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?