‘All of these binaries I once imagined were collapsed and eradicated with every shift I worked’

First and foremost, congratulations! It's the best book I've read for years. The Mind Electric seems such an apt title, because there's something electric about the way the energy of your writing courses along all sorts of pathways. You set up how our understanding of ourselves and our worlds can be compartmentalised, but then you blast through those barriers. I'm interested in whether that, or something else, was a conscious overarching approach to writing the book.

As I wrote the book, I found myself thinking about all of the liminal spaces and grey areas I have inhabited over the course of my medical training and continue to inhabit now as a physician, about all of these binaries I once imagined governed our bodies and medical practice that were collapsed and eradicated with every shift I worked and every patient I cared for. 

My most jarring realisation was also the earliest: I began my medical training imagining that life and death were a binary, that a person could only be either alive or dead. But as a doctor-in-training, I spent a great deal of time in intensive care units, and I began to learn that life and death really exist on a spectrum, and that many of the people I was caring for were stuck in this twilight zone somewhere along that spectrum, neither dead nor, I would argue, fully alive. It turns out that the binary view of life and death is a very old-fashioned one – at one time, we arbitrated death by holding a mirror beneath someone's nose to see whether it fogged up, or by pressing two fingers to their neck to feel whether they had a pulse, but we now exist in a world where we can outsource the work of the heart and the lungs to machines, which means that we have had to radically reimagine the categories of life and death. As with so much of medicine, those categories often collide or bleed into one another. 

It's a lesson that I've had to learn over and over again: that there is very little space in medicine for binaries, if any, and that the functions of our bodies cannot be easily or neatly categorised. Even our notions of 'illness' and 'wellness' are really not strictly a binary – the anthropologist Tanya Luhrmann and others have done fascinating work looking at voice-hearing across cultural contexts, for instance, and found that the experience of hearing voices is not always experienced as pathologic, or as an illness at all. I think leaving space for grey areas in medicine and when it comes to our bodies and minds is an exercise in humility, in acknowledging how much we do not understand and cannot easily categorise, and I tried very hard to capture my own genuine feelings of uncertainty as I was writing.

One of those dichotomies you demolish is doctor/patient, evidence/belief. Would you say that has been a growing awareness through your career – that a lot of science and medicine is actually about things taken on faith, about performance, about our own narratives and stories?

In writing this book, I spent quite a bit of time with medical texts that were decades or in some cases centuries old, and with the privilege of hindsight, I was struck by the similarities between the way that medicine might explain or understand an illness and other cosmologies of illness that we might consider to be superstitious or unscientific. For instance, in rural 19th century New England – the northeastern corner of the United States, where I live – there was a belief that tuberculosis, consumption, was caused by a dead family member reaching beyond the grave to suck the life from his or her ill relatives. There is an internal logic to that belief – it explains the features that people observed about consumption, including the way it tended to cluster in particular households and how it seemed to melt the flesh from people's bones – but doctors at the time dismissed it as the irrational lunacy of uneducated villagers. But at the same time, the medical establishment was treating tuberculosis by sending people to sanatoriums with the idea that mountain air would dry out the damp lungs of their tuberculotic patients. Again, there's an internal logic to that belief – doctors had the notion that a sort of dampness had settled into the lungs of people with tuberculosis, and they had this idea of treating something wet with something dry. But those two beliefs are really the expression of the same thing: trying to make sense of a disease that is both devastating and baffling with whatever tools you have at your disposal. 

Even now, we have seen the bacteria that cause tuberculosis under a microscope and we have an understanding of how it spreads, but in some ways, medicine is saying the same thing as those villagers all those years ago: it is a disease caused by something malicious that is invisible, that we cannot see except in the ways it ravages our bodies.

It's much easier to see the ways that medicine sometimes operates on faith looking at examples from the past, but even in the years since I've been practicing I've seen certain deeply held medical practices be overturned by new evidence. I think looking at the examples of the past is a lesson in how our medical practices might be viewed by the medical establishment of the future. As doctors, we love to imagine that we are infallible, or at least that all of our decisions are informed by the best available science, but there is so much ambiguity in medicine, and so many of the decisions we make are just as influenced by our own priors, by our own narratives, as those of our patients.

For instance, doctors are overwhelmingly, shockingly bad at prognostication – at predicting when someone is likely to die of their illness. But we often speak very authoritatively, or judge our patients for the decisions they make about how to spend their final days. In reality, our information is as good as theirs – perhaps worse, because our patients obviously have much better insights into their own priorities and desires than we do. I now serve as the director of a neurology residency training program, and in the course of their training, my residents spend several sessions at a local art museum, where we spend time looking at sculptures, or photographs, or Ancient Egyptian tomb paintings, trying to decipher the meaning or intent of each work, as an exercise in embracing ambiguity with interest and curiosity rather than frustration.

For me at least, perhaps the core of the book is to be found in this sentence: 'In every way, these concepts – reality, hallucinations, illness, divinity – are fluid, shaped by the stories we tell ourselves, and the ones our brains tell us.' And to illustrate that, you leap across cultures, through times. This might be impossible, but could you pick out one story you have told yourself around your own health? 

For me, pregnancy and then parenthood both felt like radical physical transformations. For all the ways that my residency training was difficult and at times brutal, I finished it feeling utterly at home in the hospital, as though I had been built specifically to be a neurologist. As a resident and then as a new attending, I poured my entire self into the hospital and my patients, coming home late and reluctantly, completely wrung out, with nothing left over. When I became pregnant, I had already written a story in which being a doctor in any other way, caring as deeply about anything else, would mean losing who I was. It never occurred to me that pregnancy, parenthood, these were common human experiences that I was sharing with my patients, that having children would give me new insights into the stakes of illness that I didn't previously have. 

I think what those new experiences are is different for every clinician – it certainly doesn't have to be pregnancy or parenthood, sometimes it's illness, or an aging family member, or any number of other beats of life – but I would encourage others to be open to rewriting the story of their vocation to make space for unexpected influences. 

Do you have any tips for readers suddenly required to write their own story around a diagnosis, either for themselves or a family member? 

I wish that I had universal advice on this front, but I'm learning that the assumptions I often make about what the 'right' choices are for someone grappling with a diagnosis are often wildly misguided and rooted in my own experience rather than theirs. The paths people choose to walk through illness are deeply personal, different for every person at every life stage and for every illness. But I think the most critical value here is an openness to rewriting the story, as illness can be unpredictable and it can be difficult for both clinicians and patients to let go of the one they've already written.

You write of a 'primal desire to separate myself from my patients'. Do you think that's standard for health/helping professionals? 

I do think this is a common impulse, and I think there is a logic to this desire given the stakes of our work. We want to imagine that we are somehow inoculated against the suffering that surrounds us, or that we somehow lack the human vulnerabilities that lead to mistakes.

Lines that have stayed with me include 'I thought I needed to be something other than human', and 'To become a doctor, I was becoming less of a human being'. Yet others have called the book 'humane'. Is that a compliment you can accept? 

Reflecting on the experience of medical training I sometimes think of Eric Kandel's Nobel Prize-winning experiments on Aplysia californica, a species of sea slug. Aplysia is enormous – up to a foot long and several pounds – but still vulnerable to everything from starfish to lobsters. To protect themselves, they've evolved a reflex in which they withdraw their delicate gills when they sense danger. As part of an effort to understand how memories are formed, Kandel and his colleagues would puff jets of seawater onto their test subjects to mimic an approaching predator. At first, the sea slugs would flinch, withdrawing their vital organs. But over time, they became desensitised, their protective response dulling and finally disappearing and the physical structure of their synapses altered by the repeated exposures. We have evolved to habituate to things that we experience frequently, because if we did not, the constant onslaught would destroy us. 

In some ways, residency training echoes those sea slug experiments. To witness death, or suffering, is profound and weighty. Most people witness very little of either in the course of their lives. But doctors witness a great deal of both. To some extent, doctors-in-training have to habituate to human suffering. In order to not only survive medical training but also function in a hospital and be of service to others in their moments of suffering, doctors cannot allow themselves to be destroyed by death each time they witness it. I have come to think of this evolution, this way that experience and empathy can sometimes seem like opposite sides of a coin, as a form of self-preservation, of softening towards oneself rather than hardening towards others. 

But I also think there are ways to remind ourselves of the weight of our work. I remember being a medical student on an organ transplant surgery service and scrubbing in to my first organ procurement – recovering the organs of a person who had been declared brain dead so that they could help others to live. The surgeons, and anesthesiologists, and scrub technicians, had all done this surgery countless times, and I can imagine that there's a temptation to approach it callously or as something routine, but I remember that at the beginning of the operation, everyone in the room bowed their heads and listened to a note from the donor's family about who she was, what she had loved when she was alive and why she had chosen to donate her organs. It was this moment of reverence that felt necessary to remind us of the loss that had brought us all there. Increasingly, medical training incorporates moments of pause, of reflection, particularly when something bad happens, as a way to honour both our patients' humanity and our own.

In parts of the book, you are less than complimentary about the working conditions of health professionals… yet you admit to your own narratives which perhaps stand in the way of change. 

Even after writing at length on the ways that sleep is essential for life, even after learning that medical residency training in the United States has its origins in a program designed by a surgeon who used cocaine to fuel his own grueling schedule, I still struggle to untangle my own thoughts about what medical training should look like. I still have this feeling that somehow the pressure of my own medical training forced a diagnostic instinct into me so deeply that it is now etched into my bones, and I cannot decipher whether that is because it is true or because I want the difficult experience of my medical training to have meant something. 

We also have to consider the labor calculus – hospitals rely on the labour of doctors-in-training, and for these hospitals, there is a tremendous financial upside to lionising doctors' ability to tolerate inhumane working conditions and obscenely long shifts. I think where I land is this: it's been more than a century since residency training was first designed, by the cocaine-addicted surgeon, and it's time to evolve. We need to radically reimagine our medical training programs in a way that honours the humanity of our trainees rather than asking them to make impossible sacrifices to prove that they are somehow more than human. 

In less than ideal conditions, perhaps it becomes more important to call on basic values. What basic values guide you, or should guide you? I'm thinking of where you say doctors can often be 'rushed and incurious'. 'Curiosity' seems like it could be a pretty foundational value of yours?

I love the idea of having foundational values that guide how we operate in moments of stress or trauma. Humility is perhaps the biggest for me. To butcher Hamlet, there are so many more facets of our bodies and minds than are dreamt of in our medical philosophy, so much we do not yet know and so much we often get wrong, that I think a feeling of over-confidence is a death-knell for the competent practice of medicine. And: curiosity, absolutely. Responding to the unknown with curiosity rather than fear or despair feels absolutely essential to continuing to do this work.

You point out several areas where women are disproportionately impacted, from autoimmune diseases such as multiple sclerosis (where the gap is actually growing) and neuromyelitis optica, to prion diseases such as kuru, to the particulars of sleep paralysis in Albania. How could Psychologists do more at the interface of medicine and gender?

The recurring theme throughout the fraught history of women's illnesses is one of women either sharing their symptoms with clinicians and being dismissed as hysterical, being told that their symptoms are imaginary, or internalising that message and telling themselves that the extraordinary symptoms they're experiencing are imagined. As clinicians, we are vested with the power to choose whose stories to hear and believe. We should choose to hear women's experiences, and we should believe them. 

Do you have any messages or advice for Psychologists more broadly? 

I feel as though dichotomy between 'psychological' and 'neurological' is in some ways an artificial one, rooted in academic history rather than any natural distinction between those two categories. Earlier, I mentioned Tanya Luhrmann's work on how culture shapes the experience of voice-hearing, and Devon Hinton and others have done similarly illuminating studies on sleep paralysis. Sleep paralysis is a biological phenomenon – a physical malfunction of the apparatus that separates wakefulness from the dreams and stillness of REM sleep (the breakdown of yet another binary!). But how people experience it – as a witch's spell or the ghost of a lost loved one, for instance – is very much sculpted by culture, trauma, and life history. All of which to say: I suspect the fields have a great deal to learn from one another in this shared mission of exploring the unmapped territories of the mind and brain!

What's left for you? 

In terms of writing: I'm still struggling to find a balance, since I wrote The Mind Electric entirely while on maternity leave and have not yet figured out how writing fits with a full-time clinical job. Still, finishing The Mind Electric somehow felt like more of a beginning, like it opened the doors to all of these other stories that didn't quite fit into the book but still feel essential to tell. Since finishing the book, I have been writing a bit on the cultural history of neurologic infections, which is my area of specialisation and which I think has the potential to reveal a great deal about equity, migration, climate change, and other forces shaping our world. I hope a next book is on the way, still focused on culture, illness, and story. 

In terms of medicine: I take care of patients at a safety-net hospital – in the U.S. healthcare system, this is a hospital that is explicitly intended to serve patients who cannot afford care elsewhere – and I spend much of my time working with resident physicians. Caring for patients and teaching residents is essential and high-stakes work, and I am constantly thinking about how I can do both better. This is a constant and sometimes painful work-in-progress, as I imagine it will continue to be for my entire career!

And in terms of my personal life: My children are still quite small – the big one is about to turn three, and the little one is almost one and a half. I feel like we are all just starting to emerge, blinking owlishly, into the light of the outside world after a period of hibernation. My kids are funny, joyful, curious, and endlessly energetic… I am eagerly anticipating some new adventures with them!

• The Mind Electric by Pria Anand is published by Virago on 5 June 2025.
  Photo, above: David Degner