Sunday, January 25, 2009
Oh, sweet humanity.
In my opinion, the case of Frances D. yielded its most fascinating insights in the footnotes. I was particularly intrigued by what Sacks referred to as the “second awakening”, ie the surfacing of primal human urges and characteristics over the course of taking L-DOPA, and the description of the mitigating effects that things like human contact, music, and internal rituals had on patients’ side-effects. These two happenings seem strangely intertwined, though they are intrinsically opposed (indeed, an unintentional Parkinsonian reference), that is, one having to do with the arrival of adverse reactions to L-DOPA and the other with combating those reactions. However, though they address opposing sides of the same issues, they both belong to the same sort of sub-element that subtly pervades all of Sacks’ observations; the innate humanness of his patients. Both the involuntary teeth-gnashing and the normalizing effect of a human touch are very human tendencies, albeit from very different sides of the spectrum. Sacks refers to the former as “genuine ancestral instincts and behaviours which have been summoned from the depths, the phylogenetic depths which all of us still carry in our persons” (Sacks 55-56), while the latter is a more familiar phenomenon that one does not necessarily associate with disease. Clearly, these are two very different descriptions of human behavior. Nevertheless, they both refer to a part of the person not affected by drugs, though the drugs may activate it. The strength of the primitive behaviors is such that they are uncontrollable and totally involuntary, while on the other side the strength of willpower and self-manipulation is such that it can raise a frozen man from a wheelchair. How different are these types of power? How different are their sources? Are they simply varying manifestations of the same thing? These are questions I found myself considering after reading the case of Frances D, and other case studies. I admire Sacks for deliberately permeating his book with reminders of humanity shown from all sides, and not simply attributing all successes and failures to interactions between the disease and the drug. Though obviously, discussions on human vitality caused by L-DOPA are also necessary; such as in the cases of Magda B and Rose R, which saw tremendous increases in personality and vivacity after the patients started on the drug. However, the unavoidable adverse effects were often worse than the original symptoms, creating an anguished impasse for the patient. I often found myself torn, while reading these cases, as to whether I myself would continue taking the drug. The vivacity granted by it is no small thing, yet I have difficulty imagining a life in those circumstances in the first place, which makes me an unfit judge. The most frightening part about their conditions was that it did not affect distinct parts of the body or the mind, but rather settled over the entire being like a fog. Within the fog a person may find clear patches through which they may speak, move, or think, but these patterns were unpredictable and thus unreliable. Their seemed to be no respite from full disability. So however brief the remission was, it was uplifting to know that a happy interlude existed between periods of crushing illness; that the patients could feel human once more.
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Re: “I was particularly intrigued by what Sacks referred to as the “second awakening”… and the mitigating effects that things like… music… had on patients’ side-effects.”
ReplyDeleteI’m an advocate for music therapy, so I, too, was interested to read Sacks’ description of Frances D’s reaction to music during her crises: “One minute would see Miss D. compressed, clenched and blocked, or jerking, ticking and jabbering – like a sort of human bomb; the next, with the sound of music from a wireless or a gramophone, the complete disappearance of all these obstructive-explosive phenomena and their replacement by a blissful ease and flow of movement as Miss D… smilingly ‘conducted’ the music, and rose and danced to it.” It is fascinating and puzzling that only legato sound would have this effect. Conversely, staccato music would bring Francis D into a state of jerking “like a mechanical doll or marionette.”
I too appreciated the humanity interwoven throughout each case study. I noticed that because of the purposeful inclusions of both medical jargon and humanistic elements, Awakenings is accessible to the “average” reader. The reader is able to grasp each case on both an intellectual and personal level. I would say that there are some fictional qualities to the case studies when Sacks interjects descriptive adjectives and his opinions on how each person must have been feeling. However, in my opinion these somewhat fictionalized components add interest and weight, not superficiality and fill in the blanks that would otherwise make it purely scientific. In doing so, the lines between the medical terms, journal entries, personal commentary, and observations become blurred and through it all, the reader is able to see the individuals as human beings. In particular, I noticed that Sacks makes an effort to point out that underneath the oculogyric crises, tendencies to freeze and speed up, tics, paranoia, and respiratory problems among other symptoms, inside, these people have a certain self awareness that was not immediately obvious to the naked eye.
ReplyDeleteSacks makes sure to include conversations between him and the patients as well as specific journal entries that contain evidence of their awareness. It becomes clear to the reader that this disease totally takes over the patients and although they feel as if they can stop the outbursts and fits, they usually have no control. Miriam H. reacted to L-DOPA at one point “with sudden violent screaming” (130). She states that ‘It was as if something built up and suddenly burst out of me. Sometimes I didn’t feel that I myself was screaming; I used to feel that it was something apart from me, something not controlled by me, which was doing the screaming’ (130). Rose R. experienced a “nostalgic state” where she would only speak of people and occurrences of 1926 when it was really 1969. Sacks asks her some questions wondering if she knows who and where she is. ‘She knew perfectly well that it was 1969 and that she was sixty-four years old, but that she felt that it was 1926 and she was twenty-one. Both Rose R. and Miriam H. are aware of themselves, but cannot help and control their thought processes and movements. Ironically, Sacks’ approach was not merely a medical one, in order to truly understand the patients’ disease, he had to look beyond the obvious and take time to observe their personal emotional journeys. This makes for interesting reading because it is as if Sacks was trying to put together a jigsaw puzzle. There were so many different aspects to this disease and Sacks makes sure to address them all.
I am intrigued by this concept of the patient’s “phylogenetic depths” in relation to the patient’s “biological time” and understanding of space and scale. Sack’s discusses Frances D. as completely lacking any sort of normal internal clock, hindering her ability to gage distances between steps, paces of breathing, and most other forms of space relations between her body and her environment.
ReplyDeleteI am curious as to wether this lack of ‘biological clock’ effects the patients comprehension of age and the passage of time. A great deal of the patients “lost” upwards of 30 years in their catatonic state and awoke at physically a new age, yet some of the patients (i.e Rolando P., Rose R., and Lucy K.) seem to have awakened mentally at a very conflicted age; nostalgic for their “alive” years (Rose R.) or unable to move beyond their adolescent desires (Roland P. is described as containing the “mind of a man with the needs of an infant” as he was struck with Parkinsonian symptoms at three years of age.) While a number of patients are deeply effected by this concept of the passage of time, Magda B. seems to be without a sense of nostalgia or immense lost. She accepts her “former identity” and assumes “the mantle of old age and grannie-hood despite having dropped as though a vacuum, from her mid twenties to her late sixties (pg. 72).” How does the patient possibly update their mental state upon awakening? Is a patients “internal clock” skewed to the extent of dissociation from their mental understanding of age?
While I very much appreciated the narrative, humanistic approach Sacks took within the book/case studies(and, certainly, it's a narrative disease, almost fairytale-like in quality- the sleeping princess, the magic potion, the sense of continual transformation),I would have loved it placed parallel to a more... biological approach to understanding the disease?
ReplyDeletePerhaps this is due to the coherent, honest account LeDoux provided on his conception of how personality related to the brain. The intermingling of biological and experiential to reveal that, ultimately, the two can ultimately be fused into one. As such, I was left hungry for the same sort of clear-headed explanation that would allow for a more developed understanding of the step-by-step neurological processes brought upon by the sleeping sickness, and the introduction of L-DOPA. This would also, I presume, give some indication as to the individual nature of the disease-why there was such variation in the patients' experiences. Hopefully this will be provided in class?