Like so much brain damage, the first symptoms that mine produced were almost indistinguishable from normal behavior. In a man less sensitive to his neurology, and less knowledgeable in matters of neuroanatomy and neurophysiology, they might have gone unnoticed, or if noticed, filed away among that enormous class of behavior (sometimes called, for want of a better word, “psychological”) that one does not associate with the brain. For me, however, such dismissal was impossible. Twenty-one years a neurosurgeon, I had seen hundreds, even thousands of people with brain damage, and I knew all too well that the early symptoms are often so unremarkable as to leave no trace, even in brains unafflicted with amnesia, in the memory. Brain damage is rarely as grotesque as one expects it to be. It’s true that it can strike like a hurricane, but sometimes it’s more like a gentle breeze, a subtle change of vectors that leaves you headed, not in the opposite direction, but almost exactly where you were headed before. A charming eccentricity becomes embarrassing, private habits go public, it gets a little harder to keep things to yourself. I’ve seen it begin with farting or belching, nose-picking, cursing, bragging, talking or laughing too much or not at all, a lean to the left or a lean to the right, too many adjectives, self absorption, visions of grandeur, arrogance, dogmatism, distraction, indecision or impatience. Some patients can’t admit mistakes, and some think everything they do is wrong. There’s nothing the brain can’t use when it turns against you. Why should it surprise us that when it goes askew it proceeds at first along familiar routes, taking the line of least resistance, like water flowing down a mountain or an artist painting portraits of his friends?
That morning, while my wife was making coffee, I decided not to move. As I saw it, it was a clear-cut decision, a choice I could neither explain nor resist, but Father, a neurosurgeon like myself who had always been conservative in matters such as these, saw it differently. His voice was extremely vivid and believable, so much like one that originated in the auditory cells rather than those involved with memory or imagination that I could not believe he wasn’t sitting beside me. What I called a decision he called an incapacity. “I don’t want to go into the decision-making process,” he said, “the neurology of Frontal Lobe behavior and all that, but time and again the research has demonstrated that motor behavior takes precedence over willpower. A man can no more will himself in the direction of paralysis than he can will himself not to breathe. The needs of the body simply cannot be malnourished.” Malnourished?! Until Mother corrected him, I thought I’d heard him wrong. “‘Malnourished?’” she laughed. “Just because he’s incoherence doesn’t mean that you should not be recalcitrant. Who said decided not to anything? About breathing? All he said is move, and who are you to play this kind of nourishment reasoning instead of?”
I was not yet so far gone that I missed the point that they were missing. The real question, what had to be determined before I could proceed with explaining my condition, was whether the decision I claimed to have made had preceded or succeeded my paralysis. In other words, whether I could not or did not wish to move, whether I was paralyzed or stubborn or perhaps merely lazy, whether my brain or I myself had restricted my mobility, whether my problem was finally to be classified as “neurological” or “psychological.” Needless to say, it was not a question with which I was unfamiliar. Very often, with brain-damaged patients, the first and perhaps the greatest issue is the delegation of responsibility. Who’s boss, in other words, you or your brain? Some patients think they’re responsible for everything, some nothing, and some go back and forth, telling themselves one minute that their brain is the cause of their mistakes, the next that —through ignorance, perversity, laziness or some other shortcoming—they’ve no one to blame but themselves. To furt complicate the matter, there are those among the latter group who draw so much inspiration from the psychological position that they often claim responsibility where none is justified. Inflicted with amnesia, they blame themselves as if by an act of will or concentration their memory will improve. “Think, damn it, what was her name?” If efforts to speak produce incoherence, they curse themselves as one might for overeating, cowardice or laziness. In effect, their symptoms make them feel guilty. People of the opposite inclination, on the other hand, feel no guilt at all. Why should they when, as they see it, their brains are responsible for everything they do? When even laziness or selfishness is neurochemical? Blaming yourself for what your brain is doing is like blaming yourself for the behavior of a stranger. This sort of patient, nothing makes him so happy as proof that his brain is damaged. So distinct are these two types that our department had tried for years to devise research to investigate them. What we wanted to locate, of course, was the neurophysiology that produced such inclinations as well as the neurophysiology which they in turn produced. Wasn’t that the fundamental issue? What sort of brain leaned toward the psychological explanation and what sort leaned toward the neurological? And once a brain had moved in one direction or the other, once the neurological or psychological explanation was circulating in the cortex, what was its effect upon the nervous system in general, what sort of chemical and electrical changes did it induce?
My wife was a small woman with very broad shoulders and hair cut short like a boy’s. She wore unmatched earrings, a single pearl in the left ear and a gold loop in the right. On her left forearm was a small tattoo of the Yin-Yang symbol which she’d got in Kathmandu, fourteen years before, when she was working in Tibetan refugee camps. I didn’t know her name but I was convinced it began with “M.” In an attempt to jog my memory, I made a list—“Martha, Marjorie, Mary, Millie, Marlene, Melissa, Margaret, and (not realizing my mistake) Nancy”— but not one of these names elicited that happy sensation the brain secretes when the proper box has been opened and such perverse hide-and-seek games have been foiled. Feeling bereft, just on the verge of panic in fact, I made a conscious, a willful decision, embracing “Martha” with conviction that was transparent in its insincerity, thinking “Martha, Martha, Martha, Martha, Martha,” as if to seduce my brain, as if by repetition it could be persuaded of what it knew to be incorrect.
She placed my mug on my nighttable, then climbed into bed beside me. As the aroma of coffee spread through the room, I felt a tremendous desire for it but this desire had an inverse effect, strengthening my original decision, my resolution not to move. I knew I’d feel better if I drank my coffee, so much so perhaps that decisions of the sort which had arrested my movement would pass through my brain without arousing the slightest interest, much less attachment, much less a need to act on them, but the very image of such improvement made all thoughts of coffee abhorrent to me. Soon its aroma lost its appeal, becoming bitter, acidic, almost nauseating in its effect. Thus did I discover that my olfactory cells were also participating in my collapse. I’m not sure why, but this information struck me as extremely significant, and it caused me to take note of my condition in a way I had not done before. Suddenly, I was no longer interested in distinguishing between different causes for my immobility, whether I could not or would not move, whether movement was possible and rejected or impossible and believed to be rejected. The indisputable fact was that I wasn’t moving. Several times, unless I’m mistaken, the wish to move had actually crystallized within me —I saw myself sitting up, for example, drinking my coffee, talking to Martha, etc.—but the resolution had led to nothing. I had an idea my body was stiffening, edging toward rigidity, but even more disturbing was the fact that this sensation, despite its discomfort, produced an overwhelming feeling of exhilaration. Is it possible that I had already attained the freedom that so many brain-damaged patients achieve, the state of mind in which pain itself becomes a source of happiness?
Father and Mother continued their bickering, but now another voice appeared. Though often repetitive and strident, it had confidence and authority, even omniscience. In fact, it was my own thoughts it seemed to be voicing. Even when I disagreed with it, it seized my interest and attention. It was almost as if, alone among my voices, it was not originating in my brain. How is it, I asked myself, that certain regions of the brain seem to be outside it? I was thinking of the cells that produce the pronouns “I” or “me,” the whole idea of what one calls “myself.” When you try to persuade yourself to do something, tell yourself, for example, “Get out of bed!” or “Drink your coffee!”, which cells are talking and which are they addressing? It seemed to me that, of all the questions brain damage had offered me, none were deeper or more important than these, none so worthy of investigation. I swore to myself that if I ever got better I’d devote myself to researching them, but even as I made this vow, I suspected that, if I really got better, such questions would never occur to me. Furthermore, it struck me that thoughts like these could very well be the worst of my symptoms. Why would one question the voices that seem outside the brain when the very fact that one thinks them outside is the source of their strength within?
In any event, the position taken by this voice was that my decision not to move was less about paralysis than brain damage in general. In other words, it wasn’t just immobility I wanted to explore but the whole world of neurological incapacity. Furtmore, unlike Mot and Father, it considered this decision not only rational but courageous. Far from viewing it as a subterfuge or a delusion, it saw brain damage as a natural outgrowth of my lifelong scientific and clinical preoccupations, namely my interest in the human brain. Having studied the brains of others, was it not natural that I had now determined to study my own? And what better way to do that than by cultivating symptoms of one’s own? As it built its argument, the voice became more passionate. “What can we learn from a normal brain?” it cried.“If words appear whenever we need them, what do we learn about the cells which have produced them? It’s only the failing brain that reveals its secrets to us. Every symptom is a mine of information! This is why he’s happy with his amnesia! This is why he isn’t moving now! What you see before you is not neurological dysfunction but neurological research!”
But consider the speed of the brain! This proclamation, as I understood it, required less than one or two seconds. It was as if the words occurred all at once instead of one after anot, as if, like a photographic image, they’d originated, not in the language regions of my brain, but in the Optic Lobe. By the time Marjorie spoke to me, it was all complete and stored in my memory, a source of fear already that it might be forgotten.