Sunday, June 2, 2013

Behavioural Neuroscience and Hannibal: the TV Show

Subtitle: Why Is No One Giving Will Graham A Hug?

Most readers won’t know this - as most people in my life don’t, so it would be weird if you did - but I originally attended university in the hopes of pursuing a degree in behavioural neuroscience. This, of course, was just a fancy title to put on my application to med school, where I hoped to pursue a specialty in emergency medicine or psychiatry, but plans went terribly array so that’s neither here nor there.

What ended these plans was a bout of serious depression and my withdraw from my undergraduate program, my hopes of becoming a physician, and finally university altogether. I likely knew, even before I enrolled, that I was suffering from a mental illness - stemming from a sensitivity drawn out in my dna and prenatal environment, and set into motion by a childhood bathed in neglect, trauma, and periodic abuse at the hands of others, who were also, in their own right, traumatized and mentally ill. Why else would I have pursued a profession so tied up with my own experience? But this knowledge was never explicit and I avoided, as long as I could, any of its terrifying implications.

But this post wasn’t supposed to be about me. Hmm. Let’s get back to Hannibal and Will.

Hannibal, the character, is a spectacular psychopath - the sort of monster who fascinates and speaks to dark curiosity and sense of the macabre. We want to know why and how he does the (fictional) things he does. This dark wonder has led to four novels and six movies in which Hannibal is a central character. (Only five? What? Instinct WASN’T the story of Hannibal Lecter’s cunning evasion of police through posing as an anthropologist studying a remote band of highland gorillas and finally discovering, in them, the sense of community he never experienced was his fellow man? WHAT?!) And this year, those watching NBC’s Hannibal have discovered a new version of Empire Magazine’s Eighth Greatest Character of the last twenty years.

Hannibal the Psychiatrist’s intense sense of enigmatic evil is matched only in the sheer adorability of central character and muffin Will Graham - the instructor turned special investigator for the FBI who is described as having an empathy disorder akin to “the opposite of autism.” He is easily drawn into the world of others, seeing into their experience with an uncanny intuitive clarity which leaves him, after, feeling shell shocked and terrified. Will sees through the eyes of brutal killers - feeling as though he himself may have committed their crimes - and uses this skill to help stop them from killing again.

So why bring up my history at all, you ask? Why describe myself in a paragraph next to what could be seen as praise for the most notorious fictional serial killer of all time? That seems like a weird and potentially incriminating thing to do.

I bring up me only because my history, education, subsequent work* in mental health, and unending curiosity regarding neuropsychiatry has made watching Hannibal a special kind of torture.

*I work with adults with psychiatric disabilities as a community mental health worker for an innercity non-profit - many of my clients struggle with homelessness and addiction. But I don’t work here because I’m trying to pray on society’s most vulnerable a la Hannibal. Because I’m not. Oh god I’m just making it worse aren’t I.

In this week’s episode (spoiler, obviously), it is revealed that muffin-face Will Graham is suffering from anti-NMDA reception encephalitis, a rare disorder which is, in the show, described as degenerative and untreatable. Not that they try and treat it - Hannibal and a surprisingly complicity neurologist are both happy to leave Will without even the knowledge that he’s suffering from an illness, all the better to watch him de compensate and study the path of his downward trajectory.

Also mentioned this episode are Mirror Neurons - a type of cell in the brain which reacts identically when viewing a behaviour or preforming a behaviour, believed by some to play a role in human empathy. This connection, however, is dubious at best and very poorly understood - Hannibal may or may not know this, and it may or may not be sloppy writing.

Cotard’s delusion, spatial neglect, prosopagnosia - all fascinating neurological symptoms featured in this week’s episode and distorted by both Hannibal the character and Hannibal the TV show to best achieve their nefarious means. Their goal is, of course, to ensnare their hapless audience - Will Graham and myself, respectively. We are told only distorted fragments of the truth.

(Speaking of the truth, anti-NMDA reception encephalitis is often a form of paraneoplastic syndrome - a reaction of the immune system in response to underlying cancer cells elsewhere in the body; see House for further details. It occurs almost exclusively in women and leads to death or permanent neurological damage in about a quarter of its patients - the other 75% make a full recovery.)

Up until this weeks’ episode, I had rejected the possibility of a neurological diagnosis for Will. Others had not, proposing any number of strokes and tumors which could have resulted in his specific symptomatology. I clung, wrongly, to the belief that Will, like so many others, was reacting as best he could to an onslaught of trauma outside of his control. He dissociated (like a soldier going through the motions amidst an onslaught of horror in battle, later having no conscious memory of events). He misinterpreted ambiguous stimuli (like the PTSD sufferer who’s hyper-vigilance leads them to jump at the slightest movement, or the abused child who hears distant laughter and interprets it as screaming). He suffered from night sweats, headaches, and nightmares (like...everyone when stressed out or traumatized, I think?).

Will had, previously, shown all the symptoms which I believed to be characteristic of stress, and our minds' spectacular ability to protect itself from that which we feel we cannot handle. Will’s symptoms were extreme and increasingly terrifying, for both himself and the viewer - but not outside of logical possibility. This is what trauma survivors do. We tune out, and repress, and distract ourselves endlessly in an effort to avoid overwhelming emotions.

We write three-page long blog articles on obscure neurological conditions and the character Hannibal Lecter, all in an attempt to avoid finishing an episode of a TV show because Will doesn’t know he has encephalitis and is sad and afraid and WHY IS NO ONE GIVING HIM A HUG???


I return to my video player with an increasing sense of unease.