As Richard Feynman noted in a commencement address to CalTech: “The first principle is that you must not fool yourself—and you are the easiest person to fool. So you have to be very careful about that.”
The reason it's so hard to be sure that “crackpots” aren't actually all they're cracked up to be is that occasionally, a seeming eccentric is proven correct. Dr. Barry Marshall, for example, came up with the idea that bacteria were the cause of most stomach ulcers. He was ridiculed by an establishment that had long held ulcers were caused by stress, spicy foods, and an overly acidic stomach. Scientists felt that bacteria simply could not live in such an acidic environment. “Everyone was against me,” said Marshall, “but I knew I was right.” Marshall eventually proved his theory by drinking a petri dish of bacteria and giving himself gastritis (and to his wife's dismay, bad breath). A dose of antibiotics cured him. Marshall—and his stomach—eventually won the Nobel Prize for his groundbreaking work.
f.Anyone, that is, except Deng Xiaoping, who easily bested the “Iron Lady” in negotiations for Hong Kong. But then, the brilliant, wily Deng had trained by surviving for decades under Mao.
g.As with Reagan's Alzheimer's, Thatcher's case is particularly poignant. Her daughter noted: “She had such a brilliant memory—like a website. She could quote inflation statistics going back years without reference to a single note.” But a series of mini-strokes left Thatcher with the frustrating inability to remember, by the end of a sentence, what the beginning of a sentence had been.
h.One example, which I've witnessed and heard about in various universities around the country, is when a more Machiavellian professor seduces a student into doing an independent study project under his or her direction. When the student is particularly hardworking and good-hearted, sometimes one can't resist attempting to give warning. Such warnings are almost invariably shrugged off—“It's only a two credit project,” the student might say, “What could Professor X really do to me?” The student always remarks on how nice Professor X seems, and one can practically hear them thinking: Why am I being warned about somebody who really likes me and is obviously such a great professor? Maybe you're the one with the problem.
A semester or two later, the tale of woe generally runs along the lines of “I'm just an undergrad, but Professor X wants me to read twenty-five journal articles and use all this information to create an advanced new theory. It's crazy! And he never shows up for meetings, never can help me with anything, and really—I don't think he understands what he's doing!” The other faculty all know what's going on, but in the topsy-turvy world of tenure, there is virtually no ability to discipline. Besides, X is so Machiavellian that even the administration is afraid to discipline him (or her). And of course, the administration has its own sinister cast of characters with their own Machiavellian mackerel to—well, you get the idea.
The students one really feels for are those from overseas, who arrive looking like lost lambs and sign on with the first friendly-looking professor they talk to. That professor is often X, in happy, charming, chameleon mode. Students don't realize that once they've signed, it can be virtually impossible to escape. However many experiments they run, papers they publish, or patents they obtain, at many universities, X is not required to allow them to graduate. Some students work full time on their doctorates for seven or more years, indentured servants who plump their masters’ credentials through their thankless, endless, low-paying work. In these cases in particular, nice guys really do finish last.
i.Even Einstein's Theory of Relativity was nearly instead named Invariance Theory, after the fact that, although space and time each vary individually, space-time itself, along with the speed of light, is invariant.
“Obsolete power corrupts obsoletely.”
—Jon Stewart
Not long after Carolyn took the trip to Europe with the emphysemic Ted, my mother passed away. A second aneurysm while she was sitting alone on a couch one evening erased her mind—her body failed a few hours later. I traveled from Michigan back to the Olympic Peninsula, where my brother had arranged the funeral. The Sequim Valley Chapel was small and plain; it filled quickly with people my mother had known, many of whom I'd never met. I stood teary-eyed as strangers reminded me of my mother's kindness, cheery nature, and ready willingness to help. My brother stood morosely beside me, steadily shaking hands and acknowledging condolences.
Carolyn sat in the front pew, her crutches beside her, eerily serene.
With my mother's and Ted's deaths, my sister was left largely to her own resources. Except, of course, for my father, who would stop by her tiny apartment to say hello, or to help by examining her cat with his practiced veterinarian's eye, or to take her garbage out, clinking his way toward the curb with plastic bags full of empty gin bottles. Her alcoholism left him loath to give her money; he had stopped bringing her by his cabin because of her incessant pilfering. But sometimes he would take her for outings. One rare photograph captures the two together around 1990, at the top of Hurricane Ridge in the Olympic Mountains, near Sequim. She smiles knowingly, hiding her thinness under bulky clothing. But the contrast of his rugged outdoorsman build with her wasted frame stands out despite her careful pose.
In the years not long before my father's death, as the tentacles of Alzheimer's began to slither more deeply through his mind, his thoughts turned more frequently toward Carolyn—worrying what would become of her. He made an appointment with an estate lawyer, his low-key good humor serving to make his final sentient preparations for death seem as simple as picking out a shirt at Wal-Mart. He carefully set aside part of whatever monies might be left after his illness in a separate trust fund for Carolyn that I was to administer. “Don't give her any money directly, ever,” he warned me. “Just use it to buy things she needs.” Later, I was to discover just how deeply ingrained my father's caution was. Toward the end, when he would have psychotic episodes at the nursing home a mile from my house in Michigan, the nurses would try to soothe him: “It's okay—your daughter is coming.” He would roll over, pausing his frantic, senseless kicking. “Which one?” he would ask suspiciously.
Fig. 12.1.
But Carolyn was also my father's daughter—his oldest daughter. Perhaps holding on to the image of an adorable, rambunctious three-year-old, suddenly rag doll–limp and terror-stricken through no fault of her own, he never stopped loving her, fretting about her, wondering how in God's name she had become what she had become.
As I wondered in turn.
Until January 2007. That's when an electronic prepublication version of a study popped up on one of my noodling, doodling, double-checking searches.1 My eyes widened as I read the abstract. This study—a massive one involving 4,660 Danish polio patients—was intended to discover whether polio could be associated with subsequent risk of hospitalization for psychiatric disorders.
It turns out that medical data in Denmark is tracked in a particularly useful fashion, making it relatively straightforward to compare polio survival with demographically similar individuals. It should be remembered that many polio survivors, unlike Carolyn, develop compulsively goal-oriented, high-achieving personalities—and they do not lack for kindness.2 Even so, this study found that polio survivors appeared to have a 40 percent increased risk of being hospitalized for various psychiatric disorders. This sounds high, and is high, but still, in all, equates to only a small bump in the incidence of psychiatric disorders in polio survivors. For those who contracted polio before age seven, as Carolyn did, the risk of psychiatric hospitalization was even higher.
It was no wonder I hadn't seen a pattern, despite my careful searches. Such a slight bump upward in the number of psychiatric disorders in polio survivors versus healthy people is tough to discern, except using the large numbers of patients that Danish researcher Nete Munk Nielsen and her colleagues were able to study. It's easy to suppose that if there was a bump upward in clinically diagnosed psychiatric disorders, there would have been a similar, or perhaps even larger incr
ease in subclinical disorders. (Carolyn, remember, was never diagnosed with any psychiatric disorder.) Perhaps without polio, Carolyn would have had the creative, emotionally dynamic personality of so many in my family. But the polio left a tragic overlay on her character.
Was this due to neural damage from the poliovirus itself? Or trauma related to the horrific experience of having polio? Or genetic predisposition?
All of the above, it seems.
Part of Carolyn's problem was that she skated ahead of the wave of research findings. When the full force of her disordered personality began to flower in her teens, it was still over a decade before borderline personality would become a diagnostic entity. No one knew the real significance of the fact that poliovirus could invade not only motor neurons, but the reticular activating system—that crucial section of our brain that maintains our attention and alertness.3
Carolyn's attentional system was dysfunctional.
This would have meant that neurotransmitter systems throughout Carolyn's brain were also dysfunctional, perhaps causing her to have some of the same sweeping neurological differences we've seen in the brains of those who are clinically diagnosed with a personality disorder.
The clues were all there, even from the beginning of my research. It's just that until prompted by this final, capstone study, I wasn't able to put those clues together. I knew that polio's invasion and partial destruction of the reticular activating system also affects the survivor's attention.4 But I hadn't associated this finding with those of Michael Posner's group, which indicated that minor differences in the attentional network appear to be vitally influential in the development of full-blown borderline personality disorder—for those with the genetic predisposition. And I also hadn't connected polio's damage to the attentional network with Joseph Newman's work. Newman, if you'll remember, had shown the importance of a dysfunctional attentional network in the development of psychopathy—a disorder he has also shown to not necessarily be related to violence.
Despite her sometimes psychopathic-like behavior, Carolyn seemed so intelligent because, indeed, she was. Polio never invades the nonmotor neurons of the cortical areas; Carolyn's natural intelligence was left intact, floating on a surreal, dysfunctional emotional foundation. Through decade after decade of manipulation and deceit, no one could know that Carolyn's strange, uncaring attitude was not a conscious choice but was almost certainly due to shaky neural underpinnings, in all probability caused by a perfect storm of neural damage due to the poliovirus infection, extraordinary stress from the consequent social isolation and ostracization, and underneath it all, a genetic predisposition.
Was the genetic predisposition related to the genetics that helped form her personality? Probably. Our family certainly seems to have had more than its share of idiosyncratic personalities. But perhaps even more importantly, the predisposition related to the genetics of the receptors on Carolyn's neurons—receptors she shared with both of her similarly paralyzed cousins, each of whom was also a descendant of my mother's father. Paralysis from polio, remember, often runs in families.5
But there is another little oddity. The gene that makes the key neural receptor that the poliovirus uses to slip into a cell is found on chromosome 19. The chromosome 19, if you'll remember, is also where APOE4—the allele that predisposes people to Alzheimer's—is found. It turns out that people who have been paralyzed by polio rarely get Alzheimer's.
Why?
The same APOE4 allele that increases the risk of Alzheimer's reduces the risk of getting polio.6
Evil genes indeed.
EVIL AND FREE WILL
Did Carolyn have free will in how she led her life? In some sense, the question is meaningless. Does a cat have a choice when she affectionately licks her kittens? Does a killer whale have a choice when it toys with a terrified seal pup? If I've learned anything through these many years of research, it's that Carolyn's choices were a bit like the choices a tree on a windy shoreline has in deciding how tall and how bent to grow. Sure, others, as for example, George Washington and Mahatma Gandhi, were probably able to produce real changes in their neurological makeup through their conscious choices—strengthening their top-down control even if they were unable to adjust their bottom-up passions. Research is in fact showing that extraordinary neural shifts can take place through long-term conscious efforts.7
But what of those, like Carolyn, who don't seem to have the requisite neural apparatus to understand that there is a problem, not with drinking, or with others, but rather, with themselves? What motivation could such a person have to even attempt a change? What if the ability to exert focused mental effort is itself dysfunctional as a result of some varying combination of genetic predisposition and environmental factors, as was probably the case with Carolyn?8 In point of fact, how many people have Washington's or Gandhi's strength of character—a trait probably intimately connected with a genetically based ability to focus—to put forth the prodigious effort needed to overcome an innate predisposition?
Perhaps neuroscientist Adrian Raine put it best when he wrote:
If some individuals have damaged brains, can they be said to be fully in control of their actions and cognitions? Do they have complete freedom of will, or does the brain damage place constraints on such freedom? At one extreme, many theologians, philosophers, and scientists would argue that, barring exceptional circumstances such as severe physical and mental illness, each and every one of us has full control over our actions. We choose whether to commit sin or not, and thus our criminal actions (sins) are a product of a will that is under our full control. At the other extreme, some scientists take a more reductionist approach and eschew the idea of a disembodied soul that has its own free will. Francis Crick, for example, believes that free will is nothing more than a large assembly of neurons (probably involving the anterior cingulate cortex), and that under a certain set of assumptions it would be possible to build a machine that would believe it has free will…
I would instead argue for a middle ground between these two extremes. I suspect that freedom of will lies on a continuum, with some people having almost complete freedom in their actions, while others have relatively little freedom of will. Rather than viewing intent in black and white, all-or-nothing terms as the law (with a few exceptions) does, it is likely that there are shades of gray, with most of us lying between the extremes. I would argue that early social, biological, and genetic mechanisms play substantial roles in shaping freedom of will…and that for some, freedom of will is constrained early in life due to brain dysfunction beyond their control. Brain dysfunction would be a primary process in constraining free will.9
Carolyn was one of the unlucky ones, someone whose genes and environment colluded to give her little freedom of will to leap the narcissistic, self-serving, self-destructive bonds that guided her thoughts and actions. If my sister was lucky, it was only in the protective shield her dysfunction provided—she remained oblivious to the hurt she caused others and retained an intermittent sense she could control herself and her destiny.
There is nothing romantic about the sufferings of those with personality disorders.10 Perhaps the future holds real possibilities for altering the unlucky fates of those, like Carolyn, who are doomed by dysfunction to sometimes horrific behavior. Once the genetics and neural mechanisms underlying these multifaceted dysfunctions are more plainly understood, new cognitive therapies and drugs might be able to provide early intervention for those with unusual emotional deficits or cognitive disturbances. Already, for example, imaging techniques are being used to prove that emotional arousal to negative stimuli can be reduced in those suffering from borderline personality disorder by using dialectic-behavioral therapy.11 Someday—perhaps sooner than we think—the genes involved may even be reengineered by inserting a sly nucleotide here and a tandem sequence there, simultaneously repairing the coding that might have been altered by drugs such as alcohol. Perhaps even new growth can be encouraged in areas where neurons have been destroyed
. It will be the brilliant researchers at the National Institutes of Health and at laboratories and universities worldwide—perhaps led by an ambitious, prickly narcissist or two—who will pioneer these new approaches.
But always lurking in the background is the haunting question of where pathology truly begins. Could we end up drugging ourselves into some Stepford baseline? Or, as Cambridge neuropsychologist Barbara Sahakian asks, “Do we want to become a Minority Report society where we're preventing crimes that might not happen?”12
And what will be the impact of these truly remarkable neuroscientific breakthroughs on the legal system? At this point, few believe that neuroscience will overturn the concept of free will or personal responsibility in the context of the law. Many of the nation's top neuroscientists and lawyers, believe the influence of neuroscience will be felt most strongly in mitigation (“he's not fully responsible, because his brain pathology made him unable to think rationally”) and in perception of risk (“this guy has brain factors that predict future violence”).13 We've already seen, however, that the concept of mitigation has hampered research in critical areas such as sadism. And, in a related issue, it is becoming apparent that America's high prison population compared to other countries may simply be a consequence of the fact that Americans have fewer involuntary patients in mental institutions.14 (Deinstitutionalization—a result of the political left's push for patients’ rights and the right's push for cost-savings—has had far-reaching, unanticipated consequences.) Certainly the debate surrounding free will and responsibility, which has occupied philosophers for centuries, is not likely to end soon.a.15
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