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Neurology and the Soul

Remembering: A Study in Experimental and Social Psychology

by Frederick C. Bartlett
Cambridge University Press, (out of print)

The Invention of Memory: A New View of the Brain

by Israel Rosenfield, Introduction by Oliver Sacks
Basic Books, 240 pp., $9.95 (paper)

La Conscience: Une Biologie du Moi Knopf in 1991

by Israel Rosenfield
Editions Eshel (Paris, 1990); to be published in expanded form by

A Critique of Artificial Intelligence’

by Israel Rosenfield. in The Enchanted Loom, edited by Pietro Corsi
Oxford University Press, 400 pp., $60.00

Man on his Nature

by Sir Charles Sherrington
Cambridge University Press, (out of print)

The Integrative Action of the Nervous System

by Sir Charles Sherrington
Cambridge University Press, (out of print)

Migraine

by Oliver Sacks
University of California Press, 290 pp., $9.95 (paper)

Awakenings

revised edition, by Oliver Sacks
HarperCollins, 448 pp., $9.95 (paper)

A Leg to Stand On

by Oliver Sacks
HarperCollins, 224 pp., $9.95 (paper)

The Man Who Mistook His Wife for a Hat and Other Clinical Tales

by Oliver Sacks
HarperCollins, 256 pp., $9.95 (paper)

Seeing Voices

by Oliver Sacks
HarperCollins, 224 pp., $8.95 (paper)

1.

There has always, seemingly, been a split between science and life, between the apparent poverty of scientific formulation and the manifest richness of phenomenal experience. This is the chasm which Goethe refers to in Faust, when he speaks of the grayness of theory as contrasted with the green and golden colors of life:

Grau, teurer Freund, ist alle Theorie,
Und grün des Lebens goldner Baum.

This chasm—which is smallest in physics, where we have spectacularly powerful theories of countless physical processes—is overwhelming in biology, in the study, above all, of mental processes and inner life, for these are, unlike physical existence, distinguished by extreme complexity, unpredictability, and novelty; by inner principles of autonomy, identity, and “will” (Spinoza and Leibniz speak here of conatus); and by a continuous becoming, evolution, and development.

The magnitude of this discrepancy, as well as our almost irresistible desire to see ourselves as being somehow above nature, above the body, has generated doctrines of dualism from Plato on—doctrines clearest of all, perhaps, in Descartes, in his separation of two “essences” (res extensa and res cogitans) and in his conception of a quasi-mystical meeting point, an “organ of liaison,” between the two (for him, the pineal).

Even in the work of C. S. Sherrington, the founder of modern neurophysiology, we find an explicitly Cartesian viewpoint: thus Sherrington regarded his decerebrate dogs as “Cartesian trigger-puppets” deprived of mind; he felt that physiology—at least the sort of reflex physiology he set himself to study—needed to be free of any “interference” by will or mind; and he wondered whether these, in some sense, did not transcend physiology and might not form a separate principle in human nature. Thus looking back on a lifetime’s work, he writes:

That our being should consist of two fundamental elements offers I suppose no greater inherent improbability than that it should rest on one only.

Wilder Penfield, the neurosurgeon who studied with Sherrington as a young man, found a lifelong interest in the exploration of “experiential seizures”—seizures in which patients would find themselves convulsed, for seconds or minutes, with a hallucinatory replay of events, scenes, perhaps music, from their past lives, scenes partly dreamlike, phantasmagoric, poetic, but with an intense and overwhelming feeling of reality. (Penfield mentions people having convulsive memories of “the action of robbers in a comic strip,” of seeing people “enter the room with snow on their clothes,” and of “watching circus wagons unload” when they were children.) Such hallucinatory replays, such experiential seizures, which might occur in some patients with temporal lobe epilepsy, could also be evoked, Penfield found, by stimulation of the exposed temporal lobe cortex during an operation. The whole of life in Penfield’s view, at least passive, “sensory life”—the whole of a patient’s experience, every sensation and feeling he ever had—was preserved exactly and totally, and recorded in the brain. Penfield uses the word “record” again and again, and sees memory, the brain’s recording, as something akin to a mechanical record, or the “memory” of a computer.

Experiential seizures,” Penfield thinks, merely serve to stimulate a random segment of this memory. This is a passive (or mechanical) view of memory and the brain—and this very passivity forces Penfield into dualism too. Thus, looking back over a lifetime of work in his last book, The Mystery of the Mind (which he dedicates to Sherrington), he concludes that though memory and imagery, sensation and experience, are indeed “engraved” in the brain, the active faculties—will, judgment—are not in the brain, are not represented physiologically in the same way, but are “transcendent” functions irreducible to physiology.

For Penfield there is the stream of memory and consciousness, “the biological stream,” and something supra-biological, “the mind (not the brain),” that watches and directs this. Thus the idea of a frontier develops:

The patient…programs his brain…. Decision comes from his mind. Neuronal action begins in the highest brain mechanisms. Here is the meeting of mind and brain. The psycho-physical frontier is here.

Such a frontier has to be envisaged, because Penfield sees all brain action as “automatic,” “reflex,” or “computational”; and yet, clearly, man himself is not an automaton. Thus Penfield sums up his views:

After years of striving to explain the basis of mind on the the basis of brain-action alone, I have come to the conclusion that it is simpler…if one adopts the hypothesis that our being does consist of two fundamental elements.

The “mind,” in Penfield’s sense, is a ghostly thing indeed. It lacks memory, or the need for memory—“It can open the [brain’s] files of remembrance in a flash.” It needs none of the apparatus, the physicality, of the brain. But, Penfield tells us, though immaterial, the mind does require “energy”; and this energy is normally provided through its attachment to the living brain. And yet (and here Penfield’s speculations become increasingly fantastical), the mind may have a way of surviving bodily death. It may do this, he thinks, by establishing a relationship, an energy flow, with the minds of the living; or with the mind of God; or with some other source of mind energy out there, in the cosmos. “When the nature of the energy that activates the mind is discovered (as I believe it will be),” Penfield concludes, “the time may come when scientists will be able to make a valid approach to the study of the nature of a spirit other than that of man.”1

The struggle between dualistic thinking and various forms of monism has raged since the time of Descartes, and it is far from finished at the present time. Most biologists believe in evolution (one may disregard the trivial rear guard of “creationists”); but neurologists and psychologists are sometimes less rational in their thought, and may exempt “mind” from the scientific considerations they otherwise entertain, and claim it for a special, privileged status. Thus Lord Adrian (who shared the Nobel Prize for physiology with Sherrington) wrote in 1966, “As soon as we let ourselves contemplate our own place in the picture, we seem to be stepping outside the boundaries of natural science.” (Penfield quotes this sentiment with approval, at the very start of The Mystery of the Mind, adding, “I agree with him.”) Sherrington’s great pupil J. C. Eccles, also a Nobel prize winner in physiology, has been an emphatic dualist from the start of his career, and indeed entertains notions remarkably similar to Descartes’s except that for Eccles it is the synapse (not the pineal gland) that “transduces” between brain and mind.2

It was in regard to Sherrington, Adrian, Penfield, and Eccles (and a host of others whose names are less well known) that Carol Feldman, a philosopher, once asked me, “Why do all you neurologists go mystical?” I agreed that this was a fascinating question, but that there were many exceptions (myself included). Hughlings Jackson, a friend and follower of Darwin and often called the father of neurology, believed in, and spent his life trying to explore, “the physiology of mind.” Whatever dualistic exceptions there may have been, it has always been the central effort of neurology to exempt nothing from the domain of natural science, to try to develop a physiology of mind.

Clinical neurologists, it should be said, even if they lack the genius of Sherrington, Eccles, or Adrian, may nevertheless have a somewhat better record here, for they have daily to face the richness of human life, the complexity of the phenomenal world; whereas a physiologist can spend a life with spinal preparations and decerebrate animals, in a world of nerve potentials, synapses, and reflexes—such a life may fail to be a corrective to dualism, may even foster its mystical development.

Barbara McClintock, the geneticist, often spoke of “a feeling for the organism” as the first and crucial necessity for a biologist. It is easy to get lost in the details of genetics or molecular biology, or in the details of neurophysiology, and to forget, or lose, this feeling for the organism. This is less so, perhaps, for the physician than for the “pure” scientist, for the physician must confront, must have a feeling for, the total being of his patients—not merely as an ethical, Hippocratic necessity, but because, otherwise, he may find himself unable to treat them.

There is a tendency in neurology and pathology to talk about “the lesion,” to see the process and end of medicine as delineating, and “treating,” the lesion. But the effects of a lesion, of any dys-function, cannot help ramifying throughout the economy of the organism, and so force one to consider the organism as a whole:

2.

The first patients I saw when I finished my training were patients with migraine. My first thoughts were that migraine was a simple pathology, or pathophysiology, which would require a pill, a medication, and that the beginning and end of medicine was to make the diagnosis and to give the pill. But there were many patients who shook me. One in particular was a young mathematician who described to me how every week he had a sort of cycle. He would start to get nervous and irritable on Wednesday, and this would become worse by Thursday; by Friday, he could not work. On Saturday he was greatly agitated, and on Sunday he would have a terrible migraine. But then, toward afternoon, the migraine would die away. Sometimes, as a migraine disappears, the person may break out in a gentle sweat; he may pass pints of urine. It is almost as if there is a catharsis at both physiological and emotional levels. As the migraine and the tension drained out of this man, he would feel himself refreshed, renewed, he would feel calm and creative, and on Sunday evening, Monday, and Tuesday, he did original work in mathematics. Then he would start getting irritable again.

When I “cured” this man of his migraines, I also “cured” him of his mathematics. Along with the pathology, the creativity also disappeared, and this made it clear that one had to inspect the economy of the person, the economy of this strange cycle of illness and misery each week culminating in a migraine and then followed by a wonderful transcendent sort of health and creativity. It is not sufficient just to make a diagnosis of migraine and give a pill. One has to inquire into the entire human drama that surrounds the attacks, to explore what they might mean in a particular person. One has to take not just a “medical” history, but to try to construct a complete human narrative.

The second group of patients I encountered were those I describe in my book Awakenings. As a student I had vaguely heard of the great sleeping sickness, the encephalitis lethargica, which had become a worldwide pandemic in the 1920s; but it was only in 1966, when I arrived at a hospital in New York, that I saw for the first time the full, and almost unimaginable, depth and strangeness of the states that this might bring about. When I came to the hospital, I found some eighty patients who were, for the most part, completely “frozen,” frozen in strange statuesque attitudes—and some of them had been in this state for forty years. Many of them had curious “crises” at times, in which their frozenness would be replaced by sudden spasmodic activity, “forced” movements, “forced” behaviors, compulsions of every kind.

  1. 1

    It is important that the thinking developed in Penfield’s last book (he died in 1976, the year after it was published) be seen not as some eccentric late development but as being of a piece with thoughts and tendencies he had entertained most of his life. His dualism, his speculations on the relation of brain and mind, seem to have started when he was a youthful student under Sherrington and saw a cat with its cerebral hemispheres removed, a cat reduced to a “mindless automaton.” (Sherrington himself had a similar epiphany, when he saw a decorticate dog in Goltz’s lab forty years before.) In the Thayer lectures in 1950—when he was in the midst of his experimental work—Penfield speculated that “mind may be of a different and distinct essence.”

  2. 2

    John C. Eccles, Evolution of the Brain: Creation of the Self (Routledge, 1989).

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