Letters, p.36
Letters, page 36
One cannot hope (usually) for more than a very little recognition in one’s lifetime—one must have some, and I have had some, from those whose calibre makes their recognition double, trebly, crucially important. Being an original, and a sort of genius, in a field as hide-bound, as demented, as “Medicine,” (so brainwashed and “officialized” that it is absolutely nothing—neither Art, nor Science, nor Popular, nor Profound); it is a very difficult and isolating and anomalous position, especially for someone as unaggressive as myself; it comes to me, more and more clearly, that I must simply proceed in my own odd way (and my “oddness” is an essential aspect of my powers, and my feeling towards my work, my deepest sense of the mysterious, the enigmatic, and the essentially funny, and almost “crazy” quality of Nature and its “laws”—for, increasingly, I see the logic of Nature as like that of Alice, of Dreams, of Jokes, of Absurdity, of Fun: I think of Nature as essentially symbolic and playful, and not at all as a superficial and “square” Order-of-“Reason”): that I must proceed then, in my own very odd, idiosyncratic, and inimitable way, hope that I shall encounter a few understanding spirits, and inure myself to the predictable pig-headedness and bewilderment of my colleagues. And this, I think, is not really paranoid: I mean, it is not an attitude which stems from contempt, fear, or hate; but rather, the sad (but in some ways rather pleasant) realization that one has outgrown the majority of one’s colleagues and contemporaries, that one has transcended their powers of understanding or acceptance, and that (even if they mean well) it is no longer in their power to follow or recognize one in the higher and more recondite flights of one’s thought. Recognizing this, one is bound to feel an essential isolation and loneliness, but perhaps a diminution of bitterness and rage.
I have rattled on irresponsibly, egotistically, far too long.
I am dead-tired inside: I wish I could take about three months off—but damn it! I have no money, no freedom. I need about three months away from this horrible winter (there has been a gale and a snowstorm going on all this week—I feel it will last, without interruption, till the Spring). I long for some comfort, some release from the drudgery, I want to be comfortable, to recover my health, and to devote myself to the two books which are burning me up. And damn it! I can’t afford to. I can’t afford to, and yet I can’t afford not to. (I had some of this desperate feeling last year, and it was undoubtedly one of the reasons why I contrived to injure myself and have a creative “holiday” in hospital; but one can’t make a habit of that sort of thing—and besides, it’s regressive, it’s a cowardly way out.)
Oh, dear Bob, what does one do? I wish I had children, progeny, like you. My biological sterility and isolation dismays me. But then I have students—and readers.
Anyhow, my warmest best wishes to you for the Coming Year—I think it will be a good year for you, a year such as you deserve and need, and haven’t known for a very long time.
Love,
Oliver
* * *
—
The following correspondent, Bill Pearl, was a founder of the Tourette Syndrome Association, a group that had coalesced around a kitchen table in 1972 and consisted of perhaps a dozen parents of children with TS. The condition was then considered very rare—less than one hundred cases, it was thought, in the United States; and it was usually treated (unsuccessfully) with psychoanalysis. But, having observed similar repetitive tics and automatisms in his postencephalitic patients (and even “prehuman,” almost simian behaviors), OS intuited an organic basis for Tourette’s syndrome—and he soon observed that it was thousands of times more common than previously thought.
Tourette’s ranges widely in symptoms and severity, and the cases OS was seeing tended to be at the more severe end of the spectrum. This was particularly so for the patient with “super-Tourette’s” whom he had described to Luria. (OS referred to this patient in On the Move as “John P.,” so he is identified thus here.)
To Bill Pearl
Tourette Syndrome Association Founder
February 2, 1976
[No Address Given]
Dear Mr. Pearl,
You […] are lucky not to be in New York today: the worst storm in umpteen years, roads iced, traffic stalled, all life and business brought to a standstill. Mercifully, this is my one free day, so I can stay at home and catch up on my writing, my letters, etc.
[…] I think I have seen […] three “paths” in Tourette’s: “low-level” tics which are felt as ego-alien, and show no tendency to be mannerized, or moulded into and by the personality; extensive “linguistic” transformations of tics, to peculiar and almost hieroglyphic “private languages,” but without shivering [sic] the integrity of the personality as a whole […]; and, in some patients—though singularly few (as you yourself could not stress enough)—a massive breakdown of the whole personality. […] What is so remarkable is that more Tourette patients hold together despite the force and strangeness of their illness, and do not go mad, or shatter, or suicide. […]
I think one must allow, if only as a hypothesis, that in some patients the involuntary motions and noises and words may serve as “carriers” of meaning and feeling, may be pressed into use as peculiar symbolic languages, in which the symbols are movements, actions, enactments (as opposed, for example, to the phantasmagoric images of a dream). […]
I will say, in parenthesis (but again, you understand, this is only a hypothesis, or a thought—one of many such which pass through my mind) that such a business of extraordinarily rapid and vivid symbolization, with extreme condensation and multiple determination of the symbols, and extraordinarily facile (and, at times, jocular and playful) association, is extremely reminiscent of what Freud delineates as characteristic of dreams. Of course here, in contrast to the dreamer, the ticqueur is awake and not enclosed in sleep, he is reacting constantly to people and things and stimuli all round him as well as to constantly-erupting intrapsychic contents, and his “images” are not merely inner perceptions, but actions, enactments, which are open to view. And yet, I think the analogies to dreaming, and also to joking, are certainly useful, and perhaps fundamental. […]
We must also ask: is there anything else significant or strange, in the motions and noises and behaviour of ticqueurs, besides tantalizing similarities to the ordering of dreams and riddles and jokes and charades? […]
Going over some of the tapes of [John P.] last weekend, […] something which is scarcely credible emerges. We were playing over this bit of tape, Kennie Gospodinoff (Scheflen’s pupil) and myself, when Scheflen[*8] himself walked into the room. He exclaimed “Holy Mackerel!” and his mouth fell open; he felt, we all felt, that what we were seeing, in this brief interaction, was not human behaviour of any known sort, was not human at all, but essentially—simian. There have been “hints,” I have had “hunches,” but some of the tapes which I got last weekend, and some of [John’s] reactions and recollections, (when very delicately, very carefully, very tentatively, I brought this up in our session on Saturday—for this is not exactly the sort of thing which comes up, which has ever come up, with a patient), provide at least partial verification of this almost mind-boggling hypothesis: that there may remain in the human brain functional “traces” or “residues” of pre-human behaviours, and that these may become activated as atavisms under certain conditions. […] If one could demonstrate beyond doubt that such atavisms or “reversions” of behaviour can occur, and to pre-human (phylogenetically primitive) as opposed to infantile (ontogenetically primitive) patterns, this would be of momentous importance in various ways, from the standpoint of evolutionary theory and cerebral organization on the one hand, to questions of identity and social response and recognition, on the other (I will expand on this a little bit later). As I write I hear Darwin’s words in my mind, at the end of his famous chapter on “Reversion”: “The fertilized germ of one of the higher animals…is perhaps the most wonderful object in nature. But on the doctrine of reversion…the germ becomes a far more marvellous object, for, besides the visible changes which it undergoes, we must believe that it is crowded with invisible characters, proper to both sexes, to both the right and the left side of the body, and to a long line of male and female ancestors separated by hundreds or even thousands of generations from the present time; and these characters, like those written on paper with invisible ink, lie ready to be evolved whenever the organization is disturbed by certain known or unknown conditions.” […]
I have only had this feeling strongly once before, namely—in the summer of 1969, when my post-encephalitic patients were reacting so strongly, and in some cases so strangely, to the administration of l-DOPA. Jelliffe,[*9] fifty years ago, spoke of “menagerie” noises (barks, grunts, howls, etc.) as being among the strangest characteristics of certain patients in the context of an acute encephalitis or its aftermath. People who came to “Mount Carmel,” in that almost-incredible summer and fall of ’69, would cock up their ears when they heard certain sounds from our post-encephalitic ward above: “You keep animals up there?”, they would say “You have experimental animals? Or maybe pets?…Or is that the sound-track of a jungle movie?” […]
You may say: “But all this is very theoretical, you know—what bearing does it have on the lives of these patients?” I wish I could have shown you the videotape of [John P.] during certain “touchings” and “interactions” with his girl-friend in the room (I myself was out of the room, but the camera “saw,” the tape “remembered”). They have problems, like any young couple, but there are certain sorts of problems which would not occur with any other couple, problems whose occurrence has specifically to do with Tourette’s—or, more precisely, with the ever-changing composite picture produced by the dynamic interaction of this man with his illness. Thus some of the touchings and the “interactions” go wrong, because his speed, and over-reactivity, put the two of them “out of synchronization,” (like two pianists playing a duet at different speeds); some go wrong, secondly, because he suddenly presents a different “face,” a different “persona,” to her (for example, a sudden, rough “Marlon Brando” face-and-voice, a sudden crude “Waterfront” persona) in the middle of an otherwise consistent mutuality; the final, and most disquieting incongruity, is when he is suddenly seized by an apeish impulse, and presents an ape’s and not a man’s face. As you may imagine, these incongruities cause sudden bewilderment, laughter—and terror; and not only in her but in others as well; one cannot explore the phenomena here in isolation from their social and cultural context; one has to see the Tourette patient in society, to see how he reacts to others, and others to him.
And by others I mean not only human others: it is fascinating, for example, that [John P.] is always being attacked from behind by dogs; but that, on the other hand—and I must film this—he may cause an uproar when he goes to the Zoo, especially when he visits the Monkeys or Great Apes. When he goes into the Ape House, he feels very much “at home” in a mysterious way; involuntarily he “apes” the Apes, except it is not Imitation, but “Memory”; he instinctively knows, as it were, how an ape behaves, and communicates, and feels; and, acting apeishly, he excites the Great Apes, and they are suddenly taken aback, and gaze at him with a mixture of “recognition” and shock, as if sensing in him a long-lost “brother.” His descriptions of this are quite plausible and convincing; it would certainly be most important to record such an interaction on tape or film; for to deceive a human audience by animal imitations is one thing, but to deceive the animal species itself into a sort of spurious “recognition”—why, this is incredible, if so, and must be submitted to critical confirmation (or refutation). […]
To Jonathan Cole[*10]
Medical Student
March 21, 1976
11 Central Parkway, Mt. Vernon, NY
Dear Dr. Cole,
I thank you for your letter (your letters!) of February 27, and am sorry to be so long in replying.
I very much appreciate your generous response to my books, and feel grateful (and amazed!) that you should want to work with me.
My delay in replying is because I don’t know what to reply. But here, roughly, is my “situation”:
a) I don’t have a Department.
b) I am not in a Department.
c) I am a “gypsy,” and survive—rather marginally and precariously—on “odd jobs” here and there.
When I worked full-time at Beth Abraham (the “Mount Carmel” of Awakenings), I often had students spend some weeks with me for their “electives”—and this was an experience we would always find very pleasant and rewarding—I have the happiest memories of those far-off days.
But now I am, as it were, without any “position” or “base” or “home,” but peripatetic here and there, I can’t possibly offer any formal sort of teaching—or anything which could be formally “accredited” to you.
“Informally” (I sometimes think) I see and learn and do a great deal, with the extremely varied patients I see in various clinics and Homes, and every seeing-and-learning-and-doing situation is, eo ipso, a teaching situation. I find every patient I see, everywhere, vividly alive, interesting and rewarding; I have never seen a patient who didn’t teach me something new, or stir in me new feelings and new trains-of-thought; and I think that those who are with me in these situations share in, and contribute to, this sense of Adventure. (I regard all Neurology, everything, as a sort of Adventure!)
But it’s all entirely unorganized and impromptu—unorganized, that is, in any curricular sense. If you lived in New York, and could casually wander round with me here and there, you might find it an interesting and novel experience (or, then again, you might find it frankly intolerable!). But I couldn’t possibly advise you to come from London to go on Neurological tramps with a Tramp like me—and I am a Tramp, a Gypsy, a Nomad, and not (as you seem to think) a Head of Department! If you worked with someone else (who did have a Department and all that goes with this) then you might “drop over” from time to time.
But, you see, I have all the disadvantages, as I have all the advantages, of being a Non-Establishment, Non-Established, person—I rove freely and widely; I spend as long as I want with any patient I want; but I have no Department, no courses, no colleagues, no help, no “position” (and for good measure no “security,” and almost no “means”).
There! I have said much too much, but it will do no harm (and may amuse you) if I acknowledge and “confess” how things are; it is doubtless indiscreet—on the other hand, it is candid.
Enough (or, most probably, much too much) said—
I’m sorry I didn’t reply before, but (as you see) any candid reply had to involve, amongst other things, a certain embarrassment.
Do write and let me know how things work out with you—once again, I would be delighted to see you in an informal, casual, peripatetic way, but I am in no sense “set up” for any formal teaching whatever.
With best wishes—and thanks,
Oliver Sacks
To Paul S. Papavasiliou[*11]
Physician
March 30, 1976
11 Central Parkway, Mt. Vernon, NY
Dear Dr. Papavasiliou,
[…] I am (finally!) writing to you this morning, in the aftermath of a phone-call from a patient of mine, a very nice woman who was almost “terminally” Parkinsonian when I saw her in October, but is now doing absolutely beautifully on Sinemet,[*12] and enjoying such a renewal of life as would have been absolutely inconceivable in pre-DOPA days.
First and foremost, I owe you both a belated apology, and a belated expression of appreciation and admiration. […]
You said, very candidly and disarmingly, that you could scarcely proceed with your own bold work if you were beset by the sort of doubts which I had; that you had to be optimistic in order to be—a Conquistador. I appreciate this perfectly, and I do think of you (and your colleagues) as Conquistadors, patient, ingenious, dauntless Adventurers into the realm of the great chemical Unknown. I appreciate this if only because I am also a Conquistador—altho’ a different sort of Adventurer in a different sort of Unknown. The Conquistador cannot be plagued by doubts—his Endeavour, his Enterprise, would be undermined by these. But doubt is needed, no question of this: constant, critical, sceptical questioning, questioning of all reported (purported) “observations,” all modes of measurement and observation, all the specific assumptions which are made, and all the general, underlying, intellectual and emotional attitudes. Someone has to question these, vigilantly, disinterestedly, someone who has no special “interest” or “animus” in the matter; and, willy-nilly, (the matter was not of my choosing) it has partly fallen to me to be such a Questioner. I think you recognized this when we were able to speak, more genially, over dinner, when you said (the highest compliment from a practical man), “I see you are also a useful man, Dr. Sacks.” This pleased me more than anything else!
We are, in a way, different species of Scientist—you represent the bold, questing, enterprising Adventurer, and I the cautious, careful, critical Doubter; and yet we are also two sides of the same coin—for the very words “Quest” (question) and “Wonder” are two-faced; questing and wondering are adventurous and affirmative, but they also turn inwards, and look at themselves, testing the foundation on which they are reared.
