We Are Our Brains (2 page)

Perhaps the two greatest scientific questions of this century are “How did the universe come into being?” and “How does the brain work?” Through a combination of my surroundings and chance, I became fascinated by the second question.

I grew up in a household where I overheard such enthralling conversations about every aspect of medicine that it became impossible to escape going into the profession. My father was a gynecologist who devoted his working life to many aspects of reproduction that were then highly controversial, like male infertility, artificial insemination, and the contraceptive pill. He received a stream of visits from friends whom I only later realized were pioneers in their fields. As a small child I got my first lessons in endocrinology from Dries Querido, who later set up Rotterdam's medical faculty. When I noticed our family dog cock his leg against a tree as we took it for a walk, Professor Querido explained that his behavior was caused by the effect of sex hormones on the brain. Coen van Emde Boas, the first Dutch professor of sexology, used to drop by in the evenings
with his wife for a drink. His stories were gripping, particularly for a small boy. I recall an anecdote he told about a patient with whom he was having trouble communicating. Finally the man came out with what had been bothering him: He had heard that Van Emde Boas was a homosexual! Van Emde Boas put an arm around his shoulders and said, “But my dear, surely you don't believe that?” We laughed uproariously when he described the look on the patient's face. It was a household in which there was no question you couldn't ask, and during the weekends my father let me look at his medical books and peer through his microscope at plant cells and unicellular creatures fished out of local ditches.

When I was in secondary school, my father took me with him on a lecture tour of the country. I will never forget the hostile response he got from very religious members of the audience when he lectured on the contraceptive pill, which was going to be tested in the Netherlands for the first time. Despite the insults hurled at him, he went on arguing his case, remaining outwardly calm, while I sat sweating next to him, in an agony of embarrassment. In retrospect it was good training for the extremely heated reactions that my own research would later spark. An occasional visitor to our house at that time was Gregory Pincus, the developer of the contraceptive pill. I got my first sight of a laboratory when I was taken along with him on a visit to Organon, the pharmaceutical factory where the pill was produced.

With such a background it seemed to me self-evident that I would study medicine. At meals I would enthusiastically discuss medicine with my father so directly and in such detail that my mother would regularly beg us to stop, even though, having worked as an operating theater nurse and at the front during the war between Russia and Finland in 1939, she was hardly squeamish.

As my medical studies progressed, I was taken aback to discover that I was no longer expected merely to ask questions but also to provide answers. Suddenly everyone around me saw me as an expert on all kinds of health problems and expected free consultations. At
one point I was so fed up with hearing about my aunt's nagging pains that I silenced an entire family birthday party with a loud, “How interesting, Aunt Jopie! Take your clothes off, and let's have a look at it!” It worked like a charm; she never bothered me again. The other relatives, though, proved harder to deter, and they continued to seek my advice.

During my studies I wanted to find out more about the experimental work that underpins medical knowledge. I also wanted to pay my own way through school, an idea to which my parents were very much opposed. There were two places in Amsterdam that would take you on as a part-time researcher once you got a basic medical degree after three years of study: the Department of Pharmacology and the Netherlands Institute for Brain Research. The first vacancy to come up just happened to be at the latter. So much for career planning. At the Institute for Brain Research I chose the logical area of focus, given my background: the new field of neuroendocrinology, involving research into hormone production by brain cells and the effect of hormones on the brain. During my interview with the institute's director, Hans Ariëns Kappers, I mentioned that my main interest lay in neuroendocrinology, so the in-house expert, Hans Jongkind, was called in. He revealed my considerable ignorance on the subject with a series of probing questions. But to my surprise, Hans Kappers then said, “Well, we'll give you a trial,” and I got the job.

For my PhD I carried out experiments to determine the functions of hormone-producing neurons. I did this research while continuing to study medicine, which kept me busy around the clock. It was with some difficulty that in 1970, while working as an intern in a surgical department, I obtained the afternoon off to defend my PhD thesis. After qualifying as a general physician in 1972, I decided to continue with brain research. In 1975 I became deputy director of the Netherlands Institute for Brain Research (see
chapter 15
) and in 1978 its director. In 1979 I also took on the chair of neurobiology at the University of Amsterdam's medical faculty. Despite holding these
administrative posts for thirty years, hands-on research remained my main focus. After all, that was why I chose the profession. In my research group I've profited immensely from the knowledge of a host of talented and critical students, PhD students, postdocs, and staff members from over twenty countries, whom I still encounter in brain research centers and clinics all over the world; it's a learning process that continues to this day. In turn, all of those academics owe much to the excellent technicians who have developed and perfected new research skills.

Meanwhile, I was getting more and more requests for information, including about issues outside of my own field. As a doctor, even if you're engaged in research rather than general practice, people will come to you with pressing questions. There's no aspect of life that brain disorders don't touch, so my advice was solicited on the most serious issues. One Sunday morning, for instance, the son of an acquaintance knocked on my door with a few scans under his arm. He said, “I've just been told that I only have three months to live—how can that be?” When I looked at the scans, it seemed incredible that he'd even been able to visit me and ask this question: The front of his brain was one giant tumor, and indeed he did die shortly afterward. At such times all I can do is listen, explain the results of tests, and help desperate people to find their way through the medical jungle. The only accurate judges of my capacities were my children, who, when they were feverish and saw me appear at their bedside with a worried air and a stethoscope, would always insist that they wanted a “real” doctor.

When I set up the Netherlands Brain Bank in 1985 (see
chapter 19
) and became known for examining the brains of dead people, I was again surprised to find myself the focus of a great many questions on every subject relating to the final stage of life: euthanasia, assisted suicide, and the donation of brains and bodies to science; in short, everything connected to life and death (see
chapter 19
). My research became intertwined with personal and social issues relating to my field. I spoke with the courageous mothers of schizophrenic children
who had committed suicide; they responded by setting up a national support network. At international conferences on Prader-Willi syndrome, I also discovered how often the relatives know more than the researchers do. At those conferences, the parents brought their morbidly obese children from every corner of the globe, taught researchers a great deal about the condition, and encouraged us greatly in our attempts to find out why sufferers eat themselves into an early grave. Interacting directly with researchers is an approach that more patient groups should emulate.

My research group was also involved in setting up the first study on Alzheimer's disease in the Netherlands, at a time when the epidemic proportions of the disease were merely conjecture. Our observation that some brain cells could withstand the aging process and Alzheimer's unscathed while others were destroyed was important in guiding our research of therapeutic strategies for the disorder (see
chapter 18
). Demographic aging means that many of us now have to see loved ones deteriorate during the last stage of life as a result of dementia. Most of us also experience the huge pressure that psychiatric disorders impose on the lives of patients, relatives, and carers. The questions about these conditions that I am confronted with as a brain researcher go so deep that I can't avoid them.

The general public, blissfully unaware of our daily battles with the technical problems of research, assumes that we know everything about the brain. People want answers to the big questions about memory, consciousness, learning and emotion, free will, and near-death experiences. As a researcher, if you don't fend off those types of queries, you'll get sucked into them sooner or later and discover that they are riveting.

Discussions about the brain always reveal how firmly convinced people are of “facts” whose origins are a mystery to me. Take the myth that we use only 10 percent of our brains. You might well be forgiven for thinking this in the case of certain people, but I haven't the faintest idea what prompted this crazy theory. The same goes for the claim that millions of our brain cells die off every day. But lack of
expertise can also be refreshing. When I give lectures, I often get asked intriguing questions by members of the audience. Sometimes even children raise the most thought-provoking issues. One Dutch girl of Japanese origin wanted to write a school assignment on the difference between European and Asian brains—differences that do exist but are rarely acknowledged.

On top of general inquiries, I also had to contend over the years with an avalanche of questions and a heated public response to my own research on the human brain, prompting the need for explanation and debate on issues like gender-based differences in the brain, sexual orientation, transsexuality, brain development, and brain disorders like depression and eating disorders (see
chapters 1
,
2
,
3
, and
5
).

In the forty-five years that I've been active in this field, brain research has developed from the preserve of a few mavericks into a global discipline that has rapidly brought a host of new insights, thanks to the efforts of many tens of thousands of researchers representing many different disciplines and employing highly diverse techniques. The general neurophobia of the old days has been transformed into an overwhelming fascination with everything connected to the brain, partly thanks to excellent science journalism. Unable to escape the questions that the public was posing, I found myself constantly compelled to step aside from my own line of research to think about every conceivable aspect of the brain and how it could all be explained to a general readership. In this way I developed my own views on features of the brain and our emergence as humans, on the way in which we develop and age, on the origins of brain disorders, and on life and death. Over the course of time my own little answers to and ideas about the big brain questions took shape. They are set out in this book.

The question I am most frequently asked is whether I can explain how the brain works. That's a conundrum that has yet to be fully solved, and this book can of course provide only a partial answer. It shows how our brains differentiate into male and female brains,
what goes on in the adolescent mind, how the brain preserves the individual and the species, how we age, how we suffer from dementia and die, as well as how the brain evolved, how memory works, and how moral behavior developed. But the book also shows how things can go wrong. It looks at disorders of consciousness, brain damage caused by boxing, and diseases of the brain like addiction, autism, and schizophrenia, as well as the latest medical advances and possibilities for recovery. Finally, it looks at the relationship between the brain and religion, the soul, the mind, and free will.

The various sections of this book can be read separately. In such a short space that deals with so many different subjects, it's impossible to arrive at deep scientific conclusions. These thoughts are intended
to prompt further debate about why we are as we are, how our brains develop and function, and how they can malfunction. I hope that this book can provide a general readership with answers to many frequently asked questions about the brain. I also hope it will give students and young brain researchers an introduction to neuroculture, encouraging them to cross the borders of their research and engage in dialogue with the general public. That this is necessary is self-evident, not just in view of the social impact of brain research but also because of the support that we, for our part, ask from society for our research.