The Tale of the Dueling Neurosurgeons

by Sam Kean

  Only two animals, chimps and humans, can “catch” yawns, though. And humans don’t pick up contagious yawning until age four or five, implying that we need to develop certain parts of the brain first, probably those related to social skills and empathy. (Along these lines, people with autism don’t pick up contagious yawning until much later in life, if at all.) Furthermore, we don’t catch yawns equally from all people: loved ones infect us with yawns more readily than good friends, who infect us more readily than acquaintances, who infect us more readily than strangers. This leads me to wonder whether you could tell someone was falling out of love with you by timing their yawn delay.

  Finally, the big question is, and always has been, why we yawn at all. And the answer is, and may always be, that no one knows.

  43. Damasio’s work here: Damasio discusses Elliot in detail in his book Descartes’ Error. Check it out for a full understanding of all the subtleties of the case.

  Chapter Eight: The Sacred Disease

  44. remain conscious during surgery: Lobotomist Walter Freeman loved to recount a story from early in his career, when he asked a surgical patient what was going through his mind at that moment. “A knife,” the man replied. There’s also an incredible video out there of bluegrass musician Eddie Adcock. To ensure that nothing was wrong with his brain during surgery, rather than have Adcock talk, his surgeons let him play his banjo. You can see footage at http://news.bbc.co.uk/2/hi/science/nature/7665747.stm.

  Walter Freeman, the notorious American lobotomist.

  45. ancient Egyptian priests: Ancient Egyptian priests may have discounted the brain, but at least some Egyptian doctors did not. The so-called Edwin Smith papyrus—based on material first compiled perhaps five thousand years ago, before many of the pyramids were built—outlines treatment options and the probable prognoses for dozens of types of head and brain injuries. For the first time in history the document also singles out the brain as a distinct organ instead of just a general part of the head. The hieroglyphic translation of “brain” in the papyrus means “marrow of the head.”

  The Egyptian hieroglyph for “brain.” Literally, it means “marrow of the head.”

  46. a common occurrence in the 1920s: Although Cushing drastically lowered the risks associated with neurosurgery in his own practice, other surgeons were slow to adopt his ways, and it remained one of the deadliest procedures out there. As late as 1900, some 75 percent of neurosurgery patients in London hospitals died of complications. (Primitive trepanners working in New Guinea at this time, who opened skulls with shark teeth and dressed wounds with banana leaves, killed just 30 percent of patients, which really makes you think.) In addition to antiseptics, work on brain localization helped reduce mortality a lot: rather than simply crack the skull open and blunder about for a tumor or scar, surgeons could now study their patients’ deficits and make an educated guess about where to open them up.

  Chapter Nine: “Sleights of Mind”

  47. vacuum of power: There’s still no clear guideline about who, if anyone, can judge whether the president is mentally capable of executing his office. We often say the vice president is one heartbeat away from the presidency, but the country itself—especially given the delusions that often beset stroke victims—is always one little arterial tear away from a constitutional crisis.

  48. electrical conductivity of skin: Lie detector tests also measure the electrical conductivity of the skin (as well as heart rate, blood pressure, breathing patterns, and other signs of physiological stress). That may sound odd, since polygraphs are often denounced as pseudoscientific hooey, but there’s a difference between the way scientists use them and the way your typical asshole interrogator does. The interrogator claims that just because you’re showing signs of nervousness, it means you’re lying—when of course you could be nervous for dozens of reasons, not least because he’s threatening you with jail. Scientists use these tests simply to measure whether or not you’re experiencing an emotion, period, and whether those signs change from stimulus to stimulus. Scientists don’t (or at least shouldn’t) claim to be reading your actual thoughts based on such signs, and in this more restricted case, the skin conductivity test does provide meaningful information.

  As a fun sidenote, the first crude polygraph machine, developed by a Harvard undergraduate named William Moulton Marston, consisted mainly of tubes that wrapped around the person being tested like a boa constrictor. Marston later (under a pen name) went on to write comic books, and he invented Wonder Woman—who of course wielded a golden “lasso of truth” that, when it ensnared bad guys, forced them to be honest and forthright. Unfortunately, Marston wasn’t always so honest and forthright in his own career: he used the polygraph in advertising research and got caught making up data when trying to determine whether young men preferred one brand of disposable razor over another.

  49. a safe, familiar context: Some people experience déjà vu constantly, as if everything that’s happening to them at that moment has already happened to them before. This can lead to some unintentionally funny complaints. Some victims refuse to watch television since everything seems like a rerun. One woman gave up her library card because she’d already read every last book there. Another woman quit playing tennis because she knew the outcome of every point beforehand. One man even claimed, against all logic, to have attended a certain funeral many years prior. Scientists don’t know why déjà vu occurs, although there are plenty of guesses. One good guess is that memories run through the brain like a loop of video. Normally we record the material first and then replay it later, but if for some reason you recorded the memory and started playing it back immediately, you’d experience déjà vu. Other scientists attribute déjà vu to different causes, and of course there could well be multiple causes.

  Incidentally, in case you’re wondering, the hearing-limbic circuit can also crap out and disconnect someone’s voice from its emotional glow. Indeed, there are cases of blind people suffering from auditory Capgras delusions. The limbic-touch and limbic-smell circuits can also die: a blind Brazilian woman who suffered from Capgras complained that her husband’s double felt fatter and smelled different.

  50. Alice victims: If you want to go there, neuroscientists have pointed out that Alice in Wonderland is full of potentially interesting neurological cases. Humpty Dumpty cannot recognize faces (face-blindness), and he suffers a catastrophic brain injury after falling. The dormouse at the tea party has narcolepsy. The White Queen has dyscalculia, the inability to do arithmetic (“I can’t do subtraction under any circumstances,” she says). And hosts of other characters betray bizarre beliefs about space, time, and the nature of existence.

  Another delusion that seems to have sprung from the pages of Alice is the glass delusion, wherein people believe they’re made of glass. Oddly, sufferers often thought of themselves as specific items, such as urinals or oil lamps. A surprising number also believed that they had glass buttocks, including Charles VI of France, who wore reinforced clothes to protect his glass bum. In a variation on this theme, Princess Alexandra of Bavaria insisted that she’d swallowed a glass piano, and that it remained intact inside her.

  51. if that’s true: While the results of Libet’s “free will” experiments are robust, the interpretation of them remains disputed, to put it mildly. Some scientists and philosophers argue that no matter how good someone’s reflexes are, there will always be a lag between when he decided to move and when his eyes recorded the time on the clock. Others object to the idea that you can pin down consciousness so precisely, to a specific millisecond of activity; perhaps consciousness is “smeared” more widely across time. Or perhaps we really are zombies when it comes to crude motor tasks like raising a finger, but we have free will with bigger, more consequential decisions. Along those same lines, perhaps our free will “programs” our brains ahead of time. So even though we spend most days doing most things on autopilot, the habits we’ve set up were indeed freely chosen.

  Libet himself found mo
st of those objections either baseless or spurious. Still, he didn’t believe he’d wiped out free will, not entirely. Libet did accept that our conscious selves do not have the free, unfettered ability to initiate action: that talent belongs to the unconscious. However, he argued that people did have the choice—the real, free choice—to squelch those unconscious impulses and refuse to act on them. As he put it, we don’t have free will, but we might have “free won’t.” The window for clamping down on the unconscious’s decisions was short—just 150 milliseconds—but it would make people morally responsible for their actions. And as Libet once wrote, “Most of the Ten Commandments are ‘do not’ orders.” It’s not the free will most of us believe in, but it might be all that neuroscience leaves room for.

  Chapter Ten: Honest Lying

  52. groundbreaking work in 1947: Amazingly, Hugh de Wardener is still alive and living in England, and he generously agreed to be interviewed for this book.

  53. the American lobotomy bandwagon: As mentioned, lobotomies sever the white matter connections between the frontal lobes and limbic system. And although lobotomies stemmed from the work of a Portuguese doctor, who won a Nobel Prize for it, the procedure really took off in the United States, which has always embraced quack medicine and quick fixes. In all, approximately fifty thousand Americans underwent lobotomies between the mid-1930s and late 1950s, with one single doctor, Walter Freeman, doing three thousand by himself. Freeman roamed the hills and byways in a mobile clinic dubbed the Lobotomobile, and performed the procedure with a rubber mallet and an ice pick from his kitchen. He operated on children as young as four, and his record was twenty-five lobotomies in one day. His most famous patient was Rosemary Kennedy, sister of JFK, who spent the remainder of her life in an institution.

  54. personal knowledge: In a normal brain, all knowledge is probably episodic at first and therefore relies on the hippocampus; it becomes semantic knowledge only later, after it works its way free of the hippocampal web and becomes context-free. For instance, you probably first learned that Abraham Lincoln was the sixteenth U.S. president on, say, a field trip to Washington, D.C., or (more likely) when you got that item wrong on a quiz. But eventually you forgot the specific moment of learning and retained only the more abstract knowledge that Abe = 16.

  The episodic/semantic distinction sheds light on confabulators as well, since they primarily lie about personal episodes. Looking ahead, confabulators also usually feel both familiarity and recollection for even their most Münchhausenian tales. Indeed, that’s their problem in a nutshell.

  55. divides up responsibility: This is just a plausible sketch of how memory works inside the brain, and plenty of neuroscientists disagree with the details presented here. In other words, like pretty much everything in neuroscience right now, it’s open to revision. Just saying.

  56. “no distinct limits” to Shereshevsky’s memory: Shereshevsky’s finite brain did not have an infinite capacity for storing information, of course. But when considering claims like this, keep in mind that the way we commonly think of memory—as a “jar” or “hard drive” or something else that can fill up—is misleading. As some scientists note, it’s better to think about memory as a muscle—a faculty that, if exercised, gets stronger and stronger. So Shereshevsky’s continual acquisition of new material wouldn’t necessarily push the old material out.

  57. we do garble details: Probably the best example of people garbling a personal memory involves September 11, 2001. Survey after survey has revealed that people have explicit memories of watching television news coverage of the two planes hitting the World Trade Center towers on that day. But that didn’t happen. No television news station broadcast the impact footage until the next day.

  Chapter Eleven: Left, Right, and Center

  58. this location: To be specific, Broca localized the lesions in Tan’s and Lelo’s brains to the third convolution of the frontal lobe, near where the frontal lobe and parietal lobe intersect. This region eventually became known as Broca’s area.

  Although Broca preserved the brains of both Tan and Lelo for later generations, later generations almost lost them. Twice. Before dying, Broca deposited the brains in the Musée Dupuytren, a museum located in the dining hall of a former monastery. The Dupuytren’s walls collapsed during a bombing raid in 1940, and during the move to a more permanent home, the brains disappeared. Not until 1962 did a scholar hunt them down. They promptly disappeared again, when a janitor who’d moved them up and died without telling anyone where he’d moved them. But they turned up again in 1979, and remain (for now) safe. For some reason Broca bottled Tan’s brain vertically, so it rests on the frontal lobes.

  59. first and second languages: Whether English, Tagalog, or Serbo-Croatian, the first language you learned was stored in your procedural memory, which explains why speaking it comes so naturally: it’s subconscious. With a second language, the situation varies. If you learn a second language “naturally” (i.e., in daily life), it will also enter procedural memory and will become nearly automatic, especially if learned when young. If you acquire a second language through formal tests and schooling, it enters declarative memory and doesn’t stick as readily. This distinction helps explain why bilingual people can lose either language, since different memory systems can suffer damage independently. (By the by, the reason bilingual people usually swear and coo to babies in their first language is that first languages, being subconscious, are more deeply intertwined with our emotions.)

  One odd disorder related to multilingualism is “foreign accent syndrome,” which occurs when people wake up from a stroke or head trauma and suddenly speak with an accent. One Englishwoman, for instance, woke up sounding like a parody of a French lady, zaying all zhortz of fun-nay zhings. The disorder sounds dramatic but actually has a prosaic explanation. It turns out that the trauma simply reduces the “acoustical spectrum” in someone’s brain. As a result, her teeth, tongue, and lips cannot make all the sounds she needs to, and for whatever reason, other people interpret her limited range as a stereotypically foreign accent.

  60. Auburtin: Auburtin’s father-in-law—a man named Jean-Baptiste Bouillaud—had offered 500 francs for any proof of a widespread lesion in the frontal lobes without attendant loss of speech. Bouillaud eventually lost this bet, albeit under dubious circumstances. At a Société meeting in 1865, Dr. Alfred Velpeau recounted the case of a sixty-year-old wigmaker admitted to his care some years before for excessive incontinence of urine. Apparently no man had ever blathered as much as this patient did: the wigmaker talked incessantly, compulsively, prattling on even while he slept. Nothing could shut him up. He died shortly afterward, and although Velpeau hadn’t planned to examine the brain during the autopsy, he decided to do so at the last minute. Lo and behold, he found that a tumor had destroyed the man’s frontal lobes. At least that’s what Velpeau claimed. Because the wigmaker had died in 1843 and Velpeau stepped forward only a quarter century later, some people suspected him of fraud. There was a row at the Société meeting where he claimed the prize, but Bouillaud eventually paid up. (From a modern perspective, the wigmaker probably did suffer some sort of frontal lobe damage, which would have lowered his inhibitions and caused him to blather. But the frontal lobes are quite large, and quite a lot can get damaged in them without affecting Broca’s area.)

  61. killed Lashley’s theory: From today’s perspective, Lashley’s ideas aren’t total bunk. Language and memory and other complex faculties do draw on multiple parts of the brain. But brain signals don’t get spirited around via electric waves; they’re carried by ions and chemicals. And saying that multiple parts of the brain contribute to something is a far cry from Lashley’s claim that all parts of the brain contribute equally.

  As for Lashley’s experiments, rats could still navigate mazes after suffering brain damage because rats, the tricky bastards, have several ways of finding their way around—touch, smell, hearing, sight. Rats even have different vision centers in different parts of the brain. The
lesions no doubt impaired these systems, but you’d have to knock them out completely to render a rat helpless. This is one reason why rats will still be around long after human beings have perished from the face of the earth.

  62. it would start getting lost again: Sharp-eyed readers may have noticed that the cat/maze/eye patch experiment wouldn’t have worked as described here, since each eye provides some input to both halves of the brain. (Again, it’s input from the left and right visual field that ends up in the right and left brain, not input from the left and right eye per se.) Sperry knew this, of course, and when he cut the cats’ corpus callosums, he also surgically rewired their optic nerves, so that the nerves provided input to one hemisphere only. As is probably obvious, Sperry was a gifted surgeon: the hand-eye coordination he developed on the playing fields of Oberlin served him well.

  63. draw a picture: Forcing split-brain people to draw with their weaker hands (usually the left) produced some pretty crappy art, even by the generous standards of neuroscientific testing (see below), but it was important to isolate the abilities of the left and right brain. Interestingly, though, the left hand of split-brain people was artistically superior in some ways. That is, the lines that the left hand drew were wobbly, because of lack of practice; but overall, the lefty picture did resemble what it was supposed to, since the right brain has good spatial skills. In contrast, the lines drawn by the right hand were sure and firm—but the overall depiction looked terrible, because the left hemisphere lacks a sense of space.