his wife before bed. And yes- traditionally humans understand one another through narrative-

But then the difficult question rears up of... and I’m still struggling with this- how “rational”, logical thought... how LANGUAGE... should factor into Skloot’s life. Language, oftentimes, seems embedded in rational thought; it functions through a series of causes and effect- language is a map that illustrates the trajectory from point a to be to c. In this regard, it’s stunning that Skloot can write as well as he can (albeit, as he repeats, with great difficulty). However, so much of Skloot’s current life seems to illustrate a necessary retreat from such formal, structured manners of thought. Is writing a positive, “safe” way of experiencing these difficult processes (he notes that none can catch his mistakes), or is it still a clasping on to an antiquated part of life (a bustling city that he should move out of). Now: Obviously he’s receiving great joy and success from his writing, though he does remark of its pain... I suppose I’m simply attempting to make note of the necessity for acceptance spoken of throughout Skloot’s work. Which spins into the fact that...

Some of the most striking characteristics of Skloot’s experience are the potential positive ramifications that came from his illness. A doctor reminds Skloot early on that he should not equate intelligence with (and I forget the exact words here) brain/reasoning functionality. In discarding balance, memory, and reason, Skloot is allowed access to a level of awesome mindfulness and equanimity. In one of the books most stirring passages, he relates,

Since I cannot presume that I will remember anything, I must live fully in the present. Since I cannot presume that I will understand anything, I must feel and experience my life in the moment and not always press to formulate ideas about it. Since I cannot escape my body and the limits it as imposed on me, I must learn to be at home in it. Since I can do so little, it is good to live in a place where there is so little to do. And since I cannot presume that I will master anything I do, I must relinquish mastery as a goal and seek harmony instead. (28)

The process seems almost like enforced meditation- a narrowing down of one’s perceptions and abilities so as to reach a supreme level of condensed concentration. By being so immersed in himself, by acknowledging that he “cannot escape his body” he’s able to, well, somewhat escape. Just a little. He makes his way with the necessitated drive towards harmony, towards acceptance and mindfulness; the whole experience brings up connections to dozens of different spiritual practices.

Skloots speaks of the beauty that comes from a lack of necessity to formulate ideas about the moments he exists in. Yet, in doing so, he writes, formulating ideas. His communication upends some of the revelation spoken of earlier. Perhaps, like all things, reflection, the fight towards “rationalism”, must be balanced.

And again we reach the question: what is health? What is illness? How can we gauge the functionality, the success, of a person’s life? Especially when language and narrative (used successfully as a neurological communication device in the Vintage Amnesia, yes) can be such a source of... at times... strained rigidity?

There’s something up with language, with narrative, and communicating the neurological experience to oneself and others... right now I feel as if I’m circling over it like a buzzard.

The mind is not the brain, but what the brain does

2009-02-22T20:17:00.000-08:00

So many details, descriptions and definitions stood out to me from Skloot’s first five essays that as I read I already knew that composing a comprehensive post would most likely not happen. Dysfunctional Mentation. “Kickback”. Dyscalculic. Labyrinthine. I truly enjoyed reading a book written from the perspective of the “other side of the examination table.” I realized that the best way to fully understand—or at least try to relate—another’s illness is to have them explain it as they have come to understand it; using their own language, their own carefully developed examples and metaphors—all derived from living day to day with deficits and obstacles of the Self affecting the mind, the body and, in the case of Skloot, every breath, thought and movement. It is through the marriage of narrative, science and metaphor that we are able to really feel—in the purest sense of the word, that is understand—what and how this “insult to the brain” has manifested itself in the body and mind of a previously well-balanced and not only successful but ambitious individual.
I found that through the combination of quotes from neuroscientists and doctors and from poets and of course the author’s words, I was able to understand the neurological side of Skloot’s brain damage in a more complete way than say I understood Zasetsky’s injury. I felt this way because the person living with this altered mind and body was explaining to me as they had come to understand and live with it. The problem for Skloot is easy to understand: it is in the processing of functions and the crucial ‘putting together’ or integrating of these necessary processes that has been affected. He explains this several times in his essays and relates it to the many and varied difficulties he experiences. “Walked as if made of wood” created a distinct image of my head and called to mind others from real life instantly.
Many things left me wondering and longing for class to meet Mondays instead of just Wednesdays! Skloot earlier on describes his brain as porous, riddled. This choice of words left a big impression on me—to think of the brain as porous makes complete sense for his specific injury and subsequent memory, balance and visual recall difficulties, to name just a few. I thought his experience of being easily overloaded when reading a menu in a busy and loud restaurant or of getting exhausted after eating very spicy food was very interesting and, like many other phenomena he describes, thinking that I could sometimes relate in my own way. It goes without saying that, as Skloot himself explains on page 33, that it is too easy for one to relate to his blink of an eye memory loss or sudden confusion, and that although this experience definitely helped me grasp the possibility and feeling better, I cannot truly imagine. To simply offer up some details I found confusing and significant: Cell understudies on page 15? Skloot’s mishaps with pouring liquids into inverted bowls and using incorrect hand gestures? I found these things so interesting in that they perfectly demonstrated the loss of integration.

Nice Writing, Skloot

2009-02-22T15:33:00.000-08:00

“I do not mistake my wife for a hat,” Skloot says on page 40 of his book In The Shadow of Memory. Indeed, this is clear in the frequently iterated descriptions of his disabilities caused by brain damage. His specific accounts of individual occurrences provide a much-appreciated insight into his world, in a way that is different from the other narratives we have read. While the connection between Skloot’s situation and Zasetsky is stated obviously in the text, (“ “I was lost in time and space, it seemed; I felt myself, my mind, to be incoherent and my world to be in fragments.”), it is the tone and grace of Skloot’s prose that sets him apart. His writing is amazingly eloquent; I found myself transcribing quote after quote into my personal journals for remembering. Ethereal observations such as, “I have been resouled,” as well as blunt explanations like, “I know that I knew what I no longer know” have equal power in relaying Skloot’s exact experience. The prose itself is a balancing act between literary eloquence, accessibility and neurological descriptions that reads perfectly in the form of a good story. This feat is more extraordinary when considering both the heightening in emotion and the lapse in memory that Skloot describes as primary afflictions. The decay of his short-term memory leads to difficulties again similar to Zasetsky’s as far as writing is concerned, though definitely less extreme. Paired with his proneness to emotional overreaction, Skloot’s essays could have very possibly read like a angry tirade, if he managed to write at all. Yet he is able to write about his “insult to the brain” more collectedly than any other author we have read thus far. There is not so much irritation as with Zasetsky, not the keen contemplation of Luria, and certainly not the manic involvement of Sacks. The difficulties he describes sound very frustrating, worthy of anger, defeat, sadness, annoyance, etc., yet he writes in a way that is almost anecdotal, that is, lightly, cleanly, and with a balanced sense of humor. There is no sign of frustration in his prose, though there are descriptions of times he did feel that way. In some cases he sounds almost nonchalant or nostalgic. In any case, Skloot has certainly found more peace with his illness than any other, which I applaud.

Thoughts on "The Other" and Synaptic Connectivity

2009-02-20T17:07:00.000-08:00

The institution of categorization is an integral part of how we see and try to understand our world. A concrete example of this occurs in how we try to make sense of humans, as a whole, and understand ourselves within this larger framework- namely, lumping humans into the categories of "healthy" and "unhealthy." Although we are fascinated, and perhaps jealous at times, by Luria's depiction of S. in The mind of a Mnemonist, we label him as a flawed individual. We put him into the "other" category where we feel safe to pick apart the inner workings of his brain and, ultimately, make judgements about him.

However, what is ironic about this situation is that S. (as well as Borges' Funes), in a way, is the mind that lies dormant in all of us. In The Quick Guide to Synaesthesia, it becomes clear how similar all human minds are- how the potential for synaptic pruning to occur in a way that would afford us similar mental capabilities as S. are not as far removed as we'd perhaps, like to think.

I am curious what we will do with the ever-growing influx of information about synaptic development, memory retention, and syaesthesia. Will we try to find a way to prenatally alter the course of synaptic connectivity- perhaps induce a certain amount of reduced apoptosis to aid in "creative thinking," as the Quick Guide claims is common among people with synaesthesia. Similarly, I am curious what the Quick Guide means by "intelligence" and why people with synaesthesia typically possess more of this quality than others- and if so, why does it seem that evolution has favored synaptic pruning to aid in the differentiation of sensory areas in the brain?

Relationship between Synaesthesia and Memory Retention?

2009-02-18T01:57:00.000-08:00

I’m attempting to place all of these pieces together cohesively in my mind. So: can we say that both synaesthesia and radical memory retention are a result of a lack of synaptic regression? This is, perhaps, simplifying the process to a level that I understand it (after all, I’m still not certain what each synaptic connection really produces- is it the connection from one thought to another? What qualifies something as a “thought”? Maybe I need to brush up on LeDoux). Yet still, unpruned synapses would seem to imply a bevy of neurological connections, so that one thought led to another thought, which... etc. The “Quick Guide to Synaesthesia” describes a lack of differentiation in the sensory areas of the brain”- is this a result of synaptic regression? This mess of connecting thought patterns fits perfectly into Luria’s case of S., where one observation immediately led to a deluge of other observations, effectively drowning the poor man in a pool of information.

Perhaps this is the connection between synaesthesia and memory retention? I was struggling throughout the readings to understand why the two seemed to be interrelated. They didn’t necessarily seem tethered to one another- one can be synaesthetic without having the mnemonic abilities illustrated in the case studies. Indeed, it seems as if, in some ways, synaesthesia and memory retention serve to contradict one another in terms of potential effects. It’s noted in the “Quick Guide” that synaesthesia seems to be related in some way to creativity. It allows musicians to perceive music in a new way by connecting it to otherwise unseen attributes. It forges connections that spark insight and productivity. Memory retention, however, when it reaches the levels shown by Luria and Borges, can lead to a level of conceptual paralysis. Creativity, even understanding is not something we would connect with S., who is described as “dull” as synaesthetes are described as typically intelligent.

This is supported by the fantastic rumination on “forgetting”, and its importance in the mental process. As is brilliantly pointed out by Borges, “To think is to ignore (or forget) differences, to generalize, to abstract. (126)” That is, to think is to streamline thoughts, deeming some necessary, some unnecessary, to take the applicable traits and work them together into a cohesive line of argument. To generalize, to abstract, one must pinpoint specific qualities. Otherwise, as did S., we lose the forest for the trees.

What exactly is this phenomena that connects both synaesthesia and memory retention? It seems a strange, complicated brew. As discussed earlier, the two conditions certainly seem interrelated, in that they deal with the construction of unseen connections. With synaesthesia, these connections are productive, not so with memory retention. So what exactly is going on when the two fuse together?

A Tale of Two Mnemonists

2009-02-15T22:19:00.000-08:00

Borges’ “Funes” and Luria’s “S.” make for a fascinating pair of contrasting mnemonists. Comparing their respective mnemonic abilities from an external, practical perspective, Funes seems like a super-powered fantasy conception of Luria’s real-life patient, whose name a quick internet search discovers is Solomon Shereshevskii. While Shereshevskii can retain and subsequently reproduce a practically infinite series of random information under proper conditions, Funes retains everything; every piece of sensory information he experiences is preserved perfectly in his memory.

Funes’ internal memory – that is, his recall of his mental experiences apart from external sensorial information – also makes that of Shereshevskii pale in comparison. Shereshevskii has a lasting and detailed internal reality, a kind of mental world as palpable is the material one, which allows him, through its manipulation, to form mnemonic devices that have permanence thanks to their imagined physical nature. It is as though he has a computer game world existing inside his head which he can explore and manipulate at will. But Funes does him one better. He holds the entirety of reality in his memory, or at least as much of it as he can experience or imagine. While these worlds do not operate on the same level of complexity – the former is like a dream landscape littered with strategically placed symbolic images and storylines, the latter recalls the nesting warehouse theaters of the film Synecdoche, New York, limited in detail only by the attention of its owner – they both possess an inherent materiality that can both inhibit and aid the man whose mind inhabits them. When trying to recall a word from a series, Shereshevski might miss the word if its image were placed within his mental world in a place where it was camouflaged such that he might not “see” it clearly. He explains that this “happened with the word egg. I had put it up against a white wall and it blended in with the background. How could I possibly spot a white egg up against a white wall?” (Luria 36). Knowing the egg was against the wall was not enough. He had to be able to perceive the egg within the physical laws of his internal world. The world’s physics were in a sense thought-proof. But the physical nature of the internal world could be turned to his advantage. He could make the egg larger, in other words more immediately visible, to facilitate an easier recall of the image. Funes uses a similar device as a tool to manipulate his thoughts. To quiet his overcrowded mind for sleep, he would turn toward the new houses in his town that he had never laid eyes on and could only imagine as “black, compact, made of homogeneous shadow” (Lethem 126). Since he had never experienced them, Funes’ otherwise infinitely detailed conception of reality resorted to a blank, placeholder substance to fill the gaps he knew existed but could never perceive. His thoughts could not infer imagined houses; his memory of everything was so precise and specific that he could not generalize in his imagination to create anything less complex than the rest of his remembered reality. The placeholder shadow houses were so sturdy in their nonexistence that they became a refuge from thought and perception.

Shereshevskii would have been served well by such a refuge. Though their informational experiences differ as significantly as the natures of their internal memories – Funes endures an unending stream of information of overwhelming complexity, while Shereshevskii is muddled by blurring and interweaving sensorial experiences – both men are comparably overmatched by neural stimulation. Neurologically, I can guess that Shereshevskii’s sensory irregularity comes much earlier in the course of processing incoming information. He is sometimes unable to process a simple narrative, because each particle of information triggers a series of sensory experiences that distract from the communicative power of the original information. Funes had no such difficulty with taking in the full meaning of abstract information. His blessing and curse is that he takes in all information at all levels. If there is anything that can be gleaned from any sensory or mental experience at any moment, he retains it with perfect clarity. This wealth of information is too much to process if he is to achieve some semblance of clarity. Similarly, Shereshevski’s mnemonic abilities are hampered by the white noise of extra sensory input. The both want for a method to block out surplus information. It seems strange to me as one of the vast majority of human beings who forgets exponentially more than he remembers, but it is clear that for someone with infinite memory, the most desirable skill is the ability to forget.

thoughts on the mind of a mnemonist

2009-02-15T22:09:00.000-08:00

The Mind of a Mnemonist provides another fascinating study of an unusual set of neurological circumstances, refracted through the lived experience of an individual. I’ve enjoyed it, although I find Luria much more restrained than Sacks. Luria’s style reflects a certain discipline and distance, whereas Sacks tries audaciously to stretch neuropsychology to its imaginative and intuitive limits. Luria is a scientist with a humanistic turn of mind; Sacks is a storyteller and philosopher who retains some roots in the sciences. It may be that Luria simply reflects the conventions of his time; and, drawing on Luria’s influence, Sacks has been able to build on a pre-existing foundation, toward greater heights. I’m more inclined to think that this is a difference of personality between Luria and Sacks, however, and the question of personality is quite pertinent here.

All of the cases we’ve considered examine the most extreme neurological circumstances--which is important, because somehow the extreme cases bring to light less marked but noteworthy tendencies in more average minds. That is to say, by looking to the mnemonist, we can gain insight into ourselves. The distinctions between these cases and neurotypical minds is really a matter of degree, it appears increasingly, but not one of kind. In other words, it is a quantitative, not a qualitative, distinction. I remember, as a very young child, experiencing some synaesthesia. For instance, the name of my third grade teacher (Ms. Edward) always seemed decidedly green to me. I remember discussing this with a friend one day, who countered that Ms. Edward's name was not in fact green, but another color. We were both experiencing synaesthesia in some mild form. With age, this slight synaesthesia has become slighter for me, but there are still the faintest traces. What, finally, do we learn from this, this similarity to the subjects? What specifically? The information is fascinating, but I’m unsure of what exactly to take away from it.

The particular case of the mnemonist may be instructive as we try to grasp the psychology of personality. Jung was the first to propose an extensive system of psychological types. There were three primary dimensions of personality in his view, three main areas in which our personalities differ most dramatically (yet in consistent ways) from one another: introversion-extroversion, intuition-sensation, and feeling-thinking. I won’t bore you with too many details, but someone who has sensing as dominant function resembles the mnemonist in a way. Sensing individuals take in information via their senses in a literal, concrete manner. Intuitive individuals immediately abstract from sensory data. These are just prevailing tendencies, at ends of a continuum.The mnemonist, thinking in almost entirely sensory terms, represents a grossly exaggerated expression of a tendency that is present to one degree or another in each of us. Notions of normality and health--as we’ve been discussing a fair amount--are somewhat destabilized by much of our reading.

What I’d like to suggest at this point--based on our discussions of Sacks and Luria--is that we not view the case subjects as fundamentally different from us. They show us the brain’s most extreme potentialities, but these potentialities are latent within ourselves. Seen this way, the model of the doctor-patient relationship that Sacks proposed looks sensible rather than idealistic. They must be equals, two humans, each striving to understand more fully the humanity of the other.

Intellect and Memory

2009-02-15T19:06:00.000-08:00

Throughout our course material thus far, I've been struck by the regularity with which Sacks (and Luria, in Man with a Shattered World) describes almost every patient as having had a high intellect before whatever condition afflicted them occurred. It's unclear to me whether this is true, and perhaps the most precocious of brains are the most susceptible to damage or change, or if this is a fabrication, a stretching of the truth on Sacks' part in order to make a more compelling story. Perhaps it is simply that once a mind is gripped by Parkinsonism or sensory deficit or any of the myriad conditions we have discussed, the clarity of functioning beforehand seems all the more extraordinary and precious in contrast.

In The Mind of a Mnemonist, however, we have the story of a man whose memory functions much higher than any normal human being, but who also "[strikes] one as a disorganized and rather dull-witted person" (Luria 65). Despite-in fact, because of-the rich fabric of S.'s inner life and imagery, he has difficulty understanding a simple story. What, then, can be said of the relationship between intellect and memory? S.'s condition is both demonstrable to others and unknowable by them, as is the inner state of the Parkinsonian patient. How are we meant to measure the capacities and faculties of others, and what is the standard against which they should be set?

Analagous Balancing Acts

2009-02-14T14:52:00.001-08:00

Ledoux’s presentation of the Instruction versus Selection debate (regarding how, why, and when synaptic connections are formed in the human brain—as well as the extent to which they are influenced by inherent or exterior conditions) dovetailed wonderfully with Luria’s account of the synesthete/mnemonist, S. Not only does the former provide a conceptual basis for (at best) attempting to understand S.’s mind; but the latter—the case detailed by Luria—is an informative illustration of what happens when one of the two complementary mechanisms outlined by Ledoux (synaptic regression) seems to be missing from the picture. Thus Ledoux’s concept that a union between the two often opposed schools of thought (“selectionist nativism vs. instructional constructionism”) underlies ‘normal’ primate brain functioning is given weight—inasmuch as the consequences of a brain leaning more to one side of the debate (so to speak) are readily observed.

It would seem that, both metaphorically and physically, S.’s brain was incapable of undergoing a necessary pruning of connections—whether these were physical (neuronal) or conceptual (associative) by nature. Indeed, that S. was indeed synesthetic implies that the connections between his cortical sensory-association-areas had not undergone the usual parsing and dissociation found in a conventional adult brain (as per the Synasthesia Quick Guide). This structural abnormality (or gift, depending on your perspective) gave rise not only to the functional crossing over of his senses (inasmuch as he could taste and feel color, while perceiving words as colors and syllables as shapes), but also to a psychological and cognitive inability to parse and dissociate nonrelevant or unnecessary information. As Luria describes, “…whenever [S.] would have to deal with a sotry that had been read to him…S.’s faces would register confusion and finally utter bewilderment…‘This is too much. Each word calls up images; they collide with one another, and the result is chaos’…a far more difficult and exhausting job…than others do for whom the written word does not summon up such graphic images; who operate more simply and directly by signaling out key points in a passage—those that offer a maximum of information” (Luria 65). In a way, S.’s compensatory process of cutting down the details of incoming information, via his methods of “shorthand” (described by Luria under the chapter, The Art of Forgetting), can be likened to a self-imposed pruning: a top-down, conscious executive enactment of what usually occurs on a nonconscious, automatic level.

Though S. did find a coping mechanism for his inordinate retention of memory, he still experienced difficulties filtering out the extraneous voices, sounds, and bits of irrelevant sensory stimulation—such as when he began to confuse number sets on blackboards shown to him during his career as a professional mnemonist (Luria 69). Even his process of writing down that which he intended to forget—an apparent reversal of conventional behavior regarding memory—proved unfruitful, as images/words/concepts he wanted to erase repeatedly popped into his mind. This, of course, directly reminded me of particular disorders involving anxiety and obsessive thought patterns. Though S. should by no means be classified as obsessive compulsive or diagnosed with generalized anxiety disorder, the symptoms (or, reflections) of his anomaly are analogous to those symptoms (or behavioral manifestations) of such disorders. Simply put, the inability for S. to let go of a certain set of numbers or a string of phonemes—and the necessary compensatory behavior to rid himself of this persistence) seems similar to the inability of those afflicted with obsessive compulsive and anxiety disorders to release themselves from their compulsive thoughts, behaviors, obsessions. All such situations, in a broad and perhaps overly generalized manner, involve an inability to let go of superfluous stimuli, a difficulty putting to rest or quieting the mind.

All such examples, however, are in turn mere exaggerations of normal human functioning. Every individual experiences the desire to forget something that will not leave his or her head—for instance, an annoying melody, or a traumatic memory. In turn, most have experienced an inability to cease fixating on (or thinking of), say, an event in the future—such as an impending test or deadline; a nervousness about hearing back from an employer or college after applying. Additionally, as Luria is quick to point out, most humans have “…remnants of synesthesia…which are of a very rudimentary sort (experiencing lower and higher tones as ‘warm,’ others as ‘cole’; ‘seeing’ Friday or Monday as having different colors)…” (Luria 27). Thus synesthesia, also, is an exaggeration of the norm (as regards general/conventional human functioning). [Attentional disorders are also called to mind here, as they may be conceived of as an inability to filter that which otherwise normal individuals hear/see but are not distracted by].

In sum, every instance of exaggeration which may be termed anomalous curves back to the original dichotomy between Instruction versus Selection—and what happens when one side of the debate is more emphasized than the other. Perhaps, then, the ‘norm’ of functioning should indeed be perceived in Ledoux’s complementary sense, with innate characteristics (genes) giving rise to a plethora of structures, which environmental influences cut and parse according to both chance and conditioning. It is only when one such mechanism (either the preprogramming or, in this case, the ‘post-programming’) steps out of sync with the other that an anomaly arises—though this anomaly may be the very thing that individuates one from another.

Short snippet on amblyopia (goes well with To See and Not See)

2009-02-09T14:29:00.000-08:00

*sidenote: I listened to this interview a while back on a disorder called amblyopia, aka lazy eye...aka loss of 3D sight/stereo vision. If anyone is interested, it's very pertinent to Virgil's experience in To See and Not See.
http://www.npr.org/templates/story/story.php?storyId=99083752
Enjoy!

Demythologizing the Brain: Laypeople's Myths and the Ethics of the Artistic Neuropsychological Experience.

2009-02-09T01:46:00.000-08:00

At first glance, this week’s section of reading from Joseph LeDoux’s The Synaptic Self provides something undeniably necessary for any study of neuropsychology: an overview of “the most unaccountable of machinery,” the human brain and its various functions, focusing primarily on the eponymous synapses. Such an overview would be beneficial for any students of the brain, whether they were approaching it from our class’s perspective, from the perspective of the straight neurologist or psychologist, or from the perspective of an interested layman; however, LeDoux seems to say, from the chapter’s onset, that exposure to such knowledge would benefit more people than simply those interested in the brain. In his opening set of paragraphs, he discusses certain “beliefs” that people “tend to carry around with them,” such as the folk notion what “we only use 10 percent of our brains” and “part truths” that, when removed from their respective contexts, “are patently false.” “Most of us,” he writes, “are mystified by our brains” – and he spends the chapter addressing this “ignorance” from an evolutionary, chemical, and scientific standpoint.

Given his background in neural science and what he has proposed to endeavor with The Synaptic Self, LeDoux’s choice to write scientifically makes perfect sense and he does so quite efficiently. But, to play Devil’s Advocate for the moment, how much use is there, for the “average” person, in “demythologizing” the brain, which is to say explaining the chemical reactions, the functions of synapses and what stimuli in which regions or areas lead to which sets of openings, closings, and relays? The overall use of studying the brain is obvious: advances in neuroscience have found applications in medicine as well as psychiatry and, ideally, can be applied to help the greater wellness of the “average” people, but it’s all too easy for someone of higher learning to give an abridged version of what a diagnosis means to a patient. Even if the “myths” about the brain that certain people “carry around with them” are not entirely true, if said “myths” have some basis in fact, is it not better than people having nothing at all? In theory, it wouldn’t be difficult for the layperson to simply read The Synaptic Self and debunk all of the neurological fairy stories that s/he had previously held to, but if it’s easier for people to live their lives with a slightly limited or vaguely skewed understanding of everything going on in their minds, are they in the wrong for not wanting to have their notions discredited?

In addition to the logic of these questions, it is necessary to consider the emotional impact of “demythologizing” the brain on people suffering from neurological ailments, which was discussed quite well in this week’s reading from Oliver Sacks, most notably in his section, “The Landscape of His Dreams.” In the footnotes to the main narrative, Sacks mentions two different cases in which artists living with neurological ailments were reluctant to have diagnostic labels pinned to their minds’ lapels: in the first, Sacks describes how painter Girogio De Chirico “was subject to classical migraines and migraine auras of great severity” but, rather than “acknowledge a purely medical or physical cause for his visions” – which he apparently used to drive his painting and integrated into his work – he focused on the strong “spiritual quality” of them, only finally compromising with the term “spiritual fevers.” In the second, Sacks notes how, despite suffering from lifelong debilitating epilepsy, author Fyodor Dostoevsky uses his character, Prince Mishkin, to ask, “What if it is disease? What does it matter that it is an abnormal intensity, if the result… turns out to be the acme of harmony and beauty … of completeness, of proportion?”

The main narrative corresponds well with these notions: although the patient, Franco, a painter of exceptional skill but limited subject matter, finds confusion originating from the “doubling of consciousness” that accompanies the seizures preceding his artistic fits, and although his family members note what seem to be significant disturbances to his general functioning – according to his brother-in-law, “Back in ’61, Franco would talk about anything. …He wasn’t obsessed – he was normal.” and, moreover, the trouble Franco gets from his malady is enough to merit hospitalization, at one point – Franco still rejects the “‘medical’ possibilities” that could explain his obsession and his art, thinking, instead, that “A gift, a destiny, had been vouchsafed to him.”

Sacks, judging from his narrative and footnotes, has a clear understanding of the fact that, for some, “demythologizing” the brain is an ineffective method of assisting them. In one footnote, he even warns against “[going] overboard in medicalizing our predecessors (and contemporaries), reducing their complexity to expressions of neurological or psychiatric disorders, while neglecting all the other factors that determine a life, not least the irreducible uniqueness of the individual.” However, the artistic rejection of “‘medical’ possibilities” seems quite similar to the “myths” that LeDoux’s average people cling to regarding how the brain functions. Is a neurologically afflicted artist’s choice not to be diagnosed, thus, a method of ego-preservation – in that, by rejecting a clinical explanation, the artist keeps alive whatever notions of inspiration s/he holds – or is it, as LeDoux seems to argue regarding laypeople’s “myths,” a willful ignorance that impedes widespread understanding? Do artists have the right to hold their notions and to ignore the scientific aspects of their suffering, or is it necessary to take a reductionist approach, in favor of helping future generations?

Distinctly Human

2009-02-08T19:49:00.000-08:00

In my sociology class last semester, we were asked to write down what we feel separates us (human beings) from animals. Most people wrote that we can differentiate between right and wrong, we have the ability to choose which path we will take in the future, and we have will power (e.g. the will power when to eat or when not to eat). Not one person, including myself, however mentioned that we as humans are able to express ourselves and communicate verbally and we are also able to read and understand other human beings’ verbal and written expressions. We use language in our everyday lives with no regard as to how and why exactly it is possible. Something that struck me in A.R. Luria’s The Man with a Shattered World was the question of what makes us distinctly human. As Luria takes the reader on Zasetsky’s insufferable and seemingly endless journey, it becomes clear that language, something that we take for granted every day, is actually made possible through a very intricate and delicate brain process that can be shut down in an instant. The idea of losing the ability to think and communicate at the most basic level is impossible to even begin to fathom. One cannot know what that is like unless one were to lose the ability to use words.

There is a definite, deliberate method to the organization of The Man with a Shattered World. I think that, much like Oliver Sacks, Luria wrote this book in the same order in which he learned about and familiarized himself with this particular case. It begins with Zasetsky’s past and then there is a description of the brain and what damage was made by the bullet. After this description there are many of Zasetsky’s journal entries which include his own journey and struggle with aphasia. Luria then makes sure the reader understands the actual severity of this case in the chapter titled “Grammatical Constructions: The Third Digression.” I found this chapter to be a sort of realization; a breaking down of Zasetsky’s living hell. The reader is put through these journal entries which can begin to take a toll on him/her. There is a lot of repetition and at times it seems that Zasetsky will regain language, but never does. Luria puts the reader through the same frustration that Zasetsky went through and yet the reader is only able to be objective until “Grammatical Constructions” where he/she can become empathetic. Luria states that “intricate turns of speech that are so routine to us that we fail to notice their complexity are, in fact, codes that have taken centuries to develop. We readily employ them, because we have mastered linguistic patterns—our most basic means of communication” (126-127). The fact is that Zasetsky lost his ability to communicate, something that seems innate to humans. Luria makes a point to give the reader Zasetsky’s background in order to make it clear that Zasetsky was an intelligent, curious man before the accident and as Katie states in her comment, so much of his identity was lost when he lost his mode of communication. It is as though with this loss of identity, Zasetsky also lost touch with humanity.

What interests me is that Zasetsky knows words and can sense a certain familiarity in words, but “no longer had the capacity for such an instantaneous grasp of intricate patterns (whether spatial of linguistic relationships)” (128). He could not understand the concept of phrases, but at some points he could pick words out in a fragmented sort of way. Another question that is raised in this book is: why write? Why try everyday to remember and to learn if you have had an irreversible brain injury? I believe that although Zasetsky lost his ability to understand language and communicate with other, he still had something that is undeniably human. This something was his will to reconnect with humanity through language.

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

2009-02-07T21:19:00.001-08:00

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

2009-02-03T22:33:00.000-08:00

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.

2009-02-01T20:58:00.000-08:00

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

2009-02-01T19:48:00.000-08:00

"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

2009-02-01T12:31:00.000-08:00

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

2009-02-01T11:41:00.000-08:00

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.

thoughts on Sacks and Awakenings

2009-01-27T21:07:00.000-08:00

At the risk of sounding grandiose and overserious, I have to say that I found Awakenings to be an important reminder of human frailty and of the inscrutable power of nature. I felt the temptation, again and again, to identify with the post-encephalitic patients. And I do believe that there’s an element of the universal in their stories. One can see their constellations of symptoms printed in miniature within oneself. Dr. Sacks’s patients make one heedful of the mysterious, extreme, and sometimes terrifying potentialities of the human mind.
I suspect that, in tomorrow’s discussion, concern will be voiced about Dr. Sacks’s approach to the case history--about his style and voice, about the strong presence of his personality and his idiosyncrasies in the studies, about the boldness of some of his assertions, about his willingness to go beyond the outward and observable to the inward and intuitive. I would argue that what one may misconstrue as strange and excessive in the histories is in fact essential to the work of doctors, especially those, like psychiatrists and neurologists, who aim to treat the mind. And it is essential to all of us who seek to study and understand the mind. How often I’ve gone to my physician with a nebulous complaint, with the feeling that something is wrong and only a rough assemblage of seemingly unrelated symptoms as data from which the doctor can make deductions. Either I’m hysterical, or there is a kind of data to which the doctor’s ears and eyes are insensible. That is the data that Sacks takes into account, and that is principally what distinguishes these case histories.
A secondary distinction of his writing and clinical work is care. Care need not be sentimental, invasive, warm or fuzzy. Care cannot, however, be alive and energetic between doctor and patient, if their relationship is sterile and unequal. I want medical implements and facilities to be sterile, but my relation to the doctor and his to me ought to be based on sympathy and equality. Sacks understands that statistics and models and infinitesimally precise adjustments in the dosage of medications, though helpful, can never be adequate substitutes for humane sensitivity and thoughtful judgment, for humane consideration of the whole experience of the patient and of the patient as a whole person. I do not want to minimize the necessity of rigorous science and empirical data, but I want to emphasize the importance of generating abstract possibilities from those data with the aid of intuition and creativity, the importance of shifting one’s gaze from the specific to the universal and then back.
In the extremity of these patients’ situations the common substrate of human mental life is exposed. Sacks speaks in impassioned tones of Frances D.’s “releases or exposures or disclosures or confessions of very deep and ancient parts of herself, monstrous creatures from her unconscious and from unimaginable physiological depths below the unconscious, pre-historic and perhaps prehuman landscapes whose features were at once strange to her, yet mysteriously familiar, in the manner of certain dreams,” of “entire behaviours, entire repertoires, of a most primitive and prehuman sort.” He writes, “What we see here are genuine ancestral instincts and behaviours which have been summoned from the depths, the phylogenetic depths which all of us still carry in our persons.” This is Jung’s collective unconscious. According to Jung, and according to Sacks, we hold the same explosive potentialities.
But these case histories also reveal how thoroughly individual we all are. Consider the endless range of patients’ particular experiences of Parkinson’s, and the infinite variability of their responses to L-DOPA. How much of what we call individuality has a biological basis in the brain? That’s the first question I hope to explore tomorrow. Another pressing question has to do with Sacks’s hints and gestures as to what these cases might tell us about the use of psychoactive medications generally. He repeatedly suggests, alarmingly, that patients’ patterns of response to L-DOPA mirror the brain’s standard response to chemical interference in the form of medication (see p. 252). If Sacks is right, what does this augur for the multitudes who daily take medications for ADHD, depression, anxiety, sleeping troubles, etc.? Need we be afraid?
I apologize for the length of my post--I just really loved Sacks--and promise to be more succinct next time.

Stark Dualities

2009-01-26T19:49:00.000-08:00

I was struck by the theme of dramatic contrasts – embodied both in the environment and in the patients themselves - that came up throughout the book. In the section “Life at Mount Carmel” Sacks offers a romanticized picture of what the hospital once was, painting an idealized picture of a devoted staff and a pleasant surrounding countryside, before using the words “fortress or prison” to express what he felt the place had become. He admits that some staff members still exhibit a genuine affection, and his more profound point is that the institution is inevitably a melding of forces of good and evil. He states, “The hospital, in short, is a singular mixture, where freedom and bondage, warmth and coldness, human and mechanical, life and death, are locked together in perpetual combat” (25). He describes it as a place of constant contradiction, irresolvable in that the nature of an institution is impersonal, structured, and rigid, but the reality of the people that live and work there is one of human individuality, irregularity, and compassion. In his note on that page Sacks points out that “The coercions of institutions call forth and aggravate the coercions of their inmates: thus one may observe, with exemplary clarity, how the coerciveness of Mount Carmel aggravated neurotic and Parkinsonian tendencies in post-encephalitic patients; one may also observe, with equal clarity, how the ‘good’ aspects of Mount Carmel – its sympathy and humanity – reduced neurotic and Parkinsonian symptoms.” As I read the case studies the stark duality of the disease seemed prominent in most of the patients, as well as the impact environmental factors had, in conjunction with L-DOPA, on their awakenings.
One example is in the case of Frances D., who returned from a day-trip to the country, Sacks says, “in a most radiant mood, and exclaimed: ‘What a perfect day – so peaceful – I shall never forget it! It’s a joy to be alive on a day like this…It this is what L-DOPA can do, it’s an absolute blessing!’” (51). It was the drug that gave her the ability to control her movement again, but the change in her environment elicited her elated mood and new appreciation for being alive. Once back in the hospital, however, her uplifted mind and body collapsed into a peril equally as dramatic as her ecstatic state. Sacks states, “The following day saw the onset of the worst and most protracted crisis of Miss D.’s entire life,” and goes onto describe her physical torment that made up that crisis. It is as though once Frances D. had experienced the highest joys life could offer, her body felt the need to respond with equal negative force.
Hester Y. embodied another kind of harsh contrast in reaction to L-DOPA. While slow and largely motionless without the drug, once under its influence her movements became uncannily quick. In a note Sacks states, “It Mrs. Y., before L-DOPA, was the most impeded person I have ever seen, she became, on L-DOPA, the most accelerated person I have ever seen” (103). He goes on to describe her extremely accelerated reaction time, where she would catch a ball, count to ten, and throw it back, all in a split second. She did this, Sacks says, “without realizing she did it so fast.” Although the drug freed her limbs from their stupor, it accelerated not only her physicality but her mental actions to the extreme opposite end of the spectrum.
These kinds of harsh dualities seem to be a fundamental aspect of the sleeping-sickness and the effects of L-DOPA. Sack’s work highlights not only the of uncomfortable incongruity of institutions and this particular illness, but it also demands that we reflect upon the irresolvable contradictions we all face in our environments, and how we then embody them in our behavior.

Tangible Metaphors

2009-01-26T13:52:00.000-08:00

What struck me the most about the cases presented throughout “Awakenings” was the unmistakably metaphoric nature of each post-encephalitic and/or Parkinsonian symptom exhibited by the patients. Sacks himself underscores this out numerous times (most frequently in his extensive footnotes), as he relates the rapid L-Dopa-induced oscillations between akinesis and akathesis to “the ‘stationary states’ and quantal ‘jumps’ postulated of atoms and electronic orbits” (Sacks 111). In his own terminology, such behaviors suggest both “macro-quantal states” (in cases of hyperkinetic activity) as well as “micro-relativistic states” (in cases of catatonically warped or retarded activity).
If the analogies to physics continue, an even greater linkage can be seen between the critical (yet usually unattainable) balance between L-Dopa administration and behavioral outcome—the elusive balance point of the proverbial pin to which so many of his patients make reference. Even beyond the Newtonian principles of spatial improbability (outlined by Sacks’s footnotes, p. 201) is the same physicist’s well-known concept of gravity: one that has long been paraphrased as what goes up must go down. Certainly, this is the case for the post-encephalitic patients undergoing L-Dopa chemical therapy. In the majority of cases presented by Sacks, the more rapid an individual’s ascension to activity, the more rapid their descent or decline. One need only recall the case of Leonard P., who flew into egomaniacal delusions, wherein he envisioned the staff at Mount Carmel “…set[ting] up a sort of a evangelical lecture-tour, so that he could exhibit himself all over the States and proclaim the Gospel of Life according to L-Dopa” (210). Even before the reduction of his L-Dopa, Leonard was observed to fall into states of “rapid exhaustions or reversals of response…profound exhaustion, associated with severe recrudescence of Parkinsonian and catatonic immobility and rigidity” (215). The words of Frances D. prove equally pertinent, inasmuch as she described such psychophysiological symptoms as “…a vertical take-off…I’d gone higher and higher on L-Dopa – to an impossible height. I felt I was on a pinnacle a million miles high…And then…I crashed…I was buried a million miles deep in the ground” (201).
An even more intriguing correlation can be seen with various laws of thermodynamics. As the second law of thermodynamics predicts, any isolated system (i.e. an ecosystem, a cell, an organism) moves spontaneously toward states of greater entropy (with entropy being the amount of disorder in a given system). Simply put, disorder always increases – and the attempt to create order in any system only increases the disorder in surrounding systems. (A basic example would be the heat energy given off by a cell as it synthesizes a polypeptide to more efficiently carry out cellular functions: by burning energy from food to use to its own advantage, the cell inevitably increases the disorder of its surrounding environment as surrounding atoms are displaced by increasing temperatures). Such an event is grossly manifested by the results of L-Dopa administration in post-encephalitic patients: a predisposition to an increasingly degenerative disease is already present, which can only increase in its levels of disorder. Such necessity is exacerbated (if not precipitated by) the introduction of L-Dopa, originally intended to induce order, but actually invoking disorder as it chemically alters dopaminergic functioning in such afflicted individuals. Though a temporary respite may be experienced in the first few months of L-Dopa treatment, the ultimate effect of the drug’s administration is to disadvantageously alter isolated systems which had already been poorly-functional in the first place. Evidence of this can be found in patients’ sensitizations to the drug, as well as intensification of tics, psychosis, bipolarity, dystonias, and other ‘side-effects,’ though Sacks argues for the abolishment of this term. Sacks even acknowledges this truth, explaining that “all patients, then, move into trouble on L-Dopa…” (246).
Most importantly, however, metaphors resonating from post-encephalitic symptoms are more significant in the way they reflect and represent the personal lives of each patient. Though each behavior pattern may be undeniably linked to an external phenomenon (such as Newtonian laws of gravity or the Laws of Thermodynamics), true revelations are present in the manner by which they personify private conflicts (either concerning a relationship to a friend, family member, or hospital staff; or regarding a
Many times, the myriad symptoms (catatonic freezings, echolalia, hallucinations, voracious appetites, dystonia, etc.) seem to be non-verbal articulations on the part of the patient. Such ‘reactions,’ in a sense, have an uncanny connection to events in the patients’ lives and seem, in most cases, to be a physical manifestation of a response the patients cannot bring themselves to vociferate. It is no wonder, for instance, that various symptoms were exaggerated in response to the loss of family members or loved ones or (i.e. Margaret A., who suddenly developed encephalitis lethargica after the death of her father; Ida T., who developed a “sudden onset of impatience, irritability, impetuosity, increased appetite, and a violent temper” characteristic of the more hyperactive and psychotic end of the post-encephalitic spectrum after the death of her husband. Also: Rolando P. who, following a “cessation of [his mother’s] visits [experienced] a severe emotional crises; and Lucy K. who “imploded again, contracted herself to an intransigent point, infinitely withdrawn” after Dr. Sacks’ refusal to marry her).
Sacks, in his Perspectives section, speaks of the need for a different language that can better describe the plight of patients, a language which circumvents the dehumanizing and depersonalizing route of quantitative data and cold, mechanical analysis. In all actuality, the physical behavior of his patients seems to be just that: a language that cannot be tied down by statistics, that cannot be understood through an abstract mathematical model. A language that communicates more coherently and directly through physical metaphors representing internal emotional/psychological states. As Sacks sums up, “the person [or patient] shows forth in all his reactions, in a continual disclosure or epiphany of himself; he is always enacting himself in the theatre of his self” (259). If this is true, then the enactment of one’s internal world cannot be ruled out as an underlying force of post-encephalitic symptoms. The metaphoric nature of the disease becomes evident, and the behavioral responses both on and off of L-Dopa take on significantly more meaning: a meaning which eludes statistical categorization, as well as predictability.

Startingly Alive

2009-01-26T00:57:00.000-08:00

I am thankful to Elizabeth for having us read the prologues because they clearly and concisely provide much needed information about the history of, among other things, Parkinsonism, the Sleeping Sickness epidemic and about Sacks himself. Reading his at times hectic style in his additions and footnotes to the original ‘Great Awakening’ text prepares one for what is to come—accounts and explanations chock full of detail—detail one would have to know some history to fully comprehend. The many facts and elucidations Sacks includes in his first thirty pages truly pulled me in and made me want to get to the case studies as soon as possible so I could begin to read about the several different effects and manifestations he mentions in the prologue. I found myself questioning many of his statements. For example, I was very surprised and still baffled by the fact that the Mount Carmel ‘awakening’ is the only existing account of its kind. I am not sure if I understand the initial hostile reactions to Sacks observations by the medical community of the time. Was this simply because his finding seemed “beyond credibility”? I imagine there had to be some fear and excited apprehension on both the part of the author and the profession with the instance of such a monumental discovery like that of a ‘miracle drug’.
Sacks honest enthusiasm for what he was witnessing and studying is humbling. “What excited me was that the spectacle of the disease was never the same with two patients.” Here Sacks refers to the “wonderful panorama of the phenomena” that he saw in the post-encephalitic patients. I also thought that his writing style and possibly his inspiration in much of his research are apparently very influenced by his elders and contemporaries such as Ibsen, Cotzias and predominantly Luria. I think Luria’s “Romantic Science” study is what may possibly characterize much of Oliver Sack’s life and work. The “combination of intellectual power and human warmth’ is very much present in his case studies and descriptions of patient, doctor, attendant relations. The great promise of L-DOPA and the consequent threat for the patients is truly a perverse case in point of the resilience and strength of will and humanity. The way Sacks describes the many unique side effects and symptoms of the disorder is truly dynamic in that he describes certain ones in medical language—yet still being accessible for a wider audience—and explains these characteristics with a very specific tone in mind. On the other hand, in describing other outcomes he expresses great empathy for the patients and their most impenetrable states. “Unimaginable solitude”, he writes, “perhaps the least bearable of all.”

Oh, sweet humanity.

2009-01-25T15:48:00.000-08:00

In my opinion, the case of Frances D. yielded its most fascinating insights in the footnotes. I was particularly intrigued by what Sacks referred to as the “second awakening”, ie the surfacing of primal human urges and characteristics over the course of taking L-DOPA, and the description of the mitigating effects that things like human contact, music, and internal rituals had on patients’ side-effects. These two happenings seem strangely intertwined, though they are intrinsically opposed (indeed, an unintentional Parkinsonian reference), that is, one having to do with the arrival of adverse reactions to L-DOPA and the other with combating those reactions. However, though they address opposing sides of the same issues, they both belong to the same sort of sub-element that subtly pervades all of Sacks’ observations; the innate humanness of his patients. Both the involuntary teeth-gnashing and the normalizing effect of a human touch are very human tendencies, albeit from very different sides of the spectrum. Sacks refers to the former as “genuine ancestral instincts and behaviours which have been summoned from the depths, the phylogenetic depths which all of us still carry in our persons” (Sacks 55-56), while the latter is a more familiar phenomenon that one does not necessarily associate with disease. Clearly, these are two very different descriptions of human behavior. Nevertheless, they both refer to a part of the person not affected by drugs, though the drugs may activate it. The strength of the primitive behaviors is such that they are uncontrollable and totally involuntary, while on the other side the strength of willpower and self-manipulation is such that it can raise a frozen man from a wheelchair. How different are these types of power? How different are their sources? Are they simply varying manifestations of the same thing? These are questions I found myself considering after reading the case of Frances D, and other case studies. I admire Sacks for deliberately permeating his book with reminders of humanity shown from all sides, and not simply attributing all successes and failures to interactions between the disease and the drug. Though obviously, discussions on human vitality caused by L-DOPA are also necessary; such as in the cases of Magda B and Rose R, which saw tremendous increases in personality and vivacity after the patients started on the drug. However, the unavoidable adverse effects were often worse than the original symptoms, creating an anguished impasse for the patient. I often found myself torn, while reading these cases, as to whether I myself would continue taking the drug. The vivacity granted by it is no small thing, yet I have difficulty imagining a life in those circumstances in the first place, which makes me an unfit judge. The most frightening part about their conditions was that it did not affect distinct parts of the body or the mind, but rather settled over the entire being like a fog. Within the fog a person may find clear patches through which they may speak, move, or think, but these patterns were unpredictable and thus unreliable. Their seemed to be no respite from full disability. So however brief the remission was, it was uplifting to know that a happy interlude existed between periods of crushing illness; that the patients could feel human once more.