Featured Neurologist: Arthur Stanley Barnes (1875-1955)

Born in Birmingham, England in 1875, Arthur Stanley Barnes was the son of Starkie Barnes, a headmaster. Stanley, as he was commonly known, received his Bachelor of Science degree from Mason Science College and his Bachelor of Medicine and Bachelor of Surgery degrees from Birmingham University, where he qualified in 1899. He trained under John Hughlings Jackson, William Gowers and Victor Horsley, eventually becoming the Resident Medical Officer at the National Hospital for Paralysis and Epilepsy from 1901 until 1903 when he became a pathologist at Queen's Hospital. Barnes was then appointed assistant physician at Birmingham General Hospital in 1907, became a full physician by 1913 and eventually became Dean of the Faculty of Medicine at the University of Birmingham. He was elected to the Association of British Neurologists in 1933 and was a very active member. He was remembered as an outstanding advocate for his university and as a lecturer who 'mimicked' his past teachers with startling accuracy. He never married. He was extremely passionate about his hobbies which included photography, archeology, golf, and fly-fishing. The last was a particular favorite, so much so that he even published a little-known book about fly-fishing named Anglers Knows in Guts and Nylon.

Neuroskeptic: Fake Clinical Trial - Real Problems

An excellent set of observations: Neuroskeptic: Fake Clinical Trial - Real Problems

The Neuroscience of Procrastination Made “Real Simple”

Supposedly most humans procrastinate. Or, at least, many of us believe we should believe that humans procrastinate. Somehow many of us have adopted a cultural understanding that allows us to believe we suffer from this odious disease. One alternative, of course, would be to recognize in ourselves the great moral failing of laziness. However our actual productivity, so we believe, implies otherwise. It seems it never occurs to us to ask the inverse: is it possible that our very productivity has led to exhaustion? Never! Ergo procrastination must be a disease.

You Don't Procrastinate. Your Brain Does! 

The great question then that we feel we must answer is why do productive people like us constantly procrastinate? Unfortunately the actual word tells us very little – it merely describes the illness. Desperate for answers, we look to experts or seek the hidden causes in ourselves. We feel in our "heart of hearts" that the word implies that early action would be preferable to late action. So why do it at all? Could it be that our brain doesn’t feel the same way? What a betrayal!

That, at least, is the diagnosis of Real Simple, a monthly magazine first published in 2000 and targeted towards an audience largely comprised of educated middleclass women. “Procrastination,” the article's author Amy Spencer writes, “is so relatable, so universal, because the human brain, it turns out, is wired for it.” The issue supposedly is there is a war “between the limbic system” and the “prefrontal cortex”. The limbic system is guilty of including our unconscious drives and emotions. It is one of the “oldest and most dominant portions of brain” and, worse, it does things automatically. The prefrontal cortex, by contrast, is “newer and weaker”. It wants “to get the job done” but it is too young in evolutionary terms to be automatic. You have to work hard to make the prefrontal cortex work. “And the moment you’re not consciously engaged in a task, your limbic system takes over. You give in to what feels good – you procrastinate.” [1] In other words, if it feels good, then it is bad.

Featured Neurologist: Denis John Williams (1908-1990)

Denis John (DJ) Williams was born in Bangor, Wales, where his father was a Presbyterian Minister. He received his Bachelor of Science from the University of Manchester in 1929 and his Bachelor of Medicine and Bachelor of Surgery from the University of Manchester in 1932. After qualifying in 1932, Williams was awarded a Rockefeller Traveling Fellowship to study neurology with Stanley Cobb at Harvard. There he began using EEG Machinery, eventually bringing the first EEG apparatus intended for clinical purposes back to Britain. He was elected to the Association of British Neurologists in 1945 and was a very active member. A Halley Stewart Research Fellow at the National Hospital for Nervous Diseases, Williams became Consultant Neurologist in 1946. He also became a lecturer in Neurology there and was known for his charisma, cleverness, articulateness, his nimble mind and elegant dress. That year, he was also appointed Consultant Physician to St George’s Hospital. He became Civil Consultant in Neurology and Electroencephalography to the RAF in 1951. A Vice-President of the Royal College of Physicians London, Editor of Brain, and a Founder Trustee of the Brain Research Trust, Williams was married with four children.

Neuroculture Watch! The Ode to the Brain - and pretty silly too!

New Sources in the History of Psychoanalysis

An online resource on the history of psychoanalysis is now available at the Wellcome Library.

NeuroCulture Watch and 21st Century Primary Sources

The work of history in the age of internet technologies has surely become more complicated. Patient resources have transformed enormously since the time when Kathleen Chevassut was beginning her ill-fated research into filterable viruses that caused multiple sclerosis. In the interwar period and before there were few patient resources available. The idea of patient organizations (such as the MS, ALS, or Tourette's societies) representing patient interests was new. And certainly the doctor was the voice of authority in the doctor-patient relationship.

Things are quite different today. Patient advocacy groups proliferate. And sometimes they do not represent the interests of their patients very well. Today's patients need to be advocates for themselves. Enter the historian's problem of new primary sources in 21st century cyberculture. Patients today are supposed to need information on the go; and doctors are supposed to provide it to them. Now there is an app for that! And that means there are now mobile primary sources that historians need to worry about tracking. I do fear, however, that such new technologies make visible the very different experiences of class that patients must experience. Can't afford a mobile phone? That's okay. You probably can't afford health insurance either. Worried that these technologies represent an erosion in the quality of medical practice patients receive? They are likely harbingers of medical deprofessionalization.  

Andrew Huxley on the Value of History

While reading Gordon M. Shepherd's excellent study of neuroscience in the 1950s, I came across this observation by Huxley:

It is common enough to mention the most outstanding of the discoveries that have led up to present-day opinions, but this sort of cursory glimpse is actively misleading in at least two ways. First, it gives the...false impression...that Science always moves forward, that is to say progresses. Secondly, it suggests that any scientist who put forward opinions which have not been upheld was either stupid or perverse, and that no intelligent person at the present day is in danger of falling into equivalent errors. The more I read the works of late nineteenth century biologists, the more I am impressed by their ability, by their range and versatility, and by the modernity of their outlook. Biologists of all kinds owe a tremendous debt to the predecessors of around a century ago.

Featured Neurologist: Fergus Robert Ferguson (1899-1974)

Fergus Robert Ferguson was born near Warrington, England, to Donald Ferguson who was a physician and surgeon in Scotland. Educated at Manchester University, Ferguson qualified in 1920, serving as a lecturer in Bacteriology at Manchester University from 1920-1922 and then held a series of hospital posts in Manchester, before becoming Resident and then Registrar at the National Hospital for Nervous Diseases and Epilepsy and Paralysis (1927-1929). In 1929 he returned to Manchester, becoming Physician at the Royal Infirmary until 1964. Ferguson, a thorough lecturer, was among the few neurologists of his generation to hold a university post in neurology; from 1946 he was Reader in Neurology at Manchester University. Throughout his distinguished career, he received many recognitions including distinctions in medicine, obstetrics, and surgery; a clinical prize; the Leed Research Fellowship; and a Gold Medal MD. He was a member of many organizations including the Association of British Neurologists, The Royal Society of Medicine's Section of Neurology, the Medical Pilgrims, and he was a corresponding member of the French Neurological Society. He also founded and became president of the North of England Neurological Association, in addition to being president of the Association of British Neurologists, the Section of Neurology of the Royal Society of Medicine and a frequent government consultant, Ferguson was also one of the first members of the Royal College of Physicians London, Committee on Neurology. He served as a physician in both WWI and WWII. He was remembered for raising clinical neurology to a level of perfection. He loved sports and gardening and was married with two children.

David Lloyd George and Modern Phrenology

The Wellcome Library Blog has an amusing article about a little volume by J. Millott Severn entitled, The Business Head of the Future. A teaser from the opening paragraph:

Recently re-discovered in a corner of the storage rooms [of the Wellcome Library] was a modest, thin volume that revealed the economic hope of the future in earlier times, when faith was placed in one man. It was none other than David Lloyd George, the Chancellor of the Exchequer who became Prime Minister. But on what basis did the author have such confidence in him? It was quite simply that he had a large head which bulged in the right places. If I tell you that it was written by Brighton's brightest phrenologist, J Millott Severn, this might help explain why it came to be and why the shape of the Chancellor's skull was significant.

Black Bile

Neuroskeptic has a fun post that asks: "just what was black bile?" In his chapter entitled "Medicine in the Greek World, 800-50 BC" which appears in the volume The Western Medical Tradition 800 BC - 1800, Vivian Nutton writes that black bile was the "fourth of the celebrated humours":

Early classifications emphasized bile and phlegm, and although 'sufferers from melancholy' are mentioned, black bile is not considered a specific humour, but rather a depraved form of (yellow) bile. Only with On the Nature of Man, the text which Galen and subsequent generations believed was quitessentially Hippocratic, does black bile become an essential humour. By contrast, with beneficient blood, black bile was regarded as mainly harmful - it was visible in vomit and excreta, and later authors described how it hissed and bubbled on reaching the ground, burning up whatever it touched. Modern scholars disagree on what black bile actually was (perhaps some form of dried blood), but once proposed as a humour, it fitted neatly into a rational scheme made even more credible to the ease with which it could be extended to cover  a whole range of circumstances (pp 24-25).

Black Bile in the Humoral System of Medicine

The Western Medical Tradition: 800 BC to AD 1800

Primary Source: Montreal Neurological Institute

I wonder how many neurological institutes had time capsule's like this? It would be interesting to try to reconstruct the reasons that people put objects in time capsules in the first place. Nevertheless, I think the document below and the time capsule are an interesting sources. They both say as much about us now as they do about figures from the past.

A Career in the History of Philosophy?

Bob Pasnau writes a letter to perspective graduate students.

Book Review: Jacques Philippon & Jacques Poirier, Joseph Babinski: A Biography

In his Diseases of the Nervous System Francis Walshe observed that the plantar reflex was probably the most “important single physical sign in clinical neurology” (Walsh 1940, 22). That most important physical sign was first introduced in February 1896 at a meeting of the Société de Biologie by Joseph Babinski. Had it not been for this sign, which eponymously established his fame, it is likely that Babinski would not have become so famous in the history of neurology. In the case of this sign, a mere twenty-eight lines was all that was needed to establish an international reputation:

I have observed in a certain number of cases of hemiplegia or crural monoplegia caused organic lesion of the central nervous system a modification in the plantar reflex, which I can describe in a few words.

On the normal side, a pinprick of the plantar foot causes, as is usual, a flexion of the thigh toward the pelvis, of the leg towards the thigh, of the foot toward the leg, and of the toes toward the metatarsus. On the paralyzed side, the same stimulation causes, as is usual in the normal situation, a flexion of the thigh toward the pelvis, of the leg toward the thigh, and of the foot toward the leg, but the toes, instead of going into flexion, perform a movement of extension on the metatarsus.

I have had the opportunity to observe this disorder in cases of recent hemiplegia, dating back only a few days, as well in spasmodic hemiplegias lasting for several months; I have observed it in patients unable to voluntarily move their toes, but also in those who were able to perform voluntary movements of their toes. I must add, however, that this perturbation is not constant.

I have also observed in several cases of crural paraplegia of organic origin an extension movement of the toes after pinprick of the plantar foot, but because in this case there is no possible comparison between the two sides, the conclusion from the demonstration is less obvious.

In summary, the reflex movement caused by the pinprick of the plantar foot in crural paralysis related to a central nervous disorder shows a modification not only in its intensity, which is known, but also in its characteristics.

Featured Neurologist: Charles Putnam Symonds (1890-1978)

Charles Putnam Symonds was born in London. He was the son of Charter Symonds, a surgeon at Guy’s Hospital. Symonds was educated at Oxford University's New College and Guy’s Hospital, where he trained under Arthur Hurst. Symonds received his medical qualification in 1915. In 1919, he was appointed to National Hospital, Queen Square. The same year, he became the medical registrar at Guy's Hospital and was quickly promoted. Soon after, he was deployed to France, where he served courageously and was eventually awarded the Médaille militaire, a prestigious medal issued for acts of bravery. Some of his letters from this period survive. After studying at Johns Hopkins Hospital in 1921 with Adolf Meyer, Symonds became Consultant Physician in Nervous Diseases at Guy’s Hospital and Physician at the National Hospital for Paralysis and Epilepsy. He was remembered as “the neurologist’s neurologist”. Internationally renowned and a frequent government consultant, this fly-fisherman, became Civilian Consultant Neurologist to the Royal Air Force in 1935 and was knighted in 1946. Symonds married Janet Poulton in 1915 (d. 1919); they had two sons. In 1920, Symonds married Edythe Dorton; they also had two sons. As an interesting footnote, some recall that Symonds described himself as a Consultant Physician in Nervous Diseases. That title came to appear a bit of an anachronism, but it factually captures the history of his appointment at Guy's Hospital. Symonds was among the generation of physicians who became neurologists (i.e. they began their careers before the specialty had achieved recognition within British medicine and ended their careers after the specialty had become autonomous).

This article is part of an on-going series of biographies published in this blog.

The Project Is Speechless!

The Patient's Brain: The Neuroscience Behind the Doctor-Patient Relationship

Discussing [history] through microformats

At PLOS Blogs Martin Fenner observes something about blogs that I wish more people would emulate in the history of medicine and science:

The best and quickest discussions of a scientific paper now sometimes happen in science blogs rather than in the peer-reviewed literature. Whereas we have a number of scholarly databases that track citations between papers, we don’t have the same tools for science blogs.

More can be said: on some level it is silly that academic journals in the humanities and social sciences persist in publishing book reviews in their journals. The most popular articles on this blog are the book reviews.Why many of the leading organs in, for example, the history of science, medicine, and technology have failed to review and promote books through blogs attached to their websites is beyond me. The costly space they devote to book reviews could easily be given over to more scholarly articles. Moreover, the reviews would be available to the public sooner and not dependent upon quarterly cycles.

If, moreover, comments were allowed, other scholars could react to positive and negative reviews of work in a democratic fashion, challenging the views of the reviewer and opening up fruitful debates.

While we are on this topic: it is also silly that the same journals don't invite comments on recently published papers in a similar fashion. Peer-review should persist. But why shouldn't subsequent critique be invited afterwards? We all know that our ideas are often in development, even as they grace the pages of illustrious organs. It would be nice to hear what other people think about our work - even if they hate it.

The BMJ does an awesome job doing this with its rapid response model and its open peer review process. Any journal could copy their pattern by paying for a domain name and pointing blogger at the web address.

L. J. Henderson on physiology (continued)



L. J. Henderson (1878-1942)

Henderson's (1913) study The Fitness of the Environment asserts that there are two ways of understanding life. The first, the perhaps more obvious way, is to study life with special attention to the fitness of organisms for their environment. The supposed corollary - the focus of Henderson's study - is to examine the fitness of the environment for life. In this passage, Henderson's program is stated with startling clarity:

It must not be supposed that the phenomena of adsorption in biology are simple and exactly understood. What is certain is that they are universal and that surface tension lies at the root of the matter. This is because all living things are colloidal, and I am inclined to think that most physiologists will admit that life without colloids is probably unthinkable, even in a world very differently constituted from our own. Colloidal structures are, in fact, the first and greatest factors in physical complexity of organization, and the principal force, unless it be in exceptional cases an electrical charge due to ions, which operates upon the colloidal structures is surface tension. This, then, is another striking fitness of water above all other things.

Several physiologists point to Henderson's book as the seminal text for neurophysiology. I confess that I have not yet been able to understand why Henderson thought this view of the environment important, or, for that matter, to understand why biophysicists should be so impressed by his work. (I wonder what Loeb thought of it.)

One observation I would make about the text is that Henderson seems to think that his argument is with the authors of the "Bridgewater Treatises" and especially with Whewell and Prout. I wonder if this was a common aspect of Harvard intellectualism at the turn of the 19th century (i.e. authors saw themselves in terms of the great debates of the modern age).

Henderson writes at the end of his chapter on water:

In truth Darwinian fitness is a perfectly reciprocal relationship. In the world of modern science a fit organism inhabits a fit environment.

Thinking about L. J. Henderson & J. Z. Young

From Robert M Young's "Science, Ideology and Donna Haraway":

In the early twentieth century the admixture of respectable physiology and confident extrapolation to society became characteristic of a whole school of writers, led by Lawrence Henderson on the fitness of the environment and the social system (1913, 1970; Heyl, 1968) and Walter Cannon on the wisdom of the body (1932; Benison et al., 1987; Cross and Albury, 1987). The sociological version of functionalism eventually came full circle, and its scientistic analogies were applied to the history and sociology of science itself, in the work of Robert K. Merton (1938, 1968). A theological version of this way of thinking - a basis for mutual harmony - has recently been revived in the Gaia hypothesis, according to which an eminent scientist, James Lovelock, invites us the see the universe and all that is in it as a vast, mutually adaptive system in which all parts are in equilibrium with all others. His notion of Gaia is thought to ensure the co-ordination (Lovelock, 1979, 1988).

One way of thinking about the role of ideology in all these disciplines is to see their concepts as part of an overall ideological project - the naturalization of value systems which have a conservative tendency. I have listed the above concepts and disciplines in the service of the claim that there have been fairly convincing ideological critiques across a broad range of scientific ideas, and I have cited publications referring to each of them.

The same can be said of many other individuals and their work, although I will refrain from annotating every example. I am thinking of Isaac Newton and esoteric knowledge (Rattansi, 1973); of Mary Shelly and Erasmus Darwin on theories of life (Jordanova, 1986; McNeil, 1987); of Gall and Spurzheim on phrenology, and the origins of brain research, of other key figures in the history of brain research in the nineteenth and twentieth centuries, e.g., Magendie, Broca, Ferrier, Sherrington, Pavlov, Eccles; of the history of the dispensing of partronage of the natural, social and medical sciences by the Rockefeller charities (Brown 1979, 1979a; Abir-Am, 1982; Kohler, 1991); of some of their most prolific proteges, the molecular biologists, whereby there flowed from Watson and Crick's double helix a whole plethora of developments, leading to a belief that genetic engineering can voluntarily reshape all of life, including humanity, eventually virtually at will (Yoxen, 1983, 1986). Once again, there are admirable learned writings on each and every one of these subjects.

Young's essay, a really wonderful read, ponders whether there is any point to talking about science and ideology any more. I wonder if he has revisited these ideas. To me, science and ideology seem the salient questions of our historical moment - but I'm a bit old-fashioned.

L. J. Henderson on physiology

The biologist studies living organisms as inhabitants of this world, and by holding fast to physics and chemistry he has created modern physiology, a science which unites many, indeed nearly all, of the departments of physics and chemistry in the task of describing the processes of life.

Carp-pet & Moire Illusion

Moiré patterns are usually annoying. But they have a certain commercial appeal. It would be interesting to actually track the emergence of products like this one. I'm sure that magic lanterns, optical puzzles, and logic puzzles have a long history. But I'm not aware of any historical literature that has actually examined the ways in which cultural products commercialized and thus promulgated scientific knowledge.

J. Z. Young on the History of Neuroscience

The historian of neuroscience therefore has a doubly difficult task. Not only must he look at the discoveries that have been made about the brain, but he must also look behind the scenes at the way the human brain investigates the human brain. Here we are in deep waters indeed and shall inevitably be swept around in many philosphical and linguistic whirlpools. Let us not be alarmed by this, but humbly proud that perhaps our science is indeed in process of competing with theology as the Queen of Sciences, the basis for all the rest.

Nervous Idioms: Rack my Brains

A little 'Photoshop' for your amusement.

To rack one's brains: to stretch the brain beyond its normal limits, in order to remember something, to find something appropriate to say, etc.

As most know, the rack was used in torture. The victim was strapped to a frame with rollers at each end, and then slowly, painfully stretched. From the sixteenth century onwards the rack was a favorite figure for expressing something that caused intense suffering. In this case, to rack one's brains takes two uncommon objects - brains and rack - and relates them together by comparing the mental pressure of stretching one's thoughts or memory to this physical torture. Apparently the phrase dates to the second half of the seventeenth century. In 1583 the composer William Byrd is quoted as saying "racke not thy wit to winne by wicked waies". This idiom conjures up a related one: to strain the nerves which invokes the notion of nerves as tendons. That seems to be the idea expressed in this quote by Boswell on Samuel Johnson.

Long Live Kuhn?

Errol Morris finishes his 5 part essay with complaints about relativism:

One more parable. For those who truly believe that truth is subjective or relative (along with everything else), ask yourself the question – is ultimate guilt or innocence of a crime a matter of opinion? Is it relative? Is it subjective? A jury might decide you’re guilty of a crime that you haven’t committed. You’re innocent. (It’s possible. The legal system is rife with miscarriages of justice.) Nevertheless, we believe there is a fact of the matter. You either did it or you didn’t. Period.

I fear, however, that Errol Morris misses the mark here and has failed to live up to his wonderful argument. Indeed, I think his argument becomes tied in knots. Whether someone is guilty or innocent does not exclude the reality that the experience of judgment is relative. In other words, certainty is something people approximate. That fact is horrible, but it explains why innocent people are sometimes convicted of crimes. But the fact that they are convicted suggests that 'reality' has a relative tint. I suppose the "golden rule" - a pretty relative injunction as injunctions go - is the best escape we have from this problem    

The Reality-Based Community

Part 4 of Errol Morris's terrific 5 part essay series is out. Footnote 70 is worth quoting:

“The aide said that guys like me were ‘in what we call the reality-based community,’ which he defined as people who ‘believe that solutions emerge from your judicious study of discernible reality.’ I nodded and murmured something about enlightenment principles and empiricism. He cut me off. ‘That’s not the way the world really works anymore,’ he continued. ‘We’re an empire now, and when we act, we create our own reality. And while you’re studying that reality – judiciously, as you will – we’ll act again, creating other new realities, which you can study too, and that’s how things will sort out. We’re history’s actors . . . and you, all of you, will be left to just study what we do.”

The text of the actual quote is here for comparison. This statement, of course, captures the nature of power. It is also why we should resist agreement with received discourses. Ultimately, it is this attitude that engenders neuroauthoritarian styles.

The New York Times has an Amazing Essay on Thomas Kuhn

If you haven't been following Errol Morris's essay on Thomas Kuhn, then you have been missing out! A teaser from Part 3:

One of the oddities of history is that legends often supersede facts. Historical evidence accumulates, monographs are written; but the number of popular accounts retelling the apocryphal story of that non-crisis proliferate. Why? Because we love to read about crisis and conflict. It’s drama. It makes a better story. 

Part 1
Part 2
Part 3

Observations about W. V. O.Quine

A great observation about how graduate education has changed.

A story worthy of network analysis

There appears to be a scientific controversy brewing in Denmark. It always astounds me that when events like this occur in science and medicine that no one pauses to consider the context or whether we ought to being doing things better in academic research. Instead gossip, anger, and suspicion falls on individuals. No one, of course, believes that the institutions and organizations involved are perfectly functioning entities. But no one publicly calls their functioning into question either.

Most historians dislike "Whig" history, or the tendency to consider past scientific theories in light of current knowledge. We also find the idea that great men or women make history naive. An equally bad corollary, of course, is that great villains can make history too.

Both bad habits tend to cloud sound judgement in cases of scientific controversy. Typically people ill-equipped to judge circumstances unintentionally act in ways that cover-up the existence of bad policy, poor regulation, widespread corruption, or perverse incentives. They do so by focusing on the poor choices – sometimes atrocious behavior – of individuals.

Don’t misunderstand me. Dishonest people deserve consequences for their dishonesty. I am merely pointing out that individuals - both good and bad - often have more limited agency than people care to admit in the heat of the moment. I cite my case study of Kathleen Chevassut as an illustration of these claims.

Beautiful Image

Mind Hacks links to an awesome image.

Reading Boswell's "Life of Johnson"

Boswell on Johnson:

James Boswell c. late-18th Century

"I suppose no person ever enjoyed with more relish the infusion of that fragrant leaf [tea] than Johnson. The quantities which he drank of it at all hours were so great, that his nerves must have been uncommonly strong, not to have been extremely relaxed by such an intemperate use of it. He assured me, that he never felt the least inconvenience from it; which is a proof that the fault of his constitution was rather a too great tension of fibers, than the contrary."

James Boswell, Life of Johnson (London: Oxford University Press, 1966), p. 222

The Problem of Technophiles

Boom! What a great review.

Deskilling Doctors

Last week I reflected on some of the problems with excessive use of imaging in medicine, noting in part that the trend spoke to wider issues of deprofessionalization in medicine. I know: old-fashioned language in the age of postmodernity! This week, however, historian of medicine John V Pickstone publishes a fantastic polemic in the BMJ that suggests how bad things have become under various regimes in Britain. He concludes:

Dogmatically inclined, unmindful of evidence, and casting about for mechanisms that might deliver quickly, recent [British] governments have proved easy prey to personal enthusiasms, management consultants, sectional interests, and the agents of private companies looking for business. Such were and are the conditions for political quackery, and thus “heroic” policy making is now ascendant. Though vastly better methods of service development have become available, and the future of a vital institution is at stake, the NHS is treated as if it were George III, when too distracted to reason.

Unless professionals, patients, and parliamentarians now call a halt—in the name of incremental development, refined empiricism, and proper public involvement—we shall remain in a land of policy quackery and political chamber pots. The NHS deserves so much better. Do not our politicians, like our clinicians, have a duty of meticulous care?

Speaking of eponyms...

Slate's Jesse Bering's Naughty by Nature describes one and concludes:

What's the take-away message? I'll let you do the hard work of thinking through the implications for our belief in free will and how it might or might not apply. But another intriguing question emerges, too: If a "good" person's brain can be rendered morally disabled by an invasive tumor or an epileptic fuse-shortage, subsequently causing them to do very bad deeds, then isn't it rather hypocritical to assume that a "bad" person without brain injury—whose brain is anatomically organized by epigenetics (the complex interplay between genes and experiences)—has any more free will than the neuroclinical case? After all, perhaps it's just a matter of timing: The "good" are born with brains that can "go bad," whereas the "bad" are hogtied by a morally disabled neural architecture from the very start. And although it may be less common, if a "bad" person behaves in an upstanding manner, could that be the result of fortuitous brain damage or epilepsy, too?

And where would we stop with this assumption? Are poor people suffering because of inadequate neurobiology? Do people vote for Republicans because of malfunctioning wiring? Bering's essay is brilliant and evocative. But his conclusion isn't so much leading towards the slippery slope as it is plunging over (note afterall that the fillip for these observations comes from a journal entitled Behavioral Science and the Law). One can critique "free will" without resorting to neurobiology. Pierre Bourdieu's sociology comes to mind as just one alternative among many.

Book Review: Douwe Draaisma: Disturbances of the Mind. Cambridge University Press. 2009

There are any number of eponyms in neurology and psychiatry. Sometimes they are named after great clinicians – Alzheimer, Parkinson, or Asperger – and sometimes they are named for philosophers like Charles Bonnet. Although the discovery of a nervous disease brought eponymous fame to some, Douwe Draaisma argues in his highly-readable and enjoyable Disturbances of the Mind that the most important thing is not the discovery of the disease but “what happens after a discovery”. For Draaisma eponyms appear almost as a medico-scientific graffiti put their by the descendants’ of discoverers. He observes:

Eponyms are at once accolade and arena. They are the site of maneuver and manipulation, where power and authority are at issue, where conflicts over what constitutes a scientific proof are settled, and where decisions are taken on matters of classification and categorization (8).

Disturbances of the Mind is consequently a very different kind of popular history of neurology and psychiatry. Whereas numerous popular histories describe the biographies of scientist-clinicians, (re)make medical curiosities out of strange nervous patients, or seek to inform readers about personhood and selfhood through the exploration of medical conditions, Draaisma studies the mystery of why a name should remain even as everything it represented changed with time. In many respects, Draaisma thus successfully moves his work between academic interests and popular ones. The result is both successful and enjoyable.

Readers familiar with neurology or neuroscience will not be surprised by the eponyms that appear in his book. Conditions like Parkinson’s, Alzheimer’s, Tourette syndrome, and Asperger syndrome are topics both easy to comprehend and of obvious popular interest. But other topics offer some surprises. His discussion of Korsakoff syndrome, for example, discusses the meaning of traces of memory in the darkness of memory loss. Or what Korsakoff described as the “unconscious sphere of psychological life” (166). Another example appears in the chapter on Capgras Syndrome. Here Draaisma, as he does in many chapters, talks about modern explanations for the condition. He writes that it seems that patients with this condition are given a glimpse into the “separate activities of the two brain hemispheres”. His discussions of Broca’s area, Brodmann’s areas, and Phineas Gage – the perhaps oddest choice – are equally compelling.

Draaisma observes that one of the interesting features of neurological and psychiatric diseases is that they often seem to flip between those specialist medical worlds. Sometimes psychiatrists appear more interested in the conditions; at other times the neurologists take over. Draaisma suggests that in part these phenomena are products of a cultural consciousness made over time. He comments:

Distance in time makes it easier to identify the shared convictions and prejudices of past generations. This holds true for historians of brain science and for brain scientists themselves…. With the passage of the time the perspectives of historians and scientists begin to converge. The absence of a temporal distance creates a deceptive transparency. The view held by prominent scientists in the 1960s that ‘refrigerator mother’ was responsible for her child’s autism is today recognizes as contestable, but how will later generations see the now widely held view that autistic children have ‘no theory of mind’ (351)?

What makes this book stand apart from many popular volumes like it, is Draaisma’s acceptance that disease is culturally embedded. For Draaisma nervous diseases are products of their times. Even as he attempts to represent the ‘biological realities’ of these diseases and syndromes, he remains firmly attached to the notion that they are socially constructed. It is this subtle awareness of the playfulness of the historical moment that makes this volume reach so many audiences. And it also explains why its a great and fun read.

Thoughts on AI in the 21st century

Sean Kelly and Hubert Dreyfus describe modern AI in Stanley Fish's regular New York Times column. A couple of lines caught my attention:

The new, embodied paradigm in AI, deriving primarily from the work of roboticist Rodney Brooks, insists that the body is required for intelligence.

And also:

The greatest danger of Watson’s victory [the computer that won "Jeopardy"] is not that it proves machines could be better versions of us, but that it tempts us to misunderstand ourselves as poorer versions of them.