An unusual and poignant brain injury

Sometimes, medical case studies are powerful as much because of what they leave out as what they contain, as in an uncomfortably moving 1935 case report of a young lady who attempted suicide with a hand gun.

It’s available online as a pdf and the point of the article is to report the remarkable fact that she survived and was apparently neurologically normal afterwards, despite losing a considerable amount of blood and brain tissue.

Scientifically, this is indeed remarkable, but perhaps more striking is the photo, ostensibly of the wound, but haunting because of the what it captures of the young woman.

Her photo is painfully personal, showing a bleak, listless expression and suggesting a difficult life undescribed. It’s a stark contrast to the stripped clean case study that contains only one line of personal detail:

On July 25, 1934, at 1pm, Mrs A., age about 30, attempted suicide at her home in Truckee, California, by shooting herself through the head with a 32-caliber automatic revolver.

Presumably the case report was published before the days when it became customary to anonymise patient photos to protect personal privacy. But these images remind us that this requirement protects the reader as much as it protects the patient, because while tragedy is important to understand in the abstract, it remains difficult to absorb in the personal.

Being able to abstract the data from the tragedy is one of the most important skills of working with people facing difficult situations, but it is barely mentioned in textbooks or training programmes. It’s just something people are expected to develop and discuss if they find challenging.

Occasionally, even the most seasoned professional is caught off-guard, where the full impact of unchecked emotional engagement outflanks the abstraction process.

This 1930s case study reflects that same experience, where the medical facts are drowned out by the immediacy of the human emotion.

pdf of case study ‘An Unusual Brain Injury’.
Link to PubMed Central entry for same.

One Comment

  1. Posted November 17, 2008 at 4:06 pm | Permalink

    Your point about photographs telling the patients story more clearly than the text is a very valid one. I have worked with many brain injured people, including some who have their injury as a result of an unsuccessful suicide attempt (normally anoxia in these cases).
    The brain injured people I work with are divided roughly into two groups – those who lack insight into their loss, and so are ironically sometimes even happier than they were before, and the others, who realising their loss tend to become extremely depressed, grieving for their old life. I have however, seen people overcome their sense of loss and make sense of their lives in new ways – something which I have found personally inspirational as I have never faced anything as devastating as a brain injury in my own life. As psychologists, we sometimes have much more to learn from the personal experiences of those we work with than they have to learn from us…
    Tom


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