The Noisy Brain

Excerpted from
Shadow Syndromes: The Mild Forms of Major Mental Disorders That Sabotage Us
By John J. Ratey, M.D., Catherine Johnson, Ph.D.

When we ask ourselves what minor flaws in the brains functioning may be affecting us or someone we love, one of the most confusing issues is how many of the shadow syndromes normal people may fit. Sometimes depressed, sometimes impulsive, sometimes manic, sometimes obsessed: we may find aspects of ourselves, our families, and our friends in every chapter of this book.

That is why we begin here with the concept of noise. The one characteristic every shadow syndrome has in common is noise: an internal, biologically based, mental white noise. When we are mildly depressed, or mildly hyperactive, or mildly anything else, our brains cease to function as the quiet, reflective center of an ordered world. We become noisy on the inside. All of the syndromes result in a stare of mental noise. No matter what their particulars, all of the syndromes have noise in common.

In this way, mental illnesses are much like physical illnesses. Every illness to which the body is prey has its specific symptoms-fever, joint pain, cell loss, muscular degeneration-whatever the case may be. But every physical illness also has nonspecific symptoms, symptoms that are universal to every disease we know. And the one universal in physical disease, the one symptom common to each and every malady human beings suffer is: the state of "just being sick." All sick people, no matter what is wrong with them, are just plain sick.

Though this may seem obvious, in fact for many years medical science failed to grasp the implications of this universal truth. It was Hans Selye who first introduced the "just being sickness" of sick people, back in 1925. He was nineteen years old, fresh from his studies in medical school, and meeting patients for the first time.

Later, Selye would go on to formulate the theory of what we to this day call stress, which he defined as "the nonspecific response of the body to any demand made upon it"-any demand including the demands of physical illness. As Selye learned, all sick people are physically stressed by their ailments.

What Selye s stress is to the body, noise is to the brain: noise is the brains nonspecific response to the demands made upon it by difficult life circumstances, or by difficult (or flawed) biology.

John and his colleague, Steve Sands, of the Boston Psychoanalytic Institute, first developed the idea of internal noise a number of years ago when they were seeking a way to grasp the interior life of patients struggling with severe mental illnesses such as schizophrenia. "Noise" offers us a metaphorical way inside their experience, because all of us have experienced the disorganizing nature of real-world noise in its normal, everyday sense. The noonday rush hour, a jackhammer outside the window, the neighbors stereo booming through the walls: while most of us will never hear voices, all of us have had the experience of being blasted by sounds and stimuli we cannot block out. We know how disorienting noise can be. We even have an expression for how we feel when the world is too loud: we say we "can't hear ourselves think."

The noise inside the brain of the severely mentally ill is not a literal noise, except in the case of schizophrenia, where a patient does in fact hear voices. It is a figurative noise; it is metaphorically akin to the very low signal-to-noise ratio of a radio channel filled with static. Inside the noisy brain, nothing is clear. The noisy brain cannot separate out stimuli or thoughts, either incoming or outgoing; everything is happening at once.

In terms of its consequences, brain-noise affects people in precisely the same way real-world environmental noise does. Overwhelming noise of any kind is profoundly aversive. Looking first at real-world noise, there are reams of data available on what happens to people attempting to recall lists of nonsense words, or add long columns of numbers, when bombarded by loud, unceasing noise. Invariably, people overwhelmed by noise make mistakes; their processing capacity falls apart. Inescapable noise is very stressful-so stressful, in fact, that when researchers investigate stress they typically choose noise as their means to induce stress in the people they are studying.

Thus we can begin to imagine what it must be like to live inside a brain that is itself the source of inescapable and incapacitating noise. This is the lot of the severely mentally ill: they must live out their lives inside a brain filled with noise, a brain that cannot settle itself down, cannot soothe its own chaos. The mental life of the severely mentally ill is a vicious whir; their minds cannot think about one thing at a time, but instead spin out wheeling masses of thoughts, feelings, sensations. Nothing coheres; thoughts are detached from feelings, and feelings are detached from bodily sensations.

This disconnect can lead to the bizarre reasoning that is the hallmark of the severely mentally ill. John remembers a patient, a thirty-one-year-old man with a thirteen-year history of schizophrenia, who arrived at his doctor's office complaining about his thighs. His thighs were bothering him; that was all he could say. Psychiatrists affectionately call this type of schizophrenic patient report "having the heebie-jeebies," because that's exactly what it is: the patient is not actually experiencing any real, diagnosable problem with his thighs. He has the heebie-jeebies.

In the case of this particular patient, he and his psychiatrist were eventually able to figure out that what he was actually feeling was a sexual attraction to one of the nurses at the hospital. But for him the channels that connect a physical sensation like desire to the mental emotion of desire were so filled with static-so noisy-that he remained completely in the dark as to what was actually going on inside himself. Deafened by his own interior din, he could not hear himself think; he could not feel himself feel. So he flailed about for a satisfactory explanation of the inchoate sensation engulfing him-which his mental illness readily gave him: the problem with his thighs, he told his therapist, was that someone had put implants in them while he slept! For the schizophrenic, a noisy brain leads to massive distortions of reality.

For the rest of us, reality-both the reality of the external world and the reality of our internal sensations, thoughts, and feelings-comes in far more clearly. Even so, the static produced by the shadow syndromes can lead to wounding distortions of fact and fancy, as we will see. For different shadow syndromes, of course, noise may come from different sources. Because of his oversensitivity to touch, for example, the mildly autistic person may be thrown into a noisy state by signals coming in from his own body. Such a person is defenseless against his body because he cannot let bodily sensations stream across his consciousness the way the rest of us do. Most of us have had quasi-autistic experiences from time to time: the experience of getting stuck on some bodily sensation we ought to be able to ignore-like the person who cannot get his glasses adjusted correctly on his nose. A person in this predicament cannot stop feeling the frames on his nose. Or, in another example: A patient once reported that she had suffered hours of insomnia the night before because she could not get comfortable in her bed. Wherever the sheets touched her body, they felt wrong. For hours she shifted about, trying to find the spot on her leg, the spot on her shoulders, the spot on her back, where the sheets would magically feel right. But she could not. A person who continually had this experience would be in the same predicament as the young autistic child who refuses to wear his clothing because he can't bear the feeling of the label brushing against the back of his neck.

Another example: The person with a mild form of attention deficit disorder may arrive at a noisy state via a slightly different route. People who suffer from ADD cannot filter stimuli from the environment; they tend to see everything there is out there to see, all at once. As one of John's patients describes it, "When I'm driving in traffic, I can't just see the car in front of me, and the car behind me. I see all the cars in front of me and in front of them, too; I can't not see them. I'm seeing dozens of cars, all at once. It wasn't until I started taking medication that I could actually look in my rearview mirror and just see the cars I needed to see." While the stimuli throwing him into a noisy state are technically coming from the environment, it is the faulty filtering mechanism of his brain that is the problem. He is continuously being thrown into mental chaos by his brain's incapacity to filter out the environments irrelevant stimuli.

The person with a mild panic disorder will develop his mental noise in yet a different way; the person with mild depression will grow noisy in still another. But for all of us, no matter what the particulars of our shadow syndromes, a shared state of noise will be the result. And the results of a too-noisy biology will ultimately be painful.