Jumping at Shadows

Introduction

Ciguatoxin

In early February 2015, two weeks after my family arrived in the atmospheric Chilean port city of Valparaíso to study Spanish for a month, I woke up in the middle of the night convinced I was about to die.

We were high up in the hills above the city center, in a compact neighborhood called Cerro Mariposa, staying in a small second-floor suite of rooms out back of our landlady Marisol's house. From our windows, the view of the Pacific in the distance, past the elegant center of the city, was similar to that which the poet Pablo Neruda, who had lived slightly farther up in the hills from our lodgings, so adored half a century earlier.

When I woke up that night, in our little bedroom opposite our even littler kitchen, I felt as if I were fading away. My blood pressure seemed to have disappeared; my heart was fluttering slowly, weakly. I stood up, and my legs took on a life of their own. They began walking frantically up and down the small apartment, back and forth, back and forth, faster and faster. They began running, as if they were seeking to help me to escape from my body. I tried to convince my legs to stop, but they wouldn't. Back and forth, back and forth. They seemed to be telling me to jump out of my skin.

I managed to wake my wife up. She started massaging my back; my heart gradually, gradually started returning to its normal pattern. After a couple hours, I fell asleep, sitting upright in an armchair—a forty-two-year-old man who suddenly felt like a nonagenarian.

Of course, had I been thinking straight, I would have woken up my landlady and her family to ask for help. For even if an ambulance couldn't have navigated the twisting, turning backstreets of our hillside cerro in the middle of the night, I'm sure they could have found a taxi or a neighbor with a car who would have gotten me down to the clinic. But I wasn't thinking straight. Six thousand miles from home, I was more scared than I had ever been, experiencing wobbles in my heart that I couldn't imagine trying to explain in a language not my own. And so I half-slept the rest of the night away and the next morning, on nervous, uncertain legs, made my way down to our language school. An hour later, Isabel, my Spanish teacher, horrified at my condition, hurried me out of the school, bundled me onto a collectivo minibus, and took me to the central clinic. There, after an uncomfortable wait of a few hours—during which time if I really had been having a heart attack I would almost certainly have died—I found myself spread-eagled on a hospital bed, shirtless, the electrodes for an EKG attached to my chest and arms and ankles, while Isabel laughingly told me that this was the strangest lesson she had ever taught.

I wasn't having—and hadn't had—a heart attack, the doctors told me. Armed with a prescription for anti-inflammatories and another for muscle relaxants, and feeling somewhat sheepish at all the bother I had caused, I headed back to the language school to resume my late-afternoon studies.

For a time, I seemed to be on the mend. True, my energy levels tanked, and there were days in the week following during which I spent twelve hours in bed; but when I wasn't resting up, there were also times I felt okay. Over the weeks that we had left in Valparaíso, our daily rituals resumed, albeit at a slower pace.

Assuming I was better, we traveled south, to the Lake District, a place of huge, shimmering blue lakes and towering volcanoes—many of them active. It was spectacular: the enormous alpine Lake Llanquihue set against the glacial peak of Osorno Volcano soaring heavenward. At lake level, it was fiercely hot. Up on the volcanoes, on the edge of the Andes, it was harsh winter. A glorious place, I hoped, to recuperate.

Two days in, however, my heart did the exact reverse of what it had done in Valparaíso. My blood pressure soared, and my heart started beating so hard and so fast I thought it was about to burst. We tried to go to a restaurant, but I had to leave immediately, feeling that I was about to pass out. Stumbling, I made it to the front desk of our hotel, told the young man on duty there that I thought I was having a heart attack, and asked him to take me to the nearest hospital. He and a colleague bundled me into a car, and we raced off.

Within an hour I was having the second EKG of my life. This time my heart had locked in at about 175 beats per minute. All I could hear was the awful beating of blood in my head. I have a vague memory of screaming at the nurses, irrationally ordering them to make my heart slow down before it exploded. I have a memory of concerned faces and another, which can't be accurate, of a small hospital room filled with the sound of my beating heart. But, again, the doctors and nurses told me I wasn't having a heart attack, and released me back out into the quiet midnight streets.

Twice in two weeks I had thought my heart was giving out—and both times the doctors had reassured me that it wasn't. My energy level was now just about nonexistent. And yet, since we were in one of the most beautiful spots on Earth, part of me was still desperate to enjoy the wonders of southern Chile.

Stubborn to a point, probably in denial as to the seriousness of my situation, we headed south again, flying over one thousand miles of ice fields to the city of Punta Arenas, on the Magellan Straits. There, in the little hostel we were staying in on the water's windswept edge, I felt my energy evaporate. For a couple days, I struggled even to get out of bed—though I also couldn't sleep properly, since it felt as if my internal clock had been turned off. I tried to nurse myself back to health, sitting in the common area of the hostel, overlooking the Magellan Straits, bundled up in my warm sweaters, drinking one herbal tea after the next and looking out for dolphins dancing in the waters just offshore; taking short walks along the windswept promenades during gaps in the rain; napping whenever I could; harvesting what little reserves I had.

To a degree, my strategy worked. After three days, I no longer felt as if I were about to die. Instead I simply felt very, very weak—an old man masquerading in a much younger man's body. And that was how it continued for the remainder of our time in Chile: okay for a few moments and then exhausted, seemingly on the mend and then floored by another bout of pain.

ONLY ONCE WE WERE ensconced in our California home again did I find out that my cousin in Los Angeles, with whom I had shared a farewell sushi meal two months previously, had, over the intervening weeks, experienced the exact same set of symptoms as I had: low blood pressure and low heartbeat, followed by high blood pressure and a heart rate high enough to ensure her a couple nights in a hospital, followed by calamitous exhaustion over a period of weeks.

Since the only point of overlap was the sushi meal, another cousin of ours, an infectious disease specialist, began reading up on fish toxins to see if we could have been poisoned. A few days later, while I was beginning a battery of medical tests at the UC Davis medical center, he phoned to tell me his conclusion. In all likelihood, we had eaten a fish tainted with something called ciguatoxin. It's a neurotoxin present mainly in tropical fish, the symptoms of which were first described by medical personnel on Captain Cook's South Pacific expedition in 1774, and it does terrible things to the body's systems controlled by electric impulses.

What makes it particularly unnerving is that there is no definitive test for the presence of ciguatoxin—a diagnosis is arrived at largely by process of elimination—and there is also no effective cure. When one has a set of symptoms that resemble ciguatoxin poisoning, all one can do is wait it out and avoid certain kinds of foods known to exacerbate its symptoms. The good news, my cousin told me, was that it usually wasn't fatal; the bad news was it could wreak havoc on one's health for more than a year.

And so began my months-long medical odyssey. I had gone from being the sort of customer health insurance companies love—someone who saw the doctor two or three times a year and took no medicines more serious than anti–hay fever pills—to being a money pit.

I DON'T KNOW FOR sure if I had ciguatoxin or some other, unknown ailment or food-borne poison. I'll likely never know, since there is no way to generate a foolproof diagnosis in situations like this. I don't know whether whatever made me so ill is still in my system or whether my body is gradually managing to eliminate it. I don't know for sure how much of what I experienced was purely physical and how much was a mental reaction to a feeling of physical decline, of losing control over my own destiny. And, above all, even though as I write this I sense that I am finally on the mend, and I feel healthy and well again, that well-being also seems appallingly fragile: I don't know if tomorrow will bring another round of sickness and pain, another crisis in yet another part of my battered body.

What I do know is that something as amorphous as a possible ciguatoxin diagnosis saps one of self-confidence. I know, in a way I never could before I became a medical mystery, that a chronic condition that every so often flares up into an acute episode affects one's psyche in unpredictable ways. It can make a person take unreasonable risks one day (like not flying back to California after the heart episodes) while leaving him or her awfully risk averse another day. It can make one live for the moment, and it can also make one irritable and unreasonable, apt to snap at the smallest provocation and desperate for sympathy and understanding.

I know in a way I never did before—at the most personal level—what fear of particular horrors and anxiety about unknown horrors lurking just out of sight feel like.

When you're battling an invisible, formless foe—a hard-to-define enemy against which there is no easy fix, an enemy with the power to upend daily certainties and to inflict chaos out of the blue—it changes how you live. It changes how you make choices, how you interact with the world. It alters your emotional state, making moroseness something of a default state and optimism appear more akin to naiveté. It is hard to stay upbeat if you always fear the worst.

SIX MONTHS BEFORE THE possible-ciguatoxin struck, I had been commissioned to write a book on the culture of fear. It was to be a book about fears of unknown assailants, overseas terrorists, hidden germs, pedophiles, violent kids, negligent parents, immigrants, inner cities, and a raft of other bugaboos. And it was to explore the political implications of this epidemic of fear.

I had been exploring these ideas in my reporting for decades, looking to understand what things and which people frighten us, and why, and exploring how we fathom risk: how our brains interpret risk and identify, rightly or wrongly, perceived threats, both at a neurological level and at a conscious one. Some of what we fear is innate. But much of it is the result of social conditions—in the economy, in how community is structured, and so on. Poverty and inequality are two themes that have continually drawn me in as a journalist. What happens when a wealthy country, such as the United States, makes political choices that result in tens of millions of people living deeply economically insecure lives? What happens to the democratic processes when a tiny group of people at the top of the economic pyramid exercise extraordinary economic, and by extension, political power? How do our stories, as individuals and as larger communities, our dreams and our fears, change in the face of this growing inequality?

While my reporting focus had long been on the United States, the story was, and is, in many ways, one playing out across the globe, affecting a growing number of countries, cultures, and legal systems in recent years. Indeed, as I write this introduction, more than two years after first starting work on this project, I am sitting in my parents' house in London shortly after voters in the United Kingdom chose "Brexit," an exit from the European Union largely driven by fear of immigrants—of the languages and cultural values and competition for jobs and social benefits that they bring with them. Meanwhile, on the European mainland, one polity after another has struggled to deal with the fears, resentments, and hostilities unleashed by the huge numbers of refugees fleeing wars and poverty in the Middle East and Africa, and seeking sanctuary in Europe. Over the past decade, in some African and Asian countries, vaccination workers have been attacked, and, as a result, attempts to eradicate diseases such as polio have been compromised.

Deeply authoritarian regimes, playing on the anxieties and insecurities of large numbers of voters, have, in recent years, been elected in Turkey, Russia, India, and many other countries. No one people or place has a monopoly on this fear-driven political rhetoric, or on its legal, educational, cultural, and even medical consequences. For whenever and wherever we divide people into "us" and "them," powerful political and psychological forces are unleashed.

What we fear and how we gauge risk is, all too often, a product of these other narratives: in America, for example, a poor person, or a black or brown person, is far more likely than a well-to-do white person to be viewed as inherently dangerous, as representing a fundamental threat to our well-being. Sometimes these views are conscious, but oftentimes, as shown in the groundbreaking research of psychologists Mahzarin Banaji, Anthony Greenwald, and their Project Implicit team, the biases exist deep below our conscious surface, influencing our behavior without the conscious "us" even being aware of their existence.

Of course, we also routinely miscalculate risks surrounding events that have nothing to do with the schisms of race and class in America. We overestimate, for example, the likelihood of being attacked by a shark while swimming in the ocean, and we underestimate the risk of dying of mosquito-borne diseases. We are more terrified of ick-factor diseases like ebola than of more mundane but infinitely greater killing machines like the flu or asthma. We fear flying more than driving, despite the latter being a massively more dangerous pastime.

What is the common thread? It is, I believe, that too often we calculate risk not by the probability of an event occurring but by the number of news items or talk radio minutes or Facebook postings or movie scenes devoted to a topic. As a result, we fear terrorism far more than run-of-the-mill, nonpolitical gunmen, despite the fact that by orders of magnitude it is the latter who, year in and year out, kill the most Americans. After all, a single large-scale terrorist attack is guaranteed to generate vastly more headlines, news stories, and follow-up feature articles on the victims than are the everyday murders-by-gun-violence or suicides-by-gun-violence that, over time, add up to tens of thousands of fatalities each year. An outbreak of ebola, similarly, is a gimme for the front pages, simply because it is such a nasty, ugly, stuff-of-nightmares way to die. But the flu, tuberculosis, and malaria, despite these three diseases having killed millions upon millions of people over the course of recent human history, are seen as yawns, unlikely to generate the sort of sensational coverage that the ebola outbreak produced in 2014.

Miscalculating risk comes with consequences. It influences the places we go and the medicines we take. It alters the way we parent our children and the interactions we have with our neighbors. It affects how we police our cities and how we think about our borders. And, of course, it skews our political preferences.

AS I BATTLED MY own medical demons, and struggled to retain a sense of normalcy amid the chaos engulfing me, it struck me that in the book I was writing, I was exploring how, increasingly, large parts of our society behave as if under continual neurotoxin attack. I remembered those terrifying days after the 9/11 attacks, when it felt as if the pillars that hold our world in place were buckling. I remembered that feeling of nauseating horror when, weeks afterwards, envelopes filled with anthrax powder started turning up at random locations around the country—the sense that invisible forces, against which we, as individuals, had no real defense, were conspiring to destroy us. In the wake of the anthrax scare, one in twenty Americans—roughly fifteen million people—stocked up on powerful antibiotics, and about three million of them actually began taking the antibiotics as prophylactics, thus, paradoxically, massively increasing the likelihood of antibiotic-resistant strains of bacteria emerging.¹ I remember, too, the sense of disorientation when a few weeks later a sniper team began terrorizing residents of Washington, DC, shooting drivers and pedestrians seemingly at random. Nothing and nowhere appeared safe anymore. The DC police responded by urging pedestrians to walk in "rapid zigzag patterns," and to avoid open spaces. Reports soon emerged of drivers crouching down behind their cars while at gas stations filling up their tanks, and nearly half of locals polled said they were now avoiding outdoor activities.²

In a training manual produced in the wake of the September 11, 2001, attacks, the Federal Emergency Management Agency (FEMA) noted that in cities such as Washington, DC, "ever increasing security became the norm, including disruptive street closures and military vehicles with mounted machine guns.… By the time the Snipers announced their presence on the morning of October 3 by killing four people, Washingtonians had already been pushed to the limits of their psychological stress tolerance."³

Less than one month after the 9/11 attacks, the Pew Research Center for the People and the Press polled Americans on their mental state. As subsequently reported by George Gray and David Ropeik of the Harvard Center for Risk Analysis, at the Harvard School of Public Health, the findings were bleak: "59 percent said they had experienced depression, 31 percent had difficulty concentrating, 23 percent suffered insomnia, and 87 percent felt angry."⁴

Perhaps those feelings wormed their way so deeply into the popular consciousness that they never truly left. In our post–9/11 collective imagination our community, our country, our culture, our civilization is always a toxic envelope or a hijacked plane away from unfathomable calamity.

In the wake of the 9/11 attacks, the Bush administration implemented a series of color-coded alerts. In the following years—often at politically expedient moments, when the government needed a jolt of popular support for, say, the invasion of Iraq—the color-coded alert system would be raised, always for nonspecific and thus all-encompassing threats. Because the actual nature and locale of the threat wasn't revealed—mostly, the government would issue an addendum to the warning saying something to the effect of "we have no specific information that a particular attack is imminent"—the impact was simply to sow anxiety. When, in February 2004, the House Select Committee on Homeland Security held hearings on the Homeland Security Advisory System, committee chair Christopher Cox warned of the dangers inherent in this. "We must," he told his colleagues, "strike an appropriate balance between providing meaningful warning where hard intelligence warrants it and causing a senseless, unfocused nationwide response to unspecified threat alerts."⁵

Cox's warnings weren't heeded. The color-coded alert system would remain in place for another seven years.

As the dial moved from yellow up to orange, and then hovered ominously close to red, so public angst would, on cue, increase. Hardware stores saw rushes on duct tape, bought by people terrified of chemical or biological attacks and wanting to seal their windows. In February 2003, as warnings of just such a biological or chemical attack were ramped up, one man in Connecticut reportedly wrapped his entire house in plastic.⁶

The media loved it. If, in the 1990s, the mantra was "If it bleeds, it leads," in the 2000s the equivalent might have been "If it scares, it blares." One network after another blared out the news: Be afraid. Be very afraid. On the cable news channels ticker tapes ran, nonstop, detailing the color of the latest alert.

Daniela Schiller, a neuroscientist who runs a brain imaging lab studying human emotions at the Icahn School of Medicine, at Mount Sinai in Manhattan, explains that our brains learn fear in three ways: through direct experience—we are personally exposed to something that makes us afraid; through observation—we see others exposed to scary events and people; and through instructed learning—we are told to be afraid of certain people or things or scenarios. And, Schiller says, the fear generated by each of these is etched into the brain in similar ways: "They capture the same basic process of rapid association, and then they are in the long-term memory."⁷

If television tells you, over and over again, to fear imminent terror attacks or rampaging criminal gangs, or people of a certain color or religion—people different from you, who can be considered members of an "out-group"—you will, in all likelihood, develop a deep and abiding set of fears, referred to by experts as "implicit biases" against particular groups or individuals. These fears are easily retriggered in the future and thus make you peculiarly vulnerable to the politics of demagoguery. "Under some circumstances, it's pretty easy for them [fears] to come back; for example, if you are stressed. It will bring fear memories back even if you thought they were extinguished," Schiller explains.

We are conditioned—by the way stridently ideological television and radio personalities cover events, by the manner in which ratings-conscious news executives prioritize stories, by the echo-chamber effects of social media, maybe even by an intuitive sense that the broad prosperity in which so many of us live our lives is deeply precarious—to fear unknown enemies. And, with this conditioning, our brains come to be flooded with an array of stress hormones that physically alter the neural networks in key parts of our brains, reshape how we act and how we think, make us more likely to inflate our sense of risk and less likely to respond rationally and in a proportionate measure to events and people we confront on a daily basis as we go about our lives.⁸

When the peanut-sized part of the brain called the amygdala is aroused, Schiller argues, it modulates "an array of responses in the brain, including perception, attention, and memory—influencing how you encode and what you retrieve; and decision making, making you more sensitive to risk and to ambiguity."

Our fears and anxieties, bubbling up in response to this increasingly toxic communications environment, are then treated as individual ailments by a medical system quick to diagnose anxiety disorders and phobias, and prone to hand out a growing array of pills to chemically tamp down our sentiments of woe. And to make matters worse, our political discourse is increasingly fueled by fear and defined by candidates playing to evermore fearful political constituencies.

In stressful times, Schiller concludes, "our cognitive abilities narrow, and turning to someone charismatic might relate to that; because that person offers solutions. In a way, putting your trust in someone charismatic might reduce the stress and ambiguity associated with the situation. It's the nature of demagogy: it's easier to grasp; it's simple."⁹ Voting for the demagogue during times of high anxiety might, in short, be the equivalent of binge drinking and drugging to avoid depression: it's the ultimate form of self-medicating.

Studies carried out by Yair Berson, a psychologist at Tel Aviv's Bar-Ilan University, suggest that in the presence of charismatic orators, be they self-help gurus in a business setting or politicians on the electoral stage, audience members' brains actually start synching; their reactions get more and more similar. MEG scans show, he reported that "across all bands of electric activity of the brain there is much more similarity across [test] subjects exposed to charismatic rather than non-charismatic messages. Charisma generates neuro-synchronicity."¹⁰ It is, he believed, how group-think emerges. "When people are exposed to a very strong stimulant—like charisma or a really good movie—people are so focused that individual differences between people are erased. The masses start to behave like one. It leads to collective identity."

Some of Berson's other research, involving subjects who have been given additional oxytocin—a vital chemical the brain releases to establish bonds of trust, in particular between parents and infants—shows that they start imitating the behavior of putative "charismatic leaders" they are exposed to in lab settings far more than do those not given additional oxytocin. Berson hypothesized that, in real life, charismatic personalities might actually relate to audiences in a way that triggers a flood of oxytocin in their brains, resulting in what he calls a "charisma bond." As a result, audiences become more ready to trust these leaders, to follow them down any and all pathways, and, by extension, to bond with other enthused audience members.

A charismatic leader playing on widespread public fears thus has an extraordinary opportunity to build a movement based around their promise, however illusory, to make things better for their rattled followers. Primed to fear a long list of despised "others" by endless exposure to sensational cable television news reports, to social media, and to talk radio, a critical mass of voters in such an anxious age will throw their lot in with demagogic figures who pander to their anxieties.

"We call it 'neurocoupling,'" Princeton University psychologist and neuroscientist Uri Hasson explained. "Brain-to-brain coupling. The more you understand me, the more similar your brain becomes to mine." It is, Hasson believed, similar to the old adage that it takes two to tango. "It's like dancing." A charismatic speaker, standing on a podium in front of an angry or fearful audience primed to want to hear certain things, can connect extraordinarily well with that audience through successfully articulating their fears. "Sometimes," Hasson said, "the partners can really be coupled and dance together, and that's when it's an amazing thing."¹¹

Hasson recalled an experiment that his team had conducted in which they recruited volunteers for a brain-imaging study, put the individuals into an fMRI scanner, and then read them a J. D. Salinger story. The narrative was about a husband who had lost track of his wife at a party, had returned home alone, and, anxious about her whereabouts, had phoned his best friend in the middle of the night. The best friend had listened to him but then, after a while, had told him that he was tired and needed to go to back to sleep. Half of the test participants were then told that the reason the best friend wanted to end the conversation was that the missing wife was having an affair with him, and, in fact, was with him in bed at that very moment. The other half was told that the best friend simply was exhausted and wanted to go to sleep.

In analyzing the data, Hasson's team found something remarkable. That simple one-sentence change created such distinct brain pattern responses among the test subjects that the psychologists studying the data could tell with 80 to 90 percent accuracy which story ending the participant had been told simply by looking at their brain's responses. Hasson's team had created two distinct brain-response communities through the manipulation and sharing of basic information.