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My stroke of insight: A brain scientist's personal journey

Article  in  Laterality · September 2010

DOI: 10.1080/13576501003621194 · Source: PubMed

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Laterality: Asymmetries of Body, Brain and Cognition

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My stroke of insight: A brain scientist's personal journey

Sophie Blancheta
a
Laval University, Quebec City, Canada

Online publication date: 24 August 2010

To cite this Article Blanchet, Sophie(2010) 'My stroke of insight: A brain scientist's personal journey', Laterality:
Asymmetries of Body, Brain and Cognition, 15: 5, 572 — 575
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 LATERALITY, 2010, 15 (5), 572
575

Book Review

Bolte Taylor, J. (2006) My stroke of insight: A brain scientist’s personal

journey. New York: Viking, Penguin Group (USA) Inc. Price: $24.95. 188 pp.
ISBN: 978-0-670-02074-4
Downloaded By: [Canadian Research Knowledge Network] At: 15:30 8 September 2010

This book will change your view of strokes occurring in the left hemisphere
(LH). Dr Jill Bolte Taylor, a neuroscientist at Harvard Medical School,
describes her life following a massive stroke. In 1996, at only 37 years of age,
she was suddenly the victim of a stroke caused by a congenital arterio-
venous malformation. Three weeks after the onset of her stroke, Dr Taylor
had surgery to remove a clot the size of a golf ball that was compressing the
language areas in the LH. With its descriptions of the extensive cognitive
deficits caused by a stroke, this book allows the reader to truly understand
how those impairments interfere significantly with many different activities
of daily life.
The book is divided into 20 chapters, beginning with a description of
Dr Taylor’s life before the stroke, followed by an account of the cognitive
and motor degradations during stroke onset and her hospital experience.
The book goes on to describe Dr Taylor’s recovery of cognitive and motor
deficits, ending with a portrait of her new life. In the appendices the author
outlines alarming signals of stroke onset as well as providing advice for the
caregivers of patients who have suffered a stroke.
In Chapter 2, the author provides a few straightforward elements of
neuroanatomy as well as a description of the different types of stroke
(i.e., ischaemia, haemorrhage, and congenital arterio-venous malformation).
Chapter 3, gives a general view of the role of each hemisphere in different
cognitive functions. In Chapter 4, Dr Taylor discusses her own case: how
different motor and cognitive functions under the LH control were severely
affected within a few hours. Her inability to move her right arm due to the
damage of the motor cortex in the LH revealed to her that she was the victim
of a stroke. She also describes, in this chapter and subsequent ones (until
Chapter 12), all her cognitive impairments and their impact on daily life
activities. The author lists a lot of cognitive impairments, although no
information acquired from an objective neuropsychological assessment is
given. Dr Taylor explains that, due to the origin of the stroke in the posterior
parietal area (i.e., ‘‘associative area of orientation’’), she lost the faculty to

# 2010 The Author

http://www.psypress.com/laterality DOI: 10.1080/13576501003621194
 BOOK REVIEW 573

delimit her body from space. The author mentions this phenomenon many
times. On the basis of neuroimaging findings (d’Aquili & Newberg, 1999),
she associates her altered sense of space with parietal damage in her LH. The
onset of the stroke brought about a loss of verbal communication (i.e.,
expression, understanding) caused by damage to the Broca and Wernicke
areas. For instance, numbers and words did not have any meaning for her*
even a word as simple as ‘‘mother’’ lost its meaning. When trying to phone
for medical assistance, she could only produce a rumbling noise from her
throat. Her mind was silent and void of any interior dialogue. Besides
language deficits, other cognitive functions under LH control were also
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altered. Her inability to do two tasks at the same time, or to follow a

conversation involving more than one other person, is suggestive of an
impairment in working memory. Her inability to discriminate relevant
information from background noise during a conversation in a noisy place
may indicate some selective attention deficits. Her mathematical abilities,
such as numbers and operations (i.e., addition, substraction, multiplication,
division), were also impaired. It is well established that the LH is involved in
analytic judgement (Hellige, 1996), which was altered in Dr Taylor. Her
inability to use familiar objects, such as a phone, probably indicates that she
suffered from apraxia.
This book should prove to be very helpful not only to clinicians*as it
offers insight into the severe aphasia that can follow a LH stroke with an
intact right hemisphere (RH)*but also to the general public. It provides
valuable insight into the communication difficulties and the experiences of
persons with impaired expressive skills after a LH stroke. Indeed, it is always
a challenge to communicate with someone who loses his/her verbal faculties
or to truly understand what a person with a severe aphasia experiences.
In Dr Taylor’s case, in contrast to the deficits in the LH, the expressions
of the RH functions were exaggerated. The author became very sensitive to
non-verbal communication: she was very aware of the prosody and tonality
of the voice or the posture of her interlocutor. Instead of an interior
dialogue, a juxtaposition of images took place in her mind. Furthermore, the
author writes that her level of empathy increased after the stroke, in
agreement with the well-known role of the RH in empathy (e.g., Rueckert &
Naybar, 2008). Because she lost the capacity to determine the boundary
between herself and space, she perceived herself as a whole in an unlimited
universe. She supports her introspections with neuroimaging findings that
have reported decreased activity in the posterior parietal area during
meditation states in nuns and priests (d’Aquili & Newberg, 1999). As a
result, she experienced a complete peace of mind.
In Chapters 13 to 15 Dr Taylor details her 8-year recovery. The author
benefited from the care of language therapists and occupational therapists. A
psychologist also helped her to verbalise what she lived through on the
 574 BOOK REVIEW

morning of her stroke. No cognitive rehabilitation seems to have been

provided. Even though patients with LH stroke have a worse prognosis than
those with RH (Hochstenbach, den Otter, & Mulder, 2003), Dr Taylor
recovered a high level of functioning many years after the stroke. Her belief in
brain plasticity probably helped her to persevere though the recovery
processes. Every moment not spent in sleep was devoted to different cognitive
activities adapted to her level of functioning (e.g., learning letters and words,
simple puzzles), aided by the constructive and warm support of her mother.
For instance, Dr Taylor learned to read, write, and speak with children’s
books while still in the acute phase. Hochstenbach et al. (2003) reported that
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the largest long-term improvements concern attentional resources up to 2

years after the stroke. In contrast, however, Dr Taylor specifies that it was only
4 years after the stroke that she was able to conduct two tasks simultaneously,
revealing probably a long-term enhancement of her working memory. She was
able to carry out basic mathematical operations, such as addition, 4 years
after the onset of the stroke, followed by subtraction and multiplication
operations. Division was the last arithmetic operation that she successfully
performed 5 years after the stroke onset.
By describing the extent of the cognitive strategies that the author had to
develop for herself, this narrative implicitly underlines that the cognitive
rehabilitation in clinical practice needs much improvement. Her experience
reminds us that cognitive rehabilitation is one of the most neglected stroke-
related research fields. For this reason, after a 2003 Canadian Stroke
Network consensus conference, Bayley et al. (2007) identified this research
field as one of the highest priorities in stroke rehabilitation.
Dr Taylor’s book ends with a chapter detailing her new life. She adopted
an optimistic view regarding the impact of a stroke. She points out that her
stroke has changed her personality in that she has become more RH
dependent. She adopted a resilient and positive attitude by accepting these
inevitable changes. She never expected to remain the same person as she was
before the stroke onset. Remarkably, Dr Taylor has been able to return to a
similar premorbid employment and is now a neuroanatomist affiliated with
the Indiana University School of Medicine.
This book is directed towards the general public; it is easy to read for
individuals without a background in psychology. It can be recommended to
a friend or a family member who wants to better understand a stroke and its
symptoms, its consequences as well as recovery. I think that everybody
working with stroke populations should read this book. A professor
providing courses in cognitive psychology or neuropsychology at different
university levels will find interesting examples of the role of cognitive
functions in daily life. The book has been translated into several different
languages. In addition to this book, the author uses other media (website,
TV shows) extensively to promote stroke awareness. The use of media to
 BOOK REVIEW 575

spread awareness is all the more relevant considering that the incidence of
stroke in the upcoming years will rise exponentially because of the ageing
population. Notably, up to 65% of these individuals suffer from different
degrees of cognitive disorders that interfere with daily life functioning
(Donovan et al., 2008). Dr Taylor’s approach is therefore very laudable.
In this line of thought, Time magazine considered her as one of the 100 Most
Influential People in the World (2008).
Unfortunately, the author provides no scientific references that make
explicit relationships between cognitive impairments and underlying brain
lesions or the concept of brain plasticity. Only the book of Eugene d’Aquili
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and Andrew B. Newberg, The Mystical Mind: Probing the Biology of

Religious Experience (1999), dedicated to a general public, is mentioned to
account for her feeling of being one with the universe. Dr Taylor’s book also
makes some references to certain websites (National Institutes of Health,
Proceedings of the National Academic Sciences). Importantly, this book
implicitly raises awareness of some gaps that need to be filled for improving
the cognitive rehabilitation of individuals with cognitive impairments
following a stroke in the left hemisphere.

SOPHIE BLANCHET
Laval University, Quebec City, Canada

REFERENCES
Bayley, M. T., Hurdowar, A., Teasell, R., Wood-Dauphinee, S., Korner-Bitensky, N., Richards,
C. L., et al. (2007). Priorities for stroke rehabilitation and research: Results of a 2003 Canadian
Stroke Network consensus conference. Archives of Physical Medicine and Rehabilitation, 88,
526
528.
d’Aquili, E., & Newberg, A. B. (1999). The mystical mind: Probing the biology of religious
experience. Minneapolis MN: Fortress Press.
Donovan, N. J., Kendall, D. L., Heaton, S. C., Kwon, S., Velozo, C. A., & Duncan, P. W. (2008).
Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22,
122
135.
Hellige, J. B. (1996). Hemispheric asymmetry for visual information processing. Acta Neurobio-
logiae Experimentalis, 56, 485
497.
Hochstenbach, J. B., den Otter, R., & Mulder, T. W. (2003). Cognitive recovery after stroke: A 2-
year follow-up. Archives of Physical Medicine and Rehabilitation, 84, 1499
1504.
Rueckert, L., & Naybar, N. (2008). Gender differences in empathy: The role of the right
hemisphere. Brain and Cognition, 67, 162
198.

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