The Tale of the Dueling Neurosurgeons (2015)

The Tale of the Dueling Neurosurgeons:
The History of the Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery (2015)
Sam Kean

“We crowned ourselves Homo sapiens, the wise ape, but Homo limbus might have been more apt.”

For anyone even slightly interested in the brain, which should include all primates, I imagine, the book is incredible.

The title comes from King Henri’s joust with another royal man. He jousted one too many times, and the lance pierced his skull, damaging his brain. He retained conscious for a while, drifted in and out for some time, and then died. But his two “neurosurgeons” – although with slightly different perspectives and thoughts for treatment – did little to help his condition.

Like his other books, Kean’s history goes outside of neuroscience when it needs to. He gives a wonderful account of how Andreas Vesalius’ illustrated De humani corporis fabrica changed anatomy and science overall, as well as bits and pieces of how the scientific revolution was avoided for thousands of years – good god, especially in medicine — and eventually came about.

One of his most amazing accounts is that of James Holman, a British officer who traveled the world, describing his adventures. For a reason I’ve forgotten, he had rather severe ailments while at home in England, and his fellow officers and superiors eventually began to think he was bluffing simply to travel more. And there was also the rather strong stigma against someone with Holman’s condition in that day, especially when he purported to travel and enjoy the sensations of the outer world with such passion. For I must remember, of course, that Holman was blind, and moved with echolocation. And what good was travel to a blind man, since he could not see new sights?

I may have teared elsewhere, but I profoundly remember doing so hearing the conclusion to the information we (don’t) know about Holman’s life. He set about to end his adventures by writing about his life, and did so. Yet his other books sold so poorly that the book wasn’t published, and alas, it was lost to history.

Two unrelated quotes that require little explanation follow, although I must remind myself of the quantity of scientists who seem to become less scientific in their latter decades.

However much suffering they produce in the short term, wars have benefitted medicine profoundly.

But Penfield convinced very few colleagues to take dualism seriously, and a flippant remark he’d made when young must have haunted his later years: “When a scientist turns to philosophy,” he’d sneered, “we know he’s over the hill.”


Another neat point is that effectively, Kean notes, because of Woodrow Wilson’s health issues, Edith Wilson was the first female president.

Identifying “doubles” of others is another of the stranger brain disorders, yet it also speaks to conspiracy-laden theories about the shape shifting abilities of aliens, or demons in the past. In actuality, this is a problem with the observer’s brain’s ability to connect the subtle changes in the visual appears of faces over time with the same emotional feelings that the face should evoke.

Kean’s description of split-brain disorder is excellent, showing both how those with a severed (or damaged) corpus callosum can function effectively normally, yet be of two minds. He even evokes some interesting philosophical questions after describing that in reality they – and we! – basically have two conscious brains. For instance, if one brain “accepts Christ” and the other rejects it, what then? I love it. Furthermore, he describes how we rationalize, giving examples of images that evoke emotion to the emotional hemisphere, but which bubble up in the logical hemisphere and demand (and receive) a justification for the brain’s feeling angry, horny, or sad: “Another memory came up that made me feel sad.”

What does neuroscience mean for free will?

Again, free will is an illusion of our conscious mind made after the fact, after we’ve made the choice. We’re certainly “free,” in some sense, to contemplate our next life decision for a few weeks, but when we actually make the decision — just like when to pick up the fork before eating a meal — we’re not in control at all. Nay, our subconscious brain is doing the real processing power, and our conscious- and cortex-bits are rationalizing the entire process.

We’re fooling ourselves, and having perfected this art for a few million years, we’re experts at it. The real difference between humans and other primates? They don’t lounge around in their trees all day deluding themselves that they’re free to choose which bananas to eat, and when to eat them.

This has ridiculously profound implications for the judicial system.

Kean ends with the most famous story of brain damage in neurosciences, especially to anyone who’s read anything even a touch related to the brain the past decade: Phineas Gage. But people like me are his target audience: most of what we think we know of Gage, after the accident, is likely wrong. As a result of some historical sleuthing, especially with a book by another author, we uncover the more likely truth: Gage lived out his later years more or less normally. He wasn’t a raging, drunk molester swearing at everyone and losing his money at each turn. He likely even worked for years at a time driving horse carriages in Chile, a task that would have suited his brain damage well, yet provided for an honest living and a decent life. But Gage is misunderstood by readers like me simply because he is misunderstood by scientists and historians. Kean says that Gage’s story has essentially been a sort of Rorschach blot for scientists. The sad story of Gage is not just how his was distorted, but perhaps how much further along neuroscience could be if we’d studied him a little more closer, as a human who could heal.



Macmillan also suggests that Gage’s story is worth remembering because “it illustrates how easily a small stock of facts can be transformed into popular and scientific myth.” Wise words.


8:31 AM: Now I am really, completely awake.
9:06 AM: Now I am perfectly, overwhelmingly awake.
9:34 AM: Now I am superlatively, actually awake.

Wearing has dozens of diaries littered with such entries, each one denying, with incredible adverbial dexterity, that he’d ever been awake before. . . .

In the end, Gage and Wearing sit on a spectrum, the tenacity of Gage’s consciousness on one end, the fragility of Wearing’s on the other. You certainly couldn’t call Gage lucky, but his focal damage at least spared his consciousness. Wearing, meanwhile, enjoys neither the gift of full mental awareness nor the release of permanent oblivion. Instead, his own brain torments him with an almost mythological malice. Like Sisyphus’s boulder, as soon as he gets a purchase on his consciousness, it slips away. Like Prometheus’s liver, it grows back every few seconds, only to be torn out again.

In this work, Kean gives me a short manifesto to describe why I’ve always enjoyed non-fiction far more than the alternative: I simply find actual human life to be far more interesting than anything we could imagine. Truth is stranger than fiction, and scientific discoveries often remind us of that. It is wise to remind myself how just the other day, reviewing The Demon-Haunted World, Sagan reminds us that the “descriptions” of aliens are far less extraterrestrial and foreign than a modern zoology or pathology textbook.

Perhaps even more important than the science, these stories enrich our understanding of the human condition—which is, after all, the point of stories. Whenever we read about people’s lives, fictional or non-, we have to put ourselves into the minds of the characters. And honestly, my mind has never had to stretch so far, never had to work so hard, as it did to inhabit the minds of people with brain damage. They’re recognizably human in so many ways, and yet still somehow off: Hamlet seems transparent next to H.M.

((It is of note that today’s book reports – The Tale of the Dueling Neurosurgeons and Black Hawk Down – both reference Shakespeare. The latter reference’s his description of the brotherhood of combatants in Henry V, and the former describes how true accounts of brain damage were far more real, personal, and touching than any work of Shakespeare might be. To each his own, I suppose.))



(All emphasis mine)