Saturday, June 27, 2009

Romantic science (Books - The Man with a Shattered World by A. R. Luria)

Before Oliver Sacks made neuropsychology comprehensible to the masses there was a Russian neurologist named Aleksandr Romanovich Luria. He worked from the 1920s - 1970s and while the field of neuropsychology did not yet really exist, his interests in psychoanalysis as well as neurology led him to study the fascinating disorders that can effect language, the ability to engage the will to use the muscles, or strange afflictions of perception, attention, or memory in a new way. Oliver Sacks tells us in his introduction to The Man with a Shattered World:
What was distinctive in his approach from the start, and formed a constant thread in all his explorations, was his sense that even the most elemental functions of brain and mind were not wholly biological in nature but conditioned by the experiences, the interactions, the culture, of the individual - his belief that human faculties could not be studied or understood in isolation, but always had to be understood in relation to living and formative influences.

Luria prefigured Sacks in writing what he termed "Romantic Science,"
Romantic scholars' traits, attitutdes, and not follow the path of reductionism, which is the leading philosophy of the classical group. Romantics in science want neither to split living reality into its elementary components nor to represent the wealth of life's concrete events in abstact models that lose the properties of the phenomena themselves. It is of the utmost importance to romantics to preserve the wealth of living reality, and they aspire to a science that retains this richness.
So Luria wrote neurological novels (his term), The Man with a Shattered World being one. His approach created, in essence, the newish science of neuropsychology. This style of writing was purposefully accessible, painting a portrait of the patient as a complete person, revealing through a literate synthesis of behavior, brain anatomy, and being a new analysis of the unusual cases that Luria saw, with the dual aim of creating both a new understanding and a deeper compassion for this patient.

The tools of neuropsychology have advanced considerably, allowing us to peer inside the human brain in multiple ways with a much finer resolution. Decades of study have led to a far more nuanced understanding of the way brain influences behavior, but the job of a good neuropsychologist (for which I am studying) has remained essentially the same.

If this field interests you at all, even as a tourist, Oliver Sacks's essay length portraits of his patients are long on compassion and readability and short on technicalities and follow in the footsteps of Luria. They are a great place to start, but it was interesting for me to finally go to the source of it all and read one of Luria's narratives. The Man with a Shattered World is an accessible account that alterrnates between the patient's own painstakingly executed diaires and Luria's commentary. The victim of a gunshot wound in 1943, Zasetsky begins with almost no language at all. He ends up regaining some of his power to communicate but only with great effort. He can perceive the world only in small fragments, as many of the parts of the brain that synthesize the parts into wholes have been obliterated by his bullet wounds (isn't war wonderful?). His ability to identify objects is preserved, but his ability to name those objects is compromised and his sense of where those objects are in space or, often, how to use them, is destroyed. He retains memories of distant childhood, but his ability to learn new information consciously is severely limited, coming only after long labor.
Again and again I tell people I've become a totally different person since my injury, that I was killed March 2, 1943, but because of some vital power of my organism, I miraculously remained alive. Still, even thought I seem to be alive, the burden of this head wound gives me no peace. I always feel as if I'm living out a dream - a hideous, fiendish nightmare - that I'm not a man but a shadow, some creature that's fit for nothing...
Due to the patient's memory, the narrative is necessarily repetitive. As literature that might become tedious but taken as the product of his behavior, this become a tool - the only tool available to the neurologist of 1943 - to identify the location of Zasetsky's brain injury, the kinds of problems he was likely to have, and some notion of the skills he might have had a chance of recovering. Sad though it is, brain injury has been one of the chief tools we have had to confirming our understanding of normally functioning brains. We might believe through experimentation that a particular part of the brain functions in a particular way, but it is only by losing that part of the brain, and consequently that function, that we can confirm that hypothesis. When patients come to a neurologists office, it is exceedingly rare that we will drill a hole through the scalp to peer inside. Even the pictures we can make with MRI are limited in what they tell us. Behavior is still the chief measure of the neuropsychologist in diagnosing complaints. In any event, to return to The Man with a Shattered World, whether experienced as a strange sort of memoir-biography or as an artifact of a science in its infancy, makes for interesting and quick reading and I now want to read Luria's other neurological novel, The Mind of a Mnemonist some time soon.

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