A Shock to the System
“Can a brain implant treat drug addiction?” This is the question Zachary Siegel poses in his recent article, featuring four individuals addicted to opioids [“A Hole in the Head,” Report, September]. As part of their treatment, each received deep brain stimulation, or DBS. Two appeared to improve, while the other two did not. Siegel is skeptical that providing electrical impulses to a person’s nucleus accumbens could be an effective addiction treatment. He’s right. The notion is absurd.
As Siegel notes, DBS has been proposed as a possible treatment for drug addiction because it has been shown to decrease some symptoms of Parkinson’s disease. But the two aren’t sufficiently comparable. One can clinically differentiate the brains of individuals affected with Parkinson’s from those of unaffected individuals, while it’s impossible to distinguish the brains of addicted individuals from those of non-addicted individuals. Because drug addiction is a complex behavioral disorder, the most effective responses include not just physical and mental health treatments, but also social services.
Brain surgery is an extreme intervention. For Parkinson’s—whose symptoms are irreversible and, ultimately, fatal, such an intervention may be justifiable. For addiction, the risk-to-benefit ratio seems dreadfully unfavorable. Permanent damage can occur during the electrode-implant surgery or as a result of the electrical impulses administered after implementation. This, in turn, can lead to a range of other disorders, including cognitive impairment. Siegel writes that the subjects of his piece failed to respond to conventional treatments and that DBS was a “last resort,” a verdict that he should have pushed back against.
There are multiple opioid addiction programs for “treatment-resistant patients” that are far less invasive than DBS. In Switzerland, for example, some people with heroin addiction are given daily heroin doses as part of their treatment, just as people with diabetes take doses of insulin. All patients also have a social worker, a psychologist, a psychiatrist, and other health professionals on their treatment teams. There is now a plethora of evidence demonstrating the effectiveness of this approach, and I wish Siegel had said more about it.
Please don’t misunderstand me. I am not suggesting that giving people daily doses of heroin is a panacea. It isn’t. There is no cure for drug addiction, just as there isn’t for any other psychiatric disorder. There are only treatments. And the approach taken by the Swiss clearly reduces the psychosocial disruptions that are associated with addiction without risking brain damage.
Carl L. Hart
Ziff Professor of Psychology, Columbia University
New York
Regarding the Maine of Others
As someone who has spent a fair bit of time on Islesboro over the decades, I admired Rafil Kroll-Zaidi’s playful but respectful attempt to take the measure of the place [“Island Time,” Letter from Maine, September]. Islesboro has largely eluded description in print, and many of its inhabitants would have liked it to stay that way. Producing a genuinely multidimensional portrait of the island that treats both summer and winter folk fairly—that captures, as Kroll-Zaidi puts it, “the subtle, intimate stories of the community”—is a difficult task.
So difficult that, Kroll-Zaidi warns us, it’s not going to happen. Such an article would entail “endless, painstaking work,” and so, in place of this, he builds most of his piece around a screwball visit to the just-up-for-sale mansion of the island’s most famous summer visitor, John Travolta. The piece was published when the island was at its most crowded, and judgment—on back porches, down at the yacht club, and on social media—was both swift and mixed. Some islanders appreciated Kroll-Zaidi’s humor and choice of detail. Others wrung their hands at how far this mysterious interloper had missed the mark. He didn’t “get” the place, didn’t understand its strange magic.
One complaint rose above all others: there was simply too much Travolta. I agree. While well-liked and certainly much-discussed during his years on the island, Travolta doesn’t really represent Islesboro. By making him the focal point, Kroll-Zaidi undercuts the quirky and captivating moments that distinguish the rest of his piece.
Ptolemy Tompkins
Islesboro, Maine
Portrait of a Lady
Christopher Tayler correctly notes that Robert Crawford is the first Eliot biographer able to quote from his long-embargoed letters to Emily Hale, but his review unfortunately reproduces inaccuracies about Eliot’s secret “muse” [“An Hallucinated Man,” Review, September].
Tayler writes that Hale served “as a drama teacher at a series of undistinguished New England colleges.” In fact, she taught at some of the country’s most prestigious women’s colleges, such as Smith College and Scripps College. Summarizing Hale’s life after Eliot’s second marriage, Tayler writes that she “quit her job and had a breakdown,” but Hale stepped down from her position at Abbot Academy because she had reached the school’s mandatory retirement age. Following her retirement, she performed leading roles in community theaters in Massachusetts.
By burning the letters Hale wrote him, Eliot succeeded in silencing his “hyacinth girl.” Their correspondence provides insight into their relationship, but the full story about this talented amateur actress and revered teacher remains to be told.
Sara Fitzgerald
Falls Church, Va.
Correction
Because of an editing error, “An Hallucinated Man” misquoted a portion of T. S. Eliot’s The Waste Land. It should be: “My people humble people who expect / Nothing.’ ” We regret the error.
