email page print pageAll Topic Reviews
"Are You There Alone?""How Come Boys Get to Keep Their Noses?""My Madness Saved Me"10% Happier365 Days49 Up56 UpA Beautiful MindA Beautiful MindA Beautiful MindA Book of ReasonsA Can of MadnessA Child's Life and Other StoriesA Dangerous LiaisonA Fight to BeA First-Rate MadnessA Good Enough DaughterA Heartbreaking Work of Staggering GeniusA Lethal InheritanceA Lethal InheritanceA Life ShakenA Life Worth LivingA Little PregnantA Message from JakieA Million Little PiecesA Numerate LifeA Pocket History of Sex in the Twentieth CenturyA Slant of SunA Special EducationA Tribe ApartAbout FaceAddicted Like MeADHD & MeAEIOUAgainst Medical AdviceAgents in My BrainAileen - Life and Death of a Serial KillerAlgernon, Charlie and IAll Out!All Seasons PassAlphavilleAlways Too Much And Never EnoughAlzheimer'sAn Anthropologist on MarsAn EducationAn Unquiet MindAngela's AshesAngelheadAnna Freud: A BiographyAnnie's GhostsAnother Bullshit Night in Suck CityAnthology of a Crazy LadyApples and OrangesApproaching NeverlandAre You There, Vodka? It's Me, ChelseaAs I Live and BreatheAs Nature Made HimAt Home in the Heart of AppalachiaAt the End of WordsAvalancheBad BoyBad GirlBeautiful BodiesBeautiful BoyBeautiful WreckBecause We Are BadBecoming AnnaBecoming MyselfBen Behind His VoicesBequest and BetrayalBereftBertrand RussellBlackoutBlanketsBloodlettingBodies in Motion and at RestBoneBorn on a Blue DayBoyBoy AloneBoyleBrain on FireBreaking ApartBreaking the SilenceBrokenBulimics on BulimiaBuzzCamus and SartreCharles DarwinChasing the HighCheeverCherryCity of OneCluesClumsyComfortComplications Compulsive ActsConfessions of a Cereal EaterConfessions of a Former ChildConfessions of a Grieving ChristianConfessions of the Other MotherConfidingConquering the Beast WithinContesting ChildhoodCrackedCrazyCry Depression, Celebrate RecoveryDamned to EternityDancing at the Shame PromDante's CureDaughter of the Queen of ShebaDavid Sedaris Live at Carnegie HallDays With My FatherDefeating the VoicesDementia Caregivers Share Their StoriesDepression and NarrativeDescartesDetourDevil in the DetailsDiagnosis: SchizophreniaDirty DetailsDirty SecretDivided MindsDivine MadnessDon't Get Too ComfortableDown Came the RainDress Your Family in Corduroy and DenimDrinkingDriving My FatherDrunkardDryEarly Embraces IIIEarly ExposuresEinsteinEinstein and OppenheimerElectroboyElegy for IrisElijah's CupElliott Smith and the Big NothingElsewhereEnough About YouEpilepticEvery Girl Tells a StoryEverything In Its PlaceExamined LivesExiting NirvanaFaces of Huntington'sFamily BoundFast GirlFearless ConfessionsFind MeFinding Iris ChangFirst Person Accounts of Mental Illness and RecoveryFirst Person PluralFixing My GazeFlanneryFolie a DeuxFor the Love of ItFortress of My YouthFrank Ramsey (1903-1930)Franz KafkaFraudFree RefillsFreudFreudFreudFriedrich NietzscheFrom Joy Division to New OrderFumblingFun HomeFuriously HappyGalileo Get Me Out of HereGetting OffGirl in Need of a TourniquetGirl Walking BackwardsGirl, InterruptedGirl, InterruptedGirls on the VergeGoing BlindGoing Through Hell Without Help From AboveGraysonGrowing Up JungGuttedHalf a Brain Is EnoughHardcore from the HeartHead CasesHeal & ForgiveHeal & Forgive IIHeavier than HeavenHeinz KohutHeinz KohutHello from Heaven!Hello to All ThatHer HusbandHer Last DeathHigh PriceHole in My LifeHolidays On IceHolidays on IceHope's BoyHouse of Happy EndingsHouse of Happy EndingsHow I Stayed Alive When My Brain Was Trying to Kill MeHow to Lose Friends & Alienate PeopleHow to Make Love Like a Porn Starhow to stop timeHumeHunger Makes Me a Modern GirlHurry Down SunshineI Am Dynamite!I Am I Am I AmI Feel Bad About My NeckI Never Promised You a Rose GardenI Remain in DarknessI'd Rather Eat ChocolateI'd Rather LaughIf I Die Before I WakeImagining RobertIn Search of FatimaIn the Realms of the UnrealIn the Wake of SuicideInside TherapyInternInvisible No MoreIt Happened to NancyIt Takes a Worried ManJack Cole and Plastic ManJean-Paul SartreJohn Stuart MillJourneys with the Black DogJust CheckingKafkaKantLa SierraLab GirlLast Flight OutLearning to FallLet Me Make It GoodLife As We Know ItLife InterruptedLife ReimaginedLimboLincoln's MelancholyListening in the Silence, Seeing in the DarkLittle PeopleLive For Your Listening PleasureLive Through ThisLiving in the Shadow of the Freud FamilyLiving With SchizophreniaLiving with SchizophreniaLockeLonelyLong ShotLook Me in the EyeLooking for The StrangerLoose GirlLosing Mum and PupLosing My MindLove Is a Mix TapeLove SickLove Times ThreeLove Works Like ThisLove You, Mean ItLuckyLudwig WittgensteinLyingMad HouseMad PrideMadame ProustMadnessMagical ThinkingMalignant SadnessManicMarcel ProustMarcus AureliusMary BarnesMaverick MindMaybe You Should Talk to SomeoneMe Talk Pretty One DayMeaningMelanie KleinMemoirMemoirs of an Addicted BrainMemoirs of My Nervous IllnessMen-ipulationMisconceptionsMiss American PieMockingbird YearsMomma and the Meaning of LifeMommies Who DrinkMonkey MindMore, Now, AgainMortificationMy Age of AnxietyMy Body PoliticMy Brain Tumour AdventuresMy DepressionMy Father's HeartMy First Cousin Once RemovedMy Flesh and BloodMy Horizontal LifeMy Life Among the Serial KillersMy Sister LifeMy Stroke of InsightName All the AnimalsNeural MisfireNever EnoughNietzscheNietzsche: The Man and His PhilosophyNinety DaysNo Apparent DistressNo Hurry to Get HomeNo Impact ManNo More ShavesNo One Cares About Crazy PeopleNolaNotebooks 1951-1959NothingOdd Girl Speaks OutOedipus WreckedOf Spirits & MadnessOn Being RapedOn the Edge of DarknessOn the MoveOne Hour in ParisOne Hundred DaysOphelia SpeaksPagan TimePassing for NormalPeople Who Eat DarknessPerfect ChaosPerfect ExamplePermanent Present TensePersepolisPlanet of the BlindPlaying with FirePlease Don't Kill the FreshmanPoisoned LovePollockPOPismPortraits of Huntington'sPoster ChildProzac DiaryPsychiatrist on the RoadPsychosis in the FamilyPuppy Chow Is Better Than ProzacQuitting the Nairobi TrioRaising BlazeReasons to Stay AliveRebuiltRecovered, Not CuredRelative StrangerRescuing JeffreyRestricted AccessRevengeRewind, Replay, RepeatRichard RortyRiding the Bus With My SisterRobert Lowell, Setting the River on FireRoom For JRosemaryRough MagicRunning After AntelopeRunning with ScissorsRXScattershotSchizophreniaSchopenhauerSecond OpinionsSectionedSeeing EzraSeeing the CrabServing the ServantSet the Boy FreeSex & Single GirlsSex ObjectShakespeareShe Bets Her LifeShe Got Up Off the CouchShut the DoorSickenedSilencing the VoicesSimone de BeauvoirSinging in the FireSkin GameSlackjawSlut!SmashedSome Assembly RequiredSome Kind of GeniusSometimes Amazing Things HappenSometimes Madness Is WisdomSongs from the Black ChairSongs of the Gorilla NationSoren KierkegaardSpeak to MeSpeaking Our Minds: Revised EditionSpecial SiblingsSpentStandbyStick FigureStill LivesStretchSunset StorySurviving OpheliaSwing LowTales from Both Sides of the BrainTales of PsychotherapyTalk to HerTell Me Everything You Don't RememberTellingTelling Tales About DementiaThe Accidental BillionairesThe AddictThe Anatomy of HopeThe Anti-Romantic ChildThe Art of MisdiagnosisThe Bastard on the Couch CDThe BeastThe Bell JarThe Best Seat in the HouseThe Big FixThe Body SilentThe Boy on the Green BicycleThe Boy Who Loved Too MuchThe Boy Who Loved WindowsThe Bright HourThe Buddha & The BorderlineThe Burn JournalsThe Camera My Mother Gave MeThe Cancer Monologue ProjectThe Center Cannot HoldThe Chelsea WhistleThe Churkendoose AnthologyThe Day the Voices StoppedThe Devil WithinThe DisappearanceThe Discomfort ZoneThe Doctor Is InThe Eden ExpressThe Family GeneThe Family SilverThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fasting GirlThe First Man-Made ManThe First TimeThe Geography of BlissThe Glass CastleThe Good DoctorsThe Hillside Diary and Other WritingsThe Incantations of Daniel JohnstonThe Infidel and the ProfessorThe Last AsylumThe Last Good FreudianThe Last Time I Wore a DressThe Liars' ClubThe Lives and Loves of Daisy and Violet HiltonThe Lives They Left BehindThe LobotomistThe Long GoodbyeThe Looked After Kid: Memoirs from a Children's HomeThe Loony-Bin TripThe Madness of Our LivesThe Making of a PhilosopherThe Making of Friedrich NietzscheThe Man Who Couldn't EatThe Man Who Shocked the WorldThe Man Who Tasted ShapesThe Marvelous Hairy GirlsThe Maximum Security Book ClubThe Me in the MirrorThe Memory PalaceThe Mercy PapersThe Mistress's DaughterThe Mother of Black HollywoodThe Naked Bird WatcherThe Naked Lady Who Stood on Her HeadThe Neuroscientist Who Lost Her MindThe Night of the GunThe Noonday DemonThe Notebook GirlsThe NursesThe Only Girl in the CarThe Only Girl in the WorldThe Orchid ThiefThe Other HollywoodThe OutsiderThe Philosopher's Autobiography The Philosophical Breakfast ClubThe Philosophical IThe Pits and the PendulumThe Pornographer's GriefThe Private Memoirs and Confessions of a Justified Sinner The Professor and the MadmanThe Psychopath TestThe Quiet RoomThe RecoveringThe Red DevilThe Rescue of Belle and SundanceThe Ride TogetherThe Rules of the TunnelThe Secret of LifeThe Shaking Woman or A History of My NervesThe Shared HeartThe Shiniest JewelThe Siren's DanceThe Statistical Life of MeThe Story of My FatherThe Strange Case of Hellish NellThe Summer of a DormouseThe SurrenderThe Talking CureThe Thought that CountsThe Three of UsThe Undoing ProjectThe Vagina MonologuesThe Velveteen FatherThe Winter of Our DisconnectThe Woman Who Walked into the SeaThe Years of Silence are PastThe Yellow HouseThe Yipping TigerThick As ThievesThinThis Close to HappyThomas S. SzaszTiger, TigerTits, Ass, and Real EstateTo Redeem One Person Is to Redeem the WorldTo Walk on EggshellsTransforming MadnessTrue CompassTruth & BeautyTruth Comes in BlowsTuesdays with MorrieTweakTwitch and ShoutUltimate JudgementUndercurrentsUnholy GhostUnlikelyVoices of AlcoholismVoices Of Alzheimer'sVoices of CaregivingVoices of RecoveryVoluntary MadnessWaiting for DaisyWar FareWashing My Life AwayWastedWaveWe're Going to Need More WineWe're Not MonstersWeather Reports from the Autism FrontWeekends at BellevueWhat Did I Do Last Night?What Goes UpWhat I Learned in Medical SchoolWhat's Normal?When a Crocodile Eats the SunWhen Breath Becomes AirWhen Do I Get My Shoelaces Back?.....When It Gets DarkWhen the Piano StopsWhen You Are Engulfed in FlamesWhere Did It All Go Right?Where is the Mango Princess?Where the Roots Reach for WaterWhile the City SleptWhile They SleptWho Was Jacques Derrida?Why I Left, Why I StayedWhy I'm Like ThisWildWill's ChoiceWinnicottWinnieWish I Could Be ThereWith Their EyesWomen Living with Self-InjuryWomen, Body, IllnessWrestling with the AngelYou All Grow Up and Leave MeYou Must Be DreamingYour Voice in My HeadZeldaZor
Michael Paul Mason is a brain injury Case Manager in the United States, and his book Head Cases is a part-autobiographical account of the nature of his role in working with clients with brain injury, in trying to secure the right health care provision for them as part of their care and recovery. As a support worker at the London Brain Injury Centre in the UK, it is interesting for me to read about the state of care provision for people with brain injury in the United States, in comparison with the UK. The most obvious differences would be firstly in the general healthcare system, with the Medicare and Medicaid systems in the US compared to the NHS in the UK, and secondly in the role of private healthcare insurance on access to services, which would both clearly impact on the pressures afforded to somebody whose main role is to secure funding and health care provision for brain injury survivors.
These pressures are made apparent in the frustration described when funding is made unavailable, a fact which the author describes accurately and is very honest about. The fall-out of this is poor emergency treatment for brain injury ('Portrait of an Injury'), lack of access to adequate treatment ('The Hermit of Hollywood Boulevard') and patients getting shifted from psychiatric hospitals, day centers and other care settings, amongst other things. We get an insight into the life of a Case Manager, travelling around the United States and even as far as Iraq ('The Hospital in the Desert') as new cases emerge constantly, demanding immediate attention. The cases can be diverse as people with diffuse axonal injury ('The Prisoner of the Present'), epilepsy and seizure disorders ('The Hermit of Hollywood Boulevard'), someone unable to produce tears due to damage to the cranial nerve ('Rob Rabe Cannot Cry'), a high-achieving, young, female artist with volatile outbursts ('Portrait of an Injury'), violent and challenging behaviors ('Ultraviolent Bryan', 'The Only Thing that Works' and 'Wood of the Suicides'), amnesia ('Fugue of the Pony Soldier' and 'In all Earnestness') and Cotard's syndrome ('The Resurrection of Doug Bearden'). The etiology and diagnosis in each of these cases, is, however, only the beginning of the line for each person's story of their ongoing battle for healthcare and recovery from brain injury.
At times, it seem that figurative descriptions are given precedence over straightforward ones, for example, from reading 'The Resurrection of Doug Bearden', on a brain injury survivor who believes he is dead, it becomes apparent that the client might be suffering from Cotard's syndrome. This explanation, however, is only demoted to endnotes, whilst the main text is dedicated to a far more ruminative discussion on the Tibetan Book of the Dead. Whilst parallels could well be drawn in terms of descriptive experience between the two, I would have preferred the straightforward explanation of how the original cause (HSV-1, or herpes-simplex type 1, virus) led to symptoms of Cotard's delusion before leading in to the discussion on the Tibetan Book of the Dead. The only connection which is explained is that the HSV-1 virus can often implant itself into the cranium, leading to symptoms of cognitive distortions, impairments and hallucinations (p. 132), from which it must be inferred, from the endnotes, that in this case these symptoms must also include Cotard's syndrome. It may be, however, that the author is trying to avoid overly-technical language in the text by placing it in the endnotes, which, for those who are interested in finding out further, are worth reading.
Similarly with 'Fugue of the Pony Soldier', a great deal is devoted to describing the author's experience of the inipi, the Native American sweat lodge which is used as part of a purification ceremony. It is, at first, not entirely clear why the case manager is participating in this ceremony apart from the fact that the client has suggested it to him, and the reason for writing about it in depth is perhaps revealed much later when it is stated that "in his [the client's] words, the condition had 'taken him far from his inipi circle', meaning that his injury had pulled him away from his spiritual practice, and he hoped that soon he would be able to return" (p. 198). So my reading of this can only be that the author is somehow trying to engage with the meaning of this practice for the client through his own participation in the ceremony. The author makes an interesting comment about the problems of classification; this client in particular might be diagnosed with dissociative fugue, since his symptoms involved amnesia, dissociation and fugue, although this is normally a psychiatric classification given for psychologically-induced states (e.g. trauma) rather than neurological ones (in this case an amnesic state caused by head injury).
A dedicated reader might try to sift through the chapters in order to discern the name, age, nature of accident, type of injury and corresponding symptoms for each case. This is, however, quite a challenging task, as this information is more revealed to the reader through shifting time frames and perspectives, at varying points in the text. The merit of this approach is perhaps that it reflects the often more piecemeal and impressionistic way in which a person's difficulties are presented to healthcare workers. Often it is simply not possible to know the exact cause or etiology of a person's difficulties (why they feel and behave as they do), and workers therefore have to be considerably imaginative in dealing with the more obvious, pragmatic and everyday. This aspect of writing about brain injury, might, however, confound anyone looking for straightforward explanations.
On the philosophical aspects of the text, I feel that the author delves into two areas. Firstly, it might be expected that working in an area as complex as brain injury might naturally lead to thoughts of a philosophical nature, for example on the relationship between mind, brain and behavior, and on notions of personal identity (especially the endurance of personal identity throughout time). It might also be expected that, having to be confronted on a daily basis with the material and political barriers in this area, both client and case manager might equally become enormously frustrated with the general order of things, divine, political, natural or otherwise.
A couple of the author's central questions are "What are we other than our brains [mind-brain identity]? Is there a part of me that can't be changed by brain injury [personal identity]?" (p. 11). At times, even the author's faith seems to dwindle as he exclaims "I'd like to hear His excuse" on the notion of one patient confronting God about her injury (p. 64). This could, it might be thought, relate to questions about the problem of evil and suffering; even though brain injury can often lead some to be more open to religious experience and faith (which is discussed earlier on pages 14-16), it is important to avoid unnecessary romanticism over this point and seems difficult to justify the suffering of brain injury on theistic grounds. His faith in his own situation as Case Manager also seems to dwindle on page 203 as he seems to almost give up on the state of affairs. The author's faith, however, seems restored by page 278, when he experiences the birth of his own child, a story which he manages to neatly weave into the rest of the narrative. I see the author's philosophical enquiries as an attempt to resolve the two areas of difficulty mentioned above, the first (concerning mind-brain and personal identity) being more within the realm of metaphysics and the second (concerning spirituality and morality) being within the realm of moral philosophy, regarding notions of social justice, fairness and equality. There is, unfortunately, not enough room to go beyond the initial conception of these ideas in Head Cases, although I would be interested in any future work should the author explore these ideas more fully.
© 2008 Alice Gee
Alice Gee, Support Worker, Rehab UK London Brain Injury Centre, MSc Philosophy of Mental Disorder, BA (Hons) Philosophy and Psychology, [email protected]