Letters, p.41
Letters, page 41
Interesting too that Harvey could never complete or publish it, even though he lived another thirty-plus years, and retained his extraordinary powers to the end. It is perhaps essential in the subject that he (one) could discover and articulate the Circulation, a closed Circuit; but not Animal Motion, which, whatever circuits and nerve-circles it contains, is ultimately open, and “inspired,” and stamped by grace—which is not the case with an automatic, largely-mechanical motion like the heart’s.
Talking about Latin, I find in Chambers Common Quotations at the end: “Solvitur ambulando: the problem of reality of motion is solved by walking, by actual performance.” This could almost be the motto of my book—I have felt this, again, quite overwhelmingly this week, where the problems involved in the nature of motion, and ambulation, when I took my first walk on Sept 11, ’74 were solved (at least, in many fundamentals) precisely four years later—by a recollection of that first walk as vivid as the original: in general it is only by such re-plays, “playing” the experience over and over again, that I can and do solve problems. I must be faithful to the original experience and, if necessary, repeat it, as nearly as I can, again and again—otherwise I am apt to get lost in abstraction. Can you tell me where this tag comes from—who said it, and in what context, etc.?
In the same week as I was reading Harvey, about a month ago, I was also reading a book by Babinski[*9]—and a whole lot of Simone Weil[*10]—which would seem very heterogeneous and arbitrary, but made a lot of inner sense for me. Babinski was an extremely eminent, world-renowned neurologist, which makes the whole business even curiouser. This was a book stemming from his experiences in WW I—and is entirely devoted to delineating a “third realm of disorder—neither attributable to organic lesions nor to hysteria,” what he calls the “syndrome physiopathique,” as a not-uncommon, often devastating, but (provided it is properly understood and treated) essentially benign neuropsychological syndrome arising from shock and reflex changes in the spinal cord and brain, following peripheral injury on the battlefield. The original library label was pasted in the book. I observed that it had been taken out in 1918 (when it was first published), 1937, 1955, and by myself, 1978—just four times in sixty years! Here is a readable, at times racy book, on an extremely important subject, by a world-renowned neurologist, and it seemingly became, from the moment of publication, one of the least read books in the world! This is exactly what happened with Weir Mitchell’s great account in the Civil War (1864), and Leont’ev/Luria in WW II (1944). I mentioned this to you last November, and finding Babinski’s book—not easy because there were no references, no clues, to lead me to it—has completed my “series” of these bizarre “over-lookings.” Perhaps there are others, from other wards: but it seems to need an extraordinary situation—with large numbers of emergencies and wounded people, and a rare atmosphere of passionate honesty and concern—to break the barrier, and allow some seeing, some insight. But then, as soon as the situation, the War, the atmosphere of rare concern is over, everything is forgotten—as if it never happened. I cannot help compare this with the situation in epidemics, for example, that of encephalitis lethargica: the huge scale of this, the insights achieved, the sense of pressing and fundamental importance and then, everything forgotten within five years. My discoveries, my detections, are not of anything new—but of what is always around, but nearly always overlooked. […]
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ADDENDUM Sept 22.
I wrote this letter last Friday and perhaps should have posted it then (or, alternatively, have destroyed it, as extravagant). I have felt miserable this last week, undone, and have been quite unable to write anything (and want to undo everything—letters, book-writing, etc. previously done, a temptation or compulsion I will do my best to resist). What has shaken me has been one real calamity (which perhaps has had neurotic resonances), and one nasty neurotic mischief (of a sort to which I am particularly vulnerable). The real sadness is over a cousin of mine here, about my own age, who is very dear to me[*11]—an immensely gifted and articulate woman who had a stroke last Friday night, and is now completely mute and aphasic.[*12] Absolutely clear and lucid in all other ways, but completely without any language or speech. It is too early to say whether there will be recovery, or how much. She had a sort of forewarning, quite explicit, and said to me a couple of weeks ago, “I’m headed for a stroke. These headaches are real—there’s something going on in my head,” and is now so frantic, and anguished, and angry, that she yells all day, like a damned soul in Hell. I think there is nothing more unbearable than aphasia for someone greatly gifted in language, who lives in a language-world. Perhaps the neurotic element is the sense of identification with her (so I keep having nightmares that I am aphasic, the terrible sort of identification which happens with family relationships, and though she was only a cousin, she was very close indeed—in effect, my “family” in New York), and an awful feeling of accusation (which, quite unfairly, gets inflected inwards), because I feel that her headaches, which were real, all too real, and due (one now sees) to the stretching of blood vessels in a cerebral angioma, were dismissed as “nothing” by her doctors, her neurologists. So the feeling that this whole thing is partly the result of neglect, and might have been avoided by proper attention, the feeling of the “bad” negligent, mindless-heartless doctor, and the feeling of the wretched, hopeless, patient “victim” both enter and alternate in my mind, even though I am not her doctor, and even though I went to much trouble to try and get the best neurologists for her as soon as she mentioned the headaches to me. But by a series of mishaps, the “good” doctors were all away, or had left New York, and she fell into the hands of some “bad” ones.
I suppose it is just this theme, of feeling-falling helplessly or neurotically into the hands of “bad” doctors,[*13] which has clouded my feelings about the Leg book and experience: the feeling which must be transcended, or distanced, if I am to write a good and graceful-grateful-gracious book, and not a silly-hateful-vicious one. But I have been unable to write anything for the last week, because the hateful feelings have been re-activated, partly by what has happened with Madeline. […]
To Robert Katzman
Neurologist[*14]
October 9, 1978
[No Address Given]
Dear Bob,
In view of the strike last week I saw [Mrs. M., a patient, and her husband] at length here—in my place.
I feel I should see her briefly, frequently, and regularly—say weekly: briefly, because as her central functions fade, they become more and more labile and fatiguable, and as I saw very clearly, her state changes radically, even catastrophically, with fatigue and stress: there is the most enormous difference between her “fresh” and “fatigued” (perhaps there is some chemical basis for this); frequently, because she is losing ground so rapidly: she was markedly worse, almost frighteningly so, since I had gone over her at the end of July and the march of the disease, in her case, is so rapid that it is detectable almost every week; and regularly, because only with this can the requisite support and centreing be provided—if, indeed, it can be provided at all.
The phrase “losing one’s mind” takes on a fearful and literal significance here—as the mental machinery falls apart, fades, dissolves, before one’s eyes. It comes to me […] that I may, so to speak, have to make a study of dying, a meticulous investigation of the dissolution of every cerebromental function, a most relentless and rapid disintegration. I have the sense that one could learn an enormous amount this way—and, so to speak, in a most accelerated way, seeing the immense elaboration of cognitive and mental functions reduced from intactness to non-sentience in little more than a year—as I think happens in the more rapid and malignant forms of “Alzheimer’s.”
As to what can be done by way of maintaining, restoring, substituting, or strengthening such rapidly-dissolving functions and functional systems, I am not too sanguine. Even in the last six weeks, the loss of abstract thinking, of logic, and language, and “quasi-spatial” schemata has been so great in this patient that I am not sure that any “algorithmic” approach would hold up. By contrast, her “concrete” powers and judgements—getting the “feel” of a situation or picture, its “mood,” its “meaning,” its intrinsic-expressive significance as opposed to the deciphering of its details and signs, are very well preserved. It seems to me particularly important to observe what sorts of things she can recognize and “hold,” and what sorts of things she is so rapidly losing; and how a sort of intuitive-aesthetic-feeling cognition is preserved, while her analytic-abstract (re)cognitions are so rapidly eroded.
The gentlest attempts to examine abstract functions—not really a formal “testing” at all—tended to provoke or bring out immediate failures, which she felt as mortifying, and which provoked extreme anguish and anxiety. At the end of July, she was able to put the numbers—or some numbers—in a clock,[*15] although their alignment was poor: on Friday, with the clock in front of her, she made smidges instead of figures, apparently not realizing what she was doing. When I drew her attention to this, she was profoundly shocked, mortified; she became quite ashen, and trembled, and said, “Am I that far gone?” I couldn’t help sharing her horror to some degree.
The consciousness of mental failure, loss, dissolution, impotence, of an ever-greater and hopeless sort, seems to me, at least with this patient (and her husband) to carry an affect of horror beyond that of any “physical” illness. The sense of humiliation, of degradation, is much greater—especially as this was a woman of superior abilities, who prided herself on her wit, her judgement, her good memory, etc., and who was outstandingly self-reliant and independent.
I am rambling—I suppose I am not sure of the point. I think I want to say that this may be an extremely grim, and even ghastly, sort of study. This is not to say that a minute study of the dying of a mind may not be of the greatest value and interest. But it is a study of something terrible—and there is terror entailed. I am not sure how far one can be “objective” and “unconcerned,” how far one can separate the cognitive and the affective, any more than the patient can.
For myself, without being “hard,” I have been watching mental decline and dissolution, in the largely geriatric populations I work with, for the last dozen years—and can “take” the feelings, combining concern with detachment. But this may be very hard on the patients, and even more on their families—and one scarcely knows whether to encourage a sort of “fighting-back,” a fighting-to-hold-on despite the certainty of steady losing and defeat—or to encourage a sort of “abdication” and resignation. The indifference (and/or denial) which Joshua[*16] shows seems to me atypical. I do not think that Alzheimer-patients are (in general) protected by a merciful blindness or oblivion, any more than most MS patients become “euphoric.” But perhaps I am over-reacting to one patient, and obviously I need to see at least a dozen more.
Mrs. M. will be seeing Jack Wilder[*17] this week, and he will undertake—I gather—whatever psychiatric support and other measures he feels needed. I have to find some sort of balance myself between the coolness of an Investigator and the warmth of a Physician. I hope I can. Her baseline is changing so rapidly that choline, if it works at all, will have to be rather fast and dramatic. […]
Forgive an overlong, and not too coherent letter.
To Mrs. Miller
Physiotherapist[*18]
November 27, 1978
11 Central Parkway, Mt. Vernon, NY
Dear Mrs. Miller,
I cannot refrain from dropping you a short note to say what a special pleasure it was seeing you again this month.
It is a curious—and significant—feeling re-encountering, at a different time, and in a quite different capacity, someone who was most significant to one at an earlier time in one’s life. There is no doubt—I cannot put my appreciation strongly enough—that you helped (pushed, bullied!) me through a most important time of disability, regression and dependence to independent function—and, no less, independence of spirit again. There is an erectness of spirit which goes with erectness of gait, as an abjection of spirit goes with an abjection of gait. It is this combined physical-moral correspondence which I hope specially to bring out in my book (A Leg to Stand On). The experience has continued to be of the utmost importance—really, my whole orientation has been changed since the experience: I listen to patients as I never did before, try to enter into their feelings and predicaments, and feel Rehabilitation is the most glorious thing in the world. I have little sympathy or contact with my colleagues, bye and large, but have found great pleasure (and spectacular results!) from working closely in these last four years with all my colleagues in Rehabilitation: physiotherapists, occupational therapists, speech therapists, music therapists, dance therapists, drama therapists—you name it. I think that you—all of you—have a depth of understanding about what the patient goes through and must go through, which (on the whole) is denied to physicians (except some rare ones, like Mr. Scott, who had himself been “through it”). One is never the same after one has been a patient oneself. It teaches one as nothing else can: at least if one lets it.
As I mentioned, I have seen dozens, scores, literally hundreds of patients since with various problems of limb “neglect” and dis/mis-use, sometimes on central, sometimes on peripheral bases, as well as scores of amputees. I could not have begun to understand their problems, and the challenges of Rehabilitating them, had it not been for my own experience—and the crucial work with you. […]
I hope you can visit New York when you are here—if not professionally, then just on a visit. I would love to take you round some of the patients I see—and introduce you to some of the fine therapists and “physiatrists” I know and work with here. So, a letter of encouragement—and, again I meant to write two lines, and have written two pages! Brevity has never been a quality of mine! Do write, please, at your convenience, and let me know what is happening with you. […] Again, my deepest thanks for all you did for and with me in ’74.
With kindest regards,
Oliver Sacks, M.D.
To F. Robert Rodman
December 19, 1978
11 Central Parkway, Mt. Vernon, NY
Dear Bob,
[…] I shouldn’t have started to write—perhaps I am not in a (letter) writing mood: I feel rather ill and sickish and distracted and distressed, especially after a phone call from my father this evening […] saying that my aunt[*19] is back in hospital, and sinking. She never recovered after her operation, which was a terrible evisceration almost—which would have taxed a youthful constitution, and was murder, in a sense, in a frail body of 87, and, damnably, was a consequence of the hospital strike, which postponed her surgery (and that of countless thousand others) at the time when it was elective and proper, [until] she had to have a partial gastrectomy, splenectomy and hemicolectomy, evisceration. I suppose I am mourning, in advance: I had concealed from myself the seriousness of all this; the feelings broke out, before I got the news of her readmission to hospital, when I heard the “Lamentations” of Zelenka last week—and perhaps some (all?) of what I said about Lamenting and Resenting had more reference to this (and my) “situation”—rather than yours. What could be more different than losing an aged aunt—and a young woman whom one loves?[*20] Between the going-away of Death, and the going-away of Abandonment. And yet, they are united (surely) in the dynamics, the universals, of Love and Loss—of Grief and Grievance, in an elevated and noble Mourning, and a lowering and “ignoble” ranting “How can she leave me like this? How can she go away? How dare she! I shan’t allow it!!” (etc.) All what you say about that enraged, outraged, sense of omnipotence.
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In a very important, a decisive way, I think my aunt was sanity-saving, life-saving, during the deathliest period of my life, between the ages of six and nine, when I was “sent away” by my parents, into a prison-like school. The affect and symbolism of this “abandonment,” and this “imprisonment,” have dominated much of my (unconscious) life, perhaps in a way both creative and destructive. At this time, when I must have approached, if not entered, an almost-autistic state, my aunt was the only one who unmistakably cared, and whose love was practical, and embedded in action: in particular, her opening to me, during the holidays, her school[*21]—a remarkable one which she had founded and built, from first to last; and which was centred around the Symbols and realities of “Home,” “Openness” (it lay in a forest, open to the forest in all directions, and yet not exposed, but protected and cosy; but with great windows which showed vistas in every direction, and doors that gave free ingress and egress). Do you know that lovely definition of “Home” which Auden quotes: “Home, as you may or may not know, is the only place where you go out and in. There are places you can go into, and places you can go out of; but the one place, if you do but find it, where you may go out and in both, is home.” Home, Openness-Spaciousness—and Enclosure (so close to, yet absolutely different from, Closed-in-ness or Shut-up-ness). The enclosures were little gardens—a little square given fully and freely to each pupil, in which he could grow and culture and cultivate what he wished (always, of course, within the limits of Nature and Necessity, and a domain of limited area). These little gardens were playthings, play-grounds, meeting-grounds, and—potentially—works of art, where infinitudes could be explored within the finitude of a few square feet. […] What you say about “that overlapping area between oneself and others, the location of Cultural Experience,” brings poignantly to my mind the Garden-of-gardens[*22] in Delamere: where we were, at once, individuals yet together, not fused, not crowded, but in that wonder-realm, play-realm,[*23] which can accommodate us all, commodiousness enough for every creature in the Universe, and yet so intimate that in it they become fellow creatures. […]
