Sir Paul McCartney and brain fade

I was struck by an earlier post by Mike about Sir Paul McCartney’s deteriorating prowess as a songwriter and performer.

>Sir Paul McCartney is still writing and performing music.

>Some of his compositions are creditable, and occasionally

>slightly interesting. But they are no longer either fresh or vital.

>This is true of almost all composing musicians and mathematicians

>who enjoy a long career. The raw processing power of youth,

>coupled with preternatural insight, is the basis for almost

>all of the blockbuster, paradigm shifting advances in physics

>and maths. Newtwon was in his early 20s when his

>fundamental insights were made.

Mike seems to say that the McCartney genius faded as he got older. The fresh exciting material of the 60s and 70s was replaced (with age) by reasonable but not stellar material, and Mike seemed to blame this on cognitive deterioration with age.  That’s an interesting concept and I see it in myself.  But I think it’s much more complex than simply isolated brain fade.

If you read Malcolm Gladwell’s “Outliers” *, his thesis is that most of the stars that made it to the top built that success on a platform not visible to the public, and a lot was not directly controlled by the individuals involved, or necessarily a direct result of their brain power. There are interesting accidents of nature that contribute to high levels of success.

For example, a disproportionate number of elite Canadian hockey players born in the first few months of the calendar year go on to hockey stardom. Since youth hockey leagues determine eligibility by calendar year, children born on January 1 play in the same league as those born on December 31 in the same year. Because children born earlier in the year are bigger and maturer than their younger competitors, they are often identified as better athletes, leading to extra coaching and a higher likelihood of being selected for elite hockey leagues.

J. Robert Oppenheimer grew up in one of the wealthiest neighborhoods in Manhattan, the son of a successful businessman, attended the best schools in the City and was afforded a childhood of unusual acculturation and cultivation. Gladwell argues that these opportunities gave Oppenheimer the chance to develop the practical intelligence necessary for success.  When Oppenheimer was a student at University of Cambridge, he made an unsuccessful attempt to poison one of his tutors. When he was about to be expelled from the school, he was able to compromise with the school’s administrators to allow him to continue his studies at the university, using skills that he gained during his cultivated upbringing.

The Beatles performed live in Hamburg, Germany over 1,200 times from 1960 to 1964, amassing more than 10,000 hours of playing time. Gladwell asserts that all of the time The Beatles spent performing shaped their talent, “so by the time they returned to England from Hamburg, Germany, ‘they sounded like no one else. It was the making of them.'”  Bill Gates gained almost unlimited access to a high school computer in 1968 at the age of 13, and spent over 10,000 hours programming on it, bringing him to the point where creating practical software was effortless. Raw talent was not a serious factor in any of these people. It was the path they trod and their ability to persevere.

So I suspect the genius of Paul McCartney was not so much his innate brain power as a youth, but rather an amalgam of his environment and those who contributed, all of which came together by chance.  Most of his greatest work was written in tandem with John Lennon and many uncredited contributions from others including George Martin, without whom the Beatles’ body of work would have been radically different. As the times changed, so did Paul’s potential to create, not necessarily because his brain power faded. Similarly, Lennon didn’t do much in succeeding years. They both inevitably evolved to different styles more mediated by their decreasing energy level and widening awareness of other life issues with age, not so much brain fade.

I think I see it in myself. In my glory days, I think I came up with some very original thought about things I was interested in. Sedation and analgesic issues in the ICU, delirium, and especially ethanol withdrawal. I wrote prolifically and instituted a lot of clinical treatment that I think still works today. Then I got old and I don’t have the same energy level and my ability to learn and retain new things diminished as well. But other facets of my brain function were enhanced with age.

My clinical Fellows are quick, they know all the latest research and medical acumen. They are spry and with boundless curiosity and energy. But there is a lot more to clinical medicine than a knowledge base.   I have spent 30 years at the bedside and there isn’t much I haven’t seen at one time or another. I walk into a patient area and I intuitively know many, many things about a patient I’ve never seen before that the Fellows have yet to learn by experience.  I sense trouble long before it starts. I sense when to hang black crepe with families regarding outcome and when to be more optimistic because I’ve been burned so many times in the past. I sense what will work and what will not, and when to act early and when to hang back.

Judgement. I think this is the value of the aging brain. The experiences of the past congeal to form teachable moments to those coming up the line who MUST achieve that seasoning to survive in clinical medicine. Trial and error doesn’t work well in clinical medicine. The only way to get it is to absorb the decision making processes of those who have been there and see the cause/effect.  Maybe that’s the way the aging brain is supposed to evolve.  The bright flame of youth cannot be sustained because the energy required to maintain it’s intensity isn’t endlessly available, so it’s prolonged at a lower temperature to  extend whatever benefit may be available.

* http://www.gladwell.com/

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