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6 March 2019

Let Me Not Be Mad: powerful case histories of unravelling minds

Neuropsychologist AK Benjamin conjures strange and powerful stories in a book poised between fiction and memoir.

By Lisa Appignanesi

A silver-haired man, still wet from swimming, sits in an NHS consulting room and nervously declares to a clinical neuropsychologist that he’s always been “ditzy”. When he can’t repeat an adequate number of words from a string in an assessment test, a future of degeneration looms.

Parents arrive at a hospital meeting without their ten-year-old son, “a big delinquent baby”, who has refused to attend, though it is he who needs assessment. Their narrative about the boy won’t coalesce into a single story: the mother noisily accuses the father, who denies any emotion. He speaks of an elaborate train-set he has bought. The boy has dramatically used its junctures to deliver a version of ECT. The clinician has a strong sense that the problem lies in the parents’ relations, not just with the child.

Lucy mistakes her neighbour’s house for her own, floods her kitchen, gets lost on her way to the ladies. Names “stick on her tongue like peanut butter”. Does she have Alzheimer’s or are grief, insomnia, panic attacks, depression, shingles, Type 2 diabetes and a host of other ills causing her anxiety and recurring distractions? Will an MRI scan and a diagnosis of Alzheimer’s increase her symptoms or help to ease them?

Michael – 58, rich, very fit, fond of extreme sports – takes his son ski jumping in Chamonix, suffers a terrible accident and is incubated and kept in coma for five weeks, then transferred to an acute neurology ward. When he returns home he is himself – or is he? And who wants that? The large egg-sized scoop in his head seems to be the smallest part of his difficulty.

These are some of the cases that AK Benjamin, himself a clinical neuropsychologist, conjures in this strange and powerful book, poised between fiction and memoir, and on that wavering line where the neurological and the psychological intersect. However white or surgically green the coats the medics wear, however detailed the algorithms that produce the MRIs, humans seem to resist being reduced to their brains, even when it’s their brains that might – on current measuring tools – be askew.

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Benjamin (a pseudonym) is acutely aware of that fundamental complexity. He recognises the seductiveness of psychiatric or neurological diagnoses, even when wrong. An authoritative medic’s diagnosis can “suggest” the patient into feeling and enacting its specifications, while also soothing them by providing a reason for a deeply buried “inchoate sense” that something has always been wrong with them. On top of that, “we must somehow make our illnesses special, our own that is, otherwise they remain terrifyingly separate from us”. As for the triggering point of illness, unless the result of a neuro-degenerative disease or a brain injury, and however it may have been exacerbated (or allayed) by drugs, drink, or the chemistry produced by extreme sport, Benjamin reaches for psychoanalytic explanations: childhood, parental inattentiveness (or over-attentiveness), family dynamics.

But this is not a simple narrative of striking cases written by a far-seeing practitioner. It’s a turbo-charged race. Language darts and hurtles through a landscape of unyielding and punitive conditions. Transference may ever be in play for the professional mind doctor. In this book, there’s a threat from the start: if Benjamin feels his patients’ conditions intensely, it’s because he also is one.

His book is like a meeting of Oliver Sacks and Hunter S Thompson. Both are on speed. There are mountains to climb, marathons to run, rivers to swim. Mania, extreme relationships and often matching prose fuel the narrative. There’s a journey up to a Buddhist retreat in California, complete with a visit to a neuropsychologist with palatial working conditions overlooking the Pacific and his own MRI scanner that allows the patient to see a lavish, rotating colour display of his functioning brain on a vast screen. The image shifts to show a sailboat that the patient, in a task aimed at bolstering his “cerebral reserve”, is asked to move by concentrating and breathing – “part of our theta wave bio-feedback training system”, says the practitioner smoothly.

Thinking of his own working conditions in the NHS, where he uses a tennis ball to illustrate a brain to his patients (a brain he describes as “a major roadworks on the M25 in rush hour”), Benjamin estimates his Californian counterpart to be “right on the line between bullshit and authenticity”. He is also hopelessly jealous. 

What stood out for me in a book that veers between the expressive and the therapeutic, were the insights into the increasingly impoverished NHS – the waiting rooms, the bare clinical spaces, the cuts, the strain on staff and medics struggling to serve extremely difficult patients. Breakdown is not only a category of the inner world. l

Lisa Appignanesi’s latest book is “Everyday Madness” (Fourth Estate)

Let Me Not Be Mad: A Story of Unravelling Minds
AK Benjamin
Bodley Head, 224pp, £16.99

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This article appears in the 06 Mar 2019 issue of the New Statesman, The next crash