Sunday, March 2, 2025

Ghost Range: Brain! Brain! Brain!

The first known professional female athlete has posthumously been diagnosed with CTE. 

Heather Anderson, who played for the Adelaide Crows, retired in 2017 after suffering on-field injuries including at least one confirmed diagnosed concussion.

Anderson took her own life in November 2022 at age 28.

Now the Australian Sports Brain Bank, which specialises in researching diseases associated with repeated head injuries, has confirmed she had "low-stage CTE" in her brain.

A recent visit to Santa Fe reminded me of one of Dr. Haffner’s most impressive cases.  A case that set the tone for me in my understanding of how our brain could recover contrary to what I was brought up in Neurology at Queen Square.
It was our first visit to Santa Fe in New Mexico which arguably had some of the famous places that has been used in an impressive number of films.  Ghost Range, White Sands and  Bandelier came to mind and of course there is Alamos, home of the Atomic Bomb that eventually finished off the Japanese and their atrocity especially in China.  Yet it is often as exciting to visit the local market on a Saturday as it is to visit famous sites.  We get to see some fresh local produce that local farmers are very proud of.  Quite unexpectedly something caught my attention at one of the stalls that reminded me of Christopher Haffner.
Everybody is afraid of Dr. Haffner at the Regional Child Psychiatric Clinic.  O.K. He is tall and quite formidable. He still carries a strong Austrian accent.  But he never shouts and he speaks very gently.  Perhaps it is because he seemed to know a good deal both within and without the medical field.  As a chief, he is unusual in knowing most things that people get up to.  One day, I was late with a family and when I got back to the office, Dr. Haffner was there looking through a number of files by the filing cabinets.  It was then that I knew how it was done.  But I am not going to tell you if I pick up this little trick from him.
Secretly though, we do know that we must take note of his utterances as he would have thrown in some gems that would affect our thinking.  Good teachers do throw in a new way of looking at things which may indeed be too obvious some times.
I later found out that he probably was one of the first to establish the three unusual in-patient units in one setting in the whole of Britain: a middle age group children’s unit where I was mainly placed, a unit for Autistic children and unusually a mother and child unit.  All the time I was there, I have not heard of another mother and child unit.
His take down of Eysenck and IQ test is the first shock I encountered and one of the side effects was years later when our girls were grown up, without prompting at all, they thanked me for never doing an IQ test on them.  His most memorable example was how a very high IQ genius when asked to pick up 3 lbs of tomatoes would fail abysmally when a untested child that has helped father at a market would come very close to it.
One day he announced that he is going to do a special presentation.  This is not something that happened often and when it did, we all make sure that we rearrange our appointments.
This was about two twins that were hardly six years old; identical twins.  One day father was taking the younger twin to some activity.  The parents always felt that it was important to bring them up separately although other parents of twins have the opposite view.  Unfortunately  they were involved in a very serious car accident. Both survived.  The boy suffered fairly serious concussion and was unconscious for around ten days.  He was eventually referred to Dr. Haffner.
The essence of his presentation was that he felt the brain can somehow recover and one advantage would be related to the young age of the patient.  At the beginning, the boy could not remember who he was and there was hardly any speech.  Mother decided to give up her teaching job to spend as much time with him.  From Dr. Haffner’s presentation, he has suggested that the parents should perhaps treat him as a new baby so that he can learn everything afresh.  It was a difficult first few months and then suddenly everything progressed rapidly.  Nine months after the accident: “I arranged for an IQ test and he is now within 10% of his brother!”
Wow!
“And IQ test does have its place!” He read my mind.


Back to Santa Fe Market:

            There was a little table with a pile of books and a little picture: Climbing Back.  A lady was behind the stall and she does not look like the usual market vegetable selling person.  So I started chatting to her.  She was promoting her book about her son’s journey back to life after a very serious accident.

Her name is Elise Rosenhaupt and her book is called Climbing Back: A Family's Journey through Brain Injury[1].

It was about her son Martin, who at the start of his second year at Harvard, was hit by a car and thrown 150 feet. He landed on his head, suffering severe traumatic brain injury.  So if anything it was much worse than Dr. Haffner’s patient who was thrown about at the back of the car although not much was known about how badly hit he was.  It was interesting to scan through her observation of the slow process of recovery, probably much slower than the much younger boy.  

It is a nice confirmation of how much more we know about our brain and nervous system.

Go to details page
Climbing Back: A Family's Journey Through Brain Injury
https://www.harvard.com/book/climbing_back_a_familys_journey_through_brain_injury/



Book to read:

9781780225920

Do No Harm is a remarkably simple book. So much so, The Guardian (the book was short listed for The Guardian ‘First Book Award’) asks, ‘Why has no one ever written a book like this before?’ Each chapter’s starting point is a real life case. The clinical and extra-curricular vignettes recited allow the reader the privilege of being a fly-on-the-wall during moments of incredible personal and professional strain, sometimes during frank disaster, and occasionally during enormous relief and hilarity. In total, the book makes up a lean, unadorned, honest memoir of just some of the emotional thrills and surgical spills from a life spent in a busy tertiary neurosurgical unit. There is no twisting, confluent, fictional, engineered storyline because the quotidian of Marsh’s operating theatres, clinic rooms and foreign trips provides a surplus of heroes and heartache to sate the appetite of even the most demanding reader, publisher or dramaturge. 

 Link: https://blogs.bmj.com/medical-humanities/2015/02/10/the-reading-room-a-review-of-henry-marshs-do-no-harm/

The Old views on Brain.

When I was training in London in the 70s, I spent some time at Queen Square. Those in the know will recognize it as the place for neurology this side of the Atlantic. It was drilled into us then that sadly we were given a number of brain cells when we were born and it was all downhill from then on or something to that effect. It was well known that neurologists were great diagnosticians but for most neurological conditions, not much could be done. How depressing indeed. Even as recently as four weeks ago, I heard a young doctor told his father that there was nothing he could do with his brain cells. One is given so many at birth and no more can be expected. Lord Brain (1895-1966) would have been so proud.

Yet it was also London that shook the world with new discoveries about the brain, and the study was on the most unlikely group of people: Taxi drivers. Their “KNOWLEDGE” was the basis of our knowledge on brain plasticity today. The “KNOWLEDGE” is a term officially used to describe the test the Taxi Drivers had to take to get the licence to drive Taxis in London. Streets in Londonhave evolved over time and are not on any grid system at all. Early postmortem examinations led some pathologists to note the small size of the Taxi drivers’ frontal lobes. Yet actual weight measurement showed that size was all relative. It was the enlarged hippocampal region that created that impression. Later work using modern scanning techniques confirmed the early impressions.

If two to four years of “KNOWLEDGE” acquisition can change the size of the brain in a grown adult, what else could we do?

The rest, as they say, is history.

The Cockroach Catcher II: Attempted Living


USA: Check it out on Amazon

 

Cockroach Catcher-Seven Minute Cure













Posted by at No comments:

Monday, February 24, 2025

Worrybot: a personal review.

I was on holiday somewhere near the equator when I received an email about writing a book review. A book about “middle-aged” children. I do know a bit about this “group” as during my training in Child Psychiatry, I landed a Senior Registrar post at a “middle-aged” children in-patient unit that provided me with experience that I never imagined possible and probably set me up for dealing with children with difficult problems of all ages (psychiatric or otherwise).

This much I will tell you about me for now as I have not quite make up my mind if I should or should ever tell you more.

This happened after having read the book (and more than once) that to review such an interesting and suspenseful book will needs lots of spoiler alerts. Even then, I may not want to spoil too much really. Yet there are bits that were such gems that I cannot wait to tell you.

Hopefully I am not violating Royal College book review guidelines on such reviews.

Spoiler alert: Making a Worrybot with shoe boxes in the book to mimic a human robot so that the sick child could let the robot swallow his symptoms.

“No, no, no. He is not sick, he is just anxious. You are too clinical, as the so called symptoms were just his worries.” Did I hear you say this?

Sorry, that was just my deliberate attempt to illustrate how we may have over-clinicalised many childhood conditions and in some countries all for the benefits of extensive use of medication/s. One boy I know was worried during Covid that he was obsessed with his “Happy Birthday” hand washing and was prescribed an SSRI plus sleeping tablets after a 10 minute visit to a Psychiatrist somewhere I am not going to disclose!

Simon should patent Worrybot as it would be safer than SSRIs (I won’t say what they might do as you can easily Google it) and be a bit green on those Amazon Boxes. By the way GREEN is often mentioned as a topic of education together with 5-a-day though our chief star in the book Josh only likes ORANGE. Five oranges a day5-a-day!!!!i To Joshs it is totally non-sense (ooops, I meant non-science based and it was indeed pulled out of thin air!)

Big surprise here: guess who are the other “patients” that used Worrybot apart from Josh, our STAR after he decided to look through his worry slips that Worrybot is supposed to have swallowed!

First---his Mom: “my performance management appraisal meeting”.

Then---his Dad: “never getting another acting job!”

What a gem or two gems! Sorry for spoiling, but I could NOT NOT tell you. His parents certainly saved on Gin or Whisky. Ooops, she is director of PUBLIC HEALTH.

Here is the best bit of Simon’s book: on lying. On Josh’s first new school day: Dad had no choice but to lie about Mom losing her car key etc. to rescue Josh from his new found friend or to be exact, his friend’s regular friend. Then the next day, Dad forgot his lie but luckily, Josh’s little sister remembered the lie and lied to rescue Dad from the new friend’s mom.

Phew, they were taught early on, in-utero or otherwise by Mom: Sometimes it’s kinder not to tell the truth.

Well, done, Simon, my kind of book.

So in this book for the “middle-aged kids”, is there sex?

After a neutral non gender start, the robot that attended school for the school refuser( which by the way is the CENTRAL part of the book) turn out to be female and is called Charlie. So when Josh asked his parents if Charlie could come for a sleepover, the parents, were humming and ha-ing and were seriously dubious but did not want to destroy their troubled son’s improved socialisation new era, were seriously troubled!

Do parents let a different gender friend come for a sleepover?

When they hesitantly plus reluctantly agreed, mom was asking about food that Charlie would like!

Smart Willows( little sister that knew how to lie) came to the rescue with the truth this time: its only a robot! Translated as totally asexual!

But Simon was quite subtle. But, yes, there is sex!

It is perhaps time I should throw in my halfpenny's worth as someone that spent a few decades dealing with children’s problems (and that includes adolescents of course) that one of the most important lesson I have learnt is not to dismiss and tried to get rid of defence mechanisms that they used. We need time, time to understand what really was going on. Rushing into the use of medication, be it SSRIs, antipsychotics or stimulants is a definite NO NO for me. My recent experience from a son of Holocaust surviving parents taught me that even denial may be a better way of coping than too much stirring up of sad old memories. After all, I have listened to a Maudsley Psychiatrist’s talk on his experience of the Kings Cross fire survivors: those that had talking therapy did the worst!

These are the gems I tried to dance around without spoiling the main story of the book which Simon has skillfully woven together, although I must admit that at times it was very tempting to reveal more! A must read for anyone wanting to be an organic child psychiatrist or parents who do not really want labels or meds for their unusual child.

I have to raise my hat to the Royal College of Psychiatrist’s decision to review this book given some of the stories I have heard; of friend’s grand kid’s experience with seeing Child Psychiatrists where diagnosis of what I called the 3 A disorders were common: namely, ADHD, Autistic Spectrum Disorder & Anorexia Nervosa and often with more than one of those and I have met one with all three. Simon had subtly inferred that we need to spend time to understand and not jump in to change what the child is using to resolve any problem.

One of the best lines in the book: “Maybe taking advice from a school refuser wasn’t such a bad idea!” Simon perhaps was aiming for this and it fits in with our ancient Chinese saying: A long sufferer will turn into a good doctor! To finish, I have to quote Picasso: I spent a life time trying to draw like a child. Perhaps we should try to think like one.



Conflict of Interest: Simon’s sister after giving birth to her first child came to one of my Child Psychiatry seminars and subtly asked if she would rotate to my department as a trainee registrar, could she bring her six weeks old baby. The rest as they say is history and I did not realise I was one of the first consultants to allow that. When she realised that I was asked to review her brother’s new book, she asked if I could be kind!

No, you do not need to be kind to a book like this one.


The BJP review: BJPsych Bulletin , Volume 48 , Issue 4 , August 2024 , pp. 272


















Posted by at No comments:
Subscribe to: Posts (Atom)