Brainspotting: Adventures in Neurology by A. J. Lees

Reviewed by Annabel

Dr Andrew Lees is a neurology professor at the National Hospital in London the first English hospital dedicated exclusively to treating the diseases of the nervous system. He is also a world-renowned researcher on Parkinson’s disease. Brainspotting is his third book of autobiographical essays for Notting Hill Editions. His first, Mentored by a Madman, looked at his medical career through the influence that William S Burroughs had on him; his second, Brazil that Never Was, stems from a childhood fascination with ships from Brazil docking at Liverpool and an enduring interest in the country. 

The hook for this set of essays is a hobby from his youth. In the first piece, he explains how Birdwatching proved an essential contributor to his future career, teaching him how to observe. I like the linguistical similarity between ‘birdwatching’ and this volume’s title ‘brainspotting’. If observation is an essential tool for a neurologist, listening is equally as important, and all of these essays will address these key skills in one way or another. 

The second chapter takes Lees back to his student days, and to that staple of medical memoirs, a cadaver to dissect. It took a term for the body to become just that, and not the person it had once been. It’s not often that medical memoirs leave out this formative experience, but Lees is brief and more eloquent than most.

He continues his memoir through the hospitals where he has practised, including a year in Paris at La Salpêtrière, where one of the founding fathers of neurology, Martin Charcot, taught in the late 1880s. 

After my journeyman year in Paris, my powers of inspection improved greatly. Now as I listened to patients’ narratives, I scrutinised their faces. […] In my future clinical narratives I aimed to convey the panoply of neurological phenomena with the directness and precision of a Métro line. The lives of my patients and the questions they asked me would from now on become the focus of my fieldwork. I was finally convinced I was in the right job.

One of the most interesting essays is ‘The Lost Soul of Neurology’, in which Lees looks at the divergence between neurology and psychiatry – Freud had studied with Charcot for a time, of course going on to develop his own methods of psychoanalysis and the interpretation of dreams.

The growth in popularity of psychoanalysis with reification of Freudian dogma in the first half of the twentieth century contributed to a growing split between doctors who studied diseases of the brain in hospitals and those who studied disorders of the mind in offices.

Lees by now has completed his postgraduate training, and acknowledges that “by the time I was appointed a consultant neurologist in 1982 I knew that listening was a more proactive and challenging skill than observation.”  The essay ‘Words’ goes onto describe his method of consultation and diagnosis in detail.

An interesting digression diverts us to Joseph Bell, who inspired Conan Doyle in creating Sherlock Holmes. Bell himself was inspired by Voltaire’s fable about a philosopher called Zadig who employed deductive reasoning to track down a missing dog. Conan Doyle was medically trained himself, so it is no surprise that his stories are full of the subject:

Included within the sixty Sherlock Holmes adventures are references to sixty-eight diseases, thirty-two medical terms, thirty-eight doctors, twenty-two drugs, twelve medical specialties, six hospitals and even three medical journals and two medical schools. 

That essay was perhaps the most fun one in the book, but the penultimate one is particularly apposite to our times. In ‘Machine Learning’, Lees looks at the advances in technology that allow us to see deep into the brain and see the body differently. However, these machines do not negate the need for the observation and listening that remain such important skills in the neurologist’s trade, indeed scans can sometimes hamper diagnoses. 

Technology remains the servant of clinical reason and not its fulcrum. I continue to resist a strictly engineering approach to neurology and consider defensive medicine, including the profligate use of brain scanning, a form of medical malpractice.

Medicine may have changed beyond recognition in the past decades with the advances that technology have brought, but they have also made it time-poor. Taking the time to observe and listen as Lees does is fundamental to all of medicine, not just neurology where every small detail can count. We can read that between the lines of Lees’ descriptions of his own specialty. 

I enjoyed the mix of history, medicine and memoir in Lees’ essays; he is an elegant writer with an interesting vocabulary. This volume will appeal to those who have enjoyed the books by brain surgeon Henry Marsh (see here and here). Now, I will look forward to tracking down copies of Lees’ earlier essay collections for Notting Hill Editions. 

Annabel is co-founder and an editor of Shiny.

A J Lees, Brainspotting: Adventures in Neurology (Notting Hill Editions, 2022). 978-1912559367, 154pp., clothbound hardback.

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