2 Journey to The Brain transcription

#2 Journey to The Brain

Oliver Trace[00:00:00]wanted to get on to how you decided to go and study medicine.

Iain McGilchrist[00:00:06]I say, I come from a medical family, so I'd always had this sort of idea that being a doctor was quite a good thing to be, and I'd wanted to do something that would be more directly ministering to people than simply kind of sitting in an Oxford room. So there was that. But I think it was much more driven by philosophical interest, basically in the mind body problem. It seemed to me that what was wrong with our study of literature was that we took something that someone, a living being in the past, had taken pains to create as something entirely unique. In other words, if they hadn't written it, you couldn't have imagined it. Entirely implicit in that, you know, as soon as you start to unpack a poem, it's sort of forced, disappears, like laboriously explaining a joke, it's no longer funny. And also very embodied, that it wasn't just about sort of an idea I could extract from it in a seminar room, which would be something that we could all sort of co-cerebrate about. It was something to do with the feelings in the body in one's sense of oneself. Indeed, simple physiological things like within reading a poem, reading a great poem, things happen to your bodily movement, to your heart rate, your blood pressure, to your pulse, to your... It can make your hair stand on end. It can bring you out in a sweat. It can bring tears to your eyes. So it's a very physical thing. And one feels that its impact is somewhere way beyond language. And yet, of course, in the seminar room, it was all about language being explicit and abstracting things from their context and making them general.

Iain McGilchrist[00:01:51]we started with something embodied, unique and implicit and ended up with something abstract, general and explicit. It seemed to me to have somewhat defeated the purpose of the work of art. And I tried to explain that in the book I wrote called Against Criticism. I was sitting at lunch one day in All Souls with a colleague I very much liked and admired, David Hawkes, who was a great Sinologist, and he was asking me kindly about what I was writing about. And I was trying to explain that making things explicit completely changes them and that, you know, that things have to be embodied. They can't just be cerebral. And I said, I can't explain in English why this should be the case. It seems when I try to explain it and people go, What? That's not logical?, and he said, Oh, well, the Chinese have words for that and that and that. And I thought, Oh, and I almost went off to do Chinese at that stage. But at this stage I was already very interested in the mind body thing. And Oliver Sacks had just written “Awakenings” in 1976 or something like that, and I had one of the first copies of it and it really, really impressed me because here was somebody who was a doctor who was thinking philosophically about the meaning of what happened to his patients, and this seemed to me wonderful and expressed exactly this coming together of the mind and the body.

Oliver Trace[00:03:20]there seems to be a hint of imitation of Oliver Sacks.

Iain McGilchrist[00:03:25]you like, imitation in the sense that I think we all are drawn to the goals we go to by exemplars. I don't think we're pushed from behind by a logical train of argument: I should do this, therefore I take this step and so on. Instead, there are things ahead of one that look magically interesting and one's attracted to them. And that's how it was for me. And I went to the medical school in Oxford and said, I'd like to do medicine. And they said, Well, that's fine. What A-levels have you got? The only relevant one was maths. They said, Well, you'll have to go back to the poly and get an A-level in... And by this stage I'd been a fellow for seven years of a rather prestigious Oxford College. I didn't really fancy going back to a poly, so in fact I went to Southampton, which was a university that had been set up, well, not the university, the medical school there had been set up on the principle that it would be good to take people from non-science backgrounds into medicine in the principle that medicine is both a humanity and a science, which is another thing I love about it. It brings together both the scientific way of thinking and the more humane way of thinking, the more rounded, deep, rooted way of thinking. So I went there, loved it, did it, got a degree. Worked at the Wessex Neuro Centre as a Senior House Officer, and then went to the Maudsley in London, which is a big psychiatric teaching hospital. And there I had some more transformative experiences.

Oliver Trace[00:04:55]you were a Psychiatrist.

Iain McGilchrist[00:04:57]was training for eight years as a Psychiatrist, and then I became a, if you like, a fully fledged Consultant Psychiatrist.

Oliver Trace[00:05:04]you speak of transformative experiences.

Iain McGilchrist[00:05:07].

Oliver Trace[00:05:07]you draw out one or perhaps two?

Iain McGilchrist[00:05:10]. It was a rather wonderful place in those days. I say in those days because it's had constraints placed on it, by the way in which universities and hospitals have changed. But in those days it was possible to explore in some depth what was going on with patients from a sort of thoughtful point of view, not just, we'll up the dose of this drug and down the dose of that one. I mean, that's something you have to do, I'm not saying you shouldn't, but there's got to be more to it, if you like. And one day I saw a poster advertising a talk by someone I'd never heard of on a topic I'd never heard spoken about. And it was John Cutting, who I considered probably the most interesting living Psychiatrist, speaking about the topic of his new book then, published by OP in 1990, called “The Right Cerebral Hemisphere and Psychiatric Disorders”. And in medical school, I'd heard very little about the right hemisphere. Everything seemed to depend on the left hemisphere, and the right hemisphere was rather like one of those territories in maps in the old days where it's sort of "here be dragons", you know, something's going on, we don't know what. And I always thought, Oh, I could sit in a common room and have another cup of coffee and study a bit more of this textbook or I could go to the lecture, and I went to the lecture. Well, thank God I did, because it really completely changed the course of my life. I couldn't hear enough of this and I couldn't believe what it was I was hearing because John was saying, he was explaining for the first time what it is about the right hemisphere that he had found in his study. And let me just say, most people at that stage had spent a lot of their time studying the left hemisphere, but very little studying the right. And what he had done was the absolutely unimpeachable scientific thing of sitting down with patients and just listening to what they had to say and recording it. And so he had 20 years of sitting at the bedside of people who'd had a stroke or a tumor or an injury affecting the right hemisphere. And what he was saying in this lecture was that... a number of things, one after another, which just struck me between the eyes. I mean, one was, the right hemisphere is the one that understands implicit meaning, whereas the left hemisphere tends to take things very much literally so metaphor, i.e. the substance of poetry and including the sound of language, i.e. again, another aspect of poetry and its movement and its embodied feeling and so on are all best appreciated by the right hemisphere.

Iain McGilchrist[00:07:57]of course, the right hemisphere can't speak. And so I began thinking, Oh, well, maybe that's why I found it so difficult to explain in language, which is the tool largely of the left speaking left hemisphere. And the right hemisphere, importantly, does contribute to language, something we could come on to. But the point is that as far as the way we speak goes, it's largely determined by the needs of the left hemisphere, which is doing the speaking. And it's very hard to convey these things in language. He was saying the right hemisphere understands the whole thing, whereas the left sees the part. The right hemisphere has a sense of uniqueness. When people have a stroke in the right hemisphere, they can no longer recognize individuals, they can only recognize the type or category to which they belong. And I thought, My God, these are all the things that we were getting wrong with our seminars on literature, explicitly talking about them in this left hemisphere orientated way, when in fact the subject was crying out for our right hemisphere to be involved in understanding it. So that was definitely one of the transformative moments of my time there. Probably the most transformative thing that ever happened to me during my psychiatric training.

Oliver Trace[00:09:13]was certainly the most animated you've been during our conversation so far. Well, if body language has anything to reveal.

Iain McGilchrist[00:09:19], it meant everything to me because after the lecture, I went up to him and said that was amazingly interesting. And I wrote a book called Against Criticism, in which I was trying to explain this about literature, Would you like to read it? And John, being a very modest and kind person, said, Yes, I'd love to. And he did. And he contacted me and said, This is fascinating. You and I should do some research. And he basically allowed me to come in on some research he was preparing. And this was about the ways in which people with schizophrenia see the world and the way in which people with affective psychoses, manic depression, as it used to be called, or bipolar disorder and depression, and they have very different takes on the world. And this has to do with the two halves of the brain.

Oliver Trace[00:10:04]'d just like to flesh out for a moment this issue that you take with people analysing literature in a mechanical way. Could you explain how that tends to work in a simple way.

Iain McGilchrist[00:10:19], first of all, I'm not against it happening. I'm just against it being the end of the process, which is a common theme with me, that there's nothing wrong with the analytic process of the left hemisphere. It's a very useful tool. It's just a very bad master. And therefore we shouldn't stop at the point where we've analyzed things. We need to give that information back to what the right hemisphere sees as the whole picture. So there's nothing wrong with, for example, taking a poem apart and saying, So what is this poem about? How does the poet go about sort of addressing this? What part does rhyme or meter or whatever play in this? What about the sound, the assonance of the movement of this? You know, what are the general themes? But the trouble is that things tend to fall very flat. I mean, an example I have often used because it's so striking is the opening of a poem by one of my favorite poets, Thomas Hardy, called The Self Unseeing. And it begins, it's very, very simple, it begins: Here is the ancient floor. Foot worn and hollowed and thin. Here was the former door where the dead feet walked in. Now if that doesn't make your hair stand on end. I've not done a good job of rendering it. But what does it say? Here I am in a room. There's a floor that used to be a door. But it's actually about the loss, the biggest loss in his life for the person who had shared his life for so long. So, you know, and I also think of Shakespeare, you know, if you render Shakespeare into ordinary prose, I mean, for example, the line: There is no art to read the mind's construction in the face. You know? Wow. But what he's saying is you can't tell by looking at somebody what they're thinking. But actually, that's not what he's saying. What he's saying is: There is no art to read the mind construction in the face. It's a different thing.

Oliver Trace[00:12:32]point is, what he's saying is what he's saying and nothing else.

Iain McGilchrist[00:12:34].

Oliver Trace[00:12:35]as soon as you try and break it down, it then...it can help with understanding, for a while, but you then want it to be taken back up into the whole.

Iain McGilchrist[00:12:44]mean, the best analogy for this is learning a piece of music. You're attracted to it as a whole. You try to play it, then you find you need to take it apart and practice that particularly difficult bar passage at Bar 18 or whatever. And you do that and you also look at it from a harmonic point of view and see that here there's a shift to the dominant and so on. All that is fine. But when you then, you must do that, but then when you go on stage to perform, you must forget all that. If you start thinking about what your fingers are doing, the thing will be ruined. So the time spent on it was not wasted. But it doesn't obtrude at the end of the day, it's almost as though it had never been.

Oliver Trace[00:13:22], I've thought about that a lot because you say how with music, you say how when you first experience something it's very much understood by the right hemisphere, that is aware of what's out there. But then once it becomes known then moves into the realm of the left. And my experience when I'm learning music is that it does become extremely known. And then in fact, I end up playing the same pieces that I already know. And it can take the life out of yourself, to be honest. And if you don't have the discipline to continue to learn a new piece, you then end up losing interest in playing altogether.

Iain McGilchrist[00:14:07]need to have a certain... having had a very close acquaintance with it, you need to have a degree of distance. And Pascal pointed this out that in order to really understand something, you have to have written it, put it away and come back to it when you've forgotten about it. And I think it was Delacroix who said about painting that you need to have this degree of distance from what you're painting. You can get too close to it for a while, while you're painting it, and then you need to go away from it and come back to it.

Oliver Trace[00:14:35]that to me is reminiscent of the... I think it's T.S. Eliot who says we will not cease from exploration, but at the end of all of our exploring, we'll return to where we began and know the place for the very first time, which seems to be this same idea that you need to go away from something, come back to where you already were, but then know it afresh.

Iain McGilchrist[00:14:58]. Can I before we move on interject, another experience during my training, was the other terribly important one.

Oliver Trace[00:15:06]. Yes. We didn't even get there.

Iain McGilchrist[00:15:09]my training, I was lucky enough to go to the Johns Hopkins Hospital in Baltimore and do neuro-imaging in Godfrey Pearlson's lab. But while I was there, I got a postcard (this was long before email) from John Cutting saying, I've just read the most incredible book. You must read it. And that book was “Madness and Modernism”, subtitled “Insanity in the Light of Modern Art, Literature and Thought” by Louis Sass, S-a-s-s, and Louis was in those days a researcher, now a distinguished professor at Rutgers. And he had written a book about essentially the similarity between the experiences of people with schizophrenia and the phenomena described in the 20th century in art, literature and thought. And he made about 30 important parallels between them that once you've seen them are obviously rich and not just an accident. At the same time, my experience of America was telling me something about the future. Because if you want to see the future, it's always what America is doing. Whatever they're doing now, we get it five years later. And what I found there was already a very disturbing tendency to have to make everything very explicit. And I was feeling very, that things had become very disembodied and remote from sort of the natural world. And everything was grid like. I mean, this is a very unfair reflection on American life, but it has its truth. And so I began to see that there was something about this in America as well, what I'd identified as the left hemisphere's take seemed to be rather prominent, that things seemed to be more abstract, more general and more disembodied, somehow. Less intuitive. And so I put two and two together because it struck me that clearly we hadn't got a society or civilization in which everybody had suddenly contracted schizophrenia. But what might be happening was that we were no longer properly paying attention to the right hemisphere, because quite clearly this world of the schizophrenics that Louis was looking at, and he does allude to it in an Appendix, looked very much like right hemisphere brain damage. And so putting two and two together, I thought, right, okay, perhaps our society is moving into a mindset in which the right hemisphere take on things is sidelined or even actively disregarded. And that, of course, became part of The Master and His Emissary. But it also got me thinking, if that's the case now, how was it in the past? And therefore the second half of The Master's Emissary, as you know, is a sort of reflection on the way Western civilization has developed. Looking at it through that one particular lens of to what extent was the right hemisphere or the left hemisphere the more dominant, or were they in balance or were they out of balance?

Oliver Trace[00:18:33]leads us on just the right time to the book, The Master and His Emissary, which you spent 20 years writing.

Iain McGilchrist[00:18:45].

Oliver Trace[00:18:46]it a struggle?

Iain McGilchrist[00:18:48]it a struggle? Is the pope a Catholic? I mean, it was the most monumental struggle. And at times I just despaired that I would ever write it. Indeed, I went into therapy at one stage simply to work out why I could not write this book. I was working and working on my computer. There are somewhere about 30 starts of the book, some of them quite long, which were all abandoned, and I just couldn't complete this. And despite the fact that if you ask me, you know, if there's one thing you want to do before you die, I'd say I want to get this book out. And so that's what I did. I went into therapy and I never found the answer, but perhaps the answer came in that I wrote the book. And it wasn't that I was afraid of what people would say or something. I mean, that probably entered into it, but it wasn't enough because I didn't think a lot of people would read it anyway. It was just that I, at the end I just thought, Oh, look, never mind. I mean, you know what you mean, so why does it matter? Nobody will read it anyway, so just forget it and enjoy the rest of your life.