The Island of the Colorblind

‘But you know,’ said John, gesturing violently, and causing the car to lurch to one side, ‘there was something else very interesting which Len described then, but which he first regarded as unconnected. He found not only forty-odd people with lytico, but no less than twenty-two with parkinsonism – far more than one would expect to see in a community of this size. And it was parkinsonism of an unusual sort: it would often begin with a change in sleeping habits, with somnolence, and go on to profound mental and physical slowing, profound immobility. Some had tremor and rigidity, many had excessive sweating and salivation. He thought at first that it might be a form of postencephalitic parkinsonism – there had been an outbreak of Japanese B encephalitis a few years earlier – but he could find no direct evidence for this.’

Kurland started to wonder about these patients, the more so as he found another twenty-one cases of parkinsonism (some with dementia as well) in the following three years. By 1960 it seemed clear that these could not be post-encephalitic in origin, but were cases of what the Chamorros called bodig, a disease, like lytico, endemic for at least a century in Guam. Now, when the patients were examined more closely, many of them seemed to have signs of both bodig and lytico; and Kurland wondered if the two might in some way be allied.

Finally, when Asao Hirano, a young neuropathologist (and student of Zimmerman’s), came to Guam in 1960 to do a postmortem study of the brains of those who had died from lytico and from bodig, he was able to show that both diseases involved essentially the same changes in the nervous system, though with varying distributions and severity. So pathologically it seemed that lytico and bodig might not be separate diseases, but a single disease which could present in very different ways.[47]

This again was reminiscent of the encephalitis lethargica: when this first broke out in Europe, there seemed to be half a dozen separate diseases rampaging – so-called epidemic polio, epidemic parkinsonism, epidemic schizophrenia, etc. – and it was not realized until pathological studies were done that all of these were in fact manifestations of the same disease.

‘There is no standard form of lytico-bodig,’ John said, as we pulled up in front of a house in the little village of Agat. ‘I could show you a dozen, two dozen patients, and no two would be the same. It is a disease which is polymorphous in the extreme, which can take three, or six, or twenty different forms – you’ll see with Estella and her family.’

We were welcomed by a young woman, who shyly motioned us to come in. ‘Hello, Claudia,’ said John. ‘It’s nice to see you. How is your mother today?’ He introduced me to the family: Jose and Estella, Claudia and her two brothers, in their twenties, and Jose’s sister, Antonia. I was struck by Estella as soon as we entered the house, because she looked so much like one of my post-encephalitic patients as she stood, statuelike, with one arm outstretched, her head tilted back, and an entranced look on her face. One could put her arms in any position, and they would be maintained like this, apparently effortlessly, for hours. Left alone, she would stand motionless, as if spellbound, staring blankly into space, drooling. But the moment I spoke to her, she answered – appropriately, with wit; she was perfectly capable of lucid thought and speech, provided somebody started her going. Similarly, she could, if she was with someone, go shopping, or to church, always pleasant and alert, but with a sort of detached, preoccupied, sleepwalking air, a strange immurement in herself. I wondered how she might react to L-DOPA – it had not yet been tried with her – for such catatonic patients, in my experience, could show the most dramatic reactions to the drug, bursting out of their catatonia with projectile-like force, and sometimes, with the continuation of the drug, developing multiple tics. Perhaps the family had some inkling of this, I am not sure; when I asked them, they said only that she did not seem to be suffering, that she never complained of her catatonia, that she seemed to be perfectly serene inside.

I found myself in two minds at this. Part of me wanted to say: But she is ill, catatonic, she can’t fully respond – don’t you want to bring her back? She has a right to be medicated, we have a duty to medicate her. But I hesitated to say anything, feeling an outsider. Later, when I asked John about this, he said, ‘Yes – that would have been my reaction, when I came here in ‘83. But the attitude to illness is different here.’ In particular, he said, the Chamorros seem to have a certain stoicism or fatalism – he hardly knew which word to use – about illness, and the lytico-bodig in particular.