Narrative Neuropsychology

essay excerpt

2007-12-10T18:36:00.001-08:00

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.

Circle complete

2007-12-03T00:14:00.000-08:00

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.

Reflections

2007-12-02T20:34:00.000-08:00

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.

Neuro-Porn

2007-12-01T13:45:00.000-08:00

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.

The Traveling Neuroanthropologist: Sacks and Ethics

2007-11-30T13:23:00.000-08:00

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.

2007-11-30T09:07:00.000-08:00

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!

-M.

Oh dear...

2007-11-25T15:05:00.000-08:00

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.

Defining the Undefinable

2007-11-24T21:47:00.000-08:00

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.
Confabulation:
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!

2007-11-24T14:34:00.000-08:00

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.

This is weird

2007-11-21T17:20:00.000-08:00

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.

Powers And Ethics

2007-11-18T10:35:00.000-08:00

(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

2007-11-18T08:59:00.000-08:00

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.

Sorry guys!

2007-11-17T14:25:00.001-08:00

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

The Truth in Powers

2007-11-17T14:03:00.000-08:00

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.

A Doctor's Obligation

2007-11-16T12:04:00.000-08:00

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.

Anonymous

2007-11-16T11:36:00.000-08:00

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,
-Matt.

Roles of memory in Oral and Written Narratives

2007-11-16T11:21:00.000-08:00

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?

Last class

2007-11-15T15:50:00.001-08:00

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

I saw this article and thought people might be interested:

http://www.switched.com/2007/11/15/17-year-old-jailed-for-stealing-virtual-furniture/?ncid=NWS00010000000001

Your self and your brain

2007-11-11T19:22:00.000-08:00

“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?

"fall from social grace"

2007-11-10T15:05:00.000-08:00

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

2007-11-10T13:24:00.000-08:00

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"

2007-11-10T08:41:00.001-08:00

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.

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

2007-11-09T20:05:00.000-08:00

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.

Opening Up

2007-11-04T09:35:00.000-08:00

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.

Autism

2007-11-03T21:18:00.000-07:00

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

2007-11-03T15:53:00.000-07:00

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?

Parallel Play and Prodigies

2007-10-29T15:38:00.000-07:00

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

2007-10-29T08:36:00.000-07:00

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!

Perspectives on Autism

2007-10-27T19:44:00.001-07:00

Though all the reading for this week was interesting, I made an immediate connection between the novel “Banishing Verona”, and Dr. Sack’s chapter of “An Anthropologist on Mars” by the same name. There seemed to be a profound understanding in both pieces of how autism can fit into the broader life of an affected individual. And I was moved by the underlying story in both accounts of a person living with autism, in contrast to an account of how an autistic person is forced to live life.
Years ago I had an English teacher who insisted that everything human beings said and did was motivated by a desire to be emotionally close to one-another. Parties, sex, drugs, music, television; she insisted all of these were attempts to share something. In her opinion human sentience was such a lonely existence that part of our “drive” as a species was to achieve some kind of connection with another person.
I’ve always thought she was over-simplifying things. I know there are times in my life (perhaps most of the time) when I want to be close to others, to be on the same page and have a kind of mutual understanding. But there are also times (definitely less often, but equally as distinct) when I want the opposite. Sometimes I don’t feel the need, for whatever reason, to form an artificial connection with someone I really don’t like, or I find myself in one of those moods in which I’d much rather be by myself for a while then surrounded by lots of other people.
When Dr. Sacks asks Temple if, when she looks up at the stars, she does not “get a feeling of grandeur” I was moved by her simple response. “I intellectually understand its grandeur”, she tells him wisely. This struck me as an incredibly honest and perceptive thing to say. I know I occasionally have the experience of being moved intellectually, rather then emotionally, by a sight such as the night sky. It is rare for an individual to always see things in terms of grandeur and awe; we’d wear ourselves out if everything around us produced such wonder.
Though I can’t possibly know the kind of isolation and feeling of being inherently different that some people with autism describe, I can sympathize with the feeling of not always being entirely in touch with my own emotions or those of the people around me.
Thus, I was pleased to find a fair amount of optimism and empathy in both Dr. Sack’s case study involving Temple Grandin, and the pages of “Banishing Verona”.
When Oliver Sacks describes Temple Grandin he includes his own account of the way in which she goes about her life; her dedication to her work, her own opinions about the way in which her mind is different from other’s, and her level of compassion and almost supernatural ability to empathize with herd animals. But included in his account there is also a marked understanding of the role that human interaction and emotional understanding play in Temple’s life. Sacks seems to understand that Temple’s mind isn’t merely a hallow shell, filled pitifully by her work and her logical reasoning, but is instead the hopes and confusions of a complicated and evolving human being. As always, Sacks seems optimistic in his description, continuously emphasizing both the ways in Temple is unique, and the ways in which she is striving to understand her own different.
Like Sacks, Livesey is in many ways compassionate in her description of an individual affected by Aspergers. For what does Livesey emphasize if not the idea that we’re all a bit in the dark when it comes to relationships and human interaction? What does Zeke portray if not the sort of difficulties in communication understanding that we all have to lesser extent? At one point in the book Zeke points out that sometimes, when it is socially expected of him to offer a greeting, he just doesn’t feel like it. Can’t we all sympathize with this on some level? We smile at someone even though we’re not really fond of him or her, or we stop to make small talk even if we’re in a rush to get somewhere. I know there are moments when I follow social conventions not because I feel the desire to do so, but merely because I know they are expected.
Thus, I found both Sack’s and Livesey’s perceptions of autistic patients to be refreshingly open-minded. Both chose to see human life as something broader then merely the connections we form with others; chose not to define a person’s existence merely by the ease with which they connect emotionally. Rather then seeing a high-functioning autistic individual as someone who will never be able to function in certain ways, shouldn’t we view them instead as demonstrating just how difficult communication and understanding can be for all of us? If we choose to see autistic individuals as sharing somewhat accentuated aspects of our own personalities, rather then seeing their limitations and deficits, perhaps we can better understand the mindset of those affected.

Outside Perspective

2007-10-26T17:28:00.000-07:00

I think there is great parallel play in both the New Yorker article under the same name and Livesey’s book Banishing Verona—actually I believe they are more perpendicular than parallel, if I am going to use this geometric metaphor.
Livesey does an interesting job of making the neurology of her characters the least of the characters' worries. I constantly have to smack myself when I get frustrated when I read, thinking ‘where is the psychology; where is the disorder,” when I am not really reading the story. I really have to get in the mindset of the story, not the disorder. It brings this to a larger point. These people are not their disease. They’re not “schizos” or “mentally disabled’ no more than I am a “man” or people are “gay” or “Asian.” I think as a society we tend to be seriously label conscious –look at the modern day prom or turn on MTVs super sweet sixteen if you don’t believe me—and Livesey does a great job of tearing away for that. I wonder if it is a seriously an American problem and doesn’t exist as much in the UK, but I find that hard to believe. When I’m reading her books he characters realities seem to be so secure that they almost don’t seem ill at all. That their way of thinking, like Zeke finding places to store food and water when working, makes perfect sense, or doesn’t seem too bizarre—and infact, our reality of “normal” life seem a bit strange. Take this section on page 135 in her book into advisement:

He had noticed that before, how people slammed a loose cupboard door, poked at a hole in her show, making sure that what was already fragile fell apart.

We all do those things, perhaps subconsciously and yet her characters, that may not get things like a simple social interaction on the street, pick up deep, subtle things like this passage noted above, how we tend to prode and poke our problems, making them worse. I'm guilty of such.

Perhaps I was rash in my judgments not to see any parallels in these pieces—I was never that good in geometry, infact I believe I passed mostly because my great colouring skills shows serious “effort” on my part.

Our New Yorker articles states “people with Asperger’s syndrome can tell us of their experiences, their inner feelings and states, whereas those with classical autism cannot. With classical autism there is no ‘window,’ and we can only infer.” So they offer this unique sense of view which they CAN explain to us. Asperger’s syndrome is so interesting to me. They are anthropologists in their own right. They have to study our (because they don’t seem to belong to it in their own minds) culture and find their way. With our customs and beliefs. Think of him reading Emily Post’s “Etiquette,” to learn everything about what was proper— I know my grandmother would have been happy and he would have been invited over any Sunday dinner. Because if you think about it, our beliefs must be strange to a complete objective party. For Religion, Christians attend church and drink the blood and eat the flesh or a man, or believe they do; in death, we drain the blood of the body, we embalm the corpse with chemicals so they last, like preserve in the kitchen cabinet. To us these activities seem so normal (mostly), but it would understanding how “outside the box’ these individuals would feel existing in a world where they wouldn’t understand the individuals!
Can you think of any other rituals that would appear “strange” to the outside individual?
Do you agree with this? Would you consider them outside or just another facet of humanity?
Are they missing our or are they more connected because they must learn, understand and then accept these rituals that we naturally associate into our lives?
Or should they celebrate what they call “neurodiversity?”
Is this part of our evolution or just a simple reordering of genes?
-- I know I’ve asked a lot here so just run with an idea or try to tie them together.

On a final note:
As quoted in the New Yorker, “My first and most powerful obsession was music—the same records played again and again while I watched them spin, astonished at their evocation of aural worlds that I not only instinctively understood even as a toddler but in which I actually felt comfortable.”—Again we see music as a cure or atleast a coping mechanism. Now unfortunately I missed Sacks’s talk (and we’ve seen that in his case studies like our ever famous Man who Mistook his Wife for a Hat) but did he give us any insight into the magic of music? Is there some about the implicit organization of chaos with notes on a sheet of music? Or is it simply soothing? What?

Hope you all had a good study break and I look forward to seeing you Monday,
--M.

Low Flying Aircraft

2007-10-25T10:16:00.000-07:00

A couple of weeks ago, I read a story called "Low Flying Aircraft" by J.G. Ballard. In the story, the population of humans on Earth had dwindled and it was generally accepted that the species was dying out. The cause of the sharp decrease in population was an alarming rise in a specific kind of birth defect; the majority of children were born blind, with incredibly deformed limbs and heads. Babies who were born like this were quickly euthanized to be put out of their misery.

In any case, by the end of the story it is made known that a number of these deformed children have been allowed to live into adulthood, and they have colonized abandoned parts of England. The twist at the end of Ballard's story is that these seemingly sickeningly malformed beings were not "defected" at all; they represented a new kind of species, a mutation of humans, that would inherit the Earth after the last of the humans died out.

Most importantly, these people were not blind per se - they could see and communicate with this special kind of silvery metal paint that they use to mark their surroundings. In this way they were actually superior to humans, because they could see things in the silver paint that their non-deformed predecessors couldn't.

Well, I thought about this story while I read "Prodigies," "Banishing Verona," and "Parallel Play" this week. The realization that a condition long considered a "deformity" or "disability" might actually represent a simple different way of being or experiencing the world is a common theme for all of these stories. It is in fact a common theme among bloggers who write about autism (I'm thinking specifically of a woman named Amanda Baggs whose website, Ballastexistenz, focuses on autism and disability rights).

We talked in class about the fact that homosexuality used to be considered a disease and in fact was listed in the DSM for many years. "Transgender disorder," someone pointed out, is still listed in the DSM. So is autism. Should they be? In some ways, yes, autistics are deficient. As Oliver Sacks explains, autism consists of "a consistent traid of impairments: impairment of social interaction with others, impairment of verbal and nonverbal communication, and impairment of play and imaginative activities" (246).

Well, there are some ways in which we are all "impaired," when we are compared with others. Compared to the way that my father (who is not autistic - just an example) can calculate sums in his head, I am impaired. I think that everyone comes to realize, sometime in childhood, that there are some things some people do better than others and some things some people do worse than others - that's non-debatable.

Autism isn't just about "impairment," then. It's about the impairment of a specific set of skills that we feel make us human: those that have to do with socializing. Impairment is acceptable only so long as you can make a joke about it: the fact that you can say, "Oh, I'm so bad at math," somehow makes it understandable. You can't say, "Oh, I'm so bad at relationships with other people." Somehow having a grasp of seemingly straightforward social niceties isn't something that you can laugh off. Somehow, while we don't presume that everyone is good at math or understanding literature, we do presume that all "normal" people are pretty decent at getting along with others.

Why, then? Well, I mentioned before - it makes us human, supposedly. Human relationships are far more complicated than animal ones. We take their complexity for granted because we are programmed to understand them. Autistics, however, are not.

As always, what we take for granted are our implicit abilities. Take Zeke, for example, who has to go "through the steps he'd learned from the poster he'd been given at the clinic" to understand that Verona was smiling at him (4). What kind of person, you might think, has to do that? Recognizing a smile doesn't seem like something you have to think about, or even something that you learn. Babies can understand facial expressions. It's something "built in."

Even more interesting and baffling, I think, than the thought that someone might lack an ability that is "built in" to all of our "normal," neurotypical minds, is the thought that such a person might have abilities "built in" that we DON'T have. I get the feeling that the general opinion on intelligence, before a couple of decades ago, was an "all or nothing" thing. If someone was "retarded," they were "retarded." There were no "different types" of intelligence.

Yet we see this in people like Stephen who "could draw, with the greatest ease, any street he had seen; but he could not, unaided, cross one by himself" (203). This seems strange to us, but would it seem strange if I told you that I have always been excellent at reading but had troubles with arithmetic? You wouldn't, because the two are seemingly unconnected. I'm simply not a "math person."

But it does not always happen, however, that someone who is bad at arithmetic is automatically good at reading, or vice versa. The strange thing about autism is that it seems to come with a certain, fixed set of strengths and weaknesses, as if they were linked somehow. True, not all autistics are prodigies like Stephen, but a commonality among autistics seems to be the tendency to see parts, and not the whole - which aids in Stephen's drawings but keeps him from understanding and appreciating the "big picture." There are other commonalities: "it is typical of autistic people, sometimes in early childhood, that they acquire geometrical conepts and terms to a far greater degree than personal or social ones," says Sacks (229).

Autism doesn't seem as unpredictable and varied as, say, schizophrenia. Autistics, in my experience, don't represent entirely different expressions of the same illness - as in schizophrenia, there are different types of the disease: paranoid, catatonic, hebephrenic, etc. - but rather different points on a spectrum.

So, there are people like Zeke, who is labeled an "oddball," "gets freaked out by things most people wouldn't even notice," and has problems with recognizing facial expressions and knowing how to behave in social situations (90) - all common with autism - but does not have symptoms severe enough to keep him from going to college, having a job, having a relationship - he "passes," for the most part, as a "normal person." The symptoms of his Asperger's are more likely to be called "quirks" or "idiosyncrasies" by people who don't know him well.

And then there are people like Stephen, who can probably never live on his own; who has a very low verbal IQ of 52 (202); and who did not speak until the age of nine (201). In his emotional development and talent for art he is very similar to Jose, who lives in an institution.

I believe that Tim Page is somewhere between Stephen and Zeke on the autistic spectrum. He barely made it through school, but he is clearly independent and self-supporting. And then, I think, Asperger's syndrome is somewhere between autism and "normal." Are we all on the autistic scale?

Some tend to think so. Page writes that "there is even some question whether it [Asperger's] should be considered an affliction or merely a "difference" - one of many human variants" (5).

Sacks says,

"Stephen's development has been singular, qualitatively different, from the start. He constructs the universe i a different way - and his mode of cognition, his identity, his artistic gifts, go together. We do not know, finally, how Stephen thinks, how he constructs the world, how he is able to draw and sing. But we do know that though he may be lacking in the symbolic, the abstract, he has a sort of genius for concrete or mimetic representations ... a sort of genius for catching the formal features, the structural logic, the style, the 'thisness' (though not necessarily the 'meaning') of whatever he portrays" (241).

We all know someone who is a little awkward in social situations, although he or she does not have Apserger's or autism. We all know someone who is particularly adept at socializing. Autism represents the extreme of that "awkward" person's difficulties. It is possible to conceive of a scale where people are positioned according to their capability in math or writing. The problem is, math and writing - while unique to humans - are not typically considered the things that make us human.

But it is possible we only think that way because so many people are decent at socializing. Even if you don't consider yourself a social butterfly, it's likely you know how to respond to simple "polite" questions like, "How are you?" and "Nice weather, isn't it?" which have no real purpose beyond to engage another person socially. But is knowing the answers to these questions really what makes us people? Maybe, if you define "humanness" by a person's reactions to others. The idea that you might define a person as human by their interactions with other humans seems flawed, somehow. What, then, is a human when there are other people around?

Whatever autism is, I don't believe that it is something to be "cured," and neither do autistics. Unless the "cure" for autism cosists of a change in our understanding of autism, and not the autistics themselves. I'm sure some autistics may think that it would be nice to be able to interact more easily with other people, so that they don't have to suffer the kind of aggravation a person gets from being "different." I would like to be able to add and multiply things better. I would not, however, sacrifice my identity for it. If being bad at arithmetic is part of my identity, I wouldn't lose it. It's not always a deficit, you know. I've met many nice people from needing to ask some random person, "What's twelve times eight?" Stephen Wiltshire has built a career out of his savant talents. I'm sure that other autistic people, who may not have become famous from their autism, nonetheless experience benefits from their unique perception of the world.

Connections and Thoughts

2007-10-13T17:57:00.000-07:00

The recent chapter, in LeDoux's The Synaptic Self, "The Mind Trilogy" has helped me to understand Floyd Skloot's situation a little better. I was a bit confused about the "Working Memory" but now I understand it's almost a "temporary memory storage" that allows us to complete the immediate problem put before us in a task-by-task sequential basis. From this I know understand that the reason why Skloot would get lost or confused in the middle of performing a simple exploit is because there was some sort of deficit in his working memory. Clearly Skloot's mother had more severe issues with this, as she would often (exhaustively) ask the same questions and repeat the same statements within seconds.

It is apparent that in "The Missing World" Hazel's working memory is mostly functioning and her largest impairment is in her declarative memory. I do find interesting the consistencies between the fictional account of Hazel and the empirical account of Skloot. Hazel also mentions the "shadows of memory"-- the essence of things you remembered-- knowing you once knew something, but not being able to recall the actual thing. I often wonder if this is an implicit function. Hazel got the "sense" things weren't right, that Johnathan's account of what had happened was off. Could this be a tactic developed by the brain, that in the event the brain cannot remember, we still can get a "feel" for what we had once "known" as means of self-preservation?

Charlotte's discussion of pondering whether or not it's best to forget certain things caused me to remember S. who had to train himself to forget and Skloot who discusses how it is necessary for the brain to discard "useless information" and how this process can run rampant causing us to forget "everything". This reminded me of the discussion we had in class about pharmaceutical pills used to suppress traumatic events in ones life. This got me thinking, if our memory makes us who we are, when we suppress certain memories we are actually shaping who we are. I wonder if, we can use these sort of suppressants as a means of artificial selection. Of course it would be unethical to dictate what a person should and should not remember from birth, we clearly see this through Johnathan. Obviously his plan backfired because of the blatant lying, lack of understand of memory and outside interferences. But in an isolated situation it would be interesting to see the results.

We Are Never Aware of Processing--Until the Processing Goes Awry

2007-10-13T09:37:00.000-07:00

As some of you could probably tell from class last week, I am not Floyd Skloot's biggest fan (see my response to Matt's blog of last week for more on this topic). Given the problems he had with both short- and long-term memory I found him to be an unreliable narrator, inconsistencies in his text added to my unease, and, while I understood that these were separate essays put together in one book, the repetition just got on my nerves and I wondered why an editor didn't step in to smooth over some of these problems.

I tried to approach A World of Light with an open mind: I was going to be less stubborn in my definition of memoir and less critical of a man who, despite brain damage, can write beautifully. This good attitude lasted until the second essay. Why must he be so repetitive, I wondered? Why do we need to be told in every essay that his mother, Lillian, asks the sames questions over and over again. Is it Skloot's own brain damage preventing him from moving on to new territory? Is he trying to give his readers a taste of what it feels like to either have Alzheimer's, or to care for someone with the disease? If so, we get the point already. Skloot would have known that, like his previous book, his new essays would be published in one collection, and I still can't figure out why they weren't edited to remove some of the tedium. I was overjoyed with the essay "The Simple Wisdom" about his mentor, Thomas Kinsella, because it was something new and different, and literally cried, "Hallelujah!" when reading "A Stable State," in which he claims to be done writing about his illness.

Moving on isn't just something Skloot needs to do with the content of his writing, it's also what he needs to do in regards to his mother. When in my frustration I asked myself, "How is this book different from In the Shadow of Memory," I kept thinking he was speaking more psychologically in these essays, like his insights were the direct result of psychotherapy, especially in terms of his conflicted relationship with his mother. This seemed most true in his essay "Fittings," in which his struggle to come to terms with his mother's state was as tedious as his repetitiveness, and once again I wondered if his own brain damage prevented him from being more accepting. (And, in the debate over what constitutes nonfiction, I have to point out the Victoria's Secret scene on page 36. Women may surreptitiously try on panties [ew] but a salesperson is certainly not going to participate by bringing anyone a thong to try on! If a nonfiction writer is going to make stuff up it has to at least be true to life. I also couldn't help but think, after reading page 180, lines 4-5, "Really? You simmer kale in the morning? That's some breakfast.")

I am not a completely heartless beast, though, and I did sympathize with Lillian. When we read about the people who suffered from Korsakov's I did not realize people with Alzheimer's experienced the same extreme symptoms. Most poignant, I thought, was her ability to remember songs, even expanding her repoitoire before beginning to lose virtually all of her music. Like Skloot's passion for baseball, Lillian's passion was the theater; if Skloot's memory were to deteriorate significantly, I bet he'd rattle off baseball stats the way his mother sang songs.

I was just as happy to be done with The Missing World as I was to finish Skloot, but for different reasons. I enjoyed this book, yet Livesey succeeded in making me so uncomfortable that I couldn't wait for it to end. I think the portrayal of amnesia was probably pretty accurate, especially the way Hazel describes on p. 144 living in three worlds: the world she remembers; the world of shadowy memories, people or events she couldn't quite grasp; and the missing world, all that had vanished. (Lillian's Alzheimer's, on the other hand, started out similarly, until she was left with the present world only, not even aware of the missing worlds.) I believe Livesey did her homework (notice her nod to doctors like Sacks on p. 145, when Hazel says she can imagine her doctor contemplating the article he would write about her case) and was especially struck by Hazel and Charlotte's conversation on p. 195 about the relationship between memory and space, something we've read about in LeDoux and Luria's account of mnemonic S. She also did a good job making memory an important theme for all the characters: Charlotte comparing herself to Hazel, wondering if she might prefer to forget the bad times (and occasionally, as she describes on p. 214, actually forgetting the events that occured after she ran into her ex with his new girlfriend, although in Charlotte's case you can probably assume alcohol had some affect on her memory); Freddie's suppression of his past; and Jonathan's utter inability to learn from the past, echoing Charlotte's statment on p. 175: "We repeat what we remember. Only forgetfulness sets us free."

Chapter 7 of The Synaptic Self gave me a deeper understanidng of both Hazel and Lillian. Lillian was left with no working memory, an inevitablity of Alzheimer's, I think, because working memory depends on long-term memory. Because Hazel did have working memory, her accident and seizures probably didn't affect her frontal lobes, but I'm guessing different types of amnesia can occur due to damage in different parts of the brain. In LeDoux's explanation of working memory, visual stimuli seem to play such an important role that I wondered how people blind from birth create memories. Do other senses fill-in? And any other animal lovers in class were probably struck, as I was, by the section on consciousness. My cat only has to get in his carrying case once a year, but he remembers it's a place he'd rather not be, and he decides to fight and run away. He also knows that if I kiss his head once, leaving his head bowed will result in more kisses, which he likes. Even cats can be trained, and doesn't that have something to do with memory?

On page 192 of The Synaptic Self, LeDoux attributes to neuroscience pioneer Karl Lashley the idea that "we are never aware of processing, but only of the consequences of processing." Based on the experiences of Floyd Skloot, Lillian, Hazel, and everyone else we've read about in this course, I'd say we are never aware of processing--until the processing goes awry.

Living in the Cracks of Memory

2007-10-12T20:40:00.000-07:00

Last week, we were first introduced to the disturbing concept of amnesia, and the idea of losing all your memories, or at least your explicit ones; being unable to consciously frame yourself in place and time, remember what you did last week, even what you said a few seconds ago. You can't even remember outwardly what you like or dislike (for example: damn, these new cherry ices in Bates are good). You may have some implicit recollection of past events or experiences, but you cannot call them up at will; your mental filing cabinets are dinged and battered. It's possible that a purely sensory reflex could summon traces of something you did or experienced, but even if it did, you cannot contextualize it within the larger structure of your life. In short, you are cut loose of your orientation and mental mooring, becoming lost in the places you used to know the best, having to struggle to achieve even simple tasks.

Is Bunuel (quoted in LeDoux) correct when he says that your memory is everything? Would having a vague, implicit self-knowledge help, if experiences grooved too deeply into your brain to be completely destroyed somehow managed to surface? What if you are lost in time, such as the Korsakoff syndrome sufferers -- or, like Skloot's mother, you are completely in the moment, a blank slate, forgetting events as soon as they occur? Can anything cumulative begin to regroup in your brain, or you Sacks' Lost Mariner all over again, sailing a complex sea of life and events without the steadying map that your organizing brain provides? Would it be possible to learn from your mistakes, organize experiences, and form deep personal connections if you did not have a wealth of backlogged information to draw on? Compare it to a blank book (or Word document, whichever you wish). Having nothing there will give you nothing to "read." While memory is faulty in the normal course of operations, and can add paragraphs, delete letters, and mix sentences up into syntactic gibberish, amnesia aggressively culls the pertinent information into confusing snippets that you can't "read" at all.

With this disease, your mental books are left scribbled and defaced. Is it possible to edit them back into any sort of coherency? This week's readings focus on how to reassemble the shattered pieces of the mind, and make some progress in how to cope with amnesia. Skloot, for example, has provided himself something of a stabilizing groundwork by re-learning to read and write. Since he was a writer previously, this allows him to tap into an old passion and fluently and elegantly file dispatches from within a permanently fractured psyche. It seems impossible, reading In the Shadow of Memory and A World of Light, that this man can be brain-damaged; he writes with a grace and poise that those of us with our neural circuits intact can only envy. Even more astonishing is his ability to seemingly remember what he is forgetting; he chronicles his struggles to find a missing bookbag or car key, for example, all the while conveying to us that he knows what the object of his search was; but could not consciously recollect it then.

The two figures who seem to bear the most comparison in this week's reading are Lillian Rosen, Skloot's mother, and Hazel from The Missing World. Both are women caught in a position of vulnerability due to their memory shortcomings, and both have a vague sense that something is wrong with where they are. They are moving in opposite directions in regards to their conditions, however; this is clearly exemplified to a much greater degree in Lillian, who has a memory span equal to Dory's and has no way to scratch out a deeper understanding of her situation. She is unsettled when told that her son has been married for nine years and comes to see her every week, because she can no longer process the idea of time. However, within seconds she has forgotten it, and approaches the world with a ready cheer never seen when she was still mentally capable.

Skloot desperately yearns to have a proper mother-son interaction with her, something he was denied earlier in life, but although he visits her faithfully every week, he is running in place. She never remembers him or his visits, and although she is now more mellow and tractable than she has ever been, this is nothing that can be improved or built upon. She lacks the mental volumns to remember who and what he signifies to her, aside from a transient pleasure at seeing his face ("Oh, Floyd! This is the happiest day of my life!") Clearly some of her implicit memories remain; she is not yet completely groundless, as she knows that he is her son and some of the very basic facts of her life, but she has been disconnected completely from her past with little hope of retrieving it. She doesn't remember that she lived in New York for all of her life until last year, she doesn't remember who or what she was then, and exists as a continually self-renewing entity; she is like Clyde, who thinks that each moment heralds a new awakening. Conversely, it is her amnesiac son who is charged with the thankless and hopeless task of trying to keep her oriented in the present. Skloot mentions how much he dreads his time with her, since he sees so many shades of his own future in her untenable situation. Will he, already quite significantly damaged, be consigned to the looming specter of The Home in a few years, left to while out his own decline into darkness, not even recognizing the faces of those closest to him?

In contrast, Hazel is still a relatively young woman who has most of her mental functions intact with the exception of the blanket amnesia carpeting her past few years. She's aware that something is wrong with her, and she is relatively operational. She has the ability to create and store new explicit memories, and has the mental wherewithal to question her situation and to be (rightly) suspicious that a great part of it is being kept from her. It may be a problem of the fictional narrative, but a complaint was mentioned in class last week that the period of the amnesia is too clean-cut and that she should at least regain some vague memory by triggering events. However, she already does have the sense of wrongness, but is unable to translate this into specific events in the past; I for one think this is as accurate a portrayal of amnesia as a non-neurologist could write, and Livesey's intent, as with Skloot, isn't to get to the scientific nuts and bolts of the case but rather to explore the human cost of the brain machinery going awry.

Hazel lacks the ability to reconstruct her "missing world" from the inside, but Charlotte and some discovered papers remind her of what Jonathan has done to her -- destroyed her choice of career to keep her with him -- and allows her the perspective to see that he is attempting to do it again. It's very difficult to imagine that what he feels for her is love, despite his constant insistences -- he is a controlling, sociopathic man who is attempting to keep her trapped in the broken pieces of her mind when she is finally beginning to have the ability to move beyond it, and he rapes her in an absolutely chilling scene, completely convinced that what he's doing is for "love." The end of The Missing World provides a glimpse to the answer of the question if Hazel will ever reach Skloot's plateau of functionality and love -- it seems as if Freddie's (healthy) attraction to her could function as Beverly did for Skloot. She transitions from being the Lillian of the piece to the Floyd, and all we can hope for her at the close of the book is that she finds a way to patch together the cracks as he did, and live -- if not a completely functional life, then at least one that is full despite its flaws.

Holding On

2007-10-06T19:53:00.000-07:00

Human relationships are a curious thing. We find ourselves caught up in a web of interactions, sometimes with no idea of how we came to be there. Our convictions are strong, but sometimes for no logically justifiable reason. The decisions we finally make are products of an innumerable confluence of forces that we call the mind. The only thing that allows a brain within a body to become a true person is memory.
It is easy to see, then, why any damage to the fragile structure of memory is immediately recognizable to a family member or a loved one as an upheaval. When someone you love loses their memory, or a part of it, so suddenly, there is no longer any rational way to view the world. There are only coping mechanisms.
Jonathan, in The Missing World, feels that somehow the erasure of Hazel’s most recent three years will mean a fresh start. Jonathan wants to time-travel in a very literal sense, but he is only ever traveling with himself and Hazel. And, as Hazel put it before her accident, “There are things you can’t apologise for. They change who you are, and you can’t change back.”
After reading the fifth chapter of LeDoux’s synaptic self, I’m inclined to agree with her. So much of who we become is subconscious, a result of implicit functions. There are so many subtle facets to memory that change people in ways they aren’t even aware of. We are always aware of declarative memory, by its very nature. But nondeclarative memory gives us our smile, our laugh, and our mannerisms. Neither Jonathan, nor even Hazel, can become the same person they were three years ago. Life moves on and there are no fresh starts.
Still there is a pull toward clinging to the familiar. I sensed a great deal of this in Floyd Skloot’s writing. He seems relatively comfortable with the man he has become today—thinking of his math as “having an accent”—but his reflections of his first experiences immediately following his contraction of the virus are much more desperate. For instance, he wants to relearn as much as he can about history as quickly as he can. He tells us that, for him, “Gaps exist in the historical record. Surrounding myself with reference books helps to fill them, and so does reading, but I am apt to forget what I have learned that way.”
But Skloot finds in Beverly a companion with whom he can share his rebirth. She says that she loves who he is now even better than who he was before. This is a very healthy way of viewing things, much in contrast to Jonathan’s attitude. But we all try to find ways to adapt that will make sense in our shaky construct of a world, and surely this is understandable. For were we to completely let go of all that we know, we might lose ourselves just as much as Skloot or Hazel.

The Seven Thousand Sins of Memory

2007-10-06T14:22:00.000-07:00

It’s convenient that Dan Schacter put labels on the failure of memory—transience, absent mindedness, blocking, misattribution, suggestibility, bias and persistence—but we have learned that nothing with the brain is ever as clear cut as that. Everything is twined together, memory, a convoluted mass of infinite possible failures, rather than just those seven.

The brain has various areas that contribute to memory, but the separate parts work as teammates. It is completely understandable that H.M. lost his ability to form new memories after a part of his brain was removed to relieve him of his epileptic fits. The LeDoux reading explored the scientific part of memory loss, explaining how scientists would tweak the brain to provoke memory failure in animals (was I the only one saddened at the thought of the animals having their brain functions stolen from them?). It made me wonder about memory versus learning. Some things we know are innate and others are escorted by memory to be processed, like learning preference of taste and being conditioned. But how much of learning has to do with our memory? And concerning, let’s say, schoolwork, where does memorizing information transfer into having the information be learned? It’s like no matter how far our research and data advances, we would still never know enough about how our brains work.

“In the Shadow of Memory” and “The Missing World” dealt with the much more humanistic side of injury/disease/illness and helplessness of memory loss. Floyd Skloot can find the humor in his predicament and on occasion, use it to his advantage (he’s a writer and his word substitutions are really quite poetic) but I suppose he would have to be after such a long time. I was only two days old when his brain infection set in and began to morph his life, so I keep trying to fathom the length of my life being the length of readjustment to his memory loss and it seems impossible. Despite living the healthiest life he could, (he ran like five miles a day without any problems!) he still was affected by some unexpected variable, which reinstates how frightening life can be; things just come at you without warning. He transformed completely, not necessarily for better or worse (although I find it incredibly interesting that his wife likes the newer version of her husband), but it’s like having a second life. He became slower-paced, calmer, more relaxed, and extraordinarily sensitive— completely opposite of his first self.

Credit this to Elizabeth, but isn’t it ironic that “In the Shadow of Memory” is a memoir by someone that lost his memory? It’s interesting to read his rich language and try to decipher what is reality and what seems like fantasy or a product of his own failure to reproduce memories. Also, it is really comforting to finally see the personal side of these horror stories because Luria and Sacks focused mostly on the patient-doctor clinical version of brain dysfunctions. Hazel in “The Missing World” barely seems affected (due to her lack of awareness) in comparison to how the lives of her friends and family have been drastically altered. I will admit, I felt the way Matt did at first, trying to sift through the narratives for concrete facts because I had grown accustomed to the style that Luria and Sacks executed stories in. But I finally relaxed and took a backseat to witness the seven thousand sins of memory, because so much more than one person or life is at stake when it comes to living after an “insult”.

The loss of Memory

2007-10-06T13:30:00.000-07:00

The Shadow of Memory, by Floyd Skloot, is a beautifully written memoir about his life after dementia. After first being struck with brain damage in 1988, Skloot writes smoothly and eloquently about the hardships and the newfound advantages of his new life. It is amazing that Skloot was able to write such a book, considering all the things that prohibit him from leading a so-called "normal" life. Although Skloot's IQ dropped considerably and he was impaired in logical thinking, he describes a new found emotional freedom, which I found fascinating. "It was apparent in small, everyday experiences that had never touched me deeply before, such as being moved to tears by seeing an outfielder make a diving catch, hearing the opening melody of Max Bruch's "Kol Nidre" etc..." Skloot describes how his love for his wife deepend, his connection with his daughter grew, and how he was finally able to face his brother's advancing terminal illness. He writes: "love and passion entered my life for the first time in decades".
An interesting connection that I found in Skloot and in Sach’s account of the colorblind painter was that both Skloot and Mr. I, adapted and found a new kind of lightness of being through their disability. Skloot writes: “I have changed. I have learned to live and live richly as I am now. Slowed down, softer, more heedful of all that I see and hear and feel, more removed from the hubbub, more internal”. When Skloot ponders the idea of returning to how he once was, there is a similar fear within him that correlates to the other readings. I think that when you have learned to live with a “new” form of yourself, the idea of returning to your old self is a frightening and unsettling thought.
In both Skloot’s memoir and in the chapter by LeDoux it is clear that memories are not controlled by one specific region in the brain, but that the whole system functions together. Skloot describes how his eyesight, hearing, smell, and speech mechanisms are all in place, but that it is “putting things together” that is the real challenge. It is obvious that both H.M and Skloot's hyppocampus are impaired and similarly can practice tasks and get better at them but cannot necessarily remeber doing them. For example when H.M. learns to copy a picture of a star, he learns how to do it and "retained the learning", but when asked about the drawing he has no recollection of ever doing it. Skloot, is also liable to forget things he has just thought or just read. It is tragic and horrible, because one feels that Skloot is able to reflect and ponder his illness but has no control over it. Without memory, our whole world as we know it becomes vague and dreamlike. The frustration and the fear of not knowing if you are supposed to remember someone or something. Even my memory is impaired sometimes, and it is embarrasing when I meet someone who knows me and I cannot remember their face or name. To constantly be living in doubt of yourself is a very scarry thought. All the readings we have studying, make me feel so blessed to be in a sound and coherent state of being.

Connections

2007-10-05T14:54:00.000-07:00

I saw some connections between the Livesey novel and the other readings, but I found that Skloot and LeDoux seemed to relate more to each other. In terms of Livesey, the most obvious connection is LeDoux's explanation of retrograde amnesia (which Hazel suffers from) and antegrade amnesia (which Skloot suffers from). I noticed that when Jonathan is trying to "adjust Hazel's memories," this relates to the suggestibility of memory as described in the end of the LeDoux chapter. There were also a lot of references to implicit memory, like when Hazel doesn't consciously remember the Indian food she likes, but when she tastes it, she remembers that she likes it. Is this a transition from implicit to conscious memory? Also, the fact that Hazel didn't remember her parents but certainly warm feelings for them seemed to be a feature of her implicit memory. Another connection between Livesey and some older readings is Charlotte's confabulation. I couldn't tell if she was consciously lying to better herself or if she actually began to believe some of her lies. Anyway, I just wanted to mention this briefly, but what I really want to discuss is the Skloot and LeDoux readings in relation to each other.

I think that the Skloot reading helps humanize people with "insults to the brain," as he might put it. The LeDoux chapter fits in nicely, serving as a resource to help better understand the biological explanations behind the seemingly bizarre behavior of people with brain damage, which might help outsiders to become more tolerant.

Skloot speaks of feeling vulnerable, embarrassed, and out of control. He gives striking examples of how people fear, villify, and mock that which they don't understand.I'm not sure that most people would realize that someone with severe brain damage could retain this kind of self awareness. I feel like the common perception of someone with brain damage is usually the opposite: that when they are lost in thought, like Skloot "staring into space... with [his] jaw drooping," they are unaware of their own actions. But both Skloot and LeDoux demonstrate that this is not the case. I feel so pained reading about the guilt and shame that Skloot experiences, because this happened at no fault of his own. I think that by writing his story and making people aware of his struggle, he will help develop an understanding and empathy in people. There are so many more variations of brain damage than I ever realized, and LeDoux does a good job of explaining how interconnected and yet separate implicit and explicit memories are.

Something that comes up in both Skloot and LeDoux is the idea that memories are not controlled by one specific part of your brain but actually depend on whole systems and circuits to function. Therefore, damage to a certain area might affect many different brain functions in subtle ways. LeDoux mentions how these systems are not even necessarily designed to remember things, but instead for other specific functions, and memory is just a side effect, in a way. Skloot describes how each of his senses work well on their own but fail "in putting things together." I wonder if his convergence zones in the rhinal areas are damaged, making it impossible to integrate his experiences into a unified representation, or if this is something different.

I saw some connections between H.M. in the LeDoux reading and Skloot, especially when LeDoux describes how H.M. was able to learn a task, "and he retained the learning. But if asked about the drawing, he had no conscious memory of having made it." LeDoux refers to this as priming, which uses implicit memory and does not depend on the hippocampus, which may be damaged in Skloot's brain. Skloot says that he has "gotten more adept at tying [his] shoes, taking a shower, driving for short periods." Is this because it is stored in his implicit memory? His explicit memory seems to fail him a lot, even within 20 seconds of repeating information he wants to remember, so it seems like his hippocampus is probably damaged. However, he mentions that his "memory for doing is compromised," that he repeats things but never learns them. So maybe his implicit memory is damaged as well, but only slightly, because he can still improve some tasks by practicing them.

On a final note, I have been thinking a lot about the collusion of art and pathology that we spoke about in class, but I did not consider that this may work against itself, too. Skloot spoke about his newly heightened emotions, and the joy and sorrow they brought to him. This connects with the original idea. However, he had trouble retaining a "flash of inspiration" and would often lose the meaningful idea that had come to him, rendering it nearly impossible to actually create the art (in the form of poetry or writing) that he was inspired to make. He quoted Yeats as saying, "The artist assembles memories," which became nearly impossible for Skloot, despite the depth of emotions he felt. He did manage to write this memoir, though, which is a testament to the positive results of perseverence and determination. It's interesting how this fits in with the idea of the brain, adapting for its survival but then aiding in its own destruction.

A New Style of Writing

2007-10-05T08:32:00.000-07:00

Hey Everyone,

I feel that we have entered new territory in this class. We have moved away from the more scientific case study style of writing of Sacks and Luria (as poetic as they are), which are laden with scientific data, history and findings, and have moved to accounts that truly belong in the memoir section of the bookstore. So I wanted to offer you some talking points on this new subject. Please, feel free to take one and run with it or give me an answer for most of the questions. It's up to you. Use this as an opportunity to give your self a change to really digest these new readings.

This past week we have had the opportunity to read “In the Shadow of Memory” by Floyd Skloot and “The Missing World,” authored by Margot Livesey. In both we were privy to not only the situation of a patient but their family, the suffering it caused “the family unit” and how disease “insults” time. I believe that Skloot offered us a really humane depiction of his disease, a first count depiction of his life and his struggle. I think that it drove the point home because it wasn’t being delivered via a third party. Skloot was directly connecting with the audience. Very different from what we had seen in Sacks and Luria, in which they were the storytellers. Sacks worked with these people and tried as he may, it still wasn’t a first person narrative. His ideas, perceptions and medical background removed the reader from the story. Now I know that we got a fantastic sense of the character anyways (and this is NOT an attack on his prose because it is beautiful) but there is something to be said when a man (or woman) sits down, especially when they are injured and must slave over their work, and crystallizes their thoughts in writing. We did see more of this struggle to express oneself in Luria (and many parallels can be drawn between S and Skloot) but the sheer fact was Luria still had to deliver the story of S because he was unable to express himself in an organized matter.

Do you agree with this? Could you argue that Luria and Sacks are even more humane because they have the medical experience and bedside manner to write these books? No confabulation necessary. It is hard to tell in our day and age when plots are exaggerated and heightened for effect just to sell more copies—think of James Fry and “A Million Little Pieces.” Can we really trust our writers anymore? Even still, to me, the fact that Skloot sat down although he was personality incapacitated with disease and turned out the prose that he did is astonishing.

Which leads into my next point: the interesting style of Skloot's book. It was almost hard for me to shift back into novel mode after reading Luria and Sacks that almost spoon-feed you the material. They explain a disease and it’s history. That did not happen with Skloot. In fact if you didn’t really understand how the back of the brain progresses forward to the forehead and that brain function heightens to more advanced levels, you must not have completely understood how a virus decomposed a lot of Skloot’s brain. How effective was this, letting you figure out exactly what was wrong? I know that I struggled with it.

As I was reading the trilogy of stories, it actually could have been based on different families on different parts of the illness spectrum. Once I realized, it had a rather intense cohesion. It was interesting how he started at the end of his life out on the North Sea; traveled back to his childhood and that of his patients; then he went to discuss his brother and his middle-aged life. How did you feel about this disjointed method of story telling? Was it effective or confusing? Personally, I love this idea of fragmented moments, because that’s all these brain-damaged people have—that’s what we all have: a string of moments. Some are longer and a little bit more tightly woven together. He would weave pages of moments from the past and then with the accuracy of a doctor he would diagnose the problem at the end of it or explain why his family acted the way he did. He was almost the personal doctor/historian of the family, cataloguing their actions (from what he remembered) and giving them justification.

I feel that Skloot really took a dynamic, shattered it and froze it in time. You see how a son’s memory and life is “changed” by a virus; how a mother copes with her existence by confabulating a life of “royalty,” how a father is starved of love; and a brother is ignored and ignores his own health. They were all starved of the lives they wanted. They were “together without togetherness,” (126). It’s hard to tell if illness took that away from them or their own devices did. Opinions?

As a final point, this is something that has been interesting me. Has anyone else noticed that in many of the books we’ve read so far about the deterioration of disease, the author tends to deconstruction words down to their etymological basis? To their root words? Take page 21 for example when he breaks down the word “dementia.” This is only one example of several that we’ve seen over the past few weeks. Can you name any others? In this book even? What do you feel is the writerly effect of such a thing? Is it to run words on a parallel basis with a patient, to strip them of added components that time gave them? Can you find any truth in that statement? Simply to fill space? What?

Thanks for stopping by,
-M.

The Case of the Colorblind Painter

2007-09-30T15:23:00.000-07:00

Sack's account of the case of Mr. I, the painter who loses his color vision, really struck a chord with me. To lose something that enables your artistic life is frightening and devistating. Mr. I's whole life and career was built around the richness of color and using color in his paintings to express himself. It made me think of what it would be like if I lost my hearing. As a singer I couldn't imagine my world without music; without being able to hear what was coming out of my mouth. It's a nightmarish thought and I don't know how I would react if something like that happened, especially late in life. What was facinating about this particular case was how Mr. I adapted after some time to his new condition: his world in shades of grey. Sachs writes how Mr. I gradually became a "night person" and would travel to different cities and explore the world at night. Mr. I's color memory quickly began to disolve and he learned to see in a whole new way. In a way that was "highly refined". Mr. I describes how textures now stood out to him, he could read licence plates from four blocks away, and enjoys the richness of his new world. What was extremely interesting to me was, three years after his injury, when Isreal Rosenfeld suggested that Mr. I might be able to restore his color vision, Mr. I declined. "...he found the suggestion unintelligible, and repugnant. Now that color had lost its former associations, its sense, he could no longer imagine what its restoration would be like. Its reintroduction would be grossly confusing, he thought, might force a welter of irrevelant sensations upon him, and disrupt the now-reestablished visual order of his world". Sachs also writes of other cases of people who grow to embrace their deformity, as in the case of John Hull who loses his sight completely. A couple years after he went blind he came to see his condition as " a dark, paradoxical gift". These different cases that Sachs writes about really inforces the strenght of human beings and people's will to live and accept their circumstances.

Thoughts on the Reading

2007-09-29T10:18:00.000-07:00

LeDoux's assertion that the brain loses the processes that are not used frequently causes me to recall Virgil. Because his brain had adapted to being visually blind when his vision returned he suffered from mild agnosia. Which makes me wonder if S.'s reliance on a sensory world caused his brain to lose the processes which create a logical world.

His inability to understand the abstract was seen through his confusion when trying to find meaning in poetry. In Luria's previous work "The Man with a Shattered World," Luria discusses how the evolution of language, from more explicit concrete phrasing to more simplified terms reflects the development of our brain. Most of us can infer so much from a minute amount of information. Meanings change depending on context, connotation and tone, but all S. could understand was the literal. Perhaps the processes that allow us to pull so much from so little is what S. has lost? And because his reliance on the senses had begun so early on he could not correct it? Or rather he didn't even know that anything was wrong.

Borges romanticizes the mnemonist "he seemed as monumental as bronze, more ancient than Egypt, anterior to the prophecies and the pyramids. It occurred to me that each one of my words (each one of my gestures) would live on in his implacable memory;" (Borges, 115) Nabokov, however sees synsthesia as a flaw and finds the imagery brought on by words and sounds often grotesque. The discrepancies make me curious as to whether the character of Funes was more accepting of his disorder because it was brought on far later in life in opposition to Nabokov who was born with it.

The symptoms of synesthesia were most fascinating and were seen within the three accounts. They all had a connection to numbers. S. could solve math visually seeing himself act out the problem, Nabokov had an aptitude as well but found himself haunted by them during times of illness, while Funes could not fully understand them and attached specific images to them as S. would with words. I also find it interesting that sharp memory is not synesthesia itself but rather a symptom. I guess one could deduce that there is a strong connection between the senses and the memory and that math being such a concrete way of thinking would naturally work for synesthetes.

I often wonder if such memory is overbearing for more emotional reasons. S. would become overwhelmed as images, sounds and feelings became intermingled and therefore needed to forget in order to properly remember. But I do wonder if there are any "bad memories" that were better left forgotten that he could not get rid of.

Luria and LeDoux

2007-09-29T07:43:00.000-07:00

I distinctly recall a year of my life, when I was about eight or nine, in which books about kids with amazing mnemonic abilities were decidedly in vogue at my elementary school.
The heroes of the stories all had their own techniques and practices that allowed them to remember things in far greater detail then you or I, and their skill were always described as infinitely beneficial. Encyclopedia Brown; the boy detective with the photographic memory, had no drawback to his heightened visual memory. Luria would have been distressed by the degree of fictionalization and overwhelming optimism with which the boy was portrayed, for he was written rather one-dimensionally as a kind of cross between superman and a 35mm camera. Then again, the book was written for nine-year-olds, so I'm sure part of the beauty can be found in its lack of realism and basis in scientific research. It turns out that reading “The Synaptic Self” in conjunction with Luria’s description of a heightened memory affected my understanding of the phenomena of heightened memory in an individual, and permanently changed the way I read young-adult fiction.
Like Madeline, I too wondered briefly about the way S.’s synaptic connections might have been subtracted or “pruned” to favor the specific connections required to result in his eidetic abilities. As she so astutely points out, given the trillions of synaptic connections we all possess, and given the process LeDoux describes of a “use it or lose it” selection of synapse maintenance or elimination, it seems quite remarkable, not that someone like S. can exist, but that more people don’t possess such specific and unique abilities as a result of the way their brains end up built.
It occurs to me, however, that perhaps there was some combination of influences on S. (both genetic variables and environmental/chemical exposures) that left him more specifically suited to the maintenance of a deeply visual and synesthetic mind. That is to say; perhaps at some point in our development every human has the capacity to develop synaptic connections based on either strong verbal ability, or strong visually associative ability (like S’s) or even perhaps some strong auditory or tactile abilities. This would mean that, as LeDoux describes on page 79, the brain arbitrarily or in accordance with generic instructions forms all kind of synaptic connections and in a kind of evolutionary way the connections that are beneficial mutations for the environment in which we live survive and receive excitatory transmitter glutamate, whereas the ones which put as at a disadvantage simply die. Thus, perhaps we can think about S. as, at some very early (perhaps even natal stage), at a metaphorical crossroads. One path would result in a rather balanced and relatively un-associative collection of synaptic connections like those you and I possess, whereas the other would result in the kind of highly imaginative, associative synesthetic mind that Luria describes. For whatever reasons then (presumably some combination of variables genetic and environmental that were highly specific to S.’s case) he took the mental road less traveled, and in terms of the way he saw and thought about the world, that made all the difference.

To rememeber or not to remember

2007-09-28T12:24:00.000-07:00

I have always wished that I had been born with better memory. I get disappointed in myself when I can not remember the academic material I learned when I was 13. If I can not remember such material, does that mean I still learned something? However, after reading this weeks stories, I realized that being able to forget is also a blessing.

In The Mind Of A Mnemonist, Luria writes a very detailed account of a man, whom he calls S, with an incredible memory. S did not ever take notes. He could repeat, word for word, passages that are written in languages he does not understand. I could also reproduce a series (words, numbers, shapes) in reverse order. He could also readily identify which word followed another in the middle of a series. S's memory had no distinct limits. S memorized material by using the synesthetic reactions he experiences when confronted with a word, voice, or any other kind of situation. He always saw colors or light when he listened to someones voice. He heard sounds when ever he looked at a color. There were some mistakes in his memory, but these were not frequent. When he could not remember something, he saw "lines," "blurs," and "splashes." What I thought was particularly interesting was that he sometimes created a narrative with the sounds or words he had to memorize. He would place the image that a word conjured up for him in some sort of setting, such as a road. He would then place the other images along the road too. If he placed the image of an egg against a white wall, he would not be able to "see" it and so would not remember it. Therefore, his lapses in memory were due to defects in perception, not memory. I assumed that his synesthetic system of memorization was a highly advanced way of thinking. However, Luria clarifies this on page 57: "The excerpts I have quoted from the records on S may give the impression that what S accomplished was an extremely logical (if highly individualistic) reworking of the material he had to remember. But, in actual fact, nothing could be further from the truth." S used a technique of eidetic images to memorize things. His highly figurative memory actually prevents him from using logical means of recall. Not only was he not able to use logic when recalling memory, but he also had a hard time reading long passages because every word summoned a deluge of sensations.

In both Borges and Nabakov's narratives, an injury preceded the capacity to remember infinite amounts of information. I thought it was interesting that both Funes and Nabakov were thought to be highly intelligent, or just special. Borges is in awe of Funes from the very first time he sees him in '84. Nabakov states that "confessions of a synesthete must sound tedious and pretentious to those who are protected from such leakings and drafts by more solid walls than mine are"(p.35). He admits that his distinct trait is seen as pretentious. However, by the end of both stories it was clear that their great memories came with an equally big price.

The Various Kinds of Self

2007-09-28T12:20:00.000-07:00

The story of S. represented a departure, to me, from the stories of Sacks and the other book of Luria's, "The Man With a Shattered World," we have been reading. The subjects of those stories - Dr. P., Zasetzky, Jimmie G., Jose, etc. - had conditions, abnormalities of brain function that were, if not easily understood, easily recognized as "problems." There was something "missing" - color vision, memory, the ability to identify objects - in all of those patients. And although whether their deficits made them "soulless" or "God-forsaken," as Sacks suggests in some cases, and the consequence on their personalities may be debated, it is clear that these people have lost something that we, as "undamaged" individuals, have. There is something "wrong" with them.

I am not so sure that something is "wrong" with S. Initially, it appears that he is "more" than a regular person; he has something that we - "normal" individuals - DON'T have: a "vast memory;" a "capacity" to remember that "had no distinct limits" (11). And yet it soon becomes clear that S.'s abilities are not simply an enhanced version of the skills that everyone has, but represent a mind that works in an entirely different way than ours. Furthermore, was his ability to remember "any lengthy series of words whatever ... fifteen or sixteen years after the session in which he had originally recalled the words" a representation of heightened capacity, or diminished capacity (11-2)? Was it incredible that he could remember, or terrible that he could not forget?

The answer, as Luria illuminates, is both. S.'s mind allowed him to recall detailed and random information from many years ago (12); to clearly picture scenes from his infancy (77-80); and to quickly solve complicated mathematical and logical problems in his head (100-111). At the same time, the very kind of thinking that allowed him to carry out those tasks limited him in significant ways. He had difficulty discerning the overall meaning of simple passages he read: "to understand a passage, to grasp the information it contains," Luria explains, was a "tortuous procedure" for S., who lacked the ability to identify and focus clearly upon the details that were most important to comprehension.

Throughout Luria's description of S.'s "strong points" and "weak points," I kept thinking of intelligence, and how it is quantified in tests like the IQ test or SAT's - how would someone like S. perform? Perhaps he would perform well on any math or logic questions, but his inability to derive meaning from simple phrases like "weigh one's words" or "the wind drove the clouds" would surely result in his score reflecting a very low intelligence - simply because we put so much more significance on verbal capacity than on mathematical ability as quantifiers of intelligence (119). To the makers of such tests, who cares if someone can solve mathematical problems quickly - if he can't understand simple metaphors and expressions, ones that are commonly used and understood by most other intelligent people, he's an idiot! S.'s story made me question (not for the first time) the accuracy of standardized testing in determining intelligence. It would seem that such tests only account for one type of brain, one type of learning and understanding.

But how is it that S. came to possess such a different "type" of brain - one preoccupied with images and his imagination, rather than verbal language and reality? I'm not sure that even Joseph LeDoux could be able to explain exactly how. His chapter, "Building the Brain," however, I believe makes it clear how it is possible that different "types" of brains develop. At the time a young brain begins to form, he tells us, there exists an incredible number of opportunities as to how it may develop, based on "genes, their products, and the local chemical environment in which they exist" (66). The course of the brain's development, in fact, is simply the process of eliminating these opportunities: "pruning back ... exuberant, unused projections" (74). Perhaps, during this time of synaptic selection and subtraction, we all have the potential to become visually-oriented, highly imaginative, synesthetic individuals like S. - but whether by the action of genes, the influence of environment, or both, the specific connections that would have allowed for that kind of development were "pruned" and eliminated in favor of a more verbally-based circuitry.

What is strange, then, is not the fact that a different type of brain is possible, but that so many of us tend to have the same type of verbally-based brain. Most of us have a much easier time understanding expressions of speech and the meaning of the written word than S.; most of us are not as capable as S. is at solving mathematical equations, or at least we do not solve equations in the way that he does, using images; the vast majority of us are able to forget - and do so without thinking about it. The fact that S. is an anomaly is interesting, less so than the fact that an anomaly could exist. What does this tell us in terms of evolution? Our early hominid ancestors were not capable of speech. When, and why, did it become more useful to have a brain focused more on words than images? What does it mean that we are not only capable of communicating with words, but that those words transcend into our inner thought processes - causing us to think in terms of words, to solve problems in terms of words, and to create personal narratives based on words? Why are we so focused on language, all of the time?

Furthermore, why is it necessary that all of our senses be so separate from each other, to point where when we HEAR a word, we HEAR it and nothing else? At first, it seemed strange to me that the narrator in Nabokov's "Speak Memory" might see "[t]he long a of the English alphabet" in "the tint of weathered wood" (34). That sort of thing is unfamiliar to us, but why? Although relative to people like S., we might consider our senses to be separate, there are times when they cross over. Certain colors, sounds, and images evoke the activity of other senses for various reasons - association being the foremost of them. If you eat a purple candy, you may believe it tastes like grape, even if it isn't flavored so. And think of all the emotions associated with colors: red, anger; yellow, happiness; blue, sadness - these are how they are most commonly categorized, although you may have different assocations for them. I know the color blue doesn't look sad to me, although red is most definitely angry.

What I come back to, at the end of all this, is whether or not we may truly call what S. has a "syndrome." Luria himself says what he is attempting to do in writing is present us with the "total picture of a disease" (5). But is that what S. has - a disease? Should we be trying to understand his condition based on what we can observe of it - he has a good memory, bad reading comprehension, good mathematical/logical reasoning skills - or should we categorize all of those as simply expressions of the functioning of an entirely different type of mind altogether?

We've discussed the boundary between disruptions of the brain's functioning and personality - how is personality affected by sickness? When do the sickness and the individual become inseparable? I don't know where to draw that boundary, but I do believe that S. is inseparable from his condition - his imagination and his vivid visual capabilities are part of what makes him who he is; they shape his personality, his thought, his behavior. If he had been born, like the rest of us, with a tendency to favor verbal thought over visual, and with the ability to forget, he simply would not be the same S.

With this in mind, is it possible for sickness to change the personality - to transform one person into a totally different being? That is one of the questions that arose during my reading of "Funes, the Memorious" - did the accident that crippled Ireneo change just his memory, or his entire self? And if he truly possessed a new and different "self," was he still a person like you or I? I believe that S. possessed a self like any other person, despite his particular brain functions. But the narrator of "Funes" believes that Ireneo "was not very capable of thought" (115). And what more famous definition of conscious existence and self is there than "I think, therefore I am?"

Use It or Lose It

2007-09-22T11:34:00.000-07:00

Just as multiple systems are at work in our brains and bodies, we need to examine behavior, disorders, and human nature from a variety of perspectives--look at one aspect to the exclusion of all others and you get an incomplete picture. If we had read only LeDoux this week, I'd be left with the uncomfortable understanding that we are machines and little else; but when neurons don't communicate properly, or glutamate is overactive, or an injury occurs, it is not a machine that is affected, but a person. (Such is also the reason, I think, that Hirstein is approaching confabulation from the angles of neuroscience and philosophy, as well as others: limit the ways of looking at something and you limit what you learn.)

The four people we read about this week all suffered losses, either of memory or vision (or both), and psychological loss (either because of their memory and vision problems, or, in the case of Franco the artist, psychological loss was the root of his suffering). Zasetsky's loss was the most tragic, because even if, as Sacks claims in his foreword to The Man with a Shattered World, "A life, a human life, is not a life until it is examined; that it is not a life until it is truly remembered and appropriated; and that such a remembrance is not something passive, but active, the active and creative construction of one's life, the finding and telling of the true story of one's life," Zasetsky's journal was never a creative construction, but a repetitious infinity nightmare. It is almost impossible to comprehend his problems with memory and sight; and while I understand that automatic writing comes from a different part of the brain, not the same area he injured, it's difficult to understand how he could write at all, given the problems he described. I also wondered why no part of his brain could begin to make up for some of the deficits; the damage was just too great?

Virgil's experience was also tragic, but the irony of his case is that it may have been less tragic if he had never regained his sight to begin with. Problems with his new vision were similar to many of Zasetsky's problems: understanding space and distance, reading, ideas slipping from his mind. And like Zasetsky could write if he didn't think too hard about the task, Virgil could use his fork and knife when he first sat down to eat, but as time went on, it became too difficult. He had to learn to see just as a sighted person does from birth, and it's no wonder that faces were just blurs of color; though the concepts seem related, recognition is not about sight.

The two artists, Mr. I and Franco, were luckier. One of the most interesting aspects of Mr. I's story was that his injury (or stroke) didn't cause him to forget the entire concept of color, but in time that happened. And while Franco was tortured by his obsession and his memory was his gift, he had things in common with the amnesiacs we've read about, like his ability to remember things long past, and his dismay at seeing his sister's face reflecting her true age.

Hirstein mentions "nature's general use-it-or-lose-it strategy," which seems to be relevant to all of this week's case studies. Zasetsky didn't have much choice in what he could use and what he lost, but imagine if he didn't work so hard to retrieve the knowledge that he could; what shape would he have been left in then? Virgil hadn't seen since he was a little boy and lost his ability to understand what he saw. His brain had compensated for his sightlessness and perhaps he could never retrain the necessary parts to go back to their original purpose. Mr. I first lost his ability to see color and then, in time, lost even his memory of color. And Franco feared that a return to his hometown would put a stop to his visual memories. It didn't, but it did change the way he envisioned it. (I wonder what would have become of Franco if he never started painting: Would the visions have ceased? Would he have retreated into himself, a prisoner of his obsession? Would he have "lost it"?)

Hirstein also mentions materialists and eliminative materialism. These thinkers believe that "all of the amazing qualities of our mental lives are actually physical properties" and "in the future we will not speak of beliefs or desires, but rather will adopt entirely new ways of speaking about the mind based on the findings of neuroscience." It's intriguing, but I don't think the messy human aspects of mental life is something we can afford to lose.

Connections

2007-09-22T10:10:00.000-07:00

What I found the readings of this week to emphasize is the hierarchical and the complex entanglement of the brain’s systems. We learn that the brain is organized by specific sections, which themselves sectioned down to the smallest degree of specialization. There are the large divisions of the forebrain, midbrain, hindbrain, left hemisphere and right hemisphere. And then there are the more characterize sections of those general areas like the occipital lobe, pariental lobe, and vestibular lobe. Even lobes are composed of even smaller systems of synapses and particular neurotransmitters, which communicate very specific processes. Despite the divisions in the brain that Le Doux and Hirstein explain, the authors as well as the case of Zasetsky demonstrate the interconnected nature of the brain. The various circuits of the brain have a huge communication network that makes it possible for humans to understand the infinite intricacy of the world. Zasetsky makes it clear just how important having these specialized processing systems is and how essential it is for those systems to have lines of communication. The specific circuits act as a way to process and comprehend a multitude of object, images, language, ideas, problems, etc. in the world. By assigning an anatomical and biological hierarchy to specific systems basic human survival is protected. It ensures that if a human were to suffer from brain damage their more superfluous brain functions would be sacrificed before the systems that make it possible to live.

Such is the case for poor Zasetsky who can still eat, sleep, have a heart beat and such but can no longer understand the world. In some ways, as Zasetsky also conveys, it is almost worst to be living and breathing in the world but not a contributing member, only a body of a person, than to be dead. It is a dilemma that arises when talking about neurological disorders. What toll does the illness or disability take on the person? Is it possible to be physiologically and emotionally resilient? What changes in a person’s spirit because of a mental illness? Is it really worth living if you are a “shadow of a person” as Zasetsky?

I believe it is at this point where philosophy and science do not meet, like Hierstien illustrates how they interact. He conveys that the two disciplines influence each other and that in fact neuroscience originated from philosophy. Heirstien also notes that many other disciplines like the arts and humanities come into play when thinking about mental disorders. The readings to an extent approach and exemplify this by including narratives, scientific reasoning, and more philosophical debates. They also act as a metaphor for the interconnectedness of the brain in this way. We see that must draw upon varying fields, like drawing upon varying circuits in the brain, in our attempt to answer the questions that rise out of neurological disorders.

Romantic Science and the Machinery of Mind

2007-09-21T17:25:00.000-07:00

The readings this week form a diverse assemblage of case studies (Sacks) neuroscience minutia and brain composition and chemistry (Hirstein, LeDoux) and a wrenching first-person account of brain damage accompanied with interwoven scholarly commentary (Luria). They present an interesting counterpoint of the technical and the personal, balancing science vs. the human experience, and the overarching theme that emerges from them is one of terrible loss and the struggle to regain, or adapt, the missing skills and memories. I am thinking of Jonathan I. in Anthropologist on Mars and Zasetsky as related through his journal entries in The Man With a Shattered World in particular.

Let's begin with the "scientific," rather than the romantic. Chapter 3 of LeDoux offers a highly mechanistic account of brain workings, the dendrites and the axons, and seems to reduce all function of the mind -- every thought, memory, hope, dream, desire, fear, and regret -- to the workings of component neurons, a vast and synchronized machine that somehow manages to elicit this end result, the complicated system of a human being. Is it possible that we as humans are nothing more than an immensely complex organic computer? Luria calls his field of study a "romantic science," but in LeDoux, we see only the bare logistics of it, as simple and straightforward as high-school biology class. Is this the way to define a person? We tend to romanticize our aspects of self; we imagine that something more mysterious and inexplicable is at work, even going so far as to call it a soul, an ethereal, iridescent substance apart from the factory housing of the brain, and in this sense, it is indeed a romantic idea. Can our secret crush, our deepest ambition, our childhood memories, really be only the result of a synapse spanning a neuron, firing up our internal processors? Are we walking IBM terminals? Are people so reducible to component parts? If we all have the same internal circuitry, why are we still such a mystery to ourselves?

The second half of the readings explore what happen when all this delicate wiring goes awry. In The Man With a Shattered World, we are introduced to L. Zasetsky, who was wounded in the head in the battle of Smolensk during WWII, and the consequences were catastrophic. He lost his memory, his perception of self, and his ability to read, speak, and organize his thoughts coherently -- he lost the grounding framework of language that we learn as children and never give much thought to. In this era of text-message, IM, email, we employ words more than ever; we have learned our language as a child without conscious effort, hearing it used around us. Now imagine being an adult, seeing letters as nonsense symbols, unable to speak -- locked in the damaged housing of your own head, unsure where the right side of your body is, where you are, who you are, and if you are anything else than a fatally defected version of the vast human computer; that bum laptop you had to return to Circuit City the other day since it wouldn't boot up or kept running out of battery. The idea, for most of us, is unfathomable. We take our perceptions and orientations for granted; we never really give active thought to the space we are occupying, the reflections we are having even subconsciously, where our body is, the letters we're scanning -- maybe not even reading, but we register the meaning anyway. To be so drastically dispossessed is something we can't even imagine. You are skewed, broken, an abstract painting, a fractured window. Death may even seem preferable to living so halfway.

Zasetsky, through persistent and agonizing effort, learned to recall the language which he knew before -- Russian -- and to write again, his only way of thinking, since any other thoughts would flee from his shattered mind. To be able to chronicle such disjunction, and to be unable to remember it or even to read what you have written is a sobering and profoundly moving thought. He suffered from a profound amnesia and language aphasia, and his journal is the record of these thoughts, which he cannot express to others with spoken words or even to himself. And yet, how far removed from the world is he, really? The end of Shattered World is almost unbearably sad. This man, who has had a full life and a brilliant mind utterly removed from him by the fragment of a bullet, writes, "Were it not for war, the world would have become a great place to live long ago [....] soon there will be flights to outer space -- first to the moon and then other planets. This will give us an even greater chance to enrich life with rare elements and substances that may be more plentiful on planets other than the earth. We could do this, were it not for war...."

Perhaps his amnesia is too dense for him to recall the precise form he gave these words, but it is doubtful that the sentiment ever leaves him. And he is only one of many, illustrating the brutal cost of humans destroying each other, leaving minds and lives in disarray. Zasetsky will never recover from his injuries; the trauma is permanent, leaving him encased in a cracked and splintered glass shell of a mind, struggling to express in transient words what has been taken from him forever in speech.

In Oliver Sacks' second book of case studies, An Anthropologist on Mars, we meet another extremely gifted individual who has suffered a cataclysmic loss, in The Case of the Colorblind Painter. Jonathan I. is a talented artist whose car accident has left him bereft of color and in a world that is completely black-and-white, like an old television set. Even his dreams and memories are empty of it. Like Zasetsky, he deeply mourns this loss -- he is unable to paint as he is used to, can only compose canvases in varying shades of gray -- but unlike him, Jonathan I. eventually reconciles himself to his new situation, even gaining a new appreciation for the complexities and textures of a world that lacks all color. Even when there is a chance to cure him of his achromatopia, Mr. I. refuses, having settled into a new perception that no longer requires color -- he finds the idea as alien and jarring as he first found the lack of it. What began as a disability has become a gift.

And what if it should work in the reverse -- if an inherent neurological handicap should be conceived and accepted as part of the self, to the point where its "cure" becomes the burden? The other reading in Sacks, To See or Not to See, investigates Virgil, who has been almost totally blind since the age of three and finally, at the age of forty, is given the chance to see again by utilizing cataract removal surgery. The blind man given sight is an archetypal parable, but for Virgil, it is not -- since he has been without sight for so long, he has no idea of how to formulate his world with it. He can get by with touch, shaping the contours of his world with his hands, but cannot connect it to the faulty images provided by his suddenly re-functioning optic nerves. What would be a gift to most people has become an inconvenience to him -- his brain does not process by means of sight, as he has developed so many mechanisms for functioning in its absence. We all find the idea of blindness to be naturally horrifying -- unable to watch sports, TV shows, movies, read books, see the faces of friends and family, to navigate alone, to be truly independent, to drive to the store at night to pick up milk, a movie -- to be caught in a world of blackness and shaping the world with only hands and ears. And yet, Virgil, who has been blind so long, receives a second blindness brought on by illness as a sort of benevolent gift. He is safe now, back in his comfortable sphere -- perversely, where we would be if we were temporarily blind and then regained our sight. Free of the burdensome need to connect his finger-pictures with his eye-pictures, he can at last find his way with assurance. Is this the blind man who can see better than those of us with eyes in perfect working order?

Sacks' second case studies are quite different in this book than The Man Who Mistook His Wife for a Hat. They are longer, far more in depth, cite the positions of other scientific researchers on the topic, and explain the symptoms and the lobes of the brain that are affected. Where Hat was a string of amusing, touching, and thought-provoking vignettes strung together, Mars feels more like a clinical chronicle of the affected patients and their symptoms. One thing Sacks does not lose sight of, however, is his subjects' deep and essential humanity. Reading the cognitive neuroscientific diagrams of LeDoux and Hirstein, it is easy to forget that beneath that "organic computer," there is in fact a human being with desires, hopes, fears, and dreams just like any of us, powered by the same enigmatic ether, whatever defects may have occurred in the processing. A disorder does not make us the same as that faulty laptop; we feel, we know, we are conscious and we understand pain, whether ours or theirs. And that may be, in fact, the most romantic science of all.

Thoughts on the Individual and Equillibrium

2007-09-17T09:06:00.000-07:00

"In disorders of excess there may be a sort of collusion, in which the self is more and more alligned and identified with its sickness, so that finally it seems to lose all independent existence, and be nothing but a product of sickness." (91 Sacks)

"My notion of personality is pretty simple: it's that your "self", the essence of who you are, reflects patterns of interconnectivity between neurons in your brain." (2 Synaptic Self)

After being diagnosed a year ago with ADHD, and especially after experimenting with stimulant drugs as treatment, I have often wondered where the line can be drawn between me and my "deficit". Like Witty Ticky Ray, I became used to defining myself by my condition, with its pros and cons, as someone that deftly connects trains of thoughts to the extent that an inner world is created. Like Ray, I often wonder which is the real me, the Adderall me or the ADHD me, feeling "forced into levity" and "forced into gravity" and truly forced into every state of being I find myself in, unable to find a true balance.

I agree with Sacks that DSM-IV hasnt got the whole picture in its computeristic classification of neurological conditions. By its determination, there are people with "normal" brains and people with "abnormal" brains, implying that the abnormal brains could, in theory, be "fixed", and that they are incapable of fixing themselves. Sacks disagrees with this inflexible categorization, and yet he continues to try and force the idea of a "soul" onto an individual, believing that once enough damage is done to certain parts of the brain this "soul" is lost. He suggests this with characters who he is unable to relate to, such as in "A Matter of Identity", and only retracts this idea once he can find some deeper level to connect with them on. And yet... isnt the superficiality shown by the man in that story a very human defense mechanism? I certainly know many individuals who act like he did on a normal basis. As we have seen, people with neurological disorders often find other senses, or defenses, heightened as the brain struggles to find an equillibrium. And the Brain Science chapter on confabulation suggests that even normal people have similar overcompensational responses, because the main function of the brain is not only to process information but to link this information together in a way that is coherent.

Therefore, havent all the patients we have read about had brains that, in fact, are still functioning with the primary goal that they are meant to? Although the certain information processers are broken, the brain struggles to compensate for them in order to preserve a centralized "identity" and coherent understanding of the world. Isnt this what makes us human?

Clearly, there is this internal struggle within ALL individuals, as is shown through our art and literature, yet in those with neurological disorders it is more difficult and pronounced. This is why I was offended by Sack's initial instincts to dehumanize, or de"Humean"ize, his patients. (Although, of course, the point of these stories is to help the reader connect with the individual.) More and more these readings are convincing me that there is no "normal" brain that has a clear understanding of the word and a clear identity. The struggle to create and preserve identity through the connection of information is inherently human because of the way our brains work, and it is the connection that we can claim to all of Sack's patients.

-Jo

Everyday Confabulation

2007-09-16T13:02:00.000-07:00

When I started taking abnormal psychology and studying all of these different diseases, I was convinced that I suffered from every single one. It wasn't until my professor explained that everyone expresses certain symptions or tendenacies but that those suffereing from mental illness exhibit them on a scale much higher than the "average person." So, apparently, the only thing I really was suffering from was hypochondria or maybe I'm allergic to suggestion. It was quite interesting to me today to find that that these small white lies I've told my whole life (yes, I did my homework; I totally called you yesterday; I lost track of time) actually stem from somewhere: confabulation.

Now, me, I'm an actor so I have always leaned towards embellishment, even with the smallest story. My goal has always been to make people to have good time, to simply entertain. Of this (Which I hate to admit) I've always been aware but I hadn't realized that I did it to myself. All of these internalizations and rationalizations. "This happened because of this; he didn't mean to be so rude it's because he's having a bad day; you didn't get the part but it's not because you're a good actor." To me a day without rationalizations can be quite depressing! We tell ourselves these stories to keep going. Well, we tend to confuse ourselves and our narrative with these confabulations.

I know that sometimes I've told a story to people and I've had to work it into my narrative because that's part of how they percieve me, or they ask me to tell it again or they have told others. Now clearly I know that these things MOSTLY aren't true. This may be philosophical but is this confabulation or truth because that's where it's been based or simply wrong. Consider this in both ways, involving me and those the story gets to. For me there may be doubt (Which is the main point that kills confabulation) but what about the people who hear the story? They have no doubt because they have no reason to, so for them what would it be?

Consider this excerpt from the essay when looking at my next few questions, " Our fundamental tactic of self-protection, self-control, and self-definition is not spinning webs, but telling stories, and more particularly concocting and controlling the story we tell others-- and others-- about who we are" (5).

Okay, I'll be the first to admit it. I lie sometimes, I fib and I completely embellish. My question is why? Are we trying to assert some kind of control over an otherwise unpredictable and uncontroable world? Improve ourselves around others? Edit history to our liking? Don a facade that really isn't like our own?

Enjoy the weekend,
-M.

Seeking the Self

2007-09-15T13:44:00.000-07:00

It seems that we have all the ingredients to create a human or “self”, mind, soul, personality and brains, but we cannot figure out the recipe. Theories and research done by philosophers, theologians, scientists and psychologists are virtually useless separately, but we inch closer to the “self” when we view them as a whole. I think The Synaptic Self may prove to be the most productive of our reading materials thus far because of its diverse insights. The Man Who Mistook His Wife for a Hat is very entertaining but after reading in the order: LeDoux, Sacks, Hirstein, I felt like LeDoux set up the necessary background information and posed important ideas that the Sacks reading supported by example. Brain Fiction sort of felt like I was conducting an experiment as I was reading because it was written in such an organized list-like manner, but I think the discussion of confabulation was significantly thought provoking.

I agree with LeDoux when he said that philosophy was the most improbable source for discovering the “self”. Descartes said that the “mental” and “physical” were two separate things, but how could this be so? The physical is a direct result of the mental; they have to be interrelated. The Sacks cases show us that any deterioration of the mind plays out in the body, with the ability to make or break a person. Some of the people have illnesses and some of the illnesses have people. For example, Witty Ticcy Ray was “fixed” after his medication. But he wasn’t himself anymore; not as quick or competitive or as “ticcy” because Tourette’s syndrome was a part of his identity. The haloperidol became a switch on his personality. This brings me back to a question LeDoux asked. Can a human lose personhood as a result of brain damage, insanity or moral transgression? What about, can a human gain personhood from said things?

In the first chapter of Brain Fiction, Hirstein explores every inch of what confabulation is. Although some diseases that cause confabulation can be some of the most awful degenerations that could happen to a person (e.g. Alzheimer’s, schizophrenia…), aren’t they intriguing? It sure is devastating when someone you know is completely altered by one of these illnesses, but do they gain a strange new personhood because of this new character they have taken on? It is clear that they have no intent to deceive you when you are told a lie, but to be so creative on the spot with a story… Frankly, I am a bit jealous of such imagination.

I think it’s strange how some diseases make you who you are, and some have nothing to do with who you are. But who are we to say that a human becomes less of a person when they transgress from a disease? Some of the most interesting people I know are the ones with tics or the ones that confabulate!

Weeks Readings

2007-09-15T11:02:00.000-07:00

While reading 'What is Confabulation?' in Brain Fiction I find the accounts to be haunting and yet humorous. How is a doctor able to keep a straight face in defence of the illness that the persons' brain has? That is it isn't it? These are misfunctionings of our brains not our selves, so where does the blame lie? And who is responsible? Perhaps these questions are redundant, but I am wondering who suffers more the patient or the doctor and which out of pity.
Confabulation indentifies its relativity to lieing, but a different kinship. It cannot be a lie because the person is not concious of it.
What I didn't understand is how can it not be considered lieing in those who are not mentally ill? In the case of the placebo pill, obviously those people were just making themselves believe that the pill was making them tired, when in fact it was all in their heads.

In LeDoux's 'Synaptic Self' the actual words of philosophers, authors, and artists caught my interest the most. Our individual relationship with God adds a different dimension as well, because although God presents different ideas in each we must have this understanding that 'God interacts, but does not interfere.'
When Descarte says 'The only thing he could know with certainty was his own mind.' it is a beautiful statement. I agree that even though we are not certain of many things and doubt and denial play a large rule in self-confidence we are indirectly responsible for knowing ourselves and our capabilities. Then when Bob Dylan says that the self that he wakes up with is not the self that he falls to sleep with, and something said by Philip Roth along the same lines of not really knowing oneself, is it that we choose not to know, or we are just unsure of what exactly 'knowing thyself' means?
Also when it is said that stress is known to impair explicit memory while doing the opposite to implicit, I had trouble identifying exactly what this meant, so maybe someone can help me out. To put it very simplictically I took it to mean that although our stress is represented externally in an uncomfortable physical form it takes shape in us creatively, and more concretely places a memory implicitly?

As for the readings of 'The Man who Mistook his wife for a hat' Those stories leave the question open for fright as many have said already and hope. In 'A passage to India' this image of watching a young girl dream her way to death and in that find eternal life, is beautiful. Horribly sad, but in that small example we are lead to believe that the mysteries of the brain are those all to their own.
In 'The President's Speech' the episodes of aphasia are so delicate. It is like another form of language. It stopped me for a moment when the nurses of aphasia patients relate them seeming most of the time fine. Then I was lead to the reading 'Witty Ticcy Ray' and it just proves that 'fine' and 'normal' can only be defined by the patient. It is hard to say whether or not we are living our lives wrong, if we are still living them. Like when Ray takes Haldol during the week to maintain 'normality' and then dismisses it on the weekends to be himself, the different Ray. The aphasiacs are the same, they just function differently. Maybe these comments are too obvious, but I find in trying to understand the complexity of situations like these stories it just easier to find the beauty.

Witty Ticky Ray and A Passage to India

2007-09-15T08:42:00.000-07:00

The exploration of tourette's synodrome by Sachs in the chapter entitled "Witty Ticky Ray" was a facinating look at how some people use their illness as form of identity. As in "The Lost Mariner" self expression frees these disabled people from their illnesses. Without Haldol, Ray was sharp, erratic, and could fly off into wild improvisations on the jazz drums, but still couldn't lead a normal life because of his violent ticks. Ray describes being on Haldol as "...dull, makes one square and sober, and neither state is really free". The most interesting and moving part of this chapter, was Ray's decision to take himself off of Haldol during the weekends, but "dutifully" take it during the week. Ray split himself into two people and as he describes neither one is balanced, but he must do the best with this imbalance to lead a life more like normal people. Reading all these different accounts of patients definately makes me appreciate all that I have and that I am not lost in another world that is not this one. As in "A Passage to India", Bhagawhandi P., a girl of just 19, gets lost in a fantasy world, because of a malignant brain tumor. In a trance like state, as Sachs describes, Bhagawhandi P. would drift off into fantasies of India. She says just weeks before she died: "I am drying..I am going home. I am going back to where I came from- you might call it my return". This story is almost romantic in its description and extremely saddening, because of course it is truth and not fiction. It's hard to think that a girl just a year younger than myself could die so abruptly and tragically. Sach's writes in a very direct and clear manner and really makes the reader understand and empathize with his patients.

The Horror

2007-09-15T07:58:00.000-07:00

Several readings this week—to me—exemplified in beautiful ways the horror I feel at facing such disorders as Korsakov’s and Capgras’ syndromes. The true wonder that we feel when imagining and learning about the worlds of patients with these disorders is, perhaps, fundamentally derived from the fact that they horrify us to some extent.

We read about Jimmie D., who remarked, “‘I cannot say I feel ill. But I cannot say I feel well. I cannot say I feel anything at all’” (Sacks, 36). Surely there is nothing more strange or frightening than feeling nothing at all. The memories that Jimmie lost are coupled with a loss of much, much more. Sacks himself said, “The fact that one can lose the greater part of a lifetime has peculiar, uncanny horror.” (40)

We read—for a very short while in “The President’s Speech”—about Emily D. Here we find a woman who has developed tonal agnosia, an inability to detect alterations in a person’s tone of voice. She copes with it by requesting that people speak in proper, non-expressive prose. The horror in this is that she was once, herself, a poet!

Then, of course, there’s Witty Ticcy Ray, who—while he finds ways to cope with it—must always be bouncing back and forth between two unnatural modes of existence, never really confident of which is the real Ray.

There are many more in these readings that scare me, but this is a diverse enough sample. In all of these cases, the root of fear—my fear at least—seems to be traceable to a commonality between the cases: all of them, in some way, force us to reassess the definition and nature of identity. How is a man himself when he forgets himself, forgets his life, forgets how to feel? How is a poet herself any longer if the only thing she can understand now is prose? Which of the Rays is the real Ray—the one with the deficits caused by Haldol or the one with the deficits caused by Tourette’s? And for God’s sake, how can you retain your identity if you—like those in certain cases of Capgras’ syndrome—have a desire to kill the ones you love the most, thinking they are imposters?

There are no answers to these questions, and that frightens me. But we can look to Jimmie D. when he is at Communion, look to Ray when he transcends his sickness, or to José who learned to express his feeling through art when he could not effectively talk. These can help to alleviate the fear and hopelessness that seems to plague some of these cases. They may be short moments of reprieve, but they are enough to make it all worthwhile.

In Response to LeDoux

2007-09-14T19:43:00.000-07:00

I was quite reassured by the emphasis LeDoux places on what he calls "an interdisciplinary approach to the understanding of how the mind works" in his first chapter of "Synaptic Self". It is always wonderful to begin a book with the knowledge that the author understands the value of a balanced and all-encompassing perspective of the material covered.
I once heard a story about the way in which Descartes's taught the concept of consciousness and sentience; apparently to demonstrate his theory that animals were not truly conscious organisms the philosopher would nail a live dog to a board of wood in front of his class of horrified students. He would then dissect the animal, exposing it's beating heart and dismissing it's whimpers of pain as merely the sounds of a machine that was functioning improperly. As the animal literally died before his eyes, Descartes maintained that it's cries were no different then the whining of a gear that needed to be oiled. Not a pretty picture.
In a slightly melodramatic sense, I've often felt that reading scientific texts can be equated to spending time in Descartes' classroom. All too often I feel that advances in science are portrayed as a final answer to the more complicated questions we have about ourselves and our bodies. Just as Descartes simplified the dog, we (human beings) are presented as purely machines, rather then a complicated collection of variables and determining factors. Textbooks often treat human life in general as a sort of mathematical equation; these nerves plus those chemicals equal the entirety of your person. It can sometimes feel a bit like reading Vonnegut, with all that talk of "bad chemicals" and "faulty wiring".
Thus, I was impressed with LeDoux's approach to his subject. His insistence that multiple branches of Neuropsychology be used in conjunction in order to achieve a more complete understanding of what makes us who we are seemed both intuitive when I originally read it (of course we should take everything into account!) and at the same time remarkably novel. I don't think I've ever read anything quite like it before. He takes his conversation of the self past the basics of cognitive science and the nature vs. nurture argument, in order to "consider the whole mind" and how every aspect contributes to the self we become.

Some questions

2007-09-14T14:55:00.000-07:00

To paraphrase LeDoux, the idea that the self is created by and depends upon synaptic connections should not diminish who we are. I understand this point, and I agree. Nothing is actually changing here – the what remains the same – but our understanding of the why develops into something greater.

At the same time, I think that our (often misguided or ill-informed) ideas of what makes us who we are vary. For this reason, his statement most likely has a different effect on each person, and for me, it is a slightly disappointing, though illuminating, one. I like the idea of the magical, unknowable, mystical. There is a certain romance to nineteenth century attempts to make scientific sense out of a confusing world. Electricity and innovation seemed like something thrilling, wholly captivating, at that time, but they have since lost their romance and are now simply the flip of a switch that we take for granted. I like having the freedom to wonder about my soul, a part of me that doesn’t seem to physically exist anywhere, exactly, but is still (seemingly) present. I guess, simply, I like asking questions.

That desire for mystery exists in me with another interest, a contradictory force that is scared by the overwhelming nature of feeling unknowable and wants to explain and understand and classify. Hopefully, the more I learn, the more I will be able to grow, to control or change undesirable thought patterns or unhealthy parts of my personality. As LeDoux himself states, “Learning allows us to transcend our genes.”

So I do think it’s important, and better, to unlock pieces of the “mystery” of who we are, but there is a certain bittersweet quality to it, one that has characterized my on-going process of growing up.

I still have questions, though they may be answerable. I understand that our learned experiences will build upon and change our genetic predisposition, so that “learning allows us to transcend our genes,” but wouldn’t your genetic makeup influence how and what you learn in the first place? Or what you are receptive to learning? Do we ever have a freedom of choice, or is the combination of who we are and what we learn in control of our fate? And if we do have freedom of choice, can we trace where it comes from, or is there any part of our personality that does not point back to a specific part of our brain? Are there gray areas?

Science and The Self: Contradictory or Complementary?

2007-09-12T08:57:00.000-07:00

When I consider the three books we were asked to read this week (due on 9/10), I categorize them in the following way:

Synaptic Self represents the most scientific reading, with its discussions of neurons, synapses, and brain development.

"The Bear Came Over the Mountain" represents the least scientific, and most personal reading. Note the absence of any talk of pathology in the story; is the word "Alzheimer's" even mentioned? Grant and Fiona don't talk to doctors and don't discuss the physical expression of Fiona's disease in her brain. On the contrary, "Bear" focuses exclusively on personalities, emotions, inter-personal relationships - the pathology of Fiona's disease is excluded, irrelevant.

Lastly, Oliver Sacks' "The Man Who Mistook His Wife For a Hat" represents a union of cold science and human emotion. Sacks, as a neurologist, is interested in the pathology of Dr. P's disease. As a sympathetic human being, Sacks is interested in P as a person and what emotions he feels in response to his condition. And lastly, as a writer, Sacks looks to combine his two perspectives into a coherent and compelling narrative. Out of all three authors, Sacks is in the best position to give the reader the most comprehensive understanding of his character, having both the scientific understanding of a neurologist and the ability to empathize that allows him to create "richly human clinical tales" (Sacks, xiv).

That is not to say that Synaptic Self does not have a human element, or that disease plays no part in the story of "The Bear Came Over the Mountain." On the contrary, an understanding of Alzheimer's (at least on a basic level) enhances one's reading of "Bear," and Joseph LeDoux seems committed to illuminating "the self" as a "psychological, social, moral, aesthetic, [and] spiritual" being as much as a "neural" one.

But I am saying that Sacks achieves the balance between the pathological and the personal most successfully out of the three authors. Synaptic Self, at least so far, lacks the human element of Sacks' tale because LeDoux has not brought us into the life of any specific human being, like Sacks brought us into the life of Dr. P. Munro, conversely, does not include a discussion of Fiona's pathology.

Both "Bear" and Synaptic Self offer great insight into the self - what it is, how it works, how certain conditions can change it, and how in some ways it is constant. But Oliver Sacks' story is the one that best fits the concept of "Narrative Neuropsychology" as I perceive it. He illuminates the life and personality of a human being, and at the same time invites us to wonder at the working of that person's brain as a physical thing - "a machine and a computer" (18). As we gain interest in the brain as a mechanism of great genius and mystery, we never forget that there is a person attached to that brain, "a human subject at the center," and that it is this person, his "essential being," who is most "relevant in the higher reaches of neurology" (xiv).

The Bear Came Over the Mountain

2007-09-10T14:43:00.000-07:00

I enjoyed meeting with you today, even in the Andrews sauna. Stephanie and Madeline were right that there is more to be gleaned from the title of Munro's story. I found a review of the film 'Away From Her' that makes it explicit. The title comes from an old folk song and another perspective on the story comes clear from the lines that follow:
The bear came over the mountain
to see what he could see
and all that he could see
was the other side of the mountain

The review's online at http://www.montrealmirror.com/2007/052407/books1.html