This semester I decided it was a good idea to take up French again. So I signed up for “LF 303,” which is now where I sit for fifty minutes every Monday, Wednesday and Friday trying to convince my professor (and myself) that I am a halfway-competent French speaker. Which, it turns out, I could be. I have a feeling it won’t be long before I start dreaming in French again, at which point I’m sure I will have something neuroscience-related to say about that.
That hasn’t happened yet, but French class has actually had some direct mind and brain content. Last month we read a short story called “Le Horla” by Guy de Maupassant. The story is written from the perspective of Dr. Marrande, a psychiatrist who comes across an interesting case and calls on some of his colleagues for their opinions. Dr. Marrande introduces his coworkers to the patient (referred to as such – “le malade”), and he lets the patient tell his own story.
“Le malade” explains that his problems started with insomnia and anxiety, for which he was prescribed potassium bromide (a widely used sedative and anticonvulsant in the late 19th century when this story was published). He was also instructed to take showers. This treatment worked for a little while, and then he began experiencing frightening hallucinations. Upon waking up one morning, he found that a glass of water that he had set out the previous night was now empty.
As an experiment, “le malade” set out water, wine, and chocolate, all of which he enjoyed, and milk, which he did not. In the morning, he found the water and milk gone, at which point he became suspicious of the true nature of his problems. Was someone coming into his bedroom at night? The hallucinations continued: “le malade” describes an instance where he saw a rose floating in mid-air and being unable to see his own reflection in the mirror before having it come back bit-by-bit in an eclipse-like fashion. The rose incident left him with the feeling that he had been haunted before and was being haunted again, and he thought perhaps “le Horla” was the cause of the mirror incident. By the end of the story, he is explaining a theory to the doctors and scientists that includes “le Horla” as a member of a new race out to take over humanity.
Is “le malade” insane? In our class discussion, I said yes (or, rather, “oui”). When you assume that the cause of your problems is a new, vampire-like race coming in on ships from Brazil to bring down humanity, yes, you’re probably a little nuts. However, one detail of the story left some of my classmates and I wondering. See, in his very lucid description of his plight, “le malade” mentions other people – a neighbor and two employees – who had problems similar to his own during the course of his illness.
Could he have been suffering from a contagious illness and lacking a better explanation assumed he was going crazy and needed psychiatric treatment? After some investigation, the only thing I found that seems to occasionally cause insomnia are yeast infections, and “le malade” never mentioned any symptoms of infectious illness. Perhaps it’s more likely that these characters were all affected by anxiety or insomnia (fairly common complaints) for which they all took potassium bromide.
Bromide intoxication creates a variation in the serum anion gap: the difference between sodium concentration and the concentration of chloride and bicarbonate in the liquid component of blood. A low serum anion gap is seen in bromide poisoning – which was still being reported on here in 1936, when alternative sedatives had become available in the form of barbiturates. I did some research regarding acetylcholine receptors, bromide, and hallucinations that quickly became too convoluted to bring me to a truly arguable conclusion. However, it seems to me that this anion gap imbalance could potentially have anticholinergic effects that cause bizarre neurological symptoms.
So was “le malade” actually losing his mind? Was Dr. Marrande doing his patient a disservice by prescribing potassium bromide, or is my theory a stretch? It’s still a mystery to me, which in my opinion, keeps the intrigue in the story.
Serum Anion Gap: Its Uses and Limitations in Clinical Medicine – Clinical Journal of the American Society of Nephrology