We Are Our Brains (29 page)

But remarkable memory isn't in itself enough to account for the savant syndrome. These individuals possess genuine talent, too. Stephen Wiltshire was an autistic boy with a verbal IQ of 52. He was known for his “London alphabet,” a series of pictures showing landmark structures in London, drawn at the age of ten. He went on to draw in New York, Venice, Amsterdam, Moscow, and Leningrad. After a forty-five-minute helicopter flight above Rome, he produced a six-foot drawing showing every house, window, and pillar in the
city with photographic precision. He has sometimes been compared to a printer because of the automatic way he draws. Artistic savants always have a strong preference for a particular subject and a particular technique. It's striking that they almost never draw people; the social brain is their Achilles' heel.

There are various theories about the neurobiological background of the savant syndrome. The exceptional gifts associated with it almost never develop unless there's brain damage, especially on the left side of the brain. It's thought that the brain damage allows links with other brain structures to be reinforced, enhancing the functioning of the visual cortex. Indeed, there are many examples supporting this theory. The left side of Kim Peek's brain was damaged, and there was no connection between the right and left hemispheres. Peek was able to read two pages simultaneously, using both eyes separately, at lightning speed. He read nine thousand books about the history of the United States and knew them all from memory. But he couldn't look after himself, relying on constant help from his father.

Epilepsy is often associated with autism. Daniel Tammet had his first serious epileptic seizure at the age of four and was treated effectively for three years with Valium. He suffered from temporal lobe epilepsy on the left side, which could explain his compulsive writing around the age of seven and his subsequent religious feelings (see
chapter 15
). Damage to the left side of the brain might cause right-side compensation and thus promote numerical skills, but the left side of Tammet's brain shows no trace of damage. Indeed, he's also a linguistic genius.

One theory is that everyone possesses potential savant talents localized in the “lower” regions below the cerebral cortex that are suppressed by “higher” processes. The psychiatrist Darold Treffert has dubbed this the “little Rainman” that each of us possesses. The idea is that these hidden talents can only be expressed by switching off the part of the brain that controls higher functions. Cases have indeed been known of people developing savant-like qualities due to a form of dementia that starts in the left frontal region. Some start to paint compulsively, for instance. These outbursts of creativity go hand in hand with a loss of language and social skills. In such cases, brain activity is concentrated in the rearmost region on the right, the visual cortex. When magnetic stimulation is used to disable the left frontotemporal region temporarily in healthy subjects, some improve at tasks like drawing, math, and calendar calculation. However, these improvements are modest, and no exceptional artistic feats have been seen. So the notion of a universal “little Rainman” doesn't satisfactorily explain the syndrome and moreover doesn't take into account its genetic component.

Brain damage at an early age appears to foster the development of savant qualities, because at that stage the brain is still fully able to make new connections with other structures. A Japanese savant caught whooping cough and measles at the age of four. It impaired his speech development, but when he was only eleven he made extraordinarily beautiful drawings of insects.

Some claim that savant talents are entirely due to training. Tammet jokes that he learned to count so well because he was one of nine children. It's true that savants are able to focus strongly and train obsessively, thus honing their skills. But they have to have a talent to start off with. And these talents are expressed at a very early age, both in savants and in child prodigies like Mozart, which conflicts with the training theory. When the young Mozart heard Gregorio Allegri's
Miserere
in St. Peter's in Rome, he made a few notes and then wrote out the music from memory back at his lodgings, in contravention of a papal ban. Stephen Wiltshire was producing remarkable
drawings by the age of seven, an ability that didn't markedly improve afterward. Some children are able to perform calendar calculations from the age of six.

Talents sometimes disappear with age. The autistic girl Nadia showed a remarkable talent for drawing between the ages of three and seven. First she drew horses and other animals, later people. By the time she was nine, however, she had lost her unusual ability. It would seem that the improved functioning of the left side of the brain, which is responsible for speech, inhibited her drawing skills. In that respect, too, Daniel Tammet is an exception. Developing his social skills didn't cause him to lose his numerical and linguistic talents. He has a remarkable brain in every respect.

Schizophrenia has been “treated” in various ways over the centuries. In China, four-thousand-year-old skulls were found with
holes trepanned into them, to let out the evil spirits believed to possess schizophrenia sufferers. In some cases bone had started to grow over the hole, showing that the patients had survived the operation for some considerable time. Jesus set a long religious tradition with his banishing of evil spirits (see the epigraph to this section). The Catholic Church ordained exorcists up to around 1970. That profession has since disappeared, though Catholic bishops still appoint priests to carry out exorcisms. In the Protestant church, exorcisms are performed by ministers. Demon banishing goes on in the Islamic tradition, too. When she lived in the Netherlands, the sister of the Somali feminist and activist Ayaan Hirsi Ali received medication for her schizophrenia. But back in Somalia she fell into the hands of Islamic clerics, who put her in an empty room containing only a mattress. They took her medication away and beat her to ritually banish her demons. This treatment proved fatal.

A painting by the medieval artist Hieronymus Bosch in the Prado, in Madrid, represents “the stone operation.” A doctor is pretending to remove a stone from the head of a schizophrenia sufferer in a placebo operation. Bosch portrayed the doctor with an upturned funnel on his head to show that he was an impostor, and next to him a nun with the Bible on her head to show that the church was equally culpable.

A picture on the gable stone of the old asylum in the Dutch town of Den Bosch shows how in 1442, schizophrenic patients were locked up in prison. For a few cents, families could go and gawk at the “lunatics” on Sundays. In the 1920s and 1930s, when my mother was a seventeen-year-old trainee psychiatric nurse, the straitjacketed patients were put in baths of alternately cold and hot water. She said she would never forget the sound of them endlessly banging their heads on the edge of the bath, the only movement they could make. Up until the 1950s, schizophrenia was “treated” by means of a lobotomy, an outpatient procedure that involved severing the connections to and from the prefrontal cortex. Opponents called it “partial euthanasia,” since it turned patients into robots. This made their
care extremely easy, though, and the terrible procedure became popular (see
chapter 13
). Fortunately modern antipsychotics have made it obsolete.

In China, a relative sits next to every hospital bed in order to help the nursing staff and make sure that their loved one has everything they need. If no relative is available, a co-worker will take their place. It makes Chinese hospitals rather jolly, chaotic places. But in the closed psychiatric wards, the picture is totally different. On my visit to one, I felt as if I were walking onto the set of
One Flew over the Cuckoo's Nest.
The enormous ward contained two seemingly endless rows of beds with identical bedding. Next to every bed hung an identical towel, while each bedside table had on it only a glass, no personal belongings. The patients on this male ward all wore identical striped pajamas. They received no visits at all; their families had disowned them. I was the first visitor for many years, and a foreigner at that. One of them was a sailor who spoke good English. He had seen much of the world, including Rotterdam, and acted as an interpreter for the excited group of patients who crowded around me, tugging at my arms in an effort to draw attention to their personal stories. I was moved and saddened by these accounts. It was very hard to abandon them once more to their isolation.

On that occasion I traveled on from China to Jakarta to give a series of lectures. I was picked up by a young chauffeur whose car radio was blasting out house music at full volume. I asked him cautiously whether he could perhaps turn it down a bit, at which he smiled understandingly and asked what kind of music I liked. “Mozart's
Requiem
,” I replied, thinking that it would prove a conversation stopper. The next morning he came to pick me up for the first lectures. To my utter amazement, amid the din of chaotic traffic—Jakarta is one gigantic slow-moving parking lot—he suddenly put on Mozart's
Requiem.
I must confess that I was extremely moved. The next day, when we were stuck in traffic, he asked me what I knew about the treatment and care of schizophrenia sufferers. It turned out that his brother had schizophrenia and lived at home. When he
was in a very bad way, they would give him a few drops of medicine. The little bottle of haloperidol had been very expensive, and they'd been making it last for years. I asked him where they kept the bottle. Just in the living room, he told me. Thinking of the average room temperature in Jakarta, I told him that that wasn't such a good idea, because medicine kept that long could lose its efficacy or even become toxic. He fell silent for a while, then said, “Oh, that explains it.” Apparently the medicine hadn't worked so well the last time they'd given it to his brother, so they tried a drop on the parrot, which fell down dead on the spot.

Treatment for schizophrenics can be even worse elsewhere in the world, as I saw from an award-winning World Press Photo exhibited in Amsterdam in 2004. Taken in Bangladesh, it showed an eighteen-year-old boy in the completely empty cell of a psychiatric clinic. He was lying on a stone floor, wearing only a pair of shorts. His legs were pinioned in a medieval contraption of wooden blocks. His arms were raised in despair, his fists clenched and his face twisted in a grimace. Apparently there were twenty-four such rooms in the “clinic” in question, and according to its director, thousands of patients had been “cured” in this way since its founding in 1880.

The afflictions of psychiatric patients in the Netherlands may be heartrending, but the sufferings of their counterparts in many other regions of the world are of a different order entirely. Our wealthy nation should never use this as an excuse to sanction cuts in treatment, though, because that would mean putting more patients in isolation cells, and isolation only makes their symptoms worse.

Schizophrenia affects 1 percent of the population, but because sufferers have it for such a long time it fills almost half of the beds in psychiatric hospitals. Schizophrenia patients are often depressed and feel that their lives are pointless. Around 10 percent attempt to kill themselves. Suicide makes the burden imposed on their families even heavier.

Schizophrenia is characterized by “positive” and “negative” symptoms. Positive symptoms are abnormal experiences, like delusions and hallucinations. During a psychosis, people see things and hear voices that they experience as completely real. (
“Later, after I'd lost my job, I started to hear voices when I was at home … and to be troubled by different voices in my head. Sometimes they're very aggressive, and cut right through me.”
). Scans show that during these hallucinations the areas of the brain that normally process auditory or visual input are extremely active. They can't be distinguished from real experiences because they take place in the same areas of the brain where external stimuli are normally processed. Other patients suffer from delusions. They believe that they are being watched or controlled by mysterious powers. (
“In the last week of my work and the two weeks that followed they treated me without my consent, using an extremely advanced system.… What's more, they modified my brain with this apparatus, so I can communicate with people in the street by transmitting thought waves.”
) During the hallucinations, patients may hear voices giving unwanted instructions. Some are even told to kill someone (see
chapters 8
and
17
). While in the grip of a psychosis, one woman believed that she could fly. She threw herself out of the window and was killed.