Author: Barbara K. Lipska
This book is about the bizarre manifestations of a mind that has lost its bearing. It is not just a tale of outlandish thoughts and weird behaviours; it is also an exploration of what happens in a brain that has gone berserk and is running amok. The author meticulously chronicles her step-by-step descent into madness, depicting a rapid evolution of very strange symptoms, all the while completely oblivious of reality. Her post-recovery reflection of her season of paranoid delusions forms the main theme of the book. As a neuroscientist, proficient in the intricate workings of the brain, she was able to discern her mental disintegration in terms of what really went wrong with her brain wiring.
The backbone of the book is the author’s battle with melanoma, ‘the rarest but most dangerous form of skin cancer’. This had spread to her brain, a metastases the author recognised as ‘almost invariably terminal‘ (page 40). She faced a bleak future against such overwhelming odds, at one stage harbouring 18 tumours and likening her brain to ‘a lump of raise-bread dough’ (page 110). Her narrative was therefore very heart-wrenching, full of dashed hopes and recurrent setbacks. It was however also an inspiring account of the determination to survive, even when things appeared bleak and hopeless. The author’s remarkable philosophical outlook was imprinted on almost every page, such as when she said ‘my passion to stay alive and my readiness to die are intermingled’ (page 173).
The most striking feature of the book is the author’s clear and detailed illness narrative. The first inkling anything was amiss was when she got lost whilst jogging in the neighbourhood she had lived in for twenty years. She said ‘I want to get home but I have no idea where it is’ (page ix). She graphically depicted her harrowing ‘descent into mental illness‘, characterising her behaviour then as callous and obsessive. She described becoming ‘the worst version of myself: selfish and unconcerned about other people’s feelings…an angry, overly critical version of myself…increasingly suspicious of my family and my colleagues at work’ (pages xiii and 81-85). Her prose was similarly striking when she recounted the side effects of her treatment, for example describing how steroids made her feel ‘like a superhero with limitless powers, a wild woman on stimulants-driven, driven, driven‘ (page 44). What was really worrying was her impoverished insight, unaware that her behaviour was abnormal, saying ‘even as my mind was deteriorating, I couldn’t see that I was slipping into mental illness‘ (page xvii).
As a neuroscientist, the author was eminently placed to conceptualise her symptoms in terms of brain anatomy. She recognised, for example, that her obsessional eating was ‘a classic sign of frontal lobe problems’, adding that ‘without a functional frontal lobe, my brain is a horse galloping dangerously after the rider has lost the reins‘ (page 89 and 109). She also noted that the ‘inability to recognize my own impairment is often observed in people with mental disorders’, pointing out that ‘50% of people with schizophrenia and 40% with bipolar disorder cannot understand that they are sick’ (pages 80-81). She also identified her dyscalculia, or inability to calculate, as a sign of lesions in the parietal lobe (page 118). Her neuroscience background also enabled her to recognise that the symptoms she experienced were not unique, as they occur in many other brain disorders. For example, she appreciated that her disinhibition was similar to the impaired judgement that occurs in frontotemporal dementia, and that her compromised visuospatial memory was identical to the impaired recognition that typifies developmental topographical disorientation (pages 83 and 95).
A theme that permeated the book is the author’s proactive approach to managing her illness. With a single-minded attitude, a principle she adopted from Lance Armstrong when he battled testicular cancer, she became the driving force in her care. As her own best advocate, she set out to learn everything about her disease; to seek out the best doctors; and to obtain the most effective treatments (pages 45-47). Her determination to defeat cancer sustained her through surgery, radiotherapy, and cutting edge immunotherapy, and this tenacity was almost certainly responsible for her survival (pages 53 and 151). Her neuroscience background also enabled her to tolerate the side effects of her treatments, recognising the mechanism behind them. For example, she understood that irradiated brain tumour cells become necrotic tissue, and this triggers what she describes as a ‘full scale war‘ in the brain. She also recognised that immunotherapy disrupts the blood brain barrier, causing the brain to swell and become irritable (page 68).
The author shared several incisive learning points from her harrowing experience. Most importantly for her was that ‘my brush with madness gave me first-hand experience of what it’s actually like to lose your mind and then recover it’ (page xiii). Indeed, one of her main goals for writing the book was to ‘better understand the experience and causes of mental illness’ (page xvii). In keeping with her positive outlook, she identified several lucky streaks that contributed to her recovery, for example she attributed her survival to the early involvement of her primary visual cortex (pages 36-37). From the academic perspective, she recognised that ‘the brain has a remarkable ability to heal itself after various kinds of injuries and assaults’, and this is ‘nothing short of miraculous‘ (pages 37 and 149). Most importantly, as a human being, she believed that her experience deepened the quality of her compassion (page xviii).
This is a very insightful book which takes the reader into the way the mind works, and how it can be disrupted by disease. The author correlates her symptoms to specific brain systems, and also makes analogies with several neuropsychiatric diseases. She gives readers an understanding of what people with mental diseases and their families go through. The book highlights the remarkable potential of the brain to recover from even the most serious insults, and it also illustrates the remarkable resilience of the human spirit in the face of disaster. The book is very well-written, and the content is enlightening. It is perhaps light on academic references, but this is not a criticism in light of the author’s stated objectives.
This is an excellent book which highlights many neuropsychiatric symptoms, and the diversity of causes. It shines a light on medical advancements which give hope to even the most severe brain diseases, at the same time spreading the lesson of perseverance and assertiveness. The author dispenses uplifting lessons which are beneficial for patients and their health care workers. I highly recommend it to all doctors.
Publisher, Place, Year: Penguin, London, 2018
Number of chapters: 11
Number of pages: 188
Star rating: 5