Thursday, March 4, 2021

Brain: New Views.

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 book covers the changes to the brains of musicians and medical students. It tells us that just three months of memory work can have noticeable effect on the brain of medical students, and music memory work has similar impact on musicians. I was pleased to learn that Bilingualism helps too. From infancy, I and my siblings were brought up with speaking two Chinese dialects at home.

Will medical schools that have abandoned traditional teachings please bring back Anatomy-the old way?

Did the 300,000 or so that took up piano this year in China know a thing or two about brain plasticity? Currently 30 million children are reported to be learning the piano in China.

As a child psychiatrist, I find the ones on ADHD showed great promise but I doubt if we are ever going to see the end of the stimulants’ hold on the condition in the West. It is interesting to note that Stimulants never took off in China, a country with a fifth of the world’s population. Computer games, on the other hand, have really taken off there.

Other Posts:

Nobel: Kandel and Lohengrin

Lohengrin: Speech Disability, Design & Hypertension

Autism, the Brain and Tiger Woods

'The Knowledge' and the Brain

Saturday, February 13, 2021

The Cockroach Catcher: Reviews





Kindle comes in very handy, literally. Yes a 3rd generation gadget that allows you to store and read books and other printed material.   You can pack with you thousands of books on this device that weighs less than a paperback.



This has inspired me to launch a Kindle edition of The Cockroach Catcher (yes, the book).   More importantly, the Kindle edition costs a fraction of the physical copy.  If you do not yet own a Kindle, you can simply download the free Kindle software and read Kindle books on your iPhone, iPad , iPod touch & your Personal Computer. You can read the book within seconds from ordering.        US Verson






Here are some reviews:

I purchased Dr Am Ang Zhang's book last November and placed it at the bottom of my ‘to read’ pile – I should not have done so.

Holidaying earlier this year – I decided that ‘The Cockroach Catcher’ would be my holiday read (even though it was still only half way up the pile) – it was a good decision.

Am Ang takes you on a fine journey from his poor beginnings in China to his education in Hong Kong, his life and experience at medical school, his decision to enter psychiatry leading to a post as registrar at The Tavistock Clinic  and to his role as a consultant paediatric psychiatrist within the NHS (and many interesting places in between).

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.

Although the back cover summary describes the book as a work of fiction, the contents are based on a good and a very real doctors’ journey through medicine.  It is a must read for all those either working in medicine or interested in child psychiatry and indeed childhood itself, and an invaluable read for parents who have concerns regarding their children’s mental health.

It is a fascinating well penned book with references documented in the footnotes and is available from  Amazon.  Visit the cockroach catcher here


Anna :o]

©2016 Am Ang Zhang

5.0 out of 5 stars
Format:Paperback
We all have stories to tell with regard to our experiences as physicians. Zhang is one of our medical school classmates who took it to a different level by writing and publishing a book. The book details how it all started, from the time his family moved to Hong Kong from China, to his years in medical school, to his experience as a child psychiatrist in the UK. The book is full of interesting case studies of actual patients he saw and the challenges he faced dealing with them.
I was captivated by many of the interesting stories in the book. It’s a must-read for all students of psychiatry. It also makes for good reading material for anyone during their leisure moments.

From another doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice (including me giving up private practice and my wife giving up a promising administrative career ) paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

From Australia:

I have finished reading The Cockroach Catcher and thoroughly enjoyed it.

Zhang, I particularly liked the juxtaposition and paralleling of your travel stories and observations with your case studies, Of course, I could appreciate it even more, knowing the author and hearing your voice in the text. Because I’m dealing with anorexia, ADD and ADHD students I was very interested in your experiences with patients and parents and your treatment. Amazing how many parents are the underlying causes of their offspring’s angst. It was an eminently readable text for the medically uninitiated like me. Keep writing, Zhang
 Squid ©2010 Am Ang Zhang
From another doctor:

Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.

I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.
The book is very well written and makes very easy and interesting reading even for the laymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

Fascinating account of child psychiatry cases, including some creative yet effective treatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.

The book makes me realize the difficult decisions with which a doctor is so often faced, the need for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.

Great book. I have bought one to give to my son on his birthday.



And CC, your book is amazing! I am only on page 44 but so far, so wonderful. I think how you turned this anorexia patient around just goes to show what human interaction rather than tick box protocols can do in a short period of time and at low cost too. This is an exemplary illustration on perhaps one of the reasons why a good health system like the one in Singapore can not be fully implemented in Britain. it's the change of perceptions and methodology to suit that's difficult.

And, as a city girl, I found your early life in villages fascinating and very enriching for a bright child like yourself, I suppose, had I been your mother, I too would have not asked you any questions when you were told to leave that school ... but the school supplier of cockroaches! [shiver]Dearime! I run a mile when I see one, let alone catch them and dissect them! boys will be boys after all, now that I know that you weren't joking. you are a cockroach catcher, not only of the soul, but for real! @@

The book is a must read doc, I am really enjoying it :-)”


From the LUL
U.com website, where you can preview the chapter Seven Minute Cure and if you so wish, order a copy of the book (after creating your own account):

Fascinat
ing! What a great read. Just reading the one chapter made me want to read the whole book. Thank you!
A beautiful opening! A piece written with of all that wit, intelligence and sarcasm! The author has managed to illustrate a boring NHS subject in the most interesting of ways. He has convinced me to read on. The NHS should urgently seek help and advice from this doctor!
Thank goodness for doctors like these!! If the rest of the book is as good as the preview chapter then it will be a fantastic resource for practitioners and the public. 
Fascinating preview chapter. I can't wait to read more.
Horrah for the doctor. Chapter 1: The Seven Minute Cure. The doctor overcame the obstacles faced from the establishment and freed a young child from her prison. Great read.
Other reviews and feedback:
Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.
I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.
The book is very well written and makes very easy and interesting reading even for thelaymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.
Fascinating account of child psychiatry cases, including some creative yet effective treatments.  Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.
The book makes me realize the difficult decisions with which a doctor is so often faced, theneed for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.
Great book. I have bought one to give to my son on his birthday.
(Note: both father and son are doctors.)




I was in Special Education for many years. I just love the way you dealt with the girl who was bullied, and the boy with Behaviour Disorder. I am buying two more copies, one for my friend who is a psychologist and one for a colleague in Special Education.

I wish I had read your book when I was headmistress. I would have had so much more insight into why some of the pupils behaved the way they did.
I have been a school counsellor for 15 years and we have had regular recommendations on books to read. None of them taught us as much as your book, which would have been very useful for our weekly screening meeting discussions.
Reading the book and his blog, you cannot help admiring the author's width and depth of knowledge, the light-heartedness, the humility, the humane and the human side of people.
You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author. 
What a book! I cried a little. I laughed a little. I know I should not. 
Your stories are amazing. I really enjoy reading it. 
My wife cannot put your book down and I shall not be able to get my hands on it until she has finished.
I was horrified by some of the gruesome cases and agonised at the suffering of some of your patients. But there are moments of laughter and smile at Dr Zhang's wit in handling the cases and patients.
Am Ang, thank you for a wonderful book. You know I could not put it down. My husband is now reading it and he said it is such an easy read as he thought it was all going to be heavy and clinical.
You have such a way with the little ones. What about the 12 year old pretending to be three and a half! My goodness.
Just the village life can fill a book. (Seriously an in-depth version will be much welcome!) Book two can be Life at HKU. And so on... Fascinating!
Having grown up in farming country, I love the Chapter on The Village. I know it is different but so much about village life just clicked with me. Makes me wants to go home to have a look. I would like you to write more about yourself. Just all the little details you are so good with.
I wish I had your book when I was bringing up my kids. I am giving each of my two children a copy. I decided to put down Pillars of The Earth for a while and start your book on a flight. I could not put it down to go to sleep. Wow: it makes so much sense.
I did expect the cover photo to be one of yours – after all, the creative mind needs full exposure, artistic and otherwise. I was just recommending it to some friends.
I never imagine I can have so much fun and gain so much knowledge by reading a book of this sort by, of course, an author with a sense of humour and a deep understanding of human nature. I really enjoyed reading it. Life could be so much easier if we had the chance to do what we like, to let our thoughts be shared by someone we trust, to make sugar pills of nasty encounters and so on and so forth for bearing more positive thinking. Just by a mere short conversation, which hit exactly at the 'dead pit' of the hiccup boy, the hiccup was over. Human nature is just like that. After reading the author's accounts of his cases, I wish I could also be endowed with such wit and wisdom, not so much for curing others, but to let my own body and soul remain healthy and sound always.
Love it. I read it in three days flat. Not only should parents read it; I think all those in the medical profession should read it. There is so much common sense. I am recommending it to my book club. Will you come and talk to them about it?




Anne of Green Gables 

Friday, February 12, 2021

Bright Young Doctors & Rainbow: NMDA & Autoimmune Encephalitis

In Medicine, it is amazing what the Bright Young Doctors can offer. In my day and now!


Forty years ago, a patient of mine was unconscious for 23 days and it was mother's belief that it was through prayer that her daughter was saved. I did not know anything about NMDA or Autoimmune Encephalitis then nor did Queen Square.

The Bright Young Doctor in my days:

" A good doctor is one who is not afraid to ask for help but he must also know where to ask.
         “Get me Great Ormond Street.”
         “I already did.”
         She is going to be a good doctor.
         “Well, the Regional unit said that they had no beds so I thought I should ring up my classmate at GOS and she talked to her SR who said “send her in”.”
         Who needs consultants when juniors have that kind of network?  This girl will do well.
         “Everything has been set up. The ambulance will be here in about half an hour and if it is all right I would like to go with her.”
         “Yes, you do and thanks a lot.”   ............."                     full ChapterHERE


But perhaps God works through his people in his own way. Discoveries in Medicine should therefore enhance our faith rather than the other way round.

It took nearly 40 years for the real answer to her prayers to really emerge.

 ©2012 Am Ang Zhang


The Bright Young Doctor now:

I was staying at our resort in Boquete and was having dinner with three friends all of them with medical connections. One was in hospital administration and one a nurse. The husband of the nurse was a pharmacist. Somehow the conversation drifted into medical topics and knowing that I am a Child Psychiatrist the pharmacist started talking about his nephew who was nearly sent to a mental institution as he suffers from catatonia and doctors eventually diagnosed schizophrenia and put him on antipsychotics. Luckily the catatonic symptom probably saved him as some bright young thing just read the book Brain On Fire and gave him the Clock Test. That led to the NMDAR antibody testing that proved positive. He responded well to the treatment regime that has been developed and is off all antipsychotic medication.

My Teratoma patient was lucky as she belong to that group that improved without further treatment once the Teratoma was removed. She eventually had a baby.


The Power of Prayers & Teratoma: Brain & NMDA!


Anti-NMDA Receptor Encephalitis

NEW ORLEANS — A mysterious, difficult-to-diagnose, and potentially deadly disease that was only recently discovered can be controlled most effectively if treatment is started within the first month that symptoms occur, according to a new report by researchers from the Perelman School of Medicine at the University of Pennsylvania. The researchers analyzed 565 cases of this recently discovered paraneoplastic condition, called Anti-NMDA Receptor Encephalitis, and determined that if initial treatments fail, second-line therapy significantly improves outcomes compared with repeating treatments or no additional treatments (76 percent versus 55 percent). The research is being presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans.

565 cases! Not so rare!

The condition occurs most frequently in women (81 percent of cases), and predominately in younger people (36 percent of cases occurring in people under 18 years of age, the average age is 19). Symptoms range from psychiatric symptoms, memory issues, speech disorders, seizures, involuntary movements, to decreased levels of consciousness and breathing. Within the first month, movement disorders were more frequent in children, while memory problems and decreased breathing predominated in adults.

My patient was under 18 and presented with catatonia symptoms. She later lose consciousness and was ventilated.

"Our study establishes the first treatment guidelines for NMDA-receptor encephalitis, based on data from a large group of patients, experience using different types of treatment, and extensive long-term follow-up," said lead author Maarten TitulaerMD, PhD, clinical research fellow in Neuro-oncology and Immunology in the Perelman School of Medicine at the University of Pennsylvania. "In addition, the study provides an important update on the spectrum of symptoms, frequency of tumor association, and the need of prolonged rehabilitation in which multidisciplinary teams including neurologists, pediatricians, psychiatrists, behavioral rehabilitation, and others, should be involved."

The disease was first characterized by Penn's Josep Dalmau, MD, PhD, adjunct professor of Neurology, and David R. Lynch, MD, PhD, associate professor of Neurology and Pediatrics, in Annals of Neurology in 2007. One year later, the same investigators in collaboration with Rita Balice-Gordon, PhD, professor of Neuroscience, characterized the main syndrome and provided preliminary evidence that the antibodies have a pathogenic effect on the NR1 subunit of the NMDA receptor in the Lancet Neurology in December 2008. The disease can be diagnosed using a test developed at the University of Pennsylvania and currently available worldwide. With appropriate treatment, almost 80 percent of patients improve well and, with a recovery process that may take many months and years, can fully recover.

Teratoma: finally!

In earlier reports, 59 percent of patients had tumors, most commonly ovarian teratoma, but in the latest update, 54 percent of women over 12 years had tumors, and only six percent of girls under 12 years old had ovarian teratomas. In addition, relapses were noted in 13 percent of patients, 78 percent of the relapses occurred in patients without teratomas.
As Anti-NMDA Receptor Encephalitis, the most common and best characterized antibody-mediated encephalitis, becomes better understood, quicker diagnosis and early treatment can improve outcomes for this severe disease.
The study was presented in a plenary session on Wednesday, April 25, 2012 ET at 9:35 AM at the American Academy of Neurology's annual meeting.
[PL01.001] Clinical Features, Treatment, and Outcome of 500 Patients with Anti-NMDA Receptor Encephalitis

Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies

Of 100 patients with anti-NMDA-receptor encephalitis, a disorder that associates with antibodies against the NR1 subunit of the receptor, many were initially seen by psychiatrists or admitted to psychiatric centres but subsequently developed seizures, decline of consciousness, and complex symptoms requiring multidisciplinary care. While poorly responsive or in a catatonic-like state, 93 patients developed hypoventilation, autonomic imbalance, or abnormal movements, all overlapping in 52 patients. 59% of patients had a tumour, most commonly ovarian teratoma. Despite the severity of the disorder, 75 patients recovered and 25 had severe deficits or died.

Related paper:

Anti-NMDA Receptor Encephalitis: Diagnosis, Psychiatric Presentation, and Treatment


Chapter 29  The Power of Prayers

The following is extracted from The Cockroach Catcher: Chapter 29 The Power of Prayers.
According to old Chinese advice, it is wise never to discuss politics or religion even amongst best friends.           Religious belief can often blur judgement in the wisest of people. In psychiatry it is sometimes not easy. This is particularly true in cases of florid psychosis, which often presents with symptoms of hallucination, delusion and even vision.         I remember my early days of psychiatry in a mental hospital in Hong Kong. Yes, it was the days of 2000-bed hospitals. Yes, it was the days of Medical Superintendents who had supreme power and all doctors of whatever rank and experience were Mental Health Officers with special authority to sign papers for compulsory admissions. The forensic unit was contained within the same complex.         Those were the days when we encountered psychosis in the raw so to speak. All the colony’s really mad people were admitted to this one place set in the furthest corner of the colony. In our year seven of us decided without much discussion that we all wanted to go into psychiatry. That was over 10% and all had quite idealistic reasons. It was perhaps a bit of a disappointment to our parents that we did not pursue a more conventional specialty that might provide us with more status and financial reward. Then there was the fear of contamination that somehow one might become mad too. Recent day medical students are said to shy away from psychiatry for these same reasons.         Education seems to have little effect on superstition.                                     ......................................….read the full ChapterHERE



Cahalan's new memoir is called Brain On Fire-My Month of Madness.      

Brain on Fire