The New Wounded: From Neurosis to Brain Damage
Fordham University Press, 2012. Translated by Steven Miller. 249 pages, US$32.00, paperback
I. Unrecognizable Subjects and the Irruption of Trauma
“You know who my mother was?” a voice asks from off-screen. The elderly woman shakes her head.
“You…You are my mother,” the interviewer replies.
“How can I really be your mother then?” the woman asks earnestly.
“You are,” the interviewer reassures her in a kindly voice, “you are.”
“I don’t know, something went wrong…” she says smiling, unsure.
The above exchange is one among many poignant, emotional vignettes in Deborah Hoffman’s 1994 film Complaints of a Dutiful Daughter. Throughout the film, Hoffman struggles to find a way to relate to her aging mother with Alzheimer’s disease; a mother who, in her failure to recognize her daughter, consequently places her own recognition at risk. Who is she now? How do I relate to her? Hoffman asks us. It was likewise the sudden mutual failure of recognition, the depersonalization, of an aging grandmother that inspired Catherine Malabou to write her latest book, The New Wounded: From Neurosis to Brain Damage (henceforth New Wounded). Originally published in French in 2007 and recently translated for English-reading audiences, Malabou’s work, like Hoffman’s, is an effort to develop a language to talk about the “psychic attack” of cerebral pathology and trauma. Malabou pushes us to “think the new faces of suffering” (xix) that arise in the wake of senseless accidents, lesions, and catastrophes; a call for a new analytic approach to contemporary forms of trauma and the often unrecognizable subjects who stand in its wake.
Malabou is no stranger to writing and reflecting on developments in neuroscience– in 2004 she published What Should We Do With Our Brain? (henceforth ‘Brain?’), which positioned ‘plasticity’ as a foundational trope for exploring contemporary developments in neurology, namely the experimental elaboration of neuroplasticity. Plasticity, in that work, appeared as a form-giving synaptic palette of possibles – an operation that was primarily ‘developmental’, ‘modulational’, and ‘reparative’. If Brain? was a treatise on the unbounded, positive, constructive aspects of plasticity, then the New Wounded is a reflection on what Malabou calls ‘destructive’ or ‘negative’ plasticity – that which operates precisely in the moment of a “radical rupture that trauma introduces into the psyche” (156). Destructive plasticity, in contrast to the ‘positive’ plasticities outlined in Brain?, paradoxically produces form through the annihilation of form. It is most visible in the “creation of identity through loss of past identity” (60, emphasis hers) that follows in the wake of neurological lesions and other cerebral pathologies that profoundly impact neurological functioning (i.e. trauma). The central question posed by such traumatic ruptures reveals the capacity for destructive plasticity to make us anew in the wake of our own destruction, not through our redemption, but through our erasure. What sort of analytics and therapeutics, asks Malabou, are demanded by the irruption of the traumatic wound-event, the survival of the subject past its own annihilation?
This rupture–the ‘sheer, meaningless accident’–is the site which allows Malabou to “organize a confrontation between the Freudian approach and the neurological approach” to traumatic wounding (166). Although, according to Malabou, neither approach has adequately conceptualized the ramifications of irruptive trauma, her primary concern is to depict the theoretical exhaustion of Freudian psychoanalytics with regard to contemporary traumatic injuries. Through a careful analysis of Freud’s texts, Malabou reveals the analytic insufficiencies of a hermeneutic psychoanalytics. Malabou deftly suggests that if the “shredding” of the psyche that occurs in the wound-event is, indeed, a birthing of a categorically “new person”, a person beyond their own psychic history, then ‘regression’ is impossible. This poses a distinct problem for Freudian psychoanalysis, which never lets go of the historical-libidinal psychic apparatus of the individual: an anticipatory psychic structure which absorbs all shocks into a psycho-sexual grid of libidinal drives and psychic traces (133). Malabou instead positions the rupture of trauma–the destruction inherent in the meaningless accident –beyond this possibility for a hermeneutic significance of such psychic histories. As such, for Malabou, there is no possibility of a return to the primitive psychic stratum ruled by a regime of ‘sexuality’. Thus, psychoanalysis remains unable to fully speak about the ‘lost persons’ of neurotrauma, ones who do not ‘regress’ but instead ‘shatter’–whose histories are left behind in the moment of erasure. How, then, do we develop “a thinking of the destruction of the psyche different from that of psychoanalysis” (84)?
II. ‘Cerebrality’ and The New Wounded
Staging a productive meeting of two regimes of the event, Malabou then turns to the neurological approach to traumatic injury, a “regime of eventality” she names ‘cerebrality’ (10). Put simply, cerebrality is a new relation between the wound-event and the psyche, one that wagers on the “cerebral etiology of psychic disturbances”. Where psychoanalysis linked ‘sex’ with ‘sexuality’, Malabou’s ‘cerebrality’ instead links the ‘brain’ with cerebral-psychic (mal)functioning (2). Cerebrality is a concept which affirms that a “cerebral organization presides over a libidinal economy”, and as such, “the brain appears as the privlidged site of the constitution of affects” (3, emphasis hers). Here she relies heavily on the contemporary neuroscientific perspectives on the ‘affective brain’–particularly from the preeminent neuroscientist Antonio Damasio–that guides her assertion that “any shock, any especially strong psychological stress, or any acute anxiety, always impacts the affective brain–this unrecognized part of the psyche” (xvii). The erasure of psychic history, the site of the failure of psychoanalytic theories of trauma, is thus the acute place to witness the cerebral effects of lesional plasticity, which manifest themselves as psychic disorganization-or more specifically, as emotional deficits. The centerpiece of this pathological process is the eponymous ‘new wounded’, those who have survived the annihilation of their identity, those who now, according to Malabou, “are characterized by disaffection or coolness” (49). In other words, the survival of the subject past the senselessness of its own accident invariably results in a new form of psychic suffering, “the malfunctioning of affective signals…[resulting in] behaviours of indifference or disaffection” (10). Cerebrality helps to articulate this new relationship between the brain, catastrophe, and the psyche: wound-events that produce suffering in the form of apathy rather than neuroses.
As an exemplar of the ‘new wounded’, Malabou deploys the paradigmatic example of neuronal injury in the neuroscience literature (again following Antonio Damasio)–that of Phineas Gage, a construction foreman who, in the mid-nineteenth century suffered a severe cerebral penetrating injury (15). Because Gage suffered profound post-injury changes in his personality, he is a prototypical case for Malabou’s argument, illustrating the ‘metamorphosis in being’ in the wake of cerebral traumatic injury. But he also deeply undermines Malabou’s insistence that the symptom of affective coolness, or disaffection, is the unifying quality of the ‘new wounded’. Instead of manifesting an unbreachable “coolness of affect”, Gage – in his post-injury state–was described by his doctor, in quite outmoded terms, as having “the animal passions of a strong man” (Harlow 1993: 277). Indeed, even today, it is well accepted that “aggression is one of the most common consequences of traumatic brain injury” (Rao, Rosenberg, Bertrand et al. 2009). Likewise, studies on the prevalence of aggression in patients diagnosed with Alzheimer’s disease make it clear that “aggressive behavior is a common phenomenon” observed in this population (see e.g. Eastley and Wilcock 1997). This is hardly the picture of the “affective barrenness” that Malabou insists “is the trait that all of these [new wounded] states have in common” (157).
A pedantic criticism, perhaps, but offered only in response to Malabou’s suggestion that the inevitable substitution of sexual for cerebral ‘eventality’ in fact relies on a “general theory of trauma that [is]…founded upon the elucidation of the traits that all of the new wounded have in common” (xix). Further, the list of what constitutes the ‘new wounded’ is indeed long and diffuse–encompassing “victims of various cerebral lesions or attacks…Patients with degenerative brain diseases…schizophrenics, autistics, epileptics…” (10). To find a symptomatic common denominator in all of these incredibly varied and distinct cerebral pathologies is at best reductive; at worst, misleading. Although her insistence that every cerebral ‘accident’ has both cognitive and affective repercussions might be grossly accurate, it is again her conflation of the two that reveal an analytical languor with regard to the neurosciences. Just as sociopolitical trauma produces effects at different sites and in different manifestations than organic trauma–a difference that Malabou wants to ultimately efface in her analysis–so cognitive sequelae are not reducible to affective ones. For an author who is painstakingly precise with her readings of Freudian theories of trauma, it is surprising to see such broad strokes painted with regard to her own conceptual contributions, namely with ‘cerebrality’ and the ‘new wounded’.
III. Thinking Beyond Malabou’s Beyond
Aside from these shortcomings, Malabou is always decisive in her incision: she cuts where psychoanalysis has hemorrhaged, where it has lost the dream as text and the subject as history. The third section of her book, On the Beyond of the Pleasure Principle-That It Exists, is Malabou’s finest; avoiding a reductive synthesis of psychoanalytics with neuroscience, but rather offering a productive provocation to take the ‘death drive’ seriously, to search past the pleasure principle and the confines of the regime of sexuality, toward something new–a formative power at work in the erasures of trauma. Malabou’s central claim–that the psyche paradoxically survives its own annihilation, and that neither psychoanalysis nor neuroscience has the appropriate vocabulary to talk about this form of post-traumatic survival–is thus both a pressing and convincing call to reposition contemporary discussions about trauma. Further, her incisive critique of the dominant tone of optimism pervasive in neuroscientific approaches to plasticity (almost always focused on the redemptive and the resilient) is quite accurate. Yet, Malabou may too strongly assert the ‘plastics of death’ as a form producer beyond all referent. Does trauma always entail an effacement of the subject, a psyche unable “to love or hate” (214)? Might it be better to ask what sort of ethics and politics of recognition positions the new wounded as unrecognizable in the first place, as forms of death in life (see e.g. Taylor 2008; Cohen 2008)?
While Malabou may be entirely correct in declaring that new identities indeed emerge –ex nihilo–in the wake of brain trauma, her analysis misses the persistent rejoinders, the possibilities of continuity envisioned and enacted in neurotrauma today. As Janelle Taylor (2008) notes, reflecting on her experience caring for her mother with progressive dementia, “we may need to…start looking more at how ‘selfhood’ is distributed among networks, sustained by supportive environments, emergent within practices of care” (326). That is, trauma and its ramifications might not necessarily operate (or terminate) solely in the apparatus of the individual psyche, but in and through the Other. Might Malabou do well to follow the question prompted by Hoffman’s film and ask “How exactly are we related”? What kind of story do we give to the ‘new wounded’, those who appear without precedent?
Malabou does indeed gesture toward the new demands for relating to the silent suffering of the disaffected, but it is only in her final pages that she suggests that we “elaborate anew the role of the analyst” in a therapeutic space beyond transference (215). In this sense, while a neuropsychoanalysis might be possible with the recognition of the effects of a ‘destructive plasticity’, Malabou remains constrained to the fixed positions of such psychoanalytics–a post-traumatic space between analyst and analysand. She seems to elide the manner in which the psyche survives its own annihilation not exclusively because of some formative power in the “dark core” of a destructive plasticity, but in the fact that its traces persist in the Other, who is–in the words of Adriana Cavarero (2000)–able to “give us our story”. And such donated narratives arrive in quite unusual ways. One sees this today in clinical biomedical approaches to neurotrauma, where charts, dreams, and stories encircle not only the patient, but the post-traumatic whirlwind that makes up a nexus of therapeutic intervention, which now extends far beyond the clinic or the therapist’s office.
In a striking example from a recently published case report, Galarza, Isaac, Porcar et al. (2013) write about a professional jazz guitarist with temporal lobe epilepsy who underwent a dramatic lobectomy, a complete removal of the temporal lobe of the brain. After his surgery, he lost not only his memories, but all musical interest and capabilities. Seven years later, he had regained his previous musical skills, releasing a well-received jazz album aptly called “The Return”. This is a celebratory report-a kind of exuberant neuroscientific memorandum, one perhaps that Malabou would find well-suited for her earlier work on ‘positive’ neuroplasticity. But did the patient not indeed survive the annihilation of his own person? And what of his recovery? Beyond a simple, mechanical sense of (positive) neurobiological plasticity, it becomes clear the patient was “aided by his father”, who “gradually introduced [him] back into his past, with the help of photos, encounters with friends, including other musicians, and mainly, by making him listen to his own records” (ibid.: 5). It is in this way that Malabou’s text, insisting that the “subject’s experience comes to an end in trauma” (70), fails to take seriously the possibility of the Other as a figure of return, as the potential site for the psyche’s survival in the form of another. The possibility of a survival where form is re-made through the destruction of form, where often the Other offers their persistent presence: “you are my mother,” insists Hoffman. “You are.”
Cavarero, Adriana 2000 Relating Narratives: Storytelling and Selfhood. Paul Kottman, trans. New York: Routledge.
Cohen, Lawrence 2008 Politics of Care: Commentary on Janelle Taylor, “On Recognition, Caring, and Dementia.” Medical Anthropology Quarterly 22(4): 336–339.
Eastley, Rebecca, and Gordon K. Wilcock 1997 Prevalence and Correlates of Aggressive Behaviours Occurring in Patients with Alzheimer’s Disease. International Journal of Geriatric Psychiatry 12(4): 484–487.
Gaetz, Michael 2004 The Neurophysiology of Brain Injury. Clinical Neurophysiology 115(1): 4–18.
Galarza, Marcelo, Claire Isaac, Olga Pellicer Porcar, et al. 2013 (in press) Jazz, Guitar and Neurosurgery: The Pat Martino Case Report. World Neurosurgery. http://www.sciencedirect.com/science/article/pii/S1878875013012308, accessed November 6, 2013. Available online.
Harlow, John M. 1993 Recovery from the Passage of an Iron Bar through the Head. History of Psychiatry 4(14): 274–281.
Rao, Vani, Paul Rosenberg, Melaine Bertrand, et al. 2009 Aggression After Traumatic Brain Injury: Prevalence and Correlates. The Journal of Neuropsychiatry and Clinical Neurosciences 21(4): 420–9.
Taylor, Janelle S. 2008 On Recognition, Caring, and Dementia. Medical Anthropology Quarterly 22(4): 313–335.
Yi, Juneyoung, David J. Padalino, Lawrence S. Chin, Philip BS Montenegro, and Robert C. Cantu 2013 Chronic Traumatic Encephalopathy. Current Sports Medicine Reports January/February 2013 12(1): 28–32.
 It is understandable that Malabou’s project, to a certain extent, is not concerned with working through the details of specific psychopathologies, but is instead working ‘beyond psychoanalytics’. It is in this sense that the list she provides is intentionally broadened to include “patients whom psychoanalysis has attempted to cure without success” (10). The ‘new wounded’ are thus positioned as an emergent category of subjects who “suffer from disturbances that had yet to be identified during Freud’s time” (ibid.). It is, in this context, fair to permit Malabou a certain conceptual liberty at the expense of technical clarity, as the category provides her expanded analytic possibilities to articulate the book’s conceptual centerpiece: the brain-psyche relationship constituted in the notion of ‘cerebrality’.
 However, Malabou declares that neuroscience has not adequately theorized ‘destructive plasticity’ as an injury mechanism. In the traumatic brain injury research of the last five years, the field has indeed taken this up seriously. First, one can see how knowledge about brain lesions has changed dramatically, especially with regard to “secondary injuries” (the cerebral events that unfold after the initial traumatic insult), e.g. “traumatic”/“diffuse axonal injury” now extended across the spectrum of brain injuries (see Gaetz 2004); and more recently (and explosively), with the emerging diagnostic entity called ‘chronic traumatic encephalopathy’ (see Yi, Paladino, Chin, et al. 2013), which is making headlines with its impact on North American professional football policy and ongoing litigation.
 For those interested, the guitarist is Pat Martino, who released “The Return” on Muse Records in 1987.
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