Oliver Sacks: A Leg to Stand On
I love Sacks’ project, following Luria, of a “romantic science,” what we might now call “humanistic medicine.” His and Luria’s essays are some of my favorite and most memorable reading, ever. But there’s something that’s always puzzled and unsettled me about Sacks: I’m always left with the suspicion that he doesn’t have a lot of empathy for his patients. Now, I have no sense of Sacks as a clinician (I’ve never read a single thing he’s written for medical circles), and I’m not among those who criticize him for “exploiting” his patients as interesting stories to sell books with. Still, he uses a language of virility and health-as-virtue that doesn’t sit easily with his “romantic science” project for me.
The first hint of this for me is in “A Leg to Stand On,” with the curious disjunction between his articulateness in describing his own experiences and his compete unfamiliarity with the feeling of unexpected helplessness that comes with being a patient (“I wanted to pursue the point, but there was something in their tone and manner that made me desist. I felt curiously helpless…and I thought, ‘Is this what being a patient means?'” — pg. 47) Can he really be so surprised by this feeling after 15 years of working with patients? As a patient, I remember thinking that kind of thought before I was ten years old…surely one who puts such emphasis on the human side of medicine should understand this basic thing?
Yet he does understand something of the human side of medicine–the soul, the spirit, the whirling thoughts, the demotion of the reasoning faculty even in one such as him. When he’s narrating his stream of consciousness, it’s poignant, like in: “Secretly, half-skeptically, hesitantly, yearningly, I addressed myself to this unimaginable ‘Thou’ [of the Psalms].” (p. 115) I enjoy his meditations on Leibniz and Nietzsche and the Metaphysicals on the nature of the soul, and I even think those were the thoughts that were swirling in a learned head like his. And maybe Sacks has exaggerated his breezy sense of virility when he opines on things like, “I forged ahead, keeping up a brisk pace despite the gradient, blessing my energy and stamina…Strong quads, strong body, good wind, good stamina–I was grateful to Nature for endowing me well.” (p. 19) But he pulls these moves repeatedly: seeming to like his witty patients better (he talks in “The Man who Mistook…” about how he dreaded working with patients with MR), calling people simpletons in what doesn’t seem like just the normal language of the time, describing his own world in epic terms and relating his case histories with some of the air of a freak show, or at least an “interesting phenomenon” that offers a chance for Sacks to indulge in grandiose reflection. Sometimes I like those wildly speculative moves–but the ego behind them can drive me a little crazy. And the condescension he gets away with by applying it to himself too (his former self, his sick self, not the “real” one): He takes the healthy idea of a place to have a peaceful interlude before entering harsh reality again and makes it into something distasteful: “If we could not face the world, the world could not face us, with our lineaments, our habiliments, of sickness and affliction. We inspired horror and fear…and for the world’s sake, no less than our own, could not be let out.”
But there are little sympathetic moments. His description of the Convalescent Home is rich and profound in its new understanding of the community of patients, and he puts better than I many themes that I see recur in my own writing on patienthood. There’s his recollection of “the summer of 1938, [when] I discovered that the whorled florets were multiples of prime numbers, and I had such a vision of the order and beauty of the world as was to be a prototype of every scientific wonder and joy I was later to experience.” (p. 34) Or when he describes having the distinct feeling that the little tiny village church below was playing the Mozart Requiem as he thought he was dying, or when he ecstatically speculates, “I felt…that life was itself music, or consubstantial with music; that our living moving flesh, itself, was ‘solid’ music…was music, I wondered, the very score of life–the key, the promise, of renewed action and life?” (119)
The flights of intellect are dazzling–but only as character-pieces. A lot of the science is outdated, and the philosophy wrong: Hume doesn’t treat the self as nothing but a bundle of momentary impressions. We recognize many mental illnesses among the seemingly well now. No, in a sober state, we can’t say music is the key to health, though it makes some strong claims to centrality. Some of it is outdated through no fault of Sacks’: we have a much better neurological understanding of “free will” and ideomotor responses now. And for all the self-congratulation, there’s the childish sense of wonder, adventure and delight that lets us excuse it, brush it off as not posturing: when he hears back from Luria, we share his excitement and don’t notice the hubris: “If such a thing happens it can only be understood, and used. Perhaps it was your destiny to have the experience; certainly it is your duty now to understand and explore…Really you are opening and discovering a new field.” (197)
And finally, the beginnings of his journey towards a “romantic [neuro]science” is thrilling. Reading Head on the train and noticing the dual language of neurology and poetry (sequence/series/complex procedures vs. wholeness/completeness/ perfection/melody), Sacks’ memory of his father saying of Head “He was the most rigorous of scientists, but he was a poet too. He felt the music of movement and speech, but as a neurologist he could not explain it.” The conflicting passions for theory and life.
I don’t agree with the cult of experience (“you can only know what you’ve experienced,”) but if it made Sacks a better doctor, so much the better. The book ends with the beginning of a humbling and exciting journey for Sacks, back to the case studies of Weir Mitchell and around the margins of the neurological literature in search of the descriptions that are “known to hundreds of thousands of patients, but entirely unknown in the medical literature,” the “early days” that are unspoiled by concepts.
Sacks asks doctors to forget their neurological studies and terms for a moment, to pay attention to the singularity of patients’ descriptions in their own words. I love him for that. He is a little too quick to draw shaky metaphysical implications from his case studies; maybe he bends the stick too far; but his project is a sympathetic one, and it’s easy to cut him slack. I wouldn’t take this as good science–but it’s a good vision.
And there’s further reading in neuropsychology to be had in this vein. Noting that Luria and Head both were themselves the humanizing forces in their new neuropsychology (and their texts are still of the “mechanical” sort), Sacks goes further with the idea (as much Leontev’s and Zaporozhets’ as Luria’s) of the “science of doing,” observation in natural environments and the study of the whole system.
Sacks is disenchanted with a Hume he invents, one who sees nothing of the self or soul behind the perceptions. But this nonetheless leads him in wonderful directions, pursuing a “neurology of the soul” that takes on the existential questions too. I’ll get to his success in an empirical way later when I discuss the case histories in “The Man who Mistook his Wife for a Hat”–but for now, let’s leave with the exchange of “music is the solution!” between Sacks and Auden, and the universal image of a transformative ecstatic experience, having discovered new vistas, while stepping off the train with two bulky volumes under arm. We all have to find our ways to come back from that land of transformation and art to the quotidian of the living.
But for now, I’m off to discover Darwin the father in his Biography of an Infant and brush up on Kant and Hume to see how Sacks’ philosophy checks out. Might make a stop by Weir Mitchell too, and see what I can dig up on Auden and Sacks. Can always count on Sacks for an inspiring reading list.