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Light from Brain Damage
by James Morton

Jay Ingram is well known to Canadians from his weekly newspaper science columns, radio and television appearances, and popular science books. At least within the English-speaking community, he is one of Canada's leading popular science writers.
The importance of such writers is often underestimated. Much modern science is incomprehensible except to specialists, and our communal understanding of how the world works depends, to a very large degree, on what we are told by people like Ingram who translate (and inevitably simplify) current scientific findings. This role is not trivial and good popular science writers are regarded as important community assets, as they should be.
Good writing is often taken to reflect good thinking; this is true in any field, scientific or otherwise. A well-written paper is more likely to find acceptance. An otherwise implausible theory, especially if described in language understood by most people, may find acceptance and gain currency in the community, if put forth with a nice turn of phrase. Would Freudian thoughts permeate our society and form a basis of much of popular culture had Freud not been a brilliant popularizer and writer? The influence of people like Ingram goes far beyond his immediately obvious domain.
In his new book, The Burning House (the winner of the 1995 Canadian Science Writers Book Award), Ingram considers the brain and the concept of "self" arising therefrom. His book proceeds in a fashion familiar to readers of Oliver Sacks's books and articles. Remarkable, and usually brain-damaged, individuals are described so as to illustrate general concepts about perception, memory, dreams, and self-awareness.
Ingram follows most researchers in the field, who try to determine how a healthy brain works from an analysis of damaged brains. The trouble with this is that a damaged brain is not merely a simplified version of a fully functional one. A functional brain may well be more than the sum of its parts. While it is true that, for example, removing the hippocampus leads to profound memory problems, this does not necessarily mean that the hippocampus processes memory. A car without its transmission will not move, but that does not mean that the transmission propels the car.
That said, little if any research could be conducted into the functioning of the brain, without making some assumptions as to the relationship between damaged and normal brains. And Ingram is conscious of the limits of extrapolating from damaged to normal brains.
It is hard to find a general thesis in The Burning House, which is anecdotal in format. Some idea of the book can be gained from two passages, the first dealing with the profoundly counter-intuitive discovery that learning a skill is not necessarily related to memory creation. One would have assumed that learning a skill involved memorizing (albeit subconsciously) the steps needed to perform the skill. But this assumption is wrong.
In 1953, H. M., a young man suffering a tremendous disability from epilepsy underwent "frankly experimental" brain surgery to attempt to alleviate his condition. Virtually all of H. M.'s hippocampus was removed. The result was a profound memory disorder:
"We now know, largely because of H. M., that the hippocampus is responsible for laying down new memories. The removal of the bulk of both arms of his hippocampus left him amnesic: he has no new memories, except for the most fleeting and fragmentary since 1953. This man, now in his late sixties, knows nothing about the Gulf War, the Beatles, Watergate, or the end of the Cold War, though he reads newspapers and watches television regularly. He has no idea of how old he is, what year it is, what he had for breakfast, or what he was doing just before lunch."
This story brings to mind a similar episode in Oliver Sacks's book An Anthropologist on Mars. In his chapter "The Last Hippie", Sacks describes attending a Grateful Dead concert with an ardent fan, Greg, who in 1970 suffered a memory impairment like H. M.'s (through a brain tumour). Greg knew all the Grateful Dead songs recorded before 1970 but was totally unaware of any more recent music. At the concert he said, "I guess it's some new experimental stuff, something they never played before. Sounds futuristic.maybe it's the music of the future." For someone who has lost the power to remember yesterday, the present is the future and just as inaccessible as the future is to someone with normal memory.
Oddly, the loss of an ability to create new memory does not bar the acquisition of new skills:
"H. M. has learned other skills over the years and his ability to do so has made it clear that there are different kinds of memory. The memory for learning a skill is separate from the learning of new information, and in his case is unimpaired. It is the difference between remembering how to ride a bicycle and remembering the colour of your first bicycle."
Sacks also discusses the curious detail that Greg could learn new skills, and even new songs or jingles, without retaining any new "facts".
Another passage of The Burning House, from which the book gets its name, deals with the phenomenon of neglect. In such cases the patients (usually after suffering a stroke) neglect everything on (usually) their left. This is not conscious; rather, they are unaware of everything on the left. In effect, the left side of the world does not exist and, so far as they know, never did.
But that does not mean that the left side of the world has no impact: "The patient was a forty-nine-year-old woman who had a brain haemorrhage. The result was a classic case of neglect: when copying drawings, she left out the left side; when asked to read words, she'd either leave the left end off (`simile' became `mile'), or reinvent it (`facade' changed to `arcade'). In the crucial experiment she was shown two cards one above the other, each of which had on it a simple kindergarten-style picture of a house, with nothing more than a roof, a chimney, five windows, and a door. The two houses were exactly the same, drawn in black and white, except that the left side of one of them was enveloped in bright red flames. She was asked to describe the drawings: `A house,' she said. `Are the two houses the same or different?' `They are the same.' `Anything wrong with either card?' `No.'
"Then seventeen different times, first with the burning-house card above, then below the other card, she was asked the seemingly ridiculous question, `Which house would you prefer to live in?' Even she thought the whole exercise was silly, especially since to her the houses were identical, or so she said. But the results were far from silly-out of the seventeen trials, she chose the house without the flames fourteen times. Yet all this time she claimed to notice no difference whatsoever between the two houses. When Halligan and Marshall then showed her new cards depicting the same house but with flames enveloping the right side, she chose the intact house every time, finally commenting in exasperation, `I hope there's a point to all this.'
"There was a point. The most reasonable way to explain why someone would choose one house consistently over another-all the time maintaining they were identical-is to surmise that subconsciously she was aware that one of the houses was less desirable than the other. In concrete terms, her brain had noticed the flames, interpreted what they meant, and was guiding her decision-making. Yet she had no idea any such process was involved."
A striking anecdote, to be sure, and, perhaps one that illustrates everyday decision-making. Perhaps decisions made on a "gut-feeling" are motivated by a reasoned, but inaccessible, analysis? Perhaps the id is closer to the ego than ordinarily suspected? Such a thought is appealing but rests on the assumption that the neglect patient's damaged brain works the same way as a healthy one.
Ingram has a very pleasant style. The Burning House is easy to read and keeps the reader's interest from anecdote to anecdote. On occasion, Ingram carefully avoids giving an opinion on a controversial topic; his treatment of repressed memory is a clear example of this. He writes:
"There are at this point only a few generally agreed-upon truths. One case of sexual abuse of a child is too many, and the incidence of such abuse is much higher than anyone would have admitted ten years ago.... Generalizations simply can't be made, and each case must be considered on its own merits. But this is obviously a situation in which it is of much more than simple academic interest to clarify what happens when memories from the distant past are recalled."
It would have been interesting to see what his view on repressed memory is, although, to be fair, he does not purport to be in a position to decide whether repressed memory is a real phenomenon. His role in writing The Burning House is to popularize, and not declare, the current thinking on the brain. Finally, his Canadian references sometimes seem forced. While Canada boasts many leading brain specialists, not every phenomenon has a Canadian aspect, and Ingram sometimes reaches for one.
Canada is fortunate in having a vigorous school of popular science writers. Issues that cause great disruption in the United States, such as evolution and creation, are of little public concern here and this may be attributed, in large part, to the strong Canadian school of popular science. Certainly, our public institutions like the CBC have fostered this forte. Undoubtedly Ingram has received much exposure from the CBC. The emasculation of such institutions would have, among many other unfortunate consequences, the effect of limiting popular science and general scientific literacy in Canada. Established figures like Ingram could probably continue in books and newspapers, but the coming generation of popular science writers could never become established; the Canadian scientific voice would then not be heard.
All that said, for the present Ingram's position is secure and Canadian popular science strong. The Burning House provides a witty and informative introduction to the brain, and is a well-written and interesting review of current thinking.

James Morton is a lawyer practising with Steinberg Morton Frymer in Toronto. He teaches at Osgoode Hall Law School and serves on the York University senate.


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