Do you think it is possible to write a simple sentence without being able to tell what it says a few minutes later? Well, if your handwriting was really bad, it would indeed be very likely. For the man I’m going to talk about in this case, this is a day to day struggle. However not that his handwriting is to be blamed, but a neurological cause!

As a child, we learn how to read and write almost simultaneously and it is commonly believed that if one is learned, the other is automatically mastered. It is assumed as soon as we have learned both, similar processes in the brain are activated when we read and write. This case however proves the both abilities are not just a combination, but present themselves as a clear separation.

For Howard Engel (86 years old), this task separation of reading and writing became apparent out of the blue. The morning of July 31st 2001 started out to be like every other morning. Wake up, go to the bathroom and get the daily newspaper Globe & Mail. At first, everything seemed ordinary, but as soon as he began taking a look at the newspaper he experienced something peculiar. The letters appeared differently when he took a closer look, but not the familiar 26 Latin letters appeared as he was used to, but for one moment Cyrillic and the next moment Korean letters. It seemed his morning paper was written in a foreign language, however this was not the case. To be sure that the problem was not the newspaper, he checked books in his library, however no matter if they were written in French, German or English, all were unintelligible to him. On the way to the hospital, we was unable to identify street names and could not read “Emergency Room” once arrived at the hospital.

The doctors diagnosed a stroke and the resulting condition to be alexia sine agraphia (word blindness). What this suggests is the inability to read letters, though the ability to write is preserved. When he was asked to write his name or given sentences, he hesitated, however completed the task effortlessly. The nurse was able to read what he had written, but Howard was not even though he was writing the letters perfectly. Instead he saw the same kind of letters as in the newspaper. This suggests reading to involve a hierarchy of complex processes that could break down at any point.

Cases like these give us an insight about the complexity of our brain. We always assume simple tasks like reading, writing or speaking to be automatic and effortless. This is indeed true when everything goes according to plan. If they cost such little effort why is it so difficult to regain those skills once something goes wrong? If researchers are perfectly able to tell which pathways are affected should basic abilities fail, why is it still so difficult to treat these people given the brain is so plastic? It proves again how surprisingly little we know. The main reason for this I believe is the fact that disorders like these are first very uncommon if we compare them to others and secondly with how much variety symptoms can appear. One patient is not able to read and recognise letters at all, whilst the other manages to recognise the letters but fails to look at the written word as a whole. This makes it extremely difficult to clinicians to pinpoint the exact pathways that are affected for each individual and therefore limits progress in this field.

Next time I will show you a woman unable to feel any pain which at first seems like a relief but that relief quickly turns into a nightmare.

See you.

Patrick

The New Yorker – Howard Engel

Howard’s book