Letters, p.24
Letters, page 24
To W. H. Auden
July 25, 1971
[New York]
Dear Mr. Auden,
You have been almost incredibly kind to me, and I have been almost incredibly boorish. I can only say that I have been in rather an ugly, depressed mood for several weeks, and virtually unable to write letters; I am going to London today, for the summer, and am feeling a sudden lightening of mood, and a sense of release; and the first thing to do, obviously, is to write to you.
Your Review[*6] was magnificent—I think you have that rarest of capacities, the capacity to be interested in absolutely everything, and to approach everything in constantly new ways. Your review even made me look into my book with renewed interest, which I hadn’t done in months! I already have intimations that your review has introduced the book to a set of readers who would never, in the normal course of events, have heard of it, or taken any interest even if they had heard of it. What I most want to do—in anything I write—is to try and restore something of the communication which seems to have been lost between scientific writing and the common reader. In migraine, and (perhaps even more) in the subjects I am currently about—Parkinsonism, tics, trances, etc.—one sees phenomena which at first seem utterly strange, and irrelevant to common experience; and then one sees that they are highly relevant to familiar things, and can illuminate these in all sorts of ways, and be illuminated by them; and, above all, one needs common language to connect them. And everywhere one sees that beautiful concord (in which every molecule and cell and organ and function has its place and role, and is perfectly fitted for it, and knows it)—so that, as you say in your poem, the body becomes a metaphor for the Cosmos.[*7]
It was particularly thoughtful of you to send me Dunbar’s poem on his Heid-Ake,[*8] which is very fine, and witty. I am gradually building up a remarkable collection of allusions to Migraine—they are almost incredibly numerous and varied, from Sumerian inscriptions to Mrs. Gradgrind. If I can ever make an anthology of them, they would represent every conceivable sort of commentary people have made about the Megrims. The Dunbar poem will be a particularly prized specimen.
[…]
To W. H. Auden
August 18, 1971
[37 Mapesbury Rd., London]
Dear Wystan,[*9]
Your letter was forwarded to me a few days ago, and it (or your poem, or you) was the best of palliatives. Does there come a point (if one is very lucky, or has the right gifts, or grace, or works at it) when style, feeling, content, judgement all flow together and assume the right form? Your “Anthem” seems instinctively and effortlessly lyrical, and absolutely natural, like an organic growth; and yet obviously has the most careful and sophisticated and exquisite choice of words—and no feeling of any “joins” anywhere, of artifice, of manipulation. Marvellous. I will treasure it.
Yes, I thought the Coleridge quote was a real find, and so to the point. And I agree (I feel) absolutely with the Novalis one.[*10] In some sense, I think, my medical sense is a musical one. I diagnose by the feeling of discordancy, or of some peculiarity of harmony. And it’s immediate, total, and gestalt. My sleeping-sickness[*11] patients have innumerable types of strange “crises,” immensely complex, absolutely specific, yet completely indescribable. I recognize them all now as I recognize a bar of Brahms or Mahler. And so do the patients. Such strange physiological harmonies—I hope I can find some way to describe these, because they are unique states, at the edges of being, beyond imaginable being, beneath comprehension, and when the last of the sleeping-sickness patients die (they are very old now) no memory will be left of their extraordinary states. Writing seems more of a struggle now—maybe I’m trying something harder—I find meanings go out of focus, or there is some sort of “slippage” between word and meaning, and the phrase which seemed right, yesterday, is dead today. […] And medical jargon is so awful. It conveys no real picture, no impression whatever, of what—say—it feels like to be Parkinsonian. And yet it’s an absolutely specific, and intolerable feeling. A feeling of confinement, but of an inner constraint and confinement and cramp and crushedness, which is closely analogous to depression (although it is not emotional as such), and, of course, is very depressing. And a painful inner conflict—one patient called it the push-and-pull, another the goad-and-halter. It’s a most hateful condition, although it has a sort of elegant formal structure. But no book that I know of brings home that Parkinsonism feels like this—they just reduce it to an unevocative listing of symptoms. I hope Osbert Sitwell[*12] didn’t have it too badly.
I’ve been reading some Goethe (for the first time, really) in the last week or two. Starting with his Italian Journey—thank God I did start with that, or I might not have got any further. And then the Pelican Faust—maybe it’s the same with any translation. I must learn German. And Mann’s fabulous essay on Goethe and Tolstoy. And Elective Affinities. And that great, meandering, affectionate Lewes biography.[*13] There is one point (I think in his chapter on Goethe’s philanthropy) where Lewes says that he could “eat Goethe for love”—and I think these are beginning to be my sentiments too.
I hope I can join Orlan[*14] on a lightning visit to Vienna.[*15] There is nothing I would like more, but I am awfully fretted with my current book, and may not be at liberty (or feel myself at liberty) until I have finished it. I would love to see you in your own Kirchstetten, but if I cannot come I will surely see you in New York a few weeks later.
Yours ever,
To George L. Fite
Senior Editor, The Journal of the American Medical Association
August 28, 1971 [Unsent]
37 Mapesbury Rd., London
Dear Sir,
I must acknowledge, somewhat belatedly, your letter, and your return of my manuscript on l-DOPA.
And, of course, the list of “comments” provided by your consultant(s). The latter is a quite remarkable production, not for its intrinsic value (for it seems almost entirely valueless as a rational critique), but for the light it casts on the state-of-mind and emotional attitudes of your consultant(s), who—if I do not misunderstand you—must be regarded as representing, after a fashion, the “official” attitude to l-DOPA. I need scarcely say that I was at first distressed, and even shocked, that innumerable observations based on years of daily contact with patients, and the probable implications of these, could be so ignorantly and wantonly dismissed, or “wished away”: the attitude immortalized in Dickens’ Mr. Podsnap[*16] (“I don’t want to know about it; I don’t choose to discuss it; I don’t admit it!…I have also said that if such things do occur (not that I admit it), the fault lies with the sufferers themselves”). Your consultant(s) do not make, and are obviously unable to make, any substantive criticisms of my work, and have therefore descended (very much like Dr. Ryan in his letter which you published last December) into petty jibing, pomposity, vapid rhetoric—in a word, Podsnappery. Indeed, if I did not know it directly, I could infer the importance of my own work from the very intensity of this threatened, denying, and defensive reaction. Your consultant(s) seem to hold their own dignity and integrity very cheaply, in that they are prepared to abuse their own positions of authority to suppress the results of an independent investigator, and to try and smother the very spirit of free enquiry. I do not, Mr. Editor, apply these considerations to you, for I realize that you are ex officio detached from opinions expressed in the JAMA, and opinions expressed by your consultants. And I also realize that you could hardly print something in defiance of the strongly-expressed opinion of your own consultant(s).
To get on to a pleasanter topic: I was most gratified to see a very fair-minded and generous review of my book on Migraine, in JAMA of July 5, 1971. It was a delightful surprise after I had got so worked up about the DOPA business, and I would be most grateful if you could transmit the enclosed letter of appreciation to your reviewer, Dr. Griffith. […]
Please forgive me for an over-long letter—but I know you will appreciate that feelings must be discharged and expressed once in a while. With this letter, therefore, I shall regard the JAMA “episode” as closed.
Yours sincerely,
Oliver Sacks
To James Hughes
Fellow Train Passenger
September 16, 1971
[37 Mapesbury Rd., London]
Dear Mr. Hughes (or James—I’m not sure which to use after meeting you once),
I enjoyed talking to you immensely on our journey down from Harwich together. You were so open and sensible and direct—like a breath of fresh air, after all the confused, devious, contradictory, mixed-up people one usually sees (at least in Big Cities). I was very moved by your telling me about your nautical Grandad, and his father, and your father, and yourself—all deeply attached to the sea, one way and another, which perhaps we should all be. I know, for myself, that looking at the sea, or swimming in it, or crossing it, gives me some very deep, elemental sort of satisfaction, an intense feeling of real-ness, and a sense of return—perhaps everyone has this; perhaps it is connected with the fact that our lives start in a sort of sea, and that we necessarily see the sea as our origin or mother. I don’t know.
I do hope you passed that silly exam. And it is a silly exam, like most exams. You are so obviously competent to manage your work, in practice, and you have shown this so clearly, that it seems ridiculous to make you take a silly exam which in itself means nothing, and provides no real qualification for anything; but that’s the topsy-turvy way it is. Once it is out of the way, you’ll be your own man and past the obstructions. I must say—just from speaking to you—that it is plain to me that on a ship you would keep an eye on everything, and miss nothing, and keep calm, and handle things in the best way; you radiate reliability; and it annoyed me to think of a pack of fools or self-styled “experts” in London forcing you to put on a suit and take a train and worry yourself sick with cramming, all for the sake of pleasing them. The only real test would be for one of them to come to Harwich and go on a real journey and see you in action.
After having lived in New York for seven years, I sometimes think that everyone is mad. And perhaps they are, in New York. And it is a rare pleasure to meet someone like you, someone, that is, who is eminently sober and sensible and down-to-earth, on the one hand, and full of adventurousness and love-of-life on the other: in short, a real person. I wish you the best of luck—and you must drop me a line one of these days.
Yours sincerely,
P.S. I enclose, with best wishes, a copy of my “baby”—Migraine.
To [first name unknown] McEwen
Reviewer
September 24, 1971
Beth Abraham Hospital, Bronx, NY
Dear Dr. McEwen,
I have just received a copy of your review of my Migraine book, and want to express my appreciation of your generous, acute, and always just comments upon it. I hope you will not think it an impertinence of me to write to you in this way—one of the joys of (a first) publication is that it opens the way to all sorts of unexpected contacts and correspondences.
I am, as you say, an “enthusiast,” although I have never been sure whether this is a good thing or not. I am not an enthusiast for any particular theory or formulation of migraine—and, if anything, I over-simplified my formulations when I wrote the book (which was in 1967). What does arouse my enthusiasm is the wonderful range and variety of the phenomena, and the endless ways in which these are arranged (and used). Migraine fascinates me in the same way as, say, London fascinates me. I see it as a sort of field or landscape, with innumerable aspects. My book is really a series of sketches, an album, which tries to picture some of these aspects. Having seen and thought a good deal more in the four years since it was written, I realize how inadequate it is; but I also realize that it could be a hundred times fuller, and would still fail to do justice to the subject. This sort of approach, in a quite fundamental sense, precludes simple definitions. Obviously one can “reduce” migraine and select certain aspects, and make a rough-and-ready definition: one has to do this for diagnostic purposes. But finally, one can’t “define” it any more than one can “define” London. One can only say—here are certain features, certain patterns, certain possibilities, a region of behaviour which overlaps with, and abuts upon, innumerable other regions. I didn’t fully realize or admit this in the book. I still had a notion, in 1967, that one could, as it were, peel off various accidental and adventitious features, and expose the “essence” or core of migraine. I stopped thinking this way when I read Wittgenstein’s beautiful and funny description of a man pulling the leaves of an artichoke in order to find the “essential” artichoke—and, of course, ending up with nothing at all. I do appreciate that one has to make a compromise between the actual and irreduceable complexity of biological phenomena, and practical, everyday needs. I may have got carried away somewhat, and probably should have put in a section on differential diagnosis, etc.
Obviously, the book could have been shorter and clearer and more succinct; but, equally obviously, it could have been longer and fuller. Like all books, it ended up as a sort of compromise. I selected 84 case-histories out of a much larger total. I could have put in 1200 case-histories, but then the book would have been about a million words in length! Again, I could have dwelt in much greater detail upon the analysis of a relatively small number of case-histories; but I feared that if I made the histories too detailed and circumstantial they might expose too much of the patient, and cause embarrassment to them (or their friends and relatives) by exposing intimate information. My preference is increasingly towards intensive rather than extensive studies, and in another book which I have in press (on post-encephalitic patients, and their reactions to l-DOPA, etc.) I do in fact confine myself to a handful of case-histories each several thousand words in length.
There are so many possible ways of writing a book, and every way has its advantages and disadvantages. But I would certainly alter my emphasis and discussion in various ways if ever the book runs into a second edition, and in this I will be helped very greatly by the comments of critics as thoughtful and perspicacious as yourself. I do thank you, once again, for a most valuable and constructive review.
With kindest regards,
Yours sincerely,
Oliver Sacks
* * *
—
OS had indeed written the first nine case histories of Awakenings in London two years before, during the summer of 1969, but then misplaced his “only” copy, as he was wont to do. At some point, however, he had given Jonathan Miller a carbon copy for safekeeping, and had then forgotten about it. By 1971, unbeknownst to OS, Miller had shown the copy to his neighbor Colin Haycraft, a renowned editor, who felt it was worth publishing.
To Colin Haycraft
Publisher and Editor in Chief, Gerald Duckworth & Co.
October 25, 1971
[New York]
Dear Mr. Haycroft [sic],
It was a very great pleasure meeting you last month, and an immense encouragement (and surprise) that you were interested by the case-histories I wrote in 1969. I am exceedingly sorry to be so tardy in replying to you—it has been most rude of me, and I don’t really know why I have been so slow. […]
My chief reason for holding back, though, is connected with the circumstantiality of the histories, and my fears that publishing such detailed information about living people might be distressing to them. A while ago I published a short letter in the Lancet (copy enclosed), which got released to Reuter’s and then to the daily press in England and the States, and I got very upset that the patient I described would see the thing and get very upset. Actually, I have found that my own scruples and fears, in this respect, greatly exceeded those of most of my patients—they are often quite happy, so it seems, to be the subject of a medical communication or memoir. I have spoken to most of the patients whose case-histories I gave you, and none of them have raised any special objections. I have wondered whether I should actually show them what I have written, but feel this would be unnecessary and maybe cruel. As you will gather, I have been struggling with my own ambivalence for the last month or so. Of all the things I have written, the case-histories are my favourite—the most vivid, and concrete, and real; and I think they combine scientific and human interest. My misgivings have been only with regard to the propriety or otherwise of publishing such intimate matter: it was due to such misgivings that I put the histories away in a drawer after writing them.
I have just been reading The Three Christs of Ypsilanti[*17]—I don’t know if you know the book—which may have some analogies to Awakenings, and which also caused the author considerable hesitancy about publishing. And Freud’s “Dora” analysis, which he put in a drawer for five years after writing!
I hope therefore that some of my conflicts being resolved, I can get on with the necessary revision and emendations which the histories require. My general feeling is that they should stay substantially as they are—despite some manifest errors—because they represent authentic first impressions undistorted by subsequent formulations. I will write relatively short summaries or epilogues bringing each case up to date—this is bound to add a rather tragic element to many of them, because in many cases the superb effects of the drug were not maintained, or otherwise compromised. […]
