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In the tradition of Oliver Sacks, two tomes investigate rare brain conditions

Unthinkable: An Extraordinary Journey Through the World’s Strangest Brains

Helen Thomson
HarperCollins
2018
283 pp.
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The Disordered Mind: What Unusual Brains Tell Us About Ourselves

Eric R. Kandel
Farrar, Straus and Giroux
2018
304 pp.
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The case report is dead. At least, it seems all but so in the realm of evidence-based medicine. It is thus thoroughly refreshing to read Helen Thomson’s Unthinkable: An Extraordinary Journey Through the World’s Strangest Brains and Eric R. Kandel’s The Disordered Mind: What Unusual Brains Tell Us About Ourselves, two ambitious books that draw on clinical profiles to tell stories about our brains and minds.

Thomson’s memoir aims to help us understand our brains through stories about exceptional others, who, she argues, may serve as proxies for ourselves. Kandel’s book argues from neuroscience research and individual illness experiences for a biologically informed account of mind and brain. Both authors are unapologetic in their focus on what might be dismissed as merely anecdotal. Each foregrounds neurological and psychiatric patient narratives and experiences and from these draws out larger philosophical and scientific lessons.

By profiling and seeking meaning in individuals with curious neurological conditions, Thomson’s Unthinkable follows a well-worn literary path but revitalizes the genre with an original and subtle shift to the personal. Perfected by neurologist Oliver Sacks, Thomson’s technique was invented before the 19th century but most famously pioneered in the 20th century by such eminent neurologists as Morton Prince, Sigmund Freud, and Alexander Luria.

Where those authors represented patients as medical mysteries or as object lessons in physiology and philosophy, Thomson finds a timelier focus that corresponds with the growing advocacy for, and social attention to, individual patients’ rights. Unlike her predecessors in the genre, Thomson enters her subject’s lives—their restaurants, homes, families, communities, and online selves.

Her account, written in an easy-going, journalistic first person, moves at times from travelogue to spiritual odyssey. Yet it is at its best when Thomson listens—to people’s descriptions of their neurological abilities, caregivers’ accounts of their lives, and doctors’ surprise at the varieties of the human condition.

Like Thomson’s Unthinkable, Kandel’s The Disordered Mind has similar sensitivity to personal experience. Kandel is an astute reader and a reflective observer. He has a penchant for thick description and a humanist’s appreciation of the sublime. Much in his study reminds the reader of the 19th-century natural historian, in whom a singular instance in nature could give rise to a grand idea. There is certainly that nostalgic, synthetic voice in his text.

Neuroscience comes alive in Kandel’s study through the personal and imaginative ruminations of disordered minds. He finds in the literary and artistic endeavors of psychiatric and neurological patients material illustrations of deeper neuroscientific concepts. Each vignette forms a natural experiment. Each patient becomes a novel performance of nature.

At his very best, Kandel recedes into the background and becomes a quiet observer of cultures, of societies, and most especially of minds puzzled at the experience of being a brain in a body. By granting so much agency to patient voices and personal knowledge, Kandel asks his reader to confront the anecdotal and inexplicable and think hard about what it means.

The varieties of neurological experience Thomson and Kandel describe are eye-opening. Both authors recall the most famous neurological patients as they describe their own evocative cases. Expected cameos include such famous patients as Phineas Gage, the famous railroad foreman whose personality changed after an iron rod destroyed much of his frontal lobe; the Jumping Frenchmen of Maine, a group of 19th-century lumberjacks who exhibited an exaggerated startle response; H.M., the man who was unable to form a new memory after 1953; and John Nash, the Nobelist and mathematician who suffered from schizophrenia. Yet these familiar patients feature only in the background.

Kandel turns up dozens of autobiographical works by mentally ill or neurodiverse people reflecting on their experiences: Here is the voice of Erin McKinney in his study describing her life with autism; there, the voice of Andrew Solomon describing his severe depression. Chuck Close, a portraitist who cannot “recognize individual people,” appears not far from Peter Moog, a likely schizophrenic whose religious imagery would partially inspire the Dadaist and Surrealist movements.

HENNING KAISER/AFP/GETTY IMAGES

Transforming faces into two dimensions helps Chuck Close, who suffers from face blindness, recognize people.

Where Kandel’s book only visits such figures in brief passages, however, Thomson’s spends whole chapters with them. The intimacy she acquires with her subjects grants her access to a variety of personal spaces normally denied to outsiders; she writes of their sexual attractions, their experiences of divorce and other life events, their permanent fears and anxieties, even their self-loathing and suicidal ideation.

Thomson meets people who see colored auras emanating from every person; she meets others who never forget a moment of any day, ever. She interviews people with synesthesia, schizophrenia, depersonalization, even whole-scale personality change, and she describes their extraordinary experiences often by examining the banality of everyday life. She finds answers to questions that must baffle neighbors. Sharon, who lives her life often completely lost in physical space, for example, explains to Thomson the reason for her large, unsightly giant lobster lawn ornament: “I see Louie…I know I’m home.”

If Thomson is sometimes too present in her own narrative, she is nevertheless an attentive and empathetic observer. It is clear from the way her encounters unfold that the people she meets on her journey throughout the book are drawn to her warmth, character, and curiosity. Nowhere is this clearer than in her treatment of Cotard’s syndrome and Graham’s experience of waking up dead (the delusion archetypical of the syndrome).

Graham, after a suicide attempt, acquired a host of subjective symptoms as a dead, living person: His emotions vanished; his sense of smell disappeared; even his addictions ceased to exercise any hold. He confides to Thomson: “I sat right there, just like you are now. All day. For months. I didn’t have anything to think about, didn’t want to do anything, say anything, see anyone. Just stared at that wall. Like a vegetable. Somehow my body hadn’t realized my brain was dead. But I knew it was. Horrible really, thinking about it now. But that was that.”

Upon neurological examination, Graham was found to have brain areas where metabolic activity was so low it made sense to compare him with coma patients, leading him to become immortalized in a paper entitled, provocatively, “Brain dead yet mind alive.” Thomson notes that although Graham eventually regained some of what had been lost, the early clinical findings of his unique brain function were of almost no value to him. “It didn’t change the fact,’ he divulged to her, ‘that I thought I was dead.’”

JOHN LUND/GETTY IMAGES

Chromesthesia, a common form of synesthesia, manifests when sounds trigger
the simultaneous perception of colors.

Despite foregrounding lived neurological experience, neither book shies away from clinical and scientific detail. Thomson, however, typically subordinates her discussion of scientific concepts and medical theory to the biographical and historical.

Kandel, meanwhile, combines his case perspective with brain genetics, brain imaging studies, and animal models of brain disorders. His volume is consequently the more technical of the two studies, but it is so skillfully written that it is easy to forget that his deeper purpose is to use the basic science and clinical medicine to ground his larger, more controversial argument: the notion that the mind can be studied biologically.

The ease with which Kandel puts patients into contexts within whole literatures on dopaminergic and serotonergic neurons, genetic mutations, and psychoanalytic categories might well suggest that all of this science is settled—indeed, even that the problem of reductionism has finally been solved. The reader should be alert, however, to Kandel’s syntheses, such as, for instance, when he brings together (without fanfare) prion disease, misfolding proteins, and chronic traumatic encephalopathy. His is a brilliant and likely correct observation, but one that could only be termed an active hypothesis. Kandel nevertheless uses this to elaborate a far larger point about the relationship between the death of neurons in the brain and erratic, sometimes violent behavior.

What goes missing in both books, and indeed goes missing in most books that foreground neurological and psychiatric patients, is a deeper ethical and humane engagement with the place such individuals occupy when—to put it in the broadest terms—their access to social, racial, and economic justice is diminished. Both authors recognize that often the cases they present are lucky exceptions.

When describing Joel, a mirror-touch synesthete (someone who feels what other people appear to be feeling physically and emotionally), Thomson wonders how his life would have been “had he not been so bright.” Joel answers that without his intelligence, “his world could easily have come crashing down around him.” Kandel contemplates retributive justice in the context of brain disease, brain injury, and major psychiatric disorder and admits that the question of criminal responsibility is a vexing one.

Such observations make clear that even as we can know so much about the extraordinary individuals who become profiles of neurological diversity, we know too little about the lives of similarly situated individuals who suffer in silence on the fringes of society. How are these types of individuals insured? How are they coded in hospital records when they die? What is their experience with law enforcement and the criminal justice system? How many health care professionals suspect them of malingering?

Because even basic statistics on rare neurological conditions are often lacking, it is hard to assess how many individuals in such circumstances live lives diminished or enriched by their own neurological diversity. It is not hard, however, to imagine that for many, their demographic attributes stand firmly against them.

Whatever the answers to such questions, it seems likely that they would rely greatly on individual case studies rather than expansive statistics. And here, of course, Kandel’s and Thomson’s books are invaluable demonstrations of the value of anecdotal evidence. These books are compassionate testimonials to the value of thinking in cases.

About the author

The reviewer is at the Department of Humanities and Social Sciences, Clarkson University, Potsdam, NY 13699, USA.