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The Dying of Enoch Wallace: Life, Death, and the Changing Brain

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The Death of Enoch Wallace is a hopeful book for anyone who has a family member with Alzheimer's disease. It describes, often in painful detail, the initial confusion of finding the right word for things, not remembering the way home, to the more serious functional deterioration in the most fundamental aspects of day-to-day living. Along side is the story of NGF, or Nerve Growth Factor, discovered by Rita Levi-Montalcini over 50 years ago, that sparked a revolution in brain research that has really taken off in the latter part of the 20th century, and continues into the 21st. This is a timely book for me as my mother has been deteriorating from Alzheimer's disease for the past three years. I've been her primary care giver for the past year and a half, and just recently I had to place her in a nursing home. She's in the middle stage of the disease now, often the longest lasting, and the descriptions in the book about Mr. Wallace's symptoms paralleled the one's my mother had. Although Enoch Wallace is not a real person, (as explained in the preface), the symptoms are real, and the confusion and fear that he feels, as well as his family feels, are dead on accurate.

The chapter on memory is very good, and the research on grafting cells onto affected brain areas in animals looks promising.

When my mother speaks now, it's mostly word salad, but she can answer simple questions with a yes or no - although I'm not sure if she's telling me what she really wants. You guess sometimes. Often she'll be seem to be speaking to someone who isn't there and sometimes her attention will spill over to include me, and for that I'm grateful. I live in hope.

Dr Black employs his talents as a cutting edge researcher to bring both technology and disease to public attention. In simple language he accomplishes this with a clever mix of scientific explanation of brain function and description of common brain diseases. The titled character is a fictitious successful banker in the process of developing Alzheimers and another is afflicted with Parkinsons. Black's dramatic account weaves in symptoms and underlying causative changes as he reviews scientific developments and laboratory experiments.

Drawing from many years of training and research at prominent institutions, he reminds us that the human brain is an ever-changing flexible organ the function of which constitutes the amazing plastic mind. The brain, previously considered a relatively static and non-renewable assembly of nerve cells, is described as a very dynamic structure whose growth factors convert experience into intercellular connections which mediate learning, memory and emotion. He suggests that new discoveries mark only the beginning of understanding, not only with respect to possible cellular transplantation but also with respect to replication of existing cells to replace dying cells of the diseased brain.

This is the best book I've read by far on the human brain -- from both scientific and humanistic perspectives. It's a must read for anyone with a loved one affected by brain disorders. It helps guide you through the human trauma of the degenerative journey of Alzheimers as well as a very broad and informative view of the past and current state of research on the brain.

Ira Black paints a moving portrait of an elderly gentleman suffering from Alzheimer's disease. A disease that too many people whom we love, suffer from. I found myself gripped by this story of Enoch Wallace's battle with the illness. In riveting detail Dr. Black walks us through Wallace's downfall. It is interspersed with up-to-the-minute scientific details that explain what's actually happening in Wallace's brain. This is a moving, must read book for anyone interested in science, or who has ever known someone who suffers from Alzheimer's disease.

Dr. Ira Black, the author of The Dying of Enoch Wallace, brings to the stage a description of the most common brain diseases and how they affect their victims in a way that is both scientific and narrative. Many people know the basics of brain diseases such as Alzheimer's, but few know their neurological pathology (how and why these diseases occur). It is through his insightful anecdotes about the sufferers of these cruel diseases that we get a firsthand look at what it is like to fall apart at the hands of the self-destructing brain.

Dr. Ira Black is a leader of neurological disease research. As a clinical neurologist, he brings unparalleled knowledge and experience from the modern neuroscience field to you in the form of his book, The Death of Enoch Wallace. Broken down into ten chapters, he reveals the past of neurological research while linking it with its future through the fictionalized tale of Enoch Wallace and his fight with Alzheimer's disease. The book is full of information that anyone interested in the field, or has experience with neurological degenerative diseases, can grasp. As each stage of Enoch's deleterious disease is documented, Dr. Black magnificently analyzes the neurological reasons behind the decline and what is being done to fix it. His clinical experience and pioneering research really adds to the authenticity of the information--consistently utilizing neurological terms that even I, as a student taking a neuroscience class at Georgia Tech, had not heard of. Dr. Black does a great job of breaking down and explaining what those terms mean in a way that is simple to understand, making you feel like an expert in the neuroscience by the time you finish reading the book. I think the way Dr. Black arranged his book is perfect for the type of material being conveyed, in that it could easily have been a dry, scientific journal-esque writing style with lots of facts and figures making it difficult to understand. Instead, he molds together a man's struggle with the onset of Alzheimer's with an easy to comprehend explanation behind the neurological aspects of the disease.

The Metamorphosis of Enoch Wallace:
The book starts with Enoch Wallace, a "distinguished sixty-two-year-old investment banker" (p. 3) waking up one morning to find that he cannot remember how to get to his bathroom from his bed. This is his first brush with the disease that would later render him forever dependent on others to function. Much like that of Gregor Samsa from Kafka's The Metamorphosis, Enoch Wallace found himself a changed man that morning in his bedroom. Although, unlike Samsa's "instantaneous transformation", Enoch's changes were slow to take a hold, yet still just as devastating. Through the life of Enoch, Dr. Black reveals the history of brain plasticity research, a field that just recently found its popularity among neuroscientists, but dating back to fascist Italy. What was once believed to be an indelible black box of information and memories, the brain has been found to be much more mutable.

Brain Plasticity:
Our brains are ever-changing. The term brain plasticity refers to this ability to change under varying circumstances. Through years of research, scientists have found that our brains are able to adapt to what was once thought to be immobilizing damage. The book refers to the search for nerve growth factors (NGF), a hormone that was discovered by Rita Levi-Montalcini fifty years ago used to prompt the growth of nerves by size and number, as one of the revolutionary ways of reversing the degeneration of brain neurons in patients with neurological diseases. Several biologists within the past decade discovered that the use of NGF with Alzheimer neurons extended the life of those neurons which usually die in sufferers of the disease. This discovery is the beginning of a whirlwind of NGF research into the link between neurons and their role in the progression of disease. It is during this time that the major swing from the immutable to the plastic brain occurred, or as Dr. Black so eloquently put it, "Almost overnight the brain was transformed from a static, immutable, hardwired switchboard into a vast reservoir of growth factors that directed growth, survival, and previously unimaginable flexibility" (p. 9).

The Question of How and Why:
After this discovery, a myriad of questions arose about how the brain functions. There were inquiries about the number of growth factors in the brain, their role in neuronal degeneration in diseases such as Parkinson's and amyotrophic lateral sclerosis, as well as, how exactly do the NGF govern growth and survival? The book goes in depth into the current understanding of neuron growth factors and how they are shaping the neuroscience field. It has been discovered that there are hundreds of neuron pathways in which information is relayed from the brain to the rest of the body. As we train our brains over time by doing repetitious tasks, the pathways learn shortcuts to deliver the signals faster and more efficiently. In patients suffering from diseases that destroy memory and concentration, like that of Enoch Wallace, these pathways lose their connections. The question is how and why--a seemingly daunting pair of questions that only those of superior intelligence could understand. But amazingly Black answers them in a way that both scientists and non-scientists can understand and enjoy.

Cell Suicide:
The death of neurons is what creates gaps in the highways of signal processing in the brain. But death has also been found to be beneficial. It is a way to "clean up useless scraps of material at the construction site" (p. 109) that is our brain--a sort of purification process, leading to more efficient processing. Dr. Black very intuitively simplifies the reasoning by likening these deaths to human death, in that there are various forms, both good and bad--as far as death goes. The cleansing of unnecessary neurons is a form of "natural death", such as dying of old age. In the case of many brain diseases, however, it is necessary neurons which die, not superfluous ones. Through research by John Kerr, among others, the process of cell suicide was discovered. It is this programmed cell death, or apoptosis, that creates the connectional problems in Alzheimer's. This is what creates the fragmentation in Enoch Wallace as he brutally confuses the real-world and the imagined. The supports cells, so needed to decipher the truth from our memories and experiences, are critical for facilitating neuronal communication and information flow. Enoch tragically lacks said cells partly due to cell suicide. And without the ability for these cells to regrow, Enoch was destined for a life controlled by his disease. Only just recently, scientists have found a way to regenerate nerve cells--a leading step in the race to find a cure. Dr. Black provides the reader with clear enough information to do research on your own if you were so inclined. Since the book was written 8 years ago, in 2001, many new ground breaking discoveries have taken place. Thanks to Dr. Black's detailed facts, anyone could find more information about the recent advancements in the brain disease field.

Final Thoughts:
As Dr. Black demonstrates throughout his book, the brain is a mysterious, often misunderstood organ in the body. But as discoveries of how the brain functions emerge, more and more is being learned about how it operates as a single entity and how it communicates with the other numerous parts of our body. It is the control center for human beings, and only within the last few decades has the minute details of brain plasticity been unveiled to reveal the "big picture". Dr. Black details the past and the future of neuroscience in a way that is easily understandable and very identifiable. You find yourself experiencing firsthand the pain and suffering of a man who cannot even find his way to the bathroom in his own home without help. All the while, you learn the science behind his descent. The story is both gripping and informative, a rare combination in non-fiction. It is a definite must-read for anyone interested in how the brain works and what happens when it doesn't.

The combination of scientific research laid against the human story of Enoch Wallace ties theory to reality in a profound way.