Monday, December 8, 2008

Annals of Anosmia



In yesterday’s New York Times, Molly Birnbaum reflects on life without a sense of smell. She became anosmic following a head injury—she was hit by car while jogging. At the time she was training to become a chef. But after finding that without smell “taste is a mere whisper,” she gave up that career for a less nasal-intensive job in publishing. Over the next couple of years she gradually regained some limited smell function: first the aroma of sliced cucumber, later the smell of garlic. Now she can pick up the scent of a bagel shop a block away.

Birnbaum is fortunate: even such mildly happy endings are rare for people who suddenly lose their ability to smell. I know this because I’m a smell scientist and I read the medical journals. But you probably know it too—because not a year goes by without someone, somewhere, publishing a first-person essay on smell loss. Welcome to the annals of anosmia: the formerly obscure malady that has taken the feature pages by storm.

Why are essays about this particular medical misfortune so popular? One explanation is that we take smell for granted and therefore its sudden loss brings home in dramatic fashion all the subtle but important things it does for us. But we also take hearing for granted; where are the comparable essays on mid-life deafness? Frustration is another possible motivator: the scent-deprived are justifiably angry that so little is known about the causes—much less the cure—of their condition.

Molly Birnbaum’s first-person essay is not the first one to appear in the Times.  In 2003, they ran “I was a Middle-Aged Anosmic” by Tom Miller, a fellow left with no sense of smell after a respiratory virus. Importantly, for the future of the genre, he listed the succession of doctors he consulted in an effort to find a cure: a dentist, a chiropractor, a homeopath, and an ear, nose, and throat specialist. This troph effectively conveys how little doctors can do for such patients.

After a fallow period in 2004, first-person anosmics really took off. In June, 2005, Matthew Kaminski, an American living in Paris, wrote in the Wall Street Journal about a cold that took down his sense of smell the summer before. He amusingly described the shrugs and indifference of his French physicians, and weighed the drawbacks and possible benefits of his newly reduced condition.

When Barbara Lantin tried to serve her children spoiled fish for dinner she realized that her sense of smell had quietly vanished. The cause turned out to be nasal polyps blocking airflow to the olfactory nerve endings high in her nasal passages. Once these growths were removed her smell ability was substantially restored, leaving her a ready-made premise for an August, 2005, feature in London’s Telegraph, “Scent is not to be sniffed at.”

The following month, Mick O’Hare wrote in New Scientist about his attempts to cure a smell loss that arrived with a head cold and never left. Like Lantin, O’Hare quotes smell experts on the causes and prevalence of anosmia. True to the genre, he lists the doctors consulted on his case: a GP, various ENTs, and a neurologist. Then he introduces what will become another classic element of the first-person anosmic: an obligatory mention of the 2004 Nobel Prize in medicine awarded to Linda Buck and Richard Axel for discovering the olfactory receptors. It’s timely, fascinating, and accurate, but of only glancing relevance to the clinical issues at hand. This major advance in basic science has yet to translate into new treatments for anosmia.

Next up, in January, 2006, was Anita Chang’s personal account, “The Scent of a Woman—Lost.” Her anosmia resulted from head trauma when she was hit by a car five months earlier. Life for her is now “like living behind a film of Saran Wrap.” Chang’s tone is upbeat, even though there was no evidence at press time that her smell abilities would ever return. While short on essential genre elements (she sees only one neurologist and doesn’t mention the Nobel Prize) she offers one uniquely distressing observation: “Not having my sense of smell has made kissing quite dull.”

By April, 2006, the anosmia trend had trickled all the way down to The Philadelphia Inquirer. Bryan David Finlayson relates how he lost his sense of smell eight years earlier after taking a tumble from a speeding skateboard in Santa Barbara. He’s bummed because he can’t smell the ocean anymore and frustrated that so little is known about his condition. Succession of doctors: one neurologist. Nobel Prize mention: absent.

Sometimes, as with Hayden’s late quartets, the greatest works appear when an art form is so well established no one expects anything further from it. So it is with Elizabeth Zierah, who wrote a genre masterpiece for Slate.com in June, 2008. A head cold three years earlier left her without a sense of smell, and the results were devastating: worse, she says, than the lingering sensorimotor aftereffects of a mild stroke suffered years before. “As the scentless and flavorless days passed, I felt trapped inside my own head, a kind of bodily claustrophobia, disassociated.” She has to force herself to eat and worries about personal hygiene. For one tantalizing week her smell ability returns and her spirits soar; but the reprieve proves temporary. Succession of doctors: internists, allergists, otolaryngologists, acupuncturists. Nobel Prize: yes. All genre elements present and accounted for.

All of which brings us back to Molly Birnbaum’s essay on Sunday. It lacks the key elements of the genre: no succession of doctors, no Nobel Prize. But her story—running under the slug “New York Observed”—is adorned with local scents: West Village coffee shops, public restrooms in Penn Station, containers of Chinese take-out going bad in the fridge. What’s remarkable is that these odors figure in her story because she is unable to smell them. It's a most post-modern literary achievement.

Where do we go from here? Clearly, we can expect first-person anosmics by celebrities to appear in People or even Vanity Fair. But I predict that the next big thing will be soul-searching essays by physicians who have labored in vain to help the victims of anosmia. Prediction number two: these first-person diagnostics will be accompanied by selfless pleas for more Federal research dollars.

So, who will be first? Jerome Groopman? Oliver Sacks? Anyone? Anyone? Bueller?

1 comment:

Anonymous said...

Hi. I'm a recent anosmic. Are you some type of sociopath?
I have the feeling that your inability to read this kind of snarky essay from the point of view of someone actually affected, may be as incurable as my newfound inability to smell or taste food.
Which problem is worse, well that could be the topic of a whole new article