Matthew is a 24 year old, right-handed man who has had severe and
uncontrollable seizures since age 11. The cause of the seizures is
encephalitis, which is an infection (presumed viral) of the brain. This
infection produced scarring which resulted in spontaneously recurrent
abnormal electrical discharges. When the electrical discharges build up
to a certain level he will have seizures. During his seizures, he will
have an aura [warning] of an unpleasant emotion, he will become confused,
he will yell, grimace, turn his [head] side to side and will run
about.
I have personally observed several of these episodes. He appears
very frightening to others during the episodes. On one occasion we had a
laboratory technician hide behind the door for many minutes after Matthew
slammed into the door during a seizure. If someone is in his path, he
will stare at them, then run into them or push them violently out of the
way.
We monitored him in our critical care neurology unit with
videoelectroencephalography recordings in June of 1986. During that time
we could observe his typical range episodes, and correlate them with
abnormal electrical activity in the brain. His seizures have occurred as
often as 10 times a day.
On October 5, 1987, Matthew had surgery on the right side of his
brain, and on November 24, 1987, on the left side of his brain in a
structure called the amygdala. This is a structure that is often involved
in seizures and in manifestations of violent behavior Unfortunately, the
procedure was of no lasting benefit to Matthew. I believe that Matthew
has sufficient brain injury that he cannot control his outbursts of
aggression. Some of these are explicitly because of seizures [and]
completely beyond his control. Others are not related to seizures, but
occur because he has brain damage, delusional thinking, and lacks the
normal inhibitory behavior that people must exert in society.
Regrettably, this is likely to be a continuing condition with
Matthew.
It is sometimes difficult to tell whether violence is part of a
seizure, or whether it is acting out of "bad temper. " In Matthew's case,
I think all these are [beyond his control].
Matthew's medical situation is unfortunate. We have been unable to
manage this satisfactorily with medications and with surgery. I would
hope that the court and authorities would view his problems as a medical
rather than a criminal issue.
Sincerely ...
Matthew is slight in build, with boyishly silky, slightly long,
dark wavy hair; he sports a neatly trimmed beard. On an early June
evening in 1990, he has permission for a special visit with his parents
and a guest -- special because authorities at the high-security hospital
for the criminally insane are strict about the number of visits to each
inmate per week. Matthew has spent almost a year here, and 16 more years
in schools and hospitals for young people with severe neurological and
psychiatric disease. Since the beginnning of the summer, the internal
review board of a prestigious medical center has been considering his
parents' request for neurosurgery to get him out.
We had to put our belongings in a metal locker behind the guard's
desk, keeping only a small tape recorder, and passed through an
airport-style metal detector. Armed guards escorted us through two sets
of locked doors, along a corridor into a room with brown Formica
furniture upholstered in bright blue vinyl. Matthew sits in one of the
chairs, facing us, wearing khakis, clean white socks, slip-on Keds, a
hospital shirt tucked neatly into his beltless pants, and sunglasses. A
burly security guard stays for the visit, too -- protection against
Matthew's unpredictable and violent rages.
Matthew: (Shaking hands.) How do you do ma'am. How about a
soundcheck? Sure. (Leaning forward, singing into the tape recorder.) "I
just called to say I loooove you, I just called to say how much I
care."
Visitor: I want to ask you about your feelings, Matthew, about
getting a brain operation.
Matthew: Yes. I want to leave here. With violent seizures, I have
been put here. They don't really know about them and they think it's just
me being bad and acting out. When I was in [a state mental hospital] this
lady named Fran told me I was a bad case, and making it up. Yes ma'am,
she said it, but I'm not.
Visitor: If doctors said to you, "Matthew there's a chance this
could help," you would do this, have an operation on your brain?"
Matthew: Yes. (Turning to look at the guard talking loudly on the
wall phone.) Can you wait until he is off the phone? I am having trouble
concentrating. I'm sorry for the interruption. Please excuse me for
saying to wait.
Visitor: When you have your violent seizures, do you remember
anything?
Matthew. No, wait, wait, yes. Sometimes. Yeah. Like I was telling
my father last night. I don't know how I do it. But -- put your fingers
over your ear (we all cup our hands over our ears) and for about a
second, I hear a muffling sound. You can hear air coming.
Visitor: You mean like putting a seashell over your ear?
Matthew: Yes, yes, yes, exactly, exactly. After that, I get a
ringing sound in both ears. One time with a violent seizure, I was in the
shower room up at ward 8 and I went into one of the showers, and I went
in there and I was hearing the ringing sound. And what happened was this
man Rudolph --
Visitor: [Rudolph] works in the hospital?
Tags:
bad reputation,
belief,
brain surgery,
dilemma,
horizon,
human brain,
human subjects,
lobotomy,
mental illness,
nam,
neurology,
philosophers,
pretension,
psychiatric disorders,
psychosurgery,
record keeping,
safeguards,
scientists,
strict regulations,
successes,
surgery,
worth the risk,
wretched excess
