A pioneer in neurosurgery, Dr A Marthanda Pillai is a Padma Shri awardee and former president of the Indian Medical Association. In a chat with TNIE, Dr Pillai sheds light on the unknown facts about the human brain, how lifestyle affects brain health, brain death and the related controversies, and his close friendship with spiritual leader Sri M. Excerpts
You are a pioneer in neurosurgery in Kerala. How has this sector evolved over the years?
Neurosurgery started in the 1950-60s when technological advancements were limited. There were only X-rays and equipment to study. Doctors relied on physical examination and communication with patients about their ailments. Now diagnosis is very easy with the arrival of MRI, EEG, and PET scans, offering up to 99% accuracy. Earlier, for a patient’s head injury, we used to put six holes (burr holes) in the skull to identify clot. The procedure itself increased the morbidity of a patient in critical condition. Now, we identify it through a scan and remove the clot through a single burr hole. While in the past we came to know if any vital part was damaged only after the patient woke up, now we have monitors to observe brain function during the operation.
It’s said we know little about our brain despite all scientific advancements…
That’s correct. As science advances, our understanding of the body too is improving. Earlier, the brain was considered ‘dough-like’. After the advent of the electron microscope, we started seeing neurons, their dendrites, and their interconnections. We are yet to build a computer that can match the scale of the brain. The portion of the brain we use is better developed than the rest.
How much of the brain does an average person use?
We don’t use more than 20% at a given time. Some functions are autonomous, like respiration and heart function, over which we don’t have control. Some yogis claim they can control breathing, heart rate, etc. Scientifically, this is true to some extent. For that, we need to work on it and try to control the central nervous system.
Can we increase the power of the brain?
If you think of the brain as a computer, a computer can be used for data entry or for complex calculations. Brain development depends on how a person utilises his or her brain. The brain controls every function of our body. If we compare the brains of Albert Einstein and an ordinary person, the volume, shape, and weight are the same. We can bring some control over functions that are normally autonomous. Heart rate, which is not normally within our control, can be increased or decreased with some training.
Neuroplasticity is a concept that has been widely discussed nowadays. Could you explain the same?
The basic tenet of neuroplasticity is regeneration. All organs in the body have a regenerative capacity. The brain also recovers, but not in the same way as other organs. This is because of the complexity of reconnecting the interconnections of faulty neurons. We don’t fully utilise all the circuits in the brain. So, if something goes wrong in a circuit that’s in use, we can activate dormant circuits. That’s plasticity—how much you can compensate for a functional loss. Earlier, we thought neurons would be lost after a certain age. The latest findings say that they only become inactive due to lack of use. When we reduce brain activity, chances of dementia increase. Intellectual functions and memory can be kept intact by keeping the brain active.
More dementia cases are being reported now. Is it because of better detection?
Yes. Awareness and technology have helped in early detection. Besides, our longevity has increased. The average lifespan of humans is around 95 years, and we may reach that with the advancement of science. Lifestyle factors such as food habits, alcohol, and drug use impact brain function, resulting in memory loss and Alzheimer’s disease.
How do food habits affect brain function?
The brain needs nutritious food. What we eat is mostly junk food – noodles, porotta, bread, biscuits – all made of maida. It contains no nutrition. We used to have a more nutritious, balanced diet. We reheat food, especially oil, which results in an increase in unsaturated fatty acids.
Does the brain get more active with age?
Yes. The most productive age of human beings is between 60 and 70. As age advances, right and left brain coordination becomes better. The life experiences stored in the brain guides an older person to make decisions better, less faulty and faster. Acceptability gets better and so also learning new skills, like playing the piano and painting. If we sit thinking we are old, the brain loses its functional edge. So, as we get older, we should try and learn newer things. If you do so, your memory and physical activity can be better. There are certain activities which, if you learn, can keep your brain young. There’s a general understanding that once you suffer a stroke, you should rest more. In fact, it’s the other way around. If you are physically and mentally active, your recovery will be faster.
Does the body give you hints before a stroke?
In a majority of the cases, yes; but we ignore them. Dizziness, stiffness in the body, slurring of speech, loss of balance while walking, and temporary loss of eyesight are some indications. It would mostly be momentary, so we ignore it. We always feel such conditions won’t affect us. Optimism is good but over-optimism isn’t. People take small fevers seriously but not major signs. Nowadays, there’s a trend of conducting executive health check-ups, which are being exploited as well. Once that comes out good, people get overconfident and indulge again in intoxicants. This leads to under diagnosis of future events.
In close to five decades of performing brain surgeries, what has surprised you about the brain?
There is more unpredictability in this than in other surgeries. Immediate recovery in some cases that I thought would take a long time to heal has surprised me. The second category is slow recovery. We send them home with food pipes and all, and every month, we see slow and steady recovery. That’s where neuroplasticity comes into play. If we can take precautions to keep patients away from infections, we see them recovering well. Plasticity has a huge role to play in those areas. I have seen patients recovering after six months, and one person has even written a book, calling his experience punarjanmam (rebirth). He was totally paralysed and bedridden for months. After recovery, he became socially active.
Some people speak of near-death experiences. What’s your take?
In near-death, the patient’s brain will be functioning, though the person is unconscious. Such people can come back to consciousness and life. But they won’t remember what happened to them in most cases. During the phase they were unconscious, it was as good as death. However after brain-death, there will be no recovery.
In the case of patients in a comatose stage, do they know what’s happening around them?
Patients in a fully comatose state won’t know. Otherwise, they might be able to realise what’s happening around them. Hence, we need to be careful about talks on prognosis, next to the patient. Negative talk can create psychological issues. They needn’t be totally unconscious; there will be different stages of consciousness.
It’s said foetus can sense inputs given to it while in the womb. How true is that from the viewpoint of brain functioning?
To some extent, it may be true. Foetal brain can respond to external stimuli. Mother’s vitals and variation in them can affect the child. So, mothers have to be careful about their emotional and physical well-being during pregnancy.
You mentioned brain death. There has been a lot of controversies around brain death certification for organ donation...
More than controversy, it is a misunderstanding. When a patient is on a ventilator, the relatives feel the person may be dead but is still kept on the ventilator. That can never happen. Once the heart stops, the body begins to decompose. Then there are certain norms for brain death. No sedatives should be given, BP and temperature should be normal, etc. There are protocols involving physical and other parameters and the EEG test. Only after such steps is brain death certified.
What exactly is brain death?
Heart is the last organ to stop when the body shuts down. Although it is weight-wise a small organ, 20% of blood goes into the brain and is the most active organ, and hence, the most sensitive too. It can be damaged irrevocably by variations in vitals like BP and sugar. Brain itself has many areas. Its most vital part -- brainstem -- is the last portion to stop. If that stops, the heart too will. So, even when other areas of the brain stop, if the brain stem works even optimally, the heart too will work.
So, the brain is the first to shut down?
Yes, some parts of it. As I said, the brainstem is the last to stop functioning in the brain.
Though we can’t compare the two, which is the most important organ in our body – brain or heart?
To sustain a life, it is the brain. We can transplant a heart but brain transplant has not yet happened. People can live after heart transplant, but when the brain stops, there seems to be no replacement. And transplanting a brain seems hard because of its millions of networks, even more intense than a computer. Even technology advancement so far hasn’t been able to transplant or replicate that. We can never do that either.
What determines a person, his brain or his genes?
Genetics does have a huge role to play, but the brain has the biggest role. Early life experiences and our situations govern our brain inputs and decide our responses. But mostly it’s a mix of both. Chromosomal data can say a lot about a person’s character and disease tendencies, but such tests are not done because they are unethical.
Which part of the brain houses the mind? Or more pointedly, is there a mind?
Mind is a memory stored area. The limbic system in the brain can be called the mind because it decides behavioural patterns and emotional content and functions as a memory storehouse. However, the mind cannot be pinpointed. The limbic system is an electrically active one where memory functions are most active. Structural variations are there in each part of the brain. Here too, the size of neurons, inter-connectivity, etc are different.
What is intelligence and how is it connected to the constitution of the brain? It’s said Einstein’s brain is still being preserved for its high IQ...
Structurally, there is no difference between Einstein’s brain and a common man’s. The difference is in the way he used it. While we use it as a typewriter, he used it as a sophisticated computer. He didn’t do it consciously; there’s a genetic component to it. Some parts of Einstein’s brain are smaller than usual, they say; whereas for a painter or artist, those areas are more developed. This means that what we don’t use shrinks over a period of time. We can find examples of this even in human evolution. Ninety per cent of this is your training and your initiative to do certain things. Brain develops based on the way it is used.
Do you mean to say that a child, if trained in a particular stream, can develop into a human as close to what Einstein was in his field?
Definitely, but the child’s surroundings and the upbringing and encouragement given should also be supportive of the child. But the genetic component also plays a part to a small extent. Environment and social situation play the most crucial part.
Could you shed some light into the concept of right-brained and left-brained people?
Generally, human beings are right-handed; their activities are controlled by the left part of the brain. On the other hand, people with right brain dominance will be more into artistic activities. Some people are ambidextrous. Many outstanding sports persons are left-handed.
Does the brain have gender?
Gender is decided by the chromosome. Brain has nothing to do with it. Structurally, the brain will be the same for boys and girls.
Cases of autism have been increasing in the state. What could be the reason?
Since we are a health-conscious state, these are being detected early. Compared to the past, the number of anomalies related to brain is relatively low now. Now, with improved antenatal care, congenital anomalies have come down.
Some say there’s a connection between autism in children and mother’s lifestyle…
Substance abuse during pregnancy could have an impact on the infant. Now we can detect it early and take follow-up action. However, detection of cases has increased.
EQ is a concept widely discussed nowadays…
Emotions are controlled by our limbic system. To a large extent, the expression of emotions is part of basic functions. Some of these can be modified as per our behaviour.
Is there any structural difference for people with criminal mentality?
Structurally or in terms of number of neurons or inter-connections, there’s no difference. It all depends on which part of the brain we use.
Brain-related autoimmune cases are increasing. Is there any specific reason?
A major portion of autoimmune diseases are viral-induced. When there’s a viral infection, the autoimmune mechanism gets activated. Unlike in the past, connectivity among people has increased and hence viral infections spread fast.
Can any activity stimulate or weaken brain functioning?
Alcohol and drugs can weaken brain activity, and can even cause irreversible damage. Increasing physical and mental activity will bring in a qualitative improvement in brain functioning.
Does the brain sleep? Or does it remain awake even when we sleep?
Some parts of the brain remain active even during sleep. At the same time, energy production, repair and replenishing activities of the brain become more active. Sleep is not a passive function... it’s a very active phenomenon.
What’s the ideal sleep cycle?
We need at least 7-8 hours’ sleep. It need not be at a continuous stretch. Even an afternoon nap will help. Children need more sleep as their body needs more rest for metabolic activity.
There’s a theory that creative people are more depression-prone. Is it true?
Depression is linked with our living conditions and social and family interactions. If an individual is socially, emotionally well-connected, chances are less for him to fall into depression. There’s no direct link between creativity and depression. Certain creative activities can reduce depression.
Spiritual leader Sri M has mentioned you in his autobiography…
We are childhood friends, neighbours and schoolmates. We share a very positive relationship.
He has detailed his past lives in his book. As a neurologist, how do you view this?
We cannot measure certain things with a scientific yardstick. It’s an entirely different area. We should not question such things. Science is not the ultimate. There are many things yet to be unravelled. Science is an endless process which proves many of the old theories wrong; many new theories come into existence, and even those will be proven wrong after some time.
There are mentions of shad chakras in this book...
Our autonomic nervous system functions without our direct control. To some extent, we can control this system through yoga and similar activities. How best you do it or how effectively you do it is an entirely different matter.
You had performed a surgery on violinist Balabhaskar after his accident...
His spinal cord was badly injured. He had swelling near the medulla. Respiration was through ventilator support. He had suffered a fatal injury. There was nothing much to be done.
A new government is about to take over. As a veteran medical professional, what are the challenges in the healthcare sector?
There is a need to promote general practitioners in the private sector. We can achieve up to 60% of our healthcare needs by strengthening the primary health sector. The private sector too should have a three-tier system consisting of primary, secondary and tertiary healthcare. Otherwise, people continue to see a neurologist for a headache and a gastroenterologist for a stomach ache, thereby wasting money and the time of super specialists.
Already, all major hospitals are under the international private sector. That is not a good trend. Our health investment remains low. The insurance-driven health delivery model, similar to that of the US, is not sustainable or ideal. It leads to delayed treatment or denied treatment. The corporatisation and insurance-driven model could push us to a scenario where our achievements in the social determinants of health get challenged.
What do you suggest the government should do?
The private sector, which caters to 60% of healthcare, operates parallelly. There is no meeting point. The government can be a facilitator, and to some extent, a provider. The government should take the private sector into confidence and consider it as a partner in healthcare delivery. That hasn’t happened yet.
Do you suggest there should be a convergence of public and private sectors?
Yes. Private sector facilities are underutilised. The government can outsource treatment to the private sector, be it a stent procedure or an organ transplant. For that, they need to fix the cost. Private hospitals will be willing to do it as their facilities are underutilised, provided the number of cases increases.
As a neurosurgeon, what do you do for your brain health?
I keep myself active – physically and mentally. Moderate exercise like walking or cycling is always needed. Also, healthy dietary habits should be followed. We need to be mentally active too. I don’t sit idle!
TNIE team: Cithara Paul, Anil S, Aparna Nair, Unnikrishnan S Albin Mathew (photos) Pranav V P (video)