Human Traces (49 page)

in the looking glass on top of the chest, the Biedermeier one that had always been there. He saw the same eyes, the same wide brow that he had seen each day since his mother first sat him on her lap one cold morning in Lincolnshire and pointed to his face in her dressing-table mirror. You idiot, he thought. You fool. He took a flask of brandy from inside his coat and drank it off. Now go on, he said out loud. Go on and tell them. He went downstairs and walked briskly over to the main courtyard, where Kitty was waiting for him at the door into the North Hall. "Are you all right?" She straightened his tie. "I love you," she said, kissing his cheek. "Thank you." "You smell of whisky." "Brandy. Never mind. Are they all in?" "Yes." "Then let us proceed." The chatter of the audience subsided to a respectful silence as Thomas walked up to the dais. He put on the glasses that presbyopia had made him wear for reading, gripped the edges of the lectern, coughed once and began. "Ladies and gentleman, when I first entered the profession of mad-doctoring, or alienism, as it was then called, I was asked to register the new arrivals at a large county asylum in England, my native country. They were all mad demented, manic, deluded, nonsensical and it was a question only of finding a bed in a numbered ward and forgetting all about them. Bang. Shut the door. Goodbye. There is an old English ballad of a woman doomed to try to keep the waves of the sea off a small rock by means only of a broom: one little brush against the rising tides. That was me, that was our asylum and there was nothing we could do to cause the seas to fall. "Since that day twenty-three years ago I have given all my working life to treating the insane, and most of my resting hours to studying brain tissue beneath a microscope. I dream in histological patterns. I have read all the prominent work of my American and European colleagues, particularly the British, as they pushed forward their researches on different fronts; in this very place, the Schloss Seeblick, I have seen modest successes, some triumphs, few cures and several disasters. "When I first became a doctor, I worked hard to distinguish what we call the organic element of madness by which we mean the observable disease or malfunction of cells from the psychological, by which we meant the effects of the events in the life of the patient on his thoughts, feelings and behaviour. "We still dispute these things, and perhaps we always shall at least until such time as we develop a magical apparatus for peering into the brain with such clarity that the function of each "neurone", as Herr Waldeyer-Hartz has christened them, is apparent to us. Meanwhile, progress has been pitifully slow. "The greatest advance in my life as an alieni st came just three years ago, when a German zoologist called Fritz Schaudinn discovered the microbe for syphilis and thereby showed that a peculiar range of symptoms, from problems of the aorta to severe psychiatric delusion, were caused by a single germ. Some of the most floridly mad people in my English asylum the Kings and Bonapartes, the Virgin Marys and Boadiceas were not really "mad" at all; they had venereal disease. Goodbye, then, good people, goodbye to the lunatic asylum: you are not wanted here and who knows perhaps one day the physicians will find a cure for you. "Quite early in my career as an alieni st I became familiar with a pattern of symptoms that first showed in young people slightly earlier in men than in women, for some reason and usually involved the hearing of voices, among other delusions and behavioural abnormalities. This complex of symptoms had been christened "hebephrenia was known to my partner and me as "Olivier's disease", then universally, following Emil Kraepelin, as "dementia praecox". Patients had a poor prospect of recovery; indeed, their symptoms generally grew worse over time. When they presented themselves to me at first young, often intelligent, bright-eyed and scared by what had happened to them I could believe them to be suffering a reaction to a terrible event. By the time they left me, most were like the chronic patients of the old Salpetriere in Paris: shuffling, spastic, incoherent, their mental functions seemingly burned away. To put it in doctor's language: they came in psychological, and they went out neurological. "Less than two years ago, in an article entitled "Die Prognose der Dementia Praecox (Schizophreniegruppe)" published in a German psychiatric journal, the professor of psychiatry at Zurich University, Eugen Bleuler, proposed that this disease should be rechristened "schizophrenia". I think there is almost no chance that this confusing word will be widely adopted by the medical or the lay world; it seems to imply some sort of split or double personality, when in fact the "personality" of the patient is more often than not tragically unified strait jacketed indeed, into its singular delusions. The last thing these poor people need is to have the nature of their suffering further mystified by a clumsy piece of nomenclature, as though they were suffering from nothing more than a nervous indecisiveness! "However, it is not the word that worries me; it is the thrust of Professor Bleuler's argument, which is to suggest that his "schizophrenia" is a psychological reaction to problems in the patient's life to the same difficulties that you and I might have, though perhaps the patient's problems are a little more severe or he is a little less robust in dealing with them. The delusions, meanwhile the cacophony of voices in his ears not in his head, dear ladies and gentlemen, but sounding from external space on the drum of his ear and then in the auditory area of his brain these voices, says Professor Bleuler, are no more than clues to the psychological basis of the distress. The inference we are to make is quite clear, I think, and it is this: that such people can be treated by psychotherapy -by talking, in other words and in Professor Bleuler's eyes the best form of such talking cure is that which is at present fashionable with the Viennese School. "Some years ago, I went to Vienna and was fortunate enough to hear a lecture by a doctor called Wilhelm Flless, an ear, nose and throat specialist who had developed an interest in psychology and believed that parts of the nostril corresponded to parts of the female reproductive apparatus. To this end, he rubbed the inside of the nose with cocaine to relieve pain in the uterus. He also believed that two magic numbers alas, I have forgotten which two provided, in combination, in square or among their factors, a key to all mysteries of human biology, as well as to the workings of the cosmos. Goodness, how I do wish I could remember what those two numbers were. "I corresponded with Dr. Flless after his lecture and took the liberty of pointing out some of his simpler errors, particularly with regard to the entry of stimulants into the bloodstream via the mucous membrane. He was a game and combative correspondent, however, and while we seldom agreed and never formed a friendship, we did continue to write. Dr. Flless became more than ever excited by the advance of the Viennese School. He felt that doctors who had started as physicians or, in one instance, as a neurologist, were now in a position to turn their back on such humble apprentice work. Instead, keen-eyed mountaineers upon Mount Darien, they were now ready to pronounce a Universal Theory of Human Behaviour. "Under my insistent teasing, Dr. Flless showed me a letter he had received from one such practitioner, whose name I shall not repeat for fear of giving it further reclame. This doctor had formulated a general rule of human behaviour, namely that all young male children must pass through a period of sexual desire for their mothers. Forgive me, ladies and gentlemen, it is indeed a bizarre thought -though the theory itself is nothing like as bizarre as its genesis, which the letter to Dr. Flless, received by him on October 4th, 1897, described thus: My libido toward matrem was awakened... on the occasion of a journey with her from Leipzig to Vienna, during which we must have spent the night together and there must have been an opportunity of seeing her nudam. The doctor does not remember if he spent the night with his mother, but thinks he 'must have'; he does not remember if he saw her naked, but thinks there 'must have been an opportunity'. He certainly does not remember being aroused. Yet on the basis of three blanks of memory, he asserts that he was indeed stimulated; on the foundation of a trebly unremembered experience, he postulates a universal human axiom. To give the theory grandeur, it is, I believe, intended to name it after the mythical Greek character, Oedipus. The crux of the Oedipus story the whole narrative point of it, you might think: that the poor man had not the faintest idea who his parents were would seem to me to disqualify him entirely from the question of a child's everyday struggles with the two people he knows best. "I have never travelled by train from Leipzig to Vienna, though I am fairly certain that, had I done so, I should not have stripped naked in the carriage whether I was accompanied by my daughters, by my wife or merely by Josef, the old lamp man It would be cold, inconvenient and unnecessary. I can assure you of one thing, though: that if I had no recollection of it, I would not base an argument about my own mind on it, let alone extrapolate from my forgetfulness a dogma for half humanity. "There are two tragedies here. One is the failure of science in a medical man. It is more risible, perhaps, than tragic. But then, when you consider some aspects of what is suggested, it does become tragic because anyone who has observed young boys will have noticed that there can, sometimes, be a tactile relationship with the mother at certain ages, and an amicable competition with the father for her attention. It is a sort of commonplace, a fireside truth, quite interesting in its way; but by no stretch of the imagination could it form part of the basis of a treatment for the biologically insane. "And this is the site of the second tragedy: that this homespun insight, for what it was worth, has become degraded as beliefs invariably are by politics: in this case the politics of a "school" of medicine that must have the universal key, the only answer. Small truths, homely facts, when they are applied to the world as representative of all the world, cease to be facts and become superstitions. Thus has this little thought become elevated, made sacrosanct and set to work as a dogma in a school of "medicine", which, so far as I know, will be the first such school since the time of Hippocrates to base its treatment of the sick on the withholding of medicine. "For many years I treated a patient in this building, a gentle, tormented creature called Olivier, after whom, for a long time we named the disease that Professor Bleuler now proposes to call "schizophrenia". I cannot describe to you the torments of that man's life or the profundity of his illness. Sometimes I fancied I could hear his voices in my own head, so real were they to him, so attentive was he to their commands, even as I tried to reach him with my own voice, offering him... Well, what did I offer him what could I? beyond consolation, the occasional sedative, the hope of better things? "I had no cure. I still have none, though I have some thoughts that I will come to in a minute. When Olivier and his kind are ministered to, one day, when we can make them well again, it will be one of the great moments in the history of medicine. In the meantime, I cannot quite describe to you the indignation that I feel at the Viennese proposition that the experience of Olivier a man I saw cut the "devils" from his forearm with a knife was something caused by the behaviour of his mother to her child and should be cured therefore not by medicine but only by a system based among other scientific non-sequiturs upon what one small boy did not remember whether he had seen (or not seen), felt (or not felt) one night, on a train." Thomas, shaking with indignation, sweating beneath his black coat, paused and drank some water. In the quiet, he heard a chair being pushed back, candid footsteps and the main door being noisily closed: it was more than an exit, it was a marked departure, though he did not see who had left. Realigning the papers on the lectern, he coughed and gathered his thoughts. "I need now to explain to you my interest in the disease which, out of respect for current usage, I am going to call "schizophrenia". My fundamental position can be put quite clearly. Schizophrenia is a disease unique to humans, neurological in its base; in other words it is like Parkinson's or Huntington's diseases, where a brain or spinal column lesion causes tremor in the dependent outlying area. A schizophrenic patient has a lesion in the part or parts of the brain that allow us to imagine. Its supreme interest is as follows: it is not just a human disease, it is the human disease." Thomas paused and looked at the audience. He was aware that his style was much more polemical and informal than that of any of his mentors; it was not like the speech of John Hughlings Jackson with its stiff grammar; but he was a modern man of the twentieth century, speaking to laymen, and he must make himself clear. "Let us look at what distinguishes Homo sapiens from other species. Some years ago, in Africa, I gave a rather excited speech to my colleague Herr Regensburger about what divided Mr. Darwin and Mr. Wallace, the co-discoverers of natural selection. It was the faculty of awareness, or consciousness." Thomas then gave a shorter account of the theory he had offered Regensburger, of how man, after he had learned language, had been able to conjure instructive voices in his head; and of how, after the invention of writing and under the influence of huge population upheavals, the ability to summon such voices had become rarer. "What it left," Thomas continued, 'was this heart-rending desire in humanity for something it has lost: its gods, its vanished Eden. Which of us can deny that at some level we are afflicted by a sense that our human lives are incomplete and that there lies, just beyond the reach of our perceptions, a paradise that once was ours? "But that is not quite all that was left. The old mechanisms for hearing voices remained in some neural patterns; and these patterns continued to be transmitted through our breeding like the bat's blind eye and the whale's vestigial arms long after we had ceased to need them. The neuro physiology of our consciousness is by no means set for all time. It is forever developing. We are not, ladies and gentlemen, the finished article. I am going to support my opinion now by reading a short extract from the father of English neurology, John Hughlings Jackson."
Thomas then took the British Medical Journal and read the passages that Faverill had marked; and he seemed to feel his old employer's hand on his shoulder as he did so. "So," he resumed,"I submit that in schizophrenia, the modern man or woman becomes something very like the earlier human I described to you. He hears external voices, and he loses the edges of himself because he cannot see his own identity and tell stories about it in the model version of the real world that normal people have that which constitutes what I earlier called our "sixth sense", our self-awareness, the very thing that distinguishes us from the beasts. I watched Olivier, my friend and patient, try to conjure up this inner world, I saw him struggle with all the information that bombarded him, and he could not shut it out for long enough to see himself. "Now, what else do we know of this condition? Well, we know that it appears to run in families. An American doctor called Isaac Ray, as long ago as 1863, noted that relatives of people with this ailment tended to display milder forms of it themselves; in 1878 the German psychiatrist Richard von Kraflft-Ebing estimated that twelve out of nineteen such patients had family histories of the illness. Thomas Clouston, the great Edinburgh mad-doctor, assiduously documented family patterns more than ten years ago. "And if it runs in families, what does that mean? Well, that a predisposition to it is inherited, of course. Another compatriot of mine, Henry Maudsley, wrote much of "degeneration" an idea he had borrowed from a Frenchman called Morel. The idea was that not only would an individual inherit the traits of insanity, but that the way he lived his own life in drink and dissolution, for instance would aggravate the characteristic when his children inherited it. "This idea of accumulated inheritance was made popular by the French naturalist Jean-Baptiste Lamarck, and a version of it, alas, was accepted by Darwin. (I believe it even informs some of the novels of Monsieur Emile Zola.) However, we now know that this is not how inherited traits are passed on. Very simple experiments have proved that an individual's accumulated experience is not transmissible through breeding. To put it crudely, if you cut off a mouse's tail, its child is still born with one. The actual way in which characteristics are passed on is through units of inheritance. The mother donates half these units, the father half. Some American gentlemen named Sutton, Boveri and Morgan have recently established that these units are transmitted through the chromosomes. But they do not blend or mix: when the embryonic cell forms, either one unit is chosen, or the other. The one not chosen, however, is still carried by the child, but mute, as it were; and then it may be transmitted in the child's own breeding to take its chance of self-expression again, in the next generation. This process is absolutely vital, and, as I said, has only recently been explained. My own knowledge of these things is limited; I am not a botanist or a biologist, so, ladies and gentlemen, when I wanted to know a little more about the subject, I did what any good schoolboy would do: I looked up the Encyclopaedia Britannica. And there, under the entry for 'hybridisation', in the 1881 edition, I found listed, among others, the name of Gregor Mendel, a Moravian monk, who discovered the principle of the "either/or" in the units of inheritance. I read his papers, and was impressed by them. I am not going to explain to you now his work with garden peas; but I am going to introduce you to a new word for the units themselves. It is not a very good word: it is etymologically ill-bred (a nice irony) and, like "schizophrenia", I feel sure it will in due course be replaced by a better. But I do not wish to appear an old cuss, so I will go along with the Swede Wilhelm Johannsen, who has recently christened it a "gene". "The point is, to recap for a moment, that the idea of inherited madness has been loud in psychiatry for more than 50 years. I am saying nothing very new here, I do assure you. It is just that now at last we may be in a position to understand better the mechanism of such inheritance. "What else do we know of "schizophrenia"? The second important thing is much harder for me to prove to you and I may as well be honest and say to you straight away that it is a speculation on my part at this time. I believe that schizophrenia is found in all human populations, regardless of climate, race or nutrition; and I believe that it occurs at roughly the same level of incidence all over the world. In Europe it seems that we can estimate that perhaps one in a hundred people will develop the disease, and I believe that one day, when we deal more often and more constructively with doctors in other countries, we shall find a similar figure. "I would like to quote Shakespeare to you now, but I fear my time is already running short. Suffice to say that Shakespeare has descriptions in his plays of such madness and many odd details that, it seems to me, can only have been drawn from his observation of people we would now call "schizophrenic". I profoundly believe that it is a universal condition. "Now, if I am right that the capacity to pass on and inherit the gene, or, more likely, combination of genes, for this illness is steady throughout mankind, then it seems to me inevitable that it must have entered the human make-up before we spread ourselves around the world. Only if it existed before the great diaspora could it be constant; it could not have sprung up by simultaneous, identical mutation in different peoples now in India, now in Peru. No, it must be fundamentally human and it must have arisen before the first Homo sapiens began to migrate from Africa, where Darwin and others better qualified than I, believe us to have originated. "In this context, what does "originate" mean? Quite simply, a chance mutation in the inherited matter, probably brought about by the simple molecular inaccuracy in cell reproduction, will cause an individual to be born who differs from his parents in some respect. And that is usually the end of it. But very rarely, that difference is so helpful to him and to his children that they can out survive those who lack it; they dominate; they preponderate; they live alongside the less endowed until those forerunners, failing in the competition for resources, become extinct or are killed off by the new mutants. This is what the fossil record clearly, unambiguously tells us. "Homo sapiens "originated", like all the others, alongside his precursor species, cheek by jowl. Now, I want you to imagine a picture. We are somewhere in Africa, many tens of thousands of years ago. Here, beside a pleasant stream, are two primitives, or "proto-humans" as some call them; let us call them He and She. For thousands, tens of thousands, perhaps hundreds of thousands of years they have not changed. Then suddenly, one day, a mutation occurs and out of nowhere He and She look up to see just there, on the other side of the stream... Adam and Eve. Let us leave the four of them there, just for the moment. But do not worry, we shall return to them. "What I want to find out is what exactly was this tiny change that opened the door for Adam and Eve. What was in Adam that was not in He? "I have cut up many brains to try and see, and, fortunately, I have not been alone. Many psychiatrists have noted something odd about the human brain. It looks symmetrical, but it is not. It is symmetrical in appearance, but not in function. Behind me if Hans would be so kind as to switch on the projector. Thank you is a large illustration of the human brain. All its parts, as you can see, are duplicated, mirror images, and for many years, that lovely duplication was taken as a sign of mankind's superiority a sort of divine symmetry, one might almost say. "Then, about forty years ago, a Frenchman called Paul Broca, when treating a patient who had lost the ability to speak an "aphasic" in doctor's terms showed that the capacity for speech was located just here, on the left. The corresponding area on the right had no such function. Then a German called Carl Wernicke showed that another left-only area, further back and down, just here, was also implicated in speech and understanding. Again, the matching area on the right had no such function. It appeared that not only were the two halves of the brain not doing the same things, but that one faculty language, the very thing that made us better than the apes and little lower than the angels was resident exclusively on one side! "This is how Broca himself put it more than thirty years ago: "Man is, of all the animals, the one whose brain in the normal state is the most asymmetrical. He is also the one who possesses the most acquired faculties. Among these faculties which experience and education developed in his ancestors and of which heredity hands him the instrument but which he does not succeed in exercising until after a long and difficult individual education the faculty of articulate language holds pride of place. It is this that distinguishes us most clearly from the animals." "So, clearly in Monsieur Broca's view, this is what made Adam different from He. That is not to say that Adam spoke at once; on the contrary, I should say the all-important change between the two was an earlier mutation which enabled the hemispheres of Adam's brain to develop differentially; and it was that mutation that gave us essentially two brains, which can both complement and back up one another, whose sum is greater than their parts and led to the vastly increased intellectual capacity of Homo sapiens over his precursor being; and thence to language, which opened the door to the development of "consciousness" and to all that we now think of as characteristically human. "Including, unfortunately, schizophrenia and the related psychoses. "To recap once more. We have already seen that these illnesses are in some way heritable and therefore that they must be related to the "genes" that we pass on. If the illness is evenly spread throughout the world, as we believe, then that gene or genes must have been acquired before the human diaspora from Africa. We know that the symptoms of the disease involve a loss of proper self-awareness or higher consciousness. It also seems likely that these symptoms are the result of improper communication between the left and right hemispheres: in other words, that in some way thoughts are being experienced as though they were external voices the left hemisphere receiving too many signals in too crude a form from the right, and, in its typical anxiety to please, resorting to prehistoric methods of dealing with it. The only hypothesis that can make sense of all these data is this: that the key mutation that changed He to Adam was one that allowed him to become functionally lopsided in the brain; that that same mutation allowed him to develop language; that language enabled him to develop a primitive voice-hearing consciousness. When, however, he developed writing and so made his self-instructions portable and when, furthermore, his environment and let us remember how the environment according to Darwin selects those best fitted to survive made the voice-hearers less useful than the readers and the self-aware, they began to be selected against: to die out. From being the majority of the population, the voice-hearers dwindled down to about, in my estimate, fifteen per cent. Most of these people hear voices only occasionally, and are not troubled by the experience. They are not sick. I myself had such a voice as an adolescent; many others are ashamed to admit to it, or in some way manage not even to admit it to themselves. In a small minority, however, the hearing of voices is part of a wider pathology, and these are the schizophrenic patients. But the important point is that the voice-hearers, whether healthy or psychotic, did not, as you might expect, become extinct. And why, ladies and gentlemen? "Darwin published the Origin of Species fifty years ago; although his reputation fell towards the end of the last century, the argument for natural selection has long been won, and its basic tenet is that only that which confers an advantage on the species is continually selected by the environment and therefore, as we should presumably now say, perpetuated in the "genes". Nature never selects against the benefit of the species; it cannot. Furthermore, these poor schizophrenic people have self-inflicted losses in reproduction. They kill themselves; they are mad; they are unattractive to others; they are sexually selected against. Yet they survive at a constant level in the population. How can this be? It breaks the first law of Darwin! It can only be that a variant of that inheritance the same units, but differently combined, so that they do not express themselves as illness confers huge advantages. So huge that they compensate both for the misery of the illness, against the species's interest, and the reproductive failure of the afflicted! And what are the advantages? They are superior brain power, language, creative ability; and, consequently, divine dissatisfaction, a yearning for the absolute... the very things that distinguish us from the animals. The same "genes" that drive us mad have made us human: in different combinations, I admit, but precisely, and in my view unarguably, the same particles of inheritance. You cannot have humanity without psychosis; they are indivisible. Both, ladies and gentlemen, stem from the same submicroscopic change that changed He to Adam." Thomas stopped to drink some more water. There was utter silence in the hall, though it was not appreciably a friendly one, he thought. His throat felt lacerated and his temples were pounding; he wished he had not drunk the brandy. He breathed in hard. "Before I go on to the concluding part of my talk," he said, "I want you to be clear about one more thing. Whatever that minute change was, from He to Adam, it could have been something else." He paused again. "As Darwin so memorably wrote: "What a chance it has been... that has made a man any monkey probably might with such chances be made intellectual, but almost certainly not made into a man." It might not have led to me and you and Carinthia and Brahms and the hall of the Schloss Seeblick tonight. It could have been one of a million changes with a million, million different outcomes. That is how precarious we humans are, and that is why it fits us to be humble." A man in the front row of the audience, known to Thomas as a lawyer in the local town, stood up noisily. "Dr. Midwinter," he said. "I paid money at the door to hear a talk I was assured would be both enlightening and thought-provoking. Instead, you have told me in the last hour that there is no God, no creator, that we are the result of some microscopic accident beside an