X-Message-Number: 13423
Date: Fri, 24 Mar 2000 20:19:42 -0500
From: Jan Coetzee <>
Subject: Injured Brains

Injured Brains of
                Medical Minds
                Views from Within

                [review] [excerpt] [endlinks] [purchase]

                Edited by Narinder Kapur

                Reviewed by Morten Kringelbach

                Oxford University Press, 1997

                 Posted March 17, 2000   Issue


                Serious brain injury is a hidden epidemic in society. A
                collection of first-person accounts by neuroscientists
                and other biomedical professionals offers important
                and timely insights for victims, their families, and
                medical professionals.

                Just before Christmas 1999, a tragic and meaningless
                accident occurred in Oxford, England. A good friend of
                this reviewer, G., fell some 20 feet by accident and hit

                his head so seriously that he was in a deep coma by the
                time he arrived at the hospital.

                During the first days in the hospital,
                G.'s condition was critical, and his
                twin was advised to summon their
                family from eastern Europe.
                Normally, close relatives are
                informed immediately in such dire
                emergencies, but G.'s mother
                suffered from chronic heart disease,
                and it was feared that the news could provoke a fatal
                heart attack. G.'s twin faced a terrible dilemma. After
                long and hard considerations, he finally decided not to
                inform the family, but to wait.

                Injured Brains

                Serious head injuries such as G.'s are unfortunately all

                too common and yet, surprisingly, little has been
                published on brain injury from the perspective of the
                sufferer. The neuropsychologist Narinder Kapur has
                tried to remedy this situation in his book Injured
                Brains of Medical Minds: Views from Within, a
                collection of around 50 self-reports from
                neuroscientists, physicians, and others in the clinical
                profession who have themselves experienced brain

                While it is true that each brain is
                unique and hence its subsequent
                recovery from injury will be unique,
                it is also true that certain persistent
                patterns are associated with
                different types of brain injury.
                Knowledge of these patterns can be
                very useful information for patients,
                their families, and doctors. Kapur's
                book provides such timely knowledge, not only in the
                self-reports, but also in Kapur's thoughtful
                commentaries that accompany each first-person

                Miraculously, after 14 days of coma, during which the
                only means of gauging G.'s condition was through the
                vital numbers on the life support machines, he returned
                to consciousness. Suddenly his pupil reactions worked
                again, and he began to breathe by himself. He began to
                follow those around him with his eyes, though he was
                still too weak to move. He seemed able to recognize
                friends and relatives, but was incapable of speech (a
                serious case of pneumonia had necessitated the
                insertion of a drainage tube in his throat).

                As the days passed, G. began to
                regain some skills. He was moved
                from an intensive care unit to a
                rehabilitation ward. G., who never
                used to watch television, was now
                watching it nonstop and listening to

                Personality Change

                During the first six weeks after G. regained
                consciousness, he made remarkable progress. When the
                drain in his throat was removed, he was able to speak
                immediately and phoned home to talk with his still
                unsuspecting parents.

                G. remained weak but without
                permanent physical injury, and he
                started to walk again. He was
                allowed to sleep at home, but still
                had to attend rehabilitation sessions
                during the day at the hospital. G.'s
                memory apparently had not been
                damaged, and he essentially
                regained his normal mental and
                physical skills.

                However, G.'s twin was worried about the personality
                change that G. seemed to have undergone. Whereas G.
                earlier had had a mild and rather self-effacing
                disposition, he was now aggressive and self-centered,
                much like a spoiled child. Yet, this also faded with

                G. is slowly becoming more like his
                old self. It will undoubtedly take
                time before he is fully rehabilitated
                both physically and mentally; and he
                will probably never be completely
                the same as he was before the
                accident. However, his progress so
                far suggests his prospects for near total recovery are

                Bruised Medical Brains

                G.'s story is an almost miraculous account of how some
                people can recover from even the most serious brain
                injuries. Indeed, some clinicians take the number of
                days spent in coma as a rough indicator of possible
                brain damage, and by this standard, G.'s case was very
                serious. Such measures are imprecise and show the
                magnitude of our ignorance. The truth is that despite
                advances in neuroscience, we still know far too little
                about the short- and long-term impact of brain injury.
                Though earlier cases might bear resemblance to G.'s,
                every brain injury is unique, and the course of the
                illness depends on a huge number of factors that are
                difficult to quantify.

                When the situation
                was looking most
                bleak for G., and his
                twin was preparing
                to transport him
                home, G.'s twin had
                the good fortune to
                read Injured Brains of Medical Minds, which helped
                him to make some sense of the situation.
                Doctors-turned-patients know all too well the
                seriousness of their symptoms. Their dual roles can
                provide them with insights and empathy that other
                medical professionals at times would seem to lack.
                Kapur's book is, by virtue of its many self-reports and
                Kapur's subsequent clinical commentaries and
                references to secondary literature, a gold mine of
                important information for both the layman and

                The book is divided into three parts: cognitive
                disorders, clinical conditions, and an overview. The
                first part is subdivided into three sections, which deal

                with disorders of memory, language, and the visual
                system. The second part is subdivided into five
                sections: Parkinson's disease, brain tumor, head injury,

                stroke, and epilepsy. The overview contains notes on
                patient management, training of medical staff, and
                recovery of functions after brain injury.

                Personal Stories

                The personal stories are frequently
                moving and heartfelt, yet not
                maudlin. The fine essay Memoirs of
                a Thinking Radish, by Peter
                Medawar, Nobel Prize winner in
                medicine/physiology, describes how
                a stroke altered his life forever.
                Medawar was treated by a senior
                consultant who told him that his arm
                "would never get better," and that it was therefore not
                worth his "while to prescribe any treatment for it."

                Medawar's wife was also told by a clinical
                psychologist that Medawar had become mentally
                impaired. Mental impairment seems unlikely, since his
                essay is written with a poignant wit that probably just
                escaped the comprehension of any of the diagnosing

                Another particularly commendable
                essay was written by Frederick
                Linge. Linge, who endured a car
                accident, writes about injuries to
                both brain and body. His 1990 essay
                describes his continuous struggle
                since his accident 12 years earlier.

                All in all, Kapur's book is full of
                interesting observations, and should be made
                compulsory reading for doctors and others dealing with
                patients with brain injury.

                    Morten Kringelbach is a neuroscientist at
                    the University of Oxford.

                    Alexandria Heather-Vazquez is art director
                    of HMS Beagle.


                    I no longer measure the worth of my life or that of
                    others by standards such as money or appearance
                    or even by usefulness to society. I believe that all
                    is worthy of respect and is precious. I no longer
                    evaluate a victory in terms of power and prestige.
                    the eyes of society, the daily struggles, defeats,
                    successes of a survivor may be trivial, but to me
                    now, they are greater than the televised victories
                    a professional athlete. And finally, I believe that
it is
                    the struggle itself that gives life dignity, at the
                    (Frederick Linge)

                You may purchase this book (442 pp., hardcover)
                directly from:

                    Publisher ( 29.50)
                    Amazon.com (list $57.50, Amazon price $52.50,
                    you save 9%)

                             Tell us what you think.


                Facts about Concussion and Brain Injury and Where to
                Get Help - provides information about concussion,
                brain injury, and where to get help. From the Centers
                for Disease Control and Prevention.

                Dana BrainWeb - list of links to authoritative
                information on brain disorders and injury.

                Brain Injury: A Guide for Families and Friends - part
                of the University of Iowa's Virtual Hospital site;
                contains reference guides on evaluation, definition, and

                treatment for brain injury.

                Neuropsychology Central - is a resource on
                neuropsychology and its application to brain and

                Coma Recovery Association - helps families of coma
                and head injury survivors by providing information and
                referrals that enable them to make informed choices
                regarding treatment, rehabilitation, and socialization

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