레프 자세츠키: 외상성 뇌 손상의 투쟁

### 레프 자세츠키의 투쟁: 뇌 손상과 회복을 통한 여정
* 🧠 제2차 세계대전에서 중상을 입은 레프 자세츠키는 1943년 3월 2일, 살아남았지만 뇌 손상의 복잡성을 강조하며 **"죽임을 당한" 경험**에 대해 일기에 썼습니다.
* 📖 25년에 걸쳐 3,000페이지에 달하는 놀라운 일기를 집필한 그는 **글은 쓸 수 있었지만 자신의 글을 읽을 수 없었지만** 자신의 삶을 상세히 기록하여 자신의 상태의 역설을 보여주었습니다.
* 🎖 과학에 대한 열정을 가진 영재 학생이었던 레브는 20세에 전쟁에 동원되어 **화염방사기 소대의 지휘관**으로 활약하다 외상성 뇌손상을 입었습니다.
* 💔 그는 부상으로 인해 **언어 처리 능력과 심각한 시각 장애**를 포함한 **심각한 인지 장애**를 겪었고, 이로 인해 현실을 단편적으로 인식하게 되었습니다.
* 🔍 신경심리학자 알렉산더 루리아는 레프의 사례를 연구하여 실어증과 뇌의 기능의 복잡성을 밝혀냈는데, **레프는 일상 업무를 처리하고 효과적으로 의사소통하는 데 어려움**을 겪었습니다.
* ✍ 레프는 자신의 한계에도 불구하고 꾸준한 연습을 통해 **자신을 다시 표현하는 법**을 배워 글쓰기에 상당한 진전을 이루었고, 이를 잃어버린 능력을 되찾는 수단으로 삼았습니다.
* 😢 그러나 레프는 자신의 어려움을 예민하게 인식하고 있었으며, 종종 **자신의 상태와 그로 인한 삶의 한계에 대해 절망감**을 표현하며 **깊은 상실감과 고립감**을 느꼈습니다.
* 📚 처음에는 "끔찍한 뇌 손상 이야기"라는 제목의 자서전으로 시작했던 그의 작품은 결국 1993년 사망할 때까지 그의 불굴의 정신과 끊임없는 회복 노력을 반영하는 **"나는 싸울 것이다"**가 되었습니다.

레프 자세츠키의 여정은 치명적인 뇌 손상 후 정체성을 되찾기 위한 심오한 투쟁을 보여줍니다.

Lev Zasetsky said that he was killed on March 2, 1943 – a line which he wrote in the past tense. Because he was probably right. Which… is confusing. He wrote it again and again during 25 years of observation by one of the Soviet Union’s most accomplished neuropsychologists, eventually compiling a 3,000 page diary recollecting his life story… He could write by hand, but he himself was unable to read it. Which… is strange.

It became one of the most valuable, insightful texts on the study of the human brain in the history of biological science – but Lev Zasetsky, whose horrific shrapnel wound to the brain in World War II that ended up destroying his life, was not a researcher or scholar.

He was the one being studied. And his story won’t just make you re-think what reading and writing are, or how your own brain works – but it’ll make you question whether a spoon can really be separated from the soup it sits in.

Lev Zasetsky was just 20 years old when Germany enacted Operation Barbarossa, a surprise invasion of the Soviet Union. As a child, Lev had been fascinated by science – which he only vaguely remembered. He’d graduated with honors from middle school and went on to complete three years at a polytechnic institute in Tula where he did advanced work in chemistry. “Early one morning I was heading for the institute, thinking about my future, when suddenly I heard… there was a war on with Germany!... they had already invaded and we had 

to defend our country. The Komsomol mobilization
had sent to the front fourth-year students who, for the time being, had to forgo their work
at the institute until the war was over. " At 20, Lev the Scientist was already
gone, and Lev the Soldier was born.

That mobilization took him
directly to the frontlines, where he eventually gained command of
flamethrower platoon 33A and served with distinction. A document of the Central Archive
of the Ministry of Defense shows that he was a:

“Military technician of the 1st rank,
a participant in the Patriotic War from January 1942 in the position of platoon
commander of a separate flamethrower company, attached to the 222nd rifle division
of the 33rd army. With his platoon,

he destroyed five German pillboxes,
personally killing five Germans.” By March of 1943, the German 6th Army had
surrendered at Stalingrad – but the Wehrmacht was in the middle of defeating the Soviets
at the Third Battle of Kharkov. Nearly 1,500

kilometers south, Lev Zasetsky was leading his
unit across a river in Smolensk when he was hit in the head by shell fragments that “penetrated
the left parieto-occipital area of the cranium”

and left him in “a prolonged coma.” He had an
opening in his skull of 16 square centimeters and he’d lost a quarter of his brain matter – the
Red Army wasn’t able to perform a cranioplasty

with tantalum plates as some Western Allies could. He was just kept alive in a field hospital as his body attempted to heal and scar tissue made permanent alterations to his brain. Lev Zaletsky had been taken out of a war against

man and thrust into a fight to the death against nature. Nearly 70 years before neuropsychologist Alexander Luria first met Lev Zasetsky, science already had only a rudimentary understanding of aphasia – the loss of the ability to process and formulate

language. Why did some people seem to understand the world around them, but had lost the ability to talk about it? Why did some people develop aphasia from unexpected, unseen internal injuries like strokes, and others from physical trauma? Why didn’t EVERYONE who experienced physical

trauma develop aphasia? And how did Phineas Gage survive an iron rod being driven directly through his skull and brain and out the other side and not lose any of his communicative faculties?! In 1873, an article in Popular Science called “On Acquired Physical Habits” described the state of

pathological research as showing that aphasia comes from “malnutrition of a certain part of the Cerebrum; and the tracing of this malnutrition back to an interruption in the supply of Blood.” That same year, a paragraph in the Miscellany section of Popular Science claimed that “aphasia

is produced by an incapacity to execute the coordinate movements requisite for pronunciation, and that it has nothing to do with loss of memory as to the meaning of words.” Oh brother. I mean c’mon, it was like 150 years ago.

Think how difficult it was to understand what
was happening: you need to have a clearly defined map of all parts of the brain. You need
to understand what those parts do and DON'T do,
and how they work in tandem. You need to
know what affects their operation in the

short-term and long-term, what damage does to
each part, what can be healed and what can't. And all of that needs to be placed in the
contexts of both the state of medicine and the actual lives of the patients, all without any
imaging or non-invasive examinations of any kind.

Studying the long-term effects of traumatic
brain injuries was particularly difficult
in the 1800s because so many of those
who suffered those injuries just… died. But we were making progress on understanding the
innerworkings of the brain – and fast. In
the August 1875 issue of Popular Science,

“Infirmities of Speech” described a “rare form
of aphasia in which the intellect is unaltered,
memory is good, the patient writes easily, and
expresses his thoughts correctly in writing as
educated deaf-mutes do. The recovery of the art
of writing (where it is recovered) is gradual.”

In an 1885 edition of Popular Science, W.R.
Benedict defined aphasia as simply “a disturbance
of the power of speech.” He broke it down into two
categories – “amnesic aphasia,” in which a patient

forgets “substantives and names,” misuses words,
or forgets the language they knew altogether,
and “ataxic aphasia,” in which “the power of
articulation is completely lost” despite the
patient fully understanding a word, although not
being able to use it despite “vigorous effort.”

Through the 1880s and 1890s, articles
about or mentioning aphasia were common
in Popular Science, like “Centers of Ideation
in the Brain” and “Word-Blindness” –
and then the progress just… stopped.

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The final appearance of the word “aphasia” in all of Popular Science came in May of 1913 in an article about William Harvey, the 17th century physician who unraveled the circulation of blood. The next great leap in understanding the physical mechanisms of the brain and its

related traumas came with the imaging revolution of the 1970s – the CT scanner finally allowed us to look inside. But in that interim period, something happened that generated more observable cases of brain injury than in the whole of human history before it: two world wars.

The Great War and World War II affected every populated continent on the globe, and in a sort of twisted silver lining for medical progress, the tens of millions of casualties provided doctors with opportunities to develop more effective treatment for acute brain injuries and to improve rehabilitation after.

Alexander Luria was assigned to care for over 800 patients hospitalized by traumatic brain injury – one was Lev Zasetsky. Luria “first met [Zasetsky] toward the end of May 1943,

almost three months after he had been wounded” and found that he “simply could not write and realized he had suddenly become illiterate.” It was a case so nuanced, so tragic, and so powerful that Luria spent decades

trying to understand it, culminating in “The Man with a Shattered World: The History of a Brain Wound,” which Oliver Sacks said ‘turned science into poetry.’ Lev Zasetsky had lost virtually all ability to use words, with all words seeming “vaguely

familiar” with meanings that were “incomplete
and unformed.” For Lev, choosing the right word wasn’t just like finding a needle in a haystack
– it was finding a needle in a stack of needles. The result was essentially paralysis.
When he ran an errand to a government

office back home in Tula, he was so “afraid
[he] wouldn’t remember the few words [he] needed to carry on a conversation” that
he simply waited in the hallway outside, working up the nerve to give even
a simple conversation a shot.

It was just as bad as he thought it would be. “... the few words I needed to use seemed
deliberately to have slipped my mind–all of them. Something felt very wrong in my
head, I just couldn’t remember a thing.”

He could see, though. Sort of. His vision was
equal parts disorienting and fascinating. His entire right side of his field of vision was
completely gone, which forced him to turn his head to view anything that wasn’t on
his left. What he could see was a maelstrom:

“Through and beyond the objects I
see are endless numbers… of tiny, shifting swarms of midges that make
it hard for me to look at objects themselves.” This “swarm” affected
his ability to understand what he

was seeing so much that he wasn’t able to
distinguish the first letter of any word. But closing his eyes was even worse: “...there were two days and nights
I didn’t dare close my eyes. I seemed to be having hallucinations” of “some
ugly thing, something weird – a human

face but with enormous ears… and eyes that
were just as peculiar.” And if it wasn’t	a Picassoan rendering of some unknown
person, he’d see other “faces, objects,
and rooms of different sorts,” leading him
to “open [his] eyes as fast as [he] could.”

He would also ‘lose’ parts
of his body because he would	forget that he couldn’t see his own right side: “Often I fall into a kind of stupor and I
don’t understand what’s going on around me;	

I have no sense of objects. One minute
I stand there thinking about something,	the next I lapse into forgetfulness. But suddenly,	I’ll come to, look to the right of me, and be
horrified to discover half of my body is gone.”

Zasetsky called these kinds of incidents
“spatial peculiarities.” He couldn’t	remember how to navigate the town he grew up
in, and Luria described his relationship with	space as being “broken into thousands of
separate parts.” He said that the “problem	

was not that he failed to see an object. He
would recognize it, know what it was for,	and how to use it. But it was altogether different
when he tried to orient himself in space,	distinguish right from left, or gauge the
distance and relationship between two objects.”

Lev didn’t really understand… anything
anymore. He’d wake up with pressure in	his stomach but not realize it meant he had
to go to the bathroom. He was afraid to reach	out and touch objects on a table. And he
was unable “to see a single object as a	

whole,” causing him to “get frightened when 
a spoon” would get “lost in [his] soup.” A simple comprehension test 
illustrates exactly what it was like to live with Lev’s brain. He was 
asked to listen to the following paragraph:

“On both sides of the house were large trees of 
a rare variety that had big berries resembling fir cones on the underside of the leaves. In the 
pond, across which four white swans were gliding, one could see the reflections of the Chinese 
lanterns, made out of brightly colored paper, 

that were hung everywhere and 
depicted grotesque, grinning faces.” Then he was asked to decipher 
it. This was his answer: “No… I can’t make anything out 
of it… They’re talking about… about… it’s hard to say… about lantern lights, and 
about swans in a pond… and something like woods on 

both sides… swans… and lantern lights. There 
are these trees… on both sides… and berries… and some more lantern lights… and swans floating. 
There’s a house… and alongside it… fruit trees… They look like fir trees. Then there are also 
lanterns… and a pond… swans floating… near them… 

horns. And so… lantern lights… colored 
paper… No, I just don’t understand it!” How do you live in a world that makes no sense 
at all? How do you exist when every second of your life is an unsolvable puzzle, and the tiny 
bits you do manage to recognize can’t come out?

The real question is: why would you go on? Luria pinpointed Lev’s injury 
to “the second major block of the brain located in the posterior 
sections of the large hemispheres.” This portion of the brain’s entire job 
is to “act as a block for receiving, 

processing, and retaining information a person derives from the external world. Luria posited that within that area is another “tertiary” sector, whose function “is to combine the visual (occipital), tactile-motor (parietal),

and auditory-vestibular (temporal) sections of the brain” which are “the most complex formations” in this second block, and “the last part of the brain to develop” in human evolution. That’s in line with the 1875 Popular Science “Infirmities of Speech” article,

which highlights discoveries made by neuroscience pioneer Paul Broca that pins aphasia to the left, anterior part of the brain, and more specifically to the “third cerebral convolution” – the same region that Luria refers to as the “tertiary” sector. Even as

far back as 1873, after performing a series of electro-shock tests on various animal brains, a Professor Ferrier was able to link aphasia to “the left side of the brain, in the posterior part of the inferior frontal convolution,” also associating it with “paralysis of the right hand.”

The precise location of Lev’s shrapnel injury meant that “a very important function [had] been seriously impaired: he [could] not immediately combine his impressions into a coherent whole; his world [became] fragmented.”

But his frontal cortex was entirely undamaged. Luria wrote that the frontal cortex allows for a person’s “capacity to recognize his defects and wish to overcome them,” and that Lev Zasetsky “was acutely aware of what it means to be human,

and to the extent his strength permitted, 
worked feverishly to overcome his problems. Lev’s human spirit was intact – he 
just needed to find a way to channel it. He’d lost the ability to read or write 
immediately following his injury, 

but he still tried. He’d forgotten how to 
use a pencil – he couldn’t control it or even hold it. And when he tried to read, he 
found that he had to go one letter at a time, 
reciting the alphabet until 
he got to the letter he saw. 

Which… he actually could do. He couldn’t remember 
a word he just heard, and he couldn’t remember anything about his time on the front lines, or 
how to get home from across the street… but he could remember parts of his childhood and the 
things he learned then. He knew the alphabet. 

Luria called these sorts of memories 
“kinetic melodies,” or a “series of 
built-in movements” that once mastered at a young 
age become second nature in adulthood. That 
meant Lev still possessed the ability to 
write somewhere in his brain. He just 
needed to figure out how to access it. 

The letter-by-letter approach had gotten 
Lev absolutely nowhere. But then a doctor 
told him to stop trying – he asked Lev 
to write a whole word without thinking 
about it or lifting his hand from the 
paper. He repeated the word “krov,” or 

blood, out loud a few times – 
and then he actually wrote it. Lev couldn’t read, he couldn’t 
understand what he saw, 
and couldn’t navigate the world around 
him – but he suddenly could write. His previously meaningless days now had 
meaning – he could do something again. 

In just six months he learned to write
as well as he could before his injury. He still wasn’t exactly literate –
words still meant nothing to him, not in the automatic and nuanced
way they do for us. He had to break

each word down into its letters and
syllables to begin to decipher it: “When I look at a word like golovkruzheniye
[“dizziness”], I just can’t understand it… But soon something begins to stir in my mind.
I look at the first letter (“g”) and wait until

I remember how to pronounce it. Then I go on to
the letter “o” and pronounce the whole syllable.” But the further he got into a word,
the letters he’d figured out were gone: “While I’m looking at that letter,
the two letters to the left of it

escape my vision… at that point I
see only a gray mist in which spots, threads, and little bodies seem to
shift and flicker back and forth.” But still… it was progress. He could only write about ten lines a
day – sometimes a page – which would

take him all day. And the personal cost was
tremendous: “If I do spend a whole day at it, the next day (or two or three) my head aches
so badly, I often have to stay in bed.”

And each time he recovered, he went right
back to writing his autobiography – Luria wrote that Lev’s goal was “to write a journal
describing the terrible abyss into which his injury had hurled him and the struggle it
took for him to recover what he had lost.”

By the time Alexander Luria had completed what became a 25-year observation period of one of his most unique patients, Lev Zasetsky had written “a 3,000 page document which he could not read.” One of the most remarkable aspects of Lev’s book is that he “completed” his story multiple times.

When he finished one iteration, he would start from the beginning again to express himself more clearly as his writing improved, and to tell more of his own story as he remembered it over time. As he wrote, Lev found that he very slowly rehabilitated his ability to communicate:

“By doing it again and again (I don’t know how many times I’ve rewritten this over the years), my speaking ability has improved. I really do speak better now and can remember words that were scattered into bits and pieces by my head wound.

By training myself (through thinking and writing) I’ve gotten to the point where I can carry on a conversation – at least about simple, everyday matters.” The Disney version of this story ends right there – Lev Zasetsky the

author overcame tragedy and lived happily ever after! It’s great. But Lev Zasetsky never really lived happily at all. The problem wasn’t just that he couldn’t do most of the things that make up daily

life. It’s that he knew he couldn’t do them. His writing included a stark degree of self-awareness – he understood that “he was not fit for anything else.” “So it turns out that because my memory is so bad I’ll never understand anything about geometry,

grammar, physics, or any other science. What's
happened to my life is simply terrible. This strange illness I have is like living without
a brain. What I remember one minute is gone the next, so that I can't understand theorems
or even simple things in my surroundings.

What Luria called Lev's "shattered" existence invokes imagery of a whole so hopelessly
broken into so many pieces that it was impossible to even start putting them
back together in a meaningful way. To Lev, it was just living life without a brain.

Lev said that, "The point of my writing
is to show how I have been, and still am, struggling to recover my memory. It's an extremely
difficult fight… By working on that one story of mine every day… I hoped I'd be able to tell
people about this illness and overcome it."

Lev Zasetsky died on September
9, 1993 at the age of 73. When he started writing, he titled his book,
"The Story of a Terrible Brain Injury." By the time he was done, he'd changed
that title to "I'll Fight On."

The Man Who Lived with No Brain

Popular Science

레프 자세츠키와 그의 독특한 사례 소개

레프 자세츠키는 뇌 손상에도 불구하고 읽을 수 없는 3,000페이지 분량의 일기를 썼습니다.

그의 일기는 인간의 뇌에 대한 귀중한 텍스트가 되었습니다.

그의 이야기는 읽기, 쓰기, 뇌 기능에 대한 이해에 도전합니다.

제2차 세계대전 전후 자세츠키의 삶

자세츠키의 초기 삶과 과학 교육.

그는 전선에 동원되어 화염방사기 소대장으로 복무했습니다.

전쟁 중 심각한 뇌 부상을 입었습니다.

19세기에는 실어증에 대한 이해가 제한적이었습니다.

실어증에 대한 초기 이론에는 영양실조와 운동 조정이 포함됩니다.

제한된 기술과 높은 사망률로 인해 뇌 손상을 연구하는 데 어려움이 있습니다.

19세기 후반 실어증에 대한 이해의 진전.

자세츠키의 사례와 루리아의 연구

제2차 세계대전이 뇌 손상 연구에 미친 영향.

루리아와 자세츠키의 만남과 그의 초기 증상.

자세츠키의 심각한 의사소통 장애와 시각적 왜곡.

자세츠키의 공간 방향 감각 상실과 신체 이미지 문제.

자세츠키의 상태와 회복에 대한 신경학적 근거

자세츠키의 부상으로 영향을 받은 뇌 부위에 대한 루리아의 분석 결과입니다.

부상이 자세츠키의 감각 정보 통합 능력에 미치는 영향.

자세츠키는 자신의 어려움을 극복하기 위한 결의를 다졌습니다.

자세츠키의 운동 기억과 글쓰기에 대한 그의 접근 방식.

자세츠키의 획기적인 글쓰기 능력과 점진적인 발전.

자세츠키의 지속적인 투쟁과 자각.

자서전을 쓰게 된 자세츠키의 동기.

자세츠키의 죽음과 그의 책 제목의 진화.