SubStance

Narrative is the inescapable frame of human existence. Thinkers as diverse as Aristotle, Barthes, and Bruner have recognized the centrality of narrative in human cognition, but have scanted its neurobiologic underpinning. Recent advances in cognitive neuroscience suggest a regionally distributed neural network mediates the creation of narrative in the human central nervous system. Fundamental network components include: 1) the amygdalo-hippocampal system, responsible for initial encoding of episodic and autobiographical memories, 2) the left peri-Sylvian region, where language is formulated, and 3) the frontal cortices and their subcortical connections, where individuals and entities are organized into real and fictional temporal narrative frames. We describe four types of dysnarrativia, states of narrative impairment experienced by individuals with discrete focal damage in different regions of this neural network subserving human self-narrative. Patients with these syndromes illustrate the inseparable connection between narrativity and personhood. Brain- injured individuals may lose their linguistic or visuospatial competencies and still be recognizably the same persons. Individuals who have lost the ability to construct narrative, however, have lost their selves.