Human Traces (50 page)

African stream, that we might just as easily not have been human beings but something else, and then, for heaven's sake, that we are all insane! Well, I have had enough. Tomorrow I shall listen to a concert of Brahms, since you mention him, or Mahler or one of the others who has made a home in our beautiful province. I shall look at the stars in the sky and I shall read Goethe. I leave you to your "genes" and your African watercourse. Good night, Doctor." "Goodnight," said Thomas. "Your money is destined for the hospital, but my wife will refund it to you, if you prefer. She is the beautiful woman at the back, sitting by the door. To you, her beauty may be "proof" of a divine hand; to me it demonstrates the astonishing good fortune entailed in the direction human evolution took. That we should end with this transcendent gift of self-awareness that has enabled us to live as moral beings, appreciating beauty, writing symphonies, pondering our own mortality... "What a piece of work is a man! How noble in reason! how infinite in faculty! in form, in moving, how express and admirable!" He found that he was hammering the lectern as he spoke, his raw voice in shreds. "Admire her as you pass, sir. "In action how like an angel! in apprehension how like a god! the beauty of the world!" Each minute of our tiny lives we should give thanks for that providence that molecular chance that proved more far-reaching, more beneficent, and yes far more improbable than the blessing of any god." There was some mild applause, some embarrassed laughter and some further discreet deserters, but the body of the audience remained. Thomas gritted his teeth and drank more water. He looked up to the long row of electric lights suspended from the beam that spanned the ceiling of the hall. He felt his life's work hang in the balance, and he moved to shore it up. "Some years ago," he said quietly,"in this very hall, my dear colleague Dr. Rebière read a most interesting paper on his theory of psycho physical resolution". It sounded revolutionary at the time, and I remember well the trouble Dr. Rebière took to point out that all his conclusions were based on existing, published work; what he had effected was a new synthesis. The ability to see original patterns in a mass of data is one of the most characteristically human aspects of our intelligence, and draws, I believe, on the functions of both sides of the brain. "I assure you that however bizarre some of what I have told you tonight may have sounded, I have done little more than add my own clinical observations to a synthesis of what is already known. If, in doing so, I have managed to make a new pattern, so be it. More than sixty years ago, a general practitioner from Brighton, in England, a man called Arthur Wigan, published a book called The Duality of the Mind, which noted that the brain's two hemispheres had separate, though to some extent interchangeable, functions. Numerous post-mortem measurements here I commend to you the work of another psychiatrist, Dr. Ernest Southard have also noted different weights in the two hemispheres. "Then came Broca's moment of "eureka", when he localised language on the left. At first, people mocked him, saying he was like Descartes, who superstitiously placed the "soul" in the pineal gland; but the clinical evidence overwhelmingly supported Broca, especially when Wernicke's area was added and the situation was pleasingly complicated by the discovery that language could, in unusual circumstances either in infant brain damage or in unusual left-handedness be switched to the corresponding area on the right. These exceptions, to cut a long story short, gratifyingly proved Broca's rule. "Sir James Crichton-Browne, a very brilliant Scottish mad-doctor on whose staff at the West Riding Asylum the great Hughlings Jackson once worked, put it strongly only two years ago in an address to the Royal Institution: "It is by the superior skill of his right hand that man has gotten himself the victory... To try to undo this dextral pre-eminence is to fly in the face of evolution". I do not have time to go into the question of right- and left-handedness here, except to say that the apes perform any task with either hand; humans are the only hand-lopsided species, and this reflects the unique skewing of their brains that enabled them so greatly to increase their capacity, to generate language and, through language, self-awareness. "Incidentally, what does it tell us that the location of language the prime human attribute is still so uncertainly moored, so that perhaps five or ten per cent of people have it in a variant place? It is as remarkable, I submit, as discovering that one in ten eagles has an eye at the end of its beak. The answer, I am sure, is that it is the most recently evolved facet of humanity; and, as Dr. Hughlings Jackson has written so persuasively, it is the most recently acquired faculties which are under the greatest pressure, while those which have been with us since our mammalian past are the most firmly embedded. In 1879, Dr. Crichton-Browne echoed him when he wrote: "It seemed not improbable that the cortical centres which are last organised, which are the most highly evolved and voluntary, and which are located on the left side of the brain, might suffer first in insanity." To give a simple analogy: modern motor cars, for all their marvellous design, are for ever steaming forlornly at the roadside with their bonnets raised; old horse-carts hardly ever need attention. "I could list the names of many others Moxon, Bastian, Gaussin, Myers, even William James who contributed to the literature of localisation; but I am not going to detain you with a history lesson on a thesis that is already established. Instead, I am now going to speed ahead to the important question: what did establishing the brain's asymmetry tell us about human beings, and about madness? "And I want to be quite clear that my mentor and source here is not Charcot and the French tradition, not German psychology and certainly not the Viennese school: it is still Dr. John Hughlings Jackson, the father of English neurology. My entire definition of "consciousness", or what I have called our "sixth sense", is based on Hughlings Jackson. His distinction between "subject" and' object consciousness was a philosophical one, but he went on to place it in the functioning of the lopsided brain. To summa rise very briefly, he believed that people became conscious of changes in themselves only by the agency of what he called "symbol-images". The words and pictures thrown up by left and right sides of the brain served to dramatise, in the mind's toy theatre, thoughts or feelings that would otherwise be imperceptible. The task of Jackson's double brain was nothing less than to provide the self with a continuous and orderly, if somewhat simplified, commentary on its personal reality. "All this, as I have said, was there to be read in the mainstream medical literature, available in any reputable library. Also there to be read, since the beginning of literary civilisation, were the first stories of mankind, including Homer and the Bible, with their accounts of early humans receiving heard instructions from their gods. All I did with these books, ladies and gentlemen, was believe them. I did not reinterpret them, I just believed them. "I started my life as an amateur of literature, devoted above all to Shakespeare, whose plays show many examples of human beings aware dramatically of themselves and their ability to choose and change this still-new entity, this "self". Think of Hamlet, whom I just quoted. If, as I believe, this second level of consciousness, the one at which we now exist with our "sixth sense", was not caused by a change of "genes" but flowed from the astonishing moment at which we developed writing not as pictogram but as sound-representation, then it must by definition be a product of culture, not of biology, and must be learned by each infant. Shakespeare did more than anyone since Jesus Christ to spread that "sixth sense", to enshrine it; one might even argue that he changed our very idea of what humans were, and say that after Hamlet, introspection became universal. "I took these literary readings and squared them with Hughlings Jackson's neurological idea of consciousness in the asymmetric brain. In my version, I have given more emphasis than he did to the verbal rather than the visual storytelling that makes up our metaphor of reality, for the simple reason that I believe language to be more important and that the model it offers us is, by definition, more exclusively human. A dog, after all, may have a picture-sample of reality, but, without language, it has no self-awareness." Thomas paused to drink again, raising his eyes above the rim of the glass as he did so to survey his dwindling flock. He saw Kitty at the back, her gaze anxiously fixed on him, and for a moment felt a scalding flush of love for her. There was a temptation to weaken, to throw up this hard argument, and to retreat into her arms behind closed doors. He tightened his jaw, coughed and drew himself up one last time. "To conclude," he said. "The implication for certain kinds of psychosis is, as I think I have told you already, fairly straightforward. Quite minor neural malfunctions, caused by minute combinations of inherited matter, could cause grotesque distortions in the signals that go through the corpus callosum from one side of the brain to the other. There may be an abnormality in the neural impulse, but the greater error, I feel sure, is in the overeager responding of the left hemisphere, which must take action to avoid being overwhelmed by excitation. It is better to mishear a half-formed thought as a real voice and respond to what it says than to drown in a deluge of impulses; it is easier to deal with a pathological story than to have no story at all in the theatre of your head. Any story is better than no story; and on that survival instinct, the brain will always come up with an interpretation, however illogical, harmful or frightening. All the accumulated aeons of natural selection, of the "survival of the fittest", are bearing down on it to do so. To fail would be, literally, inhuman though the strain of not failing killed my friend Olivier. "So, before I conclude, I would like to stress two final, minor but important things about Olivier's disease, or "schizophrenia". First, while it is an awful and frightening condition, there is a sense in which the lesion may not be organically so very profound. Why? Because its patients almost always live to the age of about twenty in males, or a little older in females, without developing symptoms. They are healthy; they are fine; indeed often, as in the case of Olivier himself, rather more intelligent and self-aware than normal. From this, we deduce that the predisposition to the disease is activated only when the development of the cortex is complete. At that moment of maturity, alas, the malfunction fires perhaps spontaneously; or perhaps the brain chemistry is excited by some external stress, as we believe to have been the case with our primitive ancestors, able to summon voices when the raised stress chemicals in their brains activated certain circuits. The difference in schizophrenic patients appears to be that once these circuits have been connected, they cannot be turned off. "One last note on this illness. I said that it was terrible, yet that in some ways very little seemed to be wrong. Imagine a ship leaving West Africa for the New World. If the compass was set only one degree out just one tiny degree out of three hundred and sixty it could end up not in New York but in Mexico. That is what I mean by a tiny flaw and a catastrophic result. "We stand now at a crossroads in the life of the mind. The gentlemen of the Viennese School tell us that their psychic apparatus of "repression" and so forth is not just a metaphysical concept but a tangible entity. We cannot yet perceive it with our senses, even with the best microscope, but, they claim, it is a functional system whose diseases are emphatically its own and follow their own pathology, independent of any brain disease. The treatment, they say, lies in talking. The famous American psychiatrist Adolf Meyer, who trained in Switzerland, wrote in The Psychological Bulletin five years ago that it is increasingly being understood that psychology not neurology must serve as the foundation for the study of mental illness. "Well, it depends what you mean by psychology, dear doctor. If you mean Oedipus and dogma, unseen and unprovable mechanisms, a church of true believers in the great universal truth that will have no other, then you are wrong. And furthermore you will systematically withhold help from some of the most pitifully suffering people in the world. Pray God you fail. "If, however, you mean that the biological illness of the psychotic mind finds shape and character in the individual life of the patient and is moulded by it, as water flooding a plain will be diverted by the topography of the valley, then you speak true. "But how are we going to cure these sick people? For all I have said, I do believe talk and kindness may have a part. Each of these patients is an individual, and each responds differently to the electrical short circuits in the brain. To me, this implies that each one, too, must be approachable and help able according to his or her circumstances. I have had some very modest success from listening and advising, from offering consolation. I have also used the resources of the pharmacy in times of emergency and they have given some temporary respite, though in reality little more than the effects of a long sleep. However, chemists busy in their laboratories may one day synthesise some compound that addresses itself to this particular, invisible disease. We do not expect it to happen soon. After all, we have as yet no cure for the visible microbe of syphilis. "If we are right about the hereditary nature of schizophrenia, then perhaps we can breed it out of the population, as we bred Jersey cows, tea roses or greyhounds. On the other hand, if it is as closely linked as we believe to the combination of genes that give us our human capacities, it can never be eradicated. You would have to annihilate the whole of humanity. "I was shocked as a young man by the writing of Henry Maudsley, Britain's most fashionable psychiatrist, who preached "degeneration" and advocated a sort of anti-breeding programme. He has now changed his mind. Last year, in his book Heredity, Variation and Genius, he wrote: "To forbid the marriage of a person sprung from an insanely disposed family might be to deprive the world of a singular genius or talent, and so be an irreparable injury to the race of men... If, then, one man of genius were produced at the cost of one thousand or fifty thousand insane persons, the
result might be a compensation for the terrible cost." I do not pretend to follow the reasoning behind his change of mind, but he has clearly seen how psychosis is indissolubly part of humanity. "Indissoluble, did I say? Why? Why can we not dissolve it, separate it out? Because to do so we would need to know the chemical make-up and the physical function of all the units of inheritance in humanity individually and in all possible combinations. And as yet we cannot even see them! "I can offer very little to my psychotic patients little but gestures of love and comfort. Their release may take thousands of years, because in my view the only certain cure is... Evolution. If Homo sapiens were to mutate again and shake the kaleidoscope of particles that make him, it is possible he could retain his modern mind but lose his madness. Possible. But the truth is, we have always, from the moment of our origination, been a profoundly flawed species mad in the basic particles of our being, radically insane and the building of the great asylums only served to show us the magnitude of our madness, as the rural lunatics were gathered up and put beneath one roof with their urban cousins for the first time. Psychosis, ladies and gentlemen, is the price we pay for being what we are. "And how unfair, how bitterly unfair it is that that price is not shared around but paid by one man in a hundred for the other ninety-nine. Think on that. "And that minute, momentous change in Africa that made us men was it really worth it? What it has enabled us to do is to understand that our brains are the result of physical processes as comprehensible to us as those which make the waves of the sea or the stamen of a flower; that we are part of a continuous physical universe and that there is no niche in it not one crack in which we can find any special dispensation for ourselves. One of the greatest achievements of the human intellect has been to show us precisely this deficiency: the fruits of our conscious brains have robbed us of any privileged place in creation. There is no god and there is no consolation for us, only death. "And yet, and yet... I do see grounds for hope. It is possible that we will lose our "sixth sense", our human self-awareness, and with it our psychosis. Since we are, in Alfred Russell Wallace's belief- and mine, for what it matters far more evolved than we have any need to be in the competition for resources, it could be that, with a change in environmental pressure, natural selection will favour a less developed brain. It is certainly possible. After all, the most miraculous organ, after the human brain, ever to have developed in nature is the eye. Even Darwin found it hard to explain this miracle. And yet, the bats in their caves, who once had sight, survive as well or better without their eyes. They ceased to use them or to need them; they are more "successful" without eyesight and now they carry vestigial blind eyes. Perhaps one day human beings will carry only vestigial higher consciousness, a simpler version having been selected in the fight for survival. "The second ground for hope is the exact opposite. We are continuing to evolve, perhaps more rapidly than ever. And just as we developed, first through mutation, then through culture, our "sixth sense", so we may go on to develop a seventh a new faculty, as great as self-awareness. To me the benefits of such a development would be less medical than philosophical. But they would be productive of happiness, if that emotion survived the change. The beings we became would, of course, no longer, strictly speaking, be Homo sapiens. "As things stand, we have a problem. To conceive of ourselves as fragmentary matter cohering for a millisecond between two eternities of darkness is very difficult, because our lives do not feel like that. Either, therefore, that is not the reality, or there is something wrong with the way that we register reality. That is why I am a psychiatrist, because the evident problems the insane encounter in dealing with the world should be instructive to us all. We who are well are straining very hard at this intermediate stage in our evolution, driving our reason to work, in an attempt to reconcile and make palatable all the contradictions, mysteries and non-sequiturs we experience from day to day. "To think of ourselves as atoms in an infinite universe is in fact not really possible; it is just not how we experience life which we feel as something linear and driven to an end. So either we have the science wrong, or we are merely encountering the limits of our toy consciousness. I believe the latter, and I hope I have shown you what a small, simplified and metaphorical sample of reality our consciousness really offers us, with its one-dimensional time and shadow "I" in its tiny inward theatre. "But we may evolve and we may change; and that, as I have said before, is how the insoluble knots and mysteries of life are eventually resolved, not by the finding of an "answer", but by the development of a perspective in which the problems no longer exist. We do not lose much sleep over the eternal conundra of the domestic cat... It is not that we could not "understand" them, I suppose, if they were described to us, it is more that they would seem beside the point. "Yet, what glory is there in our very own cat's-eye view of the world, our one-degree peephole on the sphere of reality! As I remarked to the gentleman who left, the chances of such richness, of Shakespeare and Mozart, developing from a submicroscopic mutation are so great as to be beyond calculation. From that mathematical fact, you may deduce, like my critic who left the hall and like Alfred Russell Wallace before him, that such an improbable change must therefore necessarily have involved the interference of a higher outside force; or you may believe, like Charles Darwin and like me, that the biological laws of evolution cannot be selectively breached. Whatever you believe in your hearts, ladies and gentlemen, I ask you to believe with me that either conclusion must logically lead you to see that we are the most fortunate species ever to have lived or that it is possible to conceive of existing ever, in this universe or in any other; and that it is our duty each day therefore to appreciate our astonishing good fortune by caring for the insane who pay the price for all of us, and by turning our own healthy lives, so near as we can manage it, day by day, into an extended rapture." Thomas gathered his notes and descended stiffly from the podium, rubbing his hand over the small of his back, where the muscles had gone into spasm from his long standing. He walked down the aisle of the hall, grey-haired now in his fiftieth year, between the rows of silent people who averted their embarrassed eyes, until he reached his wife. She took his arm and led him out into the courtyard where the fountain played. He slumped down onto the stone rim. Kitty sat down beside him and placed her arm round his shoulders. "They did not believe me," he said. "I believed you, Thomas." "I know I am right, but I did not convince them." "It was good, it was noble, it was very fine." He did not reply. '"O, young Lochinvar"," she murmured. "It is a hard life' Thomas as I think I told you once before." She stroked his hair. '"He rode all unarmed and he rode all alone... "'