Stark Dualities

I was struck by the theme of dramatic contrasts – embodied both in the environment and in the patients themselves - that came up throughout the book. In the section “Life at Mount Carmel” Sacks offers a romanticized picture of what the hospital once was, painting an idealized picture of a devoted staff and a pleasant surrounding countryside, before using the words “fortress or prison” to express what he felt the place had become. He admits that some staff members still exhibit a genuine affection, and his more profound point is that the institution is inevitably a melding of forces of good and evil. He states, “The hospital, in short, is a singular mixture, where freedom and bondage, warmth and coldness, human and mechanical, life and death, are locked together in perpetual combat” (25). He describes it as a place of constant contradiction, irresolvable in that the nature of an institution is impersonal, structured, and rigid, but the reality of the people that live and work there is one of human individuality, irregularity, and compassion. In his note on that page Sacks points out that “The coercions of institutions call forth and aggravate the coercions of their inmates: thus one may observe, with exemplary clarity, how the coerciveness of Mount Carmel aggravated neurotic and Parkinsonian tendencies in post-encephalitic patients; one may also observe, with equal clarity, how the ‘good’ aspects of Mount Carmel – its sympathy and humanity – reduced neurotic and Parkinsonian symptoms.” As I read the case studies the stark duality of the disease seemed prominent in most of the patients, as well as the impact environmental factors had, in conjunction with L-DOPA, on their awakenings.
One example is in the case of Frances D., who returned from a day-trip to the country, Sacks says, “in a most radiant mood, and exclaimed: ‘What a perfect day – so peaceful – I shall never forget it! It’s a joy to be alive on a day like this…It this is what L-DOPA can do, it’s an absolute blessing!’” (51). It was the drug that gave her the ability to control her movement again, but the change in her environment elicited her elated mood and new appreciation for being alive. Once back in the hospital, however, her uplifted mind and body collapsed into a peril equally as dramatic as her ecstatic state. Sacks states, “The following day saw the onset of the worst and most protracted crisis of Miss D.’s entire life,” and goes onto describe her physical torment that made up that crisis. It is as though once Frances D. had experienced the highest joys life could offer, her body felt the need to respond with equal negative force.
Hester Y. embodied another kind of harsh contrast in reaction to L-DOPA. While slow and largely motionless without the drug, once under its influence her movements became uncannily quick. In a note Sacks states, “It Mrs. Y., before L-DOPA, was the most impeded person I have ever seen, she became, on L-DOPA, the most accelerated person I have ever seen” (103). He goes on to describe her extremely accelerated reaction time, where she would catch a ball, count to ten, and throw it back, all in a split second. She did this, Sacks says, “without realizing she did it so fast.” Although the drug freed her limbs from their stupor, it accelerated not only her physicality but her mental actions to the extreme opposite end of the spectrum.
These kinds of harsh dualities seem to be a fundamental aspect of the sleeping-sickness and the effects of L-DOPA. Sack’s work highlights not only the of uncomfortable incongruity of institutions and this particular illness, but it also demands that we reflect upon the irresolvable contradictions we all face in our environments, and how we then embody them in our behavior.