The Feeling of Making a Mistake

Sometimes damaging your brain makes you better, not worse.

A 33 year old woman who had been sexually abused as a child had obsessive compulsive disorder (her YBOCS score, for those keeping count, was 25) in which she was convinced her genitals were dirty and needed to clean them; a need for symmetry and order that led her to check and recheck and recount and reread and rewrite; and a need to hoard and save. Medications couldn’t touch her OCD, though they helped her mood: the following combination did nothing to reduce her compulsions: an anti-depressant (paroxetine 20mg) + anti-psychotic (olanzapine 20mg) + mood stabilizer (valproate 1500mg) + anti-anxiety (clonazepam 2mg).

Hopeless, she overdosed on all her meds with alcohol, wasn’t found for 3 hours, and spent 3 days in a coma in the ICU. When she awoke, she appeared to have had a stroke, with difficulty with handwriting, some difficulty pronouncing words, with declines in memory, felt like nothing mattered,

In addition, her OCD was essentially cured (YBOCS fell to 9).

Lesions of the caudate and putamen reduce the subjective experience of error
A self-induced stroke cured the patient of the unshakeable sense of making mistakes

What this figure shows is what the stroke killed – and preserved – in her brain. What it killed was the ‘association area’ of the caudate – not the so-called limbic portion. Her dystonia was most likely a reflection of her putamen lesion.

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