Don’t Leave ’em Behind: How My Brother Made Medicine Better

How do you track the medical care of thousands of people in disasters? My brother, Allen, as chief medical officer of the National Disaster Medical System, spent the last few years trying to answer that, among other challenges. The NDMS works primarily by mustering and deploying medical-response teams made up of medical volunteers pulled from particular regions — a hive-mind rapid response team. When a disaster looms or strikes, the NDMS fires up a mess of pagers to call particular teams together, and they quickly converge on the site, where the NDMS delivers oversight, pop-up triage units and hospitals, and supplies. It’s an organized scramble, and my bro’s job was to make it more organized and effective.

When Allen took the director’s job in January 2008, he’d already seen, as an on-the-ground responder to disasters like Katrina and other hurricanes during the 2000’s, how a lack of patient information can hamper care both during and after the disaster. In Katrina, for instance, the paper-record system was overwhelmed by the 165,000 patients for whom the NDMS tried to coordinate care; many patients went home with no record of their care, so that any following care was often blind to what had happened in the triage tents. Just as gravely, the NDMS coordinators got only slow, scattered, rather disorganized reports on what the biggest problems were, making it harder to send the right people, drugs, and facilities to the right places.

So when Allen became chief medical officer, he quickly oversaw the creation of a real-time electronic-record system. Along with collecting individual patient information that can travel with a patient after care, the system constantly aggregates and analyzes patient data during a disaster, updating the central database every 5 minutes, so the NDMS can adjust its response as the disaster unfolds.

As Allen explains in the interview above, this helped the NDMS quickly adjust its response to the Haiti earthquake. Four hours after the first NDMS teams arrived and started seeing patients, the records showed that children composed a bigger percentage of the patients than anticipated. So even as the NDMS was organizing and equipping its second wave of teams to leave for the island, those teams could go heavier on the people, equipment, and supplies most needed for kids and infants and the problems they were suffering; more Similac, diapers, and child-size splints, for instance. The same sort of real-time record-keeping could prove even more crucial in, say, an infectious-disease outbreak in which the infectious agent was at first hard to identify.

* * *

I’m proud of my brother for doing this, and for his nearly 30 years of government service bringing medicine to people who particularly need it. Allen likes his surfing: Dude once won the over-25 surfing contest at Camp Pendleton, and that’s some surfing. Man can carve. He could have spent the last 20 years doing two or three ER shifts a week, easily matching and perhaps exceeding his government salary, while spending the rest of the time getting tanned and tubed. He could have run ER departments at private hospitals instead of Indian reservations and doubled, tripled, or quadrupled his salary.

But he did otherwise.

He doesn’t regret the missed cash; as he notes in this video, he’s managed to live comfortably on a government salary most private MDs would scoff at, even though he started medical school with little more than a Hobie surfboard, an aging Renault LeCar, and a modest stack of LPs. (This included a Santana record he stole from me, which I’ve yet to get back.)

H. Allen Dobbs
H. Allen Dobbs

A few years ago — quite a few — my brother sent me a photo of himself the day he graduated from Navy boot camp. It is, roughly, an earlier version of the photo at left, which was taken a few weeks ago. At the time, looking at the photograph from the insular cocoon of my dorm room, I was horrified that he had joined the Navy (I’m not now), but I liked the photograph. He was ridiculously handsome. I mean, ridiculously handsome. Compared to Allen, Richard Gere looked a dog.

On the back of the photo he had written, “To my brother, whom I will miss as long as we are apart.” I missed him, too — daily, badly.

I still do. But it struck me back then, looking at that photo and thinking about how brothers commonly treat each other as they grow up, that I had been particularly lucky that in the time after our parents split up, Allen, at 13, an age at which most older siblings shoo away their younger ones, had let his 10-year-old brother not just tag along but remain part of his life and circle, even though he spent his time (and thus did I) among kids his age and older. He had every excuse and rationale for leaving me behind to pursue unencumbered a bigger world of opportunity. No one would have questioned his decision. You couldn’t go through life pulling along those who by rights or bad luck or plain chance would trail you; in fact, to push ahead, even if it might leave others behind, was the way of things. It was what most people did.

Likewise, later, Allen could just as well have taken a different path through medicine. He had every excuse and rationale for shunning the public medical system to pursue unencumbered a bigger world of opportunity. No one would have questioned his decision. You couldn’t go through life pulling along those who by rights or bad luck or plain chance would trail you; in fact to push ahead, even if it might leave others behind, was the way of things. It was what most people did; it was what most doctors do.

But he did otherwise.

Allen’s been nominated for a so-called “Sammie,” or Service to America award, a sort of Emmy for public-service performance. I hope he gets it.


A Lost Polar Explorer Returns: Todd Balf’s “Farthest North”


FarthestNorth_BylinerFarthest North: America’s First Arctic Hero and His Horrible, Wonderful Voyage to the Frozen Top of the WorldByliner Orignals. $1.99  Publisher site.

 Reviewed by David Dobbs

Crossposted from Download The Universe, the science e-book review site


When people today imagine scientists, they tend to picture a man in a white lab coat, glasses, and a scraggly beard. A century and a half ago, however, people imagining see a scientist were more likely to conjure a man with a heavy fur coat, a telescope, and a beard twisted not by eccentricity but by the gales of distant places. It was the great age of exploration, when many scientists did their work afoot or at sea. The scientist was a person not just of thought but of action.

In America, no one typified this scientist-explorer image more thoroughly than Elisha Kane, an unlikely explorer who trained formally in neither science nor seamanship; who led one of the era’s most extraordinary and influential polar journeys; who was ill much of his life but found extraordinary strength during his severest trials; and who convinced himself and others, for a time, that he had made one of the most important discoveries of his time, only to be largely forgotten later. He vividly occupies Todd Balf’s, Farthest North: America’s First Arctic Hero and His Horrible, Wonderful Voyage to the Frozen Top of the World.

This is great material, and Balf, a former editor at Outside, handles it deftly. He gets the scientific dilemmas spot-on while telling a gripping, overlooked tale. He also paints a wonderful picture of how a person’s qualities, applied with energy and savvy, can find the doors of opportunity in an era and knock them open.

For the restless Kane, the exploration of the Arctic proved an irresistible draw. The voyage examined here was his second, but the first under his command. The prior journey, which he took as a naval officer, went so badly from an exploratory point of view that its leader happily left the traditional captain’s author’s account to Kane. Kane, with a romantic’s heart and a novelist’s touch for earthy detail, seduced  the American public  with an Arctic world they paid  little heed to before; his treatment was half Twain, half Whitman, says Balf. Their mission had been to find and rescue the lost British explorer John Franklin, who had disappeared years before seeking the Northwest passage. Kane’s poignant description of the traces they found of Franklin’s path— an abandoned camp with three sailors’ graves, an armorer’s forge, and a pair of officer’s gloves washed and set out to dry — flamed enough interest in Franklin’s fate to generate funding for a second rescue attempt, this one led by Kane.

So in May 1853 he set sail to search not just for Franklin, but for “The Open Polar Sea” — a coveted passage to the North, and ultimately the Pacific. Kane suspected Franklin may have found this sea but not lived to report or take credit for it. A British adventurer named Inglefield, thinking likewise, set sail from England at about the same time and on the same mission. Kane’s trip was at once a rescue mission, a test of a hypothesis, a bid for greatness and fame, and a race.

As a scientific venture, his search for an Open Polar Sea posed all the seductions and dangers of any powerful idea. It tempted not only extremes of action but the perceptual warping we’re all subject to, the tendency to see what one wants to see that students of cognition and science call confirmation bias. The expedition’s naturalist-surgeon, Isaac Hayes, encountering in the hills around Baffin Bay a “lush summer bloom,” thought it presaged mild weather and open water ahead. Likewise, as they worked their way up through Baffin’s ice flows that July of 1853, both Hayes and Kane found hope in seeing many animals moving northward, as if warmth lay there.

They soon found otherwise. Above Baffin they met cold gales that sent the ship careening among ice floes. The sea glazed over. Two weeks later, the ice seized them. IThey were further north than anyone had ever wintered and survived — 78 degrees, 44 minutes. And thought it was only September, it soon became apparent that winter was coming early and hard. Over the next 18 months, locked in ice the whole time, the men suffered an almost unbroken stretch of arctic torments: weeks on end of darkness and subzero temperatures; scurvy that turned old wounds into open sores; frostbite that forced amputations. Kane’s journal through those winters, writes Balf, “is a record of unbroken misery.”

Kane’s great feat is that he got 14 of his 17 men through an ordeal that by any logic should have killed them all. Through the second winter, Kane, who actually felt stronger then than in the winter before, relentlessly nursed and cajoled and supported his men, even as he himself sometimes bordered on delirium. It was a spectacular triumph of deadening, dumb, determined endurance. Finally, in the spring of 1855, they abandoned the ship. After weeks dragging two lifeboats southward over some 300 miles of brutal terrain to reach open water, they sailed some 1200 miles to Greenland and safety.

He returned to the U.S. that October to a hero’s welcome, his book-won fame spread explosively by news of his survival. But his health deteriorated. When in 1857 he died in Cuba, where he’d gone hoping to recuperate, it made all the front pages. His funeral procession from New Orleans back home to Philadelphia was watched by thousands — the biggest public mourning the young country had yet seen. It wouldn’t be topped until Lincoln was shot. His status is suggested by a banner overhanging Fifth Avenue: “Science Weeps, Humanity Weeps, the World Weeps.”

Now few know of him. He’s rarely mentioned in short lists of great Arctic explorers. Balf’s tale serves both as an historical corrective and a sort of fable of the fickleness of fame and the cruel risk of reaching for but failing to bring home a big idea. “Like the earliest, most ambitious pioneers to any new land, he got some things wrong,” writes Balf. “He also got a lot right.” He found new ways to survive cold and hunger. He returned “by a smart retreat and an unprecedented alliance with the native Inuit; he worked tirelessly to nurse his party back to strength.”

This contrasts, Balf notes, with Franklin, who died early on and left his men to march to their deaths. Kane’s program for surviving an Arctic winter “was brilliant … and duplicated by almost all future Arctic expeditions,” including Shackleton’s more famous escape. A notable exception is Scott’s disastrous but romantic failure at the South Pole, which rose partly because he ignored some of Kane’s lessons and innovations. Yet both Franklin and Scott remain far better known, probably because they did not return. And Shackleton’s name far outshines Kane’s, even though Kane accomplished something every bit as difficult and unlikely. They both did the impossible. Shackelton’s impossible was just more obvious.

It didn’t help that someone else largely solved the mystery of Franklin’s party. Kane also had the back luck to get the science wrong.

In that spring of 1855 in which he finally took his men south and home, he first sent two of the strongest men north to take one more shot at finding the Open Polar Sea. They marched 200 punishing miles, all the way to 81N, 22′, “shedding everything” to get that far. There they encountered a 500-foot bluff. Only one of the men, steward William Morton, had the strength to climb it. When he reached the top, he saw before him an “unfrozen sea” with “waves, … surging from the furthest north, breaking at my feet.” A northerly gale blew in his face — but carried no ice toward him. The open water stretched north to the horizon.

From this tantalizing data point — a big, fat, seemingly infinite n of 1 — Kane drew an understandable conclusion: He had found the Open Polar Sea. Balf properly forgives him this error. And when he reveals the freakishly unique alignment of forces and events from which this false finding rose — an assembly that starts with Franklin and ends with an astonishing satellite photo taken in 2010 — it’s hard not to join him. For the full, strange, richly told story, steer your browser to Farthest North.


Man Gets Taser Dart in His Frontal Lobe

For this bizarre story I thank the incomparable Vaughan Bell, who writes brilliantly on all things neuro, psych, and weird. Follow him at Twitter, at  Mind Hacks, where he frequently blogs, and in his work for the Guardian and Slate. He’s amazing. And he brought this to Mind Hacks:


A case report in Forensic Science International describes a man who had a taser dart penetate his skull and damage his frontal lobes after getting in a drunken confrontation with police.

Curiously, the man was unaware he had a taser dart in his brain and only went to hospital after he got home and noticed the dart sticking out of his head.

A 27 old man was immobilized by the police while he struggled with a police officer during an identification check and attempted an escape. He had a high level of alcohol at the time of the arrest. A X26 Taser was used to incapacitate and subdue the victim.

No immediate medical examination was subsequently performed in the patient after the wires were propelled and he was allowed to return home. However, because he complained of a headache, he decided to go to the nearest hospital a few hours later.

Upon presentation at the Emergency Department the patient was conscious. The examination revealed a harpoon-like barbed electrode dart implanted in the right frontal part of the skull and a right peri-orbital bruise…

The brain CT scan revealed an encephalic injury in the right area of the frontal lobe. In fact, the probe was implanted in the frontal area of the skull and then in the right frontal cortex with a penetration depth of a few millimeters.

There’s a moral in this story somewhere but damned if I can find it.

One moral might be: Here’s one more piece of evidence that tasers aren’t quite as safe as we’re told. It certainly seems obvious they shouldn’t be directed at the head. The journal article has a short review of overlooked hazards and deaths in its penultimate section; they include pharyngeal performation, daarts in the eyes, and some deaths.

via Don’t tase my lobe « Mind Hacks.

Illusion Puts Rotating Snakes in Your Brain

From @vaughanbell at Mind Hacks:

The latest Journal of Neuroscience features a study on the neuroscience behind Akiyoshi Kitaoka’s famous Rotating Snakes illusion and to celebrate they’re made a ‘Rotating Brain’ illusion for the front cover.

This type of illusion, often called a peripheral drift illusion, was thought to occur due to slow drifting eye movements but this new study suggests that it is more likely to be explained by rapid but tiny eye movements called saccades.

Get more straight from Dr. Bell.

A Beautiful, Conflicted Genome, All in the Mind and On the Radio

Australia RadioNational’s “All in the Mind” program has long been a favorite of mine, so it was a pleasure last week to be on the program discussing the up- and downsides of so-called ‘orchid genes’ — the gene variants long associated with vulnerability to things like depression, but now increasingly seen as producing not just vulnerability but a heightened sensitivity to experience. Host Lynne Malcolm interviewed both me and former neurobiologist Lone Frank, whose book My Beautiful Genome explores her own foray into personal genomics, and wove these two conversations into a nice discussion of what it’s like to confront one’s genome in a time when the view of behavioral genes is rapidly changing. It’s a fine fun program, with lots of good tidbits.

Lone Frank makes a wonderful analogy, comparing the genetic boom now to the PC boom that brought powerful computing tools to the masses; now we’ll all get powerful genomic knowledge. Frank took an early dive in, with special attention to behavioral genetics, and found that she had several gene variants that have been associated with high risk for things like depression. This agreed with a family history of mental illness, as well as with her own struggles. Her maternal grandmother had been committed at one point, and almost had a lobotomy. That grandmother’s father had killed himself. Her own mother, she says, was “always very concerned, often very sad and withdrawn,” and was diagnosed as depressed late in life. Frank herself has had four bouts of clinical depression and anticipates going through more.  Her descriptions of these are spot on: “It feels like sliding down … toward a black hole,” and she wakes each day “getting more and more disgusted with the world.” She finds that having a genetic explanation for this sensitivity helpful; it lets her externalize the affliction a bit and recognize that it will likely swing back up. Now she sees the signs and gets treatment; for her, antidepressants work pretty well.

Frank’s description of her testing — including the five-factor or “Big Five” personality test — is both intriguing and entertaining. The psychologist who read her personality test said, first thing he opened the door and introduced himiself, that the results made him fear the encounter, because she had scored “rock-bottom” at agreeableness — a finding rendered suspect by her warm, agreeable presence on this program.

Frank found that she had double jeopardy in every ‘vulnerability gene’ she was tested for — that is, she always had both copies (one from each parent) of the ‘vulnerable’ version of the genes in question. Yet, as it clear from the program, she’s a high-functioning, agreeable person, outright cheery at times, I daresay, who has learned to manage the sensitivity that these variants seem to grant.

How might that be?  The complex, two-sided nature of these genes — their granting of plasticity rather than just vulnerability — is the subject of the middle part of of the program, where, starting at about minute 12 and running roughly to minute 20, Malcolm and I discuss some of the research that shows these gene variants grant not just vulnerability, but a heightened response to experience that can be an asset. This newer view of these genes is the subject of a book I’m writing; for more links, see below; or just listen in to get the heart of it.

I’m always impressed with how skillfully good radio shows edit and weave together the elements of their interviews; it’s all the more impressive as a guest, as you see them cut down a much longer conversation to place your comments in the most interesting and effective arrangement. It’s good to have raw speech edited.

You can catch the program at the All in the Mind site. Lone Frank’s My Beautiful Genome — highly  recommended — is here. You can find my most recent article on the orchid hypothesis — the subject of a book I’m writing — at Can Genes Send You High or Low? The Orchid Hypothesis A-Bloom. (This is an expanded version, at Neuron Culture only, of a recent (paywalled) feature that appeared in New Scientist.) My longer treatment appeared in late 2009 in The Atlantic.


Oliver Sacks & Cab Calloway Wake The Dead

I don’t mean to be disrespectful to this wonderful man: this lovely man is clearly not dead in the literal sense. But this is an extraordinary transformation: the music revives him from a sort of depressive coma,* barely aware or responsive, to an articulate, engaged man again. It quickens both his thinking and his emotions — and as Oliver Sacks points out, his sense of identity too, reviving a meaningful relationship to the rest of the world.

From a rough-cut trailer for “Alive Inside,” a new film premiering this week the use of music to reach nursing-home residents with senile dementia and Alzheimer’s.

And if you’re wondering what Cab Calloway brought to the game:

Hat tip to my sister, Cynthia Dobbs, who is da bomb.

*I’m speaking figuratively, so please hold the definitional corrections).

Madness Ain’t All It’s Cracked Up to Be: A Corrective

The notebook in which Virginia Woolf wrote "Mrs. Dalloway".

My post two days ago on the links between depression and creativity sparked some smart comments. Perhaps the best was sent to me privately by the excellent blogger The NeuroCritic, and I am highlighting it in its own post here, with The Neurocritic’s permission, because it makes a an important point that I failed to note in the original piece: These links between madness and creativity don’t make the more severe manifestations of depression or bipolar disorder any less destructive or painful. As The NeuroCritic put it:

Sometimes I think those who talk about bipolar and creativity haven’t been around many severely manic individuals. There’s overspending, lying, cheating, alienating friends, paranoia, psychosis, taking off and abandoning family, etc. I don’t think there’s anything especially creative about that.

Here’s another idea about bipolar and creativity: the percentage of manic people who engage in creative pursuits exceeds that in the general population. However, much of the output is incoherent. Some small percentage might be brilliant (either during or in between episodes), but then how many people are Kay Redfield Jamison or Stephen Fry (collapsing across bipolar subtypes)?

At any rate, bipolar can be a very destructive illness, and I hope those that romanticize it (or are viewed as romanticizing it) truly understand that. End of rant.

A point well-made and well-taken. (NB: A few days after I wrote this post, The Neurocritic elaborated on his point in a graceful and gracious post here.)

I can see how a reader of my post, which looked at a passage on madness and creativity from Jonah Lehrer’s new book on creativity as well as a film by Stephen Fry about his own bipolar plunge, might see it as romanticizing these maladies. I think NeuroCritic recognizes I don’t set out to do romanticize madness; yet s/he is right that the post might be interpreted that way. My bad: In my focus on what these links between madness and creativity reveal about the essential nature of the creative process, I neglected to remind readers that the essential nature of severe, untreated forms of depression or bipolar disorder is a plunge — perhaps many plunges — into hopeless, dark, annihilating misery. Jonah Lehrer also understands this. And in a book that is all about creativity, a reader can be expected to understand that the main focus is on that process, and that the madness is being examined for what it says about creativity. In a one-off blog post, however, I think it makes sense to lodge at least briefly the reminder that NeuroCritic lodged with me afterwards. and I should have done so.

These ailments are horrible to suffer. Yet they fascinate us, and they do so partly because they present, in extreme forms, cycles or dips that most of us goes through in milder form. Thus the bipolar dynamics that Jonah describes illustrate starkly the complementary creative roles played by unexpected associations and new insights, on one hand, and ruminative, grind-it-out refinement of those insights on the other. We see these swings most readily in some of the artists and writers who suffered the most. The long walks during which Virginia Woolf half-consciously wrought her characters and stories — walks in which insights were often found  more than created — fed her art as essentially as did the long mornings in which she sat in her armchair penning them into coherent form. Yet when Woolf fell deeply sick she could not work at all. She would descend into the blackest despair. Even sitting up in her armchair, much less writing in it, became more than she could manage. It was as she felt one of those long drops looming before her that she took a walk that ended not back home in her chair, but at the bottom of the River Ouse.

I don’t consider such extremes necessary to art. As I’ve explained before, I think they’re the destructive extremes of a broader sensitivity that can help someone see and respond to the world in original ways. They may sometimes make it easier to create, particularly during the manic phase, when the energy and confidence or high. But they can destroy the artist, eliminating from the world who knows how much great work, and they’re rarely essential. I suspect even bipolar artists do most of their best work not at the very peaks of these cycles, and certainly not at the bottoms, but during the less extreme oscillations that create both the leaps of imagination and the long days at desk, keyboard, or easel, but do not rise to uncontrolled mania or or fall to catatonic numbness. Stephen Fry remains with us, still doing great work, because in grappling with his affliction he was able to quiet such oscillations without flattening them; with any good luck at all, he will put in a full lifetime of work, to the world’s and his benefit. I wish it had been so for Ms. Woolf.

2010 09 16_River Bank From York Bypass_0037
The River Ouse

Photo of River Ouse: Keith Laverack, via Creative Commons. Some rights reserved. 

See also: 

My post Jonah Lehrer Meets Stephen Fry – The Paradoxes of Bipolar and Creativity, 9 April 2012, which started this latest permutation of this discusssion.

The Neurocritic’s Suffering for art is still suffering, 13 April 2012, which was a response to the post above. As usual for The NC, it’s smart, graceful, and has some great art accompanying — in this case, some Edward Munch I hadn’t seen before.


DNA Ain’t Destiny. No Kidding.

Double Helix bridge to Marina Bay Sands

Many in the genetico-literary science world have been gnashing their teeth over a recent New York Times story that remarks the unremarkable: a Study Says DNA’s Power to Predict Illness Is Limited>. (The article elaborates on a Science Translational Medicine paper, The Predictive Capacity of Personal Genome Sequencing.) Erika Check Hayden (a must-follow for good writing on genomics and genetics) rounded up the face-palming in the genomics and genetics community. My favorite quick check comes from Razib Khan:

Recall that height is ~90 percent heritable on the population level. But it turns out that the standard deviation of identical twin height differences is still ~35-40 percent that of random siblings! What I want to see next, an article in The New York Times: “Identical twins not always identical in height; genes don’t explain everything.”

That’s from a post in which Razib productively ponders why Kobe Bryant is a much better player than his father was. His point cannot, apparently, be made too many times: genes don’t just build us in a vaccum. They build us by responding, ever and always, to information incoming from the environment. It starts when sperm meets egg; it stops when you do. You’re not the product of a construction product. You’re the product of — you are — a constant conversation between your genes and the environment, which includes both you and the surrounding world.

Conveying that is very difficult work taken up by good geneticists and by good writers who write about genetics.

Which is one more reason to read Razib Khan, who has been standing watch on this for years, and Erika Check Hayden, who is just killing it these days. You can catch Razib at Gene Expression (where today you can catch him holding a baby. Find Erika at her byline at Nature, her posts at the incomparable group blog Last Word on Nothing, and her website. Twitter handles: RazibKhan and Erika_Check.

Changes: Corrected Science to Science Translational Medicine as source of the paper.

Image: Double Helix bridge to Marina Bay Sands, Singapore.

By usiruk, via Creative Commons license. Some rights reserved.

Jonah Lehrer Meets Stephen Fry – The Paradoxes of Bipolar and Creativity

Last night, reading the wonderful third chapter of Jonah Lehrer’s Imagine,* I came across some material, new to me, on the links between melancholy and creativity. I’m fairly familiar with this literature, but not the the last couple years’ worth, and in that time the stack has grown. Experimental work by researchers like Joe Forgas and Modupe Akinola, which shows that melancholy can sharpen  cognition, now fattens the pile of studies pioneered by researchers such as Nancy Andreasen.

Andreasen, for instance,  found that prominent British novelists and poets were eight times as likely as the general population to suffer from major depression. In another paper she

 found that nearly 40 percent of the successful creative people she investigated had the disorder, a rate that’s approximately twenty times higher than it is in the general population. (More recently, the psychiatrist Hagop Akiskal found that nearly two-thirds of a sample of influential European artists were bipolar. )

But why? In the past, Andreasen has offered that the energy and confidence that mania produces can help someone start and finish an ambitious work of art — damned handy, since every ambitious work at times (usually many times) seems impossible. Now she adds that the ideas one comes up with during such phases tend to be quite original, as the manic person, in a set of long-distance synaptic leaps that Lehrer explains earlier, draws associations that lie beyond the reach of more ordinary modes of thought. (NB: Not everyone with bipolar gets these manic “highs.”)** The ideas they come up with, in short, can be a bit crazy. If they spit them out then and published them, they’d likely be of little worth. But, as Lehrer explains,

then the mania ebbs. The extravagant high descends into a profound low. While this volatility is horribly painful, it can also enable creativity, since the exuberant ideas of the manic period are refined during the depression.

In other words, the emotional extremes of the illness reflect the extremes of the creative process: there is the ecstatic generation phase, full of divergent thoughts, and the attentive editing phase, in which all those ideas are made to converge. This doesn’t take away, of course, from the agony of the mental illness, and it doesn’t mean that people can create only when they’re horribly sad or manic. But it does begin to explain the significant correlations that have been repeatedly observed between depressive syndromes and artistic achievement.

A new idea is borne during mania, refined when it subsides. If you read only that, you can mistakenly think bipolar disorder is a good thing to have, to let run amok. Lehrer is quick to note that but fairly quickly to move on — he’s writing a book about creativity, not depression.

But today, as I was pondering these dynamics, the Internet’s own synaptic genius brought me another exploration of just these paradoxes, one that lingers longer on the downside, in the form of a wonderful documentary that Stephen Fry and the BBC made a few years ago. Fry made the two-part film after he had  a near-fatal manic-depressive collapse. At one level this beautifully produced program is yet another wonderful BBC exploration of a complex subject — a look from many angles unified by  the sensibility and presence of a smart, amiable, literate guide. But here thge power of Fry’s own story and insight, and the extremely high stakes at hand — the highest possible — raises it another notch. Fine work by one of Britain’s finest. I’m not sure we have his match here in the U.S. — a comic entertainer who is also a public intellectual and a searingly honest man.

Hat-tip to the glorious Open Culture for bringing this film to my attention.


*I don’t think it so wonderful now that the book has been fact-checked and found to be so riddled with plagiarism, falsification, fabrication, and sleight-hand that it had to be pulled from circulation. (added 30 June, 2013).

**Added 4/10/12, 6:13 a.m. EDT. Thanks to a friend for a prod on this. Fry addresses it in the film, but I forgot to include that definitional wrinkle in my post the first time through.

Please also see my follow-up: Madness Ain’t All It’s Cracked Up to Be: A Corrective

At Last — A Clean, Mean eBook App: Robin Sloan’s Fish

Novelist and blogger Robin Sloan had something he wanted to say about three things he loves — writing, reading, and the Internet. He wanted people to really absorb it. Seems safe to say he wanted us to love it.

The usual path to such love is to write a great blog post, then track the tweets and re-tweets  and favorites, the Facebook Likes and the Google-Plus shares, the Diggs and the Reddits and the OMGs,  the Google Analytic page views … and if all those suckers light up bright, you get to feel the the internet love.

But because of what Sloan wanted to say, he did not want that sort of love. He didn’t want anyone to like or favorite or star or digg or OMG this thing he wanted to write. He wanted us to read it — to take it into our heads in a way that the web’s various distractions discourage.

Why? Because that’s what he was writing about. To quote the man:


He too often found himself distracted while reading online or in apps; the sideways allurements overwhelmed him. It was, he said,


He wanted to issue a “a short but heartfelt manifesto about the difference between liking something on the Internet and loving something on the Internet”: a call to create and appreciate things one might not just read and “like” and forget, but read many times over.

So he created Fish: A Tap Essay. Fish is indeed a short but heartfelt essay, but it’s also an app, and only an app, and only on the iPhone, and it’s about the simplest app you can imagine. It offers a single feature, which is that you tap the screen to go forward. That’s it. Yet with this simple app Sloan has kicked the crap out of almost every enhanced ebook or tablet app I’ve seen.

True, Sloan had the great advantage of simplicity: he needed to convey not the dynamics of evolution or the wonders of dinosaurs but a clean, straightforward argument: that the bells, whistles, options, features, links, and likes that now define much of our online and app reading experience can distract us from things we need to just tunnel into. So he ditched the bells and whistles and built a tunnel. And going down this thing provided one of the most satisfying short reading experiences I’ve had in some time.

Fish could hardly be simpler. As noted, you simply tap one screen to move to the next. Most screens contain, at most, one sentence. Often Sloan breaks a sentence over several screens. He does this skillfully, in rhythm with the language; never just for effect. Now and then, in lieu of a paragraph break, he lays down a blank card.

And, crucially,


You can only read forward. This means reading Fish is like reading an essay written on index cards, except that when you finish a card you have to drop it down a well. Because you can’t go back, you read more carefully. The slowed reading and the clean prose creates a feeling of brevity and concision, much as produced by a poem. I was amazed when Sloan told me the essay was a thousand words — a medium length in print, longish for a poem or a blog post — for it felt shorter, denser, cleaner than that.

“Yes!” he said. “You almost need new metrics. We usually think of work counts or column inches. But this is about the time it demands and how many transitions between screens. It’s a a three-hundred-card essay.”

This slow-drip approach, along with commitment involved, created a pleasurable sense of immersion. It reminded me, paradoxically, of the frisson I felt the first time I played Myst, years ago. Myst was one of the first computer games in which you wandered around an open world and slowly made sense of it. You find yourself on an island and have to wander around and figure the place out. It’s rich. I can still remember the goose-bumps I got when I realized how it worked. With Fish, of course, I was not in open space but headed down a spare, artfully lit one-way tunnel. The novelty came not from options, but from commitment.

Sloan loves the web and lives there. “I feel like a native of the browser,” he told me. But he sometimes gets frustrated, he says, “at the surplus. Right now, as we talk, I have 26 tabs open in front of me, all these other apps — frames within frames within frames. You can’t get anyone’s attention in a focused way. Your writing can be beautiful, gorgeously laid out, but it’ll be surrounded by other things.

“How can we escape that?”

At first he wanted to write a blog post. But he’d been thinking he might do an app sometime, and realized this might be the time to try it.

“I had some false starts. I spent a couple weeks working up a story, with illustrations, but it wasn’t working. Then I realized: No, just the cards. I’ve been learning that often the answer is to simplify. Strip stuff away.”

There’s a vital lesson here for ebook designers. What Janet Malcolm said in her superb Paris Review interview about the writer’s problem applies to the ebook designer’s problem as well: Having collected and generated stacks of thoughts and ideas and material and strategies for telling a story one, the writer’s problem is not what to put in. The writer’s problem is what to leave out. And just because you have something does not mean you should use it. Content must be slave to design — design in a strategic sense, not just in how a thing looks. When it’s right — the way it’s right in this app, the way it’s right in Malcolm’s A Silent Woman, which is the book she was talking about — the work comes alive.

This doesn’t require minimalism. But it requires care, and care throughout. In the high-features ebook world, for instance, I feel this in Theodore Gray’s The Elements. Here virtually all features complement one another and drive the same line of exploration. It helps that the writing in The Elements is superb — an exception among feature-rich ebook apps. Too many others, even some that are gorgeously produced, produce the frustration I felt watching James Cameron’s Titanic: All that money, all that production value, no end spared to show us the machine room or the beauty of DiCaprio’s smile or Winslet’s eyes … and you couldn’t find a frickin’ writer?

The words matter. Not that everything needs to be text-driven. But the text should be good, and they and every other element need mesh into something that drives toward the same end. That’s the real beauty of Fish: Amid all the media and app tools out there, it recruits or invents only those that enhance rather than distract.

Sloan’s not suggesting we should do this all the time.

“The key is and,” says Sloan. “When people talk about these things, they default to or, and force you to choose sides. We have all these tools; we should use all of them. I would never trade in the whole open web for a full-screen single-threaded essay with no back button.”

Yet there are times, he insists, when we need to slow down: to look carefully and long at something, as a student in natural history might look long and hard at, say, a fish. Or, to repeat, as Sloan does:


For more on the fish, check out the app. It’s free, and it doesn’t take long.

But go slow.

Fish: A Tap Essay, by Robin Sloan. iPhones only. It’s free. Grab it here.

This review is cross-posted from Download the Universe, a new site for reviewing science e-books.