In The Mind Electric, the neurologist explores the roots of neurological disease and the narratives that shape medicine.
You write about a patient who fabricated details about her surroundings, while denying she was blind. Can you explain the cause?
It wasn’t faking. Her blindness came not from her eyes but from the occipital lobes at the back of her brain, where vision is processed. When people have an injury there, they can—it sounds almost unbelievable—lose all their vision without realizing it. So, their brains confabulate to explain what they’ve lost. Our brains work really hard to hide our deficits from us by filling in gaps in the information that they expect to see.
You also discuss the pain of your pregnancies, and opting for an epidural anesthetic during delivery. Is medicine attentive enough to pain?
There is this specter of medicine giving weight to certain types of pain and not others, of disregarding the pain of Black and brown people, and of women. Epidurals were controversial when they were introduced. There was this idea that pain should be an inevitable part of childbirth, part of the transformation of becoming a mother. That builds on a belief that pain is somehow transformative or curative and that we should experience pain in order to achieve something. I didn’t feel that way during my pregnancy! I was in a hospital, and having an epidural reduced that sense of powerlessness. It made me feel like I was in control of my body again.
Another case concerns a woman whose seizures are preceded by, of all things, hearing a Van Halen song and feeling a sense of terror.
The temporal lobe—on the side of your head behind your ear—is prone to seizures. It includes your hippocampus, which helps form memories; your auditory cortex, which processes sound; and your amygdala, which experiences sensations like fear. This woman was having seizures originating in the temporal lobe, so she had the aura of hearing a song she remembered and the sensation of terror from the amygdala.
Should psychiatrists—and maybe moral philosophers—pay more attention to how our higher-order psychological lives are dependent on the state of our bodies?
It is so wild to think that this lump of cells can give rise to all those higher-order functions. Something that can be really challenging for neurologists is all of these sophisticated neurological symptoms can feel so removed from the physical substrate of our brain that they can get missed. The distinction between what is a psychological problem and what is a neurological problem is somewhat arbitrary. There are many conditions we thought arose from anxiety or nerves, but now understand that there’s a physical substrate or wound causing them. I wouldn’t be surprised if 50 years from now the distinctions we’re drawing now will feel just as archaic.
