Using the Brain

A User's Guide to the Brain: Personality, Behavior and the Four Theaters of the Brain, John Ratey. Pantheon Books, 416 pages, $27.50.

John Ratey, an associate professor of psychiatry at Harvard Medical School, has written several books on neurological disorders. The most incisive and far-reaching of these is Shadow Syndromes, his 1997 work that argues for the newfound centrality of neurology to our view of ourselves. To see why Ratey's new book, A User's Guide to the Brain, is so disappointing a sequel to Shadow Syndromes, it's useful to compare the earlier work to that of Oliver Sacks, our best-known teller of neurological tales.

Shadow Syndromes deals with some of the people Sacks profiles--notably Temple Grandin, the high-functioning autistic featured in Sacks's Anthropologist on Mars--but Ratey doesn't give them quite the star billing they get from Sacks. His strategy, instead, is to turn the spotlight on the audience and to show that there is less difference than has been supposed between its members and those displayed on the neurological stage. While Sacks leaves unchallenged the notion that there is a norm against which neurological states can be measured, Ratey believes that if you scratch a neurological normie, you are likely to find shadow syndromes--"walking depression," high-functioning autism, anxiety disorders, or other subclinical versions of neurological disorders. In fact, there may not be such a thing as neurological normality; there may be only neurological diversity--a variety of perceptual windows on the world that brain science has just recently learned to identify.

Ratey writes that we have traditionally overlooked the neurological roots of behavior that lead to all sorts of second-order psychological complications. His most thoroughgoing description of a syndrome currently understood to be neurological rather than psychological in origin is of autism. (In the hands of Freudians, most controversially Bruno Bettelheim, autism was seen as a result of bad parenting, especially the inimical influence of the "refrigerator mom.")

The consensus today is that autism results from anomalies in brain development. High-functioning autistics can find ways of compensating. Witness Temple Grandin, who, Ratey tells us, memorized the entire transcripts of the Camp David negotiations between Menachem Begin and Anwar Sadat in order to familiarize herself with the art of conversation. For Grandin all face-to-face interaction required the same attention to protocol that heads of state devote to peace talks. Ratey maintains that a Grandin-like approach to social interchange is not so uncommon. "Autism," he writes, "has long been thought to be a rare disorder; today opinion is increasingly coming to hold that ... the milder forms of autism may be with us in significant numbers. Certainly ... Silicon Valley is filled with potential candidates for a high-end diagnosis."

High-functioning autism is but one among the many shadow syndromes Ratey sees as radically underreported in society. It could be argued that, in seeing shadow syndromes everywhere, Ratey merely conforms to our culture's tendency to pathologize behavior and to divide human character traits into diagnostic bundles. But in a sense, the intent of Shadow Syndromes is to draw the sting of pathology. In Ratey's view, neurological discourse is relevant not only for the Other but for us all. He believes the language we have traditionally used to describe what goes on in our minds is as inadequate as Ptolemaic astronomy was to reflect the heavens. With the advent of brain-imaging techniques, as with the advent of the telescope, both a new science and a new language are in order. "We have not," writes Ratey, "developed a vocabulary to keep pace with the discoveries of neuropsychiatry: the classic language of emotion--love, hate, anger, joy, envy--does not capture the very powerful feelings evoked by conditions like obsessive-compulsive disorder."

Ratey is hardly the only writer to fly the flag of the neuroscientific revolution--Steven Pinker and Antonio Damasio are others who readily come to mind--but he may be the only one to note that it will have implications for the spoken word, even if in Shadow Syndromes he does not spell out what those implications might be. What would it be like to dispense with tried-and-true coinages like "love," "hate," "anger," "joy," "envy," and substitute a vocabulary expressly designed for the vicissitudes of neurological weather? The goal might be increased self-awareness, but getting there by way of positron emission tomography (PET), functional magnetic resonance imaging (FMRI), and other high-tech brain scans could prove too lengthy a detour. Nor does Ratey concern himself in Shadow Syndromes with the political and social effects of the situation he describes. Why have our educational systems and our cultural norms been structured to suit the needs of one out of many existing neurological types, the supposedly neurotypical? And does the recognition of neurological diversity imply a challenge not only to the linguistic but also to the political status quo?

These are the kinds of questions I hoped A User's Guide to the Brain would address. Unfortunately, Ratey's new book appears to suffer from some shadow syndrome of its own and never quite figures out what it wants to be. It is really only in the introduction and the last two chapters that Ratey connects to and extends the arguments of his earlier book. For example, in the penultimate chapter of A User's Guide, he stresses that having "ADHD [attention deficit hyperactive disorder], OCD [obsessive-compulsive disorder], mania, paranoia, depression, autism, or other 'pathological' traits" need not be debilitating. As we gain neurological finesse, we learn that many of us have such traits to some degree, and that diagnosis, therefore, is a matter of determining where we fall on a spectrum ranging from mild to severe. He writes, further, that having shadow syndromes comes with a saving grace. It is precisely those who have them who are likely to develop neurological finesse. They are typically "drawn to complexity, and the exploration of their own neurological peculiarities presents an irresistible challenge--a true inner force for a cure."

In between such insights and chapters about subjects like language, motion, memory, and perception, A User's Guide resorts to a flat, neutral style to report on the latest--often contradictory--findings of brain science. At such times, the book seems to want to be a primer on the brain. At other times, the work lurches in the direction of self-help: It's full of brain-maintenance tips--exercise, for instance, is good not only for the heart but for the brain--conveyed in overheated prose. The basic point is that neuroscience is happening, so get with it if you want to understand yourself. But when dealing with key questions, the sort you'd expect an all-purpose brain book to clarify, A User's Guide falters.

Early on, Ratey advises us that analogies to the workings of computers--while pervasive these days in discussions about the brain--are misleading. "The brain," he writes, "is nothing like the personal computers it has designed." But after saying so, he falls back again and again on computer metaphors for the brain. Is the brain like a computer or isn't it? This is a big question for a brain book to be at once so adamant and so confused about. Such disorganization marks much of the text and makes A User's Guide a jarring read. Ratey often repeats himself, as if he's lost track of what he's already told us (almost verbatim). Given that he often alludes to his own ADHD and that he exhorts us, above all, to think neurologically, it does not feel out of place to wonder if his own neurology got the better of him in this book. He writes that ADHD "can be thought of as an addiction to the present." That's not a bad way to describe the flaws of A User's Guide, with its discontinuities and failed stabs at coherence.

The culture at large, meanwhile, has taken Shadow Syndromes to heart and has added neurology to other axes of identity. Consider Mark Salzman's recent novel Lying Awake. Here's how it depicts the religious rapture of a nun, Sister John.

Higher and higher she rose, away from all she knew. Powerless to save herself, she drifted up toward infinity until the vacuum sucked the feeble light out of her... . In this radiance she could see forever, and everywhere she looked, she saw God's love.

When Sister John discovers she has epilepsy, we wonder about the relation of religious faith to neurological anomaly. Does a seizure disorder invalidate experience of the divine or serve as a legitimate platform for it? The Church, at any rate, leaves no room for doubt and rules epileptic visions out of bounds. What, then, remains of Sister John's vocation when an operation eliminates the bundle of neurons that had kindled her raptures? Salzman doesn't necessarily answer these questions, but they are posed in this novel with neurology at center stage, as Ratey would have them be.

We might think also of Tic Code, a recent movie about a musically gifted boy whose tics and facial contortions turn out to be symptoms of Tourette's syndrome. The film is almost entirely without the usual Hollywood cant and sentimentality. You know it is cutting close to the experience of neurological disorder when the boy, looking at clips from Straight, No Chaser, a documentary about Thelonious Monk, recognizes something of himself in Monk and concludes that the great jazzman's twitching, grunting, and strutting around during performances were evidence of Tourette's. In an age of neuroscience, it's not only clinicians who get better at recognizing neurological disorders; people with such disorders become adept at recognizing one another. On the Internet, high-functioning autistics meet in chat groups to hash out the implications of their being, as one writer put it, "differently brained."

A novel like Lying Awake, a movie like Tic Code, online discussions of neurological pluralism: These constitute the real follow-up to Shadow Syndromes--to be joined, no doubt, by the book John Ratey will write when he returns to form. ยค