As a retired neurologist, I really wanted to like this book, but I found it very disappointing I have tremendous respect for Dr Ropper Principles of Neurology, the textbook of neurology that he currently edits, is still my favorite introduction to general neurology I have heard him speak several times and always found him to be an eloquent and thoughtful speaker This book seemed to have been written by someone else and perhaps it was Most disturbing was the dismissive and patronizing attitude towards patients with conversion disorder and other psychogenic causes of neurologic like syndromes I have always tried to teach my residents and students that these patients are perhaps the most challenging patients we see because they not infrequently also have a real neurological problem hidden amongst the psychiatric noise, and missing this can be catastrophic and even fatal I will never forget a patient who died of pseudoseizures She had been sent to the hospital for an EEG but started having continuous seizures before reaching the EEG lab Her attending neurologist insisted these were pseudoseizures and did not need to be treated By the time it was recognized that she was truly in status epilepticus continued or repetitive seizures her brain had been permanently injured and she died It turned out that she had unrecognized porphyria, a metabolic disorder that can cause psychiatric problems as well as neurological problems including seizures At the very least, most patients with psychogenic neurologic like disorders have symptoms that are real to them, and they deserve to be treated with compassion, respect, thoroughness, and honesty. Tell The Doctor Where It Hurts It Sounds Simple Enough, Unless The Problem Affects The Very Organ That Produces Awareness And Generates Speech What Is It Like To Try To Heal The Body When The Mind Is Under Attack In This Book, Dr Allan Ropper And Brian Burrell Take The Reader Behind The Scenes At Harvard Medical School S Neurology Unit To Show How A Seasoned Diagnostician Faces Down Bizarre, Life Altering Afflictions Like Alice In Wonderland, Dr Ropper Inhabits A World Where Absurdities Abound A Figure Skater Whose Body Has Become A Ticking Time Bomb A Salesman Who Drives Around And Around A Traffic Rotary, Unable To Get Off A College Quarterback Who Can T Stop Calling The Same Play A Child Molester Who, After Falling On The Ice, Is Left With A Brain That Is Very Much Dead Inside A Body That Is Very Much Alive A Mother Of Two Young Girls, Diagnosed With ALS, Who Has To Decide Whether A Life Locked Inside Her Own Head Is Worth LivingHow Does One Begin To Treat Such Cases, To Counsel People Whose Lives May Be Changed Forever How Does One Train The Next Generation Of Clinicians To Deal With The Moral And Medical Aspects Of Brain Disease Dr Ropper And His Colleague Answer These Questions By Taking The Reader Into A Rarified World Where Lives And Minds Hang In The Balance Reaching Down the Rabbit Hole is a really fascinating book It s a little fictionalised, so we get dialogues and little portraits of character, enough that we can care about the cases discussed Dr Ropper is pretty much everything an ideal doctor should be knowledgeable, capable of acting fast, capable of explaining complex processes clearly, intuitive, willing to listen, willing to admit he s wrong At every stage, he emphasises to the reader and to the residents he s teaching that each case is individual, that the right answer for one person isn t the right one for the next, and so on.There are a couple of very good chapters on Parkinson s and ALS, some fascinating things like the fact that an ovarian teratoma can cause seizures and all sorts of neurological symptoms, etc At every turn, it demonstrates the complexity of the brain, the limits of our understanding.What nearly spoiled it all for me was the fact that Ropper really does revert to talking about hysteria When I quoted a section to my mother, a psychiatrist, she texted back to ask if the book was written in 1899 that s how out of date that section seems For the most part, he even seems sympathetic to these patients, which is than I can say for a lot of people who dismiss hysteria psychosomatic illnesses conversion disorder, etc But in this case there seems to be a barrier in his thinking he sees a young woman with a teddy bear, and he immediately chalks it up to hysteria Whatever her symptoms hysteria is the answer Sure, he dresses it up as conversion disorder , but what he means is still pretty much the Victorian hysteria He uses that term as a direct synonym for conversion disorder, psychosomatic problems, etc.And it s exactly that attitude that makes life difficult for people who have mental illnesses, insight and even a glimpse of the way that people are going to look at them If I m going into a doctor s office with some problem, I prepare myself for the inevitable questions about my levels of anxiety, my depression during the last few weeks, is there anything at home I m struggling with Because there s a diagnosis of GAD and depression right there in my file, I know that nine out of ten doctors will listen to my symptoms and hear only psychosomatic And some of those will even blame me for that me, the thinking rational person even though I could no help it than I could pick the stars out of the sky.I started having horrible stomach pains in 2010, my second year of university, at the same time as I started a pretty steep descent into anxiety Doctors were reasonably sympathetic, but continually told me that what was happening to me, whatever it was, just happened because of my anxiety Here s a pill, take it and everything will go away And I believed them the pain had to be in my head, because I have an anxiety disorder I knew they wouldn t believe in the pain and so I didn t either.Even at the point where my physical symptoms were completely blatant, when you could do a physical exam and precisely locate the source of the pain, my GP was reluctant to send me for an ultrasound because, in his opinion, I was probably just stressed about my master s degree He repeatedly asked if I was happy, if I was sure I was doing the right thing in my career, while I was trying to ask for pain relief When eventually I pushed hard enough, he sent me for an ultrasound, warning me that I was wasting everyone s time.My gallbladder was packed with stones, and the only option was to remove it.At one point in this book, Ropper discusses signs and symptoms Symptoms are what the patient reports signs are what the physician observes Don t stop listening to the symptoms just because you think you can see the signs Don t get blinded to one thing because another has already been diagnosed. A moderately interesting story of the life of a neurologist, marred by the gigantic ego of the author I m sure you need a gigantic ego to do the job and there are plenty of stories where he gets stuff wrong at first, before getting it right obv but the overall impression is of being sat next to someone at a dinner party who starts off seeming an absolutely fascinating and enthralling raconteur and by the third course you re wondering who you ought to stab in the eye with a dessert fork yourself or him This is not helped by the I don t care, sod off attitude he his persona takes to people with psychosomatic conditions, many of whom seem to have been sexually abused He sees someone who is literally so traumatised by family abuse their entire body stops functioning, and his attitude is stop wasting my time, I have real patients to help rather than, I dunno, let me refer you to another department and ideally the police And yet the narrator repeatedly applauds himself for his own humanity, humility, kindness, and willingness to listen compared to other neurologists It makes you wonder what the rest of them are like. 3.5 StarsA neurologist takes us through multiple cases he s dealt with over a short course of time Some very interesting cases with many diseases I d never even heard of A great read, especially if you enjoy books like I wanted to like this science based nonfiction book because I always like books like this But the title seemed somewhat inaccurate for this book It wasn t about the mystery and drama of brain disease..it was really all about one particular neurologist I, I, MY, MY, ME, ME was incredibly repetitive.just sayin I was also shocked by some of his statements.it sounded like disregard for others I wish I had liked this. I read it wondering if the author, a neurologist, would ever turn professional insight on himself If he did, he would realize he spends an entire book blowing eighteen over inflated tires of sexist, egotistical, out of touch diesel right up his own glowing red exhaust stack I was hoping for someone to talk about being a neurologist and the rigors of having such an interesting title, an adjunct to the great Do No Harm Instead, I got the self important musings of a tactless, namedropping, arrogant misogynist I kept reading hoping he would stop talking about himself and talk about something interesting, but alas, his reference to women neurologists using a reflex hammer to test brain reaction in unconscious patients by saying they, tend to press harder than men, as if to insure that no one is getting out alive was my final straw This neurologist should ve seen a neurologist before writing this book. Wish I could review this book I won it on September 28 as a giveaway on goodread Never received the book Looks like other people liked the book I always read the books I win and do a review on them Too bad I did not get my copy I sent a message asking why I did not receive my copy but never heard back UPDATE I received my copy of this book last week I can now do a review of the book i won in first reads giveaways Dr Allan Ropper is a Neurologist in Boston In his book he writes many cases he has worked on over the years Most of the persons are fictionalized persons to give samples of different diseases of the brain the figures skater whose body has become a ticking bomb the man found in traffic circling around because he could not find his way home.there are several cases of people who are suffering from ALS or Lou Gehrig s disease This is a pretty interesting read It can be fascinating, terrifying, heartbreaking There are so many Neurological illnesses a person can get Dr Ropper discusses many of them in his factual book there is even a chapter using Michael j Fox when he discusses Parkinson s disease There is a chapter on seizures and Epilepsy interesting but a tough one to read since i have a son who has epilepsy I liked that Dr Ropper gave stories and examples to describe his cases Glad i finally got my copy If you find reading about medical cases, you may find this a good read. This book was interesting enough for me to finish it in three days, but it s not a book I would tell anyone to go buy right now Pick it up if you find it at a book exchange or in a bargain bin, though It is well written and generally entertaining, but it spends time on the drama of brain disease than on the mystery of it A sick person comes into the hospital, no one can figure out what s wrong with him or her until our hero neurologist walks into the room and proves he s smarter than everyone else, and then their long and painful process of recovery or not is extensively described, including how it made the doctor feel It is not like the books by Oliver Sacks, because it describes common brain diseases than rare ones, which makes it less exciting than it could have been, no matter how touching the stories about Parkinson s and ALS sufferers are There is also a lot of reflection on what it means to be a doctor in general and a neurologist in particular, which is at times interesting but often strays towards the overly self congratulatory Allan Ropper is clearly very impressed by his own genius I also thought it was funny that at one point in the book he makes fun of other doctors for boasting about their celebrity patients and then continues to mention on every other page that he treated Michael J Fox for Parkinson s.
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- 272 pages
- Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease
- Allan H. Ropper
- 18 June 2019 Allan H. Ropper