At the risk of sounding grandiose and overserious, I have to say that I found Awakenings to be an important reminder of human frailty and of the inscrutable power of nature. I felt the temptation, again and again, to identify with the post-encephalitic patients. And I do believe that there’s an element of the universal in their stories. One can see their constellations of symptoms printed in miniature within oneself. Dr. Sacks’s patients make one heedful of the mysterious, extreme, and sometimes terrifying potentialities of the human mind.
I suspect that, in tomorrow’s discussion, concern will be voiced about Dr. Sacks’s approach to the case history--about his style and voice, about the strong presence of his personality and his idiosyncrasies in the studies, about the boldness of some of his assertions, about his willingness to go beyond the outward and observable to the inward and intuitive. I would argue that what one may misconstrue as strange and excessive in the histories is in fact essential to the work of doctors, especially those, like psychiatrists and neurologists, who aim to treat the mind. And it is essential to all of us who seek to study and understand the mind. How often I’ve gone to my physician with a nebulous complaint, with the feeling that something is wrong and only a rough assemblage of seemingly unrelated symptoms as data from which the doctor can make deductions. Either I’m hysterical, or there is a kind of data to which the doctor’s ears and eyes are insensible. That is the data that Sacks takes into account, and that is principally what distinguishes these case histories.
A secondary distinction of his writing and clinical work is care. Care need not be sentimental, invasive, warm or fuzzy. Care cannot, however, be alive and energetic between doctor and patient, if their relationship is sterile and unequal. I want medical implements and facilities to be sterile, but my relation to the doctor and his to me ought to be based on sympathy and equality. Sacks understands that statistics and models and infinitesimally precise adjustments in the dosage of medications, though helpful, can never be adequate substitutes for humane sensitivity and thoughtful judgment, for humane consideration of the whole experience of the patient and of the patient as a whole person. I do not want to minimize the necessity of rigorous science and empirical data, but I want to emphasize the importance of generating abstract possibilities from those data with the aid of intuition and creativity, the importance of shifting one’s gaze from the specific to the universal and then back.
In the extremity of these patients’ situations the common substrate of human mental life is exposed. Sacks speaks in impassioned tones of Frances D.’s “releases or exposures or disclosures or confessions of very deep and ancient parts of herself, monstrous creatures from her unconscious and from unimaginable physiological depths below the unconscious, pre-historic and perhaps prehuman landscapes whose features were at once strange to her, yet mysteriously familiar, in the manner of certain dreams,” of “entire behaviours, entire repertoires, of a most primitive and prehuman sort.” He writes, “What we see here are genuine ancestral instincts and behaviours which have been summoned from the depths, the phylogenetic depths which all of us still carry in our persons.” This is Jung’s collective unconscious. According to Jung, and according to Sacks, we hold the same explosive potentialities.
But these case histories also reveal how thoroughly individual we all are. Consider the endless range of patients’ particular experiences of Parkinson’s, and the infinite variability of their responses to L-DOPA. How much of what we call individuality has a biological basis in the brain? That’s the first question I hope to explore tomorrow. Another pressing question has to do with Sacks’s hints and gestures as to what these cases might tell us about the use of psychoactive medications generally. He repeatedly suggests, alarmingly, that patients’ patterns of response to L-DOPA mirror the brain’s standard response to chemical interference in the form of medication (see p. 252). If Sacks is right, what does this augur for the multitudes who daily take medications for ADHD, depression, anxiety, sleeping troubles, etc.? Need we be afraid?
I apologize for the length of my post--I just really loved Sacks--and promise to be more succinct next time.
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ReplyDeleteStuart, I am in strong agreement with you on every point but one; I think you might overestimate our class’s collective concern over Sacks’ seeming anti-rational approach. We are, after all, as much (if not more so) a collection of artists and writers as we are burgeoning scientists and psychologists. A humanizing process moves my sympathies much more easily than an empirical one, and I suspect that I am not alone in this. Like you, I feel that there is something powerful and necessary in both Sacks’ method and his writing style. The way he humanizes his patients should resonate as profoundly right for anyone who has not sacrificed all empathetic ability as irreconcilable with the scientific method. Perhaps I make my argument too forcefully, but given the intolerant and hypocritical (I say hypocritical because the medical and scientific communities claim to rely on empirical data, yet reject complicating results from a doctor who has his patients’ best interests at heart) response to his findings that Sacks describes in his foreword, I cannot help but think that to take issue with Sacks’ style is to side with an outmoded and even poisonous model of thinking. Sacks is like a William Blake (I know you’ll appreciate this reference, Stuart) who calls out the self-serving Royal Society types that hide behind the veneer of rationalism, insisting that they see how the system they built is broken, how children choke on soot to clean their chimneys or people languish in semi-catatonic states for five decades without any research done to help them. I see a dichotomy with Sacks and humane medicine on one side and prison-like hospitals with their uninterested or fearful administrators and the unavailable, unconcerned scientific community — still blinded by the Enlightenment — on the other. What kind of sense does it make when the people who discovered mirror neurons won’t allow the intuitive observations of a talented doctor to contribute to the collective well of medical information, even though their discoveries have proved that this form of observation is just as real as sight and hearing, though less easily quantifiable?
ReplyDeleteI think I have allowed my strong emotional reaction to Sacks’ writing to color my argument, but if anyone disagrees with me, as I hope someone will, perhaps this will make for more animated discussion.
Re: "Consider the endless range of patients’ particular experiences of Parkinson’s, and the infinite variability of their responses to L-DOPA. How much of what we call individuality has a biological basis in the brain?"
ReplyDeleteYes, there is a lot of material to talk about in class regarding this question. LeDoux provides some insight, although he admits that there is not yet enough of an understanding of the brain to fully support "a complete synaptic theory of personality (p.3)"- but it is a starting point. I subscribe to the common belief that both nature and nurture play an equal part in shaping our "selves", however, LeDoux takes this concept a step further: he describes nature and nurture as "speaking the same language. They both ultimately achieve their mental and behavioral effects by shaping the synaptic organization of the brain. The.. patterns of synaptic connections in an individual's brain... are the keys to who that person is (p.3)."
I think an interesting point to address is why there is an appeal to rely solely upon sterile and mechanical statistics. I do believe that for many individuals, such a constrained but predictable (at least, ostensibly so) analysis appears safer, inasmuch as it is more contained and definite. The integrative approach of both humanistic and mechanistic observation or analysis may be frightening in the implication that not one method laone is correct, and thus neither may be able to explain every aspect of a given case. Uncertainty is very terrifying, and the matter by which statistics seem to ameliorate this fear might provide a key into understanding why certain analysts (and laypeople!) adhere so vehemently to them.
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