Monday, December 25, 2006

Neurological Narratives

This thesis was inspired by my beloved professor. Without Him, it wouldn’t have had some sort of conclusion at all. Any praise for this thesis would boomerang back at His feet. His kindness kills hatred in other hearts and his humility erases any vanity. A truly compassionate human who has been a blessing for blokes like me. May He live in peace and bliss. God Bless Him.

Neurological Narratives:

A Humanistic Study of Oliver Sacks’ Narrative Medicine


Our birth is a heroic act of pain painting the pleasure of pinching the unborn. By oscillating between these extreme emotions, we enliven a routine -yet extraordinary- activity of everyday living. However, the last century and the past half-decade have feared a vehement visitor: illness. By illness, I mean something subjective like feelings of malaise or pain. Quite different from something like a disease physiologically rooted in pathogens like viruses or in revealing symptoms like memory loss.

At the onset of illness, citizens turn into patients and normal life is stalled. This break in the grand continuity of life is even more severed if one is gutted by mental illnesses. Something tries to tear down our mental fabric and strike us out of reality so much so that we begin to contemplate upon the inviolable self that has sustained us in health. Among mental illnesses, neurological disorders (affecting the human nervous system extending into the brain) have a special status because unsupported by nervous system, human body is hardly functional. These disorders cut off the crucial supply for human sustenance: self-awareness and thereby, a healthy existence. Yet, at the same time, the same disorders often reorganize and re-strengthen the lost self.

Everybody aspires to tell and retell their story or else “a self without a story contracts into the thinness of its personal pronoun.” (Polkinghorne, 1988, 72) “I” [the personal pronoun] – through a story – seek to organize the world, which the Greeks called Kosmos [order.] On the odyssey to order life, the patient’s story (or its recounting by a neurologist or a psychiatrist) is a deepest attempt to “mend discordance with concordance.” (Ricoeur, 1984, 31) Thereby, revitalizing simple stories into impressive narratives. Neurological Narratives nourish human meaning not by dull documentation of medical case-studies but by cutting through the clinical constraints to return to the critical centre of human existence: self.

Maddening history

It has taken at least thousands of years to discharge mental disorders from the heavens and safely lodge them in the human mind. From Greeks to the geeks, mental disorders have journeyed along with the expansion of human consciousness. In its long endless voyage, mental disorders have absorbed emerging thinking and adopted new meanings.

A gifted Greek, also called the father of medicine, Hippocrates (460 BC – 380 BC) had largely rationalized illness through his theory of humors. Hippocratic humors are juices or fluids in our body, namely four: blood, choler, phlegm and melancholy. As the medical historian, Roy Porter explains:

Blood was the source of vitality. Choler or bile was the gastric juice, indispensable for digestion. Phlegm, a broad category comprehending all colorless secretions, was a lubricant and coolant…melancholy…[is a] dark liquid…reckoned responsible for darkening of other fluids, as when blood, skins or stools turned blackish. (2002, 38)

For the body to remain healthy, these humors had to strike the right balance. An imbalance or one humor overpowering the other, resulted in illness. The fourth humor, melancholy, was largely responsible for the dark temperament that was commonly observed in the mentally ill. What is interesting about Hippocrates’ humoral theory is that it is holistic in its approach and moreover, it centered diagnosis around human body - not on any superhuman Greek god or goddess. As with the treatment for the mentally ill, Hippocrates suggested a regulated mild diet and a simple lifestyle limiting achievable desires.

Indian Ayurveda similarly had three humors (doshas): Vata (air), Pitta (fire) and Kapha (water.) In their metaphorical sense, Vata is air that circulates thoughts in human mind as well as it regulates the blood flow. Pitta, as fire, helps maintain body heat and metabolism and in turn, the sensory reactions to the outside world. Kapha, as water, provides the essential body mechanisms with liquids and thereby restores biological strength. Again, a balance of these humors is critical for human sanity; else, one tends to lose the mental capability of discrimination (vivekam.) Madness or unmad was a result of humoral imbalance and in this regard, Ayurveda strived to sift through rich inheritance and sought to blend the physical background of medicine with religious thoughts, spiritual life and ideals.

Meanwhile, Greek philosophy was a major impulse behind starting a long-standing battle between reason and unreason. Greek thinkers had a balanced emphasis on reason and they didn’t deny the reality of madness manifesting as unreason. Plato thought that some geniuses had been consumed the divine fire of madness.

Greek tragedy was one of the earliest art form that tried to make sense of madness. Unreason was dramatized by playwrights like Sophocles and Euripides as a fate of a divided mind. In Euripides' drama, Orestes, the mortal protagonist Orestes is ordered -by the Greek God of Medicine, Apollo- to kill his mother and he abides by it. Orestes is flummoxed: whether to listen to an immortal God or to his immortal Soul. His fraility to make the choice rips Orestes apart and because of a malicious outcome, he collapses into madness. These kinds of heroes were consumed in the cauldron of hubris and ambition - to be torn apart and bring madness upon themselves. In fact, tragedy was used as a therapeutic to inform the mortals of their immoral acts and reform their profane existence into a blissful perseverance.

Meanwhile, the Stoic philosophy also stressed on the conquest of avoidable desires (some may lead to chronic madness) as they brought disappointment to the human soul. So, Hippocratic medicine flourished with Greek drama. But, a Roman physician, Galen (129-200 AD) was primarily responsible to sustain the Hippocratic spirit till Renaissance. Galen dissected the human body and was responsible of reinstalling human mind in the brain rather than in heart as Aristotle thought it out to be.

Though the Christian Church had colored madness in supernatural contours like the Holy Ghost and the devil fighting for the possession of the individual soul, it also embraced the mysticism of some saints as the visitation of the Holy Spirit. There were patron saints like St. Dymphna of Netherlands who was revered as possessing exceptional healing powers and so is St. Christina the Astonishing and St. Teresa of Avila. Above all, one should view the overarching message of love and compassion towards any sufferer as the greatest gift that Christian medicine has given to the world.

In Christian medicine, there is a concept called anastasis, literally meaning resurrection. Among many interpretations of Christ's resurrection, the spiritual meaning points to the fact that a manlike messiah is revivified with Godlike perfection. This act of Christ can inspire the sufferer to bounce back from his debilitating condition into an entirely new pattern where God in the form of love would envelop the patient with His grace. This doesn't mean that every one should aspire to contract illness to enjoy God's grace. But, illness often seems to have the power to reward the sufferer with abundant solitude to resurrect himself into a finer human being.

The Somatic Turn

During the Age of Reason, keeping up with the all-out assault on Aristotle, Hippocratic medicine was abandoned for the machine medicine of the French polymath, Rene Descartes. Human body was depersonalized and extensive research was done on nervous system and its role in governing emotions and motion. The progress of science, managing society through economy and bureaucracy and the spread of literacy and education contributed to privileging rationality above everything else. To bring about order in the society was the zeitgeist and any aberration was to be quelled. Descartes’ separation of body and mind had an important consequence for medicinal approach to mental illness:

As consciousness was inherently and definitionally rational, insanity, precisely like physical illnesses, must derive from body, or be a consequence of some very precarious connections in the brain. Safely somatized in this way, it could no longer be regarded as diabolical in origin or as threatening the integrity or salvation of the immortal soul, and became unambiguously a legitimate object of philosophical and medical inquiry. (Porter, 2002, 58)

This approach found the fault of mental illnesses not in evil passions or humors but in the cognitive capabilities of the patient. So, a patient could be educated and corrected by restoring sanity in his mind. As the humoral theory was being replaced by mechanical medicine, the “new science refigured the body in mechanical terms which highlighted the solids (organs, nerves, fibers) rather than fluids.” (Porter, 2002, 124) So, insanity was specifically spotted as the malfunctioning of some body part. During this period, an English physician, Thomas Willis (1621-1675) dissected the human nervous system and coined the term “neurology.” He provided elaborate and exquisite descriptions about the workings in the brain based on the Cartesian and Newtonian mechanistic views of the world. Body became the vantage point from which mental illnesses were spoken about and the nervous system was given unprecedented importance in doing so.

Right into the 17th century, philosophers like John Locke analyzed the mold of human mind through perception of the sense data. Knowledge arising from sensations is perfected by reflection; enabling humans to convert the sense data into ideas like space, time and infinity. Madness of the mind was a consequence of wrong association of ideas, faulty logical processes; this development remolded conceptions of madness in new directions:

The emerging model of madness as a psychological condition pointed to an alternative target for psychiatric inquiry: rather than organs of the body, the doctor had to address the patient’s psyche, as evidenced by his behavior. The case history approach this entailed demanded the transformation of the old craft of minding the insane into the pursuit of systematic psychological observation. (Porter, 2002, 129)

Several case studies of patients with detailed observations of their behavior were regularly documented from now on. As this psychological way of reading derangement emerged, intrapersonal dynamics between the doctor and the patient was stressed. And, the best platform for such encounters to prosper was an asylum. The driving force for such an asylum need not be to completely isolate the patients from the society - to secure them from the assaults and stigma of the society. In turn, helping them to reintroduce themselves into the society afresh and saner. The point was to revive the dormant humanity in the mad, by working on residual abnormalities to stimulate normal emotions. During 18th century, this unfettering of mind was the liberating vision of Phillipe Pinel of France, Chiarugi of Italy, the Tukes of York Retreat in England.

With a resolute humaneness, these reformers valued kindness as the right medicine for regeneration of patients. Old methods like whipping, bloodletting, straight-jacketing, starvation were replaced by innovative regimes of disciplined work and exercise under vigilance. The asylum became a self-sufficient outpost where patients labored for their needs by farming, etc. Till today, several pioneering ways of treatment like community centers where patients and psychiatrists live together have been evolving. So, in fact, asylums are not a permanent solution and the only way out to treat the mentally ill; rather, as new illnesses outnumber the known ways of treatment, novel approaches will continue to emerge.

The Psychoanalytic turn

One such approach in the twentieth century was the talking cure therapy of the founder of psychoanalysis, Sigmund Freud (1856-1939). Freud was an exceptional molder of modern thought in the sense that he was the first to spot the difference between what one says and what one believes. This is a radical dimension of understanding the everyday operation of the human mind as there is an unconscious belief or striving unknown to us. Freud moved beyond the conceptual understanding of the human subject as inflected with illness and to be tackled by therapy, and was more concerned with human salvation. Freud sought the triumph of the irrational and unconscious passions by reason; the liberation of the man from the power of unconscious within the possibilities of man. Though Freud was a neurologist, he quickly abandoned this career to nourish his genius in an innovative discipline altogether: psychoanalysis.

Freud was adept at writing wonderful narratives about his patients like his famous Dora or Wolf-man clinical case-studies. What Freud did –in the case of Dora– was to analyze hysteria (a psychological or emotional disorder in which a psychological conflict is turned into physical conflict like blindness) by encouraging patients to freely talk and elicit as many psychological incidents as possible to associate them with the roots of the current conflict. In fact, Freud established:

…a logical continuity in the mental life of the individual, and therefore symptoms were not mysterious incursions from without but rather exaggerated expressions of processes common to everyone which revealed the specific stresses of the patients. (Brown, 1985, 3)

Freud was fervently devoted to extract the aim of mental phenomena whereas psychiatrists were eagerly searching for general principles by which to treat the patient. Simply put, Freud’s model was based on the idea that our basic drives are covert, lurking in our unconscious and suppressed by layers of social rules and expectations of civilization. But, as one prominent psychiatrist points out:

Nobody in any society lives his life by rationally planning every single act of emotion, since normal, as well as abnormal, goals are largely unconsciously determined and the essence of normality is that his unconscious goals and conscious aims should be in harmony with each other and appropriate to the situations in which he finds himself. (Brown, 1985, 10)

This idea of the cultural impact upon the mental mold of a person was taken up by neo-Freudians like Karen Horney, Henry Stack Sullivan and above all, most brilliantly by Erich Fromm. A sociologist and psychologist, Erich Fromm (1900-1980) based his theory of individual not on the satisfaction of biological drives (as Freud did,) but on the relatedness of the individual to the world. Fromm assesses the extent to which psychoanalysis was successful:

...while psychoanalysis has tremendously increased our knowledge of man, it has not increased our knowledge of how man ought to live and what he ought to do. (1966, 16)

Fromm’s cultural approach to psychoanalysis seeks to remedy the above drawback. His approach contends that human nature should not only be explained rationally and biologically but also sociologically as individuals are a cultural product of their environment and its prevailing spirit. This idea is echoed in a neuroscientific phenomenon called ontogenesis – the development of an individual as an exquisite interplay between genes and the environment. For Fromm, man -in interacting with the environment- not only changes it, but also changes himself in the process: develop his potential and transform it in sync with his possibilities. But:

Man’s evolution is based on the fact that he has lost his original home, nature – and that he can never return to it…there is only one way he can take: to emerge fully from his natural home, to find a new home – one which he creates, by making the world a human one and becoming truly human himself. (Fromm, 1968a, 25)

Squeezed between regression and progression, man has to make a choice that will either aid in his psychological growth or reduce him only with his physiological growth. If Freud had rooted the motivating energy behind human passions and desires in libido, Fromm roots the impulse in the human situation itself as inherent in all human existence. Every individual wants to realise his potential whereas society frustrates and binds him. So, a society’s prevalent structure and ethos largely determine the idea of the conscious and unconscious. Fromm brilliantly explains:

Consciousness represents social man, the accidental limitations set by historical situation into which the individual is thrown. Unconsciousness represents universal man, the whole man, rooted in the Cosmos; it represents [everything everywhere and] his past down to the dawn of human existence, and it represents the future to when day when man will have become fully human. (1986, 58)

We are powerful enough to be aware of our existence but at the same time are faced with utter powerlessness and usurping limitations. Fromm resolves this paradoxical situation in the wellspring of wellbeing.

All shall be well

Our wellbeing is influenced by intricate and subtle psychological principles that build and guide our self-understanding. For Fromm, a healthy existence doesn’t just lie in physiological fitness, but in psychological wellness - whereby individuals develop totally and to the best of their cognitive capabilities.

When one cannot face his frailty and make himself fragile with a façade of illusions about himself that others tell him and he himself imagines, he begins to taste the recipe of despair. And no one has extensively studied the roots of despair as Søren Kierkegaard (1813-1855), who according to Nathan Scott Jr. has studied the human situation animated by:

…despair [which] is the sickness unto death precisely because it is that illness of the spirit which is the consequence of a man’s flight from the reality of his own selfhood. (1978, 44)

There is a pervasive unavoidable sense of suffering in everyone’s life. One has to accept the way he is first and has to acknowledge that existence is the gradual triumph over suffering. Either we thirst for a glorious Edenic past and remain underdeveloped, or we absorb ourselves in the humdrum of the present so much that we deliberately disconnect ourselves from reality. Fromm strikes at the root of our very existence:

Birth is not one act; it is a process. The aim of life is to be fully born, though its tragedy is that most of us die before we are thus born. To live is to be born every moment. (1986, 31)

In the process of living, we acquire a wealth of knowledge about ourselves. Through this self-knowledge, we take hold of the liberating forces of spontaneous growth. Using these forces, we have to gradually loose the neurotic obsession with ourselves and develop love and concern for others. In developing a healthy friction with the wishes and wills of others, one is regularly challenged by choice-making: in this situation, should I preserve myself or surrender myself to a greater self of others? One may choose to submit oneself to an overarching Other like God. But, the prudence of this choice can be understood in the light of Kierkegaard’s interpretation of the story of Abraham’s sacrifice of his son, Isaac in the Old Testament.

The Jewish patriarch, Abraham, in spite of an ethical obligation to preserve his son’s life, obeyed the word of God as he was torn between the love towards his son and love of the God while sacrificing his son. This doesn’t imply that Kierkegaard wants us to give into universal norms but he takes the story further by inferring that only:

…when a man has really submitted himself to the universal norm and found it insufficiently comprehensive of his reality, he must then – and only then – dare to transcend it, dare to declare himself an exception: namely, one the concreteness of whose individual life is not fully reckoned with by a universal norm. (Scott Jr, 1978, 41)

The courage to make such a crucial decision is called “faith.” It is:

…a matter of the courage with which man, in the most critical situations of his life…dares to take a stand in behalf of his own humanity, choosing that which promises most deeply to validate what he has found to be the essence of his manhood. (Scott Jr, 1978, 41)

So, one has to consistently make priceless or worthless decisions in life and their consequence is determined by the faith with which they are taken. One such profound faithful decision is taken by Fromm to decide what well-being is:

Well-being means to be fully related to man and nature affectively, to overcome separateness and alienation, to arrive at the experience of oneness with all that exists - and yet to experience myself at the same time as the separate entity I am, as the in-dividual. (1986, 36)

Nowadays, patients function well socially without any illness; but, they suffer from the malaise of inner deadness. Without knowing what they suffer from, they make various complaints which are only the conscious form in which our culture permits them to express something. These symptoms become obsessive once they enter everyday business of life. This common suffering is the alienation from oneself, from one’s fellow human and from nature. For those who suffer from alienation, “cure doesn’t consist in absence of illness but in presence of well-being.” (Fromm, 1986, 28)

The Need for Narrative

Narratives amaze, console and make the reader filter meaning out of quotidian existence. Narratives enfold the human self in cognitive activities bigger as well as other than itself. Is the real world already organized into a narrative or we transform the reality into a narrative? Every narrative aims to tidy the reality through various techniques involving time, sequence and order of storytelling.

Factual narratives enjoy an alliance with reality – however distorted it may be. Medical narratives first preserve the anonymity of patients and thereby, rename them into fictitious characters. Through a felt (essentially phenomenological) experience, narrators excel at recording these experiences. By just telling stories, we make sufferers as bland human subjects. They not only succumb to the disease but are consumed by it. A patient’s inviolable self narrows down to a diseased or drugged self. So, a master storyteller transforms soulless case-histories into soulful narratives. In the process, the patient becomes the protagonist so that “we have a ‘who’ as well as a ‘what’, a real person, a patient, in relation to disease – in relation to the physical.” (Sacks, 1985, xiv) To talk about illnesses is quite different from writing about illnesses. As Hayden White explains:

Narrative might well be considered a solution to a problem of general human concern, namely, the problem of how to translate knowing into telling, the problem of fashioning human experience into a form assimilable to structures of meaning that are generally human rather than culture-specific. (1980, 5)

Neurological narratives are telling ways of moving across and beyond cultures to create shared realities which enhance and endorse human experience. Neurological narratives excel at the prescription of Paul Ricoeur that narrative conclusions “rather than being predictable …must be acceptable.” (Ricoeur, 1980, 174)

Medical narratives always don’t have a happy end. They are quite unpredictable - yet most of them leave us at various levels of acceptability. This suggests that while treating disorders, we may not anticipate complete amelioration but rather hope that the treatment acquires a teleological strength as time passes by. So, narrative time coincides with the time taken to better the patient’s condition.

Starving for the Self: the Existential turn

Everyone has an inviolable innermost centre from which we participate in life: self. Most identify this centre as brain but in fact, our self is an indescribable ever-accumulating essence of existence. One of the most incisive approaches towards the study of self has been done by existentialists. To exist is not that one is but to be and become what one is potentially capable of and stand out in the world not only in uniqueness but also in oneness.

Existentialism has been a major philosophical movement that has richly contributed about the limited freedom and unlimited possibilities of human life. Through its meticulous analysis about the human situation, existentialism has sustained a scrupulous “style of philosophizing.” (Macquarrie, 1978, 14) With existence peculiarly possible to man, existentialism places man at the centre and studies his situation from various foci like his “quest of authentic selfhood,” (ibid, 17) strong emotional life.

For existentialists, being is what envelops the whole of cosmos and to delve into the meaning of being, man is specially qualified. Endowed with openness and freedom, man can inquire into who he is in particular and the meaning of being in general. The gravest threat to being is nonbeing that generally manifests in the form of death. Though death is extensively dealt by existentialists, they are not limited by any fixation with death. They acknowledge that the being can only be savored in a context permitting an awareness of the ever-present possibility of nonbeing or death. Once the realization about this finitude dawns on oneself, each moment becomes more precious and one takes stock of one’s own life.

Everyone is enlivened by an ambition to move ahead in life and actualize a possibility. For the Danish philosopher Søren Kierkegaard (1813-1855), freedom is a possibility, which is animated by our decisions and choices, and also the impossibility of evading the outcomes. For possibilities to be actualized, we require to plod through “an intermediate determinant [called] anxiety.” (1976, 128)

One comes to realize that there is a point at which they might cease to be and their encounter with reality becomes characterized by anxiety:

Anxiety is the awareness of unsolved conflicts between structural elements of the personality, as for instance conflicts between unconscious drives and repressive norms, between different drives trying to dominate the centre of the personality…between the will to be and the seemingly intolerable burden which evokes the open or hidden desire not to be. (Tillich, 1977, 64)

According to the existential theologian, Paul Tillich (1886-1965), there are two types of anxiety: existential and pathological. Existential anxiety is embedded in our existence as we are constantly threatened by nonbeing or death. In the face of meaninglessness or death, everyone is existentially empowered with this basic anxiety. To reject it is a fatal mistake; one has to live with it as it cannot be removed.

If one evades existential anxiety by running away from it or refuting its continuation in one’s life, then pathological anxiety erupts. For Tillich, pathological anxiety is “a state of existential anxiety under special conditions.” (ibid, 65) What these conditions are depends upon how one tackles nonbeing. One of the principle ways of dealing with anxiety is courage which emerges from an in-spite-of challenge: the self triumphs over that which prevents it from affirming itself. This self-affirmation is the first step towards contracting with courage. Courage helps us to deal with anxiety as it “resists despair by taking anxiety into itself.” (ibid, 66)

If one fails to confront anxiety and avoid it, then one disintegrates into neurosis. Tillich applies the term neurosis generally to “the way of avoiding nonbeing by avoiding being.” (ibid, 66) One may have a fervid sense of self-affirmation but on a limited scale where the self erects a strong defense against actualization of the numerous potentialities. Simply, the self “surrenders a part of [its] potentialities in order to save what is left.” (ibid, 66) So, pathological anxiety makes one intensely obsessed about the power of nonbeing.

Neither must one be bogged down by anxiety nor should one by gripped by the threat of nonbeing. Incompleteness of the realizable possibilities in life may evoke a sense of guilt but out of this acceptance, there emerges not despair but a hopeful entry into the realm of promising possibilities. Though the dividing line between sanity and insanity is thin, one needn’t give overabundant relevance and emphasis to either. In admitting the inevitability of anxiety, one has to cut through this threat towards an ever-possible actualization of the self. The eminent neurologist, whose narratives will be dealt in this monograph, Oliver Sacks (b.1933), has an abiding existential undercurrent in doing medicine:

Complementary to any purely medicinal, or medical, approach there must also be an existential approach: in particular, a sensitive understanding of action, art and play as being in essence healthy and free and this antagonistic to crude drives and impulsions. (1985, 91)

The Neuroanthropology of Oliver Sacks

Nowadays, where anxiety has been reduced to physical illnesses, neurology has been nourished by narratives that bring alive these anxieties - with limited but extraordinary effects. Among the pantheon of prominent neurologists of the twentieth century, Oliver Sacks stands out because of two main reasons: for prescribing treatment tracking wholesome health and for preferring psychological wellbeing to plain physiological health.

Sacks was born in 1933 in London into a medical household. Both his parents were physicians and two of his elder brothers are doctors. He was molded to become a surgeon with his father’s passion for social medicine and his mother’s exuberant zeal in seeing human body in unison with Nature. He was excessively interested in chemistry and marine biology till he moved in 1950s to Oxford and in early 1960s to California to become a resident in neurology and neuropathology. Later he settled down in New York to work at the Beth Abraham hospital. He still works with this hospital and he is the clinical professor and adjunct professor of neurology at Albert Einstein School of Medicine and New York University respectively. He has treated patients with a wide variety of complaints from Parkinson’s, Autism, Alzheimer’s, and Schizophrenia to Color blindness, Tourette’s and Korsakoff’s syndromes. He has received numerable awards, numerous honorary degrees and numberless blessings from his patients.

Sacks has written scintillating narratives in more than 8 books about unusual circumstances that arise in one’s life due to the appearance of neurological disorders, which range generally from memory loss, loss of recognition to identity crisis. His writing is dense with medical humaneness sensitized by patients’ suffering. The rare remarkable empathy of Sacks towards every one of his patients is a striking feature in every narrative. His cure with care attitude throughout the treatment is exceptional; he has stayed on within the hospital premises to remain accessible to his patients anytime. His life is in fact a reference manual for the finest doctor one can be; he has remained unmarried undoubtedly for the sake of his patients.

There is a kind of democratic quality to Sacks’ narratives which are open for anybody to read and immerse in its intricateness. And yet, readers emerge with a consolation at the courage of the patients to face the unimaginable pain or with glee at the incomplete improvement of the circumstances. In fact, readers – even if they haven’t acquired such disorders – are either transformed by the momentous suffering of their fellow humans or reminded of the finitude of the human life. Readers are alerted to such wacky illnesses not to succumb to helplessness but to become aware of our limited existence. Most of Sacks’ narratives are instances of perpetual human struggle and partial amelioration in the process.

Sacks’ philosophy of medicine

The great Canadian neurosurgeon, William Osler (1849-1919), once said that "he who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." Sacks has fanatically lived up to Osler’s suggestion and has churned narratives out of his patients so much that nowhere in these clinical tales, would the reader find any reference to Sacks but to his patients. And to remedy their illnesses, Sacks uses the collective “us” referring to everyone involved in the treatment.

Some say medicine began in the Genesis itself when God breathed life into a lump of clay and made Adam. So, it is the primary medical act of breathing life into an organ that must carry on sustenance of life. As Deuteronomy of the Old Testament instructs, we need to choose life over anything else and stand out in the face of any scourge of suffering. Sacks would have learnt it at an early age when he used to visit synagogues and even listen from his father who was a prolific Jewish scholar-physician. The exquisite narrative description of the books of the Pentateuch like the Exodus and Numbers would have been an impulse for his mastery of narrative writing.

For Sacks, narrative writing is salvation from bearing witness to the human condition. Medicine has correct diagnosis as its inevitable goal but for Sacks, it is just one among the many perspectives to treat the patient. Since many of the conditions chronicled by him are incurable, the force driving his tales is not the race for a remedy but the patient's striving to maintain his or her identity in a world utterly changed by the disorder. In Sacks' case histories, the hero is not the doctor, or even medicine itself. His heroes are the patients who learned to tap an innate capacity for growth and adaptation amid the chaos of their disordered minds. By restoring narrative to its rightful place in medicine, Sacks has remodeled the way physicians have to deal with their practice. Medicine insularly focused on a patient only as a diseased subject. In his narratives, Sacks has irrevocably restored human selfhood at the centre of his diagnosis. Sacks succinctly explains:

Our health, diseases, and reactions cannot be understood in vitro, in themselves; they can only be understood with reference to us, as expressions of our nature, our living, our being-here in the world. Yet, modern medicine, increasingly, dismisses our existence, either reducing our existence, either reducing us to identical replicas reacting to fixed stimuli in equally fixed ways, or seeing our diseases as purely alien and bad, without organic relation to the person who is ill. (1990, 228)

This is the starting premise for Sacks to treat his patients who are thought to be transformed by diseases as much as the literature of the diseases is affected by the patients. This is the reason for Sacks to write about the transformative capacity (to whatever little extent) of illnesses in patients and in turn, help enrich neurological literature. For Sacks, patients are not pieces of neurological disorders but an orderless reality with borderless possibilities for recovery.

Sacks has based his philosophy of medicine strongly on another prominent neurologist of 20th century: Alexander Luria (1902-1977), the Soviet neuropsychologist. Luria was one of the first neurologists to blend neurological case studies with exceptional narrative style and in the process develop something Luria called the romantic science. Luria was one of the wellsprings of inspiration for Oliver Sacks. Luria used novel ways to describe his extraordinary patients like Sherashevsky who had such vast memory that he could not forget anything and the effects of this indelible memory on his identity and life.

Another patient Zasetsky had a bullet-pierced brain because of which many abnormalities developed ranging from complete loss of perception of right side of vision to memory loss. Yet, Luria developed a unique way to alleviate the pain of the patient. Luria came to know that Zasetsky had an intense interest to write though he lost his reading ability. So, Luria encouraged Zasetsky to plainly write, fearless of any grammatical rules. Luria believed that Zasetsky’s introspective writing would become his most reliable form of communication and his reason for living.

Ultimately, Sacks’ philosophy of medicine rests on two pillars of doing medicine: identification and understanding. (Sacks, 1990, 226) When a patient meets the physician for the first time, he indulges in identification. This involves the physician recognizing the outward symptoms, scurrying for signs that are characteristic of the disorder and tests to verify or rebut the suspicions. In fact, this has become the general attitude towards illnesses. What happens with pure obsession with identification is put across in a poem by Philip Larkin (1922-1985) delightfully:

Even to wear such knowledge – for our flesh

Surrounds us with its own decision –

And yet spend all our life on imprecisions,

That when we start to die

Have no idea why. (Drownie, 1995, 269)

But, Sacks’ scope of medicine extends to another aspect called understanding. By which, he means the human level of approaching the patient. After completing the technical review of the patient’s situation, the physician has to invariably set out into the realm of cure, care and compassion. In fact, this must go hand in hand with the identification phase. A physician should never lose the humane understanding for the sake of diagnostic precision of the disease. Because, as Sacks indisputably points out:

Patients need proper diagnosis and treatment, but they also need understanding and care; they need a human relationship and existential encounter, which cannot be provided by any technology. (1990, 226)

So, identification and understanding have to harmonize each other because as the great Jewish physician-philosopher Maimonides (1135-1204) suggested:

[The remedy for sick souls is to go to] wise men – who are physicians of the soul – and they will cure [the] disease by means of the character traits that they (the physicians) shall teach them, until they make them return to the middle way. (Drownie, 1995, 92)

And the middle way, as Maimonides too pointed, is also Sacks’ scruple: to tread a balanced path between identification and understanding, and allay the suffering of the patient by allying him with the reality of life.

Neurological Narratives of Oliver Sacks

Oliver Sacks, in self-consciously practicing narrative medicine, prefers not to reduce and localize the illness to a specific body-part but to look at the inherent inhabitant in the body. It is weird to imagine the incapacity of a husband to recognize the face of his wife with whom he has lived half of his life or a woman who deliberately impairs her hands or a 93-year old man who has to be shown a videotape of his movement to make him realise that he walks tilted. These clinical tales are narratives that will confound the reader with their unusual behavioral patterns - a result of some damage to a 1.3 kg jelly that sits right on our top: the brain, and the nervous system that supports it. Yet, one must remember that the manner and matter of illnesses depends as much on the damage to the brain as on a variety of psychological and sociological factors.

The best part of these narratives is that they are about someone really out there who is facing a nasty reality of his life knowingly or unknowingly. These narratives may alarm readers because of their bizarre descriptions and tribulations. But, at the same time, they also alert readers that they may also face a similar situation in their future. In a sense, these narratives inform the reader immediately of the prospect of contracting such illnesses common to the human situation and a variety of ways to alleviate the situation. As the philosopher-theologian Paul Ricoeur (1913-2005) explains:

A story describes a series of actions and events [in which] characters are represented either in situations that change or as they relate to changes to which they then react [and] reveal hidden aspects of the situation and of the characters and engender a new predicament that calls for thinking or action or both. The answer to this predicament advances the story to its conclusion. (1980, 174)

So, Oliver Sacks disrupts his narrative order of outlining his patient’s plight. This is done to infuse the narrative with his medical as well as philosophical insights and to pause the reader to think while encountering situations that move across from one trauma, joy to another. He is extremely careful in choosing Wittgenstein to elucidate on the role of language; or Nietzsche or Kierkegaard for philosophically reading illnesses; or the neuropsychologist Alexander Luria or the great physician William Osler to medically interpret illnesses with humaneness. Never does Sacks stumble the reader into distress - as he sees an absolute trust between the physician and the patient to be the touchstone of recovery.

Bodiless narratives

Human brain adapts to new challenges posed to it by coordinating with the whole of human body or simply put, we have an embodied brain. Without the body to interact, brain can be chemically stored but in a soulless void. Brains live in and with bodies. But, sometimes due to a stroke that affects the brain, patients have a false sensation of some body part. We all have what neurologists call proprioception: an ability to sense the location, position, orientation, and movement of our body. Without this, we will be left disoriented and lost in the world. But, shortly after the American Civil War of 1860s, soldiers displayed a peculiar experience: even after unfortunately getting their limbs amputated, they still felt their presence in the body. This unusual experience is called phantom limbs. Ever since, there have been numerous similar cases with patients engulfed in such bizarre circumstances where they become incapable of perceiving the absence of certain parts or portions of the body.

Generally, individuals turn into patients because of the onset of some illness. This new labeling of individuals shouldn’t discredit them as beings in the world. They only turn into patients due to their entry into a distressing phase of their life from which they may or may not have an exit. Neurologists and their team are responsible as much as the patient for charting out the path to recovery. The physician must be proactive enough to be sensitive towards the suffering of the patient and that’s why we term them illnesses (as they are subjective) rather than diseases (which are nearly objective.)

A 93-year old man young with bustling energy steps into the clinic and Sacks is astonished at his gait. He doesn’t walk upright but at a certain angle to the floor. And the funniest thing is that he is worried over others telling him that he isn’t walking normally and moreover he puzzles Sacks with this question:

How could I be tilted without knowing I was? (1985, 67)

This incapability to perceive his slanted gait would be really confounding because it is usually unbearable for anyone to be told of anything unusual about oneself through others. It is a typical reaction to the threat of understanding oneself through others.

But, the most fascinating thing about this narrative is that it abounds with self-reflexivity. Before Sacks suggests anything, the wise old man dissects his situation by seeking an analogy from his profession: carpentry. In fact, the neurologist is quite aware that the carpenter is suffering from a disease apparently possible in old people: Parkinson’s disease. Due to this disease, patients lose their ability for voluntary orderly movement and their muscles become rigid, and hands display tremors. Neither does the carpenter know these overt symptoms nor is he aware of the dreaded disease. But, the carpenter breaks through the neurological tags (Parkinsonism) usually assigned to a patient like him and understands his plight through metaphors of his own profession. He puzzles Sacks when he asks him:

[As a carpenter] we would always use a spirit level to tell whether a surface was level or not, or whether it was tilted from the vertical or not. Is there a sort of spirit level in the brain? [whose knocking out results in Parkinson’s] (1985, 69)

For quite sometime, the medical profession has been ruthlessly assaulted for increasing the patients’ trauma by tagging them with scary diseases and creepy symptoms. This narrative brings out a fresh outlook towards this allegation suggesting that by allowing patients to reflect on their condition and gain self-understanding about their situation; patients themselves may come up with strategies to deal with it. With this assurance of self-sensitivity to their suffering, patients can pool up with physicians to mutually sort out a way ahead. In fact, this is possible in cases where patients retain some self-awareness towards such insightful thought or else it completely depends upon the physicians (and their team) to lonely unknot the course of treatment.

Ultimately, the carpenter himself scurries for ways to make himself aware that he is walking skewed. Should I use a mirror but I can’t self-reflect on myself all the way through? But, this self-healing carpenter thinks it through:

‘Yeah, Doc, I’ve got it! I don’t need a mirror – I just need a level [that] I can’t use the spirit levels inside my head, but why couldn’t I use the levels outside my head – levels I could see, I could use with my eyes?’ (1985, 71)

So, the carpenter hints at the possible remedy for his predicament: fashioning a new form of spectacles that would make him aware of his tilted posture. With the help of the neurologist and his team, the carpenter creates a special spectacle that – though awkward – perches on his nose to keep a constant vigil on his posture. These glasses are initially bulky to wear but gradually become wearable. For some recourse to the disease to be jointly amenable to the patient and the physician, there must be an unequal participation from either side in the course of treatment. The same principle can be extended to any relationship in life: until we play our part, we can’t expect to move ahead. A prevalent point that these narratives reveal is that such situations turn into spectacles of insight into our life - as we progress through the enveloping of illness as well as engulfed by our self-understanding.


As they say, partial understanding is itself a progress made towards the whole. Yet, someone like Mrs. S (described in Eyes Right!) has a fractional view of the world that makes her imperceptive of the remaining fraction. She cannot view anything to her left, whereas everything to her right is perfectly perceptible. How can one have such an unfair worldview? She had suffered a massive stroke whereby portions to the right of the brain dealing with visual spaces on the left have been damaged. Unlike the proactive old man in the previous narrative, this nearly-old woman doesn’t know that she’s missing out half of her view. As Sacks explains:

She knows it intellectually, and can understand, and laugh; but, it is impossible for her know it directly. (1985, 73)

But, this intellectual understanding has helped her evolve ways to compensate her invisible left view. Her solution is explained by Sacks in her act of trying to eat up everything in the plate. Mrs. S gets a rotating wheelchair and she takes a complete circular turn to her right until she feels that the food on her left is perceptible for eating. Even after eating out all that’s in her view, she may feel hungry or the plate may not yet be empty. Then she takes another complete right-turn allowing her to eat out a portion of the remaining uneaten portion on her left.

So, she has to make as many right swivels as needed until she feels bellyful. She could have rotated the plate or used a video system that would mirror her such that she can see the left side on her right on the screen. But, neither of these experiments is amenable to her condition but as Sacks points out:

The matter is so physically, or indeed metaphysically, confusing that only experiment can decide. (1985, 75)

Sacks’ general approach to treatment involves a metaphysical orientation as evidenced in the above line. But, what does he mean by metaphysical aspect of the medical narrative? By metaphysical, Sacks stacks up the infinitely complex answer behind an infinitely simple question like how is your health. One can reply affirmatively or grudgingly, but words are quite inadequate to explain the inside reality and something beyond these expressions is inherent in our existence, and by not acknowledging it, we run into the risk of masquerading our troubled existence as blissful living.


When we deliberately prevent or are scared of our growth, we not only hamper our psychological evolution but also our physiological performance. This has been cussedly noticed in the case of Madeleine in the narrative Hands. In spite of being congenitally (acquired at birth but need not be hereditary) blind, Madeleine is a vivacious woman with exceptional intelligence. Yet, she has depended only on others for her growth; she has been babied from birth so much so that she doesn’t even learn Braille. Her speech is infested with too many cannots, among which the most striking is her self-chosen disuse of her hands, which are for her:

Useless godforsaken lumps of dough [that she doesn’t feel to be a part of her] (Sacks, 1985, 56)

In fact, this abandonment of hands is due to the replacement of their function by others’ hands. Though she can sense her hands, their use or the perception of hands has been substituted by the supporting hands around her. In a sense, her environment stalled her growth and on the top of it, it made her feel as if she doesn’t need hands at all. So, right from her birth she has been insulated from attempting to recover her hands. And this was a daunting task as she had to perceive something that she never did in her life: discover the presence of her hands and their use. Sacks tries to make her recognize the importance of her hands and to do that, she had to learn to use her hands unassisted. One day, without anyone accompanying her and overcome by hunger, she grabs a bagel with her hand and activates her hands progressively to even shape clay molds. Her blindness didn’t hamper her adeptness at sculpting objects exquisitely. But, she soon moved on from objects to people:

There were limits, after all, to the interest and expressive possibilities of things [so that] she needed to explore the human face and figure, at rest and in motion. (Sacks, 1985, 60)

It was only for her to discover and explore her true self to realize the latent potentials waiting to blossom out. Further, Sacks writes about another patient who is a simpleton and relatively not as extraordinary as Madeleine. He too has remained handless for most of his life but using the impetus given by Madeleine’s case, Sacks motivates him to use his hands and he begins to employ them in all kinds of ways. With these two cases, Sacks tries to disprove a pertinent misgiving about individuals:

The essential achievement of hands proved wholly possible for him as for her [and this clarifies] that intelligence, as such, plays no part in the matter – that the sole and essential thing is use. (1985, 61)

Humanist psychologists like Abraham Maslow have brilliantly explained these losses. Body organs have capacities that clamor to be well-used and if the needs of the organs are not satisfied, then:

The unused skill or capacity of organ can become a disease centre or else atrophy or disappear, thus diminishing a person. (Maslow, 1968, 201)


Scary Surpluses

If the previous section dealt with narratives that are livid with losses of certain portions in the nervous system, then Sacks offsets those narratives with others that abound with excesses in the brain. If losses are characterized by some kind of shortcoming in one’s life due to the malfunction of some part in the brain, then excesses are even more terrifying as they reach extreme ends of human existence.

One can enjoy the experience of extreme exuberance, incredible rapture of the body; but at the same time, one can be swayed to excessive states of involuntary movement and unwelcome liveliness. Euphoric states are often sought after by artists and others as an essential sickness for the mind to journey to the edge of consciousness and reap benefits out of such an experience. But, to stubbornly seek eccentricity nearly nudges individuals into neuroses and gives them a false feeling of wellness. Growth doesn’t lie in artificially inducing it in one self but to naturally spark it out in the human situation of everyday sanity.

To be ourselves we must have ourselves

On acquiring fatal illnesses, patients are often confounded at the sudden overturn of the familiar world that they experienced before. Meanwhile, the world in which one was at home gradually retires into a remote world. As memory becomes luxury, people are stripped of their identities and are torn apart from reality. This nowhere selfless existence may not be even perceptible to patients as they move from one confabulation of world to another. One such narrative is that of an ex-grocer, Mr. Thompson (in A Matter of Identity) who is mired in:

Abysses of amnesia [which] continually [open] beneath him, but he would bridge them, nimbly, by fluent confabulations and fictions of all kinds (Sacks, 1985, 104)

This is what one makes of the glimpsing reality out there when affected with what is called a severe Korsakov’s psychosis. Mr. Thompson replaces the world and self with what has been forgotten and lost. He is caught in cycles of chimeras which manifest as made-up stories about every perceivable situation. Sacks sees, in Mr. Thompson’s hypothetical narratives, the need to tell stories about one’s encounters in life. In outlining the need for a narrative, Sacks justifies - within his narratives - the nourishment that narratives reward us by their richness of storytelling. Until one enacts the inner drama, he may not be able to live in a logical continuity with life.

Mr. Thompson is tormented by the continuous business of inventing illusions to satiate his inner drive to catch up with reality. This is usually the case with most of us – and as the Existentialist has regularly warned us too – that we try to escape reality by erecting a façade of delusions. We mistake the sparkling superficial surfaces of reality to possess the ultimate depth of meaning. Mr. Thompson too presents dazzling surface anecdotes that lack the profundity of meaning. Moreover, what startles us about Mr. Thompson is that he has:

…no feeling that he has lost feeling, no feeling that he has lost the depths, that unfathomable, mysterious, myriad-leveled depth which somehow defines identity or reality. (Sacks, 1985, 107)

But, say, Mr. Thompson suspends his gibberish for sometime for some aspect of reality to penetrate his chimerical world. Then, it can be expected that something unexpected can happen. Medicine is full of miracles where something unknown unlocks its grace on the patients to redeem them of their suffering. In another clinical narrative (The Lost Mariner,) Sacks writes about a former submarine radio-operator, Jimmie. After more than thirty years of the Second World War, Jimmie is caught in time: he still feels that it is wartime. He has typically lost memory and cannot remember anything after the war till today: a vast span of more than 30 years. And when Sacks consults the erudite neuropsychologist, Alexander Luria, he suggests that:

Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being – matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him. (Sacks, 1985, 32)

So, Sacks seeks various ways of Jimmie’s redemption from this memory blackout; but with a haunting question: does he have a soul at all to be recovered or that too has been drowned by the disease? The solution Sacks finds in Jimmie’s marvelous conduct in the chapel:

He was wholly held, absorbed…there was no forgetting…for he was no longer at the mercy of faulty and fallible mechanism – that of meaningless sequences and memory traces – but was absorbed in an act, an act of his whole being, which carried feeling and meaning in an organic continuity and unity…so seamless it could not permit any break. (1985, 36)

In hopeless neurological situations, patients like Jimmie can still find a communion with the spiritual Ground of Being to reconnect them with their truer self. But, in the case of Mr. Thompson, even this reconciliation seems unlikely. Whenever he is among the crowd or enclosed by things, Mr. Thompson frenziedly and superfluously connects with them by a veritable delirium of identity making and seeking. But, if supplied with solitude, he nevertheless experienced a spiritual communion with something other than himself. Though there was no marked recovery in his situation, this quite time he had for himself could give him a respite from his uncontrolled chatter.


Usually, we experience nearly controlled body movement in most of our daily activities. If we accidentally stumble in our movement, we may feel embarrassed and correct it immediately as we are conscious of such slip-ups. But, there is a typical situation where one experiences involuntary movement abundant with nervous energy, extreme emotions and excessive motions, terrifying twitches (called tics). This is called the Tourette’s syndrome. One such patient’s narrative is the most famous oft-cited Witty Ticcy Ray.

Ray is a 24-year old dilettante who is thrilled as much by his jazz-drumming as with his tics. He was fired from his jobs because these tics tripped him into sudden outbursts of excitement and surpluses of irritation. Yet, he was endowed with a keen musical sense that was floridly displayed during his weekend jazz drumming. His tics tapped into his dexterity at drumming - discounting him of any upsetting situations as such. He lost himself to music to recover in other situations to be thwarted by tics.

A person suffering from Tourette’s syndrome seems to be living in a public dream of his private unconscious as he is disoriented and dissociated with his surrounding world. This psychoanalytic aspect of the syndrome refutes the obsession of most neuroscientists today to proclaim that psychoanalysis is a defunct discipline.

Anyhow, Sacks – on learning about a new drug (haldol) that could abate the tics of Touretters – gave a minute dosage of it to Ray. When he turned up a week later, Ray walked into the clinic with a black eye and broken nose. As a Touretter is often lured by “spinning things and revolving doors,” Ray – managing with a minute dose of Haldol – had mistimed his movements and ran into the revolving doors to get knocked out. The drug had reduced the intensity of the tics and this cutback had affected his normal movement and reaction itself. So, neither can tics be completely abandoned nor can their overabundance be tolerated. Because as Ray himself admits:

Suppose you could take away the tics… What would be left? I consist of tics- there’d be nothing left. (Sacks, 1985, 93)

This is what usually happens with patients enduring extreme suffering: their identity aligns with the illness; their self sums up with symptoms. Sacks, in just giving us few details and administering the drug, had experimented with the drug’s effect and this narrative proves the inadequacy of a pill for every ill. Just by spotting the symptoms, labeling patients with diseases (especially in the case of mental illnesses) and delivering them over to drugs, can never help the patient. Drugs and scans are a part of the treatment; not the whole treatment itself.

For the physiological imbalance to be transcended, the existential balance has to be enriched. Though Ray was continuously drowning himself with the disease, Sacks examines Ray’s life with and without Tourette’s. He collaborates with Ray on a three-month ordeal about Ray’s hidden potentials that survived unexplored during his 20 years of endurance with the disease. Even Freud devoted a protracted time (sometimes years) to his patients in understanding their tribulations; but, ultimately for the benefit of maximally diagnosing their illnesses.

Sometimes, a lack of such commitment to the patient results in what Sacks had done to Ray in drugging him with haldol. But, it is the wisdom of Sacks to renounce such isolated approaches and reconcile with Ray in coordinating with him to discover an amenable treatment. This co-working with Ray resulted in a reuse of haldol on Ray but now with a better understanding of the potentials of the patient and the physician by each other, the ill-effects (that arose earlier) are nearly absent.

Living with Tourette’s from the age of four, Ray was fascinated by the disease so much that he was not willing to give it up. Because of the three moths of deep preparation and analysis, he has now skimmed out the surface obsessions with the disease to plunge into the profound depths of his personality. Ray and Sacks etch out a prodigious plan to help Ray enjoy a normal life as well as the extraordinary life that tics had provided him:

[Ray] would take haldol ‘dutifully’ throughout the working week, but would take himself off it, and ‘let fly’, at weekends… There is a sober citizen, the calm deliberator, from Monday to Friday; and there is ‘witty ticcy Ray’, frivolous, frenetic, inspired at weekends. (Sacks, 1985, 95)

The dullness that haldol drowned Ray during weekdays was nevertheless unequally compensated by the vivaciousness of off-haldol weekends. In finding this balance in life, Ray reminds the equilibrium with which one has to negotiate his inner freedom with outer captivities.


A child follows the Bible before he follows Euclid

Finally, a neurological narrative in which the patient herself uses narratives to connect with an otherwise empty meaningless world. Rebecca was a physiologically grown-up girl of 19 but was psychologically still a child. She was – to use a medically derogatory word – a “retarded” child colored by utter confusion and clumsiness of activity, complete withdrawal from the outside world, along with a wide variety of cerebral and mental defects. Our general attitude toward people like Rebecca is to flush out pointless sympathy (originating from pity) whereas the least that was needed was to empathize with Rebecca and make her feel at home.

Orphaned at an early age, Rebecca was cared by her loving grandmother. Though Rebecca could neither write nor read, she listened to stories and poems recited by her granny, who almost enacted them in her majestic voice.

Though Rebecca seemed utterly emotionless, she was deep down an adoring girl with profound love for her grandma. In spite of her incapacity with simple principles and instruction, Rebecca wanted the world to be re-presented to her in verbal images, in language, and seemed to have little difficulty following the metaphors and symbols of even quite deep poems. Though abstract concepts were imperceptible to her, she absorbed herself in concrete poems and coalescing narratives. Rebecca may be crippled intellectually but spiritually somewhere deep down her soul, she had a spiraling sense of completeness. Unlike other narratives in the book, Sacks, in Rebecca, speaks with a special sincerity. Initially, he mentions all the noticeable signs and symptoms of Rebecca to confirm her shortcomings. Later, he is awestruck at her profound insights and observations in her delightful encounter with nature.

Sacks first saw her – with a neurological vision – as a casualty whose impairments were diagnosed with precision. Next time, he saw her – with his human vision – to be baffled at her beautiful vision of nature. Rebecca would be spellbound by nature and lose herself among the flora and fauna - stilled by moments of illumination and contemplation. She was also a devout Jew who may have been similarly wondered in synagogues by the tale of Moses who brought down from Mt. Sinai, not just the guidebook of God but the overwhelming wonder of God. Marveling at the Cosmos is an available experience to all of us but we are deliberately turning it into an unaffordable luxury.

Deficits were so promptly diagnosed that what was outside those deficits was blatantly neglected. Tests and scans could never show these inherent abilities of Rebecca and it is always advisable for the physician to treat the man not the scan. Though she was de-composed by her deficits, she re-composed herself with a stillness that – as Sacks analyzes – emerged out of her fondness for tales, for narrative composition and coherence. This is what most physicians tend to ignore:

…Evaluations [display] deficits [masking us from the patient’s] powers…they only show us puzzles and schemata, when we need to see music, narrative, play, a being conducting itself spontaneously in its own natural way (Sacks, 1985, 172)

Narratives – derived out of watching and wondering about nature – helped Rebecca to reconfigure her world and re-place herself as a worthwhile participant in it. Even when her storytelling grandma died, Rebecca acts with great poise and dignity – reacting to a dear one’s demise with an unretarded touching mourning. When Rebecca was advised and attended some workshops and classes, it didn’t work as she was constantly reminded her of her limitations because as Sacks so wonderfully puts it:

…we were far too concerned with ‘defectology’, and far too little with ‘narratology’, the neglected and needed science of the concrete. (1985, 174)

Narratives come naturally handy for us to deal with a wide variety of situations in life; Bible is easier to follow as it is “cast in a symbolic and narrative mode.” (ibid, 175) Rebecca searched for that one narrative in life that could give her a genuine meaning and she expresses it in an amazing analogy:

I’m like a sort of living carpet. I need a pattern, a design, like you have on that carpet. I come apart, I unravel, unless there’s a design. (ibid, 175)

In the changing patterns of life, Rebecca was searching for that distinctive pattern that would give her a glimpse of her life’s true meaning and purpose. At last, she herself expresses her love for theatre. She is enrolled into a theatre group, where in the shifting patterns on the stage, she dons various roles and does exceedingly well in spite of her mental deficits. Unless we find what is that which kickstarts the real self in us, every one of us are virtually mentally defective. Narratives are everywhere around us; it only takes a keen inner eye to pick out the perfect narrative and engage in the ever-lasting episodes of self-realization.

A Starting Conclusion

…it is silly

To refuse the tasks of time

And, overlooking our lives,

Cry – “Miserable wicked me,

How interesting I am.”

We would rather be ruined than changed,

We would rather die in our dread

Than climb the cross of the moment

And let our illusions die. --- W.H. Auden, The Age of Anxiety

Almost all these narratives are sewn with strands of the patient’s awakening to the presence of some illness, the physician’s diagnosis and deliberations, the ensuing tribulations and revelations. But, there are knots of existential dilemmas that must be unknotted in the process of ultimately sewing up the cloth of health. Neurological narratives challenge us with their complexity in realizing the constraints of human existence. The so-called healthy readers are confounded by the others’ illnesses so much so that the reader has to rethink about what it means to be hearty and healthy.

In fictitious narratives, readers are asked to cognitively fill in the gaps left open by the author so that the meaning of the text is completed by the active involvement of the reader. Paradoxically, in neurological narratives, readers are not only required to bridge the breaks in the text outside them. But, there is a stronger emphasis to refill and renovate their selves with novel understandings from participating in making the meaning of the medical narratives. When these narratives decompose the line separating illness and wellness, the reader is handed over the responsibility to make a meaningful judgment about the dividing line. In fact, as this subject is quite subjective and unique to every individual, it is audacious for the psychiatrist or neurologist to pass an absolute ruling on it.

Whatever may be the degree of outside relief a patient can get like drugs and therapy, it ultimately rests with the patient’s unassailable inner self to promote his psychological health. Actually, the way in which the organs disobey the human will and degenerate into disorders reflects the manner in which an individual willfully collapses into his cocoon of cravings and revels in his separateness.

Medical facts keep on restocking the infinite space created by myriad possibilities of human pathology and health. Every medical procedure is only a step closer to the source of illness whereas it is inherent in illnesses to take an astonishing form as soon as a physician offers certainty of curing an illness. No sooner there will be newer manifestations of the illness as its biological variability and the ever-changing human condition are inbuilt into it. So, listening to thousands of years of medical advice, it is always favorable for patients to have as much as self-understanding as possible to brave and combat illnesses. Until we acknowledge our innate natural levels of suffering of being born as a human, we cannot grow over them and overpower them with our uniqueness of being a human.

What has been lost is the capacity to experience and have faith in one’s self as a worthy and unique being. At the same time, we have distanced ourselves from our fellow human beings to such an extent that we have made ourselves incapable of acknowledging our separateness - let alone experiencing it. This disharmony with others can be resolved by the sufferer as he alone has got the freedom to pick among these three choices:

The effects of suffering…may stimulate in the sufferer a conscious or unconscious craving for intensification of his separateness; or it may leave the craving such as it was before the suffering; or finally it may mitigate it and so become a means for advance towards self-abandonment and the love and knowledge of God. (Huxley, 1972, 263)

Most of the patients in the neurological narratives have made one among these choices outlined by the brilliant polymath, Aldous Huxley (1894-1963) and lived with it till they turned into patients. Then, they have sustained their choice or preferred another choice that has changed their very mode and functioning of life. As was observed in Introduction, the marked manifestation of suffering is existential anxiety, which as patients are awakened takes the form of:

… [an] apprehension cued off by a threat to some value that the individual holds essential to his existence as a personality. (May, 1977, 80)

Threats can originate from the body or the psyche; but one must remember that there is no threat-less existence in anyone’s life. As long as individuals hold a variety of values central to their existence, they have to encounter anxiety but not succumb to it. Instead, this anxiety-rich existence gives us ample opportunity to rekindle our untapped possibilities and refurbish our self. Illnesses often leads to redemption - as the self is nearly emptied of all humdrum of outside quotidian existence and focuses on the inner promise of potentials.

As the awareness of existence expands, the patient discovers what value is threatened and becomes aware of the conflict between his goals and how these conflicts have developed. Then, the individual restructures his goals, makes a choice of values and proceeds towards the realization of these values responsibly and realistically. In the recovery and reorganization of the self, patients may experience self-realization that is:

…the expression and creative use of individual capacities [which] can occur only as the individual confronts and moves through anxiety-creating experiences. (May, 1977, 354)

Enriched by anxiety-creating experiences, the patient becomes creative and constructively deals with the prevalent situation readily and responsibly. Then, a surfeit of possibilities emerges and selfhood gets strengthened. But if:

…individuals seek to avoid anxiety, responsibility, and guilt feeling by refusing to avail themselves of their new possibilities, by refusing to move from familiar to unfamiliar, they sacrifice their freedom and constrict autonomy and self-awareness. (May, 1977, 356)

So, every one of us everyday combats with the illness of preserving our autonomy continuously assaulted by nothingness in life; yet, there are infinite possibilities for us to overcome the debilitating distresses in life and it is only up to us to do so. And one of the ways is to perpetually wait for a wise “storyteller [to bless]…an unending [unfinalized] world [with] the bliss of untold stories.” (Ashok, 1998, 128)

Works Cited

Ashok, AV. Narrative: A Student’s Companion. Chennai: TR Publications, 1998.

Auden, W H. Collected Poems. Ed. Edward Mendelson, London: Faber and Faber, 1976.

Brown, JAC. Freudians and Post-Freudians. Harmondsworth: Penguin, 1985.

Drownie, R.S. The Healing Arts. New York: Oxford University Press, 1995.

Fromm, Erich. Psychoanalysis and Zen Buddhism. London: Unwin Paperbacks, 1986.

------------------. Man for Himself. New York: Fawcett Premier, 1968

------------------. The Sane Society. London: Routledge Paperbacks, 1968a.

Huxley, Aldous. The Perennial Philosophy. London: Chatto & Windus, 1972.

Macquarrie, John. Existentialism. New York: Pelican Books, 1978.

Maslow, Abraham. Towards a Psychology of Being. New York: D Van Nostrand

Company, 1968.

May, Rollo. The Meaning of Anxiety. New York: Pocket Books, 1979.

Polkinghorne, Donald E. Narrative Knowing and the Human Sciences. Albany: State

University of New York Press, 1988.

Porter, Roy. Madness: A Brief History. London: Oxford University Press, 2002.

Ricoeur, Paul. Time and Narrative Vol I trans. Kathaleen McLaughlin and David

Pellauer. Chicago: Chicago University Press, 1984.

---------------- Narrative Time, Critical Inquiry (7) Autumn 1980

Sacks, Oliver. The Man Who Mistook His Wife for a Hat and Other Clinical Tales.

New York: Summit Books, 1985.

--------------- Awakenings. London: Picador, 1991.

--------------- Uncle Tungsten. London: Picador, 1991.

Scott Jr., Nathan. Mirrors of Man in Existentialism. Nashville: Abingdon, 1978.

Tillich, Paul. The Courage to Be. New York: Yale University Press, 1977.

White, Hayden. The Value of Narrativity. Critical Inquiry 7 (Autumn 1980)


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