Head Case

Dennis Cass

• Publisher: HarperCollins e-books
• Year: 2009
• ISBN:
  9780061737169
• Topic: Littérature
• Subtopic: Biographies littéraires

"Dennis Cass ventures into the terra infirma that is neuroscience, and returns with a fascinating, funny and touching tale. I recommend it for anyone who owns a brain." -- AJ Jacobs, New York Times Bestselling author of The Know it All

In the tradition of Supersize Me, Dennis Cass becomes a human guinea pig in a darkly comic journey to understand the human brain and find out what makes us who we are

Infiltrating the world of neuroscience, Cass offers his own brain up to science, subjecting his mind and body to electric shocks, mind-numbing attention tests, stress tests of his own devising and cigarettes. In the spirit of George Plimpton and early Tom Wolfe, his exploits reveal the intricacies of fear, attention, stress, reward and consciousness from the inside out. Along the way, he weaves in the story of stepfather's manic depression and drug addiction, as well as his own troubles with stress and depression, giving neuroscience a personal touch along with the clinical facts.

Cass attacks the subject of the human brain with wit and candor, turning popular science into something distinctly human. Head Case is an imperative read for anyone who's ever asked themselves why they are who they are.

WHAT BRAINS LIKE

I spent the next month cringing. In my head I kept reliving the moment when I reached into my shoulder bag and pulled out those printouts of Bill Maher. Like a car explosion in a low-budget action movie, it played again and again from multiple angles. All thirty-six thousand members of the Society of Neuroscience knew I was a complete ass (Nowture, anyone?). I would be walking around my neighborhood and suddenly think about an exchange with a neuroscientist and shudder at what a fool I had made out of myself.

Scientist #1: “Did you hear about that writer who came in here the other day acting like there was some kind of war in your head between the amygdala and the prefrontal cortex?”

Scientist #2 (rolling eyes): “I can’t even talk about it. I feel too sorry for the guy.”

If I was professionally embarrassed, the thought that I was turning into my stepfather made me sick to my stomach. Ever since my junior year in college I had defined myself as being the opposite of Bill. I had taken the melodramatic teenage I’ll-neverbe-like-you speech and turned it into a personal mandate. Living in Minneapolis, trying not to judge people too harshly, checking myself for not being grandiose or overly ambitious, respecting other people’s points of view—I had thought I had succeeded in becoming an anti-Bill of sorts. I even used to fight with him over the phone, arguing with him over his outlook on life, while he would express disappointment in me for turning soft. “I can’t believe you actually live in Minneapolis,” he would say. “It’s such a non-city.”

Whereas before I could keep some intellectual distance between the two of us, now Bill had an almost physical presence—Bill rode with me everywhere I went. He had hijacked my project, and if I was indeed turning into him, then that meant looking into topics—depression, addiction, mania—that I would have preferred to leave alone, and reliving times from my life that I preferred to forget.

Sometime early in my senior year in high school Bill stopped by my room. He took a seat on my bed, where I had been reading. We weren’t talking much at this point. It was the fall of 1985 and I was about to start my tour of potential colleges. I couldn’t wait to get away.

“Lad,” he said. The tone was serious. “I have to tell you something.”

Bill was sitting right next to me on the bed, something he never did. In our living room there was a love seat, a leather chair, and a couch; we each had our stations. We rarely talked about anything personal. It was all books and movies and TV. Bill’s earnest tone put me on guard. Anytime Bill became fatherly it usually meant something bad had happened.

“Your mother and I,” he said and then paused, his eyes up at the ceiling in thought. He made an effort to be courtly.

“I don’t want to alarm you,” he said and stopped.

“I don’t want to call it a problem, because it’s not a problem anymore, but your mother and I have had some problems with prescription drugs—it’s nothing really.”

Bill then spilled out the story of their addiction. For the past ten years they had abused prescription painkillers like Percocet, Percodan, Valium, and Demerol. It sounded serious, only Bill didn’t use the word “addiction.” Their drug history was less about dependence or abuse and more about how pills were once a lot of fun but had become “kind of a drag.”

“Not that it’s physically addictive,” Bill said. “It’s really more psychologically habit forming. You know, you do something for a while and it’s fun, and then you don’t want to do it anymore.”

I asked him how it all started and he said it dated back to when we were in Seattle.

“You know, it’s actually kind of funny,” he said. “We would be at a friend’s house and your mother would be on the lookout while I was upstairs frantically—and I mean frantically—rummaging through the medicine cabinet looking for Valium!” He let out a sigh, the kind you have after a big laugh.

He regaled me with tales of how they would con doctors or find ones who were easy with “scrips,” and about fake trips to the emergency room, complaining of phantom migraines. The way he described it, the whole escapade was mostly comic, and even perhaps the fault of a medical establishment that wasn’t as careful as it should be. But they were on methadone now, and they were fixing the problem themselves. He scoffed at support groups and didn’t once mention treatment. There was no “Help me, Jesus” or a sense of personal failure or weakness or even struggle. They had it under control.

“We thought now that you’re going off to college you should know,” he said, then quickly added, “and it’s not like we’re heroin addicts, though you’d think how some people treat us we were. We go down to this clinic near Wall Street, and there are real—I mean, whoa. There are some—whoa—some pretty rough characters. I don’t know why they don’t have a better way for us to get the stuff, you know. It’s absurd. We’re professionals. That we have to consort with drug addicts, with their gimme, gimme, like we’re abusing street drugs.”

“That explains a lot,” I said.

Bill asked me what I meant and it all came out at once: the weird hours, strange attitudes, the rages, the nodding off on the couch, his habit of slapping his own face, which was something Bill did all the time, like he was interrogating himself, when in fact he was just trying to stay conscious against his body’s better judgment, the fact that they weren’t taking care of themselves, and that I had to do all the family’s shopping and take care of the day-to-day operations of the house, like doing laundry, and how it always felt like we were on the verge of ruin.

Bill looked at me with pride.

“That is very perceptive, lad,” he said. “I’m really impressed. You picked up on all that?”

We went out into the living room. My mom was on the couch, reading a Trollope novel. She was pregnant and due in December. She wore the same kind of mischievous grin that she had when we had talked about moving to New York, the shoulders up at her ears, like she had been naughty. Bill heralded our arrival with the fact that I had been so perceptive about the apparently not-very-well-hidden behavioral aspects of their addiction.

“You’re just so perceptive, lad,” he said.

My mother agreed. There was no apology. No real remorse. No accounting of how their addiction had made my life weird or painful, and the strange thing is that I didn’t really care. Because they thought I was bright and perceptive, and I was just a sucker for that. They reassured me it was no big deal and that everything was going to be fine. They had come clean.

Since they came clean I felt I needed to make a confession of my own. They knew about my drinking because I was allowed to have a beer in front of them. I had drunk on vacation with them when I was as young as fifteen, getting goofy on Coors at my cousins’ condo in Florida.

“You guys should probably know that I’ve smoked a little pot,” I said.

They said it was okay. There was more pride, this time at my forthrightness and candor. After all, they had just shown me that there was nothing wrong with drugs as long as you dealt with them honestly.

I thought of their drug problem almost entirely in terms of feeling good or not feeling good. I knew about drug addicts, but at the time, I saw everything through the lens of the New York crack scare. The stories going around New York were of people instantly addicted from one hit, and of lives almost as instantly destroyed. Something like prescription drugs, which I associated primarily with Elvis Presley, didn’t seem the same. The idea that a drug could be psychologically, as opposed to physically, addicting made sense to me.

Today the science of addiction still isn’t entirely understood, but the underpinning brain functions of motivation and reward enjoy a little more clarity. It seems like it should be easy: the prehistoric brain seeks food, water, and reproductive advantage. You feel hunger or thirst or the desire to mate and you take the appropriate action. You itch, you scratch.

Sometimes you scratch hard. In a famous experiment conducted in the fifties, rats, with no further encouragement, would press a lever more than six thousand times per hour to receive a short pulse of electrical stimulation directly to the brain. Another study from around that time showed that animals would starve themselves when offered a choice between food and water and direct electrical stimulation. And, if electricity isn’t your thing, there are a lot of other things in the world that satisfy more indirectly. In reward experiments spanning the decades, lab animals and human research subjects have been presented with juice, money, grapes, cocaine, chocolate, photographs of food, and Bizarro cartoons.

The early research into reward focused on satisfying natural appetites. In the sixties a scientist named Vincent Dethier discovered two eating reflexes in the fly. There was an “excitatory reflex,” which made the fly eat whenever it landed on food, and an “inhibitory reflex,” which signaled for the fly to stop eating. When Dethier cut its sensory nerve, the fly would stuff its fly face until its teeny-tiny fly stomach exploded. Findings like these led scientists to believe that reward functioned similarly to stress. The body sought homeostasis, a balance between hungry and full, thirsty and quenched, horny and spent.

But it’s more complicated than that. If reward were some kind of internal homeostatic goal, then why do dogs that are given their full nutritional requirements still eat normal meals by mouth? Or why would a male rat work through a maze to gain access to a sexually willing female even if he was repeatedly taken away before he could consummate their love? There is also a wonderful anecdote about a research subject called “Tom.” In a freak childhood accident he sealed shut his esophagus while eating hot soup. As an adult, Tom fed his stomach directly through a surgically created hole in his midsection, and yet still chewed his food. If he didn’t put the food in his mouth first, he complained of not feeling satisfied.

This difference between what the body requires and what it desires drives one of the dominant theories about reward, the “incentive salience model.” The incentive salience model divides reward into two separate but interrelated brain mechanisms: liking and wanting.

In his review paper “Motivation Concepts in Behavioral Neuroscience,” Kent Berridge, a psychologist at the University of Michigan, says that liking is “essentially hedonic impact—the brain reaction underlying sensory pleasure—triggered by the immediate receipt of reward, such as sweet taste.” In one study, researchers give, alternately, citric acid and sugar to rats, monkeys, and newborn human babies who have yet to be fed by either breast or bottle—the first thing they taste in their life is Science. The reactions to these substances are the same across species. The citric acid causes baby mouth gapes and downward tongue protrusions, as well as head shaking, arm flailing, and “aversive scrinching” of the nose, while rats do “gapes, head-shakes, face washes, and paw flails.” For the sweet, human babies stick their tongues out and up. Their faces relax and they smack their lips and lick fingers, while rats exhibit “paw licking, lateral tongue protrusion, rhythmic midline tongue protrusions.” What’s remarkable is that the tongue protrusions are scaled. A gorilla may lick his lips slowly, a rat quickly, and a human in between, but they are all governed by the same formula: duration in MSEC = .26 (species’ adult weight in kg)^.32. When it comes to sugar, we are all the same animal.

We were starting to see this kind of liking in Owen. Even at six months he had preferences. Certain strained foods—sweet potatoes, lamb dinner—went down particularly well, while others were less popular. He showed other, non-food, preferences, as well. When it came to his Lamaze plush aquarium, he definitely liked the little crab that went crinkle, crinkle more than he liked the little fish that went jingle, jingle. As for the magnitude of liking, there was nothing that elicited pleasure more than a television show called Boohbah. Even though the American Academy of Pediatrics warned against showing children under two any television at all, Boohbah was so charming with its rainbow of plush, jelly-like characters—not to mention so entirely mesmerizing for both Owen and myself—that we risked the long-term damage once a week for one half-hour, maximum.

But Owen didn’t “want” yet. His brain had yet to develop this more complicated aspect of reward. Wanting, or “incentive salience,” is, according to Berridge again, “the motivational incentive value of the same reward.” In other words, wanting has nothing to do with sensory pleasure, nor does it necessarily have to be conscious. Rather it’s the “motivational value” of a stimulus. Wanting is the silent math your brain calculates when you react to the juice, cocaine, or Bizarro cartoons.

You can like without wanting. “Dopamine suppression leaves individuals nearly without motivation for any pleasant incentive at all: food, sex, drugs, etc.,” writes Berridge, but these subjects still show unconscious facial expressions of pleasure when given sugar. Subjects won’t seek out the stimuli, but when given it they will react according to their own pleasure profile.

You can also want without liking. “During lateral hypothalamic stimulation, rats’ facial expressions to a sweet taste actually became more aversive, if anything, as though the taste became bitter, although the same electrode made them eat.” There is another study involving a bird who needs to nest but is not given any nesting materials. The bird had such a strong drive, or want, to build the nest that it used its own feathers, which couldn’t have been fun.

The evolutionary psychology of liking versus wanting separates the two in order to allow the organism more flexibility in determining what is most rewarding. Wanting could have evolved to create “a common neural currency of incentive salience shared by all rewards, which could compare and decide competing choices for food, sex, or other rewards.” In other words, liking helps you figure out if a single stimulus is good or bad, but you need wanting to compare two different stimuli. At last: the science of “soup or salad?”

Or wanting could have evolved so you could go after things without necessarily knowing if they would be good or not. Unlike liking, which is rooted in physiological reaction, wanting allows for speculation. Furthermore, it doesn’t even have to be rational or guided by experience. Maybe New York would be a good place for me to make my fortune, even though I’m not cut out for it. Or maybe I should immerse myself in neuroscience, despite the fact that I have no interest or training in science and am barely able to make a living writing about television.

Now that Bill and my fate seemed to be linked, the difference between liking and wanting seemed important. He had always been a pleasure seeker. Even if he hadn’t become a prescription-drug addict, he loved the sweet, downing Pepsi—which in our private lexicon was called “spruce”—any time he was awake. Then he discovered Breyer’s Fudge Ripple ice cream, which he could consume a quart at a time; then came his Entenmann’s phase. My senior year in high school, the year he really started to fall apart, he had a different favorite every month. I could mark the months in cherry cheesecake, marshmallow-topped fudge cake, chocolate chip cookies (a half-box at a time), all eaten with noisy, lip-smacking relish.

His other pleasures were also consumed with equal enthusiasm, but when it came to talking about his appetites, it was always within the confines of liking versus wanting. The line Bill gave me about how the prescription drugs were only ...