Neurosurgeons are typically portrayed in one of two ways in popular culture. One is as a brilliant, if arrogant, boffin. These doctors are intellectuals (it is brain surgery, after all) who have very little social life. Think of Dr Jack Shephard, the protagonist of “Lost”, a television series, or Doctor Strange, a Marvel character. The other common depiction is as a mad scientist. At best, these characters perform unethical surgeries and, at worst, become cannibalistic serial killers, such as Hannibal Lecter.
But these portrayals miss much of what modern neurosurgery really is, argues Theodore Schwartz, a neurosurgeon and professor at Weill Cornell Medicine in New York. “Gray Matters”, an engrossing new book, goes on a tour through different types of brain surgery, from seemingly crude emergency treatments for traumatic injuries to high-precision surgeries to implant electrodes that provide relief from obsessive compulsive disorder. For each, Dr Schwartz skilfully weaves explanations of procedures together with personal and historical anecdotes and real-life case studies. These include his own patients, as well as notable people, such as John F. Kennedy and Joe Biden, who found themselves on neurosurgeons’ operating tables.
The result is a satisfying and varied insight into an intriguing profession. There are points when the book reads like a page-turner—in discussing Kennedy’s assassination, for example—with occasional detours through a medical textbook (“To better understand…whether this supports a second-shooter hypothesis, we’ll first need to review some basic anatomy of the brain and the skull.”)
To the uninitiated, the details of surgeries are gory. Prepare to imagine the sound of drilling through skulls and picture the sight of macerated brain tissue. But in Dr Schwartz’s telling, the impact of these grisly procedures on patients and their families is also dramatic and touching.
Most of the book documents the history and practicalities of brain surgery, starting with the work of Harvey Cushing, an American pioneer, in the early 20th century. At that time every procedure was a journey into the unknown. Now, a century later, surgeons have precise maps of patients’ brains thanks to MRI and CAT scans, and are equipped with high-tech kit to make their work ever more accurate and less invasive.
Dr Schwartz is most interesting when he muses on issues where his field intersects with society. What does a neurosurgeon think should be done about head injury in sports? Not that much, it turns out. As long as athletes are aware of the risks and are appropriately compensated, then they should be allowed to smack their heads together if they wish. Are certain brain injuries a sure sign that a baby has been abused? In Dr Schwartz’s opinion, yes, until proved otherwise.
He also ponders how a career spent rooting around in brains changes how you think about the mind. “Gray Matters” argues against the notion of free will, using evidence from scientific studies and stories of patients whose surgery has changed how they consciously perceive their surroundings. Instead of people having a unified self that controls their actions and thoughts, Dr Schwartz believes that most of these feelings arise spontaneously or in response to triggers from the outside world. The brain then generates a plausible rationale post hoc for why a movement was made or a thought conjured.
The brain is increasingly lodged in the centre of the tech world. One of Elon Musk’s companies, Neuralink, is trying to develop a sophisticated brain implant that can record and transmit neural signals, allowing paralysed patients to control a computer cursor. Meanwhile, a desire to improve the artificial “brains” that power artificial-intelligence software is driving many techies to look for inspiration in real ones. Even society’s brainiest are still intent on better understanding the mysteries of the human brain.
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