A Penn clinical neurologist explores ‘hijacked brains’ and the secrets of personality-altering diseases in her new book
Sara Manning Peskin takes readers into the worlds of early onset Alzheimer’s and other conditions in "A Molecule Away from Madness."
Sara Manning Peskin treats people facing what are among the most heartbreaking diseases in medicine.
They are people whose bodies have vandalized their minds. They may have lost their memories. They may be overwhelmed by hallucinations.
Horrible, yes. But Peskin, an assistant professor of clinical neurology at the University of Pennsylvania, does not turn away. Instead, she finds herself contemplating the social implications of the diseases. She attempts to balance respect and empathy not only for the patients, but also for the caregivers. In a sense, she winds up treating entire families.
To her, these diseases pose a basic life question: Where do people find meaning, and how do you find meaning within the limitations of these diseases?
Now, Peskin has written a book about some of neurology’s knottiest problems and the researchers who tried to unlock their secrets.
In A Molecule Away from Madness: Tales of the Hijacked Brain, she takes readers into the worlds of early onset Alzheimer’s, Huntington’s disease, and vitamin deficiencies that have staggering effects.
We spoke to her recently about it all.
What prompted you to write this book?
I wrote the book because I wanted to show what it’s like to have some of the most dramatic, personality-altering conditions of the mind. These are the kinds of diseases where a person brings their spouse to the clinic and says “this is not the person I married,” and it’s not just a typical case of people drifting apart, but rather that there is something going on, at a molecular level, that has turned the spouse into a different person.
I also wanted to be a bit of an entertainer, telling the stories of the outlandish and often ostracized scientists who discovered how these diseases work. There’s Santiago Ramon y Cajal, who spent all his money on printing scientific results and then couldn’t afford a nanny; Joseph Goldberger, who tried to catch a neurologic disease by eating flakes scraped from a patient’s rash, and even the more well-known Alois Alzheimer, who presented his findings to a room of completely disinterested colleagues who went on to a boisterous debate later in the day about the cause of excessive masturbation.
Just one molecule away from madness? Yikes! Please explain.
Many diseases of the mind are caused by changes in a single type of molecule: a DNA mutant, a rebellious protein, or a small molecule that’s either invaded the brain or is conspicuously absent.
There’s so much redundancy in the brain, so it’s surprising to see that a tiny mutation in our DNA sequence, or the proliferation of a single, dangerous protein, can wreak such havoc on our ability to think.
We don’t usually consider it as we’re eating breakfast or sitting through meetings, but our brains are in this perpetual, molecular battle to keep our identities intact. Most of the time we do fine, but sometimes things go wrong and the effects can be tremendous. Even more impressively, in many cases we have the science to bring people back.
What does this say about the beauty, the fragility and perhaps even the resilience of our brains?
On the one hand, even though the brain is the most complex machine known to humankind, it has these Achilles’ heels, these blind spots, where a tiny glitch can throw everything off-kilter.
At the same time, we have to recognize a sense of awe for the fact that most people don’t encounter any of these conditions. The average healthy 65-year-old is likely to go their entire life without ever developing dementia. This means that even though we survive on the brink, most of us actually do just fine. Our brains are inherently resilient, and on top of that we have the benefit of medical invention.
As you did your research, was there anything in particular that surprised you, any “aha!” moment that struck you?
I initially envisioned the book as a compilation of stories about patients and scientists. I pored over Oliver Sacks stories as a model for patient narratives, and Siddhartha Mukherjee as a model for telling the history of medicine.
Eventually, I realized that I was actually writing about something that I did every day in my clinic. Patients who show up in a cognitive neurology office tend to describe symptoms like memory loss, word-finding difficulty, and behavior changes. While listening to the patient’s story, the doctor is performing this great act of distillation, tinkering with probabilities in order to draw a connection from the real-life symptoms to the most likely molecular cause of the disease.
In the end, I tried to create a book that allows readers to follow along in this process, seeing what diseases look like in real life and real people, and then understanding the brilliant and eccentric scientists who found the molecules that cause the problem.
You describe horrific conditions — limbs twisted, memories vanished, an inability to speak or understand language. Amid these “tales of havoc,” as you call them, what gives you hope and optimism?
A hundred years ago, almost all of the diseases I wrote about were terminal. But today, most are actually treatable and some more are preventable. People sometimes talk about cognitive neurology as a “diagnose and adios” type of field, but in fact we’ve been lucky enough to have a slew of successful researchers who helped us make incredible advances.
We don’t yet have a cure for Alzheimer’s disease, but we’ve made such strides in the past few decades. So as much as the book is about mayhem in the brain, it is also about some of the biggest triumphs in neurological history.
Bonus question: How can we take better care of our brains?
There are essentially four things to focus on: exercise, diet, social engagement, and intellectual activity. The data for exercise benefiting cognition is incredible, and we usually suggest something like 30-40 minutes a day, three to four days a week, of an aerobic activity. Diet is harder to study, but the Mediterranean diet seems to have the best data as far as brain health. And for decades now, there have been strong studies showing that the more we engage socially and intellectually, the slower our memory and thinking abilities decline.