Affecting everything, affected by everything

 kw: book reviews, nonfiction, neurology, medicine, memoirs

A medical student begins losing her sight, but at first cannot tell; eventually she realizes that her brain is filling in plausible details where her vision has stopped working. An older woman's leg makes running motions when she tries to sleep, sometimes kicking her husband; when it begins happening while she walks it gets very hard to walk reliably. A man wakes up in the morning, feeling fine; he talks with his doctor as usual—from the doctor's perspective—but his speech is mostly nonsensical and he doesn't realize he's beginning yet another day like the prior 7,600 or so because he has been in this hospital for 21 years.

I have heard it said that if there were only one human in the Universe, that more than half of the total complexity of the Universe would be found in that person's brain. When a functional object has not just billions but quadrillions or quintillions of moving parts, it is amazing that it functions at all, let alone with any reliability.

Neurologist Pria Anand, in The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains, brings together more than a dozen stories, including a few of her own experiences, connecting them with history and mythology, to illuminate some of the things that do go wrong in the brain. Treating people (usually women) with migraine headaches is one thing. Experiencing them herself, complete with premonitory auras and even hallucinations, is quite another. For the sake of their sanity, doctors must learn to keep a certain distance from their patients. When a doctor is suffering the same symptoms, that distance is hard to maintain.

My mother died with Alzheimer's Dementia, as did her sister and their father before them. During her last year my mother was cared for by a wonderful nurse named Mary. But Mary, who also had relatives with similar dementia, eventually couldn't stand the strain and had a nervous breakdown. After Dad retained a new nurse, Mary would visit frequently, now as a friend rather than a caretaker. Mary recovered.

Many of the syndromes Dr. Anand discusses are found more in women than men, some are hard to diagnose, and in many cases a woman may be dismissed as "hysterical" by doctor after doctor before finding one with sufficient experience, and compassion, to ferret out the cause. Even something like Restless Leg may be dismissed as a hysterical manifestation, and since it has several possible causes, a doctor may be reluctant to order a whole bunch of tests to narrow the search for a cause.

I learned a few things. One that is important: the cerebellum is more than a control center for the body as I had thought. It mediates coordination, bringing together the will or desire, the evidence of the senses, and the knowledge of place and space, to weave the coordinated movements required to carry out the "orders" of the cerebrum. It can also briefly override the autonomic functions of the brain stem. We can briefly "take control" such as holding our breath when swimming underwater. But a disruption or injury to the breathing control circuit between the cerebellum and the brain stem, can produce a syndrome in which a person must breathe by an act of will, making it impossible to sleep. But being forced to stay awake has its own horrific result: in about two weeks without sleep, you just die. Diseases that damage the cerebellum produce any number of motion and coordination disorders.

Blindness is not just an eye problem. Several things can happen to or in the eye to affect our vision, such as damage to the cornea, the lens, or the retina. But between the eyes and the back of the brain where "vision happens", the optic nerves pass their signals through a few structures. A hiccup anywhere along the line can cause partial or total blindness. Damage at some junctures cause a person to be entirely sightless and yet not know it. Treating such a person cannot be aimed at restoring sight, but at setting up the support systems (relatives, spouse, friends, etc.) to keep the person oriented and safe. If such a one can't realize she's blind, she could walk into traffic or off a cliff with total confidence.

You may have heard of fever dreams. This has two meanings, one being the hallucinations that accompany malarial fevers. The other is more prosaic, something I experienced a few times as a child: when my fever due to a flu or cold rose about 102°F I would have what I called the Banging Dream. It would begin with a sound like a grain of sand ticking as it dropped from one side to the other of a small metal container that was being rocked back and forth; the container and the grain would enlarge slowly, and within a minute or two I would feel like my head was a huge steel drum in which a boulder was crashing back and forth. The basis was the sound of my own heartbeat, amplified monstrously as my overheated brain lost control of my senses. Other people experience moving colors, or "visits" from dead relatives…there is a panoply of odd things the brain under stress will do.

The author is such a good storyteller that I am at a loss how to proceed. Read for yourself and let her lead you on a guided tour of the world of a neurological resident and practicing neurologist.

The mistake collector

kw: book reviews, nonfiction, psychology, neurology, errors, consciousness

Oliver Sack's fifteenth, and last, book is The River of Consciousness. He died just two weeks after completing the design of the book, composed of his essays in various medical and popular publications. I first came across his books three years ago; this is the third of his that I've read and reviewed in that time. He may be best known to the public for The Man Who Mistook His Wife for a Hat, which I have yet to read…but it is on my short list.

As any good clinical "brain worker", he collected mistakes. Freud with his "slips" may be the one we know the best for elucidating the shortcuts our mind and brain use, from certain mistakes that we make. I find Dr. Sacks to be the best at explaining the usefulness of the categories of our errors to us.

Not all the chapters in the book are explicitly about "useful errors". The chapter "Speed", for example, attacks questions such as, "Just how fast can we think?" and "What is it like to think a hundred times faster, or slower?" We all have heard of phenomena such as having one's life flash by in a moment during severe emergencies, or of becoming so absorbed in minutiae that hours can pass with hardly a ripple on our thoughts. Sundry drugs can affect our time sense: I once began to take a prescription drug for systemic fungus, and on the fourth day managed to work up enough ambition to phone my doctor to say, "I just realized that the wallpaper texture in my office is so interesting that I've been looking at it for four hours." He recommended that I stop taking it, and dropping by for a different prescription!

The chapter "The Creative Self" dwells much on the apparently unconscious problem-solving abilities we have (you can call it "right brain" but it is more involved than that). For much of my career as a systems programmer, I relied on it: Near the end of a work day I would often set up a structure in my mind, of the current algorithmic problem I faced, and sort of give it a mental push. I could usually expect to awaken at 3:00 AM with a flowchart "sitting there," ready for me to spool out into working code. From the dancing flames that Kekulé was watching when the structure of Benzene suddenly sprang to mind, to the introduction to Das Rheingold that Wagner had been struggling with, and which erupted into his consciousness while he took a hike to take a break, creative "flashes", while not too common, are well enough known to us all. They do not really denote lightning inspiration, but rather, they culminate a long and laborious fitting and re-fitting of ideas that goes on in the background; it seems almost independent of our conscious problem-solving, and usually quite linear, processes.

I was also quite taken with the chapter "Scotoma: Forgetting and Neglect in Science." The author digs into the lore of "ideas born before their time." It is usually the case that such ideas enter an arena that is already full of competing theories, and in particular, they usually incite the ire of numerous and powerful figures whose work is threatened thereby. My father used to say, "Really good ideas often have to take Moses's way: 40 years in the wilderness for a generation to die off." Sometimes it is more like a century or two! The most extreme example is that Archimedes seems to have invented calculus nearly 19 centuries before Liebnitz and Newton (re)formulated it.

Rather than comment on every chapter, I'll leave it to the reader to enjoy the book.

Making lemonade from the absence of a lemon

kw: book reviews, nonfiction, neurology, neuroscience, autobiographies

I seldom show a book jacket, but this book's cover illustration tells the objective story. Nicole Cohen has a hole in her brain the size of a lemon. It is not in a random location, but represents most of her right parietal lobe.

As she tells us in Head Case: My Brain and Other Wonders, this was not determined until she was in her early twenties and preparing to go to graduate school. She did not yet have a driver's license, but felt she really needed one at this point. Yet so far, she had been unable to pass a driving test. A long list of impairments finally convinced doctors to order MRI and other tests. Finally. Finally she knew she wasn't "just weird" or "not paying attention". A necessary bit of her brain was missing.

The parietal lobes integrate our sense for time and distance. They are necessary to form an accurate internal map of the world. We seldom realize that our ability to navigate the world requires us to sense the relationships of other objects to each other and to ourselves, both in space and time. If you can't judge how far an oncoming car is and how quickly it is approaching, you can't safely cross the street.

Children learn safe crossing by about age six or eight. Cole Cohen never has. She crosses with others, relying on their sense of time and space. While other children were learning to navigate the world safely, she learned how to rely on other people's abilities. Thus she could safely walk, but you can't drive that way.

Her writing is fluid and enjoyable to read; she is not "dumb". You don't need street-crossing skills to navigate your way to Bachelors' and Masters' degrees. She has learned to play well the hand she was dealt. As she writes, it hasn't been easy. Certain aspects of human relationships were as foreign to her as the distance to the nearest door. Touch is particularly problematic, probably because when she was quite young, touching something usually meant she'd misjudged where she was going and had just knocked something over. She learned to cope. She learned to thrive. A heartening story.