The Brain, the Body, and Behavior – Paul Okami

Freeze Frame: excerpted from Chapter 2: The Brain, the Body, and Behavior in Psychology: Contemporary Perspectives by Paul Okami

João da Silva kissed his 10-year-old daughter Nara—for what he later insisted would be the final time—2 hours and 10 minutes before stepping aboard Delta Flight 89 for Los Angeles on October 14, 1981. He had pulled her down from her treasured place atop his shoulders, turned her upside down, and grasped her by her ankles so she could walk on her hands. He finally let her plop down, giggling, on the carpet. He remembered all this, and numerous other seemingly trivial details, with poignant vividness.

Da Silva spent several weeks in Los Angeles, trying to negotiate a favorable contract to adapt a popular novel for a television mini-series, and then flew back to his home in San Francisco.  As he waited for his luggage to appear at the airport carousel, he decided to check his voice mail to see if any messages had arrived that day. What he heard caused his spine to freeze. The first message was from Nara’s teacher at school. “I’m just calling to see if there is any news about Nara. If you get the chance, please call me.” The next, was from João’s girlfriend, Reiko. “I just heard about Nara. I’ll be at work, but I’ve arranged to be able to leave as soon as you get here.” The next was from his ex-wife. “Call me as soon as you get back.”

João slammed the receiver down, picked it up again, and called his ex-wife. “João, please stay calm … Nara was hit by a car—she’s hurt pretty badly, but it’s going to be all right. They think she will live. I’ll meet you at the hospital.”

João left without waiting for his luggage, taking a cab straight to Mount Sinai Hospital, where he found Nara in intensive care. She was unrecognizable—swollen, bloody, purple with bruises; surrounded by medical people, tubes, wires, oscilloscopes, and an atmosphere of fear. She had suffered head trauma and was unconscious. João lurched out of the room and came face to face with his ex-wife. He burst into tears, and the two parents embraced for the first time in almost 10 years.

Somewhat amazingly, considering the extent of her injuries, Nara not only survived, but completely recovered from her wounds and the emergency surgery she had required. Only a small scar at the edge of one eye and another at her rib cage remained as testimony to the accident.  She was released from the hospital within a month. The doctors assured João and his ex-wife that the trauma to her brain had been mild, given a relatively short period of unconsciousness, and that no lasting damage had resulted.

But after eight months, João had to confront a certainty that something was, well, wrong with Nara. The only way that João could describe it was that Nara had “disappeared” leaving another child in her place. What was it exactly? In the past, various teachers and friends had described Nara in terms such as “hilarious and loving,” “incredibly talented,” “bubbly” “possibly brilliant,” “just beautiful—so engaged in life,” “almost like a young woman—thoughtful and perceptive.”

Who then was Nara now? The first adjective that came to João was “flat.” Her face had ceased to have much expression, her sense of humor was gone, and no objective observer could now describe her as “bubbly.” Perhaps more worrisome, the “possibly brilliant” student had begun to get failing grades at school—and to be unapologetic about it when João came to her with her report card, mystified.  She had dropped most of the friends she had once loved. Formerly a voracious reader, she now watched television with her mouth slack and her eyes lidded. She had occasional frightening outbursts of rage.

Had Nara reached the onset of puberty, João might have attributed all these things to “hormones” and “peer pressure.” But Nara showed few signs of oncoming puberty.

Finally, João called his ex-wife. Very carefully, he broached the topic of the personality changes he had witnessed in Nara, sending out feelers, not wishing to commit to statements that would put him out on a limb. Surprisingly, Nara’s mother began to weep, reciting a story in bits and pieces that matched João’s in every detail. Nara had simply disappeared from the face of the earth, leaving someone else in her place.

Nara da Silva has experienced childhood personality change due to traumatic brain injury, a poorly understood event, but one that occurs in a surprising number of cases of head trauma (Chapman, Wade, Walz, Taylor, et al., 2010; Hawley, Ward, Magnay & Long, 2004; Max, Levin, Schachar, Landis et al., 2006). Often, personality change is temporary, resolving within several months, but sometimes—as with Nara da Silva—it does not resolve for years, if at all. How can a brain with “no lasting damage” produce radical and long-lasting personality change? This is just one of the thousands of questions addressed by neuroscience, the scientific study of the nervous system and its most celebrated portion, the brain. The questions posed by neuroscientists—and answers provided—are highlighted in Chapter 2: The Brain, the Body and Behavior in Psychology: Contemporary Perspectives by Paul Okami (OUP, 2013).

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