People who’ve read my work in other places know what a fan I am of James Burke’s original series Connections. There’s a new series on Netflix called Connected, which I may get around to after re-watching my old favorite for the first time in 20+ years.
While I lived in Houston I also listened to John Lienhard’s somewhat similar The Engines of Our Ingenuity, which as far as I can tell does not have a podcast, but is freely available to any radio station that wants it. Since our local NPR station WFDD canceled its homegrown SciWorks Radio series, and my nerd colleague Shawn Fitzmaurice moved back to Boston to start his own dream-job voiceover business, we have no science on the radio. Listen to a few of the short Engines episodes (there are over 3,000 to choose from!) and let me know if it would be worth lobbying WFDD to carry it (again, for free!).
But anyway, connections …
I have been watching a few select episodes of PBS’s American Masters, a series of biographies of people who did important things, according to the standards of the time of broadcast. SF author Ursula K. LeGuin (who also translated the Tao Te Ching), native poet and novelist N. Scott Momaday, trumpeter Doc Severinsen (who played here in Greensboro a few years ago), people like that.
Originally from England, Sacks came to America after his mother reacted badly to his coming out, and except for a few reconciliation visits, stayed for the rest of his life. Partially due to the experience of growing up with a schizophrenic brother, and partially because of early parental expectations, he became a doctor. Importantly, not a psychiatrist, as in our last issue, but a neurologist. They are not the same thing at all. Psychiatrists treat minds, which are largely theoretical, even today, and neurologists treat brains. Or perhaps it might be better to say that psychiatrists treat syndromes (clusters of unexplained symptoms) like depression and bipolar disorder and neurologists treat diseases, things like strokes and head trauma and brain tumors and Parkinson’s Disease.
Sacks originally got slightly famous for his role in testing a new drug (L-DOPA, a precursor to the hormone and neurotransmistter dopamine) in a group of patients who had Parkinson’s-like symptoms, but not Parkinson’s disease, which is normally age-related. In fact they were survivors of some mysterious contagious thing called encephalitis lethargica, which swept the world in the 1920s. Encephalitis just means inflammation of the brain, and lethargica implies one of the main symptoms, that victims wanted to sleep all the time during the infection. This experiment became a book called Awakenings and later a Robin Williams movie of the same name, which made Sacks really famous, and contributed to the sales of his later books, including the one that hooked me on neuroscience, The Man Who Mistook His Wife for a Hat. I saw him speak twice, once at the Rochester Academy of Medicine in the 1990s (though I have no memory what about (turns out it was sign language, a specialty at the U of R and at neighboring RIT), and once at the University of Houston in the early 2000s.
The documentary was filmed in the last few months of Sack’s life, after his terminal cancer diagnosis, when he no longer cared about secrets. His homosexuality was so secret that he was essentially celibate for 35 years, and he didn’t come clean about his heavy drug use until he was in his 70s. One of the case studies that interested me most in The Man Who Mistook His Wife for a Hat, “The Dog Beneath the Skin,” about a medical student whose sense of smell was heightened by amphetamine use, was actually about Sacks himself. There’s not much of a filter in the documentary, though. There’s even a risque story about Jell-O, which I thought pretty unusual for PBS.
This documentary has an even more tenuous connection to last week’s issue, in that this famous writer (none of whose work I have yet read) lived most of her life in Milledgeville, Georgia, which also hosted one of those giant state mental asylums, at one point the largest in the world with over 12,000 patients. At least two books have been written about it, neither of which I have read, though the author of the latest was on C-SPAN, talking about it at the Atlanta History Center. There are tours.
I was completely unfamiliar with Flannery O’Connor’s life and work. I had only heard her name as a famous Southern writer, and until the documentary I hadn’t even been sure about the she (“Flannery” being a name like “Ashley” that might go either way in my mind, depending on the time period).
She lived on a farm near Milledgeville, with her mother, because she had lupus, an autoimmune disorder that sometimes displays a variety of neurological symptoms, depending on where the inflammation is. The documentary features a lot more artwork and animation than most of the films in this series, which mostly rely on photos and archival film (and talking heads). Probably some are illustrations from her stories, published in the glossy paper “slick” magazines of the time, which were more colorful than the cheaper b&w pulps, but O’Connor herself was also a cartoonist! I had never heard about that before.
Brain Inflammation Is a Chameleon
The blood vessels that feed the brain are more tightly sealed than others throughout the body. The cells that line them are glued together by proteins, creating a “blood-brain barrier” that under most conditions prevents immune cells from squeezing through and crawling freely around in the brain the way they can in most other tissues. The barrier can be broken by trauma, but it can also open up if there is a noticeable infection, or sometimes by mistake.
Because the brain is somewhat localized, temporary inflammation of any specific location can mimic the effects of drugs that inactivate neurons in that location, or those of other sorts of more permanent damage. Note that both lupus and Susannah Cahalan’s anti-NMDA-receptor autoimmune encephalitis, mentioned in Mysteries of Mental Illness from last week’s issue, can on occasion cause psychotic episodes that would otherwise indicate very different mental illness syndromes.
My Favorite Lupus Story
In the early 1990s, long after Flannery O’Connor died, a neurologist at the University of Rochester, Robert Ader (“the father of psychoneuroimmunology”) and a pediatrician collaborator, Karen Olness (who is also a hypnotist!), were contacted by a desperate mother. Her daughter had lupus, which had specifically keyed in on one of her blood clotting factor proteins, mimicking hemophilia, and if they didn’t do something before the girl started menstruating, she was in danger of bleeding to death. The only other option was removing her uterus, or scarring the inside of it so there was no lining to shed every month.
I wrote about their experimental approach to saving her life in this column for the Intergalactic Medicine Show. Bill Moyers also talked to all the people involved in this clip for his series Healing and the Mind, which I didn’t know about at the time. Both the patient and Bob Ader are dead now, but I’ve been wanting to talk to Karen Olness about whether hypnosis might amplify the kinds of placebo effects they took advantage in their experiment. If this would interest you, too, please let me know.
So we jump from a doctor with literary ambitions, Oliver Sacks, treating the after-effects of a mysterious, possibly viral inflammation of the brain, to Flannery O’Connor, a literary author who sometimes wrote about mental illness but died of an autoimmune disorder, to a partially placebo-based treatment for the same autoimmune disorder that Bob Ader speculated (and I agree with him) could have very wide applications in reducing our dependence on drugs of many sorts, and on the pharmaceutical companies that profit off that dependence.
This is, for better or worse, how my brain works.
Further Reading / Listening
“A New Take on Psychoneuroimmunology,” by Beth Azar (2001), so not so new, now.
Conditioning Immune and Endocrine Parameters in Humans: A Systematic Review. Tekampe et al (2017).