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.
Monday, April 6, 2009
Tuesday, March 31, 2009
Inherent Instability
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).
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).
Sunday, March 29, 2009
The Illusion of Normalcy and the Mercurial Self
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
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?
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?
Monday, March 9, 2009
Becoming a Part of Her
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”.
Sunday, March 8, 2009
The time has come, the Walrus said, to talk of many things
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.
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
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.”
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