Thursday, February 9, 2012

Brain Donation

Do I want to give my brain away? Not right now, I mean, but if and when I die. Do I wish to allow someone to saw my skull open, manhandle my precious brain tissue out of the nest in which it has been living for the past half a century, then slice it and dice it and post pieces of 'brain salami' around the world for researchers and students to try experiments on? Er, no, I really don't want to do that at all, and I don't even want to think about my death, thanks. But ... it seems like the right thing to do.

At an event held this evening, at the GV Art Gallery in Marylebone, three speakers presented the case in favour of brain donation. Dr David Dexter & Dr Stephen Gentleman gave excellent talks on why they want my brain and what they will do with it when they've got it. Not just my brain. Yours too, or just about anyone's.

GV Art at 49 Chiltern Street ( has a current exhibition entitled 'Trauma' -- physical and mental trauma in a broad sense of the term. One of the exhibits is supposed to be a representation of a pedestrian hit by a car, which is the kind of thing that the word 'trauma' first brings to mind. But the exhibition spans pretty much everything else that can go wrong with our frail human minds and bodies -- cancer, madness, viruses, senility, nerve degeneration. The yuk factor in the exhibition is surprisingly low. One set of exhibits, Luke Jerram's glass sculptures of viruses, are exquisite in their delicate beauty. The one exhibit that ought to be disturbingly and desperately messy -- the road traffic accident or RTA -- is almost perversely sanitised. I gather that people of an older generation were fond of the motto "always wear clean underwear, in case you are knocked down by a lorry". Even when dead, it was a matter of pride to be found to be wearing clean undies. Unfortunately the first thing the body does when it dies (and often even in acute injury) is to relax the smooth mucles and let the urine and faeces out. But don't worry, David Marron's dead pedestrian has clean pants. Marron sublimates the savagery and unspeakable ugliness of a car accident into an abstract conceit resting on mythology and wordplay.

Visceral yukkiness is again sublimated to an intellectual frisson of taboo-breaking in Andrew Krasnow's scupltures made of (bloodless) human skin. GV Art is exhibiting his sculpture of a human, made of human skin. The front desk is selling a book on Krasnow's work, featuring an interview of Krasnow by Bella Land and Jonathan Hutt, which is worth reading.

Even the subject of yanking out people's brains and slicing them like loaves of bread on a lab bench is handled in a matter-of-fact way at GV Art's panel discussion. Dr David Dexter, Scientific Director of the Parkinson's UK Brain Bank, started by giving us a summary of the war against Parkinson's Disease. More people have Parkinson's than you would think. (Take a guess, then add a zero to the end.) The good news for the lower animals is that they never get Parkinson's and so they are not going to get roped into lab exeperiments to do research on the disease. Only human brains exhibit Parkinson's, and so quite obviously the scientists need shedloads of human brains to poke around with. Thank heavens we live in a society (at least, we do in England) where human vivisection is not allowed. So the only human brains that the research labs are going to be able to use are yours and mine when we've popped our clogs. Next with the mic was Steve M Gentleman, Professor of Neuropathology in the Department of Medicine at Imperial College, who calmly told us about being woken up at 2 am by distraught and bereaved relatives who nevertheless had suffcient presence of mind to call up the brain donation hotline and offer their loved one's freshly deceased brain for dissection. As he said, you get used to it. Kind of. These two speakers who work at the bleeding edge of brain research gave clear and informative talks. The panel session was rounded off by Caroline Browne, Head of Regulation at the Human Tissue Authority, who read from her notes about the legal control of the bits and pieces of body that may be taken from our carcasses when we shuffle off the mortal coil.

Then there was the Q&A session, generously lubricated by a good red wine courtesy of Robert Devcic, the proprietor of GV Art.

I am intrigued by the disconnect between our experience of human consciousness in all its glories and miseries, and the utterly prosaic lump of tissue "with the consistency of cold porridge" that occupies the space between our ears. What, I wondered, did the speakers, who deal with harvested brains in their daily routines, make of this conceptual dissonance? I opened the Q&A by throwing these sensible speakers a question about that old philosophical curveball, the human soul.

"Many people", I said, "believe in something called the soul, which dwells in the human body. And because of this soul, the body is in some sense sacred. The brain is supposed to be the seat of the soul, and hence is sometimes thought of as especially imbued with a sacred and numinous quality. Do you believe in this? If so, how does it impact your work in harvesting and mutilating brains? If not, how does that impact your dealings with prospective donors and the bereaved relatives of donors, who may have such religious beliefs?" Why do people squirm at such an obvious question? Maybe it's the great scientistic ideology that any part of a human being that you can't see under a microscope is a mythical nonsense left over from the Dark Ages.

The speakers gamely fielded the question. David Dexter made the interesting observation that in parts of Africa brain donation is non-existent because of the pervasive believe that the brain contains the soul and must be buried with the body.

What I found interesting, but as a philosopher disappointing, was that the dialogue on the soul and sacredness of human tissue was immediately segued into the dialogue on consent. The thinking seems to be: if the donor has given written consent then our legal arses are covered and the ethics committee can tick its boxes. Numinosity is not on the agenda for discussion. Consent, however, is just bare minimum to ensure that medical scientists don't trample on the sensibilites, sentimental or religious, of the prospective and actual donors. It deftly sidesteps the question of whether human remains are sacred and intrinsically deserve a kind of respect not accorded to, say, a tissue culture grown in a Petrie dish.

Stephen Gentleman was the most explicit about this. "Look", he said, "I don't know what the soul is supposed to be but whatever it is, it's not in a dead brain."

This is a pragmatic compartmentalisation of thinking and sentiment. On the one hand, we need to do research on the brain otherwise we will not make much headway on Parkinson's. On the other hand, as decent human beings we need to treat living people as having an inexplicable right to dignity. So, let's just agree not to look too closely at the awkward twilight zone of the no-man's land between life and death. We have one way of relating to living human beings, and another way of relating to dead brains. Let's just leave it at that, right?

Philosophers, however, just can't leave conceptual dissonance alone. They are drawn to it as if to a "splinter in the mind". Like a Necker cube that seems to switch between concave and convex, the problem of the brain may oscillate in our mind between diametric conceptions. On the one hand, we project the full sensorium of human experiences onto the brain -- the sound of a violin, the taste of wine, the feel of a caress, feelings of joy and rage -- all of that is thought of as residing in the brain, which makes the brain a very special lump of matter, one might even say magical. On the other hand, the neuroscientist who rips a brain apart with a scalpel, dyes and scrutinises its fine structure under a microscope, and correlates its defects with behavioural problems, reassures us that it is just 'plain vanilla' matter, albeit built within infinite intricacy.

Those two perspectives cannot both be right. Furthermore, when we factor in the moral dimension, the gulf seems unbridgeable. For if the brain were just a lump of matter, why would we ever care about it, in the way that we care dearly about human beings? For according to the scientific orthodoxy, a human is absolutely nothing but a meat machine: you and I are just physical objects moving around under the rigid control of laws of biophysics. No free will or consciousness: just an assemblage of tissue acting and reacting to stimuli. It makes no sense to think that it is wrong to do violence to an assemblage of tissues activated by electical pulses, or that we owe any duty of care to such a meat machine. The only excuse for ethics in such a worldview is the principle of enlightened self-interest: don't hurt other people as they might hurt you back. It is a joke to even label that squalid attitude as a 'morality'. The fact is that unless we ascribe a spiritual or sacred dimension to a human being, there is no basis for any framework that could meaningfully be described as moral. And yet, and yet ... when we pull a human body apart all we find is tissue.

David Dexter made a very revealing answer to a later question. The two men were asked by Robert, "Have you filled in the form to donate your own brains?" We were surprised that the answer was no. As a matter of policy, staff who work in the brain bank do not offer their own brains for donation whilst working there. The reasoning is that Dr Dexter's colleagues might find it upsetting to have lunch with him on Monday, and on Tuesday morning to be sawing open his head and scooping out his brain for slicing up. But if it's just a mass of tissue, why would that matter? If he had donated his hair or fingernail clippings, nobody would raise an eyebrow. But to have in your hands the brain of your friend and colleague ...? Yuk!


In case you're wondering ... yes, I did bring home the brown envelope, and I will be giving away my brain.

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