The Shattered Man

The Battle of Smolensk was part of a two-month offensive in 1943 designed to drive Nazi invaders from the city that they had held for two years. Although the offensive was ultimately successful, it came at a terrible cost.with much of Smolensk being devastated.by the occupation and the battle to retake the city. Along with countless casualties, thousands were left seriously injured including one 23-year old lieutenant named Lev Zasetky.

Born in 1920 in the town of Kazanovka (now Kimovsk) in Russia's Tula region, Zasetsky completed his third year of courses at a polytechnic institute when war broke out in 1941. His writings contain only scattered recollections of his childhood but he comes across as a bright young man with a promising future before being sent to the western front. It was on March 2, 1943 when he received the injury that would alter his entire life. A bullet penetrated the parieto-occipital area of the cranium and left him in a coma. Despite prompt treatment at a field hospital, Zasetsky's case was complicated by meningitis and scarring of the lateral ventricles. The location of the brain damage and the progressive medullary atrophy that resulted would have far-reaching effects on him.

Describing his experiences in the field hospital following his injury, Zatseky wrote: "For some reason, I couldn't remember anything, couldn't say anything. My head seemed completely empty, flat, hadn't the suggestion of a thought or memory, just a dull ache and buzz, a dizzy feeling". Relearning language in the hospital was a long, slow process and most details of autobiographical memory were missing. He would later describe himself as having been "killed" due to his injury and living a "senseless existence" as a Alexander-luria result. Lev Zasetsky was sent to a rehabilitation hospital and it was in May of that same year that he first met Alexander Luria.

Already a prominent brain researcher, Luria spent much of World War II as head of a research team investigating psychological assessment and treatment techniques in brain-injured soldiers. His research would lay much of the groundwork for the modern field of neuropsychology. As with his other famous patient, Solomon Shereshevsky, Luria regarded Zasetsky as an ideal candidate for a longitudinal study that continued over the course of the next twenty-eight years,

Even after his discharge from the hospital, Luria met with Zasetsky on a regular basis and would later publish his findings in the classic work The Man With a Shattered World in 1972. Not only did the book summarize Luria's findings, but it also included excerpts of Zasetsky's own writings. As a way of coping while in hospital, Zasetsky forced himself to begin writing about his injury and struggle to deal with his devastating impairments..

Based on pneumencephalography results and Luria's observations, it was determined that Zasetsky's perceptions of the world had been profoundly altered by his injury. Not only was he experiencing a form of homonymous hemianopsia (loss of half the visual field in both eyes), but he was no longer aware of the right side of his body. When asked to raise his right hand, he became confused and agitated although his motor functioning seemed unimpaired. Becoming aware of the right side of a page or a photograph meant having to move his head to place the missing information into his range of vision. Being asked to identify different parts of his body was a major challenge and he was frequently forced to "hunt" for the location of the hand, foot, or arm that he was trying to name.

The "spatial peculiarities" that Zasetsky experienced made writing a particular challenge for him. He forced himself to learn how to sit at a table and grasp a pencil properly. Not only was his concept of self affected, but his grasp of language as well. He was forced to retrain his brain to make simple logical assumptions and judgment tasks.After months in the rehabilitation hospital, Lev Zasetsky was finally sent home to the care of his family in Kimovsk. A nurse accompanied him to the railroad station and provided him with his family's address on a sheet of paper. Despite initial confidence that he could reach home on his own, his mental confusion forced him to depend on strangers for assistance. Even when finally reaching Kimovsk, he had difficulty recognizing his family home and found himself getting lost whenever he left the house for brief walks.

Simple tasks such as reading maps, and doing household chores became agonizingly difficult for him. When his family bought a new kerosene cooking stove, Zasetsky spent weeks trying to understand the instruction manual and eventually learned to operate the stove through trial and error. Although he would return to see Luria at regular intervals, the wounded soldier never regained his former independence. The promising young man who had gone to war seemed to be lost forever.

Despite Zasetsky's devastating impairments, he was forced to deal with a skeptical bureaucracy that questioned whether a veteran with no visible injuries could even be considered disabled (a common problem with neurological patients). At one point, he would have his veteran's benefits cut and needed the active intervention of family members and therapists to have them restored. In the decades that followed, Lev Zasesky continued to add to his journals (eventually running to thousands of pages which were carefully archived by Luria's assistants).

The final chapter of Luria's book is simply titled "The Story That Has No Ending" and shows Zasetsky continuing as before. His condition never improved and he remained dependent on his family for care. He himself would write that "Over two decades have slipped by and I'm still caught in a vicious circle. I can't break out of it and become a healthy person with a clear memory and mind". For all that his case inspired generations of treatment professionals, there was little help for him.

I have no idea what became of Lev Zasetsky in later life (Luria himself died in 1977) or when he eventually passed away.  As an epilogue to his book, Luria speculated on the cost of war and the number of lives that have been destroyed as a result. It's a lament that still has relevance today given the rising number of brain-damaged veterans who need treatment more than ever.

           

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