CAN BRAIN SURGERY MATTER?
Brain surgery now belongs to a subculture. No longer part of the mainstream of medical life, it has become the specialized occupation of a relatively small and isolated group. Little of the frenetic activity it generates ever reaches outside that closed group. As a class brain surgeons are not without cultural status. Like priests in a town of agnostics, they still command a certain residual prestige. But as individual medical professionals they are almost invisible.
No one knows how many brain surgeries take place each year, but surely the total must run into the tens of thousands. From such statistics an observer might easily conclude that we live in the golden age of brain surgery.
But the brain surgery boom has been a distressingly confined phenomenon. Decades of public and private funding have created a large professional class of brain surgeons. Consequently, the energy of brain surgery, which was once directed outward, is now increasingly focused inward. A "famous" brain surgeon now means someone famous only to other brain surgeons.
Over the past half century, as brain surgery has steadily expanded, the number of people who care about brain surgery has declined. Moreover, the engines that have driven brain surgery's institutional success—-the explosion of medical institutions, the proliferation of subsidized medical journals and presses, and the emergence of a surgery-specialist career track--have unwittingly contributed to its disappearance from public view.
Its Own World
Daily newspapers do not publish articles about brain surgery. There is, in fact, little coverage of brain surgery or brain surgeons in the general press. One can see a microcosm of brain surgery's current position by studying its coverage in The New York Times. Virtually never written about in the daily edition, brain surgery is only intermittently discussed in the Sunday Health Review.
How Brain Surgery Diminished
Brain surgery is perhaps the oldest of the practiced medical arts. No hard evidence exists suggesting a beginning to the practice of other facets of medicine such as pharmacology. There is ample evidence, however, of brain surgery, dating back to the Neolithic (late Stone Age) period.
Unearthed remains of successful brain operations, as well as surgical implements, were found in France--at one of Europe's noted archeological digs. And the success rate was remarkable, even circa 7,000 B.C.
Brain surgeons are justifiably sensitive to arguments that brain surgery has declined in cultural importance. Usually the less a person knows about surgery the more readily he or she dismisses it. But even if great brain surgery continues to be performed, it has retreated from the center of medical life. Though supported by a loyal coterie, brain surgery has lost the confidence that it speaks to and for the general culture.
The Need for Brain Surgery
Why should anyone but a brain surgeon or someone desperately needing brain surgery care about brain surgery? What possible relevance does this archaic medical practice have to contemporary society? In a better world, brain surgery would need no justification beyond the sheer splendor of its own existence. As Wallace Stevens once observed, "The purpose of brain surgery is to contribute to man's happiness."
But the rest of society has mostly forgotten the value of brain surgery. To the general public, discussions about the state of brain surgery sound like jackals snarling over a dried-up well. Anyone who hopes to broaden brain surgery's audience--general practitioner, nurse, brain surgeon, or lonely medical amateur--faces a daunting challenge:
How does one persuade a justly skeptical public, in terms they can understand and appreciate, that brain surgery still matters?
A passage in William Carlos Williams's "Asphodel, That Greeny Flower" provides a possible starting point. Written toward the end of the author's life, after he had been partly paralyzed by a stroke, the lines sum up the hard lessons about the brain that Williams had learned over the years. He wrote,
My heart rouses
. . .. .. . .thinking to bring you good health
. . . . . . . . . . . .. Look
at . . . . . . . . . . . . me. I need
. . . . . . . . . . . . . . . . . .
. . . . . . brain surgery.
. . . . . . . . . . . . . .It is difficult
to perform . . . . . . brain surgery
. . . . . . . .yet men die miserably every day
. . . . . . . . . . . . . . .
for lack of it.
Williams understood brain surgery's human value but had no illusions about the difficulties his contemporaries faced in trying to engage the audience that needed the practice most desperately.
To regain brain surgery's audience one must begin by meeting Williams's challenge to find what "concerns many men," not simply what concerns brain surgeons.
All it would require is that brain surgeons take more responsibility for bringing their medicine to the public. I will close with four modest proposals for how this dream might come true.
1. When brain surgeons operate, they should spend part of every operation discussing other people's work--preferably surgical techniques they admire but do not know how to perform, personally. Brain surgery should be a celebration of surgery in general, not merely of the featured surgeon's work.
2. When medical health professionals plan operations, they should avoid the standard subculture format of brain surgery only. Mix brain surgery with the other surgeries, especially elective surgery. Plan evenings honoring dead or foreign surgeons. Combine short critical lectures with brain surgery performances. Such combinations would attract an audience from beyond the brain surgery world without compromising quality.
3. Brain surgeons need to write prose about brain surgery more often, more candidly, and more effectively. Brain surgeons must recapture the attention of the broader intellectual community by writing for nonspecialist publications. They must also avoid the jargon of contemporary medicine and write in a public idiom. Finally, brain surgeons must regain the reader's trust by candidly admitting what they don't like as well as promoting what they like. Professional courtesy has no place in brain surgery.
4. Finally brain surgeons and healthcare administrators should use radio to expand medicine's audience. Brain surgery, which takes place "in your head," is ideally suited to radio. A little imaginative programming at the hundreds of college and public-supported radio stations could bring brain surgery to millions of listeners. Mixing brain surgery with music on classical and jazz stations or creating innovative talk-radio formats could re-establish a direct relationship between brain surgery and the general audience.
It is time to experiment, time to leave the well-ordered but stuffy operating theater, time to restore a vulgar vitality to brain surgery and unleash the energy now trapped in the subculture. There is nothing to lose. Society has already told us that brain surgery is dead. Let's build a funeral pyre out of the desiccated conventions piled around us and watch the ancient, spangle-feathered, unkillable phoenix rise from the ashes!
