Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

January 23, 2018; 90 (4) Reflections: Neurology and the Humanities

A letter to a rat from a medical student

Andrew L.A. Garton
First published January 22, 2018, DOI: https://doi.org/10.1212/WNL.0000000000004852
Andrew L.A. Garton
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
A letter to a rat from a medical student
Andrew L.A. Garton
Neurology Jan 2018, 90 (4) 186-187; DOI: 10.1212/WNL.0000000000004852

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
323

Share

  • Article
  • Info & Disclosures
Loading

Our lecture halls speak in chattering keyboards. Every time a teacher says something particularly poignant, helpful, or testable, we all applaud with fingertips on laptops. But today I'm clapping for you, little rat: there is a picture of you on the projection screen, and you are drowning. Feverish notes pop up on every screen: little yellow bubbles reading “learned helplessness,” “lack of motivation,” and “quicker to give up.” Or so I imagine. I'm actually sitting in the front row—this is the first lecture in the last 3 weeks that I have attended. Lately, I've preferred to watch them online, at my own pace, on my own time. But today's topic is “Neurobiology of Depression,” and I wanted to hear how my classmates' fingertips would respond. And I wanted to check up on you, little rat.

Little rat, you remind me of a friend I used to have. R was a girl, a young woman, with a bright smile and hair as dark as the circles under her eyes. She preferred crayons to coloring pencils, she never wore her hair down, and she loved to play field hockey. She loved to win at field hockey. But her glowing smile never quite lit her eyes. Early on in our friendship, I learned that she lived with depression. That she lived despite depression.

Oh rat, you are still drowning, I imagine, but you have been replaced by a slide explaining “Epigenetic Modifications Under Study in Animal Models of Depression.” What (I hope) we are supposed to understand is that early life experiences shape the ways that certain genes implicated in psychiatric illnesses are expressed later in life. It turns out that, among rats determined to be genetically vulnerable to developing rat-depression, those who are licked by their affectionate mothers grow up to be phenotypically resilient. They also end up vigorously licking their own offspring as well. Not to demean the findings of the study, which I think are pretty interesting, a sarcastic voice in my head retorts, “So you're saying that even in kids who got the bad genes, they will be saved if their mothers just love them a lot?”

I wonder what R's mom would say. R was not an easy child to parent: vivacious and charming one moment, supplanted by misdirected anger the next. R's mom would yield, yield, yield, then break; her emotions would spill out as through a break in a dam, swirling with R's until their combined force laid waste to whatever situation they were in. And yet, when R would wind up in the hospital following one of these levee ruptures, R's mom would bring brownies for everyone on the unit. Did your rat mom love you, little rat? Did she love you as much as R's did? Is that why R resurfaced, clambering out of the rising tide, but you are anchored? Do you need a hand?

Now there are images of rat brain scans on the screen, illustrating the parts of the brain involved in rat-rumination. Apparently, they have ways of knowing whether you little guys ruminate or not. R told me what that felt like: how it was a spiral of concrete sludge that slowly oozed from the top of her head down her spine into her stomach, poisoning every thought it touched, distracting her from worldly sensations so that she was left alone with only thoughts of self-loathing that carouseled in circles, ricocheting off the walls of her skull, getting louder and louder and meaner and meaner until something would wake her up from her coma and she would realize she was still in the shower, 30 minutes late for school.

What part of the brain does that, Dr. Lecturer?

Oh, the anterior cingulate. Yea, that makes sense actually. Okay. I think we understand each other, little rat.

I bet I have classmates with family members who have fallen prey to cerebrovascular disease, heart disease, diabetes who sat through those lectures waiting anxiously to see if the instructor would say something to help explain everything. I bet I have classmates sitting with me in this room right now who empathize every bit as strongly as I do while you drown, while you literally learn how to be helpless. You go, little rat. Great job being helpless. You have to be helpless so that they can study you and figure out what goes wrong when happiness and joy lose their flavor, the future loses its promise, and life loses its meaning. Can you do that, little rat? For all of us?

R is not dead. I have not seen her in many years, but I keep in touch with her from afar and I know she is all right. I think, and I do not think she would resent me for saying it, that aging and maturing amid friends and family who supported her gave her the strength to climb out of her pool. She is on medication now, and according to this lecturer we do not even really understand how those work either. We stare into a patient's eyes, dark with depression, and hurl question marks at their head until something recalibrates their neurotransmitters. It's less barbaric than that in practice, I know. But, at times, it no doubt feels that way for patients. I am sorry if it feels that way to you too, little rat, but we do not have a better way yet. I am so grateful for you, little rat. You have made so many sacrifices for medicine, for R, for human understanding. It's twisted, and I know you probably don't have enough neocortex to understand, but you mean a lot to me. I see how you feel, noble rat, I think we can all feel it ourselves. I promise I won't forget you.

Footnotes

  • Listen to a reading of Mr. Garton's story, available on the iPad® and Android™ devices.

  • Copyright © 2018 American Academy of Neurology

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Footnotes
  • Info & Disclosures
Advertisement

Related Articles

  • No related articles found.

Topics Discussed

  • Pediatric depression
  • Depression
  • Adolescence

Alert Me

  • Alert me when eletters are published
Neurology: 96 (8)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2021 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise