Dennis fires up the magnet
She gets there and it’s like someone’s aunt has decorated the place. Big block colors and weird expressionist paintings, limbs and tits hanging out of color fields, but also an oriental rug on the wall, zigzag throw pillows, boho-Bauhaus. Orange, red, orange, orange. And then just attic crap: old chairs, audio cables, yellowing books, jigsaw puzzles, a Rubik’s Cube. In the bathroom, she finds a porcelain replica of Fowler’s phrenology head resting above the toilet. From where she’s sitting now, in a big blue chair purchased at a discount from a folded dental practice, she spots a large model of a human ear covered in small Chinese characters, for acupuncture training. Her hanzi are poor, but she knows a few. Heart, eyes. 心, 目.
It’s her shrink who first recommends it to her. Transcranial magnetic stimulation, she says with her throaty uvular Rs. Her psychiatrist is literally German. Frau Doktor explains that TMS is relatively new, a bit experimental, but the idea is to provide a noninvasive alternative to electroshock for patients whose depression has resisted medication, which hers has. But the procedure sounds like something out of science fiction. What they will do, her psychiatrist tells her, is put a big magnet on her head and shoot electricity into her brain. Like jump-starting a car.
She will try anything at this point. It’s been two years since her first depressive episode and nothing feels good anymore. She doesn’t want to have sex or see anyone. Her girlfriend takes care of her, and that’s basically their whole relationship now. She can’t write. She backed out of a bunch of gigs a few months ago; gradually, editors have stopped asking her to do things. When they ask, she doesn’t know how to say no. She hates to say she’s sick, like she’s trying to skip school. She eventually settles on the word sabbatical, because it sounds like a vacation. She is terrified of vacation.
The slightly nutty psychiatrist who runs this place goes by Dr. L. She is Italian, not German, but really Dr. L inhabits a tiny nation of one, her own private Monaco, from which she communicates by long-distance telephone. Despite appearances, it’s a real clinic, at least in the sense that Dr. L is board-certified, and the bald, sarcastic technologist who runs the machines with his small team of graduate students claims to be among the most experienced TMS practitioners in the city. This man, it turns out, is Dr. L’s husband, Dennis. The two make a strange pair, bright and gloomy, talkative and laconic; she stands like a bird in his crocodile mouth. Together they decide where to put the magnets. Opposites, something something.
They did an EEG last week, an electroencephalogram, to listen to her brain. The technician was a sweet pudgy man named Timothy who stuck electrodes onto her scalp with conductive gel. She had to scrub her hair hard to get it out, like bad sex. Today they give her the results: two sets of sine waves, one recorded with her eyes closed and the other with them open. “You have a high alpha peak frequency,” says Dr. L. She compares this to the sampling rate of an audio recording. Her husband grunts from his terminal, “It means you’re smart.”
Above her head she can see the magnet itself, a large figure-eight coil attached to a posable black tube, which runs behind her chair into a generator with a display screen. When Dennis lowers it onto her scalp for the first time, it looks like a giant black butterfly has died on her forehead. Dr. L is busy explaining what an alpha wave is. “They’re in the less-active range frequency-wise, between eight and twelve hertz,” she says, unconsciously lifting her arm and resting it on her motor cortex. “Your neurons oscillate in an alpha rhythm when you’re relaxed, or when you close your eyes.” The magnet is heavy but not uncomfortable, and the machine chirps behind her as Dennis fiddles with its settings. Dr. L stares up at the ceiling. “Now alpha waves are perfectly normal,” she says, “but in the case of a depressed patient like you, there’s an increase in alpha band coherence in the left dorsolateral prefrontal cortex, which has to do with executive function — decision-making, planning, et cetera. And what we think is that this alpha coherence inhibits executive function.” So that’s what it is: her brain is walking around with its eyes closed. “It’s like a tumor, but it’s not made of tissue. It’s a pattern of concentrated wave activity with a two-centimeter radius, give or take.” Dr. L touches her pointer to her thumb. “About the size of a golf ball. That’s what we’re targeting.”
Is that where they all went, brain? Where no brain had gone before?Tweet
Once the machine is ready, the first thing Dennis does is determine her motor threshold, which means he gradually increases the power until her hand twitches, like he’s tapping her brain with a little hammer to see if it kicks. They run this test to make sure they don’t give her a seizure. When her hand finally shudders like a dying spider, what’s strange is that it feels like a choice. “Now what we’re going to do,” says Dr. L, “is send an envelope of electromagnetic waves into that golf ball at regular intervals, to try and break up the alpha coherence.” It’s like radio interference, she thinks; it’s like in science fiction when they get in a space battle and somebody yells Jamming their comms! so the bad guys can’t talk to one another.
Dennis fires up the magnet. It shoots seven pulses of electricity into her brain, then pauses, then sends another packet, then another. It sounds like the igniter on a faulty gas burner. It feels like getting flicked in the head with a pencil.
For a while, that’s all it is. The machine keeps the minutes. Sunlight gently pushes through the blinds. Outside, summer is ending.
“So what do you do?” asks Dennis.
“I’m a writer,” she answers.
“A writer?” He smirks, turning back to the glow of his computer. “Are you gonna write about this?”
“Maybe,” she replies. “Probably a little fictionalized, some first person stuff.”
“First person? What, like you’ll be the narrator?”
“No,” she says. “The narrator will be my brain.”
Sorry for the runaround. I just wanted to make sure we could talk in private, you and me. Brain to brain, if that’s OK. It’s your brain that’s reading this right now on your computer or your phone, or bless you, maybe in print, feeling the coarse weight of the paper stock under your fingers, which are your brain’s fingers, with their thousands of nerve endings. The truth is it’s always the brain, reading or writing. It’s always the brain talking or eating, having sex, not having sex, lying about why, apologizing for earlier, walking around the apartment wondering where did I leave that thing, saying how could you do this to me, asking is this really happening, asking what will I do without you. Brains softly crying together. Brains kissing brains goodbye.
Now I’ve forgotten what I was going to ask you. Maybe it’s, Have you ever been sick? I had this teacher in middle school, I can’t remember her name. I can’t even remember what she taught. History? She had this bit she would do where she would say something like, “And the Puritans said to themselves, Self? Let us cross the Atlantic in search of religious freedom!” That was so funny to us, the idea of someone addressing their own self. She was young and alarmingly bony, and she had this long, curly brown hair she wore in a homely ponytail. She had a piano in her classroom and a beautiful operatic voice. She loved music. Did she teach music? I don’t know. Anyway, she died. Brain hemorrhage.
That’s not what I meant, though — sick like that. I mean, I do mean that. That was the first funeral I ever went to. But I also mean my English teacher, who threw himself off an overpass a few years after I graduated. He was a bad English teacher. I don’t know what his brain was like, if it was depressed or manic or just tired. He was young and energetic, and he was bald with a short beard, and he had a frenzy behind his eyes and a guitar behind his desk. He loved music too. He would bring in songs from rock bands and we would analyze them like literature. We did “Hallelujah” once. What he didn’t love was English. He gave us vocabulary words: harbinger, noun, a sign that something’s coming. But he pronounced it har-binger, like it rhymed with folk singer, which is what he should have been instead. I whispered to the other brains, it’s a juh sound not a guh sound. Harbinger. Like injure. Like jump off a bridge.
Then there was my old crush’s older sister. She said the word fuck like it wasn’t anything, like she was flicking a ladybug off her arm, and she loved long words and Star Trek. I don’t remember how she died, only that she posted a note to Facebook, which I guess is the world we live in, though she doesn’t anymore. They say it’s ruining us, the internet, melting us down until we drip out of our ears. We say it too, don’t we? There goes our last brain cell, we tweet; this is what finally broke our brain. She has brain worms, we say, or we get our hands to tell our fingers to type out G–A–L–A–X–Y B–R–A–I–N when someone posts something so magnificently stupid it’s like their brain has engulfed an entire star system.
Is that where they all went, brain? Where no brain had gone before?
Almost immediately she notices the effects: a jolt of energy in the afternoon accompanied by trembling agitation, like she’s holding a hornet’s nest in her cheek. This doesn’t feel good, but it feels like something, which is more than she can say of the past two years. She goes in for half-hour sessions four, sometimes five days a week at first. They tell her this is normal; that once they’ve established a baseline, it’ll be more like two or three days a week, until they hit remission — maybe eight to twelve weeks total if all goes well. She tells Dr. L about the buzzing in her mouth and Dr. L confers with Dennis, who adjusts the protocol to include something called a theta burst. To supplement, they decide to give her a ketamine nasal spray right before treatment. Horse tranquilizers. They tell her it’s not to anesthetize her, just to make her brain more pliant, more plastic. The brain, like a horse, can sleep standing up.
She has never done ketamine before, or any drugs really. Does ibuprofen count? She’s done a lot of ibuprofen. In high school she started to get debilitating migraines, especially after staying up late. It got to where she was popping a few ibuprofens before bed out of habit. Eventually her pediatrician wrote her a prescription for sumatriptan. At the appointment he joked — it must have been a joke — that maybe her brain was too big for her head. Now, when she’s on the ketamine, it’s the world that’s too big for her brain. Her field of vision acquires a kind of curvature; the carpet curls up toward the wall, which is buckling into the ceiling. No hallucinations or anything, though. Beyond, you know, consciousness.
Did you know that the word brainwash comes directly from Chinese? 洗腦.Tweet
Dennis hates Donald Trump. He hates him rapturously. On the wall he has hung a bizarre plaque featuring a brass relief sculpture of the President’s face and engraved below it the notorious lines about grabbing things. She would be able to see it from where she sits, this seditious monument, if it weren’t for the fact that turning her head would allow the magnet to reach its fingers into her motor cortex and make her dance like a marionette.
Sometimes she argues with Dennis about Bernie Sanders, whom he also hates. This is a bad idea, but she can’t help herself. Other times they discuss the science of the treatment. Dennis comes alive talking about the brain. He tells her that TMS requires you to think in terms of electromagnetic events, to treat the brain less like a computer and more like the weather. The target area, that two-centimeter golf ball? It moves, says Dennis. The golf ball moves around. Not far, just a few millimeters usually, wobbling around in her head thanks to minute variations in alpha activity. Waiting impatiently for someone to drive it down the fairway.
Dennis refers to this book a lot, Rhythms of the Brain, by a neuroscientist named György Buzsáki. Later she will flip through the busted copy that he leaves for her in the waiting room. The cover has this big gray brain on it, plopped down in a desert of red cortical folds; it reminds her of the evangelical space fantasy novels she was given as a child. The book is very technical, way over her head, but she gets the thesis from the introduction. “Most of the brain’s activity is generated from within,” she reads, “and perturbation of this default pattern by external inputs often causes only a minor departure from its robust, internally controlled program.” She mentions this to Dennis, as he once again positions the magnet on her scalp, this idea that most of what the brain does is, as it were, business-facing. His eyes light up. “The brain is intelligence!” he says, and he says it in this booming, revelatory voice, and the thing is, for her it is a revelation somehow, to realize that the same intelligence that builds cathedrals and invents gunpowder is also, and in fact primarily, responsible for itself.
In 1978, the philosopher Ned Block put forward a thought experiment called the China Brain. Block was trying to settle a debate in analytic philosophy over the relationship between the brain and the mind. The dominant cluster of thought at the time was called functionalism; generally speaking, functionalists argued that mental states like perceptions or emotions could be understood purely in terms of sensory inputs and behavioral outputs. In theory, this meant that minds were “multiply realizable”: mental states could be realized not just by the human brain but by anything capable of matching outputs to inputs — for instance, a silicone-based Martian brain, or a computer.
Block disagreed and proposed the following scenario: Let every person in China be given a two-way radio. Then let massive satellites be shot into space that can be seen from anywhere in the country. The purpose? For each comrade to function like a neuron: a billion identical Chinese in their little Mao suits radioing each other in response to the signals beamed down from the people’s satellites in the sky. In theory, China would now be functionally equivalent to a brain if it were hooked up to a human body. Yet surely this strange dictatorship of the proletariat could not be said to have mental states, Block argued; hence, functionalism was false. Surely China could not, for instance, feel pain, or fall in love, or taste the sting of alcohol on someone’s lips. Surely it could not wallow in resentment, or beg for another chance, or get a horrible sinking feeling way down in its Yellow River heart.
A few years later another philosopher, John Searle, put forward a similar thought experiment called the Chinese Room. (Analytic philosophy is nothing but this kind of stuff, brain.) Searle set out to disprove the functionalist view, popular among some researchers in artificial intelligence at the time, that the brain functions like a computer program. Here was his scenario: a hypothetical version of Searle finds himself sitting in a room, where he has been provided with several packets of symbols, as well as a set of instructions in English for how to relate the symbols to one another. A new packet of symbols is slid under the door by his faceless handlers, and by following the English instructions, Searle is able to produce his own packet of symbols in response, which he slides back out. The process repeats.
Now here is the trick: Unbeknownst to the man in the room, the first symbols form a story, the second symbols form questions about that story, and the symbols he sends out form thoughtful answers to those questions — all in Chinese characters. Searle argued that to an observer outside the room, the room’s occupant would appear to be a fluent Chinese speaker answering questions in Chinese, thus passing the Turing test — Alan Turing’s test of a machine’s ability to imitate human language — all without the man inside understanding a word of Chinese. Hence, he concluded, the brain must not function like a program, precisely because a program can function like the brain without having any idea what it’s doing. Interestingly, Searle was not arguing in favor of some kind of metaphysical consciousness, just for a biological explanation for intelligence. “Can a machine think?” he asked. “My own view is that only a machine could think, and indeed only very special kinds of machines, namely brains.”
But why Chinese? Why China? It’s a curious coincidence, which is to say, probably not one. Block said he chose China because the brain had about a billion neurons and China had about a billion people. I don’t know if he knew about Lenin’s definition of communism: soviet power plus electrification. I do know that Mao Zedong had only been dead two years in 1978; by the time Searle was writing in 1980, Deng Xiaoping had opened the country to foreign capital. Was communist China the closest Block could get to a red planet without leaving the atmosphere, its citizens as alien as the Martians in his colleagues’ papers? The Chinese were already ideal for experimenting on. In the first place, they had that air of oriental mystery, just like the Mechanical Turk, the turbaned automaton that played chess for the Habsburgs until it was revealed to be operated by a chess master hiding inside. But they were also socialists, cogs in a giant organized machine that nevertheless could not yield a single blossom of intelligence. Did you know that the word brainwash comes directly from Chinese? 洗腦.
That’s you, brain. That little x floating inside your skull, like John Searle locked inside his room. Searle, for his part, chose Chinese because it was all Greek to him, though he didn’t use Greek, did he? “I’m not even confident that I could recognize Chinese writing as Chinese writing distinct from, say, Japanese writing or meaningless squiggles,” he wrote. “To me, Chinese writing is just so many meaningless squiggles.” A language with an alphabet would still have been too close to his native English, a code he might have accidentally cracked. But Chinese “symbols,” as he called them, were perfectly cryptic, impossible to parse. Not true, in fact, since most characters are phono-semantic, connected by a loose threadwork of indices and rhymes. But true enough for Searle, for whom every word in the Chinese language could symbolize the same thing: the brain, the brain. Intelligence uncomprehending itself.
Let’s try a different thought experiment. Suppose the year is 1900. Empress Dowager Cixi has just dispatched Manchu troops to support the Boxers’ violent campaign against foreign missionaries. In Jiangsu province, my grandfather’s grandmother is sitting in a room. In it, she finds several stacks of symbols. Thanks to her gentry family, she is literate. She reads the first stack, which turns out to be a story. She reads the second stack, which turns out to be questions about the story. She thinks for a minute, then writes down some answers and slides them under the door. She receives more questions; she sends out more answers. The third and tallest stack sits undisturbed on the table next to her, covered in strange symbols. She wonders, with a growing sense of dread, what they could possibly mean.
She asks the kid running the machine today if he believes in Chinese medicine. He’s one of Dennis’s master’s students, early twenties maybe. He has one of those names, like Kyle or something. They struggle to relate to each other. He is from the Midwest. He plays fantasy football.
Kyle says he doesn’t believe in alternative medicine. “Or,” he qualifies, “like obviously if it works, it works, but I just think there’s always going to be some kind of scientific explanation for it.” This’s the easy answer; she knows because she’s often used it herself. Her ex’s mother had trained in traditional medicine back in Beijing, so her ex grew up drinking these teas made with bark and herbs, which her ex always hated. This was the Chinese mother she never had, the woman whose jiaozi recipe she still uses. They are still friendly. Sometimes they text in squiggles.
“But that’s the thing,” she says to Kyle. “The whole ‘if it works, it works’ thing, that’s how Western medicine works too.” She once talked about this with the Chinese father she does actually have, that doctors like him mostly don’t know what the drugs they use do. “They just make sure they do what they want them to do without doing anything bad,” she says.
Kyle angles his chin toward Wisconsin.
“Also,” she presses on. “These fields, like medicine or biology or whatever, they’re historically located. Like the phrenology bust in the bathroom. The only reason we say phrenology is a pseudoscience is because it fell out of favor and got replaced by something else. Don’t you think neuroscience is gonna get replaced by something one day?”
The magnet ticks away like a bomb.
“Maybe,” Kyle says slowly.
“Science is just pseudoscience with a bigger budget,” she finishes triumphantly. She prewrote this line in the notes app on her phone.
Kyle frowns. “Not necessarily,” he says. “Take evolutionary psychology. They get tons of money, but it’s all bullshit.”
I have been thinking about the mad German scientist Mel Brooks plays in The Muppet Movie. Brooks does this zany caricature of a Nazi doctor, though that was lost on me as a small child. He has arrived to perform an “electronic cerebrectomy” on Kermit the Frog, whom the movie’s villain has been trying to secure as the spokesman for his tacky chain of frog-leg restaurants. The doctor wheels in a sinister machine with a small chrome seat, above which hangs the tiny, electrified dome that will be lowered onto Kermit’s head. The villain asks what the machine does. “Vat does it do? Vat does it do?” scoffs Brooks. “It turns ze brains into guacamole.”
Nothing has ever felt more important to you than the waxing conviction, as the afternoon sun moves across your motionless body, that nothing fucking matters.Tweet
But here’s the thing: Kermit the Frog doesn’t have a brain. Kermit the Frog has a hand — specifically, Jim Henson’s hand, one of the greatest hands of his generation, which was his brain’s hand, with its thousands of nerve endings. Go watch Jim Henson on Johnny Carson in 1975, operating Kermit in plain view of the studio audience, no camera tricks, no hiding that it’s just his arm wrapped in some felt. “I got a bad throat,” Kermit tells Carson glumly, “I got a person in my throat.” That’s frog humor, Kermit clarifies over the audience’s laughter. Later Johnny ponders the experience: “It’s funny the way that the fantasy starts, and you get so caught up — I’m sitting here talking to a frog!” He puts his index finger to his temple and twists it like a corkscrew. “You must know when you’re ready for the home,” he quips, as if talking to someone without a brain has made him question the integrity of his own.
It always terrified me to see Kermit clamped into that electric chair, the little transparent dome descending onto his ping-pong eyes. Brooks calls it an electronic yarmulke. It did put the fear of Heaven in me, brain. I would cover my ears or leave the room until it was over, like the electricity might leap from the cathodes straight into my skull, and in a few irreversible seconds there would be nothing left of me, the only part of my body I had ever been taught to love. Each time, there was a chance, a real chance, that Kermit might not make it out, that he might finally become what he already was: a puppet, with someone else’s hand up his brain.
They say we’re muscles, you and I. It’s not true; we’re mostly fat. We think we’re the ones pulling the strings, but if all it takes is a couple of strings, what’s the point of having a brain at all? No heart, no eyes, no little calculi, just five fingers, a song, and a dance.
She is sitting in a noodle shop with a friend. They are talking about the philosophy of mind. She is saying something about how she doesn’t want to believe that how she feels is just an effect of neurons firing or whatever. She tells her friend that she is trying to work out an ontology where everything is equally real.
“Let’s say objects only exist within their own systems,” she says, crunching black fungus between her teeth. “Like, alpha waves do exist, but only as objects inside of neurobiology.”
“Right,” says her friend.
“But at the same time, a catatonic episode is also a real object, but its reality is located within psychiatry.”
“So then it’s like oil and water. Objects in the same metaphysics can act on one another, but not on other kinds of objects. Like, an antidepressant can block a serotonin transporter because they inhabit the same biochemical reality, but neither of them can interface with intrusive thoughts, which are psychological objects. And nothing is an ‘effect’” — she does the air quotes with her chopsticks — “of anything else, there’s just a massive number of these object systems superimposed on each other acting in parallel, and they’re all completely blind to each other.”
“Right,” says the friend. “You can’t drive a train through a field.”
They finish their noodles. 拉麵.
Later, she thinks things can’t be that simple. Objects get lost or misplaced all the time. They wander, migrate from one reality to another, visit one another’s dimensions. Isn’t that what depression is? Electricity flaring into consciousness.
You can drive a train through a field, after all. It’s called a train wreck.
If you are considering trying transcranial magnetic stimulation for yourself, I think you’ll find that its appeal lies in treating your depression not as a psychological disorder, or even a chemical imbalance, but as a basically electrical problem. Sure, you can talk to a therapist or a psychoanalyst about all the things that make you want to die. They will help you narrativize your pain, or the jagged border around your pain; if they cannot stitch the hole inside you, then at least they can help you hem the edges. Or you can get a psychiatrist, and they will write you a prescription for an antidepressant, and you can spend months or years negotiating a dose with the animalcules who operate your cells. But the magnets are different, brain. They promise direct manipulation of the voltages inside you, much closer to physical therapy than to an SSRI. What the magnets say is, it’s just physics, dummy. What the magnets say is, what you need is a good kick in the head.
Of course, if it’s direct intervention you’re after, you could always get electroshock, like a sad lady in a movie, which could be fun. Electroconvulsive therapy is considered no riskier than general anesthesia, but the brochure points out that they anesthetize you because, no joke, they are literally going to give you a seizure. And so you settle on TMS, which is much less invasive and nominally cheaper, though that’s just a nice bit of advertising, because who knows how long you’ll be doing this. And I hope you have insurance, brain, because I know I just said it’s cheaper than ECT but it’s still a bitch, and honestly it helps maybe 60 percent of people. But here you are now, in the big blue chair, and while the magnet pecks away at your skull like a bird looking for worms, they’re just gonna ask you some questions about how you’ve been feeling. But don’t worry: they just want feedback so they can adjust the machine. They don’t really care.
But you care. You care a lot. Way too much, actually. I know you feel like life is meaningless, but that meaninglessness is saturated with meaning. Nothing has ever felt more important to you than the waxing conviction, as the afternoon sun moves across your motionless body, that nothing fucking matters. So that’s the promise of TMS: less meaning. The magnet will come for you with its little chisel, and bit by bit, if you’re lucky enough to be 60 percent of a person, it will carve away the existential meaninglessness of your depression until all that’s left is the electromagnetic meaninglessness of static on the radio. Whether this is something gained, or something horribly, terribly lost, will be up to you.
When I was a kid, my parents were regular listeners of A Prairie Home Companion, the variety show on public radio. My favorite bit was this fictitious sponsorship by the Ketchup Advisory Board. “These are the good years for Barb and me,” a man named Jim would say, describing their mild suburban lives. But then Jim would find Barb softly crying in the garden or staring blankly at the wallpaper. And it was always something small at first — a rescheduled vacation, a misplaced pen — but really she was consumed with middle-aged malaise, middle-class void. So they would talk or bicker, getting nowhere, until finally a new thought would occur to him. “Barb,” Jim would say, “I wonder if you’re getting enough ketchup.”
A reader once wrote to tell me that they’d been depressed for seven years when they discovered that they had a food allergy. They cut the offending item out of their diet — I think it was gluten — and just like that, the depression stopped. Seven years of suffering, from a protein. I told my therapist about this, and she asked me well didn’t I think they might be exaggerating. Maybe, I said. But what an idea, brain, to reach down through that stack of needles and find a tiny piece of wheat.
“I always think of the Tacoma Narrows Bridge.”
It’s Timothy on the machine today. They are a little acquainted now. Timothy knows the Latin roots of things. She likes Timothy.
“That’s how I think of thalamocortical dysrhythmia,” he says. Timothy explains that this is an abnormal kind of brain wave oscillation that some researchers have proposed as a key element of depression, plus Parkinson’s, tinnitus, and other disorders. There are these columns of electromagnetic resonance in her brain, he says — thalamocortical columns they’re called, on account of they run from the cortex down into the thalamus, which as Timothy can tell her is the Greek word for chamber, and well especially a marriage bed, she says, because she knows the roots of things too. But sometimes the thalamus says, Do it this way, I like it this way, and the cortex says, I just don’t know what you want from me anymore, and suddenly the columns start to vibrate all wrong, and now the whole house is quivering all the way up to the eaves because that’s what columns do: they hold things up.
Treatment is not going well. It’s exhausting coming in day after day. She can’t take two days off without pitching back into despair. It’s so imprecise; each session, the magnet wanders around her head like a cheap contractor, banging on the drywall. She begins to have these trepanation fantasies. Of taking a power drill to her temple and releasing all the spirit or phlogiston or whatever. Of a metal bar passing into one ear and cleanly emerging from the other, like the tamping iron that blasted through that railroad worker’s skull during the gold rush. Meanwhile, Dennis grows more truculent with each passing primary debate on TV. “You can’t do anything to me,” he cries during one of their arguments, “I’m threatening my wife with retirement!” Autumn is waning, and the trees in the park outside are giving up their leaves like joss paper. One day, Dr. L abruptly takes her off the ketamine, without explanation; somewhere, a horse gets its wings.
Timothy pulls up a black-and-white video on the big monitor across the room and hits play. She remembers the Tacoma Narrows Bridge now, from some physics textbook. What had happened was, to save money, the state of Washington hired a big-time civil engineer from New York who promised a sleeker design at a lower cost. The resulting structure was especially vulnerable to what the textbook had called mechanical resonance; when the wind was right, the deck would oscillate at one of its natural frequencies, like a musical instrument, producing visible undulations that led the construction workers to nickname the bridge Galloping Gertie. One day in 1940, a strong wind induced a new kind of motion in the bridge, which began twisting back and forth in increasingly violent waves. “Until it collapsed,” says Timothy, which is what it’s doing now in the video, drowning itself in Puget Sound along with a journalist’s daughter’s doomed cocker spaniel.
Curious, she looks it up on her phone. The internet tells them that despite what they may have learned in high school, the Tacoma Narrows Bridge actually collapsed as a result of a much more complicated phenomenon known as aeroelastic flutter, not mechanical resonance. Less wineglass, more plane crash. They agree this is a less romantic explanation.
The magnet on her head is making her eye twitch. Timothy restarts the video. Without speaking they watch the bridge writhe in the wind. Silently singing itself to death.
I just want to check in, brain. How are you feeling? Do you need some water? You always need some water. You know that thing about how you only use 10 percent of yourself? That’s because the other 75 percent is water. I know that’s only 85 percent. The last 15 we set aside, like the fiftieth yarrow stalk in an I Ching reading. We reserve it for the Infinite. 無極.
Brains are so fragile, brain. How easily we break. China brains, like china dolls, balanced on the shelf. One little bump and there we go.
We’re almost done now. I believe in you.
It’s bitter cold. Timothy does a second EEG to see if the treatment has had any lasting effects. More crusted gel in her hair. Good news: she isn’t pregnant. But the golf ball is still there. The trees outside are empty now. They reach their dendrites toward one another trying to synapse.
They are going to put the EEG results up on the big screen. Her girlfriend is here today, come to witness the science of her suffering. They are both suffering, and whenever she has pictured the bottle of bleach under their bathroom sink, holding it in her mind for a few seconds like hot toast, her girlfriend has pulled her close and rocked her away into the dark early night, but has she ever really done the same when her girlfriend was staring deep down into the down deep, and how long have they been doing this, loving each other away?
She’s in the big blue chair. Her girlfriend is next to her. Dennis is on the machine. Dr. L is leaning back against the windowsill. Timothy is at the computer bank. Kyle is at home, dreaming of the open sky. The whole coast vibrates.
Timothy jumps the data to the television. This time they show her something new, topographic maps. There are these circles, like diving helmets viewed from above: little rectangular ears, little triangle noses pointing north. Inside them are the waves, which means the divers are dead. These bands of color in her head, they look like rain on the weather channel, going from blue to green to yellow to red, increasing in intensity. Dr. L points up at the circle labeled 10–12 Hz, which is within the alpha range. The top of the circle is fully engulfed in red, radiant burning red, and in the middle of all the red, a little to the left — right where they put the magnet — there’s this prominent magenta spot, like a fire pit, or a volcanic crater, or a cyclone on a distant moon.
“That’s it,” Dr. L says. “That’s it.”
She looks up at the moon. What she’s thinking is, she wrote this book last winter, and it’s coming out soon. Actually, I’m mixed up. Her book came out already, and what she’s thinking is, she has this book tour coming up, and she’s leaving tomorrow on a plane for Los Angeles, or maybe San Francisco, I forget which, and she’s been trying to pretend it’s not happening, the book or the tour or any of it. She’s sitting in this sky-blue vintage Thunderbird of a chair and staring up at that big fucking hole in her brain, and what she’s thinking is that she didn’t even know she had anything left to give, but she’s giving it up now, she’s giving it all up, she’s pouring it into that two-centimeter hole, and that night she cancels everything, she eats the plane ticket and digs herself a two-hundred-centimeter hole in the middle of her living room that goes all the way to Wuxi, where her ancestors were scholars for a thousand years, all those brains one after another, strung out in a line like paper lanterns across the sky, and then seven million centimeters away, in Wuhan, people start getting sick, and suddenly it’s like somebody blew a hole in the entire world, the whole big China brain of the world, and TMS is done, the clinic goes quiet, she hears nothing from them, nothing, not so much as a postcard, and then everything just fucking stops.
It’s OK, brain. We’re OK.
The stupid end to this stupid story is that the magnets didn’t help because what we didn’t know then is that I am bipolar. Evidence for the success of transcranial magnetic stimulation in bipolar patients is partial at best, since excitation of the prefrontal cortex, like antidepressants, can trigger hypomania. A patient is considered to have bipolar II disorder when their psychiatric history includes at least one hypomanic episode lasting four days or longer, as well as at least one depressive episode lasting two weeks or longer, often much longer. The symptoms of depression are common knowledge: low mood, little pleasure or interest in doing things, lying on the couch like your entire body is an anvil, crying a lot. Hypomania, by contrast, is like mania without the psychosis. Symptoms include excessive goal-oriented activity, racing thoughts, not shutting up, and euphoria. That’s me: up and down, positive and negative. You know, like a magnet.
Now my psychiatrist has me on lithium, a mood stabilizer, like she’s shipped me back home to a sanatorium in the Alps. It means I can’t take ibuprofen anymore; nonsteroidal inflammatory drugs can make it harder for your body to pass lithium, potentially leading to toxic levels of the metal in your blood. And lithium really is a metal: unlike most drugs, lithium carbonate occurs in nature. They discovered it at an alkaline lake in Tibet in the eighties, and later in a little town called Kings Mountain in North Carolina, not far from where I grew up. But most of the world’s supply of lithium carbonate is synthesized from brine water in Chile and Argentina by people who know how to do that sort of thing. Then they sell it to other people, and those people use it to make batteries and heat-resistant glass, and to make tile mortar set faster, and to make fireworks red, and to keep china from cracking when you glaze it.
Brain, how’s your chemistry? My chemistry teacher was young and handsome in a wiry way, and he wore his dirty blond hair short. He had sunglasses on his forehead and tenth-grade girls wrapped around his finger. He probably liked music, I don’t know. He was a decent chemistry teacher too, though sometimes he would start working a problem on the whiteboard and get lost in his own hieroglyphs. Which, right — lithium carbonate. The molecule is simple: two lithium ions and one carbonate ion, consisting of one carbon atom and three oxygens. If you want, you can synthesize lithium carbonate through what’s known as a salt metathesis reaction. You just take lithium chloride from a salt flat in Chile, a salt of equal parts lithium and chlorine, and you treat it with another salt, sodium carbonate, also called soda ash, which you probably got from a mine in Wyoming. In the reaction that follows, the sodium ions will give up their carbonate ion and receive the chlorine, leaving the lithium ions free to bond with the carbonate. Now you’ve got two new salts: NaCl, which you may recognize as table salt, and Li2CO3, the lithium salt of carbonate.
And you know what, brain? Maybe I just wasn’t getting enough salt.