Monday 7 April 2014


A couple of days ago I was getting snitty about the fact that John "Beautiful Mind" Nash was 'treated' for schizophrenia with insulin shock therapy.  In a different hospital or under the direct care of a different doctor at the time, he might have had a session or two or twenty of electro-convulsive therapy (ECT) where two electrodes are attached to the temples and a jolt of current (kaZANG!) is administered to the seat of reason.  I would have taken the high-moral 20/20 hindsight ground on that form of treatment as well  . . . until I heard the TED talk by Sherwin Nuland, about his experience with ECT.  He was extremely well qualified to give such a talk because he was an highly effective and well-connected Ivy League surgeon - who had been cured of crippling depression by a course of ECT.  What made his talk particularly affecting was that the treatment had saved his life and his sanity a long time ago and he had never before talked about in public.  But it was also important because it shook me out a complacent knowledge that ECT was a barbarism that was thankfully in the past and of which the medical profession should be ashamed.  Drugging (MAOIs, TCAs, SSRIs, SNRIs, Lithium) depression is now the norm and it's a HUGE $80billion market - very lucrative because the drugs deal with the symptoms and each sad, shuffling cash-cow keeps taking them for decades unless they top themselves first.  Investigating it all will take a blue chunk out of my Summer.

Nuland's depression was utterly debilitating, it seems to have been triggered by a collapsing and recriminatory marriage and not helped by an almost total lack of support or empathy from his medical colleagues.  Maybe mathematicians are kinder?  The general consensus among the senior medics was that the best treatment for his depression (and a good dash of obsessive compulsive disorder) was to give him a pre-frontal leucotomy which surgically severs connection to the part of the brain which deals with affect.  So you cure the madness but turn the patient in a sort of shambling oaf.  As Norbert "Cybernetics" Wiener famously noted "prefrontal lobotomy ... has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier."  The young intern who had been actually caring for Nuland persuaded his senior colleagues to try a course of ECT instead. That less invasive intervention gradually but permanently cured him and Nuland eventually went back to his successful and well-respected life as a surgeon and pillar of his community.

Our fear and loathing of mental illness is highly developed: almost as if it was contagious.  It was the redemptive power of tolerance that cured John Nash but it took decades to achieve.  Trinity College being a city-centre campus has its fair share of the wandering deranged who are let hang-out and attend lectures if they are quiet.  That used to be the case anyway.  The management is quite possibly insisting that these unfortunates pay fees nowadays.

Nuland is most famous as the author of a revelatory book called How We Die which lifts the bed-clothes to reveal that, to a close approximation, there is no such thing as a good death.  The great transition is usually painful, degrading, ugly and messy.  But acknowledging this to be true is the first step in dealing with it. I'll have more to say about this in due course. Sherwin Nuland died at the beginning of March this year, he'll be missed.

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