What we have here is a failure to reduce…

In the Saturday April 9 WSJ Mind & Matter column Susan Pinker painted a brave and honest portrait of her altered sense of self since she sustained a post-concussive mild brain injury 18 months ago. Pinker’s description of her protracted recovery adds another piece to the accumulated evidence that we understand very little about mind/body. Trauma can result in life-altering changes in how we see ourselves in the world. One moment we are fine and going busily about the day and then suddenly the world goes blank and we wake up in an utterly different place. There is pain, disorientation, loss of some capacities – and if we are lucky – a recovery process including various forms of rehabilitation to regain strength, mobility, and the many functions making up daily life. But what happens when one of the parts of us sustaining damage is also the organ of learning, decision-making, emotion, and self?
How do we tease out the survivorship effects of a serious accident – feeling precarious, vulnerable, fragile while at the same time pondering why it was that you were singled out — why did the accident happen at all? Now add the aftermath of the brain injury itself: fatique, foggy-thinking, memory loss, attentional difficulties and other symptoms.

Neuroscience can describe the concussive damage in terms of white matter shearing, or edema, or other structural issues depending on the temporal-spatial scale used to make meadurements – but it can not yet truly explain how it is that those structural injuries manifest in the lingering alterations of our cognition and our behavior – nor can neuroscience fully explain how changes in cognition and behavior then alter neurological function.