Letters, p.23
Letters, page 23
Of course, physicians have no right to use the term “side-effects” in this context. The very use of this term is based on assertions and assumptions which are quite without backing. All the so-called “side-effects” of l-DOPA are essential and inevitable effects, and this would be fully realized if there were adequate comprehension of the nature of Parkinsonism and the effects of continued stimulation of a damaged nervous system, on the one hand, and no intrusion of redemptive phantasies, on the other hand. Not the least part of the trouble is that everybody (and here patients, as it were, collude with physicians) has phantasies that some “miracle” drug, discovery, invention etc. will come along and make everything wonderful, will restore primal health, strength, virility, stability, etc. It is a phantasy which goes back to the Elixir of Life, and the Golden Apples of the Hesperides, and Nectar and Ambrosia, etc. And the greatest people (Freud, for example, in his early eulogistic essay on “Cocaine”) have fallen prey to such delusions, and lent the weight of their authority to them. I will be publishing my own data on the use of l-DOPA (which I believe to be the most complete available), and my thoughts on the whole matter, in book-form. I have completed the book, but I can’t think of a title. Or, rather, I can think of too many titles! What is finally so tantalizing is that l-DOPA does have the most extraordinary therapeutic effects to begin with (even in patients who have had Parkinsonism for 50 years), but that these are succeeded—at best—by relapse, and at worst by an endless and incalculable nexus of “side-effects” (like antibiotics, insecticides, etc. etc.).
I suspect we think and feel alike on the matter.
I am not a “campaigner” myself, by temperament, and I think that for and/or against positions are both very tricky. My own chief concern is to tell the truth about the matter—which I have endeavoured to do in my book. But there is no doubt that campaigners with good heads and hearts—like yourself—are immensely valuable, and do a heroic and often thankless job trying to undo the dreadful muddles which we (as physicians, as human beings, as creatures of phantasy and greed) are constantly creating.
Thank you again, and the best of luck to you in your endeavours,
Yours sincerely,
To Elsie and Samuel Sacks
November 7, 1970
[New York]
Dear Ma and Pa,
It seems a long time since I wrote or received a letter, but I don’t suppose it can really be so long—it must be an illusion created by intense pre-occupation and busyness writing for the past five weeks. […]
In the meantime, I have decided to split my originally-planned book into two. The [first part…] will deal specifically with l-DOPA, laying stress on its dangers, on the reasons why these have not been adequately reported, on the dangers of being seduced by phantasies of “miracle” drugs which make everything come alright, etc. I think it will be cool, but white-hot (if you know what I mean), deadly, very topical, and very important. And I want it published in a hurry—if only to save the minds and lives of patients who would otherwise lose these in consequence of getting l-DOPA. I have been in touch with Faber’s, and hope to send them off at least a rough (i.e. not retyped manuscript) this week or early next. The immense detail of the data, its flawless organization, etc. should greatly add to the book’s effect, and make it impervious to attack. And I have no doubt that it (and I) will be attacked, for I have not concealed my opinion that most of the published work on the subject is drivel, if not hum-bug, and has amounted to an enormous act of deceit and self-deceit, and a blot on the medical conscience, etc. And one can hardly state such opinions and be loved for them. But state them I must. I am borne up by a feeling of moral duty in the matter, and by the knowledge that I am not myself in any sense a campaigner or combatant. […] I think (I hope, and doubtless I fear) that this DOPA-book will be something of a bombshell. […]
I have held my hand for nearly two years, refraining from any premature publication of large studies (as […] my own commonsense advised, although Messeloff, of course, was always pestering and nagging me to publish “something positive,” in less-than-no-time, etc.). But now I have seen the whole melancholy round of l-DOPA (and it is round—like the Earth: a man cannot escape from his Parkinsonism any more than he can walk off the surface of the earth: at the point when l-DOPA seems most effective, when the patient shows anti-Parkinsonism, or is in the Antipodes of Parkinsonism, at that moment his course is already rounding itself to return to where he came from)—now I have seen the whole round, I am ready to pour out a spate of publications. […]
As you gather from my content and tone, I have really had no other activities or interests of any kind for some weeks. […] I have scarcely seen the autumn change of colour—and it has been an unusually lovely Fall here. And I’ve been too busy for any exercise, and over-eating and smoking, which is bad—as soon as I get the packet off to Faber’s, I think I will take a few days off, and devote some attention to the other things in the world. Things seem appreciably cheaper now, and I have got enough to pay off Augusta […] and withdraw that particular thorn from my flesh. […] I should be grateful, Pa, if you could refrain from mentioning my DOPA-book to anyone at the moment, especially cousin Calne. Do write and tell me how you all are, and what is happening in London.
* * *
—
OS continued to work on his L-dopa book. Meanwhile, in January 1971, after various production delays, Faber & Faber finally published his first book, Migraine.
To Rita Henryk-Gutt
Reviewer
[ca. April 1971]
37 Mapesbury Rd., London
Dear Dr. Henryk-Gutt,
You have recently reviewed my book on Migraine in Nature and the British Journal of Hospital Medicine. […]
I need scarcely say that I have found your reviews both distressing and disturbing. I am grateful that you give me credit for a “considerable reading” in philosophy, biology, history of medicine, and psychology, and that you allow that I have had “extensive experience” in the field. But you make it sound as if I have used whatever knowledge I have as a weapon, as a means of discouraging research. And you must feel this very strongly, or you would not have written two hostile reviews.
And yet, perhaps, you are partly right. A most eminent neurologist recently said to me: “Your book is fascinating, and awfully well-written and all that, but of course it’s irrelevant.” I was somewhat taken aback, and enquired what he meant. He replied: “There’s no point talking to patients, asking about their symptoms, when they have attacks, and so forth. All that matters is to find the final common path of migraine in the brain, and block it. And that’s that!” It was partly in reaction to this sort of de-humanizing outlook that I laid so much emphasis on the migrainous person, and his symptoms, sufferings, feelings, etc. and so little on his chemistry. […] I think that you have also been unfair in concentrating your attention on the Chapter which most offended you, and failing to give me due recognition for the earlier parts of the book. You should, if only in passing, allow that I have provided a very careful and detailed account of the phenomenology of migraine, and that this has real value. There are the biological phenomena of migraine, and there is the physicochemical substrate, and one cannot be reduced to the other. […] By training and temperament I am a biologist and clinician, that is to say, I deal directly with biological phenomena and not with physicochemical phenomena. If I were a laboratory doctor, it would perhaps be the other way round.
So, I’m sorry if you received the impression from my book that I wanted to do down neurochemistry, etc. Of course I don’t. I know perfectly well that an event like a migraine must be associated with profound neurophysiological and neurochemical changes. If I pleaded for a wider approach to research on migraine, I meant only that its very important biological aspects should not be ignored. Indeed, my original title was “The Biology of Migraine,” and perhaps I should have steered clear of the dangerous neurochemistry! It is certainly improper for a biologist or a clinician to under-rate the profound importance of physicochemical processes; but it is equally improper for a neurochemist, for example, to under-rate the biological processes.
I do hope you won’t take this letter amiss, and I hope that you will give me (and my book) its due.
With kindest regards,
Yours sincerely,
Oliver Sacks
Skip Notes
*1 OS uses “DOPA” as a shorthand here for L-dopa.
*2 “Enough,” in Yiddish or German.
*3 A schnorrer, in Yiddish, is a moocher, someone who is always happy to take rather than give.
*4 Shenley Mental Hospital, outside London, had a reputation as a progressive treatment center and was a leading training hospital as well.
*5 Girolamo Cardano, a sixteenth-century Italian polymath and physician.
*6 OS uses “fond” here in its archaic sense of helpless, weak, or silly, as Lear calls himself “a very foolish fond old man.”
*7 Charles Messeloff, Beth Abraham’s medical director.
*8 This piece does not seem to have survived.
*9 A town in France not far from Giverny.
*10 I.e., to London.
*11 This very academic-sounding book eventually became Awakenings.
*12 Shengold, like most New York analysts, did not see patients during the month of August.
*13 The order of marine mammals including whales, dolphins, and porpoises.
*14 Names abbreviated for privacy.
*15 Israel Shenker’s article, headlined “Drug Brings Parkinson Victims Back into Life,” appeared on page 43 of The New York Times on August 26, 1969.
*16 George Cotzias and Melvin Yahr were pioneers in the use of L-dopa to treat Parkinson’s.
*17 American Medical Association.
*18 Fellow weight lifters from Muscle Beach.
*19 Ergotamine is an alkaloid derived from the ergot fungus. An overdose of this can cause not only gangrene but hallucinations and even convulsions. At therapeutic doses, it has been used to manage severe migraines.
*20 Death instinct.
*21 So much for OS’s vow to give up amphetamines, unless he is speaking historically here.
*22 He seems to be referring here to his love for Mel.
*23 He is paraphrasing William James.
*24 A bodybuilder and a model.
*25 Daniel Paul Schreber, a German judge whose 1903 description of his own schizophrenic psychosis, Memoirs of My Nervous Illness, influenced psychiatrists from Freud onward.
*26 In a way that might seem odd to a twenty-first-century reader, OS rarely wrote to Michael about his schizophrenia, though they sometimes spoke to each other about it in person. For the most part, though, they seem to have regarded it as a delicate subject, and OS often feared saying something that might upset his brother.
*27 OS had just moved into an apartment next door to Beth Abraham, owned by the hospital and reserved for physicians on call. He had agreed, essentially, to be on call continuously, the better to observe his patients at all hours.
*28 A. R. Luria, the Russian neuropsychologist, was a mentor to OS (he is introduced as a correspondent in the editorial note on page 261).
*29 Miller would have known this famous quotation from Darwin.
*30 Walter Rudolf Hess, a Swiss physiologist and author of The Biology of Mind.
*31 Turner and OS had been young doctors at Middlesex Hospital together.
*32 St. Bartholomew’s Hospital in London, familiarly known as Barts.
*33 The cathedral.
*34 Donald Calne, a neurological colleague and distant cousin.
*35 Highlands Hospital, on the outskirts of London, was home to about two hundred postencephalitic patients, the largest group of such patients OS knew of beyond his own patients at Beth Abraham.
*36 Kurt Goldstein, author of The Organism.
*37 Dickens characters, from Dombey and Son and Bleak House.
*38 OS admired the work of William Osler (1849–1919), a Canadian physician and renowned diagnostician who believed in teaching medical students through patient histories rather than textbook descriptions.
*39 OS referred to the school itself as “Braefield” (spelled variously) in Uncle Tungsten and elsewhere. Officially called St. Lawrence College, this noted prep school had evacuated during the war to Courteenhall in Northamptonshire, a few miles from the village of Brafield-on-the-Green. OS and his brother Michael were sent there at the outset of the war, when OS was only six. It seems that the Sacks family may have referred to it by its location.
*40 Anthony Buckeridge, the headmaster of Braefield, later became a well-known author of children’s books.
6
In the Company of Writers
1971–1973
OS had been introduced to the celebrated English poet W. H. Auden (1907–1973) by a mutual friend, Orlan Fox, at a cocktail party in 1967, after which Auden occasionally invited him for afternoon tea at his apartment on St. Mark’s Place in the East Village. Auden had a keen interest in medicine; his father had served as a medical officer during the initial outbreak of the encephalitis lethargica epidemic. In 1969, OS invited Auden to visit Beth Abraham and meet his patients.
In 1971, Auden asked Fox to send OS a new poem, “Talking to Myself (for Oliver Sacks).”[*1]
To W. H. Auden
Poet
May 15, 1971
[New York]
Dear Mr. Auden,
I have been greatly moved by the magnificent poem which Orlan has transmitted to me, and your wish to dedicate it to me. The poem itself has resonated in all sorts of ways in my mind—indeed, it has evoked so many images and feelings that I find it quite impossible to write a proper letter (I have written about twenty and torn them up!). It is marvellously accurate, and evocative, and as densely-woven as Nature itself.
I would be most deeply flattered and honored to have such a poem dedicated to me, and it would afford me a pleasure which would last as long as I do.
Thank you for the poem, and for everything. I shall try to write you a longer and more coherent letter soon.
With best wishes,
Yours sincerely,
To Thom Gunn
Poet
May 25, 1971
[New York]
Dear Thom,
I don’t know which gave me more delight—your letter or your book.
I had seen some of the poems in Sunshine,[*2] and had read “Moly” and a few of the others in MS when you were in New York (you were just about to send them off to Faber’s, I seem to remember). You fuse style and content so beautifully—I was going to say, so easily, but I know that every poem and thought and image is the fruit of an enormous and invisible tree. And you have become so warm (so Sunshiny) in your poems without sacrificing anything of the exactness and sobriety and accuracy you always had—but it’s a warm accuracy now, a loving sobriety, where before (I think, and hope I don’t offend) there was something cold and constrained and almost ferocious which used to look through some of your poems.[*3] It is lovely to see someone and their work grow and ripen, as you and yours have been doing in the last decade—beyond belief. I congratulate you on them, and love you for, in, and through them—and without any of the somewhat frightened, somewhat repelled, somewhat abject feeling for you and your poetry which I used to have.
A phrase in your letter puzzled me: that my book[*4] terrified (?) you. I think it is partly because there is something in it (and me) which relishes my patients’ symptoms, and which admiring their structure forgets the suffering they represent. Some of my patients would come to share this feeling, and would present me with bouquets of symptoms. And, perhaps, it is partly after years of analysis and coming to feel myself an explorer rather than a victim of human underworlds. I don’t think it’s a sadistic feeling—I think it is a sort of reprieve from the old sadism, and a relish for human nature in every form. Or, at least, I hope it is. You put it perfectly about the necessity for one’s judgement being part of one’s style—I suppose words like “appreciation” and “relish” conjoin these. I used to have delusions about a perfect scientific language, a calculus, with the meaning of every term fixed and finite, for itemizing and inventorying reality. I now realize that such a calculus would be like a net which would let most of one’s perceptions and feelings slip through. This terrible Gradgrind passion for defining and itemizing and reducing to commodities—so much of my scientific education, so-called, consisted of this, and it is deadly, as well as being nonsensical. I think I started to wake up when I started to see things in my patients which completely passed the bounds of any such “objective” description, which were almost ineffable—yet perfectly distinct and recognizable (like Chartres, or a symphony, or a complex ramifying joke or metaphor).[*5]
