And so, as my confusion grows, my brain fills in the gaps between what’s in my head and what’s happening around me with conspiracy theories. I become increasingly suspicious of my family and my colleagues at work and increasingly dissatisfied by everyone’s performance of even simple tasks. I’m certain that people, especially the members of my family, are plotting against me.
Kasia doesn’t really like me anymore. I don’t think Mirek does either. Why are they talking about me? I can tell they’re hiding things from me. But what? What are they hiding?
Feelings of suspicion—sometimes rising to the level of paranoia—can be a symptom of many types of mental illness, including Alzheimer’s disease. Alzheimer’s patients may accuse their romantic partners of cheating on them or their caretakers of stealing property or trying to harm or even kill them. While neuroscientists don’t really understand the networks or parts of the brain related to paranoia, in some cases this condition is attributed to temporal lobe damage.
And while the turmoil in my brain may be responsible for my behavioral overreactions, it’s true that my feelings are not completely irrational. I have good reason to be suspicious; after all, my worried family is talking about the way I’m acting. To their dismay, all of my least likable characteristics—my need for organization, my insistence on doing things my way—are growing more exaggerated as the days go by. I’m becoming the worst version of myself: selfish and unconcerned about other people’s feelings. I’ve lost empathy, the trait that was always so strong in me. Whereas once I listened patiently to Kasia on the phone as she described her workday or challenges with the kids, I now cut her off. I am losing my emotional connection to the people closest to me, especially my caring husband.
Why are some people highly empathic while others are profoundly selfish? Like so much about human behavior, we don’t know for sure. Empathy, like other complex behaviors, is not situated in one isolated part of the brain but regulated by a wide network of connections among many brain regions. An intricate mix of genetic and environmental factors are probably at work: how each brain is structured and internally connected, how a person is brought up, and where and in what culture he or she is raised. Each individual’s personality is a result of complex interactions among countless factors that influence the brain’s function.
However, some scientists think that some brain regions may be more involved in empathy than others, and these include the frontal cortex, the temporal lobe, and the insula, a cortical region located deep inside the brain between the frontal and temporal lobes. If that’s true, it may explain why loss of empathy is often a core symptom of a kind of dementia called frontotemporal dementia (FTD), which is caused by a progressive and ultimately fatal neurodegenerative disease.
Dementia is a broad term that refers to certain mental declines, such as loss of memory and social and cognitive abilities, that are serious enough to interfere with daily life and that have lasted at least twelve months. The most common cause of dementia is Alzheimer’s disease, which accounts for 60 to 80 percent of all dementia cases and is characterized by lapses in memory, language, or executive functioning. Certain other neurodegenerative diseases also cause dementia, and so can stroke, traumatic brain injury, and infections such as syphilis and HIV. The World Health Organization estimates that roughly forty-seven million people worldwide suffer from dementia of some kind, with nearly ten million new cases diagnosed each year.
Since my symptoms are so new and transient, I don’t come close to meeting the criteria for dementia. But some of the personality changes I’ve begun to experience during the trip to New Haven are similar to those seen in cases of frontotemporal dementia, which, as its name suggests, affects the frontal and temporal lobes. FTD typically strikes people at a younger age than Alzheimer’s, with 60 percent of cases occurring in people forty-five to sixty-four years old; that is, in middle age. Because the frontal lobe is involved, patients often become disinhibited and lose their judgment, and it is sadly apt that FTD is sometimes called the midlife-crisis disease. Some people become sexually inappropriate; some go on wild shopping sprees, become financially irresponsible, or eat junk food with abandon. They may behave as if their ids are running amok with no superegos to override their impulses and desires. People with FTD typically lack empathy, and also are convinced that they’re doing nothing wrong. This lack of insight is a core criterion for FTD and for many other mental disorders, including schizophrenia—the disease I have spent so much of my life studying.
While I don’t have frontotemporal dementia or schizophrenia, the swelling in my brain is causing me to act like someone with mental illness: I am here in body but not always in mind. The people around me recognize me yet don’t. They are struggling to understand why I could possibly be behaving so strangely. And I am oblivious to their concerns.
The world around me seems more and more peculiar, and my confusion often morphs into anger.
Everything that everyone does is so irritating. More than irritating—infuriating!
What’s the matter with everyone at work? Why can’t they do things the right way? Why is it always up to me to correct their mistakes? Mirek isn’t any better. Everything he does is wrong. And no matter how much I point it out, he keeps screwing things up. It’s unbelievable.
My complaints are relentless. “Why did you put a napkin
