by Amy Tan
I thought about what was different in my life and remembered I had started a new medication to control temporal lobe seizures only a week before. My seizure episodes had never been that debilitating. I did not have grand mal convulsions. In fact, for the most part, they were entertaining sensory aberrations, and the only problem was the stupor that immediately followed some of them; the brain interprets a burst of excess electrical activity as the equivalent of not having slept for three days, and thus shuts me down for about fifteen minutes. One time, the people seated with me at a restaurant appeared to swing away from me and then back, as if they were on a giant turntable. A few times, I saw Renoir paintings as big as life. I saw low-budget alien creatures from a B movie. The most frequent one occurred in the morning as soon as I awoke: an odometer, about fifteen numbers long, spinning so fast the numbers disintegrated and dripped like raindrops. I made it a game to call out the numbers as they fell. Twenty seconds later, it was over. None of these sensory quirks held any meaning to me. They were not frightening or symbolic of anything in my life. (The renowned neurologist Oliver Sacks, who would later include my case in one of his books, confirmed that seizure-induced hallucinations are typically meaningless.) When I was diagnosed with epilepsy, my neurologist told me that the likely reason for the seizures was sixteen brain lesions in my brain, a souvenir of neurological Lyme disease. He showed them to me in an MRI scan. The lesions in the left temporal lobe were possibly irritating to the cortex, and from time to time, excess electrical activity gave rise to seizures. In prescribing the antiseizure medication, the neurologist warned that I should note any unusual signs, such as a spreading rash, which could be deadly. He had mentioned nothing about an outbreak of jolliness that could wax and wane throughout the day. I found the tissue-thin sheet of instructions and warnings that came with the medication, and read the tiny type that said this medication was also prescribed off label and at a lower dosage for clinical depression and bipolar disorder. In other words, my antiseizure medication was also a mood stabilizer. I suspected that it had tilted my already stable mood up and out of whack.
I have had bouts of depression in the past. They had occurred after big changes in my life, what should have been happy periods—including the unanticipated success of my first book, The Joy Luck Club. On the day my book was published, I cried. They were not tears of joy for a dream come true. I was afraid. I had never dreamed of having a novel published. I was too practical to have imagined a career as a fiction writer, and I was already making a good living as a freelance business writer. I owned a home and was married to a wonderful compatriot who shared my beliefs and values. But now there were early signs that my life was about to change in momentous ways. To counter the building excitement among my editor, publisher, and agent, I prepared for humiliation and a quick return to obscurity. I was overwhelmed with a sense that this book would upend the happiness I already had. Everyone expected too much, and I was certain I would fail. I refused to allow myself any pleasure from what was happening. Unexpected praise brought me back to those days in childhood when praise was followed by greater expectations, greater and greater hopes, and then came failure, humiliation, and disappointment from others. Praise, I had learned, was temporary, what someone else controlled and doled out to you, and if you accepted it and depended on it for happiness, you would become an emotional beggar and suffer later when it was withdrawn. Praise was given to me in heaping loads, and I had to emotionally push it away. When I received prizes, I gave dour acceptance speeches. One went something like this: The moon is more admired when it was full than when it was a sliver, and yet it is the same moon even when the perspective of others had changed. A book reviewer for the local newspaper wrote that I gave the most morose acceptance they had ever heard. Criticism was heaped on me as well—bad reviews, eviscerating ones. I overheard or had reported to me conversations about my inability to write a sentence, and that I did not deserve success, or that I was not really Chinese, comments made by people who I had once thought were my friends.
Serendipity, chaos, and drama ruled my life. I did not need a psychiatrist to tell me that my need for stability was related to a childhood in constant tumult, which had forced me to decide which was better: numbness or pain, acceptance or avoidance. I started antidepressants and found it dampened my sense of impending doom. Eventually I simply felt normal and could carry on with a life that would never be normal. Unlike the antiseizure medications, however, the antidepressants never once made me feel euphoric. If they had, I probably would not have discontinued them.
A few months after the happy effect started, I attended a holiday party of women writer friends. The conversation turned to a discussion of loyalty, and a friend related an example. When she was a child, she went to a dentist who had handled her family’s dental care for years. Even after the dentist lost an arm in an accident, the family continued to use his services. Everyone at the party thought that was very touching. My friend said there was no question they should remain loyal, but as a kid she had felt uncomfortable when the dentist awkwardly leaned his armless side against her for balance while using his other hand to do a filling. This image was so startling that a giggle escaped before I could censor myself. My friend stared at me, as did others. I quickly apologized. I was shocked that I had found humor in a man’s misfortune and a family’s loyalty, but then I giggled again, and my attempt to suppress further laughter led to my snorting what I had been trying to hold back. The sound of those nasal farts then caused me to laugh so hard I was wheezing, nearly breathless, pausing only to whisper an apology to the guests for this regrettable lack of decorum. There were other episodes of unwarranted hilarity to come, and I eventually noticed something odd: a ticklish sensation around my ribs that accompanied irrepressible laughter. It caused me to bend over—literally doubled over with laughter.
More mood changes followed. One day, while focused on my writing, my two little dogs came bounding into my office, wagging their tails. They often did that. But this time, I felt a ticklish squeezing sensation in my heart—the pulling of a heartstring, you might call it. The idiom actually got it right. It was the physical equivalent of saying, “Aw, how sweet.” I had felt that sensation before—but only on rare occasions, for example, when witnessing a touching moment at a wedding or a funeral, or in being surprised with an expression of deep affection. The problem now was the frequency of these heartwarming moments. Every time the dogs gave me a sassy look and wagged their tails, my heart twanged. The dogs wagged their tails a lot. Sometimes the ticklish sensations came one after the other and were disruptive when I was writing. A friend suggested I check with my doctor to ensure the sensation was not a symptom of incipient heart disease. I was certain it was not, since the effect only occurred in moments of endearment, and never when I was, say, angry or bored.
I eventually did some sleuthing on the Internet and pieced together a possible explanation: the tickle effect did not originate from within the heart. It was, in reality, a sensation transmitted by the vagus nerve, whose pathway runs from the temporal lobe and down areas of the neck, lungs, heart, and stomach. It is essentially the brain’s emotional control center and can trigger all kinds of visceral reactions—otherwise known as autonomic responses, like trembling, fainting, low blood pressure, a fast heartbeat, butterflies in the stomach, nausea, gooseflesh, or the feeling that your blood is running cold—those “fight or flight” sensations that are simpatico with fear. It can blur judgment when you fall in love, feeding you a dopamine high that disables your ability to discern that the object of your infatuation may actually be, as your friends have been trying to tell you all along, a cheating, manipulative asshole. I guessed that my left temporal lobe, now chemically altered by antiseizure meds, had developed a hypersensitive sweet spot for cuteness and poignant situations and, fortunately, not for assholes. I should have been grateful to have so much sweetness and light in my life. However, I did not need to be reminded of that fact twenty times an hour. I had to kne
ad my chest to rid myself of the wriggling worm sensations of vagus spasm overdrive.
My vagus nerve hit a low point when it began reacting to both genuinely heartrending moments and sappy ones. I felt the pang of poignancy watching two friends in their sixties exchange wedding vows. I felt the pang of poignancy seeing a Viagra commercial giving hope to seniors that sex does indeed follow dancing. My vagus nerve had a defective algorithm for recognizing genuine emotions. It wrung out tears for corny love scenes. It caused my eyes to flood when I was at funerals and heard eulogies for people I barely knew, which then caused people near me to think I had been especially close to the deceased. I became teary-eyed listening to the national anthem of any country whose flag was raised during televised Olympics award ceremonies. It could have been North Korea or other dictatorships—it didn’t matter. I had become Pavlov’s weeping dog.
I wondered every now and then how my altered brain might be altering my personality. I might soon become one of Hare Krishna’s disciples, who beamed happiness as they chanted and tossed flower petals. If I smiled too much, people might think I was either stoned or smirking. I recalled an experiment done on the effect of smiling. People who deliberately smile more often are quantitatively and qualitatively happier. Was it actually true that the musculature of the face can reconfigure the brain and increase happiness and lessen fear? Too much happy-go-luckiness could also become detrimental to my fiction writing. If I was such an easy sucker for contrived sentimentality, I might lose my sensitivity for the nuances of human nature, intent, and emotional truth. I would become a divining rod for schlock. I would become the literary embodiment of clichéd expressions and too many exclamation marks. I chuckled! I gasped! I sighed! I sobbed! I would gush to people: My dogs are just too cute. My husband is just so sweet. My best friend is just the greatest. Maybe the change had already started and it showed in my writing.
One of my friends suggested I stop taking the medication and switch to something else if my altered mood bothered me so much. I was reluctant to do so because this particular medication not only controlled my seizures fairly well but it had also dampened the pain of peripheral neuropathy in my feet. Both of those things were genuine reasons to be happy. If I stopped this medication, the new medication might not be as effective, and if the seizures resumed, I had a 70 percent chance that my simple partials would evolve into grand mal. If the pain in my feet returned, I would become restricted once again in my mobility, unable to walk more than a block to a restaurant without excruciating pain, let alone hike or ski. Outdoor activities made me genuinely happy. I was concerned that the withdrawal of the upswing medication might possibly cause a downswing that would dump me into prolonged depression. Instead of crying for fake joy, I would cry at stop signs. So, in comparison to the risks and benefits, what was wrong with being too happy? Whatever the medication had done to my brain, I had become protective of my new sympathetic nervous system friend.
Time solved some of the concerns. The side effects of the medication settled, the happy-go-lucky surges decreased in frequency. I am no longer waking up with cheeriness and a song in my heart; I need coffee. I do get stressed at airports. I can indeed stop laughing. I still get the tickle in my heart, but my brain is a bit more discriminatory. It happens when my little dog makes repeated attempts to lead me, a clueless human, to play fetch with a toy that is bigger than he is.
Because the ticklish responses had become less frequent, I started analyzing them; for example, how long they lasted in comparison to how truly heartwarming the stimulus had been (i.e., my cute dog versus a cute dog in a dog food commercial). And that’s how I made an odd discovery: I always felt the visceral reaction—the tickle spasm—before I was mentally aware of the emotion. The delay was only a fraction of a second. But having experienced it so often, I knew that this was the sequence: heart tickle, oh how cute. The tickle was like having someone tap me on the shoulder to call my attention to my dog’s wistful expression. The body’s reaction was preconscious, and it led me to wonder if the same held true in fearful situations. Would my heart race before I was consciously aware that an earthquake was happening? I’ve asked others about these sensations, and no one recognizes what I’m talking about. Perhaps I’m the only one whose emotions and vagus nerve are ever so slightly out of sync. Or maybe you need to experience the spasm and accompanying emotion a thousand times to discern the very fine gap. Whatever the case, I am actually pleased that a medication meant to tamp down neural activity also tampered with my moods. It led to my investigation of the cause, and thus my discovery of the connection between emotions and the vagus nerve.
My ongoing interest in mind-body reactions made me aware of yet another neurological process that is significant to me as a writer: in heightened situations, the vagus nerve releases a hormone, norepinephrine, into the part of the brain known as the amygdala, where the strongest emotional memories and their original reactions are stored. The more fearful the experience the greater the surge of norepinephrine into the amygdala, and that increases the amygdala’s ability to store vivid, more strongly felt, lasting memories. They are called visceral reactions for a reason: the viscera react subconsciously when memory of the traumatic moment rises, often unexpectedly. For assault victims, the popped balloon instantly brings back the moment they were shot. This is not where you’ll find happy memories of birthday parties or trips to the zoo—unless the birthday cake exploded and the lion escaped the cage and ate your ear. In the amygdala reside the horror stories of our lives: the worst experiences we’ve had. This is memory lane for people with post-traumatic stress disorder.
I recall a time in Italy when Lou and I were in the backseat of a rental car, and two friends were in the front. The husband was driving eighty miles an hour on the autostrada, a speed that is slow by the standards of natives, who drive treacherously fast on freeways. About a mile from our turnoff, we heard a mysterious beep in the rhythm of a heartbeat. It soon grew to the speed of a racing heart. “What’s that sound?” I asked, and it stopped. A few moments later, it started again, a slow then faster series of beeps that soon turned into a continuous blare for a second before a car slammed into us, sending us caroming down the autostrada. Lou and I gripped each other’s hand, but we were absolutely silent as the car spun, then hit a barrier and spun in the other direction. By then I was certain we would die. We made no protest to fate, no plea to God. I just hoped we would not suffer. Just when it seemed we were going to flip over, the car hit another barrier, tilted, then it righted itself and slid to a stop. The car was crushed every which way, the windows knocked out, the wheels twisted under. But we were uninjured, unlike the passengers in the other car. Actually, I did receive a scratch on my right elbow, and although it did not bleed, it turned into a scar, which I still have today, a reminder of the miracle. The wreckage closed the autostrada for three and a half hours. Later that evening, we made it to a friend’s outdoor dinner party. I thought I had recovered, but my body shook and my voice quivered as I described our close call. Over the next week, the moment I awoke, I would half jokingly ask Lou, “Are we dead?” Our window overlooked a vista of hills and columnar trees, the landscape backdrop of Renaissance paintings. Maybe we’re dead and don’t know it, I mused. We’re ghosts on holiday, like George and Marion in the 1950s TV show Topper, gadabouts who died in an avalanche while skiing in Switzerland. Instead of ski slopes in Gstaad, our afterlife was in a four-hundred-year-old hunting lodge in the hills above Lucca. We returned home, and the memory of that auto accident soon traversed into becoming part of our stock of close-call anecdotes, told with just a few humorous embellishments—
“As the car spun, I was thinking I won’t have to finish writing that novel after all.” If we could laugh about it, we had clearly recovered. A few months after the accident, I was in Melbourne, being driven in a hired limousine to an event. As the driver backed up to turn around, I heard a beeping sound and in an instant, I yelped and flattened myself onto the seat. My heart was still rac
ing when I sat up a few seconds later, laughing with embarrassment. The beeping sound was part of a car warning system, not yet common in the United States, which lets the driver know how close objects are, be it a parked car or one tailgating in the high-speed lane of the Italian freeway. After that, my amygdala took the beep out of circulation as a fear-inducing stimulus, which was good, since the next car we bought was equipped with the same warning system.
I have gone through my share of terrifying moments—being held up at gunpoint, being trapped by a mudslide, nearly drowning, cartwheeling down a glacier, watching the World Trade Center’s second tower collapse while I stood on the street—events that have provided a ready supply of true-life tales for dinner conversation and sober thought. I have also gone through horrific emotional traumas, like the time we accompanied a police detective into a former roommate’s apartment, where I saw blood on the bed, the rope that had been used to strangle him, and a strong odor of fear. We had to identify items that may have been stolen and then look at a morgue photo to identify him. For several years, even after I thought I had psychologically recovered, I lost my voice the day before the anniversary of his death, which happened to be my birthday. My subconscious was still speechless with horror.