Neurological literature: Neurophysiology

Posted in Neurological Literature,Special Feature on 15th Mar 2017

 

andrew-larnerAJ Larner, Cognitive Function Clinic,
Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK. Correspondence to: a.larner@thewaltoncentre.nhs.uk
Published online: 15/3/17


Previous articles in this series have focused on literary accounts or narratives of various neurological disorders, including headache, epilepsy, cognitive disorders, and sleep-related disorders. Since these conditions are the very stuff of human experience, and likely to be encountered at either first or second hand by the majority of the population, it is perhaps unsurprising that novelists have on occasion taken such conditions as source material for elaboration in their narratives. Neurological investigations, on the other hand, are perhaps less familiar to the general populace. This brief article looks at some literary references to neurophysiological investigations.

Electroencephalography (EEG)

It is perhaps unsurprising that authors within the genre broadly described as “science fiction” have been attracted by the technological implications of EEG for recording and/or monitoring the human nervous system.

The prolific sci-fi author Philip K Dick (1928-1982) explored the possibilities of EEG in his 1974 novel Flow, my tears, the policeman said.1 (Musicophiles may know that “Flow, my tears” is taken from the title of a lute song composed by John Dowland in the late 16th century; the phrase was also used, almost three centuries later, by Gary Numan, based on his reading of Dick, in the first line of Listen to the sirens, the first track on Tubeway Army’s eponymous album of 1978, re-issued 1979.) In the dystopian world of Dick’s novel (possibly set in 1988), the “pols” (police) want a “fingerprint, voiceprint, footprint, EEG wave pattern” from the protagonist, Jason Taverner:

… seated, he allowed terminals to be placed here and there on his head; the machine cranked out three feet of scribbled-on paper, and that was that. That was the electrocardiogram [sic! Checked in two separate editions of the book].

Despite having the EEG print Taverner suspects that the pols will not be able to find his information in their extensive data pool. Later when Taverner is being sought by the pols, they suggest that “we may be able to catch him with an EEG-gram projection from a copter”, to get “a match of patterns”. Clearly the view here is that EEGs are sufficiently individualised as to permit identification, even if recorded with leads placed “here and there” on the head.

Through its incarnation as the film Blade Runner (1982), probably the best known of Dick’s novels is Do androids dream of electric sheep? (1968).2 There may be EEG references here too, specifically in the allusions to the “Penfield mood organ”, a method of “artificial brain stimulation” which features in both the first and last sections of the book. For example, Rick Deckard, squabbling with his wife, “at his console … hesitated between dialling for a thalamic suppressant (which would abolish his mood of rage) or a thalamic stimulant (which would make him irked enough to win the argument).” Different dialling codes on the organ permit the selection of different moods, such as 888 for “the desire to watch TV, no matter what’s on it” or 670 for “long deserved peace”. (Music aficionados will know that this dialling trope also appears in Gary Numan’s I dream of wires from the Telekon album of 1980.)  As a neurologist reading this book (en route to, and in the interstices of, an international neurology conference!), I immediately thought the Penfield mood organ must be a reference to Wilder Penfield (1891-1976), whose work (with Herbert Jasper) stimulating the cortex of awake epilepsy patients undergoing surgery allowed him to map the functions of various regions of the brain.3 The possible influence of Penfield on Philip Dick is acknowledged in a psychology textbook.4 I do not know whether Dick ever underwent an EEG. His biographer Lawrence Sutin speculates a possible diagnosis of temporal lobe epilepsy to explain some of Dick’s experiences, in particular a series of “visions and auditions” experienced in February-March 1974 which influenced his later writing.5

Ursula Le Guin (born 1929) is another author categorised as within the sci-fi genre who has explored the narrative possibilities of EEG. The plot of The lathe of heaven (1971)6 revolves around EEG recordings. Dr William Haber of the Oregon Oneirological Institute records EEGs during the dreams of George Orr:

As soon as the cap was in place he switched on the EEG … Eight of the cap’s electrodes went to the EEG; inside the machine, eight pens scored a permanent record of the brain’s electrical activity (20),

Somehow, Orr’s dreams affect outward reality (“effective dreaming”), a faculty which Haber seeks to take control of, using his Augmentor which operates by “instigating and then reinforcing … d-state activity” (56), for his own advancement, with catastrophic results.

In The word for world is forest (1976),7 sometimes regarded as Le Guin’s indictment of the Vietnam War, colonists from Earth have enslaved the peaceful Athshean people. Raj Lyubov, the colony anthropologist, has studied the Athsheans:

He had wired countless electrodes onto countless furry green skulls and failed to make any sense at all out of the familiar patterns, the spindles and jags, the alphas and deltas and thetas, that appeared on the graph.

However,

It was with Selver [an Athshean] as EEG subject that he had first seen with comprehension the extraordinary impulse-patterns of a brain entering a dreamstate neither sleeping nor awake.

Suffering a migraine headache, Lyubov wonders what Selver would do:

Although knowing nothing of electricity he could not really grasp the principle of the EEG, as soon as he heard about alpha waves and when they appear … there appeared the unmistakable alpha-squiggles on the graph recording what went on inside his small green head; and he had taught Lyubov how to turn on and off the alpha-rhythms in one half-hour lesson.

Electromyography and nerve conduction studies (EMG/NCS)

Literary accounts of EMG/NCS might be anticipated in patient accounts and fictional narratives featuring individuals with neuromuscular disorders.

In his account of the episode of Guillain-Barré syndrome (GBS) he suffered in 1981-2, the author Joseph Heller (1923-1999), best known for his 1961 novel Catch-22, reported two EMG examinations.8 The first, performed at the Mount Sinai Hospital in New York, lasted less than fifteen minutes, whereas the second, performed at a rehabilitation facility, the Rusk Institute at the New York University Medical Centre, lasted more than two hours. “The worst both times … was the needle plunged into the palm of the hand near the base of the thumb.” At Rusk, all four limbs were examined as well as the face.

None of the pain from the individual electric shocks or from the needle punctures was so intense as to make one wish to cry out. It was the repetitions of the electric shocks that rapidly wore me down, and which gradually proved more and more terrible …

Although “[m]y F-wave responses were not too good” and “the doctor muttered to himself that there was definite facial involvement”, Heller was subsequently informed that the “results of the EMG test were inconclusive, neither confirming nor eliminating Guillain-Barré”.

In Solomon’s Porch: the story of Ben and Rose, a college professor in his 50s develops a neurological illness which is labelled as GBS9 (I have critiqued this diagnosis elsewhere10). It does not appear that EMG/NCS is ever performed, which may account for some of the diagnostic confusion.

Incredible as it may seem, EMG/NCS has been the stimulus for a poem, “The Nerve Conduction Studies” by Simon Armitage (born 1963),11 from which these selected lines are quoted:

We loop conductive strips over the toes

 

and fingers, press conductive strips and pads

into the calves and wrists, ..

 

the trace comes up on the screen and we ask

 

for a second or third flick of the switch

if the jolt doesn’t travel the distance

the first time.

 

These tests are well known to hold true; we trust

they prove nothing less than you dared hope for.

 

References

  1. Dick PK. Flow, my tears, the policeman said. London: Gollancz, 1974: 76,78,79,210.
  2. Dick PK. Do androids dream of electric sheep? London: Gollancz, 1968:1-4,189-192.
  3. Penfield W, Jasper H. Epilepsy and the functional anatomy of the human brain. Boston: Little, Brown, 1954.
  4. Banyard P, Flanagan C. OCR psychology. AS core studies and psychological investigations (3rd edition). Hove: Psychology Press, 2013:133.
  5. Sutin L. Divine invasions. A life of Philip K. Dick.       London: Gollancz, 2006 [1989]:231-232.
  6. Le Guin UK. The lathe of heaven. London: Gollancz, 1971.
  7. Le Guin UK. The word for world is forest. London: Gollancz, 1976:45,80.
  8. Heller J, Vogel S. No laughing matter. New York: Simon & Schuster, 1986:38,54-55,191-194.
  9. Riley J. Solomon’s Porch: the story of Ben and Rose. Baltimore: America House, 1999.
  10. Larner AJ. GBS100: some literary and historical accounts. In: Willison HJ, Goodfellow JA (eds.). GBS100: Celebrating a century of progress in Guillain-Barré syndrome. Peripheral Nerve Society, 2016:20-27.
  11. Armitage S. The universal home doctor. London, Faber and Faber, 2002:43-44.
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