Switched On

by John Elder Robison

  After leaving the battlefield, Hitzig returned to Berlin and turned his experimentation to living dogs, applying electricity to different areas of their brains and observing the results. He used their responses to create a rough map of a dog’s brain. His 1870 paper that describes the canine cortical map stands as the first real description of what we now call the motor cortex. The insights in the paper would guide a generation of scientists, but the method by which he gained this knowledge would trouble ethicists. Did the end really justify the means? Some readers were horrified by the notion of dissecting and experimenting on living animals. They called those protesters antivivisectionists, and they banded together to question the medical ethics of the day. Thanks to them, the University of Berlin banned Hitzig’s dog experiments from campus labs, but he continued them in a colleague’s basement. Guys like Hitzig may have made great contributions to medicine, but they also inspired a thousand horror movies.

  In London, neurologist John Hughlings Jackson was developing his own theories about the functions of the nervous system, including the then-novel idea that epilepsy originated in the cortex. He’d formed that opinion working with patients at the National Hospital for Paralysis and Epilepsy, and he passed his thoughts on to David Ferrier, a younger colleague. Ferrier was already fascinated by Hitzig’s work, and he decided to test Jackson’s theories. By 1873 he was inducing epileptic seizures in dogs by using a battery to stimulate the exposed cerebral cortex. Just as Hitzig had mapped out the motor areas, Ferrier mapped out locations on both sides of the brain that induced seizures.

  Ferrier and, presumably, the others were well aware that cutting open the skull of a living creature was painful, and he suspected that electrical stimulation might hurt too. The problem, as Ferrier described it in an article published the following year, was that anaesthesia made his subjects less responsive to stimulation. Without anaesthesia, however, responses would be more difficult to interpret because they might be the result of stimulation, reflexive pain responses, or attempts to escape. Ferrier, Fritsch (another nineteenth-century brain researcher), and Hertzig had all described tranquilized animals crying out in pain after some stimulations. For those reasons, and what he called “the sake of humanity,” Ferrier used anaesthesia “before and throughout” his experiments.

  However, that wasn’t enough to diffuse the public’s horror and outrage when word leaked out about his research. There was a tremendous outcry by antivivisectionists, but the importance of his work ultimately proved to be his defence. His 1874 paper and the work that followed established Ferrier as one of the great experimental neurologists, and he was elected a Fellow of the Royal Society three years later.

  Once that paper came out, it took less than two years for someone to try systematic electrical stimulation on a living human brain. Roberts Bartholow* was a well-respected physician at Cincinnati’s Medical College of Ohio. He believed first-person experimentation was the best way to advance knowledge of the brain. When he found himself presented with a rare opportunity—a thirty-year-old cancer patient whose skull had been perforated by a terminal cancerous ulcer—he was quick to act. There’s no record of how he went about getting the patient’s permission, or what he may have promised her, but shortly after making her acquaintance, he was prodding the hole in Mary Rafferty’s head with several needles connected to a primitive but powerful battery.

  According to Dr. Bartholow, Rafferty was friendly and “eager to please.” Bartholow assures his readers that he had her “full informed consent,” but just a few pages later, he describes her as “feeble-minded.” His descriptions of the experiments were even more disturbing. After inserting a wire into her brain, “she complained of acute pain,” and his response was to increase the current! At that, “she showed great distress and began to cry.” Soon after, she frothed at the mouth and passed out.

  Dr. Bartholow’s report remains in the archives of the National Institutes of Health, where you can read it today. In it, he describes what came next. “After spending a day in bed, [she was] decidedly worse . . . stupid and incoherent.” Things didn’t get better with time. Rafferty had a seizure and slipped into a coma following a second round of electrification. She died a few days later, and Dr. Bartholow removed her brain and dissected it during the autopsy. He published an account of her case a few months later.

  There was some outcry in the press, and one doctor in town sent a complaint to the judicial council of the American Medical Association, but little came of it. A few years later, in response to continued professional criticism, Bartholow expressed regret that he had caused Ms. Rafferty some injury and pain, though he also said she was “hopelessly diseased” and cancer already “threatened an early extinction of life.”

  “She would have died anyway” is no longer a justification for this kind of mistreatment, and the standards of medical ethics and informed consent in research are very different today. Still, it’s a wonder that after reading all that grisly history, I managed to stay so upbeat. It’s a testament to how strong the promise of life-changing discovery can be.

  When I looked back at Bartholow’s work from the perspective of today, I felt shock and horror. Yet he was a renowned and widely admired brain expert by the standards of the late nineteenth century. Who’s to say that in a hundred years a scientist might not look at the experiments in Alvaro’s lab much the same way? I always felt absolutely confident that Alvaro did his best to look out for me (and everyone else in the study), but his ability to do so would always be constrained by the knowledge of the day.

  And with that in mind, I hadn’t forgotten Alvaro’s gentle warning: “The effects you feel might not always be so positive.” We talked about this at some length the next chance I got to stop by his office. Busy as he was, he always had time to consider my questions, often with no notice. We’d sit at his conference table, with tall bookshelves full of books about neuroscience surrounding us and light streaming through the window in the corner above his desk.

  Our talks were always enjoyable. I could never predict what he would say. Sometimes he spoke of contemporary research, but he was just as likely to bring up the ideas of some philosopher or scientist from one hundred or two hundred years ago and ask what that might tell us about our current question. That day, he seemed confident that there might be a single interesting explanation to account for why my changes were mostly good, and why they seemed so durable. “Remember that sled-run analogy that we talked about, and how a path becomes more natural and easier to use the more times you run it? Maybe that explains what happens here. When we do a stimulation and it produces an effect you don’t like, one that makes you uncomfortable, you don’t choose to run that path. But when we get a result you do like, you ask your friends if they see any changes, you look for them yourself, and you run the path as hard as you can. So your own mind is selecting and reinforcing for a good result. Maybe nothing protects you from having a bad effect in the initial stimulation, but your mind essentially throws the bad away and focuses on what it thinks is good.”

  I still wasn’t sure if his theory explained the way changes were settling in for me. “I had this really incredible sense of seeing into people and being part of the music. That insight went away quickly, but a new sense of emotion seems to be growing in its place.”

  “Awakening.” Alvaro smiled a bit at that thought. “That seems to be what’s happening. This sense of emotion is awakening in you. You’ve always had the ability to feel deeply—that’s clear from your writing. But what’s awakening in you is the ability to feel deeply in response to what you see in others, or what you hear about them.” The implication of his words was that the emotion I was feeling now in response to things I heard or read was an ordinary human ability or trait, but it had been suppressed or asleep in me all these years.

  I’d started to realize that there was a continuum, with highly logical thinking on one side and emotional response on the other, with most of humanity somewhere in the middle. Alvaro agreed
with that, but he added that our position on that continuum is a dynamic thing, as the brain regulates our responses to suit the environment. “It was biased toward the rational end for you,” he added, “and maybe now it’s not so much.

  “Yes,” he continued, “that sounds right. I think the wiring to do these things was in your head all along. That’s the only way they could have come to life immediately after TMS. Perhaps you never knew how to access them, or perhaps the circuits were suppressed and the TMS was able to bring them to life. As surprised as you were that the effects didn’t come to you till the next day, that’s nowhere near enough time for your brain to build new pathways. So they must have been there.”

  He sat there, thinking for a moment. “When we do the TMS for depression, that has a delayed response too. Some patients say they walk out feeling better, but for many of them, it builds over time, somewhat like you reported.”

  His words made me wonder what else might be prewired in my brain. Did we have multiple personalities all wired up and ready to use, just as “emotional vision” was always latent in my mind, waiting for activation? Thirty-five years earlier, when I was fifteen, my mother’s terrifying hallucinations had been totally real, just as real as my sense of seeing into other people. “The monsters are right up there, John Elder. Two of them,” she would say during her psychotic episodes. I’d look where she pointed but all I could see was the ceiling. Still, she was so sure there were demons that she became angry when I could not see them.

  The doctors at the hospital tried to reassure me by saying there were no demons and it was “just my mother’s psychosis talking.” They would medicate her, and she would emerge in a subdued but normal state a few days later, but I never forgot the speed with which she threw a switch in her mind and began seeing a totally different reality than any I had known. Ever since then I had wondered if demons are inside all of us, waiting for the right trigger to set them free.

  “TMS may be particularly effective for you because you have an exceptional power for self-reflection. Maybe that’s why you wrote your book, or maybe you developed that ability by writing. Either way, it’s uncommon and it may help you as you identify a change and focus on it, whereas someone who is less internally aware might overlook it.”

  That raised an interesting possibility. Alvaro had said that some of the younger participants in the study were not noticing any effects at all, even though they might show differences on the tests. I didn’t meet those other volunteers, and they remained anonymous to me. Still, we speculated about why I described experiences that they didn’t report. Was it necessary to notice the effects of TMS and “work the changes” to get an effect? Might my own efforts to do that have accounted for the bigger changes in me?

  “It’s possible,” Alvaro said. “Perhaps the TMS would be most successful if it was done in conjunction with therapy. But there’s a problem with doing therapy in a study like this. Critics would ask if it was the TMS or the talk therapy that made the difference, and it would be hard to separate them.”

  I realized that was true. From his perspective as a researcher he wanted to keep the experiments simple. But from where I stood—as an individual who wanted to change—I could definitely see how counselling or discussion might make all the difference.

  That first TMS experience, the awakening of my insight into music, had taken me by surprise. No one had predicted such a result, which told me I should be open to just about anything that might come next. So as the sessions continued, I think I paid closer-than-average attention to my reactions. I knew that greater emotional intelligence was the general target, but I had no idea exactly what to expect. The fact that the researchers didn’t know either told me I should take special note of anything out of the ordinary, because I had no idea what would be important and what would be irrelevant.

  I contrasted my experience with the little I knew of some of the others in our study. Some of them lived alone and didn’t interact with as many people as I did. Some of them may well have been temporarily changed by TMS, but then maybe they went home and were alone all night till the effects wore off. In that case, they may have experienced some of the same changes as I did only to have them fade away, unnoticed.

  My son had felt a change in his perceptions, but he didn’t ruminate on what happened as intently as I did. He seemed to alternate between uninterest and excitement when it came to TMS. Still, he never forgot the sense of sharpening the TMS gave him, and both of us wonder how much permanent effect there was on him. It’s hard to say because he wasn’t thinking much about people and emotional insight when we did the study. He’d wanted a distraction from the upcoming trial, and his interests remained technical—chemistry and computers. TMS hadn’t changed those things in his mind. It’s also possible that teenage boys simply aren’t emotionally mature enough to be so self-reflective. I could see—with considerable unease—that the foundations of my own marriage were shaken by TMS, and I had no idea if anything similar was happening with my son. I wondered if TMS had affected his relationship with his girlfriend, but it was his first romantic relationship and I reasoned that he had nothing to compare it to. Seeing the world differently is a really big deal—all the balances in your life change. Martha’s fears had felt like depression talk in the beginning, but they were proving prescient as the study unfolded. My friend Michael Wilcox didn’t think he’d been hit with a new sensitivity to emotion when we discussed it right after the study, but now he feels differently.

  Michael recently told me that he’s become unable to read fiction, and that came to pass after TMS. He had always eagerly awaited the weekly arrival of The New Yorker magazine and the terrific new short story in each issue. He had once dreamed of writing himself and had taken creative writing classes back in his college days at Harvard in the early 1990s. But after TMS, his love of fiction was replaced by an absolute dread of the emotions that would well up in him when he read of others’ misfortunes. And that remains true to this day. It’s funny, but neither of us shared our newfound emotional fragility until we spoke this past fall, and each of us was surprised to hear that it had occurred in the other. I think we were both a little self-conscious and embarrassed at the notion of grown men reduced to tears by reading magazines!

  What about the hallucinations I experienced? None of the researchers had a ready explanation for them. Dr. Timothy Leary—another Harvard faculty member—had described his drug-induced hallucinations as visions that facilitated life changes. My own life sure felt different since they had appeared. Dr. Leary had studied hallucinations that came from psilocybin mushrooms, like those I’d recalled that night in the pizza parlour.

  I thought about friends who’d done mushrooms or LSD back in those days, and how five of them could eat the same mushrooms while only one or two described having hallucinations. Some of them even complained about the lack of effect. “Nothing’s happening,” one would say, and he’d eat another handful. At that point things might explode, but one fellow’s “handful dosage” might be ten times what it took for the most sensitive fellow in the group to be sent into orbit.

  Perhaps something similar happened with TMS. Earlier life experience had shown that I might be particularly sensitive, and perhaps everyone else would have shared my experience had their dose been doubled or tripled. I also wasn’t sure how many participants would speak up, even if they had the hallucinations I’d experienced. Many people would be self-conscious or embarrassed, given the status of hallucinations in today’s world. The sixties and seventies were a very different time.

  “What makes you think you are unusually sensitive?” That seemed a reasonable question for Alvaro to ask me when I raised that possibility. Luckily I had a better answer than a long-ago psychedelic drug experience. I told him about three recent occasions on which I’d been given prescriptions for psychiatric medication (for depression and anxiety—both of which are common in autistic people), and how each time I was overwhelmed by what the doctors described as “mini
mal starting doses.” With each medication, I ended up taking a fifth to a half the standard dose, and I discontinued those quickly because I felt they still affected me too much.

  Lindsay wasn’t surprised at all. Several times she had remarked on how I sensed things that no one else commented on—like counting the multiple taps of a TMS burst, or describing the stirrings inside my head.

  In recent years there’s been some research that validates my experience—we now know autistic people can have exceptional sensitivities, such as mine for sound. And other autistic people do seem extraordinarily responsive to psychiatric medications. But all I knew for sure then was that some guys could drink a twelve-pack of beer and not show any effect, whereas if I drank one can, I felt a buzz. That was one reason I stuck to iced tea for refreshment and stayed totally clear of illegal drugs—I’m too old to be getting high and flying my motorcycle to Mexico.

  Or maybe I’m a little bit scared to find out what would happen if I actually went there. The more I reflected, the more I understood what powerful and prophetic things hallucinations could be. Back in the day, most people dismissed them as just being high. But I knew others who felt themselves powerfully changed by them, even years later. As an interesting side note, other researchers are now exploring the use of hallucinogens to help terminally ill patients find peace and comfort through expanded consciousness. Perhaps the TMS experiences gave a little of that to some of us.

  * Harris, L. J., and Almerigi, J. B. “Probing the Human Brain with Stimulating Electrodes: The Story of Roberts Bartholow’s (1874) Experiment on Mary Rafferty.” Brain and Cognition 70, no. 1 (2009): 92–115.

  Science Fiction Becomes Real

  WAY BACK IN EIGHTH GRADE I read the science fiction novel Flowers for Algernon.* If you’ve read that book or seen the movie, you probably remember how things begin so hopeful and end up so tragically for Charlie, the main character. He starts out as a cognitively crippled janitor in a bakery, and then some scientists change his brain and turn him into a supergenius. In a matter of months he goes from cleaning toilets to writing cutting-edge research papers. But then Charlie discovers a flaw in the science that made him smart, and he watches his intellect evaporate as fast as it arrived. I suddenly found myself haunted by the story, and wondering if I wasn’t a bit like Charlie. My own transition was nowhere near as dramatic as his, but the TMS study still marked a tipping point in my life.