Half a Brain is Enough: The Story of Nico
Antonio M. Battro
Cambridge Uni. Press
134 pp.; $23

Listening in the Silence, Seeing in the Dark: Reconstructing Life after Brain Injury Ruthann Knechel Johansen
Univ. Of California Press
246 pp.; $24.95

Most of us experience our "self" as a stable property of our psyche, an identity that links our past to our present and can be projected into the future. It belongs to us, it is us—distinctive, inviolable, and enduring. Those who have experienced brain injury, malformation, or disease have learned otherwise. Their often agonizing journeys have revealed that the "self" can be shattered, altered beyond recognition, and—sometimes—reconstructed. These experiences have profound implications for our understanding of the nature of the self.

The observation that the self appears to be vulnerable to material injury or pathology challenges those who view the self as an immaterial entity enduring through time, experience, and beyond death. Some conclude that the self is simply the subjective manifestation of the organization and activities of the brain, and has no reality beyond this complex biological system. Others believe that the self is something richer and multidimensional, emerging from the relationships and interactions of a body-brain with the physical and social worlds.

These books tell the stories of two boys: Erik, 15, and Nico, five. Erik was a normal, intelligent boy until he suffered severe and extensive brain trauma in a car accident. At the time—1985—his prognosis was poor: even if he recovered from the initial coma, he was not expected to function as a fully self-aware, relational, and independent person.

Nico was born with some left-side paralysis. At two he began to experience epileptic seizures, originating in his malformed right cerebral hemisphere, and soon they were so frequent, severe, and unresponsive to medication that they interfered significantly with normal activity and development. Doctors and parents agreed on radical neurosurgery, disconnecting his right cerebral cortex from the rest of the brain. The identity and development of both boys were significantly altered by these widespread and profound changes in brain structure and function.

Antonio Battro is a physician and cognitive psychologist who worked closely with Nico from age five. He shares Nico's story to illustrate how the neural architecture underlying our cognitive abilities can be reorganized or profoundly altered with no apparent detriment. Battro has expertise in diverse fields including medicine, perception, Piagetian cognitive psychology, philosophy, education, and computer science.

They frame his exploration of the neural mechanisms of cognition and how computers can facilitate cognitive and perceptual development when these mechanisms are damaged. While cautious about generalizing, his passion to understand the flexibility and limitations of the brain, and to develop methods to actively mediate the relationship between brain and environment, provide inspiration and hope to those whose brains have been wounded.

Unfortunately, Battro's book is not very accessible to readers without a strong background in neuroscience and cognitive development. The presence of a brief glossary will be insufficient to guide most readers through the high-level concepts and occasionally convoluted arguments. The benefits of this book will be more indirect, as its insights may influence professionals attempting to facilitate healing and cultivate the potential of those with brain trauma or developmental delays.

Nico's story shows that, at least under certain circumstances, "there is no such thing as half reasoning with half a brain." Despite more than three and a half years with a malfunctioning right hemisphere, often debilitated by seizures, and currently using half the usual amount of cortical tissue, Nico demonstrates completely normal reasoning and emotion, and advanced language skills. His only symptoms are some motor and visual impairment on his left side. Remarkable! If one can function quite normally with half a brain, then what is the other half for?

Battro concludes that the remaining neural tissue has become reorganized and is used more efficiently, but he provides no direct evidence for this neural reorganization, only inference from performance. Nico's cognitive development has been facilitated through carefully designed interactions with computers, suggesting that computers can provide a kind of prosthesis for the missing neural circuitry, plus a framework through which functionally useful neural reorganization can be stimulated. Thus, while the brain is a necessary component in the development, experience and expression of aspects of the self, it functions as a flexible architecture that is shaped at least in part by experience.

Nico's story focuses mainly on what Battro calls "neuroeducation": the use of computers to "educate" the brain as the foundation for perception, reasoning, and motor skills. Battro also briefly discusses the power of computers to facilitate and mediate social relationships and skills, primarily through email. He recognizes the importance of social and emotional, as well as cognitive development. However, he does not explicitly include a role for human relationships, nor any sense of a spiritual dimension to selfhood. While such additions go beyond the scope of Battro's research and possibly expertise, their absence contrasts strikingly with Erik's story.

Erik's story is told by his mother, Ruthann Johansen, currently a professor of literature and writing at the University of Notre Dame, who is reaching out to those who are "waiting through the long, starless nights of coma or later searching in vain for reliable markings along the path back into life." She invites us into the journey that Erik, his family, and his community traveled through self-disintegration and reconstruction.

The story is engaging, compelling, and multilayered, told through poetry, metaphor, narrative, and philosophical reflection. It transcends Erik's journey to become our own. As with Nico, we learn of the vital roles of medical and technological interventions and rehabilitation protocols, including the valuable contribution of person-computer interactions in reorganizing the neural architecture of the self. However, we also learn the absolutely central roles of family, community, and story in the formation of selfhood.

Erik's family refused to allow him to be merely the mechanical body-brain that Erik was to the medical professionals. Through insistence that Erik was still a "self," albeit shattered and scattered, they became exquisitely sensitive to his attempts to respond and reintegrate. His gradual emergence from coma into self-awareness demonstrated that the sense of self does not simply lie intact, waiting to be reawakened, but must be rebuilt, piece by piece, layer by layer.

Development of selfhood and self-awareness are similarly built in infancy. However, for Erik fragments of his former self and memories of his previous abilities haunted him. Both he and his family had to grieve the loss of hope of a return to his former self so they could be liberated to accept the new self that was being born.

Rebuilding Erik's identity was a multidimensional process, involving repetitive patterns of movement, speech, perception, and thinking, the practice of social skills, the dialogue of relationships, and the web of community. Johansen is convinced that Erik would not have recovered as fully without each of these elements.

This suggests that a true understanding of self must include not only a neural architecture but also a profoundly spiritual-relational dimension (a conclusion that will not come as a surprise to Christian readers). The Johansens' involvement in the Society of Friends provides much of the communal web that sustains them, and Erik's rebirth into full selfhood included his need and decision to become a member of the Society of Friends.

It is unclear whether Johansen herself understands this spiritual dimension of selfhood as reflecting a genuine relationship with a transcendent being or simply a further development of the "human spirit" in community. It is nonetheless interesting to see how faith provided not only community but also motivation and inspiration to treat Erik as more than a body-brain, and appears to be a central ingredient in a process of self-reconstruction that went far beyond the expectations of the medical world.

Nico shows us how our neural architecture can respond flexibly to facilitate the emergence of normal cognition and selfhood, while Erik shows how relationships provide vital structures for and inputs to the self to enable a whole, multidimensional entity. Both stories provide hope and encouragement to those who struggle with selfhood—its formation (the mentally handicapped), its reconstruction (the brain-injured), and its disintegration (those with progressive neural degeneration). They reveal that the brain's central role in selfhood occurs in interaction with the body, the physical world, and social and spiritual relationships.

The brain-injured have hope for self-reconstruction, and the mentally handicapped or sufferers of dementia can take comfort in the fact that the self transcends the brain to include narratives that emerge from relationship.

For both Nico and Erik, self-construction and reconstruction occur in a context of relative wealth and privilege—Nico has access to high-quality education, the latest technological resources and expertise, while Erik's insurance benefits permitted time and resources for long-term rehabilitation. Reconstructing the self does takes time, energy, and resources, and thus, as Johansen recognizes, position and privilege also affect the fundamental shape of personhood.

Christians should be concerned about the justice issues implied in this observation. How can we enable all to participate in loving communities that provide and sustain the narratives and resources needed to cultivate our potentials for selfhood? For, as these books make clear, the self is not a stable, inviolable, and enduring entity, but is shaped by and is vulnerable to the web of relationships we experience and create with the physical, social and spiritual worlds.

Heather Looy is assistant professor of psychology at The King's University College, Edmonton, Alberta, Canada.

Copyright © 2003 Christianity Today. Click for reprint information.

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Christianity Today sister publication Books & Culture presents Books & Culture Corner and Book of the Week Mondays at ChristianityToday.com.

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Facing the Past Günter | Grass and the debate over Germans as victims in World War II. (May 19, 2003)

Are Movies Fundamentally Inferior to Books? | Two responses to Ralph Wood's claim that "biblical tradition elevates word over picture." (May 12, 2003)

Buffy and the Meaning of Life | Buffy the Vampire Slayer finally gets some respect. Too bad the life is slowly ebbing out of the show. (May 5, 2003)

Bird Watching with Anne Lamott | A PBS documentary enters the unruly, grace-filled world of the author of Traveling Mercies. (April 21, 2003)

A Story Darwin Might Love | Brian McLaren's evolutionary interpretation of the faith promises more than it delivers, but what it delivers is good enough. (April 14, 2003)

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Letter from Spain | A former resident returns to find that it is still stony ground for the Gospel. (March 31, 2003)

Lessons in Nation-Building From a Fledgling Democracy | Shays's Rebellion describes a time when revolution was no longer cool. (March 24, 2003)

Whose Reality TV? | Tune in this week to Frederick Wiseman's PBS documentary, Domestic Violence, to see some real survivors. (March 17, 2003)

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