Saturday, November 10, 2007

"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.


Madeline said...

What you wrote about dreaming in the first paragraph was fascinating. It made me remember that I've actually had dreams in which people around me were impostors. Interestingly enough, the people who are replaced are always close relatives; the impostors look identical to the people they're trying to impersonate, but I can tell them apart by some minute detail - and they're always out to get me.

It's strange that I have had that sort of dream, yet still when I first heard about Capgras I thought it was almost too much to believe. I've always thought about brain disorders in terms of a specific brain function wrong. It seems perfectly plausible to me that if humans have the ability to speak, they can lose it; if they have the ability to identify faces, they can lose that; and likewise they can be born without those abilities rather than losing them.

But what about Capgras? I couldn't figure it out. What had gone wrong? Was there a lesion in that area that lets us ... know that our relatives AREN'T impostors? I was kind of amazed that a brain disorder could be so ... creative.

"Brain Fiction" helped me to understand a lot that I hadn't before. As always, we take our brain's abilities for granted. I hadn't been thinking about the part of the brain that assigns emotional connection to faces. That is a brain function much more complicated than the sum of its parts. It's really quite incredible.

What I am still dying to know, however, is whether someone with Capgras can recover. Is there ever a moment where they see their relative and say, "Oh my God! It's YOU! You're back!" after thinking they are an impostor?

How do you treat Capgras? Is it possible to show the person their faulty reasoning, in order to convince them that their relative is NOT an impostor? Could therapy help the person to use another part of his brain to try and recognize the "impostor" emotionally? Or is there no hope once that part of the brain is destroyed?

Molly said...

I had similar questions about Capgras. It's a syndrome, so is it apart of something bigger or is it a precursor for more to come? In the case of DeClerambault's Syndrome- the ability to believe a certain person or someone famous loves you- I can't help but think of my Aunt with schizophrenia who thought that Kevin Costner was in love with her and was going to come and rescue her. My question then is would it be a different part of the brain that thinks someone loves you, than calling a relative an imposter? Being loved or recognizing a loved one can be very emotional, how much do emotions have to do with Capgras?

It's great to read The Echo Maker with these texts because Richard Powers has such a loopy way of writing that I feel I'm watching a play with a front row seat. He fully develops Mark not only has a patient, but as a person. We are placed into both of his worlds without having any present-tense evidence of them.
I found Damasio's style helpful as well. I was able to identify with Gage in a different way than with other case studies. When Damasio mentions the "collector's behavior" found both in Gage and Elliot I couldn't help but think how normal that is. This type of collecting is considered an autistic trait as well. After thinking about it more I realized that it must not just be the actually collecting of objects, but the significance and weight that they bare being placed in that category. This also made me wonder if Capgras syndrome allows for certain attachments of this sort, than they must be emotional right? Or how else would they define their sweater from someone else's?

Ashley Leone said...

Madeline, I had the same feeling while sifting through all of the texts: these are such creative syndromes. Cotard's syndrome (where everybody is "dead" or "empty" to the patient) just makes me think of a really over dramatic angst driven teenager exploring his or her negative view of society. And DeClerambault's syndrome... I didn't know they had a name for my disorder! In all seriousness though, I talk about my movie star husbands all the time. I am consciously not convinced that I am married to them (and unfortunately, nobody else is convinced either) but I would have never expected some people to actually be suffering from syndromes like these. They seem really playful, but having a loved one firmly believing in such delusions must be so traumatic.

Capgras' syndrome is devastating. In The Echo Maker, reading from Mark's voice/point of view is really disorienting. First, you have to overcome the Echolalia, and say some of the sentences out loud to realize what words he's trying to imitate. It's like that game Mad Gab, where you are given a series of words that are jibberish, but if you say them out loud enough you hear the phrase intended. "He's taken an acid dent." (Page 50) is about him being in an accident, and he mimics "Echolalia" by saying "Echo. Lala." I agree that Richard Powers really grounds himself in the disorder and forces the reader through the tragedy as well. I can't even imagine how painful it is for your brother not to believe that you're his sister. I don't recall exactly in the book where it is, but I definitely felt the blow when Mark tells Karin that she looks like his sister, but just not as pretty.

I am curious about these misidentification disorders, can the patients get past them? Is there a way for them to eventually be cured, or do their loved ones go unrecognized forever? In Brain Fiction, Hirstein describes that woman who made three cups of tea all the time, one for her, one for her impostor husband and one for her real husband. She adjusted to her life with this "new" man, but never gave up hope that her "real" husband would come back. Think about how the patient must feel, stranded, suddenly abandoned by the one person they thought they could trust. I guess you aren't lost to a person with Capgras' syndrome the same way you are lost to someone with Alzheimer's because the memory of you still exists, but they still seem like the worst things that could happen to your spouse. But then again, if someone I married suffered from any other detrimental disorder, I'm sure I'd believe that to be the worst that could happen.

Patrick said...

I, like Madeline, was fascinated by Lauren's comment about dreams. It is an idea that has plagued me for quite some time: the MEMORIES of people are all that you really have, therefore, if something changes the memory of that person and they aren't there to correct you, the REALITY of that person has changed for you as well. It's akin to "a tree falls in the forest," but a little more subtle. And it seems to me that it has a more active impact on how you view life.

I feel that dreams cannot really be denied their own realm of our mind. We spend so much time there, how can we say that our wakeful state is the only place we are really "acting" in any kind of reality?

The same is true, in a sense, of Capgras' syndrome. Where does their reality end and the "real" reality begin? Reality is a construct that we all AGREE UPON. So when someone DISAGREES, what does that imply for the rest of us? There are spectrums in autism, but really there are spectrums to every disorder. They are like branches of a tree, with all of the "normal" people at the trunk and the less-functioning people near the ends of branches. But it's all the same tree. If this analogical tree is our world-view, with everybody in existence making up a part of it, how can we deny the impact of the branches on reality?