Tuesday, October 30, 2012

The Top Of My Head, Part I - On Charcot's Straitjacket, And The New Neurological Dispensation

"As a dog returns to its vomit, so a fool will repeat his folly"

Proverbs. 

I couldn't leave it alone. I had read and thought too much about it all to let it all just be forgotten, and my condition's recent recalibration has made the act of getting it all out of my system a little more urgent. 

So here goes, a series of posts concerning my thoughts on neurology, dopamine illness, figures from the past who may have been thus afflicted (a thoroughly pointless parlour game, but an interesting one nonetheless) and my own thoughts upon some things about some sufferers that seem to keep turning up again and again, and whether or not these might be considered symptoms. 

First off, it is rather surprising that in an age of reason we appear to know very little about the organ of reason. For the religious, it isn't surprising at all - the human brain is one of the most wonderful of all God's creations, and He will let us know how it works when He is good and ready, if at all. 

However, one of the downsides of living in an age of reason is that the irreligious can become prone to elevating reason into a godhead, and if you elevate reason into a godhead you must accord the same dignity to the organ of reason. For some of those who worship reason, Brain seems to have supplanted God, a remarkably poor trade in my book, but there's no accounting for taste. I recently heard a retired missionary father describe some British doctors he had come across as having been more obtuse in their refusal of religion than some unevangelised peoples he had encountered. If you're a rationalist doctor whose only concept of a trinity is Darwin, Freud and Dawkins, the temptation to completely exclude religion from your work must be very strong. However, the difficulty with worshipping reason is that its refusal to reveal itself can be as stubborn as the rationalist's refusal to believe in religion which has been revealed, which in turn means that the fruits of reason can never be enjoyed, if only because of the nagging doubts that they have not really been found. One way in which this quest for a truth waiting to be revealed rather than one which has already been revealed (without being glib, it seems to me that believing in a revealed religion seems to free up a lot of the believer's time, if only to let them get on with believing it) can manifest itself is to publish endlessly. 

In my view, the sheer volume of materials which are published on the working of the human brain actually impedes the study of it. Over twenty years ago, the late Arthur Shapiro stated, in my view quite rightly, that the volume of material being published about Tourette Syndrome was leading to overdiagnosis and making the study of the actual pure phenomenon very difficult indeed. With the best will in the world, it just might not be possible to keep up to speed with all findings that are being made, and making impossible any attempt to determine their actual scientific value. 

However, for the reasonable the temptation to approach the organ of reason with the utmost rationality must be very strong, perhaps leading some neurologists to bind themselves into a habit of thought best described as 'Charcot's Straitjacket'. 

Everyone's heard of Parkinson's Disesase. Everyone's heard of the Gilles de la Tourette Syndrome. Not everyone will be aware that they were both named by the same person, one Jean-Martin Charcot. Charcot's contribution to neurology was, of course, immense. However, the difficulty involved in studying the brain and its workings from a purely scientific, empirical perspective, expecting to see the same results in different patients, is that one can eventually slip into a mode of thought that says 'Bob's arms shoots out to the right. Jim's shoots out to the left. They have different conditions'. The clinician has then bound themself in Charcot's Straitjacket, and is perhaps, for whatever reason, confusing symptoms for illness (that some less scrupulous neurologists might be motivated by venality and actually want to discover a syndrome so that their name will forever be attached to an illness suffered by someone else is of course shockingly irrational and should be immediately discounted). 

The most egregious example of Charcot's Straitjacket that I have come across in print is, sadly, Arthur Shapiro's 'Gilles de la Tourette Syndrome', a monumental work which distilled the labours of many years, written by a clinician who clearly always had the interest of his patients at heart. However, as I wrote about that book earlier this year

"...to this reader it is very clear that the enormous variety of symptoms that he was presented with gave Shapiro a severe problem. A good Linnaen intent in adhering to the highest clinical and academic standards, and always conscious of that most American impediment to the advance of scientific knowledge – the prospect of being sued - to the lay reader he seems at times to be lost in a taxonomical fog, unable to see the wood of illness for the trees of symptoms in a grail quest for verifiable conclusions. Branches were hacked away and raised as trophies while the trunk was ignored, his findings becoming more and more specialised and over-evolved, with the prospect of diagnostic clarity eventually diminishing into a downwardly spiralling haze of Transient Tic Disorders (TTD), Paroxysmal Myoclonic Dystonia, With Vocalisation (PMD), until the final descent into a catch-all ‘Tic Disorder not otherwise specified’. Learning of the existence of PMD was an epiphany for me; I seemed to possess all the symptoms, and, most tellingly, they had appeared at precisely the same age, 21, as the patients reported by Shapiro; but that couldn’t be right, because they all had ADD and I didn’t. What I had was like PMD, but Shapiro indicates it couldn’t be PMD. Back to the drawing board".

The bottom line about the human brain seems to be that we do not know enough about it to expect it to do what we seem to expect it to do all the time. When reason is directed at the organ of reason, reason all too frequently falls flat on its face. The organ of reason's tendency to capriciousness must be extremely irritating for those engaged in studying it. However, if neurology is the secular dispensation some consider it to be, and Brain is your god, then Charcot's Straitjacket demands that practitioners of religious neurology must attempt to determine how many neurons can dance on the head of a synapse, transforming the means of enquiry, observation and analysis, into ends in themselves, liturgical acts, in the process. 

Science conducted in that manner is not any kind of science that will benefit humanity in the long term. It will, however, be science that is very good at establishing its own self-selecting, self-perpetuating priestly elites; those who observe the most and analyse the most, and, of course, publish the most, regardless of whether not their subjects are worthy of analysis or their output fit for publication. There is no method in a madness that distorts necessary method into a religious mania. They should all loosen up a bit.

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