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The Experience of Stroke

 Neural and Behavioral Sciences Senior Seminar

Bryn Mawr College, Spring 2010

The Experience of Stroke

While suffering a stroke in her left hemisphere, the neuroscientist Jill Bolte Taylor thought, "Wow, how many scientists have the opportunity to study their own brain function and mental deterioration from the inside out?" Ten years later, Dr. Taylor published a memoir that recounted her experiences both during the stroke itself and throughout her long recovery. Physically, stroke is the interruption of normal blood supply to the brain, but how is it manifested mentally? Although many brain functions are disrupted, others are intact and even enhanced. Knowing Dr. Taylor's story, how do we tailor treatment to this unique trauma? In the links below, you will find an excerpt from Dr. Taylor's memoir, along with articles discussing innovative stroke treatments and evaluating stroke victims’ quality of life.

Background readings:

Additional material:

Some relevant thoughts from last week:

In our discussion last night about PKMzeta, we definitely needed some more scientific information on this molecule ... necessary for long-term potentiation ... aversively conditioned associations ... lack of selectivity .... precise spatial memory requires PKMzeta but more global spatial information in a search strategy (tested using a water maze and an eight-arm radial maze) was not significantly impaired by PKMzeta ... We clearly are a long way from Eternal Sunshine of the Spotless Mind or the flash of light from Men In Black ... VGopinath

Memories are not just thoughts from the past but also the feeling, the recognition that you are remembering something. In this sense, memories are as much of a sensation as they are thoughts ... Bo-Rin Kim

There are so many types of memory ...  Are all of these types of memories created in the same way, with the same molecules?  Are they all organized along the same types of pathways? ... I feel that we have very little to worry about in terms of people using ZIP-like drugs to erase memories ... aliss

at least some of the neurons involved in the recall of one memory are likely be involved in the recall of at least some of our other memories ... sberman

If we are constantly reshaping our memories, then how can researchers attempt to completely erase it? ... kenglander

what role does consciousness play in what we remember, as well as in the process of remembering? ... meroberts

thoughts most likely do not exist as reproducible patterns that can be consistently observed by an fMRI.  This made me question why we are so insistent that a particular memory exists as one clearly defined connection that could possibly be “erased” ... LMcCormick

Do we define ourselves through our memories? If we do define or identify ourselves through our memories, then that would imply our identities are constantly changing ... Sasha

Perhaps one of the most disconcerting issues concerning deja vu is how vivid or "immutable" the sensation appears to us. When we experience it, we KNOW that we have perceived our current sensations before. And yet we haven't. Maybe even more poignantly than what deja vu says about the dissociation of memory is what it says about the vividness of our experience. If we can't trust absolute lucidity, what can we trust? ... David F

the common content of thought - elements that are most easily translatable into speech or writing - might be somewhat accessible to us.  Still, defining what these common elements might be, finding broadly applicable correlates in the brain, and turning that information into meaning is very daunting, and unlikely to give more information than one might get through simple conversation ... rdanfort

"Memory" is not one "thing," but instead a bunch of interacting things, and may well be a process rather than a "thing" at all.  That has some interesting implications not only for thinking about human experience but also for thinking about how one does neurobiological research.  What is likely to be "recognizable" ("calibrateable") in brain imaging is only those things that qualify as "shared subjectivities" and so the interpretation of brain images will have many of the same interpretational issues as exist with language.  That has some interesting .... etc. ... Paul

apropos of earlier conversations and ...

Depression's upside - NYTimes 25 February

Head case - can psychiatry be a science? - New Yorker 1 March


Summary (to come)

Continuing conversation in forum below


LMcCormick's picture

Music and the brain

We did not spend much time in class discussing the article on music and improvement of speech in stroke patients; however, music and the brain in general is a very interesting and mysterious topic.  What is it about music that is so powerful and memorable?  I’m sure you’ve all had the experience where a song comes on that you haven’t heard in years, yet you can still sing along to all of the lyrics.  Similarly, music can be very important for people with Alzheimer’s.  For example, my friend’s grandmother has had Alzheimer’s for five years.  She does not recognize anyone and often speaks nonsensically, yet she can still sing the lyrics to songs from her childhood.  Perhaps music plays such a powerful role because it integrates several regions of the brain.  It must incorporate areas important for words and grammar as well as tones and harmony.  Thus, the lyrics to a song probably create a stronger and more complex network of connections in the brain than the memory of a passage in a book.  With this in mind, it is perhaps not surprising that music may be important for improving speech in stroke patients.  For example, if areas important for decoding harmony or chords are in tact, then perhaps hearing the melody of a common song will trigger the use of what connections are left in regions important for speech and even stimulate the creation of new connections.


rdanfort's picture

 I have to say, I was really

 I have to say, I was really taken aback by the difference between Dr. Taylor in writing and Dr. Taylor before a live audience.  It did make me think that, unless what she was really describing was a response or pattern common to many brain events (near-death, hallucination, etc) and many people, her specific recollection was probably colored more by her background as a neuroscientist than by a genuine connection with the fine workings of her brain.  I know that similar ideas have been studied to some extent, but don't think that her report can be generalized to others.  I'm also more generally uncomfortable with the strong association of various feelings, affects, and ways of life with which "half" of the brain one is "living" in.  It doesn't sound like a defensible picture of consciousness, even if we have seen some unusual behavior in split-brain patients.

Claire Ceriani's picture

What I found most interesting

What I found most interesting about this discussion was the question of how we should interpret Dr. Taylor's experience.  Did her own understanding of neuroscience shape the way her brain understood its own stroke?  Does she really have this bizarre ability to "go into her right brain," or is she neurologically damaged (or just trying to sell a book)?  Her description of her experience is so unusual and emotionally charged that it's difficult to see it as purely scientific, but it's also hard to dismiss.  I too dislike any integration of religion with science, but I suppose that if you see religion as an experience of the brain/mind, it's going to come up eventually when you talk about strokes.  I'm not a fan of using terms like "nirvana" to describe these right-brain experiences because it is so specifically spiritual, but I believe that Dr. Taylor considers it the best way to describe her experience.  This book (and speech) are meant to be accessible to people without a strong neuroscience background.  When I consider this fact, I find it easier to accept her description of her experience.  It may be that certain neurological skills (like language use) may be so overpowering that we just don't notice what other parts of our brain are doing.  It seems entirely possible to me that if the language centers of the brain aren't functioning (the "chatter" is silenced, as Dr. Taylor says hers was), these strange right-brain experiences would come forward.  It actually reminds me in a strange way of acquired Savant Syndrome when unusual talents emerge following brain damage.  Perhaps this unusual perception of existence and feeling of euphoria is something that just has to be uncovered by the loss of a more dominant cognitive activity, like language use.

Bo-Rin Kim's picture

Consciousness without language

I think one of the most interesting topics that arose during our discussion last week was that people can be conscious without language. Prior to this discussion, I was pretty convinced that you needed language to be conscious and to have any kind of thought. However, Dr. Taylor's account of her stroke revealed that although her language abilities may have been lost, she was still consciousness and very vividly experiencing things.Prof. Grobstein's comment that perhaps consciousness could be subdivided into consciousness that is more closely related to unconsciousness and a consciousness that is more elaborately expressed in consciousness is an interesting notion that provides a possible explanation for why language sometimes plays a larger role in consciousness and it sometimes does not. Maybe when you let go a little and move towards the area between being fully consciousness and unconscious, you enter this "nirvana" that Dr. Taylor experienced where you dont need language to experience things. This somewhat hazy, eupohoric state may be brought about because the voices that usually are so clear in your head quiet down and let you escape from the realities that tie you down to this world. Like Sasha said, this sounds a lot like a state of intoxication and the reason why so many people drink in the first place--to escape reality. Maybe the ability to enter this "middle consciousness" area between unconscious and fully conscious without the use of drugs is the source of true nirvana, and as Sasha said, perhaps Dr. Taylor was trying to teach people how to reach this state of mind.

Sasha's picture

strokes and intoxication

I found last weeks discussion on the experience of stroke to be very interesting. In particular I thought Dr. Taylors description of her experience during a stroke was a very unusual insight. I found her comparison of experiencing a stroke to that of being in "thetaville"- which our class seemed to define as when we have direct communication between our conscious and unconscious, that sort of hazy state between being awake and asleep, to be very unusal. Her description of how she felt during the stroke also almost sounded similar to being in an intoxicated and confused state yet she seemed to temporarily describe it as enjoyable and as reaching a state of "nirvana". Now Dr. Taylor goes around preaching to individuals how they should activate one side of the brain in order to disconnect from the separated "self" and connect with everything around them- get rid of the boundaries. But to some extent, I wonder if this is what individuals try to do through the use of drugs and alcohol? It almost sounds to me like Dr. Taylor is trying to preach a way for people to reach some euphoric state just without the use of chemical substances? Could experiencing a stroke be similar to being seriously intoxicated? What would these similarities teach us about the brains capacity to experience different events? Or maybe it doesn't mean anything at all...

meroberts's picture

Psychology = science of emotion

Throughout the semester I have noticed the way in which our class discussions have been mediated by the seemingly Western view of rational science. We devoted a significant number of earlier classes to the discussion of objectivity vs. subjectivity alone. What I don't understand is why we, as a class, and the larger scientific community want to create this dichotomy between objective/quantitative rationale and subjective/qualitative information. Who is to say that one is better than the other? We have learned in class that lauding the benefits of one method does not necessarily lessen the importance of another. Why should we keep emotions separate from the myriad other issues psychologists are studying today? Isn't the study of emotions what created modern American psychology as we know it? William James, heralded as "the father of American psychology", was obsessed with the study of emotions and fluctuations in mood. He had personal experience confronting "serious psychological difficulties" and this personal experience inspired him to study how his (and others, later on) own spirituality and consciousness related to physiology and neuroscience (how's that for objective experimentation?!). This eventually culminated in the evolution of American psychology. Unfortunately, Freud ruined the science of emotion for most psychologists and now even undergraduate psychology students don't dare whisper about emotions in a neurobiology class. It seems there is no place for emotions in our discussions of neural plasticity and consciousness- but that doesn't really make a whole lot of sense if you believe, as I clearly do, that they are all interrelated.

For a science (and I do believe psychology is a science, even when including emotions into the mix) with its roots in the study of the interconnectedness between emotion, spirituality, consciousness, AND physiology and neuroscience, how can emotions be left out of the discussion? It is disheartening to see that neurobiology- the metaphorical love-child of psychology and biology- has turned a blind eye to the role of emotions in cognition. Were emotions rejected/ignored from the field of study in an attempt to legitimize neurobiology and cement its place amongst the "hard sciences", like biology and chemistry, and to further distance it from the presumed "wishy-washy" abstract concept that has dominated the popular perception of psychology? Can emotions be incorporated into neurobiology without destroying its hard-science allure?

mrobbins's picture

Taylor's Iceburg of Meaning


After watching the clip from Dr. Taylor’s video, I did not form a more skeptical view of her. Of course, I realized that some of her facts were outdated or skewed but more than anything at all that Taylor was doing was hyperbolizing the importance of metaphors in science. I was in a class two weeks ago where we discussed just this. The class concluded that in many ways nothing could fully be explained without the use of metaphors because everything we show or support comes from a subjective viewpoint that must be modified towards a broader audience. There are many reasons to do this; to get more funding for more research and thus, more metaphors; to create a consensus of knowledge based on an idea of understanding that is shared by both experts and novices alike; and to perpetuate the inherent need for communication in all scientific fields. Taylor truly exemplified metaphors in a way that is more traditionally shared by religious fanatics, but she is doing nothing avant-garde here. She is just changing style but not substance. So, I truly hold no prejudice against her views and message. Just because her metaphor for scientific truth is expressed in a livelier fashion I would argue that this is no way, shape, or form should reflect on the validity of her message. All scientists do this in fact all people do this. What is communication without metaphor, really? Does anyone really know exactly what we are talking about? No, they don’t, but that’s why it is so important for us to try to relate meaning to one another. Alas, meaning does not always mean truth. Scientists, Taylor, and non-scientists-alike, share this burden.  

Furthermore, I do not believe that Taylor was trying to promote a hard-science as much as an important message. Taylor wanted to convey the importance of living a fuller and more meaningful life, but did so in a more graspable form of science. Maybe she understands that it is easier to spread her message to more of the people who need it most in more understandable forms. Maybe she doesn’t even truly believe in right vs. left brainedness. Maybe that is just one of her many metaphors, except this metaphor in particular may be based on the knowledge that more people will take her seriously if she conveys a certain format of a message within the framework of her identity as a scientist. It is not important that these details are correct as long as her overarching rainbow of enlightenment not only shines the brightest in the sky, but also reaches the most lands. In fact, her facts are not all facts, but expressions of a truer meaning and reality that are almost impossible to accurately convey no matter how lively or dully stated. Isn’t every word a metaphor for some intangible meaning? Don’t attack expression just be open to a different meaning in unexpected contexts.


Jeremy Posner's picture

I would not want to feel each of my cells individually

 The point on differing valuations of quality of life in people with locked in syndrome as compared to their loved ones and the potential impact of that difference (in terms of both how the family of the individual treat him or her and in the medical treatment that they potentially may or may not provide but I do not think that those differences are the result of evidence that social contact is not an important component of a fulfilling life.  Obviously it was impossible to determine how satisfied locked in patients are with their life prior to providing them with a means of communication and after that has been accomplished it is possible for the patient to resume social contact.  I do think that self-determination and self-control are a very important part of the appeal of things like “thetaville” (or lucid dreaming or whatever) and that the appeal of fantasy over reality is based very much in the ability to choose between the two.  Of course locked in individuals would still have to face reality at times, even if they were able to satisfy themselves with fantasy, and that would be a very tough transition to bear.

            Moving back to the woman who used the experience of having a stroke to create a philosophy based around the satisfaction gained by putting oneself in either the right or left mind while I don’t consider her approach to be especially scientific or a philosophy that appeals to me as an individual but I don’t think it really reflects at all upon more generally accepted neuroscience.  Beyond the recent evidence mentioned in class discussion that the compartmentalized view of the brain that the idea of “right brained consciousness” depends upon is not accurate the theory depends upon immeasurable and non-quantifiable ideas.  It is possible that (though again I don’t know how you would move consciousness about the brain considering that I don’t consider it separate from the brain as a whole and it’s most likely the result of a number of processes all over the brain) if you were somehow to move your consciousness to the right brain you might experience all of your cells, but I have no idea how that could be measured.  And if the theory is impossible to test it is not science, a scientific theory may not be provable across all possible circumstances, but is must be possible to disprove.  And this cannot.  Though I imagine that public speaking has helped in this case with the recovery of speech, which is certainly a plus. 

sberman's picture

Shift in view due to an academic context

First, I want to thank everyone for their participation and great thoughts and ideas on Monday evening. 

I read Taylor's book this summer, and initially, I was amazed. I thought the work was brilliant, courageous, and compelling. However, both while preparing for the presentation and participating in our discussion on Monday, I became more and more skeptical of both Taylor's account and her work as a whole. Perhaps reading the entirety of "Stroke of Insight" from start to finish puts Dr. Taylor's account of her stroke in a better scientific and rehabilitative context. The initial chapters of her book, which were not part of the excerpt read in class, discuss the pathophysiology behind the stroke and seek to justify the theory of hemispheric asymmetry by discussing both lesioned and split brain patients. Although she does present some outdated and seemingly subjective information about feelings and memories, Taylor also includes information about where language centers are located and what type of information is commonly processed in different locations (Her discussion of hemispheric asymmetry is not just that we should enter the nirvana of our right brain, the impression some of the class might have gleaned from the video). Perhaps reading these more scientific chapters in addition to the more philosophical components of the book caused me to view it so differently. Another reason for my drastic shift in opinion of Dr. Taylor's account could be due to the fact that during the summer, I was reading the book for pleasure and because rehabilitation and regenerative medicine are things that greatly interest me. While reading the excerpt and watching Dr. Taylor's presentation at the TED conference for our seminar class, I was trying to place her work into an academic and strictly scientific context. The inclusion of subjectivity and personal experience, which initially captivated me and was my favorite part of her account, is now essentially an academic turn-off of sorts. 

After four years in the bi-co, when I hear about new treatments for diseases, I find myself unconsciously subjecting them to a scientific method test. Did they have appropriate controls? Is the sample size large enough to be statistically significant? Throughout the week however, I've been thinking that at least in the treatment of mental and brain illnesses, there is some place for subjectivity, especially as if Paul mentioned, there is some non-calibrateable, non-reproducible entity in each of us. Maybe Dr. Taylor's account will allow neuroscientists to get a better understanding of what it is like for an individual to EXPERIENCE a stroke, not just what it is like to HAVE a stroke. 

I also wanted to briefly comment about a point Melissa brought up in class re: locked in syndrome; that in the U.K. LIS is viewed as worse than death. When I initially read the article about LIS, I was shocked about how high patients rated their quality of life, and was surprised that the class didn't seem to have as strong as a response as I did to this phenomenon (Given that there is such disconnect between the views of doctors/caregivers (i.e. the UK point) and the patients' experience).

kenglander's picture

I think Sara brings up an

I think Sara brings up an interesting question regarding the utility of qualitative data in medicine. To what extent can we use descriptive data to diagnose patients and/or assess the quality of life and when might it be more useful than quantitative data (i.e. vital signs, blood tests, etc.)? Can anecdotal evidence from one patient affect how another patient is treated?

Some diagnoses already rely (at least to some extent) on self-report data; patients  must report feeling upset, lethargic, or even suicidal for an extended period of time in order for physicians to diagnose them with depression. However, reliance on qualitative data seems less pervasive in the diagnosis of other non-mental conditions.

I'm not suggesting that we use emotions or feelings to diagnose patients with physical ailments, but I think their experiences may be helpful when considering possible treatment options. The article that discussed the quality of life surveys for patients with LIS clearly advocates this point; perhaps doctors and caretakers could better attend to patients' needs if the treatment extended beyond physical therapies. I know that patients will occasionally meet with a psychologist  to help them cope with their condition, but I wonder if there is a more integrative psychophysiological approach that would help the patient and also inform and improve the practice of medicine. (Then again, does this idea inherently assume that patients will have similar self-reports and thereby force qualitative data into a quantitative mold, rendering the whole point moot?)

Paul Grobstein's picture

From a stroke to ... science, religion, consciousness

Rich conversation Monday evening, and below, with more hopefully to come.  I too was struck by the issue of "as a scientific audience, [we] are more likely to question her personal account because we don't want to give her the credibility of being a neuroscientist if she presents her information as a layperson" (Vidya)" and "I imagine that as repulsive as we find the integration of emotion into science, we find the incorporation of religion about a hundred times worse" (David).   Perhaps, indeed, neurobiology (among other things) is bringing us to a point where, as David says, "emotion should not be kept so strictly distinct from science."   And perhaps as neurobiologists we need to find ways to admit as legitimate observations religious/spiritual experiences as well?

Along these lines, one of the things that particularly struck me was the relation between this conversation and several earlier ones about subjectivity and the possibility that not all brain activity is "calibrateable," ie interpretable in terms of shared subjectivities.  What all of this suggests (to me at least) is that neurobiological observations might over time lead to the conclusion that there is in all people an irreducible, non-categorizable, non-calibrateable, distinctive individuality/subjectivity.  Might experience with that residual distinctive subjectivity, unique to each individual, be related to/the origin of, what in religious discourse is referred to as the "soul" or "spirit"?  I'm intrigued by the possibility that a number of terms common in religious/spiritual discourse may actually have parallels in brain function, so that a more active exchange between "scientific" and "religious/spiritual" discourse communities might prove productive for both.  And, of course, by the idea that not only is emotion a necessary element in any program of brain research and hence emotional experiences must be treated as admissable observations but that there are likely to be new ways of thinking about brains that would arise from a more serious engagement with emotional experience. 

Among the other themes that intrigued me and I want to think more about is the distinction between "repairing" the brain and being aware of the ongoing processes of development and adaptation that are inherent in the brain and its function.  The idea that the brain is continuing to explore ways to achieve particular functions rather than that the brain has particular ways to achieve particular functions seems to me relevant in a variety of rehabilitation contexts (as well as in educational and other life adaptation contexts).  Contemporary research on the ability of the brain to use signals to control robotic devices seems to me of particular significance in this light. 

Finally, I found very interesting Taylor's reports of her immediate stroke experiences, and our discussions of the validity of those first person reports.  The latter highlights some of the problems and potentials of making neurobiology (and science generally?) more open to subjective experience as legitimate observations.  And the former, it seems to me, helped us to think more about the issue of consciousness.  Yes, there is a state that not only doesn't involve language but involve "chatter" or an "inner voice".  And perhaps no "self/other distinction" either.  Its worth thinking more about what that involves.  If not a "left brain, right brain" distinction then .... ?  Perhaps a distinction between conscious experiences more directly related to the unconscious and those more elaborated within consciousness?




David F's picture

Separation of church and science

 I agree with much of what Vidya has already said. I too watched the video prior to class, and was surprised at how different its impact on me was the second time. There were probably many causes for this change in my attitude, including the laughter in the room, the fact that we skipped the entire introduction to enter on the line "I'm as huge as a whale, swimming through the sea" or something like that, etc. However, I think there's something worth defending from my initial reaction to the video: there was something I was moved by. There is something immediately repulsing by the mixing of emotion and science, subjective and objective. And yet as we discussed in class and Vidya has pointed to, emotion is becoming increasingly a part of that very science; the subjectivity we tried so hard to keep separate has become the very topic to be investigated. This, I think, has loosened us up to the idea that maybe emotion should not be kept so strictly distinct from science. But since Vidya has already talked about emotion, I additionally wonder about another discomforting aspect of Dr. Taylor's talk: her incorporation of religion. I imagine that as repulsive as we find the integration of emotion into science, we find the incorporation of religion about a hundred times worse, and for many legitimate reasons. Strongly held religious doctrines can violently inform, often falsely, the direction that science should/can proceed. Moreover, science is often put in the place to discredit religious beliefs that many derive happiness from. As such, the mixture of religion and science is a messy one at best, and one that many feel we should shy away from. However, Dr. Taylor forcefully brings us into religious language, using abstract metaphor to describe the enormity of her experience, her connection to the universe, to her constituent parts, and nirvana. What should we do about this? Do we reject her from science? Do we convince ourselves that she's not really talking about religion, per se? While these are possibilities that we entertained in class, I wonder if they're the most productive ones. Is it possible that science is an inevitable part of religion, or even more jarringly, that religion is an inevitable outcome of science?

VGopinath's picture

Emotions and Science

     One of the topics we discussed last night seemed to parallel issues discussed in a political book "What's the Matter with Kansas?  How Conservatives Won the Heart of America" by Thomas Frank.  Frank's theory is that Kansas (symbolic of the entire Mid-West) began to vote Republic not because of the ideas of the Republican party but because the culture and presentation of the Republican party resonated with them.  Frank argues that Americans are voting against their best interest because they want to vote against liberal elites who drink $10 cups of chai mocha latte grandes and discuss Kafka.  Similarly I think that, as Sara and Professor Grobstein were pointing out, the culture of science demands that emotions must be hidden and the jargon must be cutting-edge, which necessarily prevents the vast majority of the public from  understanding.  I think that the wide variety of responses to Dr. Taylor have to do with how her story is told and the content is secondary.  She likely is aware that in trying to simplify to such a great extent the left and right brain she has alienated most of the scientific population.  Yet she has such a strong following in the general public.  I was initially surprised that she used the term nirvana to describe her euphoria but the word is probably more present in the common vernacular than euphoria.  I think that we, as a scientific audience, are more likely to question her personal account because we don't want to give her the credibility of being a neuroscientist if she presents her information as a layperson.  Another reason why the culture of how Dr. Taylor presents her information and the culture of who is watching it struck a chord for me is because I watched the video twice.  The first time I watched Dr. Taylor's TED lecture I was in my common room, on my laptop.  When I watched it during class, it seemed much more theatrical and overblown .  I was watching it in a different mind set in class and I probably would have written off Dr. Taylor to a greater extent if I didn't remember that I had recently watched it before and found it emotional, but that seemed warranted as she was describing her own stroke.  I do agree that she may not be up-to-date on cutting edge research but has managed to engage the public about the brain and raise awareness about strokes. 

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