Losses, the law and the student of neuroscience

For a medical doctor, the loss of sight, hearing, and smell are tragic for the patient but are in no way surprising. These functions can be lost for a variety of reasons, for instance through trauma or through degradation of phyisology. For the patient with these losses, adaptation is not only a unique aspect of human nature but an absolute necessity to live with these same sensory losses.

These losses make intuitive sense to not only physicians but to the public too. We all know of people suffering from at least one of these deficits. Perhaps less so in the case of the sense of smell, though now Covid has made even that sensory loss more commonplace.

The point is that the further away one gets from common senses like sight and hearing the rarer the losses become and the harder it becomes for the non-specialist to understand the deficit being as it so far removed from personal experience.

How much harder then is it, to understand a condition like abulia in which an individual loses the capacity to exercise their own will or make decisions? How are we to even wrap our heads around this concept let alone empathize with the patient with this condition?

What about the loss of proprioception, the genuine sixth sense that tells us without thinking where our bodies are in space. Closing your eyes you can move your leg up and down, wave your arm about and understand proprioceptively where the limbs are and how they are acting. Losing this sense is indeed a strange phenomenon. Sacks wrote with his usual blend of humanity and understanding of a patient inflicted with such a loss in 'The Man who Mistook his Wife for a Hat'.

The truth is that any function you think you own whether it be an ability to read, calculate or even move, is yours only by the whims of circumstance and can be lost through the same "slings and arrows of outrageous fortune" that Hamlet understood all too well. Acalculia for instance or the loss of basic mathematical ability can be gained/lost due to damage of the parietal lobes in a key area called the angular gyrus.

This is the unique perspective that the student of neurology and neuropsychology gains upon a deeper understanding of neuroanatomy. Alas for the average person going about their lives, they are unlikely to come upon such patients let alone hear of the plethora of bewildering losses suffered by these patients.

But what then of forensic losses. Losses of functions like social conscience, empathy, and inability to tell right from wrong. It's fairly simple to accept that patients exist with the above losses, but when losses such as those just described influence impulsivity or even murder - how easy it becomes to balk against the idea of a mitigating circumstance.

We may forgive easily the blind individual who strikes us with a cane, but to the criminal who murders someone, it becomes a lot less easy to judge innocent, the individual who is simultaneously perpetrator, victim, and patient. Visual losses are much easier for the lay individual to understand than the subtle losses suffered by the mind. But both are losses, and until all court rooms are not only filled with one's peers but also an informed populace on the subtle nature of such losses I find the concept of a fair legal system nothing more than a utopian dream.

I'll be posting this same post on my Medium page.

Dan Sumner

Links for further information

https://theconversation.com/proprioception-our-imperceptible-6th-sense-150775

https://www.goodtherapy.org/blog/psychpedia/acalculia

https://www.medlink.com/articles/acalculia

https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.178

https://en.wikipedia.org/wiki/The_Man_Who_Mistook_His_Wife_for_a_Hat