This one’s for you if you’re fascinated about how the brain works, what makes us who we are, and how we change when things go wrong up there.
Sacks is a great storyteller. And he’s got some great stories to tell- from autism to epilepsy to dementia and everything in between. But he doesn’t make patient histories into stories to make them more interesting or easy to read. I think he does it to make a very powerful point. The human being that sits in front of a doctor is not defined by being a patient. They are not defined by their diagnosis. They are not defined by their group of symptoms. They are not defined by the things they cannot do. And neither are they defined by what they can do. We are defined by who were are, by our personal qualities, by how we interact with people and things, by our passions, our fears, and our past experiences. And that is what Sacks’ stories have taught me.
His story about a Tourette’s sufferer (quote below from p105), makes another interesting point. Particularly with neurological and psychiatric diseases, the symptoms can become a part of who you are, and therefore any change that treatment will bring about will require a period of adjustment.
People often debate if medicine is a science or an art. Most likely it requires both. But the final thing I learnt from Sacks was to shift your focus away from what someone cannot do. Think of what you could do to help them do it. Try to forget the accepted way of doing things, and try to do it or to see it your patient’s way. His exploration of some of his patients in this way often revealed talent for, or communication through, forms of art such as poetry, music and drawing (last 3 quotes).
“To restore the human subject at the centre- the suffering, afflicted, fighting, human subject- we must deepen a case history to a narrative or tale: only then do we have a ‘who’ as well as a ‘what’, a real person, a patient, in relation to a disease- in relation to the physical.” x
“You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all…Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing…(I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s…)” Luis Bunuel p25
“Jimmie both was and wasn’t aware of this deep, tragic loss in himself, loss of himself. (If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self- himself- he cannot know it, because he is no longer there to know it.)” p38
On proprioception which he describes as “unconscious sensory flow from the movable parts of our body”. In other words its how our body knows where the different bits of our body are at any one time.
“What is more important for us, at an elemental level, than the control, the owning and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought.” p47
“This “proprioception” is like the eyes of the body, the way the body sees itself. And if it goes, as it’s gone with me, it’s like the body’s blind. My body can’t “see” itself it it’s lost it’s eyes, right? So I have to watch it- be its eyes.” p52
“She has no words, no direct words, to describe this bereftness, this sensory darkness (or silence) akin to blindness or deafness. She has no words, and we lack words too. And society lacks words, and sympathy, for such states.” p55
“And who could have dreamed that in this blind, palsied woman, hidden away, inactivated, over-protected all her life, there lay the germ of an astonishing artistic sensibility (unsuspected by her, as by others) that would germinate and blossom into a rare and beautiful reality, after remaining dormant, blighted, for sixty years?” p68
“He had not been ready to give up his Tourette’s and (I cannot help thinking) might never have been ready without those three months of intense preparation, of tremendously hard and concentrated deep analysis and thought.” p105
“You are free, you have a natural balance: we must make the best of an artificial balance.” p107
“The clinic, the laboratory, the ward are all designed to restrain and focus behaviour, if not indeed to exclude it altogether. They are for a systematic and scientific neurology, reduced to fixed tests, and tasks, not for an open, naturalistic neurology. For this one must see the patient unselfconscious, unobserved, in the real world, wholly given over to the spur and play of every impulse, and one must oneself, the observer, be unobserved.” p128
On a similar note: Tests “only sow us deficits, they do not show us powers; they only show us puzzles and schemata, when we need to see music, narrative, play, a being conducting itself spontaneously in its own natural way.” p191
“The sudden onset of Irish songs in the night, the sudden activation of musical memory-traces in the cortex were, apparently, the consequence of a stroke, and as it resolved, so the songs ‘resolved’ too.” p141
“The forced reminiscence induced by L-Dopa, cortical probes, migraines, epileptics, crises, etc., would seem to be, primarily, an excitation; while the incontinently nostalgic reminiscence of old age, and sometimes of drunkenness, seems closer to a disinhibition and uncovering of archaic traces. All of these states can ‘release’ memory, and all of them can lead to a re-experience and re-enactment of the past.” p160
“She needed the world re-presented to her in verbal images, in language, and seemed to have little difficult following the metaphors and symbols of even quite deep poems, in striking contrast to her incapacity with simple propositions and instructions.” p188
Talking of patients with severe learning disabilities who may be “unable to perform fairly simple tasks involving perhaps four or five movements or procedures in sequence, can do these perfectly if they work to music- the sequence of movements they cannot hold as schemes being perfectly holdable as music, i.e. embedded in music.” p195
Talking of a patient with a learning disability “who found in the serene and magnificent architectonics of Bach a sensible manifestation of the ultimate harmony and order of the world, wholly inaccessible to him conceptually because of his intellectual limitations.” p214
“He can draw a flower or a fish with remarkable accuracy, but he ca also make one which is a personification, an emblem, a dream, or a joke. And the autistic are supposed to lack imagination, playfulness, art!” p242