(In) sane in the Brain

 

 

I am seated in one of Delta’s new A350-900 model airplanes destination Indonesia--  from New York City a 26-hour flight.  This being a transpacific route, hot towels precede three meals.  Not being in first or business class, there have been product adjustments.

“Hot towel?” the flight attendant asks?  We are two hours from Tokyo.  I see through sticky eyes a fiftyish-year-old woman with very dyed dark-brown hair holding out with too small clear plastic tongs-- the kind you might find in a child southern BBQ play set-- what amounts to a stiff wet square napkin, size appropriate for fetal face cleaning.

“Hot towel?” I state rhetorically.

“You want a hot towel” the flight attendant smiles with only the slightest hint of annoyance.

“No hot towel for me today,” I say emphasizing the word towel.

“Are you sure,” she asks.  The once stiff napkin square now wilts at its corners like a dead star-fish baby.

I wonder why she is prolonging the exchange.  “I have never been so sure,” I say.

The flight attendant sighs, continuing to move down the aisle with the alacrity of a soviet era tank.  Next to me, an enthusiastic passenger exclaims, “I just love it when they’re hot!”  She proceeds to unwrap her napkin square as if origami surgeon and dive her face into its center as if being treated to perfumed religious cloth.  I don’t don’t admire this person.   I imagine her spirit has been earned.

In medical school, students learn of damage to Wernicke’s area.  This is pathology, usually in the form of a stroke or tumor at the junction of the left temporal and parietal areas, or the top left thigh of the brain, if you will, if you can imagine the brain the shape of an intact grocery store chicken.  This area gives us the ability to understand stimulus. Everything works to and from the left temporal and parietal junction in Wernicke’s except Wernicke’s.  The image of say a car passes through the lens of the eye onto the retina.  The light stimulates the optic nerve to fire electric currents down axons to neuronal bodies in the thalamus, which in turn relays signals to optic gyri in the visual cortex.  A picture of car is registered and a message sent as a precise package to Wernicke’s.  At Wernicke’s, the injured part unwraps the package and thinks a lot of things, just not car. Maybe instead a plane. A large girl. A piece of lint. A blue-red floral pattern.  The individual speaks as volition remains, “ddurb dribdble  aegiticakl boo ha he.” Or if s/he is semi-lucky with intact and fluent words, “this will pass Aunt may be coming some ton, ya?” It’s the coherency part that is in question.

You might think one could trick this dastardly brain part.  How about instead of seeing an actual car, you instead say the word “car” or draw a car or mime a car or make the sound of a car-- Vroom vroom.  But it turns out, language is language. Wernicke’s function is at the transition between symbolism and meaning.  This can be direct or abstract. A sunset can be interpreted as a molten hot descending orange yellow orb.  But it can also stand for the out of earth rotation of humanities main star; as the loss of the day; the transition of life energy; of natural wondrous blinding beauty. As a culture, we necessarily restrict interpretation of symbols to a long but finite list of possibilities lest we be at constant war with ourselves or others over significance. Our brains thus support a life-long Wernicke meaning construction operation, eventually able to define the language of sound, sight, feeling, touch and smell within particularized contexts. A baby observing a chair at first registers no understanding of how the chair is different from say, its father or the family dog. The baby possesses neither the language to distinguish world stimuli, nor the Wernicke bandwidth to store the lesson. In contrast, a six year old when shown the sun, doesn’t see the moon.  A girl in a dress is not a boy.  A rat is not a chicken.  As one grows-up, being in agreement with the majorities’ Wernicke outputs makes you socially acceptable, and if nuanced but not too much so, popular. 

Listen to Byron Peterson, a stroke survivor with fluent aphasia, speak with typically effortless speech with impaired meaning and poor comprehension in this interview with Megan Sutton, SLP from Tactus Therapy Solutions. Read more about Byron here: http://tactustherapy.com/wernickes-aphasia-making-sense-of-adventure/ And learn more about fluent aphasia: http://tactustherapy.com/what-is-fluent-aphasia-video/

There is latent personality associated with injury to Wernicke’s area.  Some are driven mad about the inability to understand or be understood.  Others seem quite happy about the condition as if living in a state of deafness to external stimuli didn’t produce a care in the world.  In the above video, this sufferer from Wernicke doesn’t appear to mind that he doesn’t understand what is being said to him though in not understanding, he tragically expresses nothing of consequence.  He has become inconsequential. I don’t say things like this often, but if I had Wernicke’s, I would choose Wernicke’s of this type. Then I would want my wife to blow out my brains while I was sleeping.

What is the consequence to society when words, images and gestures don’t functionally matter anymore as if citizens have suffered a global and profound Wernicke’s affliction?  How do we resolve conflict essential to growth and progress if the language of others cannot be understood or learned? These and other questions I consider as I fly 600 mph due east from America’s disastrous political state to a country with similar disastrous state, though one might argue that Indonesia never made promises. What gives with the current Administration and the enabling Republican Congress?  Why does the daily news now manifest like a stream of he said she said?  Why does it seem like America’s once prized diversity fabric has given way to crude tribalism at best, overt racism at worst?

I recall it all started out like a snack of six chocolate glazed donuts and 3 cups of whole milk each night before sleep for a year. Kellyanne Conway, Senior Advisor to President Trump on January 22, 2017 rationalized that “alternative facts” explained the mainstream media’s low-ball attendance estimates of the Presidential inauguration.  When shown side-by-side aerial comparison photographs of the Trump and Obama inauguration crowd, she continued un-phased, how did we know that the Obama photographs were real?  In fact, alternative fact photographs she had reviewed prior to taping suggested otherwise she said.  Within this entirely fascinating shoot-me-if-this-is-real 10-minute interview, it was as if Conway had suddenly manifested into an anti-hero from the orange planet Trumpet, causing on the American people with the wriggle of lips and continuous pump of diaphragm a targeted left-sided brain infarct.  Suddenly, a businessman who had not spent a single period of his life in service of others became the nation’s penultimate protector; immigrants who built the country’s infrastructure and cultivated its daily food supply became terrorists, or worse, free-loaders; a tax break for the rich became like honey-gold sweet tasting piss for the poor; efforts to implement the beginnings of universal health insurance meant doctor access restrictions to those whose care was never good

Ordinary people subsequently began using the term “alternative facts” to avoid that which they didn’t want to believe. It felt like power but it was like the slave calling herself nigger, the gay man referring to himself as queer, having 3,000 Facebook friends who like everything you do, flight attendants handing you a cold wet-wipe as if hot towel, coal miners fighting for jobs that they forgot gave them black lung, denying a dollar to a homeless man to teach him a lesson when ten hours before you lost $1000 playing craps. The cumulative effect hurt because the base supposition was mean: No matter how the issue was framed, the victim remained the victim, the real joke was on the ordinary, and the real jokester out of the picture, safe behind the gates of the West Wing.

18 months into the Trump administration, the situation has only worsened. A Kindergartener could reliably predict the minute-by-minute landing pocket on the nation's insane-in-the-brain roulette wheel. Let’s call it pocket 666 which is the color green. Green pocket 666 contains absurdities across national security, environmental, healthcare, and socioeconomic realms, but let’s just take this one:  School killings. Since Sandy Hook in 2012, more school children in U.S. schools have been shot and killed than soldiers engaged in combat since 9/11 (2001). The most recent largest school shootings at Marjory Stoneman Douglas High School in Parkland, Florida killed 17 and at Sante Fe High School near Houston, Texas killed 10. The killings produced two Wernicke type responses: Bellicose heart-felt rhetoric about gun control from the President but no federal action on fire-arm restriction including on bump stocks used in the October 1, 2017 Vegas Mandalay Casino massacre of 58 concert-goers to increase the rate of semi-automatic gun fire from 40 shots per minute to 600. In fact, shortly after commiserating with grief-stricken teens in the Whitehouse, Trump proceeded to the May 5th, 2018 NRA convention stating, "Your Second Amendment rights are under siege, but they will never, ever be under siege as long as I'm your President."

The other response came from the Paul Ryan-Mitch-McConnell Republican Party. It reframed the problem as not a matter of guns or gun accessories but on the degrading social fabric that allows for irrational behavior. In other words, it was the Democrats’ fault! Texas Lieutenant Governor Dan Patrick went right to the talking points describing his state’s particularly bad year:  "We had 50 million abortions. We have families that are broken apart, no fathers at home…We threw God (school prayer) out of school…We have incredible heinous violence as a [video] game, two hours a day in front of their eyes. And we stand here and we wonder why this happens to certain students."

Seeing, hearing and reading one thing and letting whatever wants to come out of the mouth is classic Wernicke’s!  So to is seeing, hearing and reading and not comprehending reality on real people’s lives, particularly when you’re supposed to represent them. Sometimes I think the only tough-love solution to the President’s and Republican Party’s stance is to shoot up their families’ schools.  That would give their Wernickes' a badly needed adrenaline jolt. Or for someone to take a semi-automatic with bump stock directly to the marbleized bowels of Congress. Maybe one only says guns don’t kill people when it’s not your people.  This horrible hypothetical by the way further supports the dire need for gun control.  The last physical fight I got into was in 2nd grade and still the prospect of gun ownership makes me this mad.

As a physician, I understand the risk of attributing national paralysis on guns and other vital issues to brain damage. I could be wrong. Also, such a diagnosis essentially absolves Americans of responsibility to that which there is no treatment—the equivalent of throwing an elderly person 15-years before death into a Medicaid-paid-for nursing home. Out of mind does not mean not there. We must all actively seek out solution to what amounts to a collective crisis in process and faith. Here goes my checklist in this regard for the short and long term:

1)  Bad faith is an anthropological term coined by Jean Paul Sartre (1956) to describe the ways in which individuals knowingly deceive themselves in order to avoid acknowledging realities, including their interests in the status quo, that are disturbing to them. Call the people you love on it.  Call yourself on it. Call elected officials on it. Does the Lieutenant Governor of Texas really believe that guns are not a primary contributor to the efficient sporadic eradication of particular parts of his constituency?  As disturbing as this sounds, give a crazy person a spoon or fork and report is s/he is more likely to use said implement on homicide or a meal, especially if given food to eat. Or just look at any other country in the world that restricts access to guns and its commensurate all-age low-level homicide rate.  While Lt. Governor Patrick has heard of research, he feels NRA monies like a fine cream he puts on his skin. Lt. Governor Patrick’s bad faith blinds him to the most basic gun-realities. So he must go. Not necessarily to hell. But he must go.

2)   We Americans needs more opportunities and more excuses to be together in ordinary contexts:  Concerts in the park, student exchanges, food fairs, communal yoga events, school open-houses. Just a few minutes with those we are trained to be scared of will prove that the only frightening thing is the who, what and why of fear creation in the first place. My first job out of university was as a junior school high teacher in urban Oakland. The student population at my school was 95% black and I was at first uncomfortable at how I would be received as a Taiwanese American man who grew up in Salt Lake City, Utah with little exposure to other minorities. Suffice to say by my second week on the job, I became Mr. Wang and my students, students. That experience forever left me in debt and comfortable with the African American community. To illustrate the transformation, one of the best compliments I’ve ever received was when as a doctor a teen patient of mine out of the blue one visit said, “Dr. Wang, you sure you are not black? You really seem black.” I would fight for the black community as hard as the Asian community based on the intimacy of these type of interactions.

3)   We Americans need to learn to literally speak a non-English language then go to the country that speaks that language to practice it.  We cannot simply speak English louder as a primary mode of translation or say we took three years of Spanish in high school and not even be able to order beans and rice at the local taqueria.  Learning a different language humbles you as you feel the weight of simple things like asking where is the bathroom or where to buy something to eat against a majority, which frequently forgets how to hear. If Trump in his rich existence had ever had a summer building fences for poor farmers in Guatemala or earned $5 an hour crouched with farm workers picking strawberries in rural Washington state, what different President would he be.  What policies would he alternatively espouse? Being a minority is great. Minorities say this because it’s both true and something they can’t change.  But one general blessing of minority status short or long term is that you are much less likely to proclaim idiotic things that you not to be true from personal experience physically, emotionally and viscerally.

4)   Public health as opposed to medical care is devoted to the well being of entire populations using laws and regulations as the primary modality of treatment. In public health you don’t wait for disease to strike, you anticipate it. You don’t get to treat gun injury because there are no guns in the first place or you can’t get buy bullets to kill people for your gun because they are too expensive to waste. I often think about public health when considering the time it takes to be a sane citizen of this contemporary world. Uncovering truth amidst so many stories, so many languages, and so many different people takes time and time especially to the working adult, parent and studying child is rare. But consider this: Adults and their children are watching an average of five hours and four minutes a day of television programming.  In addition, they spend an average of 135 minutes a day on social media such as FB, Snapchat, Instagram and Twitter. This means that Americans spend a total of 7 hours and 39 minutes a day on their smart-phone, tablet or computer screen doing what most would agree is entertaining but not constructive on the mind or back. I confess being a semi-automatic and automatic gun ban advocate. But I am more an advocate of taking back a significant enough portion of the 7 hours and 39 minutes lost daily for serious study, thinking, conversation and action without which no difference from the present can be made.

Strokes are irreversible. The therapeutic trajectory is one of maintenance versus progress. In this regard, the clinical picture is inconsistent with a Kellyanne Conway left parietal/temporal lobe type injury. Despite my distaste for Ms. Conway, she doesn't possess this kind of power. Given the pathophysiology of the brain, the insult is more logically occurring in an entirely different part of the brain: The frontal lobe. This is the lobe that fills the forehead, where humans have the ability to intellectualize and feel– the human head-heart. The density of neurons in the frontal lobe’s outer layers is ironically what differentiates humans from whales, hyenas, even chimpanzees and the species homo sapiens. The whale brain is six times larger than the human brain but has only 2/3 as many neurons as the human neocortex. I say ironic because the last time I checked, whales don’t clear cut forests and chimpanzees don’t build nuclear weapons. So density of neurons in the forebrain doesn't guarantee good moral standing or anything, or from a pigs perspective, at all.

Yet, the human frontal lobe with neocortex just as its means susceptibility to manipulation and deceit means the ability to change and adapt. So while many people are hurt, the resultant somato-paralysis and ineffectual reactions are self-inflicted. We Homo sapiens are a powerful bunch. We weaned from Rome. Fought Hitler. Triumphed over Stalin.  Debunked McCarthyism and the fiction of the Vietnam War. Were those less scourges on history than our current pres(id)ent? I think not. I know not. So toppled forests, dirty energy, depersonalized health care, and two-for-the-price of one aircraft carriers watch out. Gun owners save yourself the waste of having to turn in your caches and start carving your bows and arrows now. We Americans are slowed but not stopped.  We are vulnerable but not vanquished. Our brains are soft as butter but happen to be protected by a hard skull. It is imperative that we start using them to break through this made-for-reality-comedy/tragedy someone else wants us to be living.