Letters, p.22
Letters, page 22
There are two quite massive (or by New York standards quite massive), airy rooms, in the front of the house. One of these I am turning into a dining room. […] In the front room I have, as yet, no furniture, but a lovely grass-green shaggy carpet going from wall to wall. I may just put cushions, or a very low sofa here. It’ll be a sort of spacious lying-around room. Its furnishings I want to be all “natural,” i.e., I have some nice lamps with wood and cork bases, and shells and plants and so forth. I shall make a sort of plywood platform running crescentically round the window side of the room, which […] will be filled with pots and earth and mosses and ferns and other greenery, and resemble a woodland bank. At least this is the sort of motif I want. I have felt absolutely starved of nature and living objects and greenery for the last five years, and will try to create a sort of conservatory-atmosphere in the front room. There is also a square of ground in front of the house, and another behind it. These I must divest of the broken glass and other rubbish they have at the moment: I will then try to hedge, wire off or otherwise enclose them, and make a miniature or two miniature gardens. Fortunately I seem to have “green fingers,” and the loads of ferns and other primitive plants I have been digging up and transporting from nearby woods seem to be doing well, and can probably be transplanted out fairly soon. So, a new “domestic” side of me seems to be emerging. I’ll never become very domestic, if only because it wastes so much time: but it’s a good feeling pottering around one’s place, and imprinting oneself and one’s tastes on it this way and that. I feel that I have lived an anonymous, squalid, uprooted etc. sort of existence far too long. […]
One way and another, and even a year ago I would never have suspected it, my beloved post-encephalitic patients, and their infinitely varied reactions to l-DOPA, have led into a vast landscape of clinical study, really into a life’s work. And by the time I am “through” with them, I will have derived an experience and knowledge of primitive (sub-cortical) behavior matched by nobody else around, to say nothing of the “bonuses” like the study of tics, obsessions, mannerisms, perceptual distortions, memory upsurges, etc. as these occur in the patients. I seem to be getting a bit verbose, and not a bit grandiose. Actually I don’t feel grandiose, I just have a sort of feeling of being fortunate, in that such a treasure of knowledge and understanding has come my way, and is now beginning to offer itself up for harvest.
The business of my car, however, has been much less felicitous, and has caused me a great deal of rage and anxiety. I mentioned, I think, that I was beguiled from my original intention to buy a new BMW into getting a 1967 Rover, ostensibly in “showroom” condition. This car, it is true, has excellent bodywork and a good engine, but I have had a packet of infuriating troubles with it in other ways. […] I am exceedingly sorry I didn’t pay the extra $1500 and get a new BMW to start with. One has to be very car-smart and lucky in buying secondhand cars, and I am afraid I am neither, and so got cheated, etc. […] Part of the trouble, of course, is that I am now so vexed about all this. The actual trouble is with the car becoming a nucleus of neurotic feelings, which tend to become more and more dramatic: e.g. feelings that the car will fall to pieces at any moment, that the people who sold it to me were criminal psychopaths, that I want to take physical or legal action against them, phantasies of revenge, etc. Once feelings of this sort get inaugurated, I find it quite difficult to maintain my calm (or my “cool,” as they say now), and to deal with the whole matter in the reasonable unemotional business-like way it demands. […] And it’s such a flaming waste of time to get insomniac and paranoid about a mere lump of metal. I think, however, that the matter will be resolved in a day or two, and will then cease to fester in my mind.
I feel myself almost diagrammatically divided into a “good” self and a “bad” self. The good self is full of love and wonder and praise etc. This is the part which makes me see my patients as miraculous concatenations of disordered brain-systems, and to feel endless sympathy, understanding, compassion, etc. for them. The good part is the creative part, and must be in the ascendant if I am to write or even to work in any really-involved way. The bad part is full of hate and fear and blame, and is as selfish and destructive as the other is altruistic and constructive. I suppose everyone has good and bad “halves” in this sort of way, and it is just that they are both rather hypertrophied in me, and that analysis etc. has made me acutely conscious of them. […] Messeloff tends to bring out my bad half, which is why I try to steer clear of him. On the other hand, teaching, patients, poetry, philosophy, Nature, etc. bring out the good, lyrical part of me, which is much pleasanter for me, and for everyone concerned. You will be pleased (amused/amazed?) to hear that I was given quite an honour by the student body last night. There is a sort of “elite” group—the “AOA”—Alpha Omega Alpha, consisting of the top ten students in each medical school throughout the country. Anyhow the Einstein branch of the AOA asked me to be their guest at their annual dinner last night, and made me an honorary member of the AOA, and gave me a certificate and a key and other little tokens. I think, however, that one of the best parts of the evening was when my old enemy Labe Scheinberg, now Dean of the College, praised me fulsomely, and said that I was the best Neurology teacher the college had had since the late lamented Saul Korey. All of which made me blush, and feel that they were all crazy etc. But I also felt very good, and feel that this is, in a sense, perfectly true. I think that I am a good (and, very rarely, at magic moments, a great) teacher: not because I communicate facts, but because I somehow convey a sort of passion for the patient and the subject, and a feeling of the texture of patients, the way their symptoms dovetail into their total being, and how this, in turn, dovetails into their total environment: in short, a sort of wonder and delight at the way everything fits (and it does all fit, so beautifully, like a wonderful jigsaw puzzle). So yesterday evening was a good evening, and brought out the good part of me again, after this had been eclipsed by ten days of anxiety and paranoia about the car.
This letter has become much too long and garrulous. It was lovely to hear you all over Pesach, and I will look forward to your next letter.
To Augusta Bonnard
June 8, 1970
2512 Bronx Park East, Bronx, NY
Dear Augusta,
Putting together a short paper on the peculiar oral behaviour activated in some post-encephalitics by l-DOPA, I suddenly bethought myself of your paper on “The primal significance of the tongue,” and want to say how full of interesting observations and insights I have found it. Several of my patients have developed (usually in the context of other tics) “tongue-sucking,” “tongue-swallowing” and complex hand-mouth mannerisms (thumb-sucking, etc.). These acquired, gratifying practices seem to evolve from innate tongue-movements and oral behaviour (tongue-pulsions, licking and lapping, retching, etc.) identical with those elicited by Hess[*30] with diencephalic stimulations. […] I have no doubt that you have run across a good many post-encephalitic patients: they seem to me the most interesting (and in many ways the most tragic) neuropsychological patients there could be, and studying them (especially with something like l-DOPA) has been my chief pleasure and task for the last two years.
After four years of analysis (I should say nearly five years—I am “forgetting” Los Angeles) I find myself possessed of certain strengths and stabilities I never knew I possessed, and released, for at least a good part of my time, from the dreadful neurotic bondage which had me in thrall, really, between the ages of 16 and 33. I can’t say I’m too successful with personal relationships (and doubt now that I will ever be), but I find a profound absorption and pleasure in my work, and stay fairly well-sublimated for most of the time. I look back with horror at the days of drugging and narcissistic absorption, which would surely have destroyed me had it not been for analytic intervention. I am even slowly and finally becoming solvent, and think it at least possible, and even probable, that I will be able to repay my debt this year. Hitherto, with an inadequate income (45% of which was absorbed by analytic costs) and high costs-of-living in Manhattan (I have now moved into the Bronx, a stone’s throw from the Hospital where I work), I could barely keep my own head above water, let alone repay debts. […]
My parents both seem very well and active for their ages, my father especially. I must say this: that for the first two years of analysis, I was consumed with feelings of reproach and even hatred against my parents, seeing them as all-culpable vehicles and inducers of neurotic misery. These feelings I have worked through, and now I find myself loving and admiring them for a quality (indeed, the most valuable human quality) which has been the centre of their lives, and is now the centre of mine: namely, a feeling of devotion and dedication to their patients and their problems. This feeling of devotion (which gives me a sense of self-worth, an absolution from self-hate, and an intellectual and moral task or “mission” which will last me as long as I live) is something I have only really experienced in the last three years or so: And it is obvious, from my knowledge of you and from re-reading your paper, that something very similar and intense must be a mainspring in your own life, and (while in action) a means of transcending personal conflicts and loneliness.
I will be coming to England this August, which will coincide, I hope, with the final (intolerably slow and obstructed) publication of my “Migraine” book, and will hope to see you then.
Best wishes,
Yours sincerely,
Oliver Sacks
To Paul Turner[*31]
Physician
September 12, 1970
2512 Bronx Park East, Bronx, NY
My dear Paul,
[…] It was an enormous pleasure seeing you in London again, and—I realize in retrospect—a meeting which certainly coincided with, and possibly prompted, a change of mood. Because I had been feeling rather depressed, and sullen, and unwanted etc. during my first ten days in London, and you gave me such a feeling of welcome. I had a funny feeling that you spoke for all England when you said: “Why don’t you come back to us one of these days? Join in, be part of us,” etc. Because one of the most constant (bad) feelings I have is the feeling of exile, an alien in an alien country, etc. and your welcome (to say nothing of your kind efforts to arrange a talk, a radio-interview, and what-not) appealed in the directest way to my desire to come back. I spent most of my holiday walking round London, round my old haunts rich in association, and reading Dickens, and reminded myself once and for all that I am a Londoner born and bred, that I am steeped in London, and that I will inevitably feel uprooted and deprived if I live anywhere else. And perhaps the old buildings of Barts,[*32] under the shadow of St. Paul’s,[*33] reinforced the feeling, as did the splendid solid dignified meal at Simpson’s, and the brown-raftered pub, and the walk over the bridge, and the prospect of the Thames, and reminiscing together.
I went to see Calne[*34] at Hammersmith, the day after meeting you, whom I found very bright, eager, but essentially pedestrian. That’s a mean word to use after his receiving me so pleasantly, and giving me an afternoon of his time, and letting me sit in on his Parkinson clinic, and arranging a visit to Highlands[*35] for me, and showing me an advance copy of his book (which came out a few days ago). Seeing Calne, sitting through his clinic, and reading his book, were also highly significant experiences for me, for they brought into the sharpest focus the antithesis of two styles. He sat in his clinic, alert, neat, quick, with a pile of ruled test-sheets in front of him, rapidly reducing his patients to test-scores, and paying (unless I do him an injustice) almost no attention to them as people: tremor 3, rigidity 2½, akinesia 4, next patient please, etc. I was irresistibly reminded of Henry James’ impression of Ellis Island, of the immigrants “appealing and waiting, marshalled, herded, divided, subdivided, sorted, sifted…an intendedly ‘scientific’ feeding of the mill,” and of the folly of this sort of “objective” examination which replaced human judgement by stereotyped questionnaires. […] In some very fundamental sense, when all the gradings and rating and testings and measurements have been done, and all the test-sheets and schedules filled up, the very flesh of the subject has escaped, like a jellyfish through a tea-strainer. It is so senseless to describe symptoms and signs as if they were fixed emanations from the patient, when they are no more than reactions at a particular moment to a particular stimulus (“Symptoms are answers,” writes Goldstein,[*36] “given by the modified organism, to definite demands…(their appearance) depends on the method of examination”).
I am forgetting that this is a letter, and getting all hot-under-the-collar and polemical. Actually, I think I am rehearsing the preface to my book on Parkinsonism, which I have just started writing, and which perhaps Calne’s book has, in part, stimulated. I am sure that a wholly different mode of description can be used, must be used, in place of these horrid test-figures with their derivative graphs and statistics. The classical mode of description is narrative. I see no way of picturing the innumerable influences and factors involved except in a narrative. Can you imagine Dombey or Jarndyce[*37] reduced to a few figures and diagrams? I think there is something almost inhuman about the mechanical intelligence which has taken over so much scientific and medical writing: it is reasonable enough to describe physical and chemical and simple physiological processes, but cannot possibly indicate the repertoire of higher behaviour. I was reading Hard Times a couple of weeks ago, and find myself thinking of Calne’s approach (which is the accredited and almost universal approach to patients, and mode of presenting data) as pure Gradgrind. You were good enough to use the word Oslerian[*38] of one of my Lancet letters: I assure you that I was not indulging in deliberate archaism, but using the only mode of presenting the data which could begin to do justice to it.
To get off the subject (I’m sorry for riding it, quite inappropriately, here: and I think you probably agree with me anyhow), I visited Highlands last week, and had the most intense, the most uncanny, sense of déja vu I have ever had, seeing patients so similar to my own, sometimes down to the smallest mannerisms. I think they are a miraculous group of patients (and obviously much better cared for and healthier than ours), and I am quite clear in my mind that it is with them that I wish to work when I return to England. But how, when, in what capacity, by whom funded, etc. I can’t possibly say. My flaming publishers have again postponed the publication-date of my Migraine book (Faber’s, though very old and highly thought-of, are apparently notorious for this endlessly protracted muddling and bumbling along), to January 25, and I will make sure that I am in England on that day, and for a few days before and after, to look after my child, to boost it, if I can, and to see reactions. So I will surely see you then. But let’s keep in touch, by letter, in the interim.
Thank you again for everything, and looking forward to hearing from you.
Best regards to your wife,
To Barbara Waymouth
Former Staffer at OS’s School
September 30, 1970
[2512 Bronx Park East, Bronx, N.Y.]
Dear Barbara,
[…] Your phone-call, suddenly, out of the remotest past, set me to thinking of Brayfield[*39] and those days generally. My memories are very patchy and biassed, because so much of that era has been blotted out of my memory. A traumatic amnesia, I suppose, because like so many evacuees I had the feeling of having been deserted or marooned by my parents, and the recollection of this is too painful to be allowed into consciousness. And yet, it was a very pleasant time in all sorts of ways. I loved the village—and all sorts of non-human memories: of the little shop, and the walks, and the churchyard, and the nest I built in a tree with Lawrence Greenbaum, and the mushrooms, and the mild cow-y meadows, and the smell of horses etc. etc. came flooding back to me when I recently read a book about a village (Akenfield—beautiful book). And in some ways I liked Vernon House; it has ever since stood in my mind both as the image of a benevolent institution, where one could be loved and protected, and also as the image of a terrible institution, associated with memories of starvation and repeated beatings. I am sure it is no coincidence that for the last ten years I have opted to work in institutions; where my patients, in some ways, are like pupils, or perhaps children. I have always liked you, and you provided a warmth, and a fairness, which I felt extremely in need of (and which was not provided by the Buckeridges,[*40] whom I have since considered, perhaps most unjustly, as Dickensian monsters). And so, twenty-seven years later, if you will allow me, I will thank you for what you gave me, and what you stood for, at a dark time.
My very best wishes to you,
Yours,
* * *
—
In September 1970, The Journal of the American Medical Association published a letter from OS in which he reported on the effects of L-dopa in sixty of his patients and pointed out the complex and unpredictable side effects they had confronted. He expressed his reservations about FDA approval of the drug for general use, in light of these adverse effects and uncertainty about L-dopa’s long-term safety. His colleagues, stung by this criticism of the much-heralded miracle drug, responded with skepticism and, largely, dismissal.
To Leon J. Salter
Correspondent
November 6, 1970
2512 Bronx Park East, Bronx, NY
Dear Mr. Salter,
Thank you very much for your kind and encouraging letter of October 20, and for the fascinating (and terrifying) bundle of data you enclose. […] As you note, the so-called “side-effects” of l-DOPA are endless in number (and the tally is by no means completed yet).
