Tangible Metaphors

What struck me the most about the cases presented throughout “Awakenings” was the unmistakably metaphoric nature of each post-encephalitic and/or Parkinsonian symptom exhibited by the patients. Sacks himself underscores this out numerous times (most frequently in his extensive footnotes), as he relates the rapid L-Dopa-induced oscillations between akinesis and akathesis to “the ‘stationary states’ and quantal ‘jumps’ postulated of atoms and electronic orbits” (Sacks 111). In his own terminology, such behaviors suggest both “macro-quantal states” (in cases of hyperkinetic activity) as well as “micro-relativistic states” (in cases of catatonically warped or retarded activity).
If the analogies to physics continue, an even greater linkage can be seen between the critical (yet usually unattainable) balance between L-Dopa administration and behavioral outcome—the elusive balance point of the proverbial pin to which so many of his patients make reference. Even beyond the Newtonian principles of spatial improbability (outlined by Sacks’s footnotes, p. 201) is the same physicist’s well-known concept of gravity: one that has long been paraphrased as what goes up must go down. Certainly, this is the case for the post-encephalitic patients undergoing L-Dopa chemical therapy. In the majority of cases presented by Sacks, the more rapid an individual’s ascension to activity, the more rapid their descent or decline. One need only recall the case of Leonard P., who flew into egomaniacal delusions, wherein he envisioned the staff at Mount Carmel “…set[ting] up a sort of a evangelical lecture-tour, so that he could exhibit himself all over the States and proclaim the Gospel of Life according to L-Dopa” (210). Even before the reduction of his L-Dopa, Leonard was observed to fall into states of “rapid exhaustions or reversals of response…profound exhaustion, associated with severe recrudescence of Parkinsonian and catatonic immobility and rigidity” (215). The words of Frances D. prove equally pertinent, inasmuch as she described such psychophysiological symptoms as “…a vertical take-off…I’d gone higher and higher on L-Dopa – to an impossible height. I felt I was on a pinnacle a million miles high…And then…I crashed…I was buried a million miles deep in the ground” (201).
An even more intriguing correlation can be seen with various laws of thermodynamics. As the second law of thermodynamics predicts, any isolated system (i.e. an ecosystem, a cell, an organism) moves spontaneously toward states of greater entropy (with entropy being the amount of disorder in a given system). Simply put, disorder always increases – and the attempt to create order in any system only increases the disorder in surrounding systems. (A basic example would be the heat energy given off by a cell as it synthesizes a polypeptide to more efficiently carry out cellular functions: by burning energy from food to use to its own advantage, the cell inevitably increases the disorder of its surrounding environment as surrounding atoms are displaced by increasing temperatures). Such an event is grossly manifested by the results of L-Dopa administration in post-encephalitic patients: a predisposition to an increasingly degenerative disease is already present, which can only increase in its levels of disorder. Such necessity is exacerbated (if not precipitated by) the introduction of L-Dopa, originally intended to induce order, but actually invoking disorder as it chemically alters dopaminergic functioning in such afflicted individuals. Though a temporary respite may be experienced in the first few months of L-Dopa treatment, the ultimate effect of the drug’s administration is to disadvantageously alter isolated systems which had already been poorly-functional in the first place. Evidence of this can be found in patients’ sensitizations to the drug, as well as intensification of tics, psychosis, bipolarity, dystonias, and other ‘side-effects,’ though Sacks argues for the abolishment of this term. Sacks even acknowledges this truth, explaining that “all patients, then, move into trouble on L-Dopa…” (246).
Most importantly, however, metaphors resonating from post-encephalitic symptoms are more significant in the way they reflect and represent the personal lives of each patient. Though each behavior pattern may be undeniably linked to an external phenomenon (such as Newtonian laws of gravity or the Laws of Thermodynamics), true revelations are present in the manner by which they personify private conflicts (either concerning a relationship to a friend, family member, or hospital staff; or regarding a
Many times, the myriad symptoms (catatonic freezings, echolalia, hallucinations, voracious appetites, dystonia, etc.) seem to be non-verbal articulations on the part of the patient. Such ‘reactions,’ in a sense, have an uncanny connection to events in the patients’ lives and seem, in most cases, to be a physical manifestation of a response the patients cannot bring themselves to vociferate. It is no wonder, for instance, that various symptoms were exaggerated in response to the loss of family members or loved ones or (i.e. Margaret A., who suddenly developed encephalitis lethargica after the death of her father; Ida T., who developed a “sudden onset of impatience, irritability, impetuosity, increased appetite, and a violent temper” characteristic of the more hyperactive and psychotic end of the post-encephalitic spectrum after the death of her husband. Also: Rolando P. who, following a “cessation of [his mother’s] visits [experienced] a severe emotional crises; and Lucy K. who “imploded again, contracted herself to an intransigent point, infinitely withdrawn” after Dr. Sacks’ refusal to marry her).
Sacks, in his Perspectives section, speaks of the need for a different language that can better describe the plight of patients, a language which circumvents the dehumanizing and depersonalizing route of quantitative data and cold, mechanical analysis. In all actuality, the physical behavior of his patients seems to be just that: a language that cannot be tied down by statistics, that cannot be understood through an abstract mathematical model. A language that communicates more coherently and directly through physical metaphors representing internal emotional/psychological states. As Sacks sums up, “the person [or patient] shows forth in all his reactions, in a continual disclosure or epiphany of himself; he is always enacting himself in the theatre of his self” (259). If this is true, then the enactment of one’s internal world cannot be ruled out as an underlying force of post-encephalitic symptoms. The metaphoric nature of the disease becomes evident, and the behavioral responses both on and off of L-Dopa take on significantly more meaning: a meaning which eludes statistical categorization, as well as predictability.