Reaching Down the Rabbit Hole

Alice in Wonderland is quite absurd, mostly improbable, but generally not stupid. The reason for this final attribution is that there is an underlying reason why ridiculousness reigns over wonderland. In Carroll’s novel, the reason is rather lazily explained as it “all having been a dream”, but this distinction between implausible and stupid is something that is pervasive in neurology. Hence the referential title of Ropper and Burrell’s book: Reaching Down the Rabbit Hole explores human behaviour that is thoroughly erratic; that appears utterly absurd on the surface, but that is firmly rooted in the human nervous system. This can range from the “usual candidates”, such as Alzheimers or Dementia to tissue degeneration, but also autosuggestion, to the point where the Nocebo effect results in physical reactions in the patient. The only problem is how to cure those individuals whose only problem is themselves.

Bearing in mind this last group of patients, in addition to the potentially opaque nature of neurological diseases, one might think that arriving at a correct diagnosis is very hard. Dr. Ropper mentions as much – yet is able to instantly tell what is wrong at a glance in all but one of his cases, which is explained away as “It may well have been too late for the surgery to have made a difference”. The book is too positive in the sense that Dr. Ropper appears infallible, whether the patient dies or not. However, this (barely) does not come across as self-aggrandisement, which is due to the fact that Burrell is the co-author. The result of this joint venture is not a clinically precise account of everyday hospital life (albeit of everyday cases), but the highly enjoyable monologue of a chatty neurologist. There are instances where that chattiness is possibly taken a step too far, such as when the disjointed vocalisations of one patient are linked to a Red Sox baseball game. However, this tangent is warranted since the patient’s comments had consisted of a confusion of two players which ultimately provides insight into the logic of said patient’s thought process while his confusion lasted. The confusion itself on the other hand is, as the subtitle implies, one of the Extraordinary Journeys into the Human Brain. Other such journeys include Lou Gehring’s disease, wherein the patient’s nervous cortex slowly decomposes, which means that the internal organs decrement to the point where they can no longer fulfil their function; another sheds light on Parkinson’s disease, whose painfully slow neural transmission manifests itself as having to wait for ten minutes or more before the body is revved up to perform a task as simple as turning on the television.

Reaching Down the Rabbit Hole is very good at presenting various neurological cases, which includes the use of technical terms such as “coronary angiography” without ever getting too jargon-heavy. What it lacks in honest mistakes, it makes up for in its accessibility for the layman. It is a pity that some of the scientific aspects are nudged aside in favour of storytelling; yet, considering the book is not a neurological treatise, one might say that it does its job quite well. You do get a sense that neurology is “the queen of the medical specialties”, and that (despite the possibly overblown account of “instant diagnosis”) there is a need for “old-fashioned” practices such as perceptive bedside exams or properly performed autopsies, if only to teach future generations about problems that might not show up on a scan. It is however important to bear in mind that the book only offers a general idea of what neurology is like. As Ropper (or Burrell?) puts it: “An abstraction of that experience [of an infarcted spinal cord] ends up in a textbook, but is no substitute for seeing it”, which may leave the reader wondering how accurate a representation they can expect from this book.

Jérôme Cooper