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Book review by Dr John A Duley PhD

LDAA Scientific Advisory Committee
(Honorary Senior Fellow, School of Pharmacy, The University of Queensland)

I was recently browsing in a bookshop, to fill in time, and saw a new book, ‘How The Brain Lost Its Mind’.  A catchy, humorous title. It was subtitled ‘Sex, Hysteria and the Riddle of Mental Illness’ – very provocative, so I picked it up and flicked through it.

The rear cover told me the book was about the disease syphilis, of which I knew very little except that it is caused by a spirochete bacterium (now what was its name?), rather like Borrelia causes Lyme Disease, with which I have a much closer relationship (my wife caught Lyme from a tick in England, two decades ago, was undiagnosed and went through hell).

The rear cover confirmed the focus on syphilis, but then alarm bells began to ring: “Known as ‘the Great Imitator’, it could produce almost any form of mental or physical illness…” This was sounding more and more like Lyme disease!

Inside the front cover was a photo of a painting from a medical class in the 1800s, showing a scantily-clad woman fainting into the arms of a doctor, in front of an audience of famous clinicians and scientists (yes, they were all men). I bought the book.

Written by American neurologist Alan Ropper, in collaboration with a science writer Brian Burrell, the book has some lengthy medical explanations, interspersed throughout with juicy historical stories of infamy and madness. Syphilis is caused by the spirochete Treponema, is spread by sexual contact (but similar to Borrelia it can be passed on from mother to baby). It’s believed to have been brought to Europe from Haiti by Columbus in the late 15th century, but by the early 1800s it had devastated Europe as well as America, with an estimated ten percent of the population infected.

Syphilis appears first as a mild skin infection, but like Lyme disease the spirochete spreads throughout the body, then syphilis seems to disappear and the patient ‘recovers’! Then the disease reappears, usually a decade or two later, to cause madness, paralysis, and death. However, this second stage was so slow in appearing that it wasn’t associated with the original sexual infection (alarmingly, in recent years this neurological stage is appearing much faster).

Symptoms of this second stage of syphilis was finally identified as being caused by Treponema infection in the 1900s and then named ‘neuro-syphilis’. It can resemble epilepsy, with fits of irrational behaviour including – famously – bizarre ‘delusions of grandeur’. Associated with the rise of neuro-syphilis in Europe was an outbreak of ‘hysteria’ in the 1800s. This term had all but died out in the 1970s under Women’s Lib attacks led by Germaine Greer, but worryingly it has enjoyed a revival in medical circles. In Australia, a person suffering from neuroborreliosis will be referred to a psychiatrist, to treat their ‘hysteria’. So we are back in medical dark age of the 1800s.

Shortly after my wife was bitten by an English tick, she developed flu-like symptoms, but without the typical respiratory problems. This appeared to resolve after a week or so, then returned, especially myalgia, extreme fatigue, loss of appetite. Breathlessness ensued, sufficiently severe to cause me to take her to hospital emergency on two occasions – no cause was found. Then my wife became confused, to the extent that she could not remember her name, and unsurprisingly she became agitated. Certainly my wife displayed many signs that could have been labelled ‘hysteria’. Her GP eventually suggested my wife see a psychiatrist, and she refused.

The book uses the example of syphilis to show how the science of the brain (neurology) arose, and how ‘mental illness’ (which filled asylums with patients) was finally divided into either problems that arise from diseases of the brain, such as neuro-syphilis, Huntington’s disease, Parkinson’s disease and Multiple Sclerosis, compared with disturbances of the mind (such as PTSD). Some problems have defied being pigeon-holed, such as Tourette’s syndrome, autism, depression and addictions.

As it is written by a neurologist, the book does not portray the early 20th century ‘psychoanalysts’ – such as Freud – in a flattering light. Women were being blamed for ‘sexual neurosis’ when in fact they were terrified of the effects that syphilis was having on their families.

The clinical parallels and distinctions following infection by the spirochetes Borrelia and Treponema are fascinating. But even more interesting has been the same denial by specialist physicians to engage with these bacterial diseases of the brain (including Bartonella etc), and to recognise the short- and long-term outcomes including psychiatric symptoms.

Lyme disease (now often referred to, ironically, as “the great imitator”) is spreading rapidly in America and elsewhere, driven by an increasing range for ticks with climate warming, combined with urbanisation and loss of forest habitat that is bringing deer into closer contact with humans. At the same time, its victims are ironically being accused of ‘hysteria’.

For my wife, the symptoms gradually abated over about a year, and despite some late antibiotic treatment she has been left with long-term fatigue, the breathlessness, memory defects, and severe arthritis. No doubt the Australian Department of Health (DoH) would consider her a prime candidate for psychiatric therapy.

Diagnosis and treatment of ‘chronic Borreliosis’ has been complicated by misinformation and antagonism within medical circles. In America, this medical ‘reticence’ has recently been judged in court to be the direct result of a conspiracy between a panel of influential doctors and some medical insurance companies. The reticence and outright obstruction the DoH will now be open to further scrutiny by patients.

Will we see a future book on the ‘hysteria’ and false ideas concerning neuroborreliosis, like the ‘horror’ stories of neurosyphilis? I hope not: I am retired now but I prefer to think that modern medicine is up to the task of confronting new neurological diseases, rather than hiding behind 19th century concepts.

Postscript: More recently my wife was bitten by another tick, this time in Australia, and developed strange gastrointestinal symptoms. These were also dismissed as ‘imagined’ or ‘anxiety’, and a psychiatrist again recommended… until the problem was finally recognised as the newer disorder, ‘mammalian meat allergy’ (alpha-gal allergy). But that’s another story.