MOVING ON AGAIN
The public service instinct bit me once again and I served as dean of the faculty at Dartmouth. A search committee unanimously nominated me as their candidate. They gave only one name to the president for consideration. In hindsight, I realized that may not have been the best footing on which to start a new job. Also, my years of not attending faculty meetings left me without a certain skill set. To be a successful dean of faculty you must either have a fine-honed strategy for navigating faculty politics or full support from the top. I had neither. I lasted only two years. Happily for me, the University of California, Santa Barbara, asked me to return, and it looked like another golden opportunity.
Six years after I left Dartmouth, on the occasion of my class’s fiftieth reunion, Dartmouth awarded me an honorary degree (Figure 48). My family attended the event, and my class, the Class of 1961, asked me to give a lecture after the ceremony on my science. What actually occurred has been indelibly written into my mind. I let my stunning daughter, Francesca, Dartmouth Class of 2007 and then a graduate student at the University of California, San Francisco, give most of the talk. As John Kennedy said, “the torch has been passed.” One of the deans came up to me afterward and said, “Does Francesca want a job?” Needless to say, I do love Dartmouth, as does our family, and on that occasion, my brother and I, along with his two sons and two of my daughters, established an award for the top graduating scientist.
FIGURE 48. Jim Kim, the new president of Dartmouth, presents me with an honorary doctorate in 2011 on the occasion of my fiftieth class reunion. President George H. W. Bush was also awarded a degree, and Conan O’Brien gave the commencement speech.
(Courtesy of the author)
PART 4
BRAIN LAYERS
CHAPTER 9
LAYERS AND DYNAMICS: SEEKING NEW PERSPECTIVES
The beautiful thing about a new idea is that you don’t know about it yet.
—CHARLES TOWNES
I WAS READY FOR A NEW BEGINNING IN 2005, and what better place to begin it than in Santa Barbara, where I had started my professional career? Forty years earlier I had bought property in the seaside town of Carpinteria, just twenty minutes south of the UCSB campus, and I still owned it. Now, with the good luck of a new position, I was all set: My new book was coming along, the climate was intoxicating, and moving into the home that I had designed and built with my own two hands forty years earlier was fulfilling. Adding to that, many of my family lived close by. A new benefactor, the Sage Publishing Company, had bestowed a major gift on the university to start a center for the study of mind, and life seemed very good indeed.
I have a large family, so after considering the price tag of UC’s life insurance for a sixty-six-year-old man, I decided to buy my own insurance on the private market. It was a lot cheaper, and the required physical was easily done in my own home by a traveling health-care professional. A quick EKG, a vial of blood, and it was all taken care of, or so I thought. A couple of weeks later, the insurance agent called to say that our request for a term life policy had been denied. I protested as he explained their policy was not to say why. A few days later he called back and sotto voce said the words no man wants to hear, “Your PSA was sixteen.”
My prior medical care was under physicians who worked at the Dartmouth-Hitchcock Medical Center in Hanover. One of the leading epidemiologists in the world was the guiding light, and his studies had suggested there was little or no value to PSA testing, a biomarker test that detects blood levels of prostate-specific antigen (PSA). The physicians who took care of me said the decision to take the test was up to me. Knowing why the epidemiologist had his view, I sided with his reasoning, and, for the important ten years prior to my PSA of 16, I had never been tested. It all has to do with base rates of occurrence and outcomes. With large samples of data, epidemiologists had determined that, on average, patients with elevated PSA scores did not do significantly better with various medical interventions. In other words, there is no reason to get the test because if you have it, treating it doesn’t improve the outcome. On average. The problem, of course, is that the average is made up of individuals and some are on the high end and are possibly helped. I can tell you, when you have been anointed with prostate cancer, all you can think about is: When can they start the interventions? The don’t just stand there, do something! urge trumps detached statistical reasoning.
My nephew and my namesake, Michael Scott Gazzaniga, is a urologist and has clinical and patient skills that are over the top. He talked me through the troubling news, even saying he would do the biopsy for me down in his Orange County office. I had just heard some horror stories about a friend who had gone into sepsis after his biopsy and had almost died. Others routinely complain about the uncommon pain of it all. The specter of surgery, of radiation, of hormone therapy, of suffering the horrible painful death of prostate cancer, all rushed to mind. Mike calmed me down and said he had done more than three thousand biopsies, had never had a complication, and further, there would be no pain the way he did it. That was the good news. The bad news was that he determined I had the crud, real bad.
Mike quickly arranged for me to see the fabled urology surgeon at the University of Southern California, Donald Skinner. Skinner was my age, and his reputation for magical hands in prostate surgery was widely known. I remember him sweeping into the exam room holding my various charts and scans, and he simply said with a big smile, “Boy, what did you do to deserve this?” He walked my wife and me through it all and then arranged for surgery the following month, after a short course of hormone therapy to reduce the size of the prostate before surgery. On the morning of the surgery, Mike came up to sit in on the procedure, as he wanted to see the magic hands of Skinner and, of course, to offer his support. Away I was wheeled by the resident out of the prep room. I said something to Charlotte, and before I knew it, I was waking up in the intensive care unit with all the nurses smiling and saying it went well. It was a moment both weird and wonderful. My abdomen had just been filleted and my prostate cut out, removed through a foot-long incision. Within hours and with their help, the staff had me up and walking around. Morphine helps, but so does the driving good spirit of family and the staff of a well-run hospital.
The next day Dr. Skinner checked in on his morning rounds to see how I was doing. He had his flock of interns and residents following him, as is always the case in teaching hospitals. I felt compelled to ask the blunt question: “How long do I have to live?” Skinner paused and looked at me and said very calmly, “I have put you back onto the normal death curve.” Charlotte and I rejoiced. We had thought, given the nature of the preoperative biopsies, I had about two years.
Such life events do drive us to mental places that I have systematically tried not to visit: considering death in general and early death in particular. Of course, we know about death; we have had good friends die, we have had parents die. But these experiences bear little relationship to the moment you’re on deck. It’s you, nothing existential or overly melodramatic, and the jig is tangibly up.
My views are nothing out of the ordinary. The lights are on and then they are off. When they are off, you won’t know it because you will be dead. There will be no missing of family and friends because you will be dead, so there is no need to fret about that while you are alive. You will be missed by others, but that is true of them as well, should they suddenly die. You will miss out on things you wanted to do, which is true, but what does that mean since you will be dead and won’t know it? And, on and on. In the end, by working through all of this, death seemed less scary, less paralyzing. Just like the leaves that fall off a tree, life ends. In fact, these ruminations proved to be good preparation for an honor that fell to me out of the blue about a year after my surgery.
GETTING READY FOR THE GIFFORDS
In 2007, I was invited to deliver the Gifford Lectures at the University of Edinburgh, for the year 2009. I was both shocked and overjoyed. Jacques Barzun had described the Gifford
Lectures as virtuoso performances and “the highest honor in a philosopher’s career.” The lecture series, more than one hundred years old, was charged by Lord Gifford to discuss natural theology as a science, that is, “without reference to or reliance upon any supposed special exceptional or so-called miraculous revelation.” That part I could do! It also meant that I had two years to prepare, and I now had good reason to believe I would live long enough to complete the assignment.
The invitation to give the Giffords motivated me to pull together my own thoughts on the weighty issues of human meaning and the future trajectories of neuroscience. Such assignments lift one out of the day-to-day, out of the next task to get done, out of the next proximate issue to solve. I could feel my brain creak and crack under the strain of trying to lift my experiences up to a new level. As Nobel Prize–winning psychologist Daniel Kahneman likes to point out, our brains are lazy and don’t like to work too hard.1 And as George Miller had famously shown and most entertainingly wrote about,2 we have a rather limited working memory and can only keep a few items in it active at a time. I needed another level of abstraction, that is, single-word substitutes, nicknames, jargon for involved concepts, to make some room for stuff in my working memory in order to understand how all the bits in which I was immersed fit together. I needed the bigger picture. I can do it, I thought. I’m a big-picture guy. After all, abstraction is what we revert to when details overwhelm us.
Neuroscience was all about the relationships between structure and function. Two main schools of thought had formed about how they interact. Some held that the brain’s structure is set early and that the shifting actions of any organism come about by the very brain actually changing. Others held that multiple fixed structures in the brain are differentially called to duty, which only makes it look like a changing, plastic system, which in reality it is not. “Find out which is which!” was the call of the day, and the secrets of how the brain does its tricks would be unraveled. More accurately, a fixed versus plastic brain was one of the many dichotomies that had been set up. Another had to do with the deep reductionist beliefs of most scientists. Reductionism is a philosophical stance. It holds that a complex system is nothing but the sum of its parts. By looking at its parts, the whole can be predicted, and by looking at the whole, the parts can be described. In neuroscience, this translates to: A produces B, which produces C, a nice linear view of the world and a good one to start with if trying to figure out the brain. “Study simple systems!,” and the simpler the better: sea slugs, worms, and, if studying primates, then study only the behavior of single cells. Rats and mice were allowed for some issues. And again, all of this was proffered with a heavy reductionist bent that held that everything about the brain and what it produces can eventually be understood by simply looking at what the electrons in the neurons are up to. Starting from cognition to behavior to systems to cells to molecules, like peeling an orange, science could get to the bottom of it, to the seed, so to speak. And, like the seed that eventually produces a tree that produces an orange, we could build up again to the brain. So from electrons, then molecules, we could build in a straight line up to cognition. It would all fit into place. I was raised on this view, and, in many ways, I believed it, and to some extent I still do. At the same time, there is this tug on the mind, and it screams, “That can’t be it!”
What is so palpably true is that the toiling scientist is always aware of the limits of his or her own work and of the possibility of barking up the wrong tree. When an idea falls from grace, it usually isn’t because the original proponents had never thought of alternative views. They are usually painfully aware of other possible views about the underlying truth. They choose a side in the hunt and stay with it as long as possible and sometimes even longer than that. This is what Kahneman would call the “sunk cost fallacy,” where you have invested so much already that you feel obligated to follow through. It is not right or wrong. It is what we humans do. In the current era of human brain imaging experiments, thousands of scientists are committed to finding the places and/or networks that seem to be more active during certain kinds of cognitive states. All realize, however, that this neophrenology may not be capturing the essence of how the brain does its magic to make us who we are and how we feel. I have often thought a clever way to make this all more explicit would be to have scientists submit with their papers for publication a review of their own work. I am sure their reviews would be the most scathing. Not many scientists are chumps.
As life goes on and various experiments sink in and either take hold or are thoroughly rejected, the overarching view of how the mind/brain issues are to be framed changes. In many ways, it is not unlike walking down a path, a well-trodden path, and suddenly seeing something new. It has been there all the time, but for reasons of belief, or ignorance, or fatigue, or attention to another thing, the something is not seen. When a graduate student at the University of Chicago’s economics department pointed out to his professor, who deeply believed in efficient monetary markets, “Sir, there is a hundred-dollar bill there on the path,” the professor replied, “That is impossible.” Our theories blind us all. Still, it was my turn to give the big picture a shot.
BRAIN PRINCIPLES AT A GLANCE
Almost seventy years of neurobiological research has taught us that the brain is not a bowl of random spaghetti with its wires randomly spreading and slithering around with each toss of the chef. It is a highly structured biologic machine managing a complex code of action that had been called an “enchanted loom” years before by Sir Charles Sherrington.3 An organism “remembers” its evolutionary successes, in both its structure and function, from the toenail or claw to the liver, through its DNA. The brain is hardly an exception, just another one of those parts for which successes have been coded in DNA. Who wants to start from scratch learning everything? That is not a good survival strategy. Better to pass some basics along to get things up and running as fast as possible. The brain comes with lots of programs that ready us for life’s challenges.
Sperry laid this all out with his work on neurospecificity: In research that he had launched and developed before his Caltech days, he showed how the neurons in the brain hooked up.4/5 When that knowledge is carefully considered, it prepares one for all kinds of future insights about the brain. Babies come from baby factories with capacities. With every passing year, we learn not only how much one-year-old babies know, but also how much one-month-old babies know: a lot. The field of developmental psychology keeps driving back the age at which babies reveal their cards. A group of clever Hungarian psychologists have now carefully observed babies’ eye movements in psychologically structured moments and have discovered that six-week-old babies already have a theory of mind about others and see the social implications of other’s gestures.6 It also looks as if babies come born with a passion for teaching others new information. Unlike the zebra fish and the dog, which have their own extensive sensitivities to social order and more, human babies seem to come equipped to teach others.7
This formulation, that the brain is prewired in many ways, has withstood the test of time, even though some have a reflexive belief and want the brain to be infinitely malleable. It is an admirable desire and is rooted in the American belief that anything can be fixed by external reinforcements. Many professionals in the field cling to the idea of, for the lack of a better word, endless mutability. Unfortunately, most neurologic disease has a deadening finality to it. The slack such disease produces is not automatically taken up by another part of the brain.
The other idea that is powerfully captured in the last seventy years of neuroscience research is that processes of underlying behavior, cognition, and even consciousness itself are highly modular and work in parallel. Like most complex machines, this camp believes that parallel processes are ongoing throughout the brain’s operations and are intricately producing a unitary function. Intricate, integrative processing from super-modularity seems almost nonsensical at first glance. And it gets worse. Whi
le disrupting any one part in an actual machine disrupts its operation, taking out hunks of the brain can frequently have little effect on that machine’s behavior. Some hunks are vitally important, and some frosting on the cake. What’s going on?8
First, to grasp the push toward modularity, think about one of the more remarkable aspects of a split-brain patient’s reality. Prior to disconnecting the two hemispheres from each other, the left speech hemisphere merrily describes everything in full view. Just like you, when a patient is looking at someone’s face, they can see not only the right half of the face but also the left half, miraculously stitched up at the midline by the brain into a unitary whole.
Now here comes the unfathomable part. Recall that after their surgery, their speaking left hemisphere now only sees the right half of the world. When you ask them, “What has changed?” difficult as it is to believe, they say not much. Everything seems more or less normal from the perspective of the left speaking hemisphere’s point of view. How could that be? Can you imagine waking up after brain surgery, only seeing the right side of space, and saying not much has changed? Wouldn’t you say something like, “Ahhh, Doc, I used to see all of your face when I looked at your nose, but now I only see half of it. What’s up with that?” Indeed, why doesn’t the left brain miss all the other stuff that the right brain was doing when they were connected? While you think about that, here is a hint: You don’t think about or miss thinking about the gazillion unconscious processes that are ongoing in your brain that produce the conscious awareness you continually and uninterruptedly experience emanating from your left hemisphere. In fact, you don’t even know that they exist unless you follow what’s going on in brain research. Following hemisphere disconnection, what has happened is that everything that the right hemisphere did, and still does, has now joined the ranks of inaccessible processes. They have been added to that category of things you don’t miss and don’t think about.
Tales from Both Sides of the Brain : A Life in Neuroscience (9780062228819) Page 33
