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When Neurology Becomes Theology

Early in my neurology residency, a 50-year-old woman insisted on being hospitalized for protection from the FBI spying on her via the TV set in her bedroom. The woman’s physical examination, lab tests, EEGs, scans, and formal neuropsychological testing revealed nothing unusual. Other than being visibly terrified of the TV monitor in the ward solarium, she had no other psychiatric symptoms or past psychiatric history. Neither did anyone else in her family, though she had no recollection of her mother, who had died when the patient was only 2.

The psychiatry consultant favored the early childhood loss of her mother as a potential cause of a mid-life major depressive reaction. The attending neurologist was suspicious of an as yet undetectable degenerative brain disease, though he couldn’t be more specific. We residents were equally divided between the two possibilities.

Fortunately an intern, a super-sleuth more interested in data than speculation, was able to locate her parents’ death certificates. The patient’s mother had died in a state hospital of Huntington’s disease—a genetic degenerative brain disease. (At that time such illnesses were often kept secret from the rest of the family.) Case solved. The patient was a textbook example of psychotic behavior preceding the cognitive decline and movement disorders characteristic of Huntington’s disease.

WHERE’S THE MIND?: Wilder Penfield spent decades studying how brains produce the experience of consciousness, but concluded “There is no good evidence, in spite of new methods, that the brain alone can carry out the work that the mind does.”Montreal Neurological Institute

As a fledgling neurologist, I’d already seen a wide variety of strange mental states arising out of physical diseases. But on this particular day, I couldn’t wrap my mind around a gene mutation

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