Authors: Bonnie Blodgett
Frasnelli attributes phantosmia to the brain's hard-wired aversion to novelty—in this case, unfamiliar smells caused by a malfunction of some olfactory neurons resulted in an incomplete picture of the odor formed in the olfactory bulb. Since new odors are usually perceived as unpleasant, he explained, at least in the beginning (think of exotic foods we have to get used to before we can enjoy them), this incomplete picture leads to the perception of an unpleasant smell. Frasnelli seemed to leave the door open to my rather fanciful speculation about how the brain might fall back on evolutionary imperatives and invent toxic-smelling odors as warnings.
I decided to find out if neurobiologist Donald Wilson had a theory about phantom smells. Wilson thinks all odor perception is learned (humans aren't hard-wired to dislike the smell of dead fish, for example; negative experience with dead fish gives the odor that noxious spin). In
Learning to Smell,
Wilson and his coauthor, psychologist Richard Stevenson, describe odors as highly synthetic percepts whose key components—answers to the questions "What is that smell?" and "Do I like it?"—are created in the higher brain and are dependent on conditioning.
I asked Wilson to comment on the trend among neuroscientists to challenge the preeminence of the thinking brain. (Antonio Damasio called the assumption that "the many strands of sensory processing experienced in the mind—sight and sounds, taste and aroma, surface texture and shape—all 'happen' in a single brain structure" a "false intuition.") Wilson replied with a primer on parallel processing. The neurologist Joseph LeDoux, he pointed out, has shown that when you hear a sound, that information travels to the neocortex ("reason") and at the same time to the limbic system ("emotion"). How you respond reflects a balance between those two.
On to phantosmia. Did he have any thoughts? Wilson acknowledged that phantom smells tend to be "terrible." But he went further than Frasnelli by reminding me that this is true for all phantom sensations. Wilson refrained from offering a reductive theory of phantosmia that left the other senses and the higher brain regions on the sidelines. He even tossed me a bone to chew on. The evolutionary bone.
"Maybe it's more important/adaptive for our sensory systems to provide warning than reward?"
O
NE MORNING A FEW DAYS
before Christmas, I climbed the stairs to my third-floor office and fiddled with the thermostat until the furnace kicked in. Then I turned on my computer and went back down to the kitchen to fill a saucepan with water for tea. The weekly gardening column I wrote for the St. Paul paper was due at 4
P.M.
It's hard to write about roses when you're engulfed in stench. I'd been putting it off. But now it was crunch time. I headed back upstairs.
The slamming of doors and the thump-thump-thumping of feet on the staircase startled me back to reality. Cam? Hadn't he left for work yet? He seemed to be taking the stairs two at a time. He appeared in my office doorway. He shoved a smoking saucepan under my nose. "Jesus Christ!" he shouted. I could see that the copper bottom was mostly black—charred, by the look of it—as was the plastic-covered handle. "What do you think you're doing?" Cam asked. (What I was doing was, obviously, not thinking.) "Thank God I forgot my BlackBerry."
He'd come back home to get it and found the kitchen filled with smoke. He stood there in my office holding a dishtowel to his face to block out the "truly hellacious odor," not yet remembering that, for all I knew, the suffocating stench was jasmine. When that dawned on him, he let fly with another "Jesus Christ," followed by "You're going to have to be more careful. You've stunk up the whole damned house."
He set the pan on a metal file cabinet and launched into a safety lecture. His voice was biting and accusatory though muffled by a second dishtowel, which had been relieved of its original purpose, protecting his hand from the pan's smoldering handle. The first dishtowel he'd placed on the file cabinet to protect the finish. Even in extremis, my husband is a careful person. Gas leaks, fires escaping the fireplace, the dire consequences of my forgetting to change the kitty litter box were mentioned. Dr. Cushing had been over most of this.
"Okay, I could care less about the damned kitty litter," Cam said, reading my thoughts, as usual. "How would you feel if the house burned down?"
I'd be dead, I almost said but didn't. He was going to have "those worthless smoke alarms" replaced. In the meantime, I
must
remember that I did not have a working nose and couldn't fall back on his when he was away. My "total self-absorption," as he put it, could have disastrous effects on others.
None of it seemed real. Still, he'd touched a nerve: others. "Caroline needs you to be strong," he'd said only the day before. Now I followed my husband downstairs, watched him carry the smoking cauldron out to the trash on his way to work. When he'd been gone five minutes I put another pan of water on the burner. As I waited for the first tiny bubbles to break on the surface, I briefly considered disabling the ignition switches on the four burners, turning on the gas, and asphyxiating myself. Everyone gets colds, suffers indigestion, strains his back, stubs her toe. Not everyone, in fact not a single person I knew ... and so on ... and so on. And then the tape:
I can't smell and I don't know what that means.
When clinically depressed people say they can't think straight or read or watch TV or make sense out of the simplest recipe, this is what they're talking about. The mind of a depressed person is like a war zone. Not just frightening but very, very noisy. I couldn't shake my irrational thoughts—thought-feelings. I was stuck on the idea that I was slowly but surely coming unglued as I lost my connection to the things I cared so deeply about. The smelly things. Everything. (What
doesn't
have its own distinct fragrance?) Eventually I'd forget who I was. If psychosis didn't get me, clinical depression would.
I finished my gardening column and sent it off, knowing I'd managed to make a minor chore (putting roses to bed for the winter) sound like a major bore.
Why would any sane person do this?
was the subtext of my grim recital of dos and don'ts.
Who could possibly care?
After a few minutes I realized I was dwelling on something even grimmer than a grim recital. I could no Conger keep my mind off the countdown: if Dr. Cushing was right, I had very few days left before my ability to smell was obliterated.
In a questionnaire study, a psychologist asked his students to rank the loss of various physical traits. Losing one's sense of smell ranked somewhere at the level of losing one's big toe, with most students opting to keep the toe. Presumably the students' first thought was
How nice not to have to smell poop and vomit and stinky fish,
and it occurred to them only later that the stench coming off a visually perfect salmon fillet might save them from being poisoned and that they'd lose good smells too.
But maybe they'd still keep the toe and lose the sense of smell even after considering all that. The American Medical Association gave smell and taste a pitiful 1 to 5 percent rating as a measure of importance to a person's quality of life. The exact wording in the AMA's
Guides to the Evaluation of Permanent Impairment
is "value of a life's worth"; these ratings dictate damage awards in personal-injury cases.
Usually workers' compensation is at issue. How productive can a person be without a working nose, or leg, or right eardrum? A visual impairment is considered an 85 percent whole-person impairment (WPI); nasal dysfunction might get a 5 percent WPI award for someone who depends on her nose to make a living—a chef, for example. Someone whose career doesn't depend on smell—a hairdresser, say—might get a 1 percent WPI award for the same disability. As a garden writer, I might eke out a 2 to 3 percent impairment award.
If a photographer went blind, the damages paid would be significant, presumably because the impairment would also severely limit his options when it came to choosing a new career. The photographer might be an exceptional home cook but would not do well as a professional chef if he couldn't read a menu or navigate in a crowded and busy restaurant. The chef who became anosmic, however, could turn his amateur interest in photography into a job.
Pain and suffering don't count for anything when it comes to smell loss, even though studies on smell dysfunction and mood show that depression goes with the territory when the nose doesn't work.
Becky Phillips lost her sense of smell at about the same time I did, although Phillips never did find out why she nonetheless kept smelling "deadly urine" odors. This description convinced me that she was experiencing phantosmia—what else produces such an improbable pairing of words? Because her phantoms, unlike mine, were fleeting, they repeatedly kindled and then quashed Phillips's hopes that her sense of smell was coming back.
By her own testimony, she was a different person before she suffered the head injury that robbed her of smell. She could not go back to the life and career she'd had. It wasn't the accident but the anosmia that changed her. Before the accident, she had been super-stylish and always on the go, a successful advertising executive famous for her elaborate dinner parties and for the presentations at work that also displayed her love of sensory pleasures. "I was called the queen of ambiance," she said. "Scented candles, incense, aromatic lotions, the whole bit. I loved my sense of smell."
Phillips had been heading to an evening business event at a nightclub when a sheet of black ice sent her feet into the air and her head onto the pavement.
She'd worn her new rubber flats (with her three-inch heels tucked inside her purse) as a precaution, but they hadn't helped. Just-below-freezing temperatures and a drippy pipe above the sidewalk created a slick patch in front of the club entrance.
She told me that she fell backward and hit the ice so hard that the front of her brain banged against the inside of the front of her skull. That's how her doctors described the accident, which she can't remember. The soft tissues just behind the eyes, nose, and forehead received the worst of the blow. Not only the olfactory nerves but also the connections that help people think straight were severed.
Phillips came to in a hospital room filled with flowers. She'd been unconscious for days. Slowly Phillips remembered who she had been before the fall: the queen of ambiance. She wondered how the supposed queen could be surrounded by all these beautiful flowers and not smell them. She asked a nurse to hand her a rose, and she took a sniff.
Odd,
she thought to herself.
I can't smell it.
This realization, more than any of her other travails, sent her on a downward spiral. It took months for Phillips to accept the fact that her olfactory system was not only smashed to pieces but could not be glued back together again. Recovery was unlikely because the damage had been so complete. There were no nerve cells left alive to regenerate. She also suffered temporary amnesia, and her short-term memory was shot. She still has trouble reading.
Throughout her ordeal the single hardest part was the emotional distance she felt from people who "just don't get it" when it came to her loss of smell. She discovered, as I did, that friends did not even remember that she couldn't smell, much less understand the staggering loss this represented. They would express sympathy for her in a way that implied that the anosmia was no more significant in the grand scheme of what she'd gone through than her occasional mild headaches. Phillips had had breast cancer as a young woman, and when her cancer came back after a ten-year remission, just as she was recovering from the brutal fall, the new crisis made the disparity between what other people considered important and what she considered important all the more striking. Cancer, Phillips said, horrifies people. But telling a friend you have cancer when you're both forty gets a whole different response than it does when you're both fifty-five and know that many women have gone through it and survived. "They're not so frightened of what your cancer could mean to them. They know."
They didn't know about smell.
"All I can say, and I say this to you only because you've been there, is that I would wear my head in a bag for the rest of my life if that would give me back my sense of smell. I would pay a million dollars for what the AMA point system decided was only a nine-thousand-dollar impairment in my case. My lawyers still don't understand why [losing] something that they can't see is more important to my value as a fully functional human being than losing an arm or leg."
As Becky Phillips found out, a person who suddenly loses her sense of smell is thrown into an emotional crisis even more crippling in its way and more threatening than the loss of a leg. Why? Legs the thinking brain can get its arms around. Smell is invisible, unknowable in any concrete way. Studies have shown that even sudden blindness is less traumatic, in the long term, than anosmia, which almost always leads to depression and sometimes to suicide. This fact eluded the medical community until very recently, when revelations about the basic operation of smell began to raise troubling questions about its close proximity to the limbic system. Only now are serious studies being undertaken to examine links between smell and mental health.
Psychologist Rachel Herz tells the story of Michael Hutchence, the iconic lead singer for the Australian rock band INXS, who was found dead several years after an accident that left him a changed man and, not incidentally, an anosmic. She is convinced he committed suicide as a result of the loss of his sense of smell. His emotional breakdown—the mood swings, the irascibility, the deep and debilitating feeling of distance from the world—began when a bicycle accident (he was not wearing a helmet) left his smell receptors adrift and lifeless in the upper nose. He didn't find out until weeks after being discharged from the hospital that the olfactory nerves had been sheared by the blow to his head.