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In the four decades since Oliver Sacks wrote The Man Who Mistook His Wife for a Hat, the medical memoir has flourished as a publishing genre — with the brain its most popular subject. The latest author to follow in the footsteps of Sacks by using his own experience with patients to illuminate the workings of the brain is another neurologist, Masud Husain, whose emotionally powerful book delves deeply into the nature of individual human identity and how this relates to our belonging to a supportive social group.
In Our Brains, Our Selves Husain, a neuroscience professor at Oxford university, examines the way injury and disease transformed the lives of seven patients with very different experiences. The thread uniting them is that all were “confronted by the very real possibility [of social exclusion] because their behaviour had changed so significantly,” he writes. “As a consequence of the cognitive effects of their brain disorder, they were no longer considered acceptable within their social networks.”
The resulting isolation exacerbated the distress caused directly by their neurological symptoms. All the patients gained some respite when they and their community learned the medical explanation for their problems, whether or not the underlying cause could be treated.
David changed from being outgoing and gregarious to pathologically apathetic, unable to keep his job or friends. Michael lost his semantic memory for words and names. As Trish developed Alzheimer’s disease she became delusional, imagining that her longtime husband was a secret lover. Frontotemporal dementia provoked remarkable disinhibition in the previously sedate Sue, blurting out insults to strangers and wearing a pink cowgirl suit with high-heeled crocodile boots to her hospital appointment.
Wahid, originally from Pakistan, had visual hallucinations — potentially disastrous in his job driving buses. He feared he was going mad and would be interned in a psychiatric institution. People in his social circle suspected that his hallucinations resulted from demonic possession by a jinn. Eventually Wahid responded to a drug that boosted levels of a neurotransmitter that was depleted in his brain, allowing him to reconnect with his community.
Winston, whose family had emigrated from Jamaica to London in the 1950s, had a stroke that prevented him seeing anything on his left side, so he blundered into people and objects as he walked. His friends began to avoid him on the suspicion that he might be suffering the effects of syphilis, because his symptoms did not fit their expectations of someone who had suffered a stroke. After medical evidence reassured them that he was not suffering from a venereal disease, the Caribbean community accepted him back.
Anna, born in Poland, developed a brain cyst as a result of an unprovoked racist attack several years earlier. As a result she lost awareness of her right arm, which wandered embarrassingly of its own accord, leading her to touch people inappropriately. Fortunately an operation to remove the cyst cured her and enabled her to resume an active social life.
Husain makes much of the fact that Wahid, Winston and Anna were immigrants. Like him, they “were confronted by what many generations of Bloody Foreigners had to contend with when they first came to Britain,” he writes.
Having arrived in 1968 with his family from East Pakistan (now Bangladesh), Husain had to overcome powerful prejudice to pursue his chosen field. He ignored a friend’s warning: “You’re brown. There isn’t a brown neurologist. You’re an outsider and you’re not going to make it. Try rheumatology; they’re far less selective.”
The interplay between an individual’s personal and social identities lies at the heart of Our Brains, Our Selves. “With the onset of a neurological condition that takes away a fundamental cognitive function, we can lose all that our brains have worked so hard to achieve over many years: to forge the connections that gained us access to — and maintained — our group memberships,” he writes.
Medical memoirists tend to choose cases that show off impressive clinical insights and sympathetic treatment of patients — and Husain is no exception. He diagnoses the underlying neurological problem in the seven featured cases and in several he achieves a transformative improvement through drugs or surgery. Even when there is no effective treatment, understanding the neurological nature of the disorder helps the individuals and their family and friends.
This approach gives the book an optimistic tone that may not reflect accurately the tragic toll of brain disease worldwide. But anyone who reads Our Brains, Our Selves will benefit from learning the role played by basic neural functions in determining who we are. As Husain concludes, “they are crucial parts of the ‘society of the mind’ that creates our self but they are also crucial to keeping us within society”.
Our Brains, Our Selves: What a Neurologist’s Patients Taught Him About the Brain by Masud Husain Canongate £20, 288 pages
Clive Cookson is the FT’s senior science writer
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