Book Review

My Stroke of Insight: A Brain Scientist's Personal Journey

N Engl J Med 2008; 359:2736December 18, 2008

Article

My Stroke of Insight: A Brain Scientist's Personal Journey
By Jill Bolte Taylor. 183 pp., illustrated. New York, Viking, 2008. $24.95. ISBN: 978-0-670-02074-4

Despite major advances in the treatment of stroke in the past 20 years — particularly in stroke units and in thrombolysis — fear of stroke and its consequences remains deeply embedded in popular consciousness. In addition, there are major differences between what patients view as recovery and what physicians view as recovery. A recurring theme of the relatively small literature on the experience of stroke is how often the enormous psychological impact of stroke is neither recognized nor addressed by members of the medical profession.

Narratives of stroke can serve a useful purpose in bridging these gaps, educating not only the public and those affected by stroke, but also doctors, medical students, and other health professionals. Some recent personal accounts have already assumed classic status, such as Roger McCrum's My Year Off: Recovering Life after a Stroke (New York, W.W. Norton, 1998) and Jean-Dominique Bauby's The Diving Bell and the Butterfly (New York, Alfred A. Knopf, 1997). Kirk Douglas's My Stroke of Luck (New York, William Morrow, 2002) gives a remarkable description of the personal growth that can occur with stroke. For those in the caring professions, reading these accounts protects us from becoming blasé about the seismic effect of stroke on our patients and reminds us of the times when we may have lacked sensitivity, perception, and attention to the real needs of our stroke patients.

In a new account, Jill Bolte Taylor, a notable neuroanatomist and an indefatigable advocate for brain banks, writes a moving and insightful account of her hemorrhagic stroke. The irony of a narrative of neurologic disease being recounted by a neuroscientist adds piquancy to the story, and Taylor's description of the onset and progression of the stroke while she was alone in her apartment is gripping. There is also much food for thought in her account of being met with both warmth and indifference by the many who were involved in her treatment, as well as the role of family in recovery from stroke. Taylor's bravery and resilience are formidable and help to dispel the simplistic notion of disability as a disaster.

What keeps this relatively short book from being a classic, however, is that it assumes more roles than its slender frame can comfortably bear. The perceptive narrative of the illness is invaluable, but it is burdened by an interpretation of stroke through the narrow lens of hemispheric function. Ascribing emotions, thoughts, and language to hemispheric function was clearly an important means of expression for Taylor, but stroke clinicians may chafe at her emphasis on lateralization and localization, which leaves out the wider effects of stroke on whole-brain function. The self-help advice given later in the book might be valuable for those who are similar to Taylor, but such advice needs to be matched carefully to the patient, and I would hesitate to pass this on to all patients. Nonetheless, this book is a valuable addition to the narratives of stroke and can be recommended, ideally along with the other narratives mentioned above, to those in medical humanities programs, as well as to students and professionals in the many disciplines that are involved in the treatment of stroke.

Desmond O'Neill, M.D.
Trinity College, Dublin 2, Ireland
doneill@tcd.ie