The New York Times today traces the challenges faced by an occupational therapist, Jodi Levin, who works with brain-injured patients at the Kessler Institute for Rehabilitation in New Jersey (in the picture on the right, Jodi is working with a traumatically-brain injured young man). In tracing the story, readers find themselves confronting the realities of brain injury, its often young victims, and the pressure that insurance companies exert by limiting the amount of treatment they will authorize.

Over the last couple of weeks, I've finished reading two books about the experience of brain injury and this article reminded me of many issues raised in those personal memoirs. The first book, Where Is The Mango Princess? (Crimmins, 2000) offers a harrowing portrait of the realities of brain injury in the lives of a middle-aged husband and father, Alan, his wife, Cathy (the author), and their child, Kelly. Cathy's rage against the horrors of the insurance industry and the regular but heartless denial of benefits to its policy holders could hardly be better described. More subtle and personal is the 1998 autobiographical narrative of Dr. Claudia Osborn, called Over My Head: A Doctor's Own Story of Head Injury from the Inside Looking Out. Osborn is a medical internist, originally practicing in an inner-city hospital in Detroit, Michigan whose brain injury brought her to New York City's NYU-Rusk Institute of Rehabilitation Medicine and its famous Head Trauma Program (HTP) directed by Dr. Yehuda Ben-Yishay. From the first-person perspective that Osborn adopts, she weaves a powerful tapestry of the multiple and elusive problems, particularly inattention & adynamia, that TBI survivors like herself must confront and cope with. I'd be remiss if I didn't also mention a book I read in a pre-publication version about six years ago. The volume, Rescuing Jeffrey: A Memoir, was written by Richard Galli, the father of the 17-year-old boy who dove into a pool and hit his head. The effect was a disabling spinal cord injury and a perilous journey through medical and rehabilitation crises for both Jeffrey and his family. It is essential, I think, to come to grips with the experiences portrayed in books and articles like these if we wish to understand how different life becomes after injury to the central nervous system.

Target Link: Hoffman, J. (2008, January 15). Coaching the comeback. New York Times. Downloaded January 15, 2008 from the New York Times website.

References

• Crimmins, Cathy. (2000). Where is the mango princess? New York: Knopf. ISBN: 0375404910 (hardcover) 0375704426 (pbk)
• Galli, Richard. (2000). Rescuing Jeffrey: A memoir. New York: St. Martin's Griffin. ISBN: 1565122704 (hardcover) 0312283407 (pbk)
• Osborn, Claudia L. (1998). Over my head: A doctor's own story of head injury from the inside looking out. Kansas City, MO: Andrews McMeel Publishing. ISBN: 0836254198 (hardcover) 0740705989 (pbk)
• Dr. Claudia Osborn's Personal Website

The New York Times has a thought-provoking article today by Benedict Carey on the role of denial in the daily social lives of ordinary people. So much more than the relatively primitive defense mechanism described by Freud and his adherents, denial appears to be central to the ways in which our social lives are rendered tolerable. The crucial summary in Carey's article notes

Yet recent studies from fields as diverse as psychology and anthropology suggest that the ability to look the other way, while potentially destructive, is also critically important to forming and nourishing close relationships. The psychological tricks that people use to ignore a festering problem in their own households are the same ones that they need to live with everyday human dishonesty and betrayal, their own and others’. And it is these highly evolved abilities, research suggests, that provide the foundation for that most disarming of all human invitations, forgiveness. In this emerging view, social scientists see denial on a broader spectrum — from benign inattention to passive acknowledgment to full-blown, willful blindness — on the part of couples, social groups and organizations, as well as individuals. Seeing denial in this way, some scientists argue, helps clarify when it is wise to manage a difficult person or personal situation, and when it threatens to become a kind of infectious silent trance that can make hypocrites of otherwise forthright people.

I could not help but be struck by the way in which this article suggests in preliminary fashion an understanding of how scandals may arise among those in positions of authority or by those who "should have known better." I am thinking both about what goes on in the political world as well as the religious one as well. The doleful news that the Jesuits in the Oregon Province have just agreed to a $50 million settlement for the abuse that went on in the Alaskan mission during the past forty or so years is haunting. The painful reality that the victims experienced seems so obvious now that a final explanation of malice and sheer injustice by Jesuit superiors seems almost inescapable. But, if the work cited by Carey here among social psychologists is accurate, then a more nuanced understanding may eventually begin to emerge to explain the failure of the Church and its superiors in this horrendous scandal. Toward the end of his report, Carey summarizes: "In short, social mores often work to shrink the space in which a conspiracy of silence can be broken: not at work, not out here in public, not around the dinner table, not here. It takes an outside crisis to break the denial, and no one needs a psychological study to know how that ends." This seems like something that we'll need to think about very hard in the years ahead.

Reference

Carey, B. (2007, November 20). Denial makes the world go round (Electronic version). New York Times. Retrieved from http://www.nytimes.com/2007/11/20/health/research/20deni.html?ex=1353301200&en=d185b9c072a51a1f&ei=5124&partner=permalink&exprod=permalink

The November, 2007 issue of the Monitor on Psychology, the monthly magazine sent to all members of the American Psychological Association, has a set of articles exploring various ways in which the Internet is influencing the development of children. The articles include

• "It's Fun, but Does It Make You Smarter?" (Internet use and academic performance)
• "Socially Wired" (Instant messaging & email; friendships; how much is too much?)
• "Web Pornography's Effects on Children" (Development of unhealthy attitudes toward sex)
• "Creating a Place for MySpace" (Advice for parents)

This has not been a great year for the pioneers in animal-human communications. In the late summer, Alex the Parrot died at Brandeis University. And, now comes word that Washoe, the chimpanzee who learned 250 words of American Sign Language, has died at the age of 42 in the state of Washington. Back in the mid- and late-1960s, Washoe's adoptive caretakers, R. Allen and Beatrix T. Gardner, began to teach the young chimp to use American Sign Language. Their efforts were a way of circumventing the inability of primates other than humans to vocalize sounds across a broad range of frequencies. Roger and Debbie Fouts took over the early work of the Gardners with Washoe at their research center at Central Washington University.

In the four decades since Washoe's adoption, researchers from a variety of universities and perspectives have worked to establish the parameters of animal (particularly primate) language abilities and the potential for animal-human communications. As Dr. Rosalyn King has summarized on her website, these efforts extend beyond Washoe and the team at Central Washington University to include important projects such as Sue Savage-Rumbaugh with Kanzi, Duane Rumbaugh (Georgia State University) and the Language Research Center, Matsuzawa Teturo and the chimp, Ai (Primate Research Institute, Kyoto University, Japan) and several others.

The success of these efforts has been highly disputed by such linguistic and psychological scholars as Noam Chomsky and Steven Pinker. Neither of them believe that these primates have actually learned an actual language rather than a sophisticated series of behaviors which receive reinforcement such as feeding. Some researchers have concluded that primates fail to use sign language spontaneously, an observation which undermines the notion of real language learning. Nevertheless, those who have worked with animals such as Washoe argue that their charges learn language at the level similar to the abilities of a 2 1/2 year old human child. Obviously the debate will continue. For now, though, one of the founding figures of these conversations will no longer take part in them

Resources

Alex the Parrot

• NPR Alex the Parrot, an Apt Student, Passes Away (Sept. 10, 2007)
• The Alex Foundation
• Alex (parrot) [Wikipedia]
• The Alex Foundation
• New York Times: Notebook - Alex the Parrot (Verlyn Klinkenborg, Sept. 12, 2007)
• New York Times: Alex, a Parrot Who Had a Way With Words, Dies (Benedict Carey, Sept. 10, 2007)

Washoe

• Washoe (chimpanzee) [Wikipedia]
• Great Ape Language [Wikipedia]
• Chimpanzee-Human Communications Institute (CHCI, Central Washington University)
• Friends of Washoe @ CHCI
• New York Times: Washoe, A Chimp of Many Words, Dies at 42 (Benedict Carey)

The entire Science section of the New York Times today (Oct. 23, 2007) was devoted to the science of sleep. The articles included a whole range of topics and are listed for review here:

• An Active, Purposeful Machine That Comes Out at Night to Play (Benedict Carey) The lead article reviews the science of sleep and the history of research efforts to find out what sleep is all about.
• In Study of Human Patterns, Scientists Look to Bird Brains (Carl Zimmer)
• In the Dreamscape of Nightmares, Clues to Why We Dream at All (Natalie Angier)
• The Elderly Always Sleep Worse, and Other Myths of Aging (Gina Kolata)
• Sleep Drugs Found Only Mildly Effective, but Wildly Popular (Stephanie Saul)
• At Every Age, Feeling the Effects of Too Little Sleep (Jane E. Brody)
• Shh...My Child Is Sleeping (in My Bed, Um, With Me) (Tara Parker-Pope)
• From Faithful Dogs and Difficult Fish, Insight Into Narcolepsy (Ingfei Chen)
• Eyes Wide Shut: Thoughts on Sleep

When I was first went into the Jesuits over 40 years ago, I lived at the novitiate in Poughkeepsie, NY. Part of our routine as novices was teaching "catechism" to elementary school-aged children in different venues every week. One of the two places I was assigned to teach at was the Hillcrest School for Children at the Hudson River State Hospital, located only about a half-mile down the road from the Jesuit facility. Actually, the Hillcrest School was set in the very back of the property, well away from the main entrance on Route 9 and we had to take a car back and forth for our weekly visits on Saturday afternoons. I suspect that the main reason for our going there, from the point of view of the hospital, was to give the young kids (they were aged about 6 to 14 years old) someone to talk to. My catechism students, as I recall, included two young brothers who had thrown their youngest baby brother out the window and an 8- or 9-year-old boy who heard voices all the time. My most vivid memory of Hillcrest itself was the temperature inside the building. It always seemed to be somewhere between 80 and 85 degrees in all seasons of the year. I was told that the reason for this was to keep the young patients perpetually fatigued and lethargic. Whether that was true, most of the other novices and me attempted as much as possible to go outside with our young charges onto the grounds of the hospital, both to run around the somewhat hilly area nearby, play a few games like catch, and escape the oppressive heat of their institutional home. I further recall a concerted attempt by at least some of the kids in season to search out and pick rhubarb that grew along the grassy knolls near Hillcrest.

Driving onto the property of the Hudson River State Hospital took visitors into a very different world than the one outside the hospital's stone walls. In the mid-1960s, the patient population living on the grounds of the facility could be numbered in the thousands (at its height, the hospital lodged about 9,000 patients in a mostly self-sustained and enclosed "total institution" as Erving Goffman would have termed it). As our car wound its way past the older buildings on the campus (the picture to the upper left is a drawing of the original "Kirkbride" building at HRSH), we would see many groups of patients being led from one place to another by staff members while, in other spots, patients were sitting in chairs or on benches simply staring out at whatever could be found nearby. It was, I recall, a very quiet environment and few of the mostly older and dilapidated-looking residents seem to speak at all to anyone nearby. Nonetheless, the grounds went on and on and occupied many tree-filled acres.

Psychologist Michael Britt, Ph.D. offers a glimpse into the Hudson River State Hospital (HRSH, later renamed the Mid-Hudson Psychiatric Center), in a recently-posted podcast interview on his website, The Psych Files. Dr. Roger Christenfeld, Research Director at a drastically-smaller current facility, discusses the history and therapeutic work of the HRSH in his interview with Britt. During 33 minutes, Christenfeld provides a glimpse of why the hospital was built and opened in 1869, what life was like for many patients in the late 19th and early 20th centuries, and how the notion of a state psychiatric facility changed profoundly after about 1955.

Target Link: Episode 27: From Insane Asylum to Psychiatric Center: A Brief History (33 minutes, the interview is in mp3 format and can be downloaded to your computer)

Associated Resources

• Historic 51: A website devoted to the history of the Hudson River State Hospital. Includes many images and other information (e.g., a timeline) telling the story of the HRSH
• Kirkbride Buildings: This website has photos of the "Kirkbride" style building at HRSH, a standard form for psychiatric asylum buildings in the 19th century. As the introduction to this site explains: "Once state-of-the-art mental healthcare facilities, Kirkbride buildings have long been relics of an obsolete therapeutic method known as Moral Treatment. These massive structures were conceived as ideal sanctuaries for the mentally ill in the latter half of the nineteenth century. Careful attention was given to every detail of their design in order to promote a healthy environment and to convey a sense of respectable decorum. Placed in secluded areas within expansive grounds, many seemed almost palace-like from the outside. But growing populations and insufficient funding led to unfortunate conditions that spoiled their idealistic promise."