In Britain, neurologist Guy Leschziner runs one of the busiest clinics in the country. While many neurologists see patients with rare disorders of the nervous system, Leschziner frequently receives cases that deal with the still-mysterious world of sleep. While the frequent insomnia patient is always at the doorsteps of the clinic, other cases tend to fall in his laps. When other specialists are lost in the complex web of the science of sleep, they turn to Leschziner for guidance. In his first book, The Nocturnal Brain: Nightmares, Neuroscience, and the Secret World of Sleep (Simon & Schuster UK, 2019), he recollects many of those cases, following the long tradition of one of his heroes.
The Brain at Night
The Beautiful Writing of Guy Leschziner
Leschziner was one of the many enthusiasts of medicine that found solace in Oliver Sacks’ work. The late neurologist was unique. In contrast with the medical establishment of his time, he tended to write long medical sheets of his patients, integrating literary prose, while examining every aspect of his patient’s human experience. Sacks did not let the medical condition obscure the person beneath it. In the long, dreadful nights, while studying medicine, Guy Leschziner would go through Sacks’ greatest work, The Man Who Mistook His Wife for a Hat (1983). The medical cases in the book featured an array of unique personas; a sympathetic Sacks wrote about the condition of the patient and his humanity.
It is no wonder why The Nocturnal Brain is such a pleasant read. While many books about sleep concentrate on solutions and the science behind it, Leschziner goes further in exploring rare neurological cases that may explain aspects of the science of sleep. Leschziner, like Sacks, puts the human experience first. Then, he slowly expands on brain processes that give rise to the disruption of his patient’s good night sleep.
The world of books on the science of sleep tends to give way for journalists who deal with sleep disorders. These writers tend to recall their experience and explain the discipline of sleep medicine with a touch of concise writing and reader-friendly prose. (This is not to say that they’re mostly bad books, some are good. The partner of Sacks, Bill Hayes, wrote a magnificent book about his life with insomnia, Sleep Demons: An Insomniac’s Memoir.) In Leschziner’s account, the cases are many, one different from the other, shedding light on one aspect of sleep.
Equal to Sacks’ classic, Leschziner puts forward a collection of extremely rare cases. The reader meets a patient that turns insensitive towards his loved ones, gets sexually aroused around his mother, and sleeps more than 15 hours. Leschziner goes step by step in his prose to delicately examine the possibilities of his condition (Kleine-Levin syndrome) and find a way to at least alleviate the patient’s life. On that last point, I found Leschziner’s book a bit more satisfying than his hero’s. While Sacks tended to have an in-depth exploration of his patients, his cases often left the reader with a sense of hopelessness, as if the patient in the pages would never achieve a regular life. In The Nocturnal Brain, patients achieve a greater fate.
Mistaking Her Motorbike for a Bed
The biggest example of this is the case titled, “In the Still of the Night”. Jackie, a 70-year-old patient, experienced the most bizarre behavior during sleepwalking. Her neighbor noticed that she, in the middle of the night, puts on her motorcycle helmet, her jacket, and drives off through dusk. Jackie was used to such behavior, since her time in Canada, when she was 10. But, during her visits to Guy Leschziner’s clinic, her sleepwalking became acute. When she longer drove her bike during the night-time, she started to drive her car. Leschziner speculates that her sleepwalking might have something to do with the mysterious patterns of sleep that cannot be positioned in the spectrum of awake or asleep (That is, parts of the brain that appear to be active and awake, while the patient is in the deepest state of sleep – in Jackie’s case, non-REM sleep).
The condition is not enough for Leschziner, he deliberately takes his time to explain the state of the brain, which parts are awake, and which are on sleep mode. Moreover, he expands on the grey areas of the science of sleep, demonstrating that there still a lot to uncover. In Jackie’s case, her sleepwalking shows that REM is not the only pattern of sleep in which dreams occur. (What changes is the content of the dream in non-REM sleep and REM sleep.) The notion of a brain asleep and a brain awake, for Leschziner, is too simple, given the complexity in which the organ works. In contrast to other books, in which the “secret world of sleep” tends to appear as settle science, The Nocturnal Brain demonstrates that there’s a complexity that we have yet to uncover.
The other cases of the book tend to keep that same straight line. Leschziner introduces the afflicted patient; he speculates on the diagnosis, while some science history aides the reader to understand the progress in which we came to understand the condition. The KLS case mentioned before – titled “A Peculiar Fairy Tale” – beautifully showcases Leschziner’s talent in combining the latter elements; to put forward science for the lay, without watering down the quality of the discipline.
In terms of comparing it to Sacks’ masterpiece, the book tries hard, but never achieves it. Not because Leschziner lacks the talent, but, as once Sacks said: “There will be no one like us…but then there is no one like anyone else, ever.” Leschziner thrives with the cold data, the hard facts. Sacks thrived with the philosophical predicaments in which his patients dealt with their gloomy future. While Leschziner gives space to his patients, able to have a more discrete relationship with him, Sacks proved to be everywhere in his patients’ life. This was a point that the authorized biographer of Sacks, Laura Snyder, made to Lawrence Weschler in a conversation about the latter’s biography/memoir on the neurologist. The life that Sacks lived with his patients, having deep, personal relationships, while having time to write long, poetic sheets about the condition, is almost impossible these days.
The cases shown by Guy Leschziner demonstrate the modern dilemmas of neurologists who voraciously read Sacks’s The Man Who Mistook His Wife for a Hat. They know the importance of relationships with their patients, but the modern era only permits a professional and an empirical view of them. Even when a humanistic view can be employed, the need for more empirical data trumps any philosophical musing that the doctor might have. The reader will have to take this collection as an ode to the study of the medical case and the still mysterious science of sleep.
__________________________________________________
The Nocturnal Brain: Nightmares, Neuroscience, and the Secret World of Sleep
by Guy Leschziner
Simon & Schuster UK, Paperback, pp. 368