We have a lot of nerve !!

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All living beings react to their environment. Barring a few, all animals can see, hear, feel, smell and taste our surroundings. We all can also walk, jump, balance and coordinate our movements. While many animals out-do humans in these acts, we probably excel in expression of our thoughts. All civilisations express hope, fear, desires and fantasies through gestures, language and art. We learn, innovate, memorise, and forget. All of this is a play of our nerves. We all have an extensive, and intricate “neural network”, and are just beginning to understand its mysteries.

Brain sets us apart

While all animals have some nerve-elements, humans have a large bundle right at the top. Brain it is, mere three pounds (or about 1.4kg) in weight and protected all around by a tough bony skull. Since ancient times, inquisitive minds have attempted to drill these hard exteriors. Such “trephining” was probably a therapy or a ritual to let-go evil-humours. It was only in 16th and 17th centuries, that likes of Johanan Payligk, Andreas Vesalius, and Thomas Willis dissected human brains and drew intricate structures visible to our eyes.

A lot of action in the brain and nerves is however not visible to our naked eyes. In 18th century, we discovered electricity. Over the next 100 years, Luigi Galvani, Charles Bell, JE Purkinje and others, unravelled that similar electricity runs through all our nerves. We had a scientific basis for the five-senses, electrical signals rushing through to the brain. We could also apply electric current to the brain and nerves, so as to twitch the muscles. Hence, now we knew brain as both a receiver, and a generator of electric signals.

Concepts of nerve diseases

Neurology, Psychiatry, Neurosurgery, and Neuropathology – all grew up together. Pioneers of neurology, extensively studied behaviour and improved our concepts. Early 19th century was a beginning for “nerve” diseases. Moritz Romberg (1795-1873) a German physician wrote the first textbook of modern neurology. Wilhelm Griesinger (1817-1868) succeeded Romberg, and established the Medical Psychological Society. In those times, societies considered individuals with a mental illness as “possessed” and confined them to asylums. Griesinger, believed psychiatric illnesses to originate in nerves and brain, and pioneered integration of mentally ill in society.

French physician Duchenne (1806-1875) studied diseases of muscle and developed concepts of muscle biopsies and electrophysiology. Jean-Martin Charcot (1825-1893) was his student. He was a towering figure, described various diseases, and fathered a structured neurological examination. He devoted much of his later life, on hypnosis and hysteria. Many of his students became famous neurologists, psychiatrists or neuropathologists – such as Sigmund Freud, Joseph Babinski, Gille-de-tourrete, and Romano Cajal.

Discovery of nerve cells and their connections

Each nerve consists of a bundle of nerve-fibres. These nerve fibres originate from nerve-cells or neurons. Ramon y Cajal (1843-1926) and Camillo Golgi (1852-1934) were neuro-pathologists from Spain and Italy respectively. Golgi stated and revealed the structure of neurons Cajal demonstrated how they actually work. They shared the 1906 Nobel Prize for discovery of structure and function of nerve cells. Each nerve has fibres from different types of nerve cells. Some are long, others are short. Some specialise in carrying information to the brain, and others bring back the signals. Indeed we have a lot of nerve !!

With the discovery of neurons, we knew the science behind sight and hearing better. Tiny cells in our eyes and ears convert light or sound into electric signals. These signals travel to the brain, where an even more complex nerve interaction recognises their shape, colours, texture, tone or pitch. We synchronise all our senses together like an orchestra. Together, all the notes of sight, sound, smell, taste and touch create the melody of life. If one note is deficient, another outgrows its capabilities to compensate.

Unravelling nerve disorders is a lot of work

In the late 19th century, making sense of nerve connections was tough. Societies yearned to be perfect. Most western societies sent sufferers of disordered function, thought or brain injuries to mental asylums. Circus-owners paraded many human oddities as exhibits in freak-shows. Physicians, Neurologists or Psychiatrists such as Paul Broca (1824-1880), Jean Charcot (1825-1893), or Alois Alzheimer (1864-1915) would take extensive notes on manifestations attributed to nerves. Years later, when an inmate died, they would travel back to autopsy their brains. This was how Broca identified and named and numbered areas of brain, Charcot discovered multiple sclerosis, and Alzheimer found a better reason for dementia.

More electric discharge – Seizures

In some nerve diseases autopsies were negative. Prominent among them being epilepsy. John Hughlings Jackson (1835-1911) was an English physician who devoted himself to epilepsy research. In older times, the only explanation for a fit was a supernatural curse, or demonic possessions. Across all cultures, priests doubled up as exorcists. Towards the beginning of 20th century, we could capture abnormal brain waves and even replicate seizures in animals.

Nerve-wrecking Brain surgeries

In the later years of 19th century, William Macewen (1848-1928) a Scottish surgeon had performed first successful removal of a brain tumour. Later Alexander Bennet (1848-1901) and Rickman Goldee (1849-1925) performed first successful surgeries on an exposed brain. Harvey Cushing (1869-1939) was first neurosurgeon to treat a hormonal disease (acromegaly) by removing a tumour from the pituitary (a master gland located deep inside the brain). As neurosurgery became feasible and popular, it was tried as a treatment for behavioural diseases. Egas Moniz (1874-1955) was Portuguese neurologist. He proposed, and demonstrated some positive effects of removal of parts of brain (lobectomy), or severing connections between right and left brains (leukotomy) to cure psychosis. He received the 1949 Nobel Prize for his work. First medicines for treatment of psychosis had become available only in 1948. In the later years use of neurosurgery for treating psychosis was gradually given up.

Dawn of Psychiatry

Melancholy (or depression), grandiosity (or mania), and madness (or psychosis) have affected women, men, rich, poor, rulers, paupers, generals, and soldiers alike. Throughout history, sufferers of such behavioural aberrations, were caged, restrained, or isolated into mental asylums. There was no real treatment, unless the sufferer was influential. Science of nerves, and behaviour was composite.

Real reforms towards a community based psychiatry care, were adopted only in the 20th century. Gradually psychiatry became a distinct branch of medicine. Emil Kraepelin (1856-1926) was a German physician. He wrote first textbook of modern psychiatry, and frequently revised his ideas. His elaborate work is the basis of current classification of behavioural diseases. He was followed by Sigmund Freud (1856-1939) a neurologist from Austria. His magnetic personality, and force of his ideas allowed out-patient psychiatry practice. Freud focussed on psychoanalysis, power of dialogue, and theoretical constructs of human behaviour.

Carl Jung (1875-1961) was a Swiss psychoanalyst and a close associate of Freud. Two fell apart due to differences in professional thought. Jung was also an artist, and had his own moments of psychosis. His ideas about conscious and unconscious thought are a basis of many behavioural therapies. He often drew his “thoughts” in a diary – the red-book.

Psychopharmacology

As we identified chemicals in the brain, and their role in behavioural alterations, we also developed medicines for their treatment. Lithium was the first such medicine (1948), followed by Chlorpromazine (1952), Tricyclic drugs and Benzodiazepines (1960s). These medicines help to control mood, depression and sleep. While earlier drugs had many side-effects, newer second and third generation medicines are much safer and more effective.

Availability of medicines, also made it possible to treat patients outside designated institutions. Over the years care has become more deinstitutionalised. As awareness about mental health increased, and inhumane treatments in asylums became more evident, care moved to the community.

We still have a lot to discover

Beginning 1970s, we could image the brain using CT scans and MRIs. For the first time, we could identify diseases in an uncut live brain. Today we also have functional MRIs, and are trying to understand this network of nerves better. We still need to know how these nerves store memories, emotions, make judgement, and contribute to overall intelligence. Probably we will also know better, what makes us sad, happy, or ecstatic. Could we tailor our hopes, desires and fears too !!

Today we recognise mental health issues as common, and widely prevalent in society. In order to increase awareness, and to showcase success, since 1992 we observe 10th October as world mental health day.

Today we have many specialties devoted to the study of nerve and behaviour. Neurologists, Psychiatrists, Neurosurgeons, Psychologists, Neuroradiologists, Neuropathologists, Behavioural scientists and even anthropologists. Nerves run through each and every organ of our body, and are under various degrees of control. Word nerve is used both for courage, as well as anxiety. Indeed we have the most nerve amongst all living beings !!