‘I am the thinnest person I know (and that’s saying something, for I am no stranger to sanatoria)’
Stephen was not an especially troubled person. He, in his full adulthood, had learned. For example, before entering any supermarket, with money in his bank account, he would stop and say thanks. Same with clean drinking water. Same with modern medicines, dentistry, etc… Pretty good. But he did defend his corner when he felt he was being bullied. And this led to a few rows. With partners, but at work too. That sort of thing. The problem is, trouble, troubledness, is relative. And being in London in the 21st century, he could be described as angry. I mean, had he been almost anywhere else, ever, he could not be described in this way. That is a fact. Because normal people used to be quite angry, it’s just no one could really see it, and certainly not tell others outside of their circle etc . . . Doesn’t matter. The thing is, one day, Stephen got hit in the head. An accident. The details don’t matter. But he didn’t report it to anyone, just dealt with the headaches, and if anything, maybe, forgot he was struck. He went the doctors and they thought he had depression at first. Because Stephen wasn’t as eloquent as he once was. Then one day Stephen feinted and ended up in hospital and they saw the damage in his head. Anyway, you’ve been filled in.
Stephen takes from his pocket a folded bunch of paper. Folded square. It has handwritten notes on it. Stephen reads it, to himself, but his lips move. It says.
The ventromedial prefrontal cortex processes feelings of empathy, shame, compassion and guilt. Damage to this part of the brain, which occupies a small region in the forehead, causes a diminished capacity for social emotions but leaves logical reasoning intact. In the second paper in the binder . . .
Stephen realises he is holding a binder and reading from it. There is no bunched paper. He chuckles a bit.
. . . researchers posed fifty hypothetical scenarios to six people whose ventromedial prefrontal cortices were damaged by strokes or tumours. Internal damages, not external. Their responses were compared with those given by twelve people without brain damage and twelve others with damage in brain areas that regulate other emotions, like me.
Stephen points to himself. He has drawn a crowd. They don’t understand his gestures. They are curious but not helpful. How could they help. Why would they want to? None of them know Stephen. None of them are local, they just work around here. They are just passing through. They will never be here. And even if they did know Stephen, what could they do? Just hope that they themselves were not hit in the head, or angry, depending on your view of culpability. And Stephen doesn’t want help. He’s reading.
Researchers found no difference among groups in their responses to scenarios with no moral content, such as deciding to turn a tractor left to harvest more turnips. Scenarios that did not require participants to directly harm someone elicited comparable responses among the groups.
Stephen can feel something running down his leg, and he assumes an insect and he doesn’t mind. A crawler maybe, hairy and small. It’s comforting, if anything, to be touched.
For example, people, regardless of whether they had brain damage, said they would classify personal expenses as business expenses in order to lower their taxes. Furthermore, members of all groups rejected decisions that would harm someone for the personal benefit of another, such as killing a new born a parent couldn’t care for. But people with damage to their ventromedial prefrontal cortex were about three times as likely to sacrifice one person for the greater good compared with people without brain damage or those with damage in a different part of their brains.
Stephen feels really in touch with his feelings and really appreciates the clarity of the writing. His penmanship is like musical. He knows the people watching him have their own problems. So as long as they don’t touch him, everything will be fine. Stephen likes the anonymity of the big city. Especially now, when he has no history. His memories are perfectly absent, and what better way to be.
The doctors says the study proves that moral judgment is shaped by two brain systems, one focused on intuitive emotional responses and another that controls cognition, and when one of those systems is compromised, decisions are crooked. You have the former he says, that’s why your memory itself is in fact intact, but not linear, or necessarily true, and this is connected to your speech destroyed during the accident. The prefrontal cortex is located in the frontal lobes of the brain. Why does he keep speaking about the pre-frontal cortex?
Stephen feels thirsty. Someone asks him if he’s okay and he nods. He nods but thinks you better not fucking touch me. And that seems reasonable. It seems reasonable to expect people to not physically touch you. Everyone has to have rules. A memory seeps through, someone saying to Stephen, people are too polite. Stephen could not disagree more. Stephen hopes that person has fallen into a hole. He’s getting annoyed thinking about it.
Functionally, the frontal lobes are involved in inhibiting inappropriate behaviour, decision making, and planning. For this reason, prefrontal cortex damage commonly leads to an inability to plan or to behave in ways that are socially acceptable. If the damage occurs in childhood, individuals may never develop any understanding of ethical behaviour. When an injury happens in adulthood, the person may realise what is socially required but may still be unable to behave in an acceptable way.
Something jars. It’s true, Stephen might’ve wanted to hurt the man who just brushed past him in the past. I mean, Stephen was standing still, so if the man touched him, bumped into him, then it is really the man’s fault.
The prefrontal cortex is involved with the ability to suppress speech, he replies, and actions that would be considered immoral or inappropriate in most societies. For example, the person would be unable to refrain from eating when hungry, even when that involved removing food from someone else’s plate. What is known as working memory can also be affected by prefrontal cortex damage. Working memory involves holding on to information for a number of seconds, like remembering a telephone number for long enough to key the digits into the telephone. The doctor places the folder on my legs, on to the bed, and a short silence ensues.
What’s really bad is what comes out. How it leaks out. How it is very detailed, how you see how it’s attached. Stephen had a sense of that before, but he’s not a surgeon or anything, or a meat worker.
The doctor speaks again, weight in his words following such a pregnant pause, wiping my lips. When there is damage to this part of the brain, the person typically will show a lack of empathy for other people; this is one of the factors involved in the development of antisocial behaviours. That’s why we think the man struck you. Some researchers have found that many violent criminals have defective prefrontal cortexes, with a decrease in the amount of brain tissue in this area. Such findings are associated with behaviour that involves dishonesty, a lack of guilt, and an inability to see situations from a different point of view. Surgical treatment may be necessary for cases of prefrontal cortex damage that are caused by tumours or bleeding in the brain. In many cases, no treatment is possible and people will typically require supervision due to difficulties with organization and impulse control.
Stephen sits in the chair and awaits his jumper. He said he’s cold and they bring him that. His chair is comfy and he could spin in it. It’s one of those. He thinks of pipes, the terminology of plumbers, like grey water and black water, and things falling. He doesn’t think it’s fair that centre avenues are now filled in for him, but he appreciates being able to see, hear, taste, touch, and takes the time to stop and say thanks. The main thing, Stephen explains, is now he doesn’t give a shit whether anyone else can do anything. The man he’s speaking to says, sometimes I feel the same.
SJ Fowler works in poetry, fiction, theatre, film, photography, visual art, sound art and performance. He has authored a couple dozen collections of poetry, artworks, collaborative poetry plus selected essays and selected collaborations. He has been commissioned by Tate Modern, BBC Radio 3, Whitechapel Gallery, Tate Britain, the London Sinfonietta and Wellcome Collection. He has been sent to Peru, Bangladesh, Iraq, Argentina, Georgia and other destinations by The British Council and has performed at festivals including Hay on Wye, Cervantino in Mexico, Berlin Literature Festival and Hay Xalapa. He was nominated for the White Review prize for Fiction in 2014 and his short stories have appeared in anthologies including Liberating the Canon, We'll Never Have Paris and Dostoyevsky Wannabe Cities: Amsterdam. His plays have been produced at Rich Mix, where he is associate artist, and his visual art has been exhibited at the Palais de Tokyo, V&A and Mile End Art Pavilion. He’s been translated into 27 languages and produced collaborations with over 150 artists. http://www.stevenjfowler.com