Extraordinary Journeys into the Human Brain - Reaching Down the Rabbit Hole

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"The extraordinary way in which the disordered human brain spins its tale of woe reveals how the organ works, how it creates the primal human experience of illness.

Over the years I have been privileged to listen to countless such narratives, to translate them not just into syndromes [like multiple sclerosis] but into rarer categorizations of a patient's plight (confused mind, difficult family, impossible case, threatening crisis, irreconcilable opinion, slow death, tale of heroism).

My patients are compelled to get their stories out to assure themselves that there is a steady hand attending to their deepest concerns, and this book is my way of thanking them for being so open."

The above comes from this honest and compelling book by Dr. Allan Ropper and Brian Burrell. Ropper, the main author, is a professor at Harvard Medical School and senior clinical neurologist at Brigham and Women's Hospital in Boston. He has counted Michael J. Fox and Ozzie Osbourne among his patients. Burrell teaches mathematics and statistics at the University of Massachusetts Amherst.

Neurology is the branch of medicine dealing with the nervous system, its structure, and its diseases. A neurologist specializes in neurology.

What does this book's title "Reaching down the rabbit hole" mean? Patients metaphorically fall into a rabbit hole, and it's the neurologist's job to get them out.

In this intriguing book, Ropper retells patient complaints or "narratives" through the knowledge of neurological diseases (such as cerebral hemorrhage, multiple sclerosis, brain tumours, stroke, Parkinson's disease, seizures, and ALS or Lou Gehrig's disease or motor neurone disease in the UK).

We get to read how Ropper copes with difficult cases, what he was actually thinking at critical times, and what the medical specialty of neurology means to him.

I personally found the penultimate chapter quite interesting. The subtitle of this particular chapter is "When is somebody not dead yet?"

Finally, I had a bit of a problem with the chapter on malingering and hysteria. The cases that Ropper presents, I found, were rather straight-forward and he gets his point across.

However, he tells us that "Ulcers, asthma, psoriasis, eczema [were] once thought...to be psychosomatic [or all in the patient's head]." Why? Because no physical cause could be found. The same goes for a neurological condition. If no neurological cause can be found, then the problem is all in the patient's head.

The problem here is that it's assumed that medicine generally and neurology specifically are perfect. This is definitely untrue. Even Ropper admits this. And what about the patient with asthma who's told that their problem is all in their head? They now have a stigma to deal with besides a concrete medical condition. And then you have to wonder about the competency of the diagnosing doctor, etc.

I think it would have been wise of Ropper and Burrell not to have included this chapter in their book because a chapter like this opens up the proverbial can of worms.

Also, I was surprised that Ropper never mentioned stem cells (not even a sentence about them). They have the potential to revolutionize medicine, particularly neurology. It's said that neurologists are "master diagnosticians but they have depressingly little to offer their patients." Stem cells would be an effective weapon against neurological disease.

In conclusion, I feel that this book adequately reveals the complexity, the demands, the satisfactions, and the regrets of what it means to be a dedicated neurologist.

(First published 2014; introduction; 13 chapters, main narrative 260 pages; acknowledgements)

<<Stephen PLETKO, London, Ontario, Canada>>

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Though a bit disjointed at times, Ropper weaves together stories from his experience practicing neurology and emphasizes the point of listening to patients to come to the correct diagnosis. He extols the virtues of listening and forewarns the pitfalls of not doing so, and the importance of details (as we neurologists do take note of the details). Along the way, he emphasizes the importance of humanity and empathy in medicine, but also the importance of not letting the weight of the world come down on your shoulders. As a neurology resident, I greatly appreciated this book and found myself growing tearful at the end, especially with some of the stories of patients who didn't make it through but also with those who faced the end of a painful battle with incurable illness with grace and acceptance. It is a beautifully written tribute to patients, to neurology, and to the tradition of academic medicine.

'Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease' by Dr. Allan H. Ropper and Brian David Burrell takes the readers on a strange journey through the mysteries of brain disease at Harvard Medical School. It's a wild ride.

The book is told in a series of cases that illustrate the career of this neurologist and some of the unusual cases he's run across in that time. We meet a college quarterback who keep calling the same play, and a figure skater whose body is experiencing multiple strokes, possibly as a result of chiropractic treatments. We meet an aphasic man named Gordon who has a confused brain. We meet a man pronounced dead whose brain is still possibly alive.

It's a fascinating and somewhat terrifying look at the human brain. Fascinating because brilliant doctors don't give up on strange behaviors. Terrifying because we all fear being trapped in our own bodies, unable to tell others what is wrong or if we are feeling pain. The book takes on the medical as well as the moral issues with treatment of brain diseases and it does it in a very approachable way. I enjoyed this book.

I received a review copy of this ebook from St. Martin's Press and NetGalley in exchange for an honest review. Thank you for allowing me to review this ebook.

If you are interested in psychology or neurology, you'll find this book to be a great read. There's so much information here. It could be overwhelming in the hands of another author, but it's written in a clear, concise and conversational style. Like sitting down for a drink with a neurologist who tells you what he has learned, discusses patients and case studies, and takes his time being sure you understand. More importantly, he doesn't talk down to the reader or use terms that are hard to understand.

Nothing is more interesting, puzzling and fascinating than the human brain and how it works, and this book will offer you a really look at just that, with lots of interesting tidbits, casestudies and just cool knowledge. Really highly recommended!

The cases described in this book cover a wide range of conditions: from patients who might have been faking their conditions, to those whose constellation of symptoms initially elicited a misdiagnosis that was corrected midcourse when contraindicators were unearthed, to those with fatal illnesses.

The authors described how each case was handled according to each patient's varying needs, and what lessons can be learned from each case. Medical terms were explained in layman's language. Some cases had sad endings, others had happy endings.

The writing is conversational, and readers would get a good feel for what makes neurology such a fascinating but also humbling and challenging field.

Allan Ropper for President and Brian Burrell for VP.

Disclaimer: I have known Allan Ropper for over 30 years.

In a world of experts who claim to know absolutely everything and yet demonstrate that they understand almost nothing, Allan stands out because he consistently demonstrates that he understands even more than he professes to know. While I have consistently been impressed by his encyclopedic knowledge (he remembers everything he ever studied in medical school), I have been awed by his ability to weave together a lifetime of observations to arrive at the inconspicuous (OMG, why didn't I think of that) conclusion.

Burrell helps Ropper to tell the story of the patient and his brain in a human, unpretentious, conversational manner as seen though the eyes of the neurologist. The subject matter itself is not eclipsed by an irascible or idiosyncratic super-hero; there is no Dr. House or Sherlock Holmes here, Burrell and Ropper keep their eye on the ball.

When I used to watch the West Wing, I would ask myself after every episode: "Why can't our real leaders be that good?" When they make 'Reaching Down the Rabbit Hole' into a TV Series, I'll surely ask: "Why can't all Doctors be that good?"

Read this book. Your brain will thank you.

This is non-fiction written in a story like manner which makes it readable for all. The book is honestly entertaining, but while you are being entertained, you are being painlessly educated in psychology. I could go on and on about this, but I won't. I'll just urge you whether you are college student, practitioner, or just a common citizen interested in the subject, to get hold of it and read it. You'll be surprised how much it will tell you.

This extraordinary book provides insight into the nature of neurologic care. The first half largely concentrates on disordes of the nervous system and explains the diagnositc thought process of a master clinician. The latter portion concentrates on training and the teaching of neurology to young doctors, the doctor-patient relationship and the complexity of attempting to learn to communicate with a persons whose brain is malfunctioning.
The examples are real, the writing is clear, and the impact is powerful. it provides a real insight into how your dictor thinks about you and how he or she enters a world, which remains obscure to the untrained.

I picked this up because I like Oliver Sacks' books. In easily understood layman's language, Dr. Ropper takes the reader through cases he encountered at the Brigham and Women’s Hospital in Boston. The various ways the brain can malfunction and the range of symptoms presented are fascinating, sometimes funny and often heartbreaking. In chapters organized around a general theme -- such as hysteria, ALS, Parkinson's and 'death by brain criteria' -- Dr. Ropper introduces several patients' synptoms at a time and then circles back to finish their stories - usually. The book is a little disorganized. While I didn't enjoy his prose or personality as much as Dr. Sacks', this is a fun, fast and thought-provoking read for anyone interested in medical stories. For me, "meeting" George and Felicity Kalomiris made me very glad I'd read the book.

The stories in this book are fascinating, especially if you were a fan of House back in the day. The writing threw me off a bit; in one paragraph Ropper has a professional, medical tone with lots of big words, but in the next paragraph we have a bit of unnecessary humor or references/analogies to Alice's Adventures in Wonderland. The thing I remember most about this book? PNES.

An insightful look at the human side of treatment for several severe neurological disorders. The doctor - patient interactions at a major teaching hospital, with its range of medical backgrounds and finite time and resources, were intriguing. Not one to eschew erudition, Dr. Ropper informs the reader of options and urgencies. Without becoming pedantic and utilizing occasional humor in the development of that medical treatment, each patient is followed along sufficiently, in order to gage the effectiveness of that treatment. Not every patient sees a happy outcome. Each chapter seemed to deal with a specific patient and condition There were occasional reversions to a prior patient within a subsequent chapter, but it was not disturbing to the overall flow of the book. My wife and I both found the book to be a warm, informative and often compelling read.

There are many reasons doctors love their work. One of them is intellectual stimulation and nothing is more stimulating than the human brain. Following Allan Ropper around the corridors of the Brigham, is like following around a humanistic version of Dr. House. Reading about these cases, as analyzed and worried about by one of the great clinicians of his time is a joy, and, luckily, does not involve the terrible hours and stress of being a neurology resident. This is a wonderful, entertaining and highly readable book.
Joseph H. Friedman, MD; Stanley Aronson Chair in Neurodegenerative Disorders, Butler Hospital and Alpert Medical School of Brown University

If you ever wanted to experience the joys, challenges and hardships of neurology, this book is a must read. Dr. Allan Ropper, Executive Vice Chair of Neurology at Boston’s Brigham and Women’s Hospital, provides an in-depth, informative (and occasionally laugh-out-loud amusing) account of his practice as an academic neurologist. When he (and co-author Brian Burrell) describe in detail actual cases, from admission, to diagnosis, to treatment, readers quickly appreciate why Dr. Ropper insists that physicians NOT rely entirely on (and often hide behind) MRIs, CAT Scans and other technologies, but spend time with the patient – and often their families – as a critical tool to correctly diagnosing neurological conditions. Particularly moving are his descriptions of treating and counseling patients with ALS and the surprisingly detailed discussion of his work with his most famous patient, actor Michael J. Fox.

One can only hope that should someone require the assistance of a neurologist, that they would have the privilege of being treated by a doctor as passionate, bright, dedicated and witty as Dr Ropper. His insights, ability and willingness to share his expertise with peers and medical students coupled with understanding his patients and the impact of their medical condition is apparent as we learn about each patient that has had the good fortune of being treated by him. As each page of "Reaching Down the Rabbit Hole" is turned, Dr Ropper's empathy, clarity and brilliance while he treats and reflects about his patients is remarkable. Dr. Ropper has written an entertaining and thought provoking book about medicine, neurological conditions, life, people and the travails of quite possibly the worlds foremost neurologist. After reading this book, even a non MD, like myself will have a deeper understanding of the keys that must be found to unlock our minds.

This is a compelling account of the raw moments in the life of a compassionate neurologist dealing with his seriously ill patients. Told with rare candor and occasional humor, these are the stories of patients in tragic circumstances, often
facing death or permanent impairment, and the doctor who tries to hear them and help them when their brain, the very organ the doctor needs most to help him, is diseased. We begin to understand that this is one area of medicine where all our fancy tests and machines cannot replace the experience, intuition and incite of the doctor who listens and lays hands on the patient. This book reads like a novel yet leaves the reader with an appreciation of the real world triumphs and tragedies of a doctor in a big city hospital.

As a non-medical individual, I found this book highly readable & enlightening - not only about conditions or diseases affecting the brain & how it can "malfunction" - but also as a sometimes shockingly honest account of how doctors go through the process of figuring out these puzzling situations. At times serious, at others amusing & even bizarre, never dull or boring - it was an enjoyable & illustrative read. A fast-paced account & perspective of a world-renowned neurologist's special challenges & skills.

This book is more about the impact of brain dysfunction on human life than it is about neurology. The anecdotes highlight the tremendous and often tragic human cost and the challenges and frustrations for those specializing in the area. The author, a noted neurologist, presents the subject in the most basic of terms. That is fine for lay people but those seeking more technical information will likely be dissatisfied. While the book is nicely written, the organization is lacking and it tends to wander. I was most interested in the chapter on ALS. I have known a number of people who have suffered from it but found no new insights or information here. I applaud the doctor for keeping focusing on the person and the organ as opposed to just the brain but had hoped for more in terms of detail and explanation. Still, a nice introduction to the subject. 3.5 stars.

Although this is erudite, informative and engaging, the author/s lets himself down by his own arrogance and knee-jerk reaction to a very real condition: electrohypersensitivity. Although I don't suffer from this personally, my partner does and the condition has aborted teaching career that she excelled at. She has suffered from this before it really became recognised and was ridiculed by a psychiatrist who, later, used her case history in his work to later, validate the same condition! My partner gains no financial benefit from it, is a highly intelligent woman and only more recently in the Uk is beginning to experience some relief from it, if she wears the right deflective equipment. No sane person would choose to walk around an airport or drive under electricity pylons wearing a specially designed deflective mesh which certainly is received with a certain amount of ridicule. As wireless connections have increased, so has her condition become, more of a handicap. In the Uk, the amount of people who suffer from EMF is increasing all the time. I suggest the author carry out a little more research and look at the science underpinning EMF...and the affect it has on bee populations and the real science behind it... or else there is the danger of repetition of Rachel Carson's 'Silent Spring'

A wonderful, sad book. The best and most accurate account of what happened to the art and science of clinical diagnosis at the end of the 20th century. While some of Dr. Ripper'so patients are in desperate situations, the saddest part is what has happened to our profession. No surprises here for an elderly Neurologist trapped in the body of an Orthopedist, but I highly reccomend this book to all the doctors of generations x, y and z.

Although the case studies in this book are interesting, and the writing is clear and accessible to the general public, this isn't a brilliant book. It isn't literary or almost poetic, like the writing of Oliver Sacks, nor does it tie strongly into history, culture and law, like the writing of Harold Klawans. However, if you enjoy neurology, this is worth reading. One of its strengths is making a clear distinction among the types of stroke that affect the brain. The average person may not be aware that there is more than one kind of stroke. One of its weaknesses is the patting-himself-on-the-back that goes on too often, such as hearing a single symptom and diagnosing a rare disorder, or just happening to be at a patient's bedside at a moment of crisis. If you've never read any book about matters that affect the brain, I don't recommend this as your starting point. But, if you're already into the subject, this isn't a bad book to add to your reading list.

This book is fascinating. It reads like half Malcolm Gladwell and half mystery novel, and yet the whole book is filled with real life stories that help the reader understand how the brain works and malfunctions. Highly entertaining reading

Fabulous read! I particularly appreciated how Dr. Ropper openly embraces the uncertainty in a field where many diagnostic criteria and treatment protocols are routinely embarrased by the the vast ocean of patient experience and disease course.

As a person with no medical background, I throughly enjoyed Dr. Ropper's book. His style of writing drew me in and immedietly captured my attention. Not only was the book enjoyable, but it was also extremely entertaining and educational. He provides the reader with an incredible heart wrenching and heart warming look behind the scenes. Everyone I have recommended the book to, loved it.

My bookclub chose this book as our monthly selection. I do not have a good track record of completing the books that are chosen. But this time both my husband and I finished the reading ahead of our meeting. We learned a great deal form the book and enjoyed reading it. I would highly recommend this book.

As a physician trained at a Boston City Hospital, I could imagine myself rounding with the author and being struck by his intellect,
caring and ability to listen to the patient. Perhaps a sequel to this book would allow us entrance into his personal responses to illness and death and how he has been able to cope with such losses.

"Reaching down the rabbit hole" is the most beautiful and intelligent treat for the mind. Dr. Roppers amazing story telling skills make alive interesting cases in neurology. I absolutely loved the book and recommend to any reader. I give five stars.

"Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease" by Allan Ropper and Brian Burrell is a good read but, it's very limited in even alluding to the wide range of diseases associated with the brain. And it's limited to a few short case histories. I have Multiple Sclerosis and was surprised it wasn't mentioned but Parkinson's and ALS were.

There are other brain issues that would have made for fascinating studies. How concussions, tumors, and so forth affect behavior and are diagnosed and treated. The brain is fascinating be it healthy, injured, or diseased. It would have been nice to see how brain diseases and conditions compare and how diagnosis is narrowed down. Perhaps, because of my own illness I've studied and learned more about the brain than most people have and expect more.

For the person who knows nothing or little about the brain, this seems like a good introduction to the topic of Neurology. The brain is a fascinating thing to study.

Engaging, informative and insightful, wish I had it to read six years ago. Dr. Ropper's dedication, brilliance and fortitude is inspiring.
A well written book that was difficult to put down. Lesson's for everyone in the book, thanks Dr. Ropper!

This is truly a great read. Informative, funny, real and at times, sad....yet not too medical for the average reader.
A fascinating account in the life of a master neurologist. A real life Dr. House.

Was this book full of interesting tidbits? Absolutely. Was it more or less accessibly to people without medical degrees? More or less, yeah. Was it compellingly written and utterly engaging on both a human and scientific level? Well... no. Not really.

If you've already read all of Sacks's books (if you haven't, start with The Man Who Mistook His Wife for a Hat) and still hunger for more lay-neurology, grab this book too. However, everything this book does, Sacks does better.

Reaching Down the Rabbit Hole is primarily a compilation of neurology cases treated by Dr. Allan Ropper at the Brigham and Women’s Hospital in Boston. The stories of the patients and their often bizarre symptoms are vivid: heart-wrenching, funny, thought-provoking, but always fascinating. To me one of the most poignant was the young mother with ALS, whose natural maternal desire to see her daughters’ lives as they grew was in constant conflict with the necessity of suffering an ever-declining quality of life. In addition to human interest, the cases provoked reactions of a more philosophical sort, such as the patient about whom Ropper comments that he lacks insight and seems to know that he lacks insight, to which his colleague inquires how a person could be aware that he did not have insight. Think about THAT for a bit!
It was interesting to see how conditions far removed from what a lay person would call neurology can show neurological symptoms, such as an ovarian teratoma (a type of tumor), and to realize how difficult it might be to diagnose such a condition accurately. I believe the author wanted to convey what he considers the unique role neurologists play in medical diagnosis, but he could have done a better job.
The book came across as rather disorganized. A chapter would begin describing a particular patient, then abruptly take up the story of another patient, and then perhaps a third, before resuming the discussion of the first. Each chapter stands alone for the most part, and the overall message of each chapter, as well as the overall message of the book, could have been more explicit.
The subtitle of this book is “A Renowned Neurologist Explains the Mystery and Drama of Brain Disease”. Unfortunately, there is not nearly enough explanation, beginning with the basics. The author makes a big point of being a “clinical neurologist”, but he did not explain to me just what a clinical neurologist is. There are many other medical terms and concepts that the average reader would not know that are also not defined, e.g., he says the cases in the book occurred over a period of two services on the neurology ward and two on the ICU. How long is a “service”?
With better organization, this could have been a much better book, but if you are looking for vivid pictures of the ways neurological diseases manifest themselves and the ways modern-day doctors treat them, you will probably enjoy it.

The cases discussed are interesting and the book offers a look into the mind of a neurologist, which in itself is fascinating. At first I thought it a good read for a lay person, but as I got deeper into the book, I ran across terms that are unknown to me because I have no medical training. I could have paused and looked each term up, but that took away from the flow of reading. Still, I found the book interesting.

Oliver Sacks is referred to a couple of times - the book being compared to Sacks' writing - and that is fairly accurate. For me the take-away lesson is how delicate our brain and health really are. We should never take our well being for granted. I tried to put myself in the place of each patient and wondered how they coped and how would I cope if I were in their shoes. I don't know.

Even if some medical terms in the book cause you to pause, I think the book is a valuable read and it increased my respect of the medical profession in general and that of a neurologist in particular. Although not something I would call a "summer read for relaxation and enjoyment, it is a worthy volume to spend some time reading.

Dr. Ropper often implies that he is a walking library of clinical cases, poses questions such as, would a patient have survived without his presence in the operating room.

Once in the book, he describes a female having "downscale style of dress", but "above-average verbal skills", wow.

As for the content, it's just a pile of cases without much organization.

I wish I could return it.

Another useless exposition on brain disease. The authors of this book should stop wasting their time and find effective treatments for ALS Parkinson's Alzheimer's stroke, etc. or dare anyone say CURE? Wake up Mass Gen and Harvard Medical School. Your patients derive ZERO benefit from your new understandings of brain diseases. Get out of the ivory tower and into the real world. Stop impressing yourselves and each other with dissertations and start actually helping people.