Twelve years ago, a fifty-nine-year-old Dutchman checked into an Amsterdam hospital to have two small electrodes implanted in his brain. The patient, “Mr. B,” had a forty-year history of severe obsessive-compulsive disorder. Neither drugs nor therapy had helped, and he was prepared to try an experimental treatment called deep brain stimulation (DBS). Powered by neurostimulators placed under the skin, the implanted electrodes would deliver regular five-volt electrical pulses to a region of Mr. B’s brain called the nucleus accumbens.
It was a radical treatment, but it worked. After about six weeks Mr. B was better able to resist his compulsions. No longer was he seized by anxiety and panic. Along with the relief, however, came an unusual side effect: Mr. B developed an inexplicable attraction to the music of Johnny Cash.
Until the electrodes were implanted Mr. B had no particular interest in music, least of all country music. If he listened to music, it was usually the Beatles, the Rolling Stones, or Dutch rock bands. Six months after the DBS began, however, Mr. B had a transformative moment: he heard Johnny Cash’s song “Ring of Fire” on the radio. From then on, Mr. B listened to Johnny Cash and nothing else. In the journal Frontiers in Behavioral Neuroscience, his doctors wrote, “When listening to his favorite songs he walks back and forth through the room and feels like he finds himself in a movie in which he plays the hero’s part.”
Mr. B’s devotion to the music of Johnny Cash was not compulsive. His desire to listen didn’t feel alien, urgent, or irrational. He simply felt there was a Johnny Cash song for every experience in life. And as long as the neurostimulator was on, Mr. B never got tired of the music. But if the batteries ran down or the neurostimulator malfunctioned, all of Mr. B’s interest in Johnny Cash vanished. It was as if a flame had been snuffed out. As soon as the battery power was restored, however, Mr. B’s love of Johnny Cash returned.
Should we find this transformation disturbing? Mr. B was certainly not bothered by it. And the notion that we should be true to some kind of fundamental character can seem quaint and old-fashioned, a relic from the writings of Kierkegaard. In fact, if we are to believe Lone Frank, the author of The Pleasure Shock, the very idea of an authentic self has been scientifically debunked. “The concept of this stable inner core is ancient and tenacious, but it is an illusion,” she writes. “It fits poorly with what science has discovered. Apply a bit of voltage here or there, and you become someone else.”
For most of us, however, the matter is a bit more complicated. Whether such a change seems morally disturbing depends in part on how profoundly it disrupts a person’s identity. A transformation from casual Beatles listener to Johnny Cash superfan may seem insignificant. Imagine, however, that Mr. B had been the conductor of the Royal Concertgebouw Orchestra and DBS had produced an intense attraction to the songs of Barry Manilow. Even if Mr. B were thrilled with the change, it would probably be alarming to anyone who had known him before (especially the members of the orchestra).
Even more unsettling would be a significant transformation in someone’s personality. For example, Mr. B’s wife thought the procedure had made him socially inappropriate with strangers and oblivious to how often he annoyed people. While she was grateful that he was finally free of his obsessions and compulsions, the change troubled her. She said, “This is not the man I married.”
For years this has been the peril of DBS as well as its promise. The procedure is best known for treating the symptoms of Parkinson’s disease, especially tremors, for which it gained FDA approval in 1997. For some patients who receive DBS, the clinical improvements can be profound. DBS has also been studied in a much larger population of patients who would welcome a personal transformation, such as those with severe depression, obsessive-compulsive disorder, Tourette’s syndrome, anorexia nervosa, and drug addictions. But those studies have yielded mixed results. The medical literature also contains disturbing reports of unwanted side effects: penny-pinchers who metamorphose into pathological gamblers or aging patients who become slaves to a high-octane libido.
In The Pleasure Shock, Frank charts the rise of DBS through the career of Dr. Robert Heath of Tulane University, a forgotten figure with an unusual research program. Most conventional histories of DBS place its modern origins in France in the 1980s, when a team led by the neurosurgeon Alim Louis Benabid began using it to treat chronic pain and Parkinsonian tremors. (Scientists have been using electricity on the human brain in various ways since the nineteenth century, though usually to explore how the brain works, not to treat illness.) But Heath was performing DBS as early as 1950, and he started with psychiatric patients. His ambition led him into such dark ethical territory that many DBS researchers would rather forget him. Frank, in contrast, sees Heath “not so much as a monster but as a gifted, curious scientist.” While she does not quite attempt a full rehabilitation of his reputation, she gives him a far more sympathetic treatment than he deserves.
There was a time when Heath’s star shone bright. He left Columbia University in 1949 to found the Department of Neurology and Psychiatry at Tulane and served as its chair for over thirty years. A man of tremendous charisma and drive, Heath quickly became a towering figure at Tulane. He dined in fine restaurants, drove expensive cars, and played tennis like a professional. Time published articles about his work. A former student describes him as “blindingly good-looking.” So powerful was his personal magnetism that nearly a quarter of Tulane medical students chose to become psychiatrists.
According to Frank, Heath got the idea for DBS when he was working with the neurologist Fred Mettler at Columbia. The aim of their research was to develop a kinder, gentler form of lobotomy called topectomy. The topectomy study was unsuccessful, but it gave Heath an idea. He believed that anhedonia, or the absence of pleasure, might be the central problem in schizophrenia. Without the ability to feel pleasure, Heath thought, patients with schizophrenia could not regulate their behavior. “It was like being a horse that was constantly whipped no matter what it did, never getting a carrot,” Frank writes. “It can’t help but move in zigzags and circles.” Heath wondered: What if I gave the horse a carrot by electrically stimulating its septal region, an area of the brain associated with pleasurable feelings of social connectedness? He started with psychiatric inpatients at Charity Hospital in New Orleans.
In June 1952, at a symposium in New Orleans, Heath presented his results. His team had implanted electrodes in the septal regions of nineteen subjects with schizophrenia. According to Heath, thirteen of them had shown either “marked improvement” or “significant improvement.” So impressive were these findings that Heath expected his colleagues to be dazzled. They were not. One by one the psychiatrists picked apart Heath’s study: the lack of an adequate control group, an unconvincing theoretical explanation for the changes, and the possibility that Heath and his team were not placing the electrodes in the proper regions of the brain. The skeptical reception left Heath stunned. Frank writes, “The farewell dinner that evening was excruciating.”
In fact, the problems with the study went even deeper than Frank admits in the book. As psychologist Alan Baumeister has pointed out in a critical review, two subjects died of brain abscesses after the implantation and a number of others had serious complications, including seizures and infections.* A mortality rate that high strongly suggests the procedure was unsafe, yet Heath pressed ahead. Even some of his successful patients experienced severe side effects. The patient Heath described as having the best clinical result was a seventeen-year-old girl with diagnoses of schizophrenia, mental retardation, and anorexia nervosa. She began having seizures on the operating table and went into a coma that lasted two days.
The purpose of the experiment with these early subjects was treatment. But Heath and his colleagues later implanted electrodes in patients with schizophrenia before dosing them with LSD and mescaline—not because they thought the drugs would help them but to provoke symptoms of psychosis for them to document and study. One woman tore up her clothes. Another subject, writhing on a bed, had hallucinations of tombstones on the ceiling. Frank describes a patient Heath filmed in his lab in 1953 while his brain was stimulated. “I’ll rip this shit into a thousand pieces,” the patient screamed as the current was turned on. “I just want to kill someone!”
Heath’s real interest was pleasure, however, and over time his team got better at producing it. In the early 1960s, after implanting electrodes and cannulas into the brain of a mildly mentally disabled woman with epilepsy, Heath introduced small amounts of the neurotransmitter acetylcholine into her septal region. Within five or ten minutes, the woman became alert and, after fifteen minutes, mildly euphoric. Her movements turned sensuous. Soon she experienced “repetitive orgasms.” Heath conducted this procedure at least fourteen times, noting that, in addition to becoming orgasmic, the woman “solved simple mathematical problems with more ease.” Soon Heath began sending some patients home with transisterized devices they could use to stimulate themselves.
Heath’s most notorious experiment involved a patient he called B-19, who had been confined to the psychiatry ward at Charity Hospital after being arrested on a drug charge. Heath characterized the twenty-four-year-old patient as a walking bundle of psychological dysfunction: arrogant, paranoid, convinced that he was worthless yet unable to tolerate being ignored. He had a diagnosis of temporal lobe epilepsy and a drug habit remarkable for its variety. In addition to using amphetamines, barbiturates, major tranquilizers, marijuana, and the occasional hallucinogenic, he sniffed vanilla extract, nutmeg, and paint thinner. The son of a tyrannical, alcoholic ex–army officer who considered him a “coward and a failure,” B-19 had joined the military at age nineteen but had been discharged after a month for “homosexual tendencies.” For the two years before Heath met him, he had been financially supported by a series of gay partners. He told Heath, “I live with the idea of suicide daily.”
Heath wondered if DBS could turn B-19 into a heterosexual. First he showed B-19 a fifteen-minute “stag film.” It repelled him. Heath and his team then implanted stainless steel electrodes in over half a dozen of B-19’s subcortical areas. When they stimulated his septal region he reported feelings of good will, alertness, and a “compulsion to masturbate.” Next Heath equipped him with a device that allowed him to stimulate the septal region himself. B-19 proceeded to push the button 1,500 times in a three-hour period. Not only did this considerably improve his general outlook, it also produced a more enthusiastic response to the stag film.
The next step was sex with a prostitute under controlled conditions. With the permission of the Louisiana attorney general, Heath hired a twenty-one-year-old woman to spend two hours with B-19 in the laboratory. The prostitute coaxed him into intercourse while Heath recorded his brain activity. “Despite the milieu and the encumbrance of the electrode wires, he successfully ejaculated,” Heath reported. Other experts have not been convinced. As the Emory University psychiatrist Gregory Berns has pointed out, “If the experience was accompanied by septal stimulation, he could probably have sex with anything placed in front of him.”
Heath published the study in 1972: ten years after Ken Kesey’s One Flew Over the Cuckoo’s Nest, three years after the Stonewall riots, and the same year that the whistleblower Peter Buxtun exposed the notorious Tuskegee syphilis study, a US government experiment in which hundreds of poor African-American men with syphilis were deprived of treatment for forty years. In a single stroke, Heath appeared to have exploited psychiatric patients, gay men, and human research subjects. In May 1972, protesters gathered outside the site of a neurology conference he was attending in New Orleans holding signs that read “Stop the Mind Control.” In 1973 a Senate subcommittee investigating human experimentation summoned him to defend himself. The next year a New Orleans weekly newspaper published a scathing takedown titled “The Mysterious Experiments of Dr. Heath, in Which We Wonder Who Is Crazy & Who Is Sane.”
In the summer of 1975, the Senate’s Church Committee revealed the existence of Project MKUltra, a secret program in which the CIA and the Department of Defense had conducted “mind control” experiments on human subjects. Documents obtained by The New York Times in 1977 suggested that Heath might have been involved. He admitted that the CIA had approached him to explore the brain’s “pain center” in 1962 but he said he had refused. He also acknowledged testing a supposed “brainwashing drug” called bulbocapnine on monkeys for the CIA, but said he had never tested it on humans. It was later revealed that Heath had tested the drug on a prisoner recruited from the Louisiana State Penitentiary in Angola.
Yet the biggest blow to Heath’s credibility had little to do with the CIA or DBS. In the mid-1950s he had claimed to have isolated a protein in the blood of schizophrenic patients that produced symptoms of psychosis when he injected it into healthy volunteers (who were also recruited from the pool of prisoners in Angola). He called the protein “taraxein.” The discovery of taraxein would have been groundbreaking, yet no one could replicate his results.
Frank may have discovered why. According to Dr. Arnold Mandell, a well-known psychiatrist who trained under Heath as a medical student in the 1950s, the biochemist in charge of isolating the protein for Heath was actually not a biochemist at all. He was a con man named Matthew Cohen who had faked his way into the laboratory job. Cohen had just enough training in lab techniques to fool Heath and his team, and at the times when he claimed to be isolating taraxein, he always happened to be alone in a locked room. The scam unraveled when Heath discovered that Cohen had been forging his signature on invoices to buy expensive personal items. Then he learned that Cohen had intentionally omitted crucial information from one of their taraxein articles. Heath was livid, but exposing the deception would have destroyed the credibility of the taraxein project. Later he quietly cut Cohen loose without revealing the reason.
In 1971 Walker Percy published a dystopian satire of biological psychiatry called Love in the Ruins. Set in a fictional Louisiana golf community called Paradise Estates, the novel has as its hero an alcoholic, lapsed Catholic psychiatrist named Thomas More, who has invented an instrument called the Ontological Lapsometer—a “stethoscope of the spirit.” Lapsometer in hand, Dr. More can diagnose and treat the existential ailments afflicting late-twentieth-century Americans.
Percy trained as a doctor before turning to fiction. His Louisiana home was less than an hour’s drive from Tulane, and the objects of satire in Love in the Ruins bear a striking resemblance to Heath and his laboratory. At the hospital where Dr. More works is a sex facility called the Love Clinic, where white-coated technicians monitor the vaginal console as a subject in the observation room “autostimulates” herself. As with Heath and the CIA, Dr. More has entered into a Faustian bargain with a sinister research sponsor—in More’s case, a Mephistophelean character who looks like a drug rep and whose appearances are signaled by the smell of sulfur.
Above all, Percy lampoons the brand of biological psychiatry that Heath championed. Heath thought it made perfect sense to use DBS to make patient B-19 heterosexual. Was B-19 not suffering? Would he not suffer less if he were no longer gay? In The Pleasure Shock, Frank defends Heath by noting that his experiment was relatively benign compared to the barbaric “gay conversion” procedures used by some other psychiatrists, such as repeated electroconvulsive therapy and painful electric shocks to the genitals.
Yet neither Heath nor Frank seems to have grasped the central problem with Heath’s procedure. Of course there are people who are unhappy with themselves in ways that doctors can try to fix. But that unhappiness can sometimes come from a painful mismatch between a person’s individual biology and larger social norms and expectations. In a society in which gay people are made to feel ashamed of their sexual preferences, it is no surprise that desperation would lead patient B-19 to Heath’s lab. But it is a mistake to locate the sickness solely in the patient’s head rather than in the society in which he lives.
The mistake runs through The Pleasure Shock. Frank describes a case study published in 2012 that could have been lifted from Love in the Ruins. Doctors in Germany implanted electrodes in the nucleus accumbens of a young man with anxiety and obsessive-compulsive disorder. Afterward, they asked the man to describe his levels of anxiety and happiness as they calibrated the device. At a single volt the man was still sad and anxious; at five volts he was so euphoric he felt he was losing control. The man wanted the device set a notch lower, at four volts, where his anxiety level was zero and his happiness a ten out of ten, but his doctors refused. Instead, they set it at three, where the man merely felt “relatively happy.” Frank asks, “Why not allow patients to set their own moods to suit their own circumstances and desires?”
It is a fair question. Yet it is also fair to wonder, as the doctors did, whether unbridled happiness and no anxiety would serve the patient’s long-term well-being. Some situations call for grief, guilt, anxiety, or remorse; the word we use for the person who does not feel these emotions appropriately is “sociopath.” Nor does Frank pause to consider how deeply strange it would be for people to choose their moods by dialing them up on a device. Exactly how much happiness should you choose for the wedding of your only daughter as she marries a questionable man? What level of grief is appropriate for the funeral of an uncle you barely knew? We usually expect a person’s emotional responses to be involuntary, both a guide to action and a clue to his or her inner life. Talking to a person who can dial up emotions on demand would be like talking to a puppet that can pull its own strings or a brilliant method actor who can lose himself immediately in any role. How is an emotion authentic if it is the result of deliberate self-stimulation?
The Pleasure Shock is as much a story of Frank’s own investigations as it is of Robert Heath. Frank tracks down Heath’s former colleagues in St. Kitt’s and California, watches grainy 16mm films of patients as they are being stimulated, and interviews contemporary researchers working on DBS. When Tulane refuses to give Frank access to its archives on Heath, she gets them from Heath’s son instead. This makes for an entertaining narrative.
But Frank fails to make a convincing argument that history has treated Heath unfairly. When he retired from Tulane in 1980, he was honored with a two-day scientific conference and dinner at Antoine’s. Five years later Tulane awarded him an honorary doctorate and created the Robert G. Heath Chair in Psychiatry and Neurology. In 1993 Tulane launched the Robert G. Heath Lectureship Fund to support visiting professors. The alumni association of the Department of Psychiatry and Neurology at Tulane is even called the Robert Heath Society. This doesn’t sound like vilification. It sounds like a proud institution celebrating a medical hero.
“Robert Heath was not a mad scientist; he was a pioneer,” Frank writes. In fact he was neither. Heath was a physician in love with his ideas. Psychiatry has seen many men like this. Heath’s contemporaries include Ewen Cameron, the CIA-funded psychiatrist behind the infamous “psychic driving” studies at McGill University, in which patients were drugged into comas and subjected to repetitive messages or sounds for long periods, and Walter Freeman, the inventor of the icepick lobotomy and its most fervent evangelist. These men may well have started with the best of intentions. But in medical research, good intentions can lead to the embalming table. All it takes is a powerful researcher with a surplus of self-confidence, a supportive institution, and a ready supply of vulnerable subjects. Heath had them all.