Gray Matters: A Biography of Brain Surgery. By Theodore Schwartz. Dutton; 512 pages; $32. One world; £25
Neurosurgeons are usually portrayed in one of two ways in popular culture. As a brilliant, if arrogant, boffin. These doctors are intellectuals (this is brain surgery after all) who have very little social life. Think of Dr. Jack Shepherd, the protagonist of a television series “Lost,” or Doctor Strange, a Marvel character. Another common portrayal is as a mad scientist. At best, these characters perform unethical surgeries and, at worst, become cannibalistic serial killers, like Hannibal Lecter.
But Theodore Schwartz, a neurosurgeon and professor at Weill Cornell Medicine in New York, argues that these portrayals ignore much of what modern neurosurgery is actually about. “Grey Matters,” a captivating new book, goes on a journey through a variety of brain surgeries, ranging from seemingly unsophisticated emergency treatments for traumatic injuries to high-precision surgeries to electrode implants that treat obsessive compulsives. Provide relief from disorders. For each, Dr. Schwartz skillfully weaves explanations of the procedures with personal and historical anecdotes and real-life case studies, including those from his own patients as well as notables like John F. Kennedy and Joe Biden themselves. Found on the neurosurgeon’s operating table.
The result is a satisfying and diverse insight into an interesting profession. There are a few points when the book reads like a page-turner – for example, when discussing the Kennedy assassination – with the occasional detour through a medical textbook (“to better understand… what “This supports the second-shooter hypothesis; we will first need to review some basic anatomy of the brain and skull.”)
For those unaware, the details of the surgery are gory. Be prepared to imagine the sound of drilling through skulls and the sight of macerated brain tissue. But according to Dr. Schwartz, the impact of these terrifying procedures on patients and their families is also dramatic and poignant.
Most books document the history and practicalities of brain surgery, beginning with the work of Harvey Cushing, an American pioneer in the early 20th century. At that time every process was a journey into the unknown. Now, a century later, surgeons have precise maps of patients’ brains thanks to MRI and CAT scans, and they are equipped with high-tech kit to make their work more precise and less invasive.
Dr. Schwartz is most interesting when he considers issues where his field relates to society. What to do about a head injury in sports, according to a neurosurgeon? Not so much, it turns out. As long as athletes are aware of the risks and are compensated appropriately, they should be allowed to bang their heads together if they want. Are certain brain injuries a sure sign that a child has been abused? In Dr. Schwartz’s opinion, yes, until proven otherwise.
He also reflects on how a career spent rooted in the brain changes the way you think about the brain. “Grey Matters” argues against the notion of free will using evidence from scientific studies and stories of patients whose surgery has caused how they consciously perceive their surroundings. Rather than people having a unified self that controls their actions and thoughts, Dr. Schwartz believes that most of these emotions arise spontaneously or in response to triggers from the outside world, again a plausible argument. Causes why a movement was made or why an idea arose.
The brain is rapidly becoming the center of the technological world. One of Elon Musk’s companies, Neuralink, is trying to develop a sophisticated brain implant that can record and transmit nerve signals, allowing paralyzed patients to control a computer cursor. Meanwhile, the desire to improve the artificial “brains” that power artificial-intelligence software is leading many techies to look for inspiration in the real brain. Even the most intelligent people in society still intend to better understand the mysteries of the human brain.
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