Month: August 2021

I am uncomfortable with badges in general. Butcher, baker, candlestick maker (incidentally who does that these days?). Tinker, tailor, soldier, sailor, rich man, poor man and so forth. Badges pigeonhole people. They are diminishing not encompassing. Badges belittle. So I am uncomfortable with their overusage. In any case, few of the above descriptors apply in 21st-century parlance. Everyone is either a media consultant, a lifestyle guru, communications analyst, or website designer. Even the dustmen are now tarmacadam surface cleansing technicians, whatever the hell that means.

Not surprising then that such descriptors unsettle me. More to the point I am specifically uncomfortable with badging myself. For much of my life it has been easy, sequentially climbing each rung on the academic ladder: student, doctoral student, postdoc, lecturer, senior lecturer and reader. I never made it quite to professor before my academic career ended, a fact that still rankles some two decades later.

In terms of broad subject arena, I used to describe myself as a neuroscientist and, whilst I led a neuroscientific research lab, it seemed reasonable. But those days ended nearly 2 decades ago and any current claim to that noble epithet is, at best tenuous. If you don’t conduct research, it’s hard to call yourself a neuroscientist. With the onset of retirement, my grip on any neuroscience title hangs by a thread.

Friends – well, the kinder ones – tell me ‘neuroscientist’ is still appropriate, reflecting perhaps the primacy of past achievements over current standing. That makes me feel a little better even if I’m not sure I buy it myself. But if I’m not a neuroscientist, then what am I?

It feels a little awkward to call myself a writer. I have friends who are genuinely writers, their work published, acknowledged and recognised as such. I don’t mean blogs and bloggers although (seeing that I am digging myself into a hole) some of those can also legitimately be considered the work of ‘writers’. Many however are not, being little more than vehicles for political rants, social commentary, hobbies and interests. Nothing wrong with that. Everyone needs an outlet and, if a blog provides such a mouthpiece, so be it. It works for me, a convenient space to contain and constrain my ramblings and meanderings. I’m happy to hold my hand up as a blogger. But a blogger is not necessarily a writer.

I certainly don’t consider myself to be a writer or any suchlike. Writers are people like Hemingway, Kerouac, Twain, Austen, Joyce, Elliot, Dickens and Kipling. Those are writers. And there is a world of difference between what they did and what I do. But, in the sense that I am paid (sometimes) for what I put on paper, I suppose I am a writer of sorts. And you can see why I’m uncomfortable with the title. It doesn’t sit well.

For me, writing is a noble profession and writers estimable practitioners of the same, their work unconstrained, free-flowing and imaginative. Others might define it differently as little more than a process by which facts are conveyed. For me, that’s not writing. Technical writing is a grim bastardisation of the profession. I know. I’ve been there. In one of the darker corners of my curriculum vitae are the several years I spent fruitlessly trying to get back into academia. Nobody, as I know now but didn’t then, wanted ex-academic fortysomethings. But the kids still needed feeding so I reinvented myself, dividing my time as a psychology lecturer with the Open University and as a medical writer. The former briefly pandered to my lingering academic pretensions while the latter paid the bills. I wasn’t proud.

Let me put in a disclaimer here. I have a good many friends in that industry that I admire and appreciate. Lifers. And maybe for them this was the chosen path. But not for me. I resented writing other people’s research. It felt wrong. Still does to be honest. It didn’t feel like writing. One day I will shine the torch more deeply into those dark recesses. But not today.

It brings me to my final point about writing. Writing is not the squawking of a caged bird. Writing must be free. Writing is soaring the thermals at sunset, catching insects on the wing. That’s writing. And that’s the work of writers. And I know one thing for sure. I’m not there yet.

As time passes, my memory fades on some of the peripheral details. It was sometime in the early 1980s at the Wigmore Hall in London where I was waiting for a concert.

I glanced down at my watch. 7:10 and a steady drizzle was encouraging the concertgoers to file in. The concert in question was sold out many weeks in advance, long before I was aware of it. But fortune smiled on me that day and a friend ducked out, generously passing on his ticket to me via a fellow student. I was still waiting for Aidan, uncharacteristically late for a mathematician who prided himself on precision. When he finally appeared, joyfully waving the tickets at me in a manner that precluded any serious admonishment, I was greatly relieved. Not least because, standing in the rain, I needed to be greatly relieved.

You will perhaps forgive me for dabbling in hyperbole but, in classical music terms, these were the hottest tickets in town. A rare recital of the Wesendonk Lieder [1] by the great Wagnerian soprano Gwyneth Jones – Bayreuth’s celebrated Brunnhilde for much of the 1970s [2] and early 1980s. One of my absolute musical heroes.

After a brief exchange of tickets, money and banter about keeping a lady waiting, we headed for our seats. Or would have done had a taxi not drawn up immediately behind us. A lady’s voice from within the cab called “excuse me, young men…” in a tone that made bystanders look as much at us as the source of the voice. “Yes, you two” she said “you look strong”. Aiden and I exchanged looks of bewildered amusement.

Anyone who knows me at all knows that my physique is not that of an Adonis. I have a barrel where others have a sixpack. And matchsticks for arms. My PE teacher at school once asked me if I would ever consider bodybuilding. I told him body building was unlikely as I would, almost certainly, not get planning permission. In short, I don’t get called strong very often. Or at all. Ever.

Still, the tone of her voice made it clear that we were to assist in such manner as she needed. After a brief ‘discussion’ with the cabdriver over the fare (the cabbie capitulated quickly), she turned her attention to us, the strong men, and outlined our role. Once she had extracted her husband’s wheelchair from the taxi, we were to extract him from said vehicle, make him comfortable in the chair and wheel him to the awaiting disabled seat at the front of the auditorium, brushing aside anyone in our way. Aiden pushed while I cleared a path with more ‘excuse me’s than a tea dance at the Ritz.

“Do introduce yourself dear” she said to her husband. He tried – it was clearly a big effort – and, in stroke-scrambled speech managed to say “I’m Peter M*****”. I didn’t catch his surname, so slurred was his diction. Eventually we made it to the front, the journey interrupted by several “Hello Peter, hello Jean”. Just as we turned to find our own seats Jean said “We are having a little supper with Gwyneth afterwards. Would you gentlemen care to join us for a drink?”

The concert itself was magnificent. Gwyneth Jones had, at that time, a glorious honeyed soprano voice, Effortlessly ranging from the delicate intimacy of lieder to the soaring peaks of the Wagnerian canon. A voice capable of whispering the words of a song as though in your ear or taking on the massive wall of sound that is a Wagnerian orchestra in full charge. A voice of subtlety, emphasis, tenderness and beauty, all capable of being delivered at heroic volume. But of course she was Welsh and all Welsh can sing!

But who was Peter? He looked faintly famous and certainly the greetings from other members of the audience seemed to support that but I couldn’t quite place him. Then I remembered I had seen his picture whilst at school which was doubly confusing. Why would he be featured there? Was he a writer? An artist perhaps? Or a scientist? As the music played, I ran through the mental desk file of famous people who went alphabetically to my school [3] until I reached M and one Peter Medawar. Indeed the science block was named after him. And of course his portrait hung there.

It suddenly dawned on me that I was in the presence of one of the most celebrated biologists of his generation. And this generation included people like JZ Young, JBS Haldane and JD Bernal. Sir Peter, for it was he, had won pretty much every prize in biology there was. Indeed it went further – there are even prizes in biology named after him. In 1960 he was awarded the Nobel prize for his work on tissue grafting, research which provided the groundwork for modern organ transplantation. In short, a genius.

His achievements were breathtaking, his life strewn with academic and civil awards and titles. Indeed he would have been president of the Royal Society had not a stroke rendered that impossible. Medawar was also a prolific writer on science and the philosophy of science. One of my most treasured possessions is a first edition of his book “Advice to a Young Scientist”, still essential reading for anyone starting out on a PhD.

That much was well-known. Less well-known was his passion for cricket, philosophy and opera – especially Wagnerian opera. He was a polymath in every sense. My favourite kind of person.

I still treasure that remarkable chance encounter some 40 years ago, often playing over the details in my mind. After all, it’s not every day you find yourself invited to take a glass of fizz with the greatest Wagnerian soprano of her time and a Nobel Laureate.

[1] I can’t be absolutely certain it was the Wesendonk Lieder. It could just possibly have been Richard Strauss’s Vier Letzte Lieder (Four Last Songs). But they are both magnificent song cycles for a soprano.

[2] Gwyneth Jones sang her first Wagner role at Bayreuth in 1966 and her last in 1982. She was Brunnhilde from 1975 to 1980 and starred in the infamous centenary production under the direction of Pierre Boulez and Patrice Chereau.

[3] I went to Marlborough and, like Medawar, didn’t much enjoy it. Nonetheless it has, in its time, had a few famous pupils – Sir Francis Chichester, Siegfried Sassoon, Capt Mark Phillips, Kate Middleton, John Betjeman, William Morris, Anthony Blunt, James Runcie, Chris de Burgh, Jack Whitehall and John Zachary Young to name a few. I must’ve been quite a letdown.

When you stop to think about it, it’s hardly surprising that DBS is associated with some degree of behavioural change in those given the procedure. In part that’s the reason to do DBS – to change things.

That’s perhaps a little glib. When you “change things” in the brain you alter the activity of at least one neuronal pathway and, because such pathways are close proximity to others, most likely more than one. Depending on the placement of the electrodes one may get more or less stimulation of our desired pathway relative to the unwanted stimulation effects. Think of it like darts. If you aim for the treble 20 with your three darts you may get lucky (or be incredibly good at darts) and score 180 (60+60+60). If your aim is off by a couple of centimetres vertically, you may well score only 60 (20+20+20). A few centimetres horizontally and your score could be as low as 3 (1+1+1). And yes, we’re being ultra pedantic, you could miss the board altogether and score 0+0+0. But in that case you should probably just give up darts (or, by analogy, neurosurgery).

The point is that there is a ‘sweet spot’ within the subthalamic nucleus where one gets most benefit at the least cost. That seems to be in the superior lateral parts of the nucleus.

So in other words, perfectly placed electrodes can be thought of as a 180 score. But most of the time, and bearing in mind that this is the brain not a dartboard, the scores are lower. And that’s not placing any burden of responsibility upon the neurosurgeons; that’s just down to variability in our patient brains. None of us (well, few of us) have supermodel brains, perfect in every curve and tuck. No, most of us have rather frumpy brains, sometimes asymmetric but often – especially by the time we are considering DBS – misshapen or battered in some way or other. So, even if your neurosurgeon is the best darts player in the world, he will struggle with your tatty old darts board.

Okay, and I realise I’m testing your patience with a further analogy, but think of the subthalamic nucleus once more as a busy railway station. Lines (neuronal pathways) pass through the station. Some terminate, others carry on. Some stop briefly, others pass through without stopping. Think of DBS as the equivalent of a transient signal malfunction. Traffic through the station is disrupted for some lines more than for others. Some are even reversed. No, I know this doesn’t fit with the darts analogy. Forget the darts. We are on trains now.

So where do the railway lines go to and come from? As you can imagine, there are many. The subthalamic nucleus is Clapham Junction. Neurones come in from the cerebral cortex, and parts of the thalamus. Trains, sorry neurones, leave for the substantia nigra.and beyond. It has reciprocal connections with the internal and external globus pallidus and the pedunculopontine nucleus.

The point I’m (rather laboriously) making is that we cannot affect individual lines – yet. Whatever stimulation parameters we choose, it will always affect adjacent brain nuclei to some extent.

What does that mean?

In simple terms it can mean changes in behaviour, affect, emotion and action. Mostly trivial and perhaps even unnoticeable but occasionally more extreme. in some cases, changes of personality have been noted. Again mostly minor modifications but occasionally more profound changes.

If I’m honest, this worries me a little. I like to think, and perhaps I’m flattering myself, that I am a reasonably nice human being. I try to be friendly, to do the right thing and so on. I’m no saint but I hope there aren’t too many people out there I’ve offended or upset (unless intentionally obviously). I’m reasonably comfortable in my skin. I don’t want to find my personality changed out of all proportion. I don’t want to be apathetic, depressed, anxious or disinhibited.

Of course there is no way of knowing whether any of this will happen. It may be plain sailing. I may emerge psychologically indistinguishable from my pre-DBS form. That would be wonderful and, in many respects, is the most likely outcome. I’m probably fretting over nothing. But lurking at the back of my mind is the concern that inside my Dr Jekyll, there is Mr Hyde, just waiting for those electrodes to release him.