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Brain scans, clichés and complexity

Last Chance Saloon is the story of Neil ‘Twink’ Tinning, a troubled, magnificent man living with bipolar disorder, and his unique attempt to understand the science behind his, and many other, mental health conditions - all while getting ready to play the biggest gig of his life.

In part 4, Twink goes to the Cardiff University Brain Research Imaging Centre (CUBRIC) to get an MRI scan of his own brain, in the hope it might shed some light on his illness. With Professor David Linden, Twink explores the contents of his skull, producing more questions than answers...

Previous episode: Part 3 - Hope, meds and schizophrenia

Next episode: Part 5 - Post-partum psychosis and motivation

Transcript

[Previously on Last Chance Saloon…]

Scientist: It is very misunderstood. It’s probably the most stigmatised-against disorder. In some sense because it’s about cognition, it’s about perception, it’s about belief, it’s almost one of the most human disorders that exists. It’s kind of at the core of being a human being.

Neil ‘Twink’ Tinning: The thing is it’s not a band.

Interviewer: Well, what is it then?

Twink: To be honest with you, it’s probably more to do with the fact that it’s rehabilitation for me, and I’m using music as some type of therapy.

Twink: What’s the most amazing thing about the brain?

Michael: Gosh, there’s so much, I think. I suppose the most amazing thing about it, though, is –

[Opening music]

Twink: Dr Ian Jones invited me to go up and do a little five-minute speech at St Nicholas's Hospital, which is in Newcastle; it was an old Victorian mental health asylum when it was built. I started off with the usual sort of mental health gag, which is: “Firstly I'd like to thank my care manager, my consultant psychiatrist and diazepam, for making it possible for me to speak with you today. My yesterdays have been very difficult. In my darkest days, my stability could only be measured by the thickness of the ice that I skated upon. My view of bipolar is it's an enigma wrapped up in a complex riddle.”

And then I went on and I developed this thing that I tend to do, and it's called the bipolar cliché: “Bipolar is a life-threatening illness. Put it this way, if you spill the beans you open a whole can of worms. How can you let sleeping dogs lie when you let the cat out of the bag? Bring in a new broom and if you're not careful, you'll find you've thrown the baby out with the bathwater. Change horses in the middle of the stream and the next thing you know, you're up the creek without a paddle. The balloon goes up, it hits you for six, in fact an own goal. Then you end up talking in clichés until the cows come home.”

[Music]

David Linden: Well I've always been interested in the brain, and after my medical training it just so happened that techniques were becoming available where we could look into people's brains, what they were thinking or imagining things or seeing things – or indeed were being ill, and that just fascinated me to be able to get a glimpse with neuroimaging of people's working brains.

Twink: Do you think it will ever be possible to diagnose depression by brain scanning?

David: [After a long pause] Yes. People are trying this at the moment with what's sort of being globally labelled as brain reading. So …

Twink: Is that like horse whispering?

David: It's a very interesting development, and people are reporting stunning results in terms of using these brain images together with other measures, to determine whether someone is in a certain diagnostic group, or whether someone's going to respond to treatment or not – but it's very, very early days.

Twink: The brain scan thing was done at a time when I'd had a number of bad days, and he said to me about the idea, “Well what happens if they find something?” Well, me being me, I said I'd want to know. The normal way I do things is bravado first and think later. And it dawned on me what that might mean as I was going into the scanner – well, oh, fuck, what if they do find something?

Assistant: So all pockets are empty? Okay great. So, do you want to …

Twink: The process of actually lying on a slab made me feel a bit like I was being laid out in a morgue. I found that a bit weird. What spooked me even more was how claustrophobic it was inside the scanner. The only way I could deal with it was to close my eyes and try and get through it, because I didn't know what to expect. To be honest with you, I was terrified.

David: I believe it's your first brain scan?

Twink: Yes.

David: So we scanned your brain from top to bottom, and we can just travel through it. I suppose the most remarkable thing at some level is we're not actually seeing much; we're seeing essentially what looks like a normal brain, and that is a general feature with patients with mental illness, as opposed to neurological illness, that mostly on a normal brain scan you're not seeing much or any abnormality. So one hope is, if we link this in with the genetics to have more refined measures – by sub-grouping patients, not taking everyone together who suffers from bipolar disorder but take the carriers of particular risk genes that people like Nick Craddock might identify in their research – we may be able to get more refined groups and improve our findings, and at the same time we'll help them discover what the genes they find actually do to the brain.

Twink: When I saw the scan, I was pleased that it looked the same as everybody else's scan, so I wasn't abnormal in that sense. What I found difficult to comprehend was the fact that it was like a 3D scan. You could slice it; you could take a slice of the brain and look at it very, very closely. But I was perhaps underwhelmed, in the sense that I thought we knew more about the brain.

Twink: So this is like a 3D model, is that right?

David: Yes, in a way, that's right.

Twink: So you can turn it round or take an individual slice, can you?

David: That's right.

Twink: Where's memory?

David: Ah, memory is in the hippocampus, which is here.

Twink: Where's creativity in the brain?

David: There's no answer to that …

Twink: Well, it must be somewhere.

David: It must be somewhere, but it's almost certainly not going to be in a particular area. The more complex the functions get, the more distributed they are across the brain.

Twink: What does this mean for other bipolar sufferers? What does it mean for anybody with a mental ill health? To have it done is great – but it's more the realisation that the brain is so complex …

Twink: A hundred billion neurons. It only takes a few neurons to have a problem – that has a ramification over the rest of the hundred billion neurons. I mean, where do you start? There just seems to be so, so many unanswered questions about an organ that is your primary organ in your body, and we don't know anything about it, really. We're merely scratching the surface. There's so many more questions I've got.

[Music]

Twink: I don't know what I was expecting. It's fairly mind-blowing stuff. I guess it'd be like X-raying: years ago, you couldn't see a broken bone.

David: Yes.

Twink: With photography, you're capturing an image and you're sort of encapsulating that in time. But every time I ask a question and get an answer, my brain's processing that answer, which means me experience of prior to going into the scanner is different now, because I've seen a snapshot of me brain.

Interviewer: Which one's which? Which one's the real Twink?

Twink: I don't think even I've worked out that one. I've been trying for 50 years to work out who I am.

[Music]

Twink: We’ll just repeat – if we fuck up we’ll do another one, and then we always end on the three. Okay Barry, on film. What did you think?

Interviewer: Oh, I think you're great.

Twink: So we won’t embarrass ourselves?

Interviewer: Totally not. Totally not.

[Music]

[Coming up in part 5…]

Scientist: Well there's a spectrum of illness that – a new disorder that comes on after childbirth, but we're talking about with post-partum psychosis is the very severe end of the spectrum. Women who become incredibly ill following childbirth and they get probably illnesses that are some of the most severe illnesses that we see in psychiatry.

[Music]

Woman: I had these slightly scary hallucinations where I remember my brother gave me this brown teddy bear and I just kept seeing it all over the place in strange places. Maybe that was in some way my subconscious kind of warning me, be careful, you could do something silly here.

[Music]

Twink: My imagination of the gig, the amount of emotional investment I'm putting into the 28th of March, is what you'd expect Oasis to be emotionally committing to at Knebworth. It's that huge a gig for me.

[Music to fade]

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