Final Project: Clinical Case Study or Relaxed Case Study?

I am attempting to complete a rudimentary neuropsychological clinical case study for my final project. There are a few reasons why I think the case study will be successful. My client, KJ, is extraordinarily intelligent and highly communicative, though her language abilities were profoundly affected by her stroke. She has been in speech pathology treatment for years, and after interviews, she told me that this has been by far her favorite therapy modality to come. When a patient becomes even more invested in the therapeutic process, and when that process highlights creative thinking, the therapeutic modality will probably be more successful. 

To date, here's what I have done:

I finally have the most integral part of the project, the clinical intake and diagnostic reports for KJ from the UCF Communication Science and Disorders Clinic. These include all scientific notes, a medical background, and other notes. This, along with my personal experiences with KJ, will serve as the most cited source. 

I will also include an upcoming progress report in my study. 

I have interviewed KJ on numerous occasions and taken extensive notes from each meeting. I will use my own impression and 

I have KJ's photographs for further analysis and figure annotations. 

I have the class hand-outs on Emotive/Descriptive terms and formal elements of the photograph. My case study will focus on the specific "photography as language" therapeutic modality. 

As far as research, I still have a ways to go. I orginally was going to have the project be more of a research paper, but then I thought--how many chances will I get to be able to prepare a real case study? 

Here's an important fork in the road, though. Either I focus it at laypeople or I make it jargon heavy and attempt to get it published.

pros and cons for publication

pros: if it passes the peer review process (which I'm not sure it would) it might actually get published in a neuropsychological journal and spread the story of KJ and the photography as language course conception to practicing clinical professionals

cons:

It would mean everybody in the class just wouldn't get it. I want this story to be accessible to the other clients, and the scientific specialization sounds quite off-putting. 

It will also mean a hell of a lot more work. I know not many of you are psych majors, but the Americal Psychological Association guidelines are a bitch, and there's not much to equivocate on there. 

Incomplete bibliography: 

"The neural organization of language: evidence from sign language aphasia"

Gregory Hickok, et al

This article has a great background section concerning Broca's and Wernicke's area. 

"Emotional words: what's so different from just words?"

Theoror Landis

This is an awesome article talking about the discrepancy between the right and left hemisphere in language. KJ uses a lot of "frustration words" and I think this will be an interesting tangent in the case study. I'll talk a lot about corpus callosum pathways leading to a reduction in lateralization damage. 

"The verb-noun double dissosciation in Aphasia: Theorettical and neuroanatomical foundations"

Luzzati, et al

This will be one of the main referral studies, and it also refers directly to our treatment modalities of emotive/descriptive words. 

Thus, the crossroads: do I attempt to work on a clinical neuropsychological case study for publication, or do I write a more generalized (but still neuropsychological) case-study, similar to Oliver Sacks's books (The Man Who Mistook His Wife for a Hat, An Anthropologist on Mars) which will be able to be discussed among both scientists and the lesser of you mortals (kidding--scientific jargon is ridiculous). 

I'm torn. Oliver Sacks is my hero, his books are the reason I'm aspiring to be a neurologist. He writes case studies about neuropsychological and neurological cases, but artfully intertwines them with discussion on philosophical quandaries. The brain is the seat of the soul, he says. On the other hand, it would be awesome to get published, but, thinking realistically, I don't think that would happen. I frankly don't have enough clinical data to warrant a a "legitimate" case-study approach, a 15 page undertaking sputtered with graphs and usually months or years of direct contact with the patient. If I take the relaxed case study route, I will talk more about aphasia and the neural bases. A clinical case study would assume that the readers already have a strong foundation in clinical stroke presentation, and would focus on the specific aspects of the class--such as the problems of right-sided hemiplegia and the digital camera controls, the discussions in class, and the subjective reaction to discussing photographs. I'm very torn, because both routes will produce good case studies. 

Where to go from here:

Whether or not I focus on clinical publication, I need to begin the first draft of my case study, and run it by both Dr. Whiteside and Dr. Queen. If I do decide on the academic peer-review route, I will need to work with other psychology professors to garner advice and have help editing. 

I have all of the pieces of the puzzle, which, to be honest, is the hardest part. KJ will present a compelling narrative and I'll try to pull it together to the best of my ability. 

"Home" Denote vs. Connote

KJ just so happened to be attending the birth of her grandson, so we should all be expecting quite a few newborn pictures this Wednesday. Unfortunately, due to my client's absence, I was unable to assess her reaction to each of my pictures.


An important distinction was raised concerning verbal semiotic notation in aphasic patients. Denotations, descriptive words, tend to be easier for patients with more profound Broca's. Telegraphic speech, the omission of semantic connectors, is a common characteristic of expressive aphasia. Connotations, inferential words, tend to involve a higher range of cognitive associations and are a much deeper thought process. As such, interpretative descriptions require more mental work. I'll give examples for this speech dichotomy in the following pictures. 

Denote:
Brown, Grey, Green, Tan
Roses, Leaves, Shadows
Dried


Connote:
Preserved, Fragile, Love

Denote:
Blue, Water, Sky, Sand
Child, Ocean, Wind
Trucks
Footsteps


Connote:
Cold, Mystery, Peace, Dusk

This was chosen as the strongest image of the group. 

Denote:

Red, Blue, White, Brown, Silver

Wood, Pots, Pans, Plates, Mugs, Tins 

Connote: Rugged, Rustic, Old-Timey, Patriotic (Admittedly, this picture was taken in the Rebel Camp of a Civil War Reenactment, so take what you will with that one)

The Marlboro Man Died of Cancer

As a psychology major, I am constantly bombarded with in-depth analysis of advertisements, social cohesion, internalization, and theories of persuasion. I've taken social psychology classes and sociology classes, qualifying me as far from an expert as possible. To pontificate about Barthes and signification perception or Bourdieu's concept of reflexivity as metaliteracy may be an academic necessity, but the thought experiments truly are worth the confused notes and befuddled, contorted faces. Rene Magritte (my absolute favorite artist of all time) does provide wonderful commentary on our addiction and dependence on images. He paints a pipe with a caveat. This is not a pipe, he says. It is a painting. An image. A two dimensional representation of an object. 

Delving into neuroscience, this epistemological crisis evaporates. We have neurons in our brain that are specifically devoted to recognize objects. We live in a three-dimensional world, and our neurons must respond to their specific object at any angle. This is why two-dimensional representations are so powerful in our daily lives. We recognize the image not as a picture, but as the item itself. Print ads of say, food, still activate areas of our brain that produce gustatory responses and release hormones and neurotransmitters signaling good taste and hunger. Two-dimensional representations are not, as Magritte and existentialists might suggest, just pictures. They activate our brain in the same way the real thing would. In a culture where ubiquitous images of sex, violence, and female sexual degradation permeate our daily lives, it is important to note our brain recognizes these not as advertisements or harmless two-dimensional pictures, but as true representations of the act. 

One of the most powerful articles I have read is a comparison of the leaked images of the abuses of Abu Ghraib and the circulated photographs of black lynchings in post civil war south. The author brilliantly conveys an analysis of a culture both enamored and desensitized to gruesome, sadistic, and homoerotic images. Opponents of abortion have long since abandoned scripture and appeals to reason and emotion, but now instead display posters emblazoned with pictures of Rwandan genocide next to photoshopped pictures of bloodied, ripped up aborted fetuses. How do we innoculate our children against the internalization of the violence shot at them from every direction?

 As a society, we come to expect the next shocking celebrity photoshoot. I'll use tween heart throb Robert Pattinson as an example.Warning: Nudity and Implicit Degredation A naked woman lies submissively spread eagle in a bathtub while the clothed and dominant male lies disinterestedly on the floor. These images don't sell a product, they sell a cultural standard. Barthes's model, for instance, we see Mr. Pattinson in the trendiest white slacks and relaxed button-down shirt, signifying modern success and masculinity. Enforcing the signifier, the naked woman solidifies the meaning of the ad--Mr. Pattinson in his smart slacks and sexy shirt has conquered the beautiful model, making the sign of fantasy masculine dominance concrete. 

Have we really gotten any better?