The TV show Agents of SHIELD's portrayal of post-brain-trauma symptoms is in fact fairly accurate. Fitz did suffer cerebral hypoxia, and his hallucination of Simmons is an accurate symptom of his condition, although her ability to help his speech difficulties is overly emphasized for the sake of pathos. I could find no direct correlation between hypoxia and the specific symptom of aphasia, but aphasia is attributed to the broad category of brain trauma to the speech areas of the brain (the Broca's area and/or the temporal lobe), which hypoxia presumably could cause. According to the difficulty in word retrieval and narrative discourse that Fitz portrays, it can be surmised that Fitz suffers from anomic aphasia.
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There is no cure for patients with anomic aphasia, just as with other brain injury disorders. Like Fitz experiences in the first two videos above, it is all too easy for people to either alienate him for his anomia, or overcompensate. However, Mack, in the video in the bottom left, exemplifies the correct way to help people like Fitz: be patient and encourage them to help them regain confidence. Mack's encouragement is helping Fitz episode by episode, and Fitz is making huge progress in not only his speech itself, but also accepting himself and his disability.
After my research, I concluded that Fitz has anomic aphasia, which is an aphasic syndrome caused by damage to the temporal lobe and is linked through fMRI analyses to the Broca's area, especially regarding speech execution difficulties (Woollams). This would align with both what the show suggests and my previous research.
The paper that supports my diagnosis, "Narrative discourse in anomic aphasia," from the journal Neuropsychologia, was written based on an experiment in which patients were asked to produce narratives based on pictures, two of them comic strips, and told that their audience did not know the stories, so the narrative needed to be as clear as possible. Table 2 shows that patients with anomic aphasia had a lowered speech rate and, though they did not have many phonological errors (they could say words the correct way), they had much more semantic paraphasias (they substituted related words instead of the correct word, eg. "mother" instead of "wife") and much fewer complete uninterrupted sentences. However, "interestingly, this lexical difficulty did not result in the production of a high number of semantic errors as merely 1% of all words were scored as semantic paraphasias. Rather, it led to frequent interruptions in the flow of speech, mainly occurring within the boundaries of ongoing utterances" (Andreetta). Fitz exemplifies this description: as seen in the videos, including the one above, he does not substitute related words often. However, he does pause for "Simmons" to fill in the gap, but since Simmons is not really there, it appears as if Fitz simply left the sentence hanging as he moves on to his next thought (eg. "I'm having trouble communicating properly due to...right.") However, Table 3 shows that, though anomic patients had trouble with cohesion and coherence, they had little to no trouble with thematic informativeness, meaning that their narratives "contained the same number of main ideas and details as the narratives from the healthy controls" (Andreetta). This is significant because it is saying that Fitz' anomia does not hinder his intelligence or his ability to have complex ideas, just his ability to communicate them.
Two groups of patients, healthy ones and ones diagnosed with different aphasia syndromes, were given a blocked naming task: they were shown four sets of pictures and asked to name them. The pictures were either semantically related in a certain category - eg. truck, car, bike), or from mixed categories (eg. truck, foot, dog). The blocking growth during the naming cycles was measured, which is the increase in the patients' inability to name the pictures due to competition among lexical items simultaneously activated for semantic relatedness (because the patients expect all the pictures to be related according to the pattern) (Schnur). As shown in figures A and B, increased damage to the Broca's area was shown to correlate with increased blocking growth. (In Figure A, "HIGH" refers to high blocking growth and interference, and "LOW" refers to low blocking growth.)
Fitz has a similar problem: he has trouble selecting and producing the correct words not only in reaction to images and objects, but also to express his ideas. He definitely has an aphasic syndrome that is somehow related to damage to the Broca's area but is not as severe as Broca's aphasia, because his sentences still show grammatical structure. So knowing this, and accounting for the show's mention of damage to the temporal lobe, Fitz can be furthered diagnosed with one specific aphasic syndrome that I will discuss in my next post.
So in order to continue, I needed more details about the type of brain damage Ftiz suffered, as well as what kind of aphasia Fitz now had. Basically, I needed to diagnose the character as accurately as possible, accounting for possible exaggeration in the show for the sake of drama and shock value. To do this, I used two papers, which I will discuss in my next posts.
According to the National Institute of Neurological Disorders and Stroke (NINDS), cerebral hypoxia is "a condition in which there is a decrease of oxygen supply to the brain even though there is adequate blood flow." Furthermore, "brain cells...begin to die within five minutes after oxygen supply has been cut off."
In Fitz's situation, though Simmons was able to bring him to the surface, they had been submerged too far under water and so he was deprived of oxygen and essentially drowned. Drowning is, in fact, one of the causes of cerebral hypoxia. Others include strangling, choking, suffocation, cardiac arrest, head trauma, and carbon monoxide poisoning. So this aspect of Fitz's condition is correct. The show also implies that Fitz suffered for over five minutes, as Simmons took longer than that amount of time to swim to the surface. Though he was able to regain consciousness through the work of top SHIELD doctors (suspending disbelief), according to the NINDS, his symptoms during recovery could include "amnesia, personality regression, hallucinations, and memory loss." The next post will discuss which, if any, of these symptoms Fitz has.
[Anyway, we tried to escape from Garrett, but he hijacked a SHIELD plane, and Ward found us trapped in an infirmary pod.]
Right. And Ward, instead of shooting us, opened the hatch and dropped us to the bottom of the ocean. I figured out a way for us to escape...but...but... [But there was only one oxygen mask, and he gave it to me. It's all right, Fitz...the video will explain the rest.] Based off of the recent plot twist regarding the character of Leopold Fitz on the TV show "Agents of SHIELD," this project will compare the cause and symptoms of Fitz's brain trauma, as portrayed on the show, to real cases of brain injuries of the same nature. Through this comparison, I will diagnose Leo Fitz's current condition, prove my diagnosis, and decide whether Agents of SHIELD is portraying traumatic brain injury accurately, or simply exaggerating real life symptoms in the effects of Fitz's injury for dramatic effect.
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