Into the Silent Land: travels in neuropsychology by Paul Broks

When it comes to neurological case histories, Oliver Sacks casts a long shadow. So it's no surprise that Paul Broks admits to having "studiously avoided" Sacks's works while writing this book. He recommends them to students with the proviso that their appeal has less "to do with science or philosophy" than with "the intrinsic fascination of the aberrant and the bizarre", and goes on: "Morbid fascination would not be too wide of the mark."

The same might be said of his own book. Many of the pieces collected in Into the Silent Land had their origin in columns for Prospect magazine. This makes for a certain amount of repetition, and for a tendency to "round off" an article, sometimes enigmatically.

As well as case histories, there are autobiographical fragments, literary criticism, scientific speculation and a venture into science fiction. Broks is always interesting, but the most riveting pieces are the most Sacks-like: stories of people with brain damage, which do indeed feed our morbid fascination.

Because we are so constrained by the fear of embarrassment, or by social correctness, we are intrigued by inappropriate behaviour. When Broks's assistant, Beth, politely asks a patient called Martin what he has been up to, she is not expecting him to reply, "I've been masturbating quite a lot", especially not in a booming voice in a public place.

Broks's initial response is to laugh, but he can't quite carry it off and finds himself "sitting red-faced with tears on my cheeks and everyone looking at me instead of him". For Martin, unaware of behaving inappropriately, there is no embarrassment. It's different for Broks - and presumably for Beth.

Broks was attracted to neuropsychology, "the science of brain and mind", because he hoped to reconcile the "bright, intangible qualities of subjective experience ... with the dark substance of the brain". This seems an impossible task, since there is "nothing but meat inside our heads", and while experience is "a first-person business" science "operates in the third person".

An early encounter with a boy who had fallen down a lift shaft and now "sat contorted in his wheelchair, head turned sideways and back at an uncomfortable angle, limbs buckled with spasticity, a stream of saliva dribbling from the corner of his mouth", incapable of speech except for "the vilest gobs of abuse", was hardly promising material.

But the different ways in which people are affected by damage to different parts of the brain does enable scientists to refine their understanding of how that organ functions, even if this gets us no closer to a "satisfactory account of how the brain generates conscious awareness".

A central paradox of the book is that what is professionally frustrating for Broks - the fact that there is "no ghost in the machine" - is something that he also finds personally exhilarating: "We subsist in emptiness. A beautiful, liberating thought."

Like his mentors, the great Russian neuropsychologist Alexander Luria as well as Sacks, Broks is an advocate of a "romantic science" which combines "close observation of individual patients ... with a more systematic, 'classical' understanding of the facts of neurological disorder derived through conventional scientific method".

On the evidence of Into the Silent Land, this is a most fruitful combination.