Monday, December 10, 2007

essay excerpt

Hi! Below is an excerpt from my migraine essay. This is the beginning; the rest of the piece includes a detailed description of the most recent migraine, more on the migraines of my female family members, examination of what could be some of my migraine triggers, and a bit about my health/state of mind during the migraine-free years. Let me know if you have questions. Thanks for reading and I look forward to hearing about the rest of your projects next week!

(As we would say in publishing all the time, right up until a book went to the printer, this is NOT TO BE CONSIDERED FINAL! I'm still proofing, refining, etc.)

The Mind of a Migraineuse

On a gray, humid day in late summer, Lauren S. decided to take a walk in the park by her house. She had awakened that morning feeling discombobulated, like her skin was too tight for her body, and thought the edginess may have been due to the fact that she hadn’t exercised since moving from peaceful Vermont to suburban New Jersey three weeks earlier. A mild sinus headache pulsated by the top of her nose as she washed the previous night’s dishes, but she put on her sneakers and headed out anyway.
She completed two laps around the duck pond then returned home. Tired, thirsty, hot, and hungry, she changed out of her sweaty clothes and opened cupboards in search of lunch. That’s when it happened: While reading the cooking instructions for Annie’s microwaveable mac and cheese, Lauren realized she couldn’t make out the words on the box. She glanced away and back again; still a blind spot. The sun was tucked behind a thick quilt of clouds and none of the lamps in the house were turned on, so her impaired vision couldn’t be the result of accidentally looking directly at a light. This was Lauren’s first migraine in fourteen years.
She was a frizzy-headed, bifocal-wearing kid of nine when migraine made its first appearance in Lauren’s life. It was a hot day halfway through her first summer at sleep-away camp and her parents were visiting, there to watch her in a play later that evening. In the afternoon she developed a headache unlike any she’d had before, a rhythmic, dull throbbing on one side of her head, inches behind her right eye, deep within the skull. When she coughed or turned too quickly the pain would bounce to her scalp as well. After two hours of rest in her quiet, dark bunk, she felt better. If her mother and sister—both migraines sufferers—understood from her description of the pain that it was her first migraine, they kept this to themselves. She appeared in the play that night as scheduled. As far as she knew, there was no vision disturbance—the migraine aura—before the headache began.
The second came a few months later when Lauren was in fourth grade and this time she knew what it was because, before her head began to ache, the blue rules on her sheet of paper seemed to wiggle away and disappear behind a beam of light. Her mother had described this light, like a sun spot or the after effects of a camera’s flash. This migraine also lasted just a couple of hours and she waited it out in the carpeted corner of the classroom, surrounded by bookshelves. She was grateful that, so far, her migraines seemed more like her mother’s than her sister’s: While their mother could take over-the-counter pain relievers at the first sign of migraine and continue to function, her sister was left incapacitated, bedridden for hours, only getting up to throw-up.
Her good luck continued until puberty, around her twelfth birthday. Up to that point, the migraines were coming once or twice a year; after fifteen or twenty minutes of disrupted vision the headache would beat its dull, continuous thud on one side of her head and pass after two or three hours; she never became nauseated; and the only residual pain she experienced came when she laughed or coughed, like a jab to her scalp. This changed suddenly. Instead of an episode of a few hours, her migraines became all-day events. The headache itself, which she had previously thought of as finger tapping her from within, turned violent, no longer a finger but a fist, beating her up from the inside out, the waves of pain bursting from the blows tumultuous, crashing, incessant. The only time the headache would lessen, just a little, for just a few minutes, was after she vomited, which she did over and over again. She was either writhing in bed or running to the toilet. Four, five, six hours into the headache the aura would return, diamonds of light piercing her eyes, reminding her that it wasn’t close to being over; it may never end. And this was happening about once a month. Unable to keep anything down, medicine came in the form of suppositories, administered by her mother.
One of her worst migraines came a few months after her thirteenth birthday. It was a Monday—she had seen Dead Poet’s Society with her mother the day before—and hot: She wore a tank top to school. She’d eaten Apple Jacks for breakfast, slurping down the sweet pink milk after all the cereal was gone. She was at school just long enough to feel self-conscious about her pubescent boobs in the tank top, but not long enough to digest breakfast. An expanding star of blinding light floating in front of her eyes, she got home quickly, took Tylenol before the nausea would make swallowing anything impossible, put on pajamas, and settled into her parents’ big bed, a few feet from their bathroom. Apple Jacks shot out of her nose the first two times she vomited, but not the next nine. Sometime in the evening, when her family was eating dinner, the headache finally began to fade. She put on MTV, watched the video for Tom Petty’s “Runnin’ Down a Dream,” changed her mind, shut the television off. The next day a remnant of the headache was still there but felt like her early migraines, a nagging finger poking her in the right side of her brain.

Monday, December 3, 2007

Circle complete

We have made it to the end and it really does seem like we have gone full circle. Sacks has assumed the role of Virgil in The Divine Comedy not only in the way he guides his patients through their illness, but also in a the way he has guided us in our course work. We began the semester with The Man Who Mistook His Wife for a Hat, which laid the groundwork for our understanding of romantic science and tried to instill a tolerance and appreciation for neurodiversity. I feel as though Sacks then become apart of the class’s implicit memory and felt his presents during weeks were Sacks was not on the syllabus. We could not help but to compare Livesey, Skloot, Powers, Hirstein, Le Doux, or Luria, even if it was an assignment. I also think that it is appropriate the Sacks was our guild not only because that is obviously what he is good at but also because he lives in a very specialized niche between science and art. He is an ambassador of science in the realm of the people, which includes either mentally disabled or ill and those mentally “normal”. Not only is he an ambassador but also his writings in turn shift the paradigm of how medicine interacts with their patients, as Hawkins and Cassuto describe in varying degrees. In these ways Sacks is greatly responsible for the way that we examined our course work and was able to grasp the idea of narrative neurophysiology. It is only right that we wrap up our semester with him.

I also appreciated how the reviews of Sacks’s work came into play during this last reading. First of all, the reviews made a nice connection to Webber in The Echo Maker and his issues with how his narrative case studies were perceive. Points like Cassuto’s on the freak show platform in which he claims Sacks presents his patients almost seems like it was directly quoted in The Echo Maker. Also Harkin’s point of the phenomenological nature of Sack’s writings is conveyed in the way Weber becomes entangled in the happenings in Nebraska, his influence by Mark’s illness, and losses a firm sense of self. Webber’s demise does not seem to completely align with the impression we get of Sacks’s life, however you cannot help but to associate the two neurologists. Secondly, the reviews also function nicely to see how Sack’s is perceived in reality, and to see what others out side of class think of him.

Sacks is painted in a variety of lights in the reviews, just as Bennett has two side of his personality. Bennett is described as having a very intense case of Tourettes, however at the same time he is a remarkable surgeon. Sacks explains how Bennett is able to “forget” about his disorder and be able to focus on him work when he is in the middle of surgery, he becomes Bennett the Surgeon rather than Bennett the man with horrible Tourettes. Sacks similarly has a Dr. Jackal and Mr., Hyde dual personality. He is at times the well-informed, objective neurologist, preoccupied with clinical facts. Sacks can also push aside his concrete scientific background and be a complete humanitarian, focused on understanding how his patients’ disorders affect their personality and livelihoods.

Le Doux provides a nice ending in the way he tells us to understand the brain as an integrated whole. This is a useful approach for understanding not only synapses but also all the other issues we have examined. We must tie together Sacks’s dialectic qualities to fully appreciate his work. We also must tie together the various forms of writing that exists on neurological disorders; from Luria to Sacks, from Hirstein to Powers, there is a lot that can be learned about our synaptic selves.

Sunday, December 2, 2007


I think this weeks readings was a great way to end the semester. They provided an interesting way to reflect on what we've read, not just on a neurological level but also on a moral and ethical level.

We've spent a lot of time discussing the various processes of the brain, how these processes can malfunction and how viewing these malfunctions allows us to better understand or perhaps even acknowledge their existence. I think through this weeks reading, rather the semesters readings, has shown us that "the self" is in fact a summation of many parts that create a single whole and that the brain is a reflection of "the self," an integration of functions that are shaped by are genes and environment. And perhaps our society reflects this, a group of diverse people that must work together (and yet separately) to maintain order and stability, where there can easily be chaos.

With that, I think there certainly is something hardwired into our society that allures us to the chaos, parts of us want to see things go wrong (we don't read books about utopian societies.) I often wonder why that is, why we are so intrigued with what can go wrong? But as we studied the brains processes, especially the chapters in LeDoux about fear conditioning, I began to wonder if it's instilled in us for self preservation.

When we watch a movie or read a book, fiction or no, we give ourselves up to that suspension of disbelief because it is exciting and intense I wonder if that is similar to fear. That we need to know what can go wrong in order to prevent it, that perhaps we get excited and this triggers something chemical that is necessary to protect us. But with something like neurological disorders how much can this hypothetical self imposed fear conditioning do? Can we really prevent such disorders? So again we question the ethics of Sacks. Is he really exploiting his patients? I think it is fair for Couser to make the distinction between freakshows and Sacks; the contact between the viewer and the patient is indirect-- less traumatic -- because he is at a safe distance.

I think any time pieces of anyone's life is put on display is can be exploitation, no matter the intention, it is so easy to perverse what is meant to be positive. I think it is important that we hardwire our society's brain to have an objective opinion. I also believe people are hardwired to perceive things in a way that is specific to them and because everyone, when reading or watching, brings "what they have to the table," they will perceive Sacks differently. I don't think it's possible for a patient to fully understand the capacity of what they are doing when they allow their lives to be used as an example or case study for scientific purposes, similar to anyone in any other situation where potential "fame" is involved.

I do feel that it is necessary for us to read Sacks and similar case studies. I do believe that although Sack's cases may be extreme, they do show the humanity in people with various disorders. They show the "soul" separated from the brain which is necessary to our understanding of illnesses. They show us that one malfunction is not the end of the entire structure and that there are alternative ways of living subconsciously or consciously; and I do believe it is important that we as a society see that we can still function as a whole even if some of us fulfill our processes differently than the rest. But perhaps I am just hardwired into thinking this way.

Saturday, December 1, 2007


I have spent much of the past week in the hospice wing of Beth Israel hospital and I am not feeling too kindly toward medical professionals, yet when all is said and done, I don't think Oliver Sacks is guilty of ethical shenaningans. I agree most strongly with Leonard Cassuto's assertion that "Sacks’s work argues that people will want to stare, and the best way to counter this desire is not to forbid it but to shape and direct it, to make the gaze into a mutual look, a meeting of two worlds." Sacks's work wouldn't be as popular as it is if there weren't a market for it, and better to have his style of presentation than, say, a Ripley's Believe It or Not type show featuring the same patients Sacks has introduced.

Yet, in all honesty, if I saw a preview for a Ripley's-like show about people with diseases/disorders of the brain, I would still want to watch. And Sacks may be a very good writer, but if I skimmed any of his histories, it was the parts not about the patient, like his description of the mountains while flying with Bennett. I am interested in the tics, the obsessions, the bizarre. A nature writer can give me the Rockies; I turn to Sacks for neuro-porn. And if I couldn't get it from him, I'd go elsewhere. To invert LeDoux's final sentences, I am my synapses; they are who I am. Thanks to Sacks and my own nature as a reasonably compassionate person, I would not mistreat anyone I met with one of the disorders we've learned about, so I feel no need to apologize for or defend my fascination with the wild workings of the brain.

As Anne Hunsaker Hawkins described, I think Sacks's emphasis on the entire patient, the "sense of the character, life-history, important human relationships (with both family and staff), and personal values and goals of the individual patient" that he includes in his histories can't be anything but beneficial. As we've seen with the confabualtion disorders and those that involve disinhibition, the personality of the patient before onset of illness is critical to understanding who the patient has become. This week's LeDoux reading touched on this as well, changing connections changing personality. And after my week of dealing with doctors and nurses, I wondered how Sacks's approach to patients could benefit family members as well. Imagine how comforting it would be to have a doctor who learned about all the people supporting a patient, how much more effective the doctor may be if he/she considered the person being spoken to, rather than following some standard script. But doctors don't have time for that.

Friday, November 30, 2007

The Traveling Neuroanthropologist: Sacks and Ethics

This week's reading, in bringing full circle the material we've studied all semester, also investigates the questions of ethics that we've been raising in class. Is it ethically permissible for Sacks to write about his patients in this way? Is his work a contribution to the understanding of neurologically different people, the fascinating range of disorders and syndromes, and an attempt at increasing our empathy and understanding for them, or it is a shallow and exploitative, P.T. Barnum-like attempt to sensationalize and expose the mentally disabled community?

The three essays we read on this topic, by Hawkins, Cassuto, and Couser, all seem to reach the middle ground on this question. While there are aspects of Sacks' work that are certainly problematic -- such as Heidi, the girl with Williams' syndrome that he refers to in the third person and hurts the feelings of while forcing her to perform a task to show her disability -- he does manage to tread a level path, may not have a binding responsibility to adhere to a biomedicinal code of ethics while working in the realm of personal memoir, and develops as a writer during the course of his case studies. It's true that in Hat, as pointed out in one of the essays, uses freakshow-like names (The Disembodied Lady), displays a much less refined version of his technique, and focuses on highlighting the shocking nature of the patients' disorders rather than their development in whatever other social or psychological spheres may be open to them. Yet, throughout, Sacks takes care to camoflauge them under pseudonyms and doesn't, for example, include photos or medical diagrams of them (especially something awful like their face with eyes covered by a black box, such as found in medical textbooks). As Couser's essay highlights, there is a stark difference between keeping their personal identities anonymous and denying visual representation then there is in contrast with the immediate and visceral response that a person being physically stared at would feel.

Sacks' style as a biographer and investigator grows and changes considerably in between Hat and Mars. The cases he selects in Mars take care to include the patient's representation in all facets of life; in A Surgeon's Life, about Dr. Carl Bennett, we see his life at home with his wife and children, his passion for flying his plane, and the great care and precision he takes with his work despite the fact that he has a condition that many see as exemplifying the complete opposite. No charges of exploitation can reasonably be leveled against Sacks in this essay, otherwise we'd find ourselves in an awkward position of having to argue that no medicinal and psychological exploration can ever be done. Bennett has a condition that makes him different, true, but writing about it, and contributing to our body of knowledge on the work, cannot be censored on charges of "exploitation" without crippling our scientific and cultural progress. We are a curious people; we want to know more about our surroundings and the permutations that our fellow man can undergo. It's not "us vs. them." If anything, Sacks is helping bridge a chasm by showing us, at least in this work, how very much "they" are like "us," and that such distinctions and prejudices are petty and unnecessary; they are just like us because, well, they are us.

And besides, if we charge that the mentally disabled are not legally able to consent to their images, stories, and conditions being represented in published literature, then we ourselves are the ones who are dehumanizing them by dismissing their ability to make any choices for themselves. It was mentioned that some see the display of disabled people as low-grade shock value and freak-show exploitation no matter if they were participating willingly or not. I'd never advocate for keeping someone in any situation against their will, but if the performers celebrate their oddity and conceptualize it as a key part of their mental identity (as has also often been shown in these stories and reports) then why should they be denied the chance to have a life of their choice? Wouldn't it be much crueler if we presumed to know what was better for them by virtue of our "normal" brains, and therefore forced them into a "normal" life? We are becoming in fact too dangerously holier than thou here. Those who cry foul and try to make disabled people fit into the mainstream -- even if it may be against their will -- are every bit as guilty as those they accuse. If we respect them as humans such as we say we do, then let's start by respecting their own choices. How is it any different from a "normal" person choosing to fly hot air balloons, climb mountains, be a fire-eater, work in a circus? We don't shout "Exploitation!" when we see that. By claiming foul play, we are in fact continuing prejudice against the disabled by assuming that they don't have enough self-identity and personal compass to make informed decisions about their own life and that we have to shepherd them through the "proper" stages. It's hypocrisy.

We shouldn't give Sacks an entire carte blanche, as the essential nature of his work is to ferret out those with differences and attempt to interpret them to the public, but it seems to me that criticisms of his so-called "P.T. Barnum" nature are grossly general and overreaching. While he is often extraordinarily sensitive to his patients' needs, he does occasionally breach them, as noted in the case of Heidi. But as also noted, Sacks does not cut that footage from the final film, although he tries to deflect and re-direct her criticism. When she asks him to stop filming, he does so immediately; he doesn't keep the camera rolling for the sake of capturing data at the expense of the patient's personal feelings. There are far worse examples to level charges of exploitation at aside from Sacks.

Hat is undeniably a bit problematic, but as Sacks matures as a physician and writer, he takes time to mend this flaw. His work is in a tricky gray area between medicinal text and personal literature, and it's been examined whether he has a definite need to adhere to the traditional patient/practitioner trust system. He's writing much more about people in Mars, people who just happen to have a different way of viewing the world that's beyond their control. In Hat, this technique is somewhat sloppy and suspect, but there are no photos or real names provided for his patients; someone can and probably has, many times, passed them on the street if they've returned to their regular lives. Once we reach Mars, the human element shows much more clearly, and we can read it as a biography of unique and interesting people without having to attack the mediator.

The Actor's Life.

Well this will officially be my last blog (hard to believe that!) and I couldn't have been happier with the reading selections for the week. The readings offered a greater cohesion of ideas we've all had the pleasure to discuss, argue and talk about these past few months. In going into this class Elizabeth told me that I would have a better understanding of myself as a human being, and perhaps a little more leniency with some of my own person "tics," not to say that I'm a big confabulator or anything...

LeDoux quotes on pave 301, "If we want to understand how our brains make us who we are, we have to figure out how [the
] Individual process blend together to cause a person to emerge effortlessly from the electrochemical activities of... his or her brain." Simply, you must look at the whole of you mine to understand "who you are-- who who, who who?"
Speaking of whos and hoots, I think that lyric by the Who tied in beautifully from our reading from Sacks, "The Surgeon's Life." Sacks explains, "any disease introduces a double ness into a life-- an "it'" with its own needs, demands, limitations" and a person afflicted will suffer to seek balance between their own desires and the "alien will of the "it." As we see in Dr. Bennett and throughout the course, balance is such a key part of illness. How does one cope with an illness? How do they find a calm in the storm of their lives? In Dr. Bennett's case that was to strike a balance between professionality and the mentality of his illness, when and where he could tick, if that meant looking down a hall before skipping, that's what it took. In the past we've seen Sack's patients like Mr. P and Witty Ticky Ray who found music to soothe their pangs of illness, to find a balance with it. I think as a society we are so ready to label and classify to understand who we are. That this person suffers from schizophrenia. Where as Sacks offers us a better understanding using Tourettes as an open example: "The toureet's and the self shape themselves each to the other, come more and more to complement each other, until finally, like a long married couple, they become a single, compound being" (Sacks 77). Exactly like that of our experiences. Not one single moment or event or part of our personality shaped our life, nor does a disease solely explain who a patients is.

Sacks goes on to further drive home the point "neither a biological nor a psychological nor a moral-social viewpoint [on understanding illness and self] is adequate; we must see Tourettes [or any illness or personality] not only simultaneously from all three perspectives, but from an inner perspective, an existential perspective, that of the afflicted person himself. Inner and outer narratives here, as everywhere, must fuse" (Sacks 78). Haven't we been reading about this all year? Our narrative like that of our brain MUST work together to form a conglomerate of who we are. It all ties together to create a tapestry of self, several strands from different aspects and perspectives to create the fabric of our being.

Just because Dr. Bennett has Tourettes syndrome doesn't mean that is all he can be. He's also a father, a husband and a (as shocked as I was) a surgeon. I hate to admit it but I had a hard time separating out how it was quite possible for him to pursue any profession with his limitations, until he explained it to me in his own words, "most of the time I'm operating, it never even crosses my mind that I have Tourette's" (Sacks 97). Well, it only takes one look at my title to see how that made sense to me. Yes, he lives a surgeon's life: completely focused on the task at hand. I can imagine that saving lives and removing tumors is rather taxing on the mind, no surprise that that focus and pressure channels the minds thoughts away from ticking. I cannot explain this in any other way but as an actor. When I'm on stage, lines memorizes, lights up and I'm acting, of course I'm still Matt Nicholson but not in that moment, I'm Aladdin on a magic carpet, Oscar Wilde in England past or I'm high kicking in A Chorus Line. My mind is so focused on what comes next (what movement, what emotion, what scene, what line, what song) that I do not have time to mentally go through my grocery lists of read a book. I have a task at hand, and that is exactly like Dr. Bennett, once you've practiced something so much like surgery and the information behind it, the path of surgery or acting is so easy to slip into.

"That the synaptic self can be a curse-- it doesn't take much to break it apart. But this is also a blessing, as there are always new connections waiting to be made. You are your synapses. They are who you are" (Le Doux 324).
I think that we've all come to know this in college, and particularly in this class. So often I realized that my conceptions of the mind and illness were so off base. Every time I enter class I had to remind myself that our memory is not a large warehouse that one portions of the brain like the amygdala does affect the whole if damaged. So thank you all for speaking your minds, challenging my ideas and putting it all out there. It doesn't take to much force to change an opinion (when backed up with evidence of course-- we did talk about that in class: When you're the only one battling for your feelings and EVERYONE else has evidence, you're more ready to be knocked down) but remember what we know may possibly change as technology and knowledge itself grows, so keep yourself up to date! You are what you know and do; you are your synapses-- so in that case, learn all you can! And good luck tying up all your conference work, I look forward to seeing them all!


Sunday, November 25, 2007

Oh dear...

Well, we've finally come to the end of Powers' novel. I'm going to be completely honest and just say from the start that I didn't like it. I suppose the actual truth of it is that I was ambivalent about it, but I was ambivalent for all 451 pages of it. He attempts to inspire a philosophical thought process in the reader, but it seems to me that he always falls short. His musings continually struck me as lack-lustre compared with the other material we read over the semester.

And then of course there's what I'm sure we'll all be talking about on Monday: the ending. Honestly, I didn't know the specifics the whole time, but I saw this one coming. There was something perpetually--and by the last quarter of the book, annoyingly--concealed about Barbara. Her nervousness when talking about medication, her continual self-deprecation...and the fact that she was such a lower level character for most of the book made her the perfect candidate for the big twist finale in a very classic-mystery kind of way. I suppose the revelation that she was trying to commit suicide and stepped in front of Mark's car was sufficient enough to get me excited, but somehow I had lost interest in ALL of Powers' characters by that point. They return continually to their ridiculously unfulfilling lives. I suppose this was one of the points Powers was trying to bring across with the whole crane metaphor, but by the end it just got redundant. Everyone messing up their life to various degrees. Nothing is ever resolved, like the book itself, really. I know, I know--in the end, people are just people. But honestly, you have to give some kind of denouement. But no, throw in an off-hand mention of how Mark is perfectly normal now and move on.

In the end, I feel that the main problem with this book is that it is simply too linear not to have any real kind of story arc. It seems like Powers could have written it very well if it were more disjointed, more about vignettes in the lives of people. He does this to a certain extent, but when he strings them together the way he does we end up wanting it either to be a typical story centered around the events, or else to be about character development. And it really isn't either of these. He gives all of the parts of a typical story and then doesn't follow through with any kind of cohesion.

Saturday, November 24, 2007

Defining the Undefinable

Sorry I just have to say how fast this semester has gone by! When I finished The Echo Maker and then looked at the remaining course readings all on the same page. I remember wondering if we would get through them all and I guess we're almost there!
I think Powers had trouble ending this book. Did anyone else find that? I found myself wondering why he spent so much time on Barbara and Weber and the unfolding of emotions the reader didn't have enough basis to understand. The destruction of land and water, the extinction of cranes, relationships, the brain, what else can possibly go wrong? Nothing is really defined until we lose the obsession we had in the first place to define it. Karin has been looking for Mark to find her and then when he comes back for a little while in the end it is less than epic. It doesn't need anything more, they are reunited as brother and sister in a way that is completely sibling, another definition that needs no explaination. The way that Powers leaves out history in The Echo Maker is really interesting. Capgras is the only aspect in the novel that has an origin. Some history of the family dynamic is given in the first part of the book but it mainly deals with the ligistics of the accident. I did like the fact that I didn't know how the book was going to end until the end, but Barbara was responsible for it and I don't think that was ever dealt with. At the same time, how much would it have helped if they knew that she was the one who caused the accident?
The readings this week had a domino affect in my brain. The readings on confabulation and the varied definitions that are given to this state of mind really intrigued me.
Feinberg- "an erroneous yet unintentional false statement."
Talland- "false verbal statement about facts."
Berlyne- "a falsification of memory occuring in clearn conciousness in association with an organically derived amnesia."
Berios is not convinced that all confabulators have an memory problem.
Wegner- "convenient stories made up to fit the moment."
Mercer- "a necessary (though not sufficient) prerequisite for confabulation is impaired memory function."
I thought this was interesting because is there a universal definition for confabulation? For Capgras? Is it definite that we need to have some sort of impaired memory to be a comfabulator?
In all of these definitions false is the common denominator. I can't help but think that Barbara convinced herself that she was doing good all along. Her intentions, to her, were completely justifible. Maybe that's the part that bothered me, in the wrapping up of the end, nothing was really wrapped up, no remorse, no real 'I'm sorry's' just straight up facts; strangely being the exact opposite of confabulating. Maybe its just that when Barbara is around everyone loses their mind. Weber obviously forgets the life he has built with Sylvie, Karin doesn't know what to think, and Mark is trying to get her a job.
The symbols that are used to help the chapters in Brain Fiction, are the same types of symbols Powers includes throughout the book with the use of Cranes, and the diminishing of land equalling the diminishing of life. What do all these symbols really mean? Do they help us with the texts or are they just a way of using other words to do something that explaination might easily do?

Capgras', Fregoli's, Cotard's, Oh My!

While reading, I made hundreds of connections from this reading to other readings, things we discuss in class etc., but when I looked back on all of the pages I folded or highlighted, I can’t seem to recall what I wanted to write about them. My memory has really been failing me, which I suppose is a connection to our class in itself. I managed to salvage half of what I wanted to share with you all, so here goes.

I find it interesting that each sub-story relates to a syndrome the book and our class have been discussing. On page 347, Karin has this devastating revelation that zings throughout her body during the crane debate. What if everybody had Capgras’? I think the characters in the book express the fear we joked about in our last class. Orienting yourself so fully in a disease or syndrome can almost make it contagious; it appears as if everyone has it. On page 353, Powers draws a parallel to Fregoli’s syndrome. Weber’s talking to Sylvie about how Barbara reminds him of someone, and until then, he hadn’t been able to put his finger on whom. Turns out, she reminded him of himself (would a patient suffering from Fregoli’s syndrome ever have this mistaken reminder? Is that another syndrome?) This reminds me of the two books we read by Margot Livesey. She made her undiagnosed characters appear even more ill or affected than the so-called “sick” characters.

Mark suffers from the array of syndromes we read about in Chapter 5 of Hirstein’s book. He lives through a years worth of Capgras’ syndrome, only for it to get worse. It triggers Fregoli’s syndrome, and eventually Cotard’s syndrome. Reading about Cotard’s in Hirstein’s book made it seem really unrealistic to me. Powers illustrated the severity of the syndrome in an urgent way. When Mark calls her in the middle of the night, I wanted her to go get him! I wouldn’t believe in his safety, despite how much he reassured me. I have some questions about Mark’s ailments. Might this be a typical series of events for actual Capgras’ patients? Is it normal for a person to experience all three syndromes or was this just a particular case? I remember Weber saying that accident induced Capgras’ is a rare occurrence, so it makes sense if this is case specific.

There are a couple of things I don’t feel resolved about. On page 374, very briefly, only a line, Karin asks is Cappy ever touched Mark. Is this the slightest allusion to sexual abuse? What would that mean for the story, the relationship between the characters, Mark’s personality? Why was this line included? The second thing that has been bugging me is Daniel. He was the dullest character for the first 300 pages, I hated reading about him. He didn’t respond much to Karin’s tooling him around; he didn’t feel like a realistic character. But then all this crazy information drops on you like a bomb. Mark accuses Daniel of homosexuality and bestiality. And I just wonder, are these theories grounded? Is this to show the failure of Marks mind, does it have any real significance? Why would this be included in the story?

After Hirstein’s chapters, I am even more curious about this creation phase. The example is given that two people can sustain the same kind of damage and one will confabulate while the other will not. What does this mean? Is confabulation a good or bad thing? Does it show a healthy brain trying to overcome an illness or does it show an unhealthy brain? Will we find out more about a patient when they confabulate? Would a doctor rather see a patient confabulating (after suffering from such damage) or not? On page 196, it is mentioned that patients who spontaneously voice confabulations are sicker than the ones who only confabulate when questioned. I guess this would prove that the more the confabulation occurs, the worse off the patient is, but isn’t being vocal better than being non-responsive at all? I think I’m not getting something here. Hirstein seems to be repetitive so you can learn things, but doesn’t go far into the detail that he should.

On 199, it is made clear that a patient that confabulates can sometimes unconsciously tell the truth. Even though I understand his points on this matter, why can’t the patient be noted on being truthful? It’s not like the patient is consciously lying and accidentally telling the truth. It’s all unconscious!

One last thing on the last few chapters or Hirstein’s book… Did anyone else detest the structure of “if p then q” mathematics symbolism? It made everything twenty times harder to understand. I came to Sarah Lawrence for a reason, guys.

Wednesday, November 21, 2007

This is weird

Put on headphones, make sure everything in the room is quiet, and listen to this. It's short, don't worry. It's a 3-D sound thing, and although it's really cheesy (fake Italian accents), it's really powerful. The narrator explains some things about why your brain processes the sound in the way that it does, but maybe Elizabeth can expand upon it? I feel like it's related to everything we've been discussing in class, especially in The Echo Maker.

Sunday, November 18, 2007

Powers And Ethics

(I posted this last night, but when I came back to check things today it was gone! Or maybe for some reason it's not showing up on my computer, so forgive me if I post it twice, I just want to make sure it's on here!)

To be honest I wasn’t quite sure what it was that troubled me about the second part of Richard Power’s novel “The Echo Maker” until I read Madeline’s post below. I’ve been sort-of rushing through the book, and so it’s left me with vague impressions rather then completely formed thoughts; I recognize that there are broader implications and themes represented within the complexly woven plot, but I’d be hard pressed to put a name or a label on some of those ideas.
Thus Madeline’s post really helped me process my own conflicting feelings about the Sacks character presented in Power’s novel, and allowed me to actually solidify my reactions into an actual opinion:
Like Madeline, while reading I found myself confronted with similar questions about the moral implications of, and possible motives behind, Sack’s work. As she so astutely points out, Power’s depiction of a man who makes a living doing exactly what Sacks does not come off as particularly positive.
And, as Madeline points out, calling Sack’s work into question also called into question my understanding of my own motives, even for taking this class. Why is it that I found myself so engrossed in these narratives? Why is it that Sack’s work is so broadly read, that his newest work has so quickly become a NYT Best-seller? Why is it that whenever I describe my reading assignments to friends and family they are fascinated and want to hear more? I recently read “Don Quixote” for another class, and let me tell you, I never found myself in a conversation where someone said, “Really you’re reading Cervantes? Tell me more…”
What is it that draws us to these stories? Is it, as Madeline wonders, some kind of sick, sideshow fascination we all have? Are Sack’s books the written equivalent to a circus freak-show? Are the case-studies simply a more socially acceptable version of “Ripley’s Believe it or Not”?
I want to believe there’s more to it then that. For one thing, the stories we hear from people like Sacks and Luria are inherently dramatized. They allow us to stretch our imagination in all kinds of ways, and they make for fascinating tellings and re-tellings. (When I first read about the results of Mark’s brain trauma all I could think was; “This is just like ‘Invasion of the Body Snatchers!’) I have a feeling that these stories would be told with or without Sack’s writing, simply because they often lend themselves to being told.
But even beyond the basic draw of the dramatic, I think there’s something personal about the narratives we’ve read which allows us the opportunity to be more then mere voyeurs into the misfortune’s of others. I think Sacks recognizes something deeply personal in these stories. He grapples with a scientific and spiritual understanding of the self, and tries to come to grips with how we understand the human soul in relation to the human physiology. To some extent one could argue that Sacks capitalizes on the tragedy that befalls others and the fears of people like you and me (since we’re all pretty terrified by the idea of losing our very selves due to some unpreventable brain damage.) But would Sack’s work be half as successful as it is if it lacked the kind of deep empathetic tone and philosophical searching which characterizes his work? If it were grossly sensationalized or paired down to a simple grocery-list of terrible symptoms I doubt it would be so widely read. It requires that human element, and I believe it's that same human element which saves it.
Part of how I can justify both Sack’s impressive body of work and my own interest in the field is my hope that on some level these narrative efforts are still about an emotional connection between people. As readers of Sacks we may in fact be pulled in by the strange and bizarre complications of brain damage, but we are also asked to sympathize, to attempt to understand and to theoretically place ourselves in a similar position. We ask ourselves: what would this be like? How would I experience something as profound as Dr. P or Mark? Could I withstand this? And I think in the end we arrive at the question: now that I know, what can I do?

Double Echo

As the Echo Maker moves into its second half, we are presented with the character of Weber. This character who is modeled on Oliver Sachs is an interesting turn in the novel. After reading about Karin’s perspective on her brother’s injury and her alarm and panic when he fails to recognize her, it is refreshing that Powers presents the medical take on Mark’s case. It is amusing to read the fictional portrayal of Sachs in Powers’ book after reading so many of Sachs’ case studies, but I think that Powers does a good job in staying true to the essence of Sachs. Powers describes him as “…a cross between Charles Darwin and Santa Clause…” (101). I couldn’t have described him better myself. Like Sachs, Weber is at ease with his patient, and Mark is able to trust him, even if he can’t trust the “imposters” around him.
When Dr. Hayes and Weber are reviewing Mark’s brain charts, it brought me back to our discussion in last week’s class. We were talking about how the emotional self is really connected to everything having to do with our functioning life. Powers’ writes: “Getting all associations for a face without that gut feeling of familiarity. Pushed to a choice, cortex has to defer to amygdala…’So it’s not what you think you feel that wins out, it’s what you feel you think’” (131). This is a very well articulated point—a point that is true with all human beings, not just those with Capgras syndrome.
The amygdala is an emotion site in the brain. Joseph Le Doux’s work on emotion was highly focused on activation in the amydala. He has mostly studied fear, but it is clear that many emotions also have neural correlates that focus on the amydala. The higher regions of the brain in the cortex, the frontal lobes are often called the executive part of the brain. In Capgras syndrome, the theory is that the emotional neural circuits are disconnected from the higher cognitive circuits and without communication between them, the patient suffers from a lack of emotion when he or she looks at a beloved family member or spouse. The inability to feel anything for that person creates the idea that he or she must be an imposter or double. Weber says in the novel, “I have always found it worthwhile to consider a delusion as both the attempt to make sense—as well as the result—of a deeply upsetting development” (132). Weber is talking about something which is called “confabulation” in neurology. Capgras’ is usually the result of right brain lesions. Confabulation is an explanation created by the language regions in the left hemisphere to explain what the patient is feeling. It isn’t lying. It’s an attempt to make sense of what a person feels when he looks at loved ones whom he recognizes but feels nothing for.

Saturday, November 17, 2007

Sorry guys!

I pressed publish poast but I was only on my first paragraph. The rest is coming SOON!

The Truth in Powers

As The Echo Maker moves in its second half, we are presented with the character of Weber. This character modeled after Sachs is an interesting turn in the novel. After reading about Karin's perspective and her alarm and panic over Mark, Powers takes a refreshing turn to the perspective of Weber. It is funny after reading many of Sachs's case studies to see this fictional portrayal of him. Yet Powers stays very ture to the essence of Oliver Sachs . Powers describes him as "...a cross between Charles Darwin and Santa Clause..." (101). This description is humorous and ture. Like Sachs, Weber is at ease with his patient and Mark is able to trust him, even if he can't trust the "imposters" around him.

Friday, November 16, 2007

A Doctor's Obligation

As we've ventured farther in our exploration of the brain and theories of the mind in "The Echo Maker," questions of ethics in writing and artistic license have troubled me. First there are the dilemmas that rise within the story itself - to what degree is Weber's work exploitative? Is he primarily a writer with neurology as a subject, or a neurologist who writes? and can his subject ever really consent to having their stories told publicly? - and then there are dilemmas concerning Powers. Is Weber really supposed to be Sacks? How can we know the difference? And if he is supposed to be Sacks, are we supposed to interpret a negative portrayal of Weber's work as criticism of Sacks?

As always there are the questions of identity, memory, and consciousness, but the above questions interested me more. I had never before considered Sacks' work to be exploitative. To put it this way - I had never thought to myself, "Is Sacks' work exploitative?" and said, "No," rather I had not even considered it. But naturally questions of exploitation SHOULD arise whenever the author of work based on other people's experiences is making so much money. Sacks has made thousands - millions? - off of his writing about patients. Doubtlessly his own talent and insight have been key to his success. But he would be nowhere without his material - his patients. I think about people like Jose, stuck in an institution for the rest of his life while Sacks makes money off of his story, and it does seem a little wrong. Sacks mentioned that Jose could have a career in art with the amount of talent he has. Well, why hasn't Sacks done more to build that career for him? It might require as little work as connecting Jose with the right publicist, like Stephen Wiltshire has, or sending his art to a few significant people who might be interested in selling or buying his drawings.

In our class, we value Oliver Sacks' stories for the questions they raise about the meaning of identity and consciousness. But it may be true that most of Sacks' readers are in it simply for the "freak show" element, especially considering that Sacks writes for a mainstream audience. Should we be concerned that people might pick up "The Man Who Mistook His Wife for a Hat" simply to read about all the fascinating freaks in it?

I was a little disturbed by Weber's abuse of doctor/patient confidentiality. Perhaps once you have published your patients' stories for the whole world to see, it seems like nothing to tell your wife and your publicist absolutely everything about a new patient - but it is a breach of that special agreement between doctor and patient. I'm not saying that Weber isn't allowed to tell other people - especially his wife - anything about the work he does. However, I would expect any doctor to use much more discretion when it comes to giving out identifying information about the patient and his symptoms. It's especially worrisome to me considering that Mark lives in an extremely small town in Nebraska, and that he has an extremely rare condition. Weber would not have to give away very much detail about him in order for a LOT of people to know exactly who he was talking about. How many people in Nebraska have accident-induced Capgras? Or even in the Midwest? I would guess only Mark does. Surely most of the people in his town know that he's been "off" since the accident, seeing how word gets around in Kearney. However, everyone does not know that Mark is prone to paranoid delusions about conspiracies and thinks that everyone in the town might be impostors - this is information only his close friends, Karin, and Weber know. Weber needs to keep his mouth shut, or else the whole town will think that Mark is "crazy" - and then it will be very hard for him to face his neighbors, much less return to his job or function normally.

I suppose I'm very concerned with this because my mother works in medicine, and she has always been much more discrete about her patients than Weber is. She can't tell me, my dad, or anyone ANYTHING that she experiences. I can't believe that Weber - or Oliver Sacks, really - has never faced a lawsuit from either his patients or the families of patients that recognized themselves in his writing. I do believe that he asked them for their consent, but like Weber's interviewer, I am skeptical as to whether all of his patients really understand what they are doing in consenting. I don't mean to undermine any of the patients' intelligence, but surely people like Greg - who was in the story "The Last Hippie" in "Anthropologist on Mars," which I don't believe was assigned but I read anyway by mistake - who was extremely mentally handicapped by a brain tumor cannot fully understand the implications of consenting to being part in a book by Oliver Sacks. In addition, some of Sacks' patients are children. Completely neurotypical children are not considered capable of consent to many things by law. The parents may consent on behalf of the child, but it is the child who will ultimately face the consequences of that decision later on.

It is not that I don't think that Sacks' work is important, that is encourages empathy towards victims of brain disorders and disease, or that it should be publicized. It's just that reading "The Echo Maker" has raised questions for me about ethics in Sacks' work that I hadn't considered before.

Furthermore being a neurologist and writing down cases you have encountered is one thing, but what if that writing becomes so popular that you find yourself engaged in the business of tracking down the most interesting cases in order to write about them? It troubles me because it seems that Weber is only concerned by the most "out there" cases. As a neurologist, isn't he obligated to take on more than just the patients that interest him? No other doctor would consider it ethical to turn away a patient simply on the basis of their condition being to "boring." "I'm sorry, Mr. Smith, but your heart disease is simply too common for me to treat you. Come back when you have something interesting and rare like those patients they have on 'House.'"

Or more simply put, what happens when a doctor's main goal is not to CURE his patients, but to write about them to make money? Surely this is what has happened with Mark. It is a doctor's job to treat his patient's illness to the best of his ability. But Weber didn't even stick around to see if the treatment he recommended would work. HIS job is simply to write about illness. There is nothing in it for him in seeing Mark cured. I used "House" an example above, but at least on that show the doctors are only satisfied when they are able to successfully treat whatever "out-there" disease is featured each week. Weber is satisfied simply by finding the "out-there" disease. Treating it holds no added benefit for him.

I have used Weber and Sacks interchangeably a bit, but the truth is that they are not interchangeable. They are certainly different. Even from the little I know about him, I would say that Sacks is much more of an oddball than Weber - and I use the word "oddball" in the most positive and affectionate way. Weber strikes me as any middle-aged career man. He might as well be a successful businessperson or a lawyer as a neurologist. I believe that Sacks' personality and idiosyncrasies lend him to the study of the mind and ITS idiosyncrasies much more than Weber's do.

And that being said, I really do like Sacks. I wouldn't tell him to stop writing on account of the ethical questions that hound his work. But I would tell him to consider them. That would probably be a moot point, as I'm sure has has considered them. Still, there is still much that we can consider about them, and "The Echo Maker" is surely a good avenue for that.


Hey All,
I hope you are all having a good week. I just wanted to formally invite you to come see Anonymous tonight and tomorrow in the DownStage theatre of the PAC. I know that I saw Hilary last night. The show grapples with losing and reconstructing one's personal memory and narrative, whilst constantly dealing with "where we come from." It is based on the odyssey but is told in the context of modern times, dealing with issues in identity and border crossing. I think it's got great relevance for our class, and you'd be supporting your schoolmates, so if you have the time and the interest, we'd love to have. It starts at 9:30. If you show up twenty minutes before, you should get in no problem.

I hope to see you there or in class on Monday,

Roles of memory in Oral and Written Narratives

Richard Powers so beautifully shows us that “The self is an incredibly ingenious novelist,” for we are always crafting our existence and the world, interpreting, translating everything around us, from the basest movement to the utmost beliefs and emotion, every second of our lives. “The processes of the mind are held together by narrative.” Clearly the mind is quite a power tool, or weapon, for survival. It works not only as this master organized secretary for our existence but also it copes with all of our problems, too, even if that means pushing them away. Forgetting. Denying. Deleting. This anosognosia (lack of knowledge) can complete from complete repression of traumatic events or brought about from illness as we see in the Echo Maker.

“This case [of Capgras] is a chance to see just how treacherous the logic of conscious [is].” I found this illness in particular to be rather eerie. Picture that for a second, lake eerie: a windless afternoon, sailboats sailing along undisturbed. The scene is one of complete calm. The picture of normalcy. The disturbing parts lies in the stagnancy of the bottom waters. That’s where the illness hides here. The problem is Deep within. Missing the basest of emotions that are rooted in the amigdala—it’s almost like the upper regions of the brain with higher processing are over thinking the easy, the known, the experienced. These people who suffer from such an delusion to see “Not neighbors, colleagues or friends but those closest to him” as “aliens” or “government agents.” “Capgras syndrome “looks upon people close to him as, somehow, substitutions,” Mr. Powers clarifies.

The writing and mentality behind writing his book, as explain in the NPR interview, is completely fascination, in my opinion. Powers doesn’t write any longer, he speaks. He uses voice recognition to tell his stories. Do you, class, feel that changes something? There is some different to “careful and perfected language” as our Fresh Air host suggests to an oral history, even of the same events. Remember: The brain always is editing, like we’ve found, no memory is solid upon itself. They change, grow, and subtract from an event: a memory is not an exact thing. One would think then that something written would at least remain consistent in its story rather than a tale told which could change with time and it’s orator. Do you feel that this is a reasonable assumption that something written is more concrete in reality than a story uttered? Keep this in mind: “Typing and speaking are two completely different neurological activities,” explains Richard Powers.

I know that I hesitate to say yes, that writing is more concrete, but I think back to our conversation on Autism two Monday’s ago with Lyde Sizer and Michelle. Michelle offered us an amazing clear, time-lined accounts of her and her sons’ lives. An act which can not have been easy, telling a personal story in front of a room of strangers—even as an actor, myself, I would find that difficult. Her story was almost if not more fluid that Lyde’s “letters.” There is something to be said about an oral story: never revelations can occur when reaching back into the past. Sometimes it’s as if the present afflicts aphasia and we can only see clearly years later in the future. Think about this idea of narration and stories, our past conversations, and perhaps your own experiences and write about written and orated narratives and their role in narrative stories. Does one tell a more reliable story? Are the both valid modes of story telling? Both invalid? What are your feelings, based in your logic and studies, on this subject?

Thursday, November 15, 2007

Last class

Re: our discussion about second lives on the internet...

I saw this article and thought people might be interested:

Sunday, November 11, 2007

Your self and your brain

“The distinction between diseases of “brain” and “mind,” between “neurological” problems and “psychological” or “psychiatric” ones, is an unfortunate cultural inheritance that permeates society and medicine. It reflects a basic ignorance of the relation between brain and mind. Diseases of the brain are seen as tragedies visited on people who cannot be blamed for their condition, while diseases of the mind, especially those that affect conduct and emotion, are seen as social inconveniences for which sufferers have much to answer.” Antonio Damasio

In this short aside, Damasio spoke about something that I’ve noticed and wondered about in each of our readings so far. It makes sense that ideas about identity and the self keep coming up in a class about how our brains formulate our individual narratives and moments in which they are disrupted. I agree with Lauren’s post – each reading is so linked with the others. I thought of Sacks’ patients with Korsakov’s Syndrome when, in The Echo Maker, Karin acknowledged that Mark was getting better, which made him “worse than hopeless.” That paradox stood out to me as extremely unsettling. What calm or peace could he find when so many of his brain functions were in tact but the one he was missing made his life a constant struggle? Would he be better off if he were back in the coma? What did it matter if you could function on nearly every level if you were missing your “self”? Would you adapt to the new self?

As I read The Echo Maker, I kept waiting for Mark’s brain to resume its normal functions, so that his true “self” could return. Implicit in this statement is the idea that healthy brain activity actually is a person’s identity. At the point where Mark begins to speak but can only curse, Karin thinks to herself that “this was injury, not her brother.” Where, then, is her brother? If he disappears when his brain is injured and will reappear (hopefully) if his brain heals and restrengthens, then what separates him from his brain? Does anything?

This is very similar to Gage and Elliott, in Descartes’ Error. Actually, to connect this to Sacks again, I thought of Temple while reading about Elliott. Damasio described “Elliot’s predicament as to know but not to feel.” I remembered the way that Temple would look at a beautiful scene and note that people found it beautiful but she could not understand what that meant. Or the brief mention Sacks made of a child who very simply explained that his mother died, but he did not feel a sense of loss. Elliot and Gage, of course, were different in many ways. It’s incredible how the brain can actually work against itself instead of for its own survival.

I understood their situations better after reading the LeDoux chapter about motivation and the prefrontal cortex. When he wrote about the complexity of motives and decision making, how drives, incentives, and reinforcers work on a biological and emotional level but constantly shift within the context of an ever changing environment, I felt for someone like Gage or Elliott so much. As competent as they both were, even of extraodinary intelligence, they lost something vital to who they were. LeDoux explains how, “cognitive processing will be accompanied by emotional arousal,” and this seems to be exactly what Elliott lost. I was glad that we read the selection from Descartes’ Error after reading chapters in LeDoux on working memory and executive functions, because it made use of that material.

The questions I’m still left with are... Is every personality change accounted for in the brain? (I’m interested to know if autopsies have been performed on particularly cold-blooded killers. I feel like I have some memory of this happening and would be interested in the results. Does the brain of a sociopath look different than the brain of a compassionate person?) Also, if the brain controls personality, do we have free will? (Yes, I seem to ask this in every post.) What role does consciousness play? Do we have control over our consciousness? Since we seem to have little or contradictory information about consciousness and subjective experience, can we actually trace this to specific brain activity? And finally, when can you hold people accountable for who they are – or can you ever?

Saturday, November 10, 2007

"fall from social grace"

We seem to be working within a particular continuum. For the past two weeks we have been looking at, at scratching our heads over, Autism and the complex nuances of the vast spectrum. From out readings and discussions it seemed that we could contain the spectrum with in the poles of low-functioning (borderline mentally retarded) Autism and high-functioning Aspergers. However, this week we discover there is another closely related disorder, Capgras. The similarities between Capgras and Autism are striking in many respects. The dysfunctional workings of the amygdala, a more general defect in the orbitofrontal cortex, resulting in lack of theory of mind, disturbed face recognition or recognition of people in general, shortcomings in emotional processing, and a “fall from social grace.” This makes me wonder if the Autistic spectrum should be opened up a little more to include Capgras. Or is Capgrass an example of how we can break apart the Autistic spectrum and organize the continuum? This also makes me consider the usefulness of the spectrum. Should it stay in its ambiguous state or be shaped a bit better?

The Hirstein, Damasio, and Powers reading all spoke on the intricacies of theory of mind, emotion, and decision-making. I found the connections between these brain functions to be surprising at first yet in the obvious. Having theory of mind makes it possible for a person to understand the perspective of others. Knowing this from this weeks reading on Capgras and previous readings in Autism, it makes sense that without a theory of mind people have no social tact. We also see that dysfunction in emotional responses and recognition also plays into theory of mind and behavior. Apart of the inability to recognize people is because one cannot draw upon an emotional connection to that person. Because those with Capgas do not have this emotional connection, and do not understand the perspectives of others they live in this detached world. A lot like those with Autism. They confabulate the world around them, because they have faulty emotional ties, which make their actions in the real world inappropriate and wrong.

Mark, Gage, and Elliot, all had the fundamental aspects of brain functioning intact, however we see that this does no mean that they are fully intact people. Capgras eroded a huge part of their personalities and thereby altered their behavior by taking away particular higher brain functions. Thanks to Mark, Gage, and Elliot’s dissociation, we see how essential to survival it is to have ones personality in place. Because these men were not able to recognize their family members, have appropriate emotional responses, and confabulated much of their world, they had no feeling of self anymore. They knew about their live, were conscious of the fact they had families, jobs, etc, however they are described as not having emotional connection to their lives. Mark knows he has a sister, yet her does not recognize and feel connected to Karin. I believe, and as was touched in the reading, that this emotional connection to ones life and self is essential in ones personality. We also see in Elliot that with out his personality he made horrible business decisions where he ended up in bankruptcy. What the cases of Capgras boil down to is a debate about the core of a person. What really makes a person? Damasio asks the important question when talking about Gage, “Is it fair to say that his soul was diminished, or that he had lost his soul?”

Understanding Motivation

Motivation is simply fascinating—what drives us, what “makes us tick.” Prior to this course I had never thought of motivation as being a function of the brain outside of a very “hunter/gatherer” sense. I understood that people wanted things foremost on a basic level like food and water (incentives) because they were necessary for survival, but I never really understood why people wanted other things like material possessions (secondary incentives) that weren’t evolutionarily “programmed” as a means to survive.

The use of dopamine in the brain was most interesting. I often hear the word dopamine thrown around, usually associated with drugs. Even in the movie Super Size Me, it was proposed that fast food raised dopamine levels in the brain and therefore had “addictive properties,” that would cause a continued consummation of the product.

I always thought dopamine simply caused a sense of euphoria—in essence, it made you feel good. The fact this is incorrect, that dopamine is rather was motivates you to obtain incentives is quite intriguing. I can’t say that I fully understand how pleasure centers work. If dopamine is what makes you want, then what exactly makes you feel pleasure? What occurs in the brain that causes satisfaction?

It’s interesting to read about motivation in the context of The Echo Maker. A woman, whose brother suffers severe brain injury, is driven to determine what exactly happened to him. I think the closeness to her brother is a great factor in what drives her here, had they not had such a strong relationship prior to the accident, would she still be so consumed in what went wrong? I think it’s logical to assume that what motivates us differs on an individual level which causes me to recall the idea of nature/nurture and being wired for certain behaviors.

Remembering Zatesky and Skloot who still had their motivation intact, whose motivation became their lives because their lives had become fragmented and piecing what they had lost back together was the incentive. But I think even prior to their brain insults they were determined people in general, it was part of their persona.

I think it’d be interesting to determine how much of us is wired toward certain motivations as opposed to others; and how much of that is predetermined by the critical time during our childhood where we are more susceptible to wiring.

"In the Neighborhood of Benevolence and the Front Part of Veneration"

You dream about someone special in your life, someone you are close to or love. In the dream, the person hurts you, or behaves unexpectedly, does something shocking. The next time you see that person, you look at her or him a little differently. It was just a dream, but you can't help feeling like the person in front of you is somehow changed.

This, I imagine, is sort of what misidentification syndromes such as Capgras must feel like. I read Part One of The Echo Maker before tackling the other readings this week and wondered how different the experience is now than if I had read it before taking our Narrative Neuropsychology class. Four months ago I still would have been fascinated by Mark Schluter's brain disorder, but I think I would have been more anxious to find out the secrets behind the car crash than the secrets of Mark's mind. But maybe that's just a confabulation. I couldn't help noticing how many parts of the text reminded me of other people and situations we've read about: page 36, where Karin asked, "If he can say a word, it must mean something, right?" called to mind dementia and Alzheimer's patients who sing, and Sacks's patients with Parkinson's who could be driven to speech through music lyrics; Mark's first nonsensical phrases reminded me of Skloot's occasional trouble with word retrieval, and Mark's profanity brought to mind Tourette's patients; page 59, when Mark asked if he were asleep, reminded me of Zasetsky; page 78, as Mark considered what it meant to be related, made me think of Zeke's feelings of gladness at not having any siblings; page 80, where Mark "seemed for a moment about to break free, to know her," had me considering the relationship between Capgras and memory. It's no wonder, given what we've learned in our readings about the interconnectedness of the brain, that one disorder would have whispers of another.

Richard Powers is also examining issues of identity and labels that we've touched on in class. When Karin, on p. 56, spotted a bird she couldn't name, Powers wrote "Names would only have obliterated the thing." This is like losing sight of the human once he is diagnosed with a certain disease, what Sacks works against. This is reiterated on p. 71, when Karin says of the attendant Barbara "She just sees you, sees whoever is in front of her." And Daniel meditates because it makes him "disidentified," a rather ironic thing to say to a person who is the misidentified victim of her brother's Capgras.It is revealed throughout Part One that Karin has changed, or hopes she has changed; doesn't want to be seen as the same person she was. Perhaps that's behind Mark's Capgras: The sister in front of him isn't the woman he remebered. It's also common, when around someone sick or injured, to behave in a way that differs from usual; maybe Capgras sufferers react to this. And besides my example of the dream at the beginning of this blog, we all have little Capgraslike moments in our lives, like on page 93, when Daniel and Karin argue, "And, for a minute, he turned foreign."

If we were all to go crazy, we wouldn't go the same way, and sometimes I amuse myself by thinking of the most entertaining ways friends or colleagues could demonstrate that they've lost it, based on their unique personalities. I thought of this as I read about disinhibition in Brain Fiction. As with the Powers novel, this reading also tied together different disorders, such as autism, Tourette's, and the confabulation disorders. It all leaves me wondering if Capgras and the other misidentification syndromes are mainly problems of perception, memory, or emotional response, or a combination of all three? If, in Capgras, the loved one isn't recognized because the expected emotional response is missing, where did it go? If emotions are just bits of our brains that can be erased by a bonk on the head, what does that say about who we are and what love is? And do we really want to know?

The more I read for this class, the less I believe in psychology at all. The misidentification syndromes seem on the surface to have a psychological basis, but in truth they do not; and I wonder how many people in the past, like Phineas Gage and Elliot described in the Damasio reading, changed after brain injury or illness and were believed to be acting out psychologically--reacting to the trauma of sickness and recovery--rather than altered physically? I enjoyed Damasio's style and, as he described Elliot, compared him to Sacks. He didn't make himself a character in Elliot's story, as Sacks would have done had he written about this patient, but Damasio still gave a nice description of the man behind the illness. Some things I would have liked to know sooner, such as Elliot's own perception of his changed life, but generally thought Damasio was thorough, clear, and compelling. The lack of records about Gage's condition--specifically, as mentioned on p. 51, emotional defects following his accident--reinforce the importance of detailed narratives such as those by Luria, Sacks, Skloot, etc.

A final comment on The Echo Maker: "But she's still sexy as a pay channel" is the best line I've read in a long time.

Friday, November 9, 2007

Mental Deafness: Confabulation, (Mis)Identity, and Reality

This week's readings focused on the theme of confabulation, the accompanying mental scars, and the effects on both the afflicted and their doctors, families, and friends. As Hirstein illuminates in Chapter 5 of Brain Fiction, confabulators display certain traits: orbitofrontal damage, a lack of embarrassment or consideration of others' feelings (edging toward the sociopathic) and a dogged adherence to their claims of "impostors" replacing their loved ones, even in the face of all explanations and facts. (We've all heard about the horrible things that people can do and wondered how someone "normal" could go that badly wrong -- this offers a possibility of argument that sociopaths really do have a different chemical composition, mental defect, or otherwise faulty wiring that leads them to plan and execute acts unfathomable to the average person -- Hitler, Pol Pot, etc.) But while Capgras' syndrome has been meticulously charted in neural terms and doctors can point to the roughly accurate areas of where trauma has occurred, it has also to do with something that cannot yet be fully assembled and picked apart (despite the best efforts of neurologists) -- emotion.

As we've seen in our readings from LeDoux, he is constantly attempting to define emotion solely on the basis of gross neural circuitry and which synapses fire where. While it's true that every operation for humans, consciously or unconsciously, filters back to the "computer in the cranium," this is understandably met with a great deal of resistance when getting into subjects considered more ephemeral, such as emotion, the soul, and innermost fears and desires. As mentioned in The Echo Maker, patients with Capgras have an emotional link severed, and do not automatically access the inherent database of memories, emotions, thoughts, and reactions that, for them, their "real" loved ones would surely activate. As Hirstein explores, the sight of a familiar and much-loved face has much more impact on us than the sight of a stranger. If we see someone we know and care about, our brains activate good memories, pleasant feelings, and the remembrance of experiencing love to reinforce the basic perception of a person that our optic nerves are transmitting: this is a close friend or family member, not an empty automaton, and we know this because we have positive identification and feelings for them. Yet this is precisely what patients with Capgras syndrome lack, and it is this that leaves them to believe they are left alone in a world of impostors.

The Echo Maker explores this issue from both a scientific and humanistic perspective. Unlike Margot Livesey, Richard Powers is clearly writing for both audiences -- scientists and the general public -- and makes sure to enrich his novel with the neuroanatomic prerequisites and manifestations of the syndrome in addition to the effect that his sufferer, Mark Schluter, has on friends and family. We can sympathize with Karin, who is trying desperately to take care of him, and envisioning ourselves in her position is wrenching -- not only has her brother almost lost his life and now requires long-term care, he refuses to even recognize her or be grateful for her presence, because he is convinced that she is someone else. The contortions that our brains can put us through are downright frightening, and yet again raises the question of what reality constitutes. Clearly, Mark has an incorrect idea that Karin is a clone of herself, but for him, it makes perfect and unshakeable sense, and although he might have departed from the mainstream, his life is as informed and his motivations as determined for him as they are for anyone else -- we can only act and react according to what our brains tell us is unshakeably true. Mark cannot live in Karin's reality because he is convinced, on the same level that we are sure of ourselves and who we are, that it is invalid. We can pretend to live in a fantasy world, but quickly run into conflicts with our notions of reality not matching up to everyone else's; besides, it can land us in Bellevue and however much we complain about the food here, it's undoubtedly much worse there.

But that's just the question. We see confabulation as lying; what the patient expresses as reality and what we know from empirical research or evaluation simply do not match up. They will not be convinced otherwise, however; how would you take it if a researcher came up to you and told you that your reality was entirely fabricated and things were much different than you instinctively knew? You'd take it badly, of course, and offer a constant parade of excuses and explanations as to why things were in fact the way you knew them to be. If the patient lacks the awareness or the intention to deceive, and is in fact following their brain's preconceived constructs of reality (as erroneous as they might be) can you really call it lying? Can we even trust our brains? What in the heck are all of us doing? We don't lie about our fundamental surroundings because we have the inherent assumption that they are true, and the same goes for the Capgras' patient. They speak the "truth" for them, which becomes a distortion and paranoia for us because of the different channels mapped by our brains.

Mentally "sound" patients know they are sane because their ideas and precepts match up with everyone else's; that good ol' peer pressure theory back to work. If both you and someone else agree where the wall is, you'll steer your route through your physical space to avoid walking into it; you have the same perceptions and the same mental "channel." The Capgras' sufferer is like that old electronic toy that just kept backing up and hitting the wall again; their reality is out of sync with everyone else's and they are being told that what they know (never mind what subconscious circuits aren't working) is completely wrong. They are in a universe completely different from what they think and perceive to be true, and they are swimming upstream while believing that their real family and friends are being kept from them, most likely through a malicious conspiracy on the part of the doctors -- can they trust these people to heal them? Sounds pretty isolating and frightening to me.

We as readers can sympathize with both the patient and their families/friends, and, like Karin Schluter, we'd be in desperate desire for a cure. Is that what neuropsychology is after all -- altering reality, one brain at a time? Timothy Leary isn't even involved.

Sunday, November 4, 2007

Opening Up

This week’s reading primarily focused on autism, a continuation of the themes of last week. However, both weeks have also emphasized emotions: to what extent someone on the autistic spectrum can experience emotions, how we live with the choices our emotions seem to make for us, and, in the case of the LeDoux reading, what the nature of emotions really is.

I don’t know about anyone else’s take on the assigned reading of this week, but I feel as though emotions are an even grayer area than before I started the reading! True, the reading explores human connectivity and emotions in new and deep ways. But it seems to get so tangled when it all comes together. LeDoux talks about how a “pattern of inputs…biases us more toward an open and accepting mode of processing…” He tells us that, “The net result in working memory is the feeling of love.” While there is surely no elegant way to describe love in technical terms, I feel as though I’d much rather leave it nebulous than have it become a bias that is a result of “a pattern of inputs.”

All of this week’s LeDoux reading was interesting. From the credibility problem and the idea of finding a way around it, to his description of a processing approach for studying emotions, to the studies of people with damage to their amygdalae, to the discussion of wanting to study voles because they mate for life—all of these things fascinated me. And perhaps in a technical sense they help approximate where our emotions, conscious and unconscious, come from. But in a purely visceral way (and I know, here I am calling upon the visceral in a discussion of the visceral!), they seem to fall short of the important aspects of emotions. He tells us that, “Emotions…amplify memories,” but this sidesteps a discussion of the amazing feeling that nostalgia brings. I know that emotions are probably one of the most interesting things to study about the mind. This is because they present the greatest mystery. But personally, I rather think that mystery is what makes life interesting, and I wouldn’t want to solve this one even if I could.

Lyde Sizer speaks in-depth about the need for contact that all of her children—including Ryland, her autistic son—share. This would seem to go against most definitions of autism. So here I am, fuzzier than when I began. Here, her child clearly shows a need for physical contact, which implies a certain amount of emotional response in a child who, by nature of his condition, should not really be driven to such personal interactions. I suppose we must come to understand that individualism is no less prevalent simply because a child is on the autistic spectrum. Humans have a bent for uniqueness that no syndrome could take away. We are all so different in subtle ways that it seems to me that even our idea of a “spectrum” for autism is flawed. Someone could fall in one place mentally, in terms of IQ, and then another place entirely in terms of how well they interact with people. Should we accept some arbitrary quantization of terms into an aggregate total? Or should we rather love and respect people for who they are?

The issues explored involving emotions are issues that we all deal with, autistic or not. They are issues of opening up, letting go, feeling relaxed in our own bodies. In reading the Developmental Psychology article that was assigned, a curious question came into my head: Do autistic children really have more trouble coming up with an introspective response, or are “typically developing” children just better at making something up? The main difference between the two types of children seemed to be that typically developing children were more prone to telling stories. This simply made my mind jump back to our discussion of confabulation. Do we really know what we feel any better than an autistic person does? Or do we pretend we know? Do we tell a story, finding our feelings only after the story has been told? Emotions are more than words. So, is a measure of our ability to give words to our emotions really an accurate measure of whether we have complex emotions? I would say no.

Saturday, November 3, 2007


Autism seemed to be the main focus in these readings, but I also related them to a mind and its secrets. With the readings of Sizer I was really placed in a world outside of myself. I have many questions and to things I am not sure I'll find a way to understand as much as I would like. I really respect Sizer for sharing her story, it takes a lot of courage and I look forward to her speaking. Last week in class we talked a lot about the spectrum of austim, that is the part that is so difficult, it is not completely one thing, its many things that make up an idea of something because even the 'common' characteristics aren't universal.
I liked Sizer's writing style, we are placed in her situation but from a different angle, and maybe that also has to do with the ambiguity of autism. It is about a mother, a person, who has questions about a continuing life. She has similar questions that we would have about our own lives, but they are transferred not to someone else as advice, but to someone else through thought and out of hope. I wanted to know more about how autism is accepted, how taboo it is in society or others' reactions to the disorder. There are many other disorders that have reputations for being associated with other things, where in society it is easier to place them into boxes. For example children with down syndrome, questions pertaining to the age and health of the mother arise. ADD,schizophrenia, depression --- I know these things don't fall into the same categories, but they accompany ways of dealing whether it be through diet, attitude, approach, treatment. It seems with autism education and communication is key to development and nourishment -- maybe that is why I have such hope, because it is so mysterious.
In the LeDoux chapter about the amygdala, I thought about this secret mind, and the question of whether or not the amygdala has anything to do with emotions. Maybe I didn't read it correctly, but wouldn't fear be based on nothing if the amygdala didn't have some sort of a relationship with emotions?
'The advantage of the emotions is that they lead us astray.' - Oscar Wilde
This is key in the question linking emotion and fear because we are led astray because of the emotional attachment people have to fear. Then this lead me to a question about autism; can people with autism react to fear? How many places in the brain are affected or does that vary as well? I guess the thing I realized with these readings is how many questions I still have about these ideas. I have been thinking a lot about SLC and the way that the school works and the way the people work. As a school SAT's are not required, we are smart kids with or without them, but for most people it makes them nervous. Why wouldn't these tests, over and over again, make a child with autism nervous, having them perform worse in a disorders eyes? What is a true representation of autism? Is it like gaining a memory where things will continue to come and go and situations arise and opportunities are taken for no rhyme or reason?

Understanding of Emotional Experience in Autism

In “The Synaptic Self”, we learn that memory is accompanied by emotional components. The limbic system has long been associated with memory and emotion although some scientists believe that we should abandon the limbic system theory entirely (but then where does that leave us? Back to square one?). Emotion is what sparks our brains to record a memory. This reminds me of Floyd Skloot’s mother retaining an abundance of music; I can imagine her singing jollily all day at the nursing home. Songs were the last thing her Alzheimer’s erased. I am also thinking of Hazel in “The Missing World” because even though she lost a good portion of her memory, she still remembered Jonathan. I suppose this is in the realm of complex emotion, because we cannot really label the way this music made Lillian feel or what emotional attachment Hazel had to Jonathan, but generally, such strong emotions explain such strong memory.

In the psychology article (“Understanding of Emotional Experience in Autism: Insights from the Personal Accounts of High-Functioning Children with Autism”), they tested children on the higher end of the autistic spectrum to discover their knowledge of emotion. Some kids seemed to confuse embarrassment and guilt with anger and sadness and some interpreted happiness as surprise or being proud. It is not that they lack or do not have emotion; it is that they can not decipher their feelings or understand complex emotion. This is troublesome to me, in terms of memory. What kind of affect does this have on their ability to remember? What is important enough for the brain to absorb and what situations get discarded because there is not a strong enough emotional connotation? Autistic children suffer from tremendous disadvantages. You begin to mold who you are in youth, your social interactions depend on the transfer of emotion. Children respond to clear cut emotions and will probably gravitate towards someone who would be cheery all the time. What they might not respond so well to is a child who does not portray emotion much or very well. Again, because most children (sorry for generalizing so much) think in clear cut and concrete terms, they may automatically label that child as “weird”. On Wednesdays, I work in a second grade classroom with children who have special needs and I see this happening all the time. It kills me to see one boy outcasted because he doesn’t know how express himself properly. The rest of the class may not even outwardly feel opposition towards him, but they cannot relate to him in any way, so they all become distanced from him. Everything we took with ease as children, learning, making friends, developing personality based on everything around us and what we like or dislike, seems like it becomes a thousand times more difficult for autistic children.

The essays by Lyde Sizer were beautiful and honest. Reading a first person account of something is always very helpful. The main thing I wondered throughout the entirety of that reading was about the weight Lyde carried of her son’s disadvantage. Has Ryland ever articulated or attempted to describe his feelings about his disadvantages? Lyde seemed more embarrassed and ashamed than Ryland was (not that we saw too much of him in the essays). When Jay’s friend is gently playing with Ryland, Lyde is bothered by the fact that the flapping visibly enforces his autism to the world. Initially, I felt like it was a huge blow to her ego that her son was autistic. In relation, I think I would have to ask her if she has gotten close to other parents with autistic children since Ryland’s birth. I wonder if they collectively all went through the same grieving process. What are the things he responds to above all? Is his memory largely affected by his Autism? Does he have his own ways to show his emotions? How does he show his love for her?

Monday, October 29, 2007

Parallel Play and Prodigies

After reading Tim Page’s article, Parallel Play, and Sachs’ chapter, Prodigies, I was immediately struck by the different degrees of aspergers syndrome and autism. For example Tim writes: “Caring for inanimate objects came easily. Learning to make genuine connections with people—much as I desperately wanted them—was a bewildering process.” For Tim, he mourned his inability to interact with people in society and was very hurt as a child by his teacher’s frustration with him. In contrast to Page’s account, Sachs writes that Stephen really didn’t have much connection with people and was not aware of any kind of deficit in his emotional capabilities. Sachs writes: “Other people held no apparent meaning for him [Stephen] except to fulfill some immediate unspoken need; he treated them like objects” (197). When Stephen’s mentor Chris Marris can no longer be there for him, Stephen seemingly doesn’t hold any emotional attachment to the man who had been in his life for so long. For most normal children this would have been a great loss and sadness, yet Stephen appeared completely devoid of any feeling for his long time companion. However when Margaret falls ill, due to an asthma attack, Stephen actually is very distressed and stays by her bed. This was very striking to me. Is it possible that through Stephen’s artistic expression that he is actually more open to human relationships? It is unclear as Sachs writes, but it is still interesting to pose the question of how much Stephen actually can penetrate? He laughs and is amused, but by what? Is it random laughter or is he actually connected to someone or something?
Finally, the saddest account was Christopher Gillberg’s encounter with a fifteen-year old autistic boy who had lost his mother to cancer. The boy is unable to grieve his mother’s death, but can logistically explain that he has no sense of loss because of his Asperger syndrome. It is almost more terrible to be able to be aware of your problem than oblivious. This made me think of Zazetsky and Dr. P, who are both suffering from similar disorders, yet one is painfully aware and the other oblivious. Throughout all these accounts it is apparent that there are many varieties of autism and none can be neatly categorized.

Unconscious Cognitive Processes

In Sack's chapter on Prodigies, I was alarmed by his descriptions of how their special abilities are carried out. This was shown with the "calculators" and with Stephan. With the former, Sacks explains how not only are they unaware of the methods used to arrive at their answers, but that people with this ability seem to store such problems in an unconscious part of their minds and work out the answers there. The idea that someone can come up with ANY mathmatical answer intuitively makes me uneasy, let alone the level of difficulty and long numbers they can work with. They arent using their working memory, they arent using our ideas of reasoning.

I was reminded of mathmetical tests that have been done on infants that show a basic mathmatical sense. This is done by observing surprise and how long babies look at objects to infer what babies expected to see juxtaposed with what what they find in front of them. These are very basic mathmatical concepts, however, and suggest an abstract mathmatical and spacial understanding rather than a numerical one, which is what the calculators show.

We saw how Stephen's artistic process was similar to the calculators' processes when Sack's is told that while Stephen is drawing, he does not need to worry about distractions. He seems to simply absorb the visual information in front of him as he "bestowed a quick, indifferent look at my house--there hardly seemed to be any act of attention." His "transcription" is similar to the calculators in that he can converse while working and outside distractions cannot deter the process in anyway. Concentration does not work in the way that it does in the "normal" mind, where any distractions in our trains of thought may cause us to forget the information we are temporarily holding. Stephen and other savants work out of their own realm of understanding, which processes and stores information independently of a guiding and controlling "self". Perhaps these processes are heightened in the autistic because the information is not first filtered through the connections that the "self" makes, which temporarily discards information in order to see the big picture.

The part that makes me uneasy is that this means all of us with "normal" brains really do have cognitive processes that we are unaware of, though they are not as well developed as in the savants. To what extent can we tap into them, to what extent are we unconsciously controlled by them? Awww man, I hate Freud!