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Book Commentary on Head Cases: Stories of Brain Injury and Its Aftermath

merry2e's picture

 “Without rebirth and resurrections, humanity loses its heroes and loses its capacity for transformation. In order to gain life, the monomythic lesson goes, we must first lose it” (146). ~Michael Paul Mason 

Head Cases: Stories of Brain Injury and Its Aftermath by Michael Paul Mason reveals the impact traumatic brain injury has on the lives of the survivor, family and consequently on society.  Through his work as a case manager at Brookhaven Rehabilitation Hospital in Tulsa, Oklahoma, Mason has worked with hundreds of brain injured patients and has had the opportunity to fly all of the country working with many more families.  His work has taken him into the depths of the Iraq war, seeing the most miraculous advances neuroscience has to offer brain injured military and has witnessed firsthand the most devastating traumas a brain can withstand.  Through his journey he details his accounts of heroism, culture as disability, and explains his life experiences with those he has met along the way. Mason has the ability to bring together in one book the topics of: neuroscience, medicine, spirituality, government policy, politics, sociology, and psychology.  Each case presents a different aspect of trauma, its effect on the physical body as well as the emotional, and what the toll of the injury takes on the family.  Mason delves into the history of the patient regarding their life before trauma and how their cognitive, physical and emotional abilities have been impacted in order to evaluate for proper placement for further rehabilitation or treatment.



Throughout the book he continues the mind-brain connection with several important questions which seem to guide his life work, “Who are we without our brains and is there a part of me that cannot be changed by a brain injury?”  As I read through the different cases, it became apparent that though each of the individuals experienced loss of functioning, whether it be cognitive, physical, or emotional, the “”I” function continued to play an imperative role for each of the patients throughout their recovery.  Their prognosis for recovery became greater depending on the well-being of their “I” function in connection with the other parts of the brain.  Relationships the patients had with their caregivers and doctors also played an imperative role and helped shaped the story the “I” function developed in each individual regarding the battle through their trauma.  Two cases particularly stood out for me in relation to the functioning of the “I”.


Doug Bearden, a retired Air Force Traffic Controller, believed he was dead.  He contracted Herpes Encephalitis which attacked his brain especially the temporal lobes (132).  After his initial recovery, Doug did not quite understand that he was alive and went into death trances which Mason goes on to describe.  He compares the trances to the use of The Tibetan Book of the Dead.  Tibetan Buddhists use dreams and trancelike states to prepare for death and rebirth.  Doug Bearden, as parts of his brain deteriorated developed hyperphagia, the sign of a damaged hypothalamus (141).  He constantly craved food and could not regulate his consumption.  The connection between the “I” function and other parts of the brain were not linking properly.  Through a combination of therapies; medical interventions, behavioral and pharmaceutical, Doug Bearden was able to regain a new life but with a tremendously high cost to his own self, family, and friends.  Over a three year period, he survived twenty placements and his family went bankrupt (146).  His family fought for the right for medical care through the military which was finally mandated through the governor’s office (145).  Doug’s is just one case in 1.4 million people who will sustain a brain injury each year according to the Centers for Disease Control and Prevention (7).


In the chapter “Rob Rabe Can’t Cry,” Mason discusses a case on a patient named Rob who, after a TBI (traumatic brain injury) could no longer shed tears.  Mason explains the neuroscience behind the development of three different kinds of tears, reflex, basal, and psychic, the latter being the type Rob has no ability to use.  Psychic tears are made up of different chemicals then reflex or basal, thus deducing one possibility that his cranial muscles were pinched or suffered damage in the trauma not allowing him to produce psychic tears but still produce basal and reflex tears (79).  If psychic tears are created by emotion, then Mason asks, “If numerous physiological and neural systems are involved in the act of crying, how is it that an emotion can dance between these systems to arrive manifested as a tear?” (84)  This case is another example of how the neural pathways between the “I” and the other brain systems are interconnected.  


Mason, as an advocate for brain injury survivors, delves into the ethics behind insurance companies, the nightmares of insurance roadblocks, and government and state policies which deter patients from receiving rehabilitation for the sake of saving a buck.  He makes the reader aware of the many hurdles that are present in accessing services for TBI survivors and the limited amount of resources available despite our ability to provide for survivors.


Though the stories are of the survivors, they are told by Mason by his “storyteller” who notably projects his own feeling and opinion into each individual case. In every story, every patient, Mason sees himself in some way.  While speaking with his boss, “”He’s always half joking that the world is seen only in projection.  Only by looking at others, he once told me, are we able to see ourselves” (99).  I believe it is the “storyteller” in Mason making peace with the injustice of policies, the consequences of war, the fragility of the human brain, and the knowing that one human being can only create change if they share their story with others.  Storytelling, a unique gift humans have the ability of sharing with one another is ultimately the gift of Head Cases.

 Works Cited

Mason, Michael Paul. Head Cases: Stories of Brain Injury and Its Aftermath. New York: Ferrar,          Straus and Giroux, 2008.  


Michael Paul Mason's picture

Testing for I-Functionality

Dear merry2e,

Thanks for an insightful commentary on my book, Head Cases.

I'm particularly intrigued by a fascinating statement you wrote:

"Their prognosis for recovery became greater depending on the well-being of their “I” function in connection with the other parts of the brain."

It's a pattern I certainly had not noticed, and wonder what the repercussions might be for this kind of concept in the realm of brain injury treatment. Do you envision that someday neuropsychologists might offer a test to gauge "I-functionality," and would it in turn act as a measure to determine certain outcomes? It's certainly a compelling notion.

Kind regards
Michael Paul Mason