THE HABIT LOOP
How Habits Work
In the fall of 1993, a man who would upend much of what we know about habits walked into a laboratory in San Diego for a scheduled appointment. He was elderly, a shade over six feet tall, and neatly dressed in a blue button-down shirt. His thick white hair would have inspired envy at any fiftieth high school reunion. Arthritis caused him to limp slightly as he paced the laboratory's hallways, and he held his wife's hand, walking slowly, as if unsure about what each new step would bring.
About a year earlier, Eugene Pauly, or "E.P." as he would come to be known in medical literature, had been at home in Playa del Rey, preparing for dinner, when his wife mentioned that their son, Michael, was coming over.
"Who's Michael?" Eugene asked.
"Your child," said his wife, Beverly. "You know, the one we raised?"
Eugene looked at her blankly. "Who is that?" he asked.
The next day, Eugene started vomiting and writhing with stomach cramps. Within twenty-four hours, his dehydration was so pronounced that a panicked Beverly took him to the emergency room. His temperature started rising, hitting 105 degrees as he sweated a yellow halo of perspiration onto the hospital's sheets. He became delirious, then violent, yelling and pushing when nurses tried to insert an IV into his arm. Only after sedation was a physician able to slide a long needle between two vertebra in the small of his back and extract a few drops of cerebrospinal fluid.
The doctor performing the procedure sensed trouble immediately. The fluid surrounding the brain and spinal nerves is a barrier against infection and injury. In healthy individuals, it is clear and quick flowing, moving with an almost silky rush through a needle. The sample from Eugene's spine was cloudy and dripped out sluggishly, as if filled with microscopic grit. When the results came back from the laboratory, Eugene's physicians learned why he was ill: He was suffering from viral encephalitis, a relatively common disease that produces cold sores, fever blisters, and mild infections on the skin. In rare cases, however, the virus can make its way into the brain, inflicting catastrophic damage as it chews through the delicate folds of tissue where our thoughts, dreams-and according to some, souls- reside.
Eugene's doctors told Beverly there was nothing they could do to counter the damage already done, but a large dose of antiviral drugs might prevent it from spreading. Eugene slipped into a coma and for ten days was close to death. Gradually, as the drugs fought the disease, his fever receded and the virus disappeared. When he finally awoke, he was weak and disoriented and couldn't swallow properly. He couldn't form sentences and would sometimes gasp, as if he had momentarily forgotten how to breathe. But he was alive.
Eventually, Eugene was well enough for a battery of tests. The doctors were amazed to find that his body-including his nervous system- appeared largely unscathed. He could move his limbs and was responsive to noise and light. Scans of his head, though, revealed ominous shadows near the center of his brain. The virus had destroyed an oval of tissue close to where his cranium and spinal column met. "He might not be the person you remember," one doctor warned Beverly. "You need to be ready if your husband is gone."
Eugene was moved to a different wing of the hospital. Within a week, he was swallowing easily. Another week, and he started talking normally, asking for Jell-O and salt,...