Letters, page 38
I am delighted—and amused—by your reference to Starship Enterprise; and it set me thinking. I had thought of this as just a harmless fad, a sort of relaxation I could look forward to after the toil of the day. But your letter makes me see it somewhat differently: I think that it is neither accidental nor superficial that I have grown so fond of Star-Trek,[*18] and it must be because it resonates with my own sense of being an Explorer in Deep Space, continually setting out to discover new worlds, and somehow to see the “alien” as dear (without in the least denying its otherness). Although Star-Trek often degenerates into an improper xenophobia or xenophilia, at best it deals with that right relation to the Strange for which the only proper word is (that very rare word!) XENIAL: grasping, and being grasped, by the strange as dear, welcoming the strange(r), making it (him) at home, and feeling oneself at home in the strange; the mysterious ultimates of home and hospitality, host-ship, guest-ship, the relation between them. Somehow, at best, I think this is what Starship Enterprise is about; and perhaps what any pioneer, or any properly, creaturely, enterprise is about. Anyhow, in some very deep way, I feel absolutely regenerated by my visit to the West Coast, and my Starship Enterprise is winging once more, either to the Rim or the Hub of the World, or into that good Space and Spaciousness whose “Centre is everywhere and Circumference nowhere.”[*19]
Cordially,
Oliver
To Jonathan Kurtis[*20]
Former Student
January 15, 1977
11 Central Parkway, Mt. Vernon, NY
My dear Jon,
[…] I gather that you must just have started your year in Greenville. I suppose it’s rather an uprooting from Duke—but perhaps not really, because now you carry your own roots and centre with you, within you…and as for the future, […] I think that one’s nominal or external or titular “position” matters less and less as one begins to find oneself and one’s real position.
This came up, amusingly, and paradoxically, a few days ago, when I met some of my old professors at UCLA, who quizzed me closely on “where” I was (what I was, who I was, etc.). When I mentioned my peripatetic, nomadic life—I have become a real free-lance now, driving from borough to borough, even State to State, with nothing but my good head and a portable videotape, one of them said: “But, Oliver, this is all very—eccentric. You mean you don’t really have any position at your age?” I said, Yes, I did have a position. “What position?” he asked. “You have no centre, no base.”
“It is very simple,” I answered. “I have the only real position there is, the only tenable one, the only one with real tenure. My position is precisely at the centre of Medicine—taking in the view from all sides, sitting serenely, securely, at the very heart of Medicine.” Maybe it sounded arrogant, or crazy—but at least it made him pause, and took that look (half-sneer, half-concern) off his face. What a passion people, at least one’s colleagues, have to label one. I was also asked: “You’re not doing regular, orthodox neurology—what are you doing? Some sort of zany, fringe activity?” So I invented a word. I said, “I make a precise structural analysis of all sorts of neurological phenomena, in a way which nobody else has done. It’s Neuro-Analysis. I’m the first neuro-analyst, and my present patient the first neuro-analysand, and I have the first neuro-analysis in its entirety on tape.”
They obviously don’t know what to think: they both understand and misunderstand; they see that I’m authentic, and have something to offer, something new; and they’ve asked me back to give some talks; but they imagine it’s something “up my sleeve,” sort of a new gimmick, or method, or technique, or theory—when really what I “offer” is none of these, isn’t a “thing” at all, but merely an example of a total concern, and a sort of transparency which lets everything through; and this, which should be the commonest, simplest, most elemental “position” in Medicine, is apparently rare, suspect, and unintelligible to the narrow, doctrinaire, opaque majority. Extraordinary. I shouldn’t let off steam like this, but I know that you are also simple and transparent, in the best possible way, and I imagine that you may run into odd difficulties with your colleagues, if not now, then later, as you achieve your autonomy, that sort of autonomy which is so “dangerous,” such a stumbling-block, to the “heteronomy” of the group. It’s just like the old odium theologicum, where simple honesty and autonomy are seen as heresy. […]
I found my brief, sudden, impulsive visit to the West Coast (mostly the Beach Fringe in Venice and Santa Monica) absolutely fascinating. It’s so innocent, and sweet—and silly, and corrupt. I see that the picaresque Beach novel I sketched out a dozen years ago, and imagined to be entirely “dated” now, is in fact as relevant as ever, because the whole “climate” there is absolutely dateless, timeless, unHistorical, against History. I see what I had forgotten—though it was this which, romantically, first drew me to California, and which later led to my leaving it in fear: life is so easy, so comfortable, so lacking in problems and challenges of all sorts, that one could easily be a child for ever, living in a childlike, childish, ingenuous Eden, an “endless summer” of body and spirit, never taking on oneself the responsibilities and pains (and joys) of adulthood. I went to California, in my twenties, because I wanted to “escape”—escape the rigidities and repressions of my (English) life hitherto; and I think it was the right decision. Then I left California, five years later, because I felt myself adrift in structureless emptiness, a rather comfortable “situationlessness” which everyone there shared. Now, I must confess, after having been bruised and battered into adulthood [in New York], being centred in myself (I mean creatively centred), being a going concern and a Worker (whether I like it or no), I wouldn’t mind going back to California now. I could no longer be tempted, but life would certainly be easier and sweeter, infinitely less stressful, in a physical sense. And increasingly I am beginning to feel the vulnerability of the flesh, the need to preserve oneself from unnecessary stress, and to give oneself an atmosphere of unhurried peace. […] I will look forward to hearing from you when you get settled down. And, of course, seeing you, on one of your occasional visits to New York (unless I make one of my even-more-occasional visits to South Carolina!).
Cordially,
Oliver
To David Goodacre[*21]
Vicar
January 17, 1977
11 Central Parkway, Mt. Vernon, NY
Dear Mr. Goodacre,
I have just received your review of Awakenings with real delight—delight that anyone should be moved to read the book with such passion and penetration, and great gratitude for your thoughtfulness and generosity.
Work—and writing—isn’t done in a vacuum (although sometimes one gets the feeling that it is!); an author needs his readers and reviewers, especially ones as perceptive as yourself; because it is only through you that a real sense of communion is established, the feeling that one exists (and one only exists for others), of a good intercourse with the world. And it is only through the transparency and courage of people like yourself that one gets a real idea of what one is doing—your good review makes me see Awakenings, myself, and my work, in a new light.
I am particularly happy that such appreciation comes from a “spiritual” quarter—because I suppose now (I am not sure that I realized this, consciously, when I wrote it) that Awakenings is a sort of theological myth—of Exile and Redemption, Crucifixion and Resurrection, or what you will. And I suppose, increasingly (but it is especially your response and review which makes me think in these terms) that what I try to grasp, and what grasps me, are those intersections of history and myth—clinical situations which are parables or incarnations of the human predicament—of our wretchedness and uprootedness, and the great promise which is given to us all. What is so instructive about disease, like disaster, is that it shakes the foundation of our previous securities, of everything we have previously taken for granted; abysses open beneath our feet; helplessly, hopelessly, we fall in, engulfed, with a sense of absolute lostness and despair; and then “miraculously” or “providentially,” perhaps, we find firm ground, new ground, in the depths of the abyss, and this is a radical healing or redemption. The lure, the danger, the temptation of l-DOPA was that it seemed to provide (and, for a short while, so to speak, provided the conditions for providing) a radical hope where none existed before: this mythical-theological sense was explicitly felt and formulated by some patients—thus “Leonard L.”, with his characteristic humour and irony, called dopamine “resurrectamine” as soon he had heard of it, long before he had actually taken it! And he also called Cotzias “a Chemical Messiah.” […]
Now, in 1977, almost all of the patients are still alive; they are not very “well,” physically speaking, but their experiences, their bearing, has made them profound human beings. I find their courage and faith—inexplicable, and inspiring; and it makes me sure of something, or rather some transcendent power, to which one turns, to which one must turn, when the resources of the finite are exhausted. I have a book coming out, which is (perhaps) as eschatological as it is medical: it concerns a patient, a patient I know well: the patient was myself when I spent several months in hospital in 1974, and came very close to losing a leg. I had lost it, subjectively, and could discern no basis, no way, in which it might recover or return. That it did seemed scarcely short of a miracle, and has given me an enduring sense of the great, suprapersonal powers in whose hands we lie, and before whom we must give up our calculations and arrogance, and give ourselves totally, freely, in faith. This will be a sort of neuropsychological-theological book—an experiment, if you will, in “clinical ontology”; and since I can’t resist a play on words, I am calling it A Leg to Stand On.
Really it is a great privilege, and destiny, to be a physician—or a patient. It makes one pause, and question what one has taken for granted before. It shakes one’s foundations, and it makes one deeper. And, ultimately, it gives one a gratitude and an awe, which the healthy and happy have perhaps never known. […]
I would not wish or prescribe sickness or injury or calamity for anyone; but if it should happen, a new and special destiny may be found, or created, by one—and perhaps it is THIS which I am ultimately interested in: the way in which people are “made” or “broken” by disease and misfortune, and this, ultimately, depending on whether one finds any ground beneath one’s feet, after ill-fortune has thrown one in the abyss. I think disease, in this sense, is an ultimate testing-ground of a man’s manhood, the wounded creature losing and perhaps (re-) finding its foundations.
I am sorry I have written a rather verbose, tangential, uncalculated letter—and one which is perhaps not too directly related to Awakenings or your review. But it is about attitudes, orientations, which are central to us both—to us both as caretakers of the Body and Spirit.
With many thanks and my kindest regards,
Yours sincerely,
Oliver Sacks, M.D.
* * *
—
Although OS was still struggling with the book that would become A Leg to Stand On, he was also continuing to accumulate more case histories. In this letter to his old boss at UCLA, he tells a story that a few years later would become “Cupid’s Disease” in The Man Who Mistook His Wife for a Hat.
To Augustus S. Rose
February 11, 1977
[No Address Given]
Dear Augustus (if I may!),
It was very good of you to write me; I am sorry there has been so little contact over the years (for I have always thought of you as the teacher, above all, who taught me how to observe—although you may now feel a bit disquieted at the sort of observations I make!), and did hope to see you in my brief (unplanned, impulsive) visit to LA. […]
Something which often makes me think of you, and wish I had a hundredth of your clinical experience in the area, is seeing (a quite astonishing amount of) neurosyphilis. It is very odd—perhaps it is chance—but just in the last year or two I have seen dozens of cases, where I scarcely saw any in the preceding decade. It really is a “wonderful” disease (I’m afraid this sounds a very outrageous word to use, but you, if nobody else, will know what I mean) with respect to the astonishing variety and complexity and strangeness of the syndromes it produces. Two weeks ago I saw a woman of ninety, accompanied by her hale husband of ninety-three: the history was of “a change in personality” coming on at the age of 88, when the old lady—habitually prim and staid, characteristics accentuated by age, started to become more and more “animated,” and distinctly disinhibited, rather flirtatious and jocular. I found a remarkable psychomotor excitement, with (as yet) no real dementia. She herself made the diagnosis—she said, “Would it have caught up with me after sixty-five years?” I asked, “What?” rather dazedly. She said, “The squiggly things, Cupid’s disease,” and went on to tell (she was an Armenian) how she had been impressed by the Turks into a brothel in Salonika, in her early twenties, contracted syphilis, but was given “heavy metals.” […] She wondered if it had persisted, latent, all these years, and was now the cause of her unnatural animation. We did a spinal tap: it was—astonishing story.
I do hope you are keeping well and active—it sounds very much as if you are; and I will look forward to seeing you in May. Again, my warmest thanks for your very kind letter,
To Josephine De Luccia
Correspondent
February 22, 1977
11 Central Parkway, Mt. Vernon, NY
Dear Mrs. De Luccia,
Thank you very much for your letter of the 19th. I offer you all my sympathy—I think nothing is more dreadful, or tragic, than the development of a pre-senile dementia in one’s spouse—but I am not sure that I can offer you anything more.
If the diagnosis was made at Einstein, and called “Alzheimer’s Disease,” then, I fear, so far as current knowledge goes, nothing can be done—nothing, that is, in the way of any “miraculous” Medicine or Surgery. A great deal can be done, of course, in the more general matter of care—by which I mean everything which invests life with meaning and dignity. One can have a relentless dementing disease, be it Alzheimer’s or Huntington’s chorea, without it being felt as a torment, or an indignity. It is, of course, a catastrophe—but catastrophes can be borne with dignity and calm—indeed there is no other way to bear them.
And you, you have to do the bearing too—and perhaps, as the disease progresses, it may be harder for you than for your husband to bear. When misfortune or calamity strikes one member of a family, everyone else is affected too: the suffering is multiplied—but also it is shared. I think that the proper sharing of suffering—sharing in the mode of concern and compassion, as opposed to any improper worrying and fussing—is ultimately, perhaps, as much as one can do to ease another’s lot: for the worst horror of all is being-left-alone, left alone, abandoned, to sicken and die.
Having said this, I hope that you do not misunderstand me. I think that you need to “support” your husband, to be with him, as it were, as the darkness closes in—this is the least, and the most, another human being can do; but you must not sacrifice your own life in the process, or feel that you have to be with him every minute of the day. He himself, I am sure, would want you to live a full life yourself, and not anguish or fret over him in a way which is profitless and can only torment you. In particular, I think that you are on dangerous and foolish ground if you are (in your own words) “looking for a miracle”—a miracle-drug, or anything similar. And you sound as if you are obsessing for “a miracle,” constantly reading everything on senility which you can lay your hands on. There are, in some sense, “miracle drugs”: cortisone, as you say, was/is in some ways “miraculous,” and so was/is l-DOPA which I describe in my book. But no such “miracle” is available for Alzheimer’s—nor, I must add, is one likely to be forthcoming. You ask me to be “kind” and “considerate,” and I fear that you may find my words harsh; I don’t mean to be harsh, I only mean to be truthful, and to try and spare you further futility, when I say that yearning and searching for “miracles” here is profitless alike to you and him, is provocative of anguish, and stands in the way of a serene and dignified acceptance of reality. If the reality could be altered, the matter would be different; but if it can’t, then any hopes are illusions, and one has to accept what one cannot alter. This is the law of Fate—and though it seems strict, it is merciful as well.[*22]
Yours sincerely,
Oliver Sacks, M.D.
To Mel Erpelding
May 14, 1977
11 Central Parkway, Mt. Vernon
Dear Mel,
Thanks very much for the package—and your letter. […]
I found my brief visit to Oregon deeply happy, and reconciling—and, perhaps, in some part of me, a bit sad. It was very good to see you, to see you both, so happy and settled: and, for the first time, I didn’t see Pilar[*23] as an enemy or “rival,” didn’t feel any envy or hostility, didn’t want to bisect you with her and I think she felt this, this new acceptance in me, and the long-standing tensions between us ceased. I no longer want to “possess” you, and the disappearance of this phantasy, after so long, gives me a serenity and a relief. But perhaps also—and this is why I spoke of sadness—the renunciation of a long-held phantasy is a sort of bereavement; but it’s a sane renunciation, and a healthy sadness—such as go with an acceptance of the unalterables of life.
