Allan H. Ropper > Quotes

“The Brits call this sort of thing Functional Neurological Symptoms, or FNS, the psychiatrists call it conversion disorder, and almost everyone else just calls it hysteria. There are three generally acknowledged, albeit uncodified, strategies for dealing with it. The Irish strategy is the most emphatic, and is epitomized by Matt O’Keefe, with whom I rounded a few years back on a stint in Ireland. “What are you going to do?” I asked him about a young woman with pseudoseizures. “What am I going to do?” he said. “I’ll tell you what I’m goin’ to do. I’m going to get her, and her family, and her husband, and the children, and even the feckin’ dog in a room, and tell ’em that they’re wasting my feckin’ time. I want ’em all to hear it so that there is enough feckin’ shame and guilt there that it’ll keep her the feck away from me. It might not cure her, but so what? As long as I get rid of them.” This approach has its adherents even on these shores. It is an approach that Elliott aspires to, as he often tells me, but can never quite marshal the umbrage, the nerve, or a sufficiently convincing accent, to pull off. The English strategy is less caustic, and can best be summarized by a popular slogan of World War II vintage currently enjoying a revival: “Keep Calm and Carry On.” It is dry, not overly explanatory, not psychological, and does not blame the patient: “Yes, you have something,” it says. “This is what it is [insert technical term here], but we will not be expending our time or a psychiatrist’s time on it. You will have to deal with it.” Predictably, the American strategy holds no one accountable, involves a brain-centered euphemistic explanation coupled with some touchy-feely stuff, and ends with a recommendation for a therapeutic program that, very often, the patient will ignore. In its abdication of responsibility, motivated by the fear of a lawsuit, it closely mirrors the beginning of the end of a doomed relationship: “It’s not you, it’s … no wait, it’s not me, either. It just is what it is.” Not surprisingly, estimates of recurrence of symptoms range from a half to two-thirds of all cases, making this one of the most common conditions that a neurologist will face, again and again.”
― Allan H. Ropper

“To become a good clinical neurologist, you have to be intensely interested by what the brain does, how it works, how it breaks down.”
― Allan Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“What they hope, what they expect, what they deserve, is that we take the time to listen, because the act of listening is therapeutic in itself. When we do it right, we learn details that make us better doctors for the next patient. The residents may not get this yet. They are focused on diagnosis and treatment, on technology, on scales, titers, doses, ratios, elevations, and deficiencies. All well and good, I tell them, but don’t forget to listen.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease

“We rarely stop to think about how much of our persona is created by the forty-three or so facial muscles at our disposal, especially those that encircle our eyes. When we think of eyes, other than their color, we think mainly about their frame: the lids, lashes, and brows; a squint, a glint, an arched brow, a purposeful asymmetry. We speak with our eyes. We read other people’s faces through a myriad of micro-expressions. One of the cruelties of ALS is that it not only forces its victims onto ventilators, thus robbing them of speech, but it eventually neutralizes most of the facial muscles, reducing the expressive palette to a few basic gestures.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“The patients are holding out their troubles. They are not really asking you to take them. You should only take them if you want or need to take them. Otherwise, leave it. They’ll get along without your suffering. You have another job to do.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“You have to respect their wishes as human beings, we are told. But if you ask me whether the custom is always right, I would say, “Not at all”. The patient is so very often dead wrong, and very much so when it comes to his own brain.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease

“Of course, sharing the illness du jour with large numbers of fellow-sufferers has a supportive, salutary effect. In this case, the affliction is called electromagnetic hypersensitivity, or just electrical sensitivity syndrome. There is a wealth of Web sites and chat rooms devoted to it. Sadly, when it comes to dealing with, much less treating, such borderline theories, I have no spiel to offer, and sometimes revert to being a jerk. In this case, I suggested that they both might be magnetized. As an experiment, I said, he and his wife should float on their backs in their swimming pool to see if they both pointed north. I was guessing that they had a pool. I was right. They never came back.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“a case of amnesia brought on by sex,”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“But those friends that were able to look into the ugly face of ALS and not turn away came to realize that the essence of George had survived this calamity, and for that they have been blessed with the ongoing gift of his love, his humor, his friendship, and an inspiration for life that comes from being around him.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“there is no right or wrong road. There is only the road you choose.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“Suspecting an overdose of some kind is not a transcendent judgment about them or their lifestyle or their character. It is one moment in somebody’s life. People poison themselves all of the time.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“Only one organ has a mind of its own, and it is constantly causing problems for itself. These problems, once termed “hysterical” and “psychosomatic,” are now called “functional” or “somatoform.” The conditions themselves are referred to as conversion disorders, implying the conversion of psychic distress into physical symptoms. It is one of the last vestiges of Sigmund Freud’s legacy still lurking in mainstream medicine.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“may not get this yet. They are focused on diagnosis and treatment, on technology, on scales, titers, doses, ratios, elevations, and deficiencies. All well and good, I tell them, but don’t forget to listen.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease

“When you no longer have a reason to get out of bed, that’s when you’re going to take a long look at the worth of your life.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

“Like clinical neurology itself, it proceeds on a case-by-case basis.”
― Allan H. Ropper, Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease