In the sixth form, I became very interested in insects and particularly butterflies, ants and beetles. I read Walter Henry Bates’ book about his travels through the Amazon where he collected voucher specimens of over a hundred different butterfly species as well as many other insects. In his book published in 1863, Bates wrote about the Passion Vine (Heliconius) butterflies who despite their gaudy showiness and exuberant colours danced in freedom through the forest glades largely avoided by predators. Bates discovered that their wings contained cyanide generating compounds that were unpalatable to birds and insects. He then noticed that there was another species of butterfly in the Leptalides genus that closely resembled the Passion vines providing it with similar protection, a beautiful proof of the truth of Darwinian Natural Selection. Mimics and chameleons are now terms commonly used in neurological parlance to describe diagnostic challenges where diseases masquerade as other clinico-pathological entities. The Gouldian finch, an endangered species in Northern Australia exhibits polymorphism which allows the species in the wild to produce males with black, less commonly red and rarely yellow heads. The red headed finches are more dominant and preferred by the females but have poorer reproductive outcomes, so this has little to do with the survival of the fittest. For a time the striking difference in the external appearance of these birds led to the early ornithologists considering them to be separate species. This helped me to understand how the same gene mutation could lead to very different phenotypes and how even identical twins carrying the same genetic mutation did not always express the same diseases. I discovered in Nature the magic and useless delights I sought in art. It reminded me of the mystery of life and its benevolence.
In 1873 Sir James Paget, a keen naturalist who perhaps had read Bates’s book, wrote in the first of his clinical lectures published in the Lancet in 1873 about the phenomena of neuromimesis in hysteria that he believed was due to a negation of will. He was struck by the remarkable similarity of symptoms and signs many patients had with those seen in common neurological diseases, and contemplated what might be the biological even evolutionary value of this behaviour. There has been renewed interest in this notion with Akihiro Nishi and Jon Stone raising the possibility that functional paralysis might result from maladaptive deeply rooted survival strategies such as the freeze response occurring in response to diverse physiological or psychological stress. They also suggest that other functional symptoms such as tremor and seizures could be triggered by a mixed fight and freeze response.
Many neurologists are influenced in their career choice by their love of life sciences. Botany was part of the new introductory course for medical students at UCH in 1862 when William Gowers sat the examination and botanising became one of his enduring interests. He was elected a Fellow of the Royal Botanical Society in 1885 and had an intimate knowledge of grasses and mosses. Ornithology is a popular pastime for many neurologists and the Canadian Neurological Association had a special interest group for bird watchers for several years. The connection between them may have something to do with the pleasure of noticing, recognising patterns and paying attention to detail.
In this book James Bashford, a neurologist and amateur lepidopterist, with a special passion for moths, explains how an exploration of connectedness in Nature can not only help us save the planet, but at the same time help save ourselves from ourselves. Bashford believes, in part through his own life experience, that greater engagement with the natural world can be beneficial in restoring internal harmony for people experiencing existential crises. In the course of his scholarship he is somewhat disappointed but undeterred to discover that in comparison to mindfulness, the medical literature describing the prescription of nature for brain disorders is paltry and largely restricted to trials in dementia. One study, however, raised the interesting possibility that ‘nature deficit disorder’ leading to ecological loneliness and disconnection from soul might actually predispose to cognitive deterioration. People who lived in the greenest areas in the study reduced their risk of dementia by as much as a fifth. Chronic neurological disorders are life-changing and Nature therapy, while no panacea, may hold its greatest value in relieving fear and depression that often coincide with brain injury. Bashford also believes that neurologists may acquire greater understanding of how sickness arises by paying attention to knowledge that has been acquired from beyond the human world. He also challenges the algorithmic, process-driven disease management beloved by the medical industrial complex.
The chapter entitled ‘Chameleons in the Clinic’ is a good example of Bashford’s knight’s move informal approach covering Covid, the evolving nosology of disease, a need for acceptance of the unknown, gene therapy in spinal muscular atrophy, the importance of storytelling in medicine, and a scientific description of how chameleons blend into their surroundings. Elsewhere in the book he compares and contrasts fungal blight leading to blockage of xylem in Dutch Elm disease with the dying back of axons in motor neurone disease. A fascination with autoimmune NMDA encephalopathies leads him to muse over the large number of unknown and often implausible biological connections still waiting to be revealed.
Physicians have a pressing responsibility to promote sustainable health care. As Bashford searches the gardens around King’s College for the unlikely sighting of a Camberwell Beauty he is constantly discovering things that help him in his neurological practice. Most medical scientific discoveries occur when several varieties of chance coincide. Nature Within should be read as part of neurologists’ continued professional development.
