Review of Professor Andrew Lees book by Professor Michael Trimble
Andrew was appointed as consultant neurologist to the National Hospitals in 1982. He tells us that he had a shortened version of his earlier worn shoulder-length hair and his northern English accent may have been softer. It was, after all, a time at the hospital when stiff collars and sherry were still voguish while the veneer of authority and reverence were the required demeanour. In this lively confessional autobiography, Andrew reminds us of the shocks that confronted him with his first introduction to the London medical scene. He was excited but bemused by London itself and he was nostalgic for the romance of the Northern towns and the flat vowels of his earlier world, even if a bit mollified by cockney slang. There are some wonderful touches, since he recalls even the name of the man whose body he dissected at medical school: “I was not invited to Wolynski’s funeral but I was grateful for his sacrifice and have never forgotten him”.
Hardened to the realities of such impersonal intimacy, and encountering the mysteries of post-mortem examinations, since the living and the dead crossed his path daily, and causes of the pathology on the table were so often unknown, he faced the realities of the darker side of the city and its medical hegemony. He lived a “double life” moving between “alternative worlds”, combining daytime life at the hospital, with the personal intimacy of Soho night clubs. Only one of several confessions spring out to us in his journey to what became his main clinical passion, movement disorders. Uncharacteristically, for a neurologist he was at this time reading some psychiatry; he notably quotes Enoch and Trethowan’s Uncommon Psychiatric Syndromes as a relevant text.
Early on, Andrew introduces us to William Burroughs, the beat poet, drug addict, and pervert, and author of The Naked Lunch. And then to Dr Benway. Dr Benway, the Director of the Freeland Reconditioning Centre is his main protagonist; a psychopathic, sadistic madman who reminded him of one of his colleagues. “Now boys, you won’t see this operation performed very often and there is a reason for that…I think it was a pure artistic creation from the beginning”.
The conformity of medicine was suffocating, “a mosaic of depravity, violence and cruelty driven by plain sexual desire”. Burroughs, a heroin addict who was helped by apomorphine, for Andrew “opened a crystal door that led to the moon”.
The book takes us to his fascination with Parkinson’s disease and his journey from the lamentable state of affairs in the pre- L-DOPA era. Today’s younger neurologists have little awareness of this time, or of the dramatic effects that the initial work with L dopa produced, as so beautifully and dramatically described by the late Oliver Sacks, a close friend Andrew’s, in Awakenings. Andrew became “a molecule man”.
In his neurological journey he mentions especially warmly William Gooddy and Gerald Stern. Gooddy pointed him to The Complete Works of Sherlock Holmes and A la recherche du temps Perdu. Much better as educational guides to neurological inspection and introspection than Brain’s Diseases of the Nervous System. “To study the phenomena of neurological disease without books was to sail an uncharted sea, but to study books without patients was not to go to sea at all”. His further education was spent as a flaneur in Paris at the Salpêtrière, making contacts with colleagues that have remained close to him over the years.
Having witnessed from his own work some of the negative side effects of l dopa in some post encephalitic patients with Parkinsonism, a la Sacks, he progressed to trial bromocriptine. At this point, another spark illuminated his ideas for his molecular quest, the work of Albert Hoffman and the discovery of LSD (d-lysergic acid). Andrew visited the Speed Laboratory and started looking at the effects of compounds, such as amphetamine in rats. He then received a gift from Merton Sandler, deprenil (a murky tale not fully recounted), and he became one of the list of daring scientific investigators taking part as a subject in his own study. Deprenil had a dramatic effect on his own mental state, and in this experiment, aware of the sometimes fatal effects of combining amines with a MAOI A drug, he combined this MAOI B relative with large doses of tyramine to see if his blood pressure had been affected.
Andrew, as every good researcher now has to face, like many of our colleagues, was arraigned by the authorities over the results of deprenil trials; a fascinating interlude in the book, the acrimonious conflicts between differing experts, some of dubious quality, being nearly enough to put him off more experimental work. But undaunted he pursued the molecular trail. Once again he became his own experimental subject. He was puzzling a possible solution to the on-off swings of Parkinson’s disease, and in a dream, like that of August Kekulé something “unfurled before my eyes”. Apomorhine, a substance lauded by Burroughs for the help it gave him, and for Andrew helped him towards the development of the apomorphine pump. Yet his paper “Hedonistic homeostatic dysregulation” linking the drug most employed in the treatment of Parkinson’s disease, L-DOPA, with addictive and aphrodisiac properties created another downblast of icy criticism, yet this is now a well acknowledged clinical problem.
Like many of those researchers who applied imagination and thoughtful introspection to their work, Andrew experienced what he refers to as “oppressive bumbledom”. The reader is caught up with his frustrations that nowadays stifle not only clinical research, but also day-to-day clinical practice. Who has not been suffocated by the restrictions and totally unnecessary burden of bureaucracy inflicted on us by poorly undereducated and faceless members of committees? Frogpodian lamebrains, for whom in the NHS “new was better than old, more was superior to little, complex always trumped the simple…lack of trust and a culture of patient complaining …(had led to) …those wishing to do research… buckling under the sheer volume of inflexible rules, auditing and clinical guidelines”. Let us refer to his method of perseverance and curiosity as the basis of clinical research as the Andrew Lees way.
They never met, Andrew and his mentor. The confessions continue with his epiphany in Columbia where he tried the psychotropic agent yage….. “finding new symmetries amid the changing shapes of molecules”, there he touched “the vine of the soul”, heading for the Milky Way; “Oh ecstasy/for a second/I was once/Gigantic as the world/and small as a molecule” - a Faustian plea for help, but after all Faust was redeemed.
I recently gave a lecture at le colloque annuel d’histoire des neurosciences at the Salpêtrière on Hughlings Jackson. Immediately I finished, Andrew came forward from the audience and spoke briefly, saying he had come to Paris just to hear my presentation. Flattered, in the melee that followed in the next break, I had expected to see him and perhaps arrange a dinner. But he seemed to have vanished. Paris was quite lively at this time, and the weekend was to be further excited by another demonstration of the Gilets Jaunes who would be congregating at the heart of the city. Next time I see Andrew, I must ask him where and with whom he had found himself later that day…
Mentored by a Madman: The William Burroughs Experiment is available from https://www.nottinghilleditions.com/news/andrew-lees-a-visionary-mentored-by-a-madman/