Ogden's Trouble in Mind is a book of case studies in clinical neuropsychology. But, unlike other volumes of case studies in neuropsychology this is a series of life stories of individual patients who through accident or misfortune became Ogden's patients. Through her writing style and expertise in clinical neuropsychology she is able to empathetically convey the emotional impact of a neurological injury to patient, friends, and family together with detailed descriptions of the facts of the case from a scientific perspective. Technical language is well defined and scientific jargon held to a minimum without watering down content. This approach makes this book understandable to any interested reader as well as offering new insights to students and seasoned health care professionals alike. For the interested reader without a graduate degree in neuropsychology, the stories provide a window into the complexity of the brain and behavior. Like Oliver Sack's The Man who Mistook His Wife for a Hat, the book describes the fascinating nature of the human brain and how through disease and injury we have begun to understand its workings. For the student of neuropsychology, who is in the process of learning the neuroanatomy, behavioral taxonomy, and methods of neuropsychological assessment the book presents the human face behind the research and test data. Because Ogden was able to interact with each patient and family members for days and months and sometimes years, she is able to provide the reader with the life story of the brain damaged patient before and after the event. Even those of us who are very familiar with the various neuropsychological syndromes sometimes forget that our most interesting cases are other people's real life tragedies and we will come away from this book with that reminder.
The book begins with a primer of clinical neuropsychology and basic neuroanatomy designed to provide some background for the non-neuropsychologist and as a refresher for students and practicing clinicians. Beyond the first chapter, the chapters do not need to be read in any specific order and can be read according to interest. So in reviewing the book, I will do the same. I actually found the case I thought I knew most about the most interesting, Chapter 7, the case of HM. As with most students taking introductory psychology I learned about the case of HM, and how it was from this case that we discovered the critical role of the hippocampus in forming new memories. I also recall reading the original articles for my doctoral dissertation which involved neurogenesis in the hippocampus, and I followed the many other articles written about HM over the years. But, I did not appreciate who HM, Henry Moliason, the man really was until reading Ogden's chapter. Ogden had been fortunate to have worked in Suzanne Corkin's laboratory at MIT doing studies with HM around the time he turned 60. Her descriptions of his presurgery history, his everyday life since the surgery, his personality, and her personal conversations with him as well as his limited understanding of his place in scientific history, give what most of us already know about this case a rich new context.
The case of a woman, who endured a hemispherectomy (Chapter 9), while relatively unknown in comparison to HM, is fascinating in its demonstration of the limits of plasticity in the developing brain. Again, Ogden follows this woman's life story from her head injury in infancy through her adult life. The tragic story of the woman's childhood brain injury and subsequent surgeries is intertwined with her cognitive and psychological development, family interactions, neuropsychological evaluations, and CT scans, together with theoretical explanations make this an instructive yet heartwarming story. In other chapters, Ogden provides us with this same level of the human experience of brain damage. In Chapter 2, she describes two cases of aphasia. The first is a case of expressive aphasia in a young Maori man, who was brought into the hospital by his friends following a cerebral hemorrhage. This was a man from an indigenous community in New Zealand who had struggled in school, dropping out at age 15, and who was a member of a Maori gang. Ogden pulls together the role of this man's early history, socioeconomic status, and minority culture's impact on his assessment, rehabilitation and course of recovery. The second case is of a well educated 68-year-old white woman who suffered a left superior division middle cerebral artery stroke leaving her with a classic Wernicke's aphasia. The people in each case could not be more different other than each had a stroke and lost their language. But, in this chapter the contrast of backgrounds and the disease, brings the reader beyond the dichotomy of expressive and receptive aphasia and into the realm of what happens to patients in the real world who suffer the tragic consequences of aphasia.
Hemispatial inattention or the neglect syndrome is one of the most fascinating behavioral phenomena in brain disease. In Chapter 3, Ogden describes a 50-year-old artist with a right hemisphere syndrome secondary to a grade 2 astrocytoma. In her description, she presents not only the patient's hemispatial neglect, with test data and real life examples, but also descriptions of her anosagnosia and personality change in order to provide the flavor of the right hemisphere syndrome. Ogden's descriptions are based on serial evaluations over a four year period and include information obtained from family and treatment staff so you are not simply seeing a snapshot of the patient's condition but the illness evolving with the effects of time and various treatments. In subsequent chapters cases are presented in the same way to demonstrate frontal lobe disease (Chapter 4), autotopagnosia (Chapter 5) and cortical blindness (Chapter 6). Chapter 8's story tells how even seemingly good treatment options can pose hard choices. It's the story of a recently married young woman whose temporal lobe epilepsy is well controlled with medication. However, because the medication is contraindicated in pregnancy she faces a dilemma. In order to be able to become pregnant, she considers and then opts for having a right temporal lobotomy. But, this too has its downside in that she is also a musician, and the consequences of the surgery will likely impact her musical abilities. Chapters 10 and 11 involve traumatic brain injury, mild and severe. The stories of two boys from very different walks of life who suffered mild traumatic brain injuries playing soccer are especially timely given the current climate on sport related concussions. The story of a talented young woman who incurred a severe head injury in a motor vehicle accident and her long struggle with rehabilitation to regain some semblance of a normal life is sad but also uplifting. The last three chapters are devoted to cases of neurodegenerative diseases. Chapter 12 differs from other chapters in that the narrative comes from the patient. He is a 50-year-old physician who develops Parkinson's disease. From its insidious onset to its inevitable conclusion, Ogden shares with the reader with the trials and tribulations of a doctor becoming a patient and coming to terms with this life changing neurological and neuropsychological disorder. Chapter 13 spans three generations of a family with Huntington's disease. It explores the human as well as the psychiatric and neurological side of this devastating disorder, and issues surrounding genetic testing. The final chapter is a story of early onset Alzheimer's disease. It's a story about a well-educated upper middle class woman with a wonderful family who knew much about Alzheimer's disease having cared for her affected mother. At age 49 she began experiencing similar symptoms, and the narrative takes the reader through her journey, the family's struggles as caregivers, and the challenge of the neuropsychologist to be there as a guide and resource for all of them.
Case studies remain a powerful tool in the study of brain and behavior. In this book of case studies, Ogden describes 15 of her most memorable cases. In each case she integrates the patient's diagnosis with her assessments and detailed stories of each patient's life which can only be gleaned from longstanding relationships with each patient. Her description of each case, the behavioral syndrome, evaluations and outcomes are presented with historical background, scientific rigor and theoretical explanations that can only have come from her many years of clinical experience in neuropsychology. By the end of each chapter the reader feels he or she too knows the patient, as well as having a thorough understanding of the disorder. Because every case in neuropsychology is somewhat unique, clinicians need to appreciate the impact of a range of variables, physiological and psychosocial, as both influence outcomes. In Trouble in Mind Ogden achieves this by putting a human face on her patients. I highly recommend this book to the student of neuropsychology, who while they are studying neuroanatomy and assessment will also hopefully grow to appreciate the uniqueness of each patient, and to the practicing neuropsychologist, to remind us that all of our most interesting cases are real people.
