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Even irrational behavior has its logic

Yale Medicine Magazine, 2016 - Spring


Schizophrenics who hear voices. An otherwise rational teacher who insists she was abducted by aliens. A woman with multiple personalities.

Most of us, including many physicians, would consider these people “crazy.”

Eliezer J. Sternberg, M.D., a first-year neurology resident at Yale New Haven Hospital, begs to differ. Their behaviors may be strange, but they are not necessarily illogical, Sternberg wrote in his recently published book, NeuroLogic: The Brain’s Hidden Rationale Behind Our Irrational Behavior.

“A lot of Oliver Sacks-type stories seem so crazy on the outside,” he said. “But often, if you find out exactly what the defect is, exactly the brain problem, it’s almost as if their behavior is a logical compensation for a really unfortunate circumstance.”

Take schizophrenia. Hearing voices is the ultimate in irrationality, but schizophrenics don’t recognize the voices in their heads as their own, Sternberg said. Faced with the irrational, their brains draw a logical, if false, conclusion: The voices are those of the FBI, or God, or aliens.

“How would your brain explain that to you?” Sternberg said. “If you are the kind of person who is paranoid about the government, then government paranoia might overtake you. That would make sense to you and give you closure.”

Schizophrenia is just one of many neurological disorders or phenomena—both mundane and unusual—that Sternberg explains in his book. He tackles everything from why we forget to buy milk on the way home and whether visualizing golf improves your score to whether someone can be hypnotized to commit murder and why people believe in alien abductions. Along the way, Sternberg discusses such obscure and unusual disorders as Anton’s syndrome, in which blind people do not realize they have gone blind. He explains how the damaged brain compensates in ways logical to the sufferer, if not to the rest of us.

A second theme is the mind’s relentless striving to make sense of the world and maintain a sense of self. What appears delusional is the brain’s way of compensating for a deficit or illness, he said. “Our brain is always trying to create a narrative of our lives and give us a story, give us a history, give us a purpose,” Sternberg said.

The 28-year-old Sternberg has been fascinated by the brain his entire life. NeuroLogic is not his first book. The Buffalo, N.Y., native had already written two volumes on the mind, the first when he was a 17-year-old high school junior, the second as an undergraduate at Brandeis University.

Driving him is the question of how a mere collection of cells—the human brain—can have consciousness and autonomy. “We are all made up of the same matter that everything else is,” Sternberg said. “But human beings are the only collections of matter that reflect on their own existence. What is it that makes that possible?”

He wrote the first three chapters of what became NeuroLogic during a gap year he took from Tufts University School of Medicine to do research. Inspired by the popular economics book Freakonomics, Sternberg wanted to write a book for a general audience that didn’t shortchange the science of the brain. To his surprise, several publishers loved his proposal. Once he had settled on a publisher, Sternberg finished the book in his last year and a half of medical school. How did he do it? By composing most of the book in 10- to 15-minute increments snatched from his studies. “I am good at doing a lot with a very little amount of time without losing momentum,” he said.

The book was released in early January by Pantheon with a print run of 25,000 copies and has been reviewed in The Washington Post.

After completing his training, Sternberg, who dedicated his book to his wife, Sharona, and their 2-year-old son, Alex, wants to go into practice and do research. He also plans to write more books, possibly about epilepsy or comas.

Physicians should speak more often to a popular audience to prevent the spread of such dangerous misinformation as unfounded fears about childhood vaccines, Sternberg said. “People in medicine are really good at talking to each other but not as good at talking to the general public,” he said. “I think that’s a big problem, because some of the biggest speakers on medical issues have no medical training and say things that are really, really damaging.”

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