Showing 1 - 10 of 11 annotations in the genre "Case Study"
One day in the 1920’s, a newspaper reporter walked into the laboratory of Russian psychologist A. R. Luria and asked him to test his memory, which he recently had been told was unusual. It was not unusual. It was uniquely and astoundingly retentive. Luria gave him very long strings of numbers, words, nonsense syllables and could not detect any limit to his ability to recall them, generally without mistake, even years later. (Luria studied S., as he identifies him, for thirty years.)
Luria discovers that the man had some interesting characteristics to his memory. He experienced synesthesia, i.e., the blending of sensations: a voice was a "crumbly, yellow voice." (p.24) S.’s memory was highly eidetic, i.e., visual, a characteristic not unique to him but which he used as a technique to memorize lists and details. (He had become a performing mnemonist.) It was also auditory. He had trouble remembering a word if its sound did not fit its meaning. The remainder of the section on his memory involves fascinating aspects of his having to learn how to forget and his methods of problem solving.
The remainder of the book is equally interesting since it relates the epiphenomena of S.’s prodigious memory: how he mentally saw everything in his past memory; how he was virtually paralyzed when it came to understanding poetry since metaphorical thinking was almost impossible for him, a mnemonist who lived in a world of unique particulars! As Luria wrote, "S. found that when he tried to read poetry the obstacles to his understanding were overwhelming: each expression gave rise to an image; this, in turn, would conflict with another image that had been evoked." (p. 120)
S. could control his vital signs by his memory and, last but not least, this human experiment of nature had such a vivid imagination that, probably more than the most creative of us, he engaged in "magical thinking": "To me there’s no great difference between the things I imagine and what exists in reality. Often, if I imagine something is going to happen, it does. Take the time I began arguing with a friend that the cashier in the store was sure to give me too much change. I imagined it to myself in detail, and she actually did give me too much--change of 20 rubles instead of 10. Of course I realize it’s just chance, coincidence, but deep down I also think it’s because I saw it that way." (p. 146)
This is the story of Betty, a 250-pound, 5-foot-2-inch woman who comes to the psychiatrist-narrator's office to be treated for her eating disorder. What makes the story more than the sad tale of a depressed, obese woman is the immediate disclosure of the narrator that he is "repelled" and "disgusted" by fat women, that his "contempt surpasses all cultural norms."
Nevertheless, he decides to treat Betty, who successfully manages to shed huge amounts of weight and come to terms with many of the problems leading to her obesity. The narrator, too, confronts his own excessive biases so that readers are left with a sense that Betty "helped" him too.
Witty Ticcy Ray tells the story of Dr. Sacks’s treatment of a 24-year-old man with disabling Tourette’s syndrome. The first half of the essay is mainly medical-historical, with some technical language. When Sacks first tries treating Ray with a minute dose of Haldol, Ray finds that even that low dose too effective. It breaks up the rhythms that have determined his life since the age of 4, and he doesn’t like it. Later, a second trial using the same dose succeeds, Sacks believes, because Ray had by that time accommodated mentally to a change in self-image.
Still, over time Ray missed his old wildness and speed, and he and Sacks agree on a compromise: During the week, Ray takes Haldol and is the "sober citizen, the calm deliberator." On weekends, he is again "’witty ticcy Ray,’ frenetic, frivolous, inspired"--and a talented jazz drummer. This, according to Ray, offers Touretters an acceptable artificial version of normals’ balance between freedom and constraint.
A desperate patient visits a renowned oncologist with hope for a miraculous cure of his kidney cancer. The patient, a venture capitalist, doesn't want to die--can't face his death. He is willing to take whatever risk is necessary to survive. After a grueling course of experimental treatment and an expected period of remission, the cancer returns, leaving the patient (according to the physician-author) with an awful ending to his life--a death filled with regret.
What is revealed as Groopman deliberately walks "along the milestones" of his patient's life is more than the patient's story, however. For in addition to a chronicle of the disease's effect on his patient, the physician himself, and his concerns about the proper use of his knowledge and powerful tools also are revealed.
Kirk, a man in his 50s with highly metastasized kidney cancer, presents himself to Dr. Groopman after having been turned away as a helpless case by several respected cancer clinics. He tells Groopman that he is a risk-taking venture capitalist and is willing to take any medical risk on the chance that it will save him. After pondering the ethics of the situation and the nature of informed consent under such conditions, Groopman agrees to treat Kirk. He proceeds to devise a highly risky (and untried) combination of chemotherapeutic agents. The course of treatment is excruciatingly difficult, but the experiment succeeds, and Kirk's cancer goes into complete remission.
Kirk calls it magic, a miracle, and the hospital interns call it a "fascinoma," a case defying normal expectations. Groopman releases Kirk to home and weekly checkups with a local internist, but in doing so he notices that Kirk's mood has mysteriously changed. He has lost the "piss and vinegar" of their earlier contact. Kirk continues to improve physically, traveling and playing golf and even tennis, but Kirk's wife soon reports that Kirk has stopped reading the newspapers he used to devour, which now collect in their driveway.
Several months later some physical symptoms return, and Kirk's cancer is back. A month later he is dead. In talks with Kirk near the end, Groopman discovers that Kirk's brush with death had brought with it a new and sharply negative view of himself as selfish and disconnected from the world and other people. Suddenly all his financial success seemed to him "pointless," and, since his life contained nothing else, it seemed to him a waste, and he felt it was too late to live it over. What Kirk ironically calls "my great epiphany" seems to have undone his doctor's "magic."
Subtitled "The Story of a Gifted Young Obstetrician's Mistake and the Psychologist Who Helped Her," this is an absorbing account of a young female physician's torment following the difficult delivery of a baby who was soon thereafter diagnosed with cerebral palsy. "Doctor Amelia" seeks counseling after she has taken an indefinite leave of absence from her practice and faculty position. The book intertwines reconstructed counseling sessions in the voice of the doctor-patient, with the therapeutic strategy and personal reflections of her therapist, author Dan Shapiro.
The obstetrician enters therapy because she has lost confidence in her professional abilities. Once deeply engaged in her chosen profession, she has lost her enthusiasm for it and feels "numb." Her marriage is under strain. When asked if she is suicidal, she hesitates and then denies she is. Shapiro thinks there may be trouble ahead, and so does the reader. Gradually, Doctor Amelia reveals the incident that triggered her changed emotional state. She had delayed performing a cesarean section on a patient who was in extended labor and whose baby was showing deceleration of its heartbeat rate. A few weeks later, the baby's pediatrician informed Doctor Amelia that the baby had cerebral palsy and now the baby's parents are filing a lawsuit.
Jose is a patient who exhibits all the classical symptoms of autism. The caregivers in his institution treat him dismissively, as though he is stupid. Sacks notices, however, that, given a pencil, Jose draws not only with amazing accuracy, but with a quality of liveliness in his representations that betokens close, insightful, and even empathetic observation and awareness. As he encourages Jose to draw, he finds his drawings diagnostically helpful, and powerful evidence of an active interior life to which they provide a valuable link.
P., a music teacher, whose associates have questioned his perception, is referred by his ophthalmologist to the neurologist Oliver Sacks. During the first office visit, Sacks notices that P. faces him with his ears, not his eyes. His gaze seems unnatural, darting and fixating on the doctor's features one at a time. At the end of the interview, at which his wife is present, P. appears to grasp his wife's head and try to lift it off and put it on his own head. "He had . . . mistaken his wife for a hat!" She gave no sign that anything odd had happened.
During the second interview, at P.'s home, P. is unable to recognize the rose in Sacks' lapel, describing it as "a convoluted red form with a linear green attachment." He is encouraged to speculate on what it might be, and guesses it could be a flower. When he smells it, he comes to life and knows it. The wife explains that P. functions by making little songs about what he is doing--dressing, washing or eating. If the song is interrupted he simply stops, till he finds in his sensorium a clue on how to proceed.
This cantatory method of compensating allows P. to function undetected in his professional and personal life. He remains unaware that he has a problem. Sacks chooses not to disturb his ignorant bliss with a diagnosis. Though his disease (never diagnosed but hypothesized as a tumor or degeneration of the visual cortex) advances, P. lives and works in apparent normalcy to the end of his days.
This is one of the two dozen studies of patients with right-brain disorders that make up Sacks's volume The Man Who Mistook His Wife for a Hat. The nineteen-year-old Rebecca has significant physical and mental defects (her IQ is 60 at best), and by conventional neurological standards she is severely impaired, but Sacks discovers that she has moments of being quite in touch and "together" (her word).
The essay tells of Sacks's discovery of Rebecca's poetic expression and spiritual qualities, and of her self-awareness, in planes unknown to standard neurological and psychiatric categories. Sacks is broadly critical of psychological and neurological testing as constituting a "defectology" that is blind to important human qualities. He warmly recommends music and story-telling, both as modes of understanding and also as narrative therapies that work by ignoring the defects and speaking to the soul.
During the Battle of Smolensk in the Second Word War, a soldier named Zazetsky sustained a severe head wound, causing "massive damage to the left occipito-parietal region of his brain." This injury shattered his whole perceptual world. His memory, his visual fields, his bodily perception, even his knowledge of bodily functioning--all break into fragments, causing him to experience the world (and himself) as constantly shifting and unstable.
Zazetsky coped with this fragmentation by writing a journal of his thoughts and memories as they occurred, day after day, for 20 years. He then arranged and ordered these entries, in an attempt to reconstruct his lost "self." From over 3000 pages of this journal material, the neurologist A. R. Luria has constructed this extended case history from which emerges a remarkable portrait of Zazetsky as a determined and courageous human being. Zazetsky's first-person account is interspersed with comments and descriptions by Luria himself, explaining the relevant structure and function of the brain.