Jules Montague

I purchased this book in the hopes it would help me understand the process of dementia. Perhaps in understanding, to better relate to those who have the condition. This is not that book. It is, however, a very interesting book about the brain and how it functions, or more particularly, how it malfunctions.

Through case histories, the author describes several types of brain malfunction and explores the question: Who are we when our brain no longer remembers who we were? That is the focus of the book, defining personality, soul, spirit or whatever it is that makes us who we are. As a complete novice to medical literature and terminologies of brain function, I still found this book compelling and interesting. Admittedly, I did not stop to look up every medical term, but the author went into enough detail in lay-person terminology that I was able to follow the meaning.

The cover is quite misleading giving the title as "Lost and Found: Why Losing Our Memories Doesn't Mean Losing Ourselves; when the actual title is: Lost and Found: Memory, Identity, and Who We Become When We're No Longer Ourselves. I would recommend this to anyone interested in the definition of "self," or in the function of the brain for that aspect.… (mehr)

As the subtitle of her book suggests, consultant neurologist Jules Montague is interested in “memory, identity and who we become when we’re no longer ourselves”. She states up front that the concept of “identity” encompasses not just how we see ourselves but also how others see us. “Self”, on the other hand, “refers primarily to the experience of the individual, (a sense of one’s own being).”

Montague proceeds to look at a number of neurological (and some psychiatric) disorders, among them: Alzheimer’s Disease; Korsakoff syndrome (a chronic memory disorder caused by severe Vitamin B-1 deficiency, most commonly seen in longtime abusers of alcohol); dissociative amnesia/fugue states (in which patients’ autobiographical information is out of reach, often as the result of traumatic events); frontotemporal dementia (which has an earlier onset and a more significant inherited component than Alzheimer’s and is initially characterized not by memory loss but by dramatic, inappropriate behavioural change—think: kissing complete strangers or urinating in public); multiple personality disorder, now known as dissociative identity disorder; Parkinson’s Disease; and ALS.

The author doesn’t entirely restrict her discussion to those with brain disease. She also considers the unreliability of memory in neurologically normal people. Memories are not stable in any of us, Montague reminds the reader. A memory is rebuilt each time it is accessed, with new details added each time—based on what a person has experienced and learned since last calling up the memory. False memories can be implanted in anyone, and a person doesn’t have to be cognitively impaired to embellish, distort, or transpose details that are recollected.

In reading Montague’s book—a synthesis of philosophical, psychological, and neurological material—I was reminded of things I already knew about the way in which memory does and doesn’t work. I was also glad to encounter some new information. A few times, Montague does make pertinent observations about identity in patients with disordered brains, but sometimes the matter of identity takes a back seat to other details about the conditions. The author does note that family members are most likely to perceive a neurologically impaired loved one as essentially himself if his core moral faculties are preserved—that is, if he still shows empathy, gratitude, a sense of fairness, and a willingness to cooperate, etc. (The loss of other mental faculties does not seem to matter as much for a patient to continue to be seen as himself.) Montague also refers to interesting research on patients with semantic dementia, a kind of frontotemporal dementia which causes the loss of language abilities. The study revealed that some brain lesions can actually make a patient even “more himself”. When semantic dementia affects a patient’s dominant anterior temporal lobe (usually the left one in a right-handed subject), he is likely to experience a heightening of the philosophical, spiritual, or religious impulses he showed in his former life. His behaviour remains consistent with his pre-morbid identity. However, if the non-dominant frontal lobe (the right one in most people) is affected, there can be diminishment, even reversal, of the patient’s previous core values and self-concept. A normal, intact non-dominant frontal lobe, the study’s authors suggest, ensures the maintenance of the self—from political and religious affiliation to career choice.

Some of the conditions Montague explores in her book quite naturally raise questions about identity. However, a number of them do not. It’s a bit of a stretch to examine sleep disorders (including sleep walking and nighttime out-of-body experiences) through the lens of identity. Comas, vegetative, and minimally conscious states also seem to have less to do with identity per se than with the matter of consciousness. A section on multiple personality disorder, which focuses almost exclusively on criminals opportunistically using the diagnosis to get away with having committed murder, really have no place in a book that purports to deal with “who we become when we are no longer ourselves”. All this is to say that Montague frequently strays from her stated purpose. Her book often reads more like a ragbag of interesting neurological tidbits than a serious consideration of how diseases that strike the brain alter self-concept and others’ perception of who the patient is (or who he has become). The title, too, is misleading: The selves of many of the patients Montague reports on are lost and never found again. Patients move further and further away from the people they were thought to be.

As interesting as I found some of the material, I was frustrated by the poor quality of the writing in the book. There are several pages on which grammatically correct sentences are outnumbered by sloppy fragments. Rules regarding punctuation are regularly ignored. Clarity is sacrificed to a loose, rambling, conversational style. Words are often used carelessly and imprecisely.

To provide an example, consider the term “Personality”—an important one in a book like this. The problem is that Montague can’t seem to use it in a clear and consistent way. In one section (without explaining what she means) she mentions that personality “shapes” us—which surprised me. I’m used to thinking about the things that shape personality: nature (genetic inheritance), nurture (environment, including parenting), and experience. A few pages later, the author changes tack: Now, “Personality” is described as “not just a bundle of traits [in a person], but the very notion of ‘who he is’.” Things then get even more muddled when Montague wonders if a “shift in personality” might change the essence of who he [a patient] is”. Hmmm. . . Didn’t she just imply that personality was a person’s essence? She said it was “the very notion of ‘who he is’”.

On another page, the author instructs the reader: “Plot the essence of you over time—do you see yourself disrupted and dissociated from one day to the next, or instead a character perpetually continuous and connected?” (“The essence of you”? . . . sounds like a perfume. How do you “plot” it? And what about the phrase ”perpetually continuous and connected”? What’s that about? If Montague is asking the reader whether he perceives his “self” or identity to be fairly consistent over time, why doesn’t she just say so?) Where was the editor? How could this kind of writing have passed muster?

Montague’s book had the potential to be a fine one, but it needed to be more rigorously edited and revised. I did pick up new information, but that learning demanded more work and annoyance than it should have.… (mehr)