Thursday, October 1, 2009

My Life as an International Awardee - Part II

In a recent blog piece, I brought up the shock and dismay I experienced more than two years ago over being singled out for a major international award, named in honor of a legend who revolutionized psychiatry. But I also noted the hard work I had put in to merit such an honor, in the first place. To continue:

At a convocation lecture delivered by John Nash at the 2007 APA 40 miles down the road in San Diego, I got an unexpected insight into what something like a Mogens Schou Award can do for your recovery. John Nash (pictured here) is the mathematician who shared the 1994 Nobel Prize in Economics, upon whose life the book and movie, "A Beautiful Mind," is based. A good case can be made that whatever drove Dr Nash to experience paranoid delusions initially allowed him to make the kind of novel connections upon which ground-breaking mathematical theorems are based.

Schizophrenia rarely just descends full force on an individual. Years of eccentric and erratic and sometimes brilliant behavior tend to precede the definitive break. Various recovery advocates like to point out that Dr Nash’s schizophrenia remitted naturally, without meds. That may be true, but Dr Nash in his Nobel autobiography acknowledges he lost 25 years of his life to his delusions.

Nevertheless, in his talk to the APA, Dr Nash raised the possibility of an adaptive advantage to schizophrenia, with his own games theory twist. I’m presuming he was referring to schizophrenia in its more benign manifestation, what the experts refer to as the prodromal phase, that quirky quiet time before the entire brain tragically implodes and robs its owner of the gift of rational thought. Or perhaps a form of “schizophrenia lite,” what psychiatrists call schizotypal personality disorder, characterized by oddball thinking and weird social behavior without the delusional psychosis.

Indeed, at the same conference, I heard prominent psychiatrist Nancy Andreassen MD, PhD of the University of Iowa advance a similar thesis. Newton, she said, entertained unusual beliefs and had a psychotic break later in life. The eccentric Einstein had a son with schizophrenia in his family and displayed schizotypal traits. James Watson (of Watson and Crick fame) also had a son with schizophrenia.

"So we can say that three of the most important discoveries in modern science were done by men who had association with schizophrenia," Dr Andreasen pointed out. "What’s the odds that occurred by chance? There must be something there."

It turned out that Dr Andreassen’s research uncovered a far more obvious connection to creativity - namely bipolar. Still, the general thesis is valid. Our brains don’t have the same filters as normal brains. Too much stuff coming in, what the experts refer to as “low latent inhibition.” We have trouble tuning things out - thoughts, feelings, senses. Our in-trays are always overflowing, frequently overwhelming.

Meanwhile, our neurons don’t communicate in the same predictable patterns. We make novel connections. At the time of her talk, Dr Andreassen was investigating an area of the brain called the association cortices. If I understand Dr Andeassen correctly (and also taking into account latent inhibition), in a creative mind the association cortices can pull the background noise of a refrigerator (which most people manage to ignore) from one part of the brain, an unpleasant childhood memory (which most people have long ago put to rest) from another, a weird observation about Hannibal and his elephants from yet another (what is it with my obsession about Hannibal?), a reptilian urge to throw Richard Simmons off a cruise ship and into a school of sharks who are slow picky eaters (now you are relating), and come up with the grand unified theory of everything, which is kind of my mission in life, along with “enjoy the peanut butter.”

The catch is one needs what they call strong “executive function” to keep track of this crazy internal dialogue and take charge. Think of the “I” in the control room. When you respond with “but roosters don’t lay eggs” to a classic brain-teaser, you can give this little guy all the credit.

But when the “I” fails - typically in response to too much happening at once - bad things happen. No one is home, no one is in charge. Thoughts and feelings and senses inerrantly find their way of disorganizing into chaos.

Maybe the outcome is a panic attack, perhaps a psychotic break or a manic episode or explosive anger. Another way of looking at it is the brain is finding its own way of taking refuge. The frontal lobes may even shut down, which is how a lot of people view their depressions. Or the entire operating system may refuse to boot up, which is one way of looking at autism.

Sylvia Nassar’s terrific book, “A Beautiful Mind,” serves up John Nash as a classic case study of all that can go right and all that can go wrong in the brain. Dr Nash's great creative work was done in his early-mid twenties, before his illness manifested in full. But Nassar’s account gives us the unmistakable impression that this particular beautiful mind was always a case of schizophrenia waiting to happen. From Day One, he was an outsider, an outlander from West Virginia with a weird way of looking at the world and a noticeable deficit in social skills. Even in a profession notorious for its oddballs and cranks, John Nash never quite fit in.

In short, a man with no ordinary brain, understood by few. Thoughts connected in startlingly original ways. On one hand, it produced a stunning piece of rationality - games theory - that was so novel that his contemporaries failed to fully grasp its significance. On the other, this same remarkable brain morphed into astonishing irrationality - he actually thought he was the king of Antarctica - a tragedy that robbed its owner of a quarter century of his life.

And here he was, at the podium at the APA, trying to explain this strange phenomenon of a thinking machine of nearly limitless dimensions spewing out gibberish. Figure out a law of nature that governs such an occurrence and you will get a branch of science named after you, guaranteed, or a religion - take your pick.

Dr Nash was talking to the right people, people profoundly interested in the mysteries of the human psyche, but - like me - they found his message terribly difficult to comprehend. It didn’t help that Dr Nash was reading in a monotone off a densely-typed, jargon-laden script held very close to his face. One minute into the talk and I was looking this way and that way into a sea of glazed eyes. Some of the attendees began discreetly ducking out, and I considered doing the same. Then I reconsidered. You don’t walk out on a Nobel Laureate, I decided. (Donald Trump, yes, and I would make sure to knock over a chair on the way out, stupid asshole.)

Suddenly, Dr Nash started talking about his return to sanity and my ears pricked up. Significantly, he mentioned that his recovery began when his reputation finally started catching up with the acclaim he felt he deserved.

Now I could relate - me Mr 400 Math SAT, him Dr Uber Equations. It turns out on one level at least, the two of us had a lot in common. Say what you want, recognition counts. Whether from a Nobel committee or the top bipolar experts in the world, or for that matter the local bowling league, it’s sure nice to get a pat on the back.

We toil mightily, nameless nobodies never anticipating so much as a simple thank you. Too often, we put up with thoughtless behavior and abuse. Too often, we have nothing to show for our labor, held in contempt, written off as not like everyone else. But we persist, either because we’re driven to do so or because it’s the right thing to do. We take our small comforts where we can find them - a handshake, a compliment from afar, a small act of kindness.

But our lot is that of an outsider. Just ask that skinny kid afraid to get on the school bus. Then - one day - the bus door opens and there’s a whole seat to yourself near the front. That cute redhead you kind of have a crush on breaks off a piece of jelly donut for you. The cool tough guy in the leather jacket with the duck’s ass haircut strolls from his throne in the back, claps a hand on your shoulder, and lets you know there is always a place in his circle for short nerdy kids with glasses.

You try to make a coherent reply by way of a lame joke, and the whole bus breaks out in appreciative laughter. Some idiot tries to rain on your parade, and you respond with, “Eat it raw,” like you know what it means. The bus driver shoots you a questioning look, but you just grin, as if to say, don’t worry, I’ve got it covered.

You now have everyone’s attention. “Listen up, guys,” you shout down the aisle, voice brimming with confidence. “Hannibal never won a battle with his elephants.”

Shit! Why can’t I just keep my big mouth shut?

To be continued ...


Lucy Talikwa said...

I'm both enjoying and getting a lot to think about out of this series. Thank you, John.

AliceT said...

John - you deserve many awards. You are helping people in ways you don't even realize. I never knew before about "Association Cortices" --- the thing I've pretty much referred to in my own experiences with Bipolar as being part of the super elaborate cross filing system.....and despite years of reading and doing my homework, didn't know about the term "low latent inhibition" before either.....another thing I didn't realize had an official name.....and that part of the executive function control room going into failure because of overload and/or over-stimulation, and the brain finds its own way to repair......gee, John, wish you were there 23 years ago when I had my first breakdown and some others after that....but thank God you are there now for me and for other people who get tremendous, invaluable, life altering and life saving help from you all the time........we love you John.

John McManamy said...

Many thanks, Lucy.