two books and a human being
Two recent reads for which I haven't made brief notes in my reading list, mostly because I have much to say about them, and I've been mulling over how to get a grasp on the whole thing: Memories of Amnesia, Lawrence Shainberg; A Leg to Stand on, Oliver Sacks.
Memories of Amnesia is a work of fiction. Shainberg's protagonist is a neurosurgeon who discovers, in himself, evidence of mental dysfunction. He struggles to reconcile the inconsistencies within his experience and between his experience and his expectations of "normalcy", while recognising that he's doing so with impaired faculties. With heroic (blind? stubborn?) determination, he continues to pursue the task of self-analysis in the face of welling self-doubt. He covers ground that's familiar to me (as part of my experience with Chronic Fatigue Syndrome), though he doesn't always end up in the same place as I have:
- trying to make a distinction between psychological and neurological symptoms;
- There's a decision required as to what best to do, and this question seems primary. Brain surgery or psychotherapy? Psychotherapy isn't going to excise a brain tumour, and neurosurgery won't chase away the ghosts of the past. There's a sound pragmatic basis for him wanting to make the distinction, and I also felt strongly at one time that the distinction was necessary.
- The book has him deciding that the primary cause is neurological. I think it remains possible for a reader to argue either way. If you've read the book, I'm interested in hearing impressions and/or arguments for either case. I'm undecided (and will probably stay so - I don't have to write an essay for an English teacher, supporting one view over the other).
- For my condition, brain surgery wasn't an option, though I still have clusters of CNS "snap, crackle and pop"s for which medical science can offer some symptomatic relief, and I use whatever has a good cost/benefit balance. Psychotherapy was an option, and one that I found valuable. I've long found the examined life of value, and brief therapy gave me access to someone else's expert processing skills at a time when my cognitive skills were disrupted. This is currently a major issue within CFS support groups in Australia. The Australian Medical Association published a paper recommending Cognitive Behavioural Therapy as best practice in CFS treatment. Many support group members find it upsetting that this seems to indicate a psychological, rather than physiological, basis for the disorder. As I've come to see it, even if one's committed to a model with a physiological basis, that doesn't alter the fact that CBT is a process that helps manage the severe life-disrupting effects of the condition. And for as long as there's no mechanical/chemical cure, it makes sense to use the best management techniques available.
- a self-referential loop that results in "second-guessing" and an inability to come to a conclusion
- recognising evidence of cognitive dysfunction, there a vortex of "I think this, BUT I'm not thinking well, so maybe this is not so. Then again, I'm thinking well enough to recognise both possibilities and to work through them, so I was probably right the first time, OR maybe, knowing that I'm not thinking well, I was right to question my original thoughts..."
Sacks' book is autobiographical. He once suffered massive injury to a leg, and herein chronicles his recovery. The orthopaedics and peripheral neurology of the case were reasonably well understood and managed at the time, but the interesting aspect is the psychological impact of the physical damage. He suffered severe disruptions to his sense of self, and reflects that he's heard similar stories from other patients. Some of the mental states he reports are scarily familiar, but it's reassuring to hear that it's not uncommon.