Sacks

At this time there still existed a union of literary and scientific cultures; there was not the dissociation of sensibility that was so soon to come. There was indeed, between Coleridge and Davy, a close friendship and a sense of almost mystical affinity and rapport. The analogy of chemical transformation leading to the emergence of wholly new compounds was central to Coleridge’s thinking, and at one point he planned to set up a chemical laboratory with Davy. The poet and the chemist were fellow warriors, analyzers and explorers of a principle of connectedness of mind and nature.

Coleridge and Davy seemed to see themselves as twins: Coleridge the chemist of language, Davy the poet of chemistry.

Davy’s inaugural lecture enthralled many, including Mary Shelley. Years later, in Frankenstein, she was to model Professor Waldman’s lecture on chemistry rather closely on some of Davy’s words. (Specifically, when, speaking of galvanic electricity, Davy had said, “A new influence has been discovered, which has enabled man to produce from combinations of dead matter effects which were formerly occasioned only by animal organs.”) And Coleridge, the greatest talker of his age, always came to Davy’s lectures, not only to fill his chemical notebooks but, as he said, “to renew my stock of metaphors.

I do not think my experience is unique. Many scientists, no less than poets or artists, have a living relation to the past, not just an abstract sense of history and tradition but a feeling of companions and predecessors, ancestors with whom they enjoy a sort of implicit dialogue. Science sometimes sees itself as impersonal, as “pure thought,” independent of its historical and human origins. It is often taught as if this were the case. But science is a human enterprise through and through, an organic, evolving, human growth, with sudden spurts and arrests, and strange deviations, too. It grows out of its past but never outgrows it, any more than we outgrow our childhoods.

On the whole, I disliked school, sitting in class, receiving instruction; information seemed to go in one ear and out the other. I could not be passive—I had to be active, learn for myself, learn what I wanted, and in the way that suited me best. I was not a good pupil, but I was a good learner, and in the Willesden library—and all the libraries that came later—I roamed the shelves and stacks, had the freedom to select whatever I wanted, to follow paths that fascinated me, to become myself. At the library I felt free—free to look at the thousands, tens of thousands, of books; free to roam and to enjoy the special atmosphere and the quiet companionship of other readers, all, like myself, on quests of their own.

Seeing my distress, a librarian reassured me that everything “of worth” had been digitized. But I do not use a computer, and I am deeply saddened by the loss of books, even bound periodicals, for there is something irreplaceable about a physical book: its look, its smell, its heft. I thought of how the library once cherished “old” books, had a special room for old and rare books; and how in 1967, rummaging through the stacks, I had found an 1873 book, Edward Liveing’s Megrim, which inspired me to write my own first book.

One must assume in such a case that the disease was already affecting her neural function and that the unconscious mind, the dreaming mind, was more sensitive to this than the waking mind. Such premonitory or precursory dreams may sometimes be happy in content and in outcome, too. Patients with multiple sclerosis may dream of remissions a few hours before they occur, and patients recovering from strokes or neurological injuries may have striking dreams of improvement before such improvement is objectively manifest. Here again, the dreaming mind may be a more sensitive indicator of neural function than examination with a reflex hammer and a pin.

Dreaming, for Freud, was the “royal road” to the unconscious. Dreaming, for the physician, may not be a royal road, but it is a byway to unexpected diagnoses and discoveries, and to unexpected insights about how one’s patients are doing. It is a byway full of fascination, and should not be neglected.

That evening, Spalding left home, saying he was going to meet a friend. He did not leave a suicide note, as he had so often before. When inquiries were made, one man said he had seen him board the Staten Island Ferry.

Two months later, Spalding’s body was washed up by the East River. He had always wanted his suicide to be high drama, but in the end he said nothing to anyone; he simply disappeared from sight and silently returned to the sea, his mother.

One sees a kaleidoscopic array of symptoms and dysfunctions, never exactly the same in any two people. The neurological dysfunctions interact with all that is particular and unique in an individual—their preexisting strengths and weaknesses, their intellectual powers, their skills, their life experience, their character, their habitual styles, as well as their particular life situations.

Thomas DeBaggio, a writer and horticulturist, was even able to publish two insightful memoirs about his own early-onset Alzheimer’s before the disease killed him at the age of sixty-nine. But most patients are frightened or mortified by the knowledge of what is befalling them. Some continue to be severely terrified as they lose their intellectual competences and bearings and find themselves in a world increasingly fragmented and chaotic. But the majority, I think, become calmer with time as they perhaps start to lose the sense of what they have lost and find themselves shifted into a simpler, unreflective world.

Kurt Goldstein, studying brain-damaged soldiers during World War I, was moved from his original, deficit-based point of view to a more holistic, organismal one. There were never, he believed, just deficits or releases; there were always reorganizations, and these he saw as strategies (albeit unconscious and almost automatic) by which the brain-damaged organism sought to survive, although perhaps in a more rigid and impoverished way.

This theme, the preservation of identity, is well brought out by Donna Cohen and Carl Eisdorfer in their fine book The Loss of Self, which is based on painstaking studies of a number of people with Alzheimer’s. The title of their book is perhaps misleading, for it is not loss (at least until very late) but surprising preservations and transformations that we see in Alzheimer’s, and this, indeed, is what Cohen and Eisdorfer show.

The neural embodiment of self, it seems, is extremely robust. Every perception, every action, every thought, every utterance seems to bear the mark of the individual’s experience, of his value system, of all that is peculiar to him. In Gerald Edelman’s theory of neuronal group selection (as in Esther Thelen’s work on the development of cognition and action in children), we find a rich account of how neuronal connectivity may be determined by, literally shaped by, the individual’s experience, thoughts, and actions no less than by all that is hardwired and biologically given. If individual experience and experiential selection so determine the developing brain, we should not perhaps be surprised that individuality, self, is preserved for so long even in the face of diffuse neuronal damage.

It is the nature of living a real life that experience is not uniform, but ever changing and ever challenging and requiring more and more comprehensive integration. It is not enough for the brain/mind simply to tick over, maintaining uniform function (like the heart); it must adventure and advance throughout life. The very concept of health or wellness requires a special definition in relation to the brain.

If the brain is to stay healthy, it must remain active, wondering, playing, exploring, and experimenting right to the end. Such activities or dispositions may not show up on functional brain imaging or, for that matter, on neuropsychological tests, but they are of the essence in defining the health of the brain and in allowing its development throughout life.

We cannot be taught wisdom,” as Proust remarks, “we have to discover it for ourselves by a journey which no one can undertake for us, an effort which no one can spare us.

Richard Rhodes, in his 1997 book Deadly Feasts, has told the kuru story with psychological insight and dramatic force, virtually reliving the early days of this investigation—a time of fear, bewilderment, great ambition, and intellectual discovery.

This polarization…flies in the face of everything that we know about the cauldronous, fluctuating nature of manic-depressive illness.

He had long, searching discussions with Sally, and only more than a decade later did he feel that he might have the balance, the perspective, the tone that Hurry Down Sunshine would need. Sally, too, had come to feel this, and urged him not only to write her story but to use her real name, without camouflage. It was a courageous decision, given the stigma and misunderstanding that still surround mental illness of any kind.

Patients often lived in state hospitals for decades, and died in them—every asylum had its own graveyard. (Such lives have been reconstructed with great sensitivity by Darby Penney and Peter Stastny in their book The Lives They Left Behind.)

Sadly and ironically, soon after I arrived in the 1960s, work opportunities for patients virtually disappeared, under the guise of protecting their rights. It was considered that having patients work in the kitchen or laundry or garden, or in sheltered workshops, constituted “exploitation.” This outlawing of work— based on legalistic notions of patients’ rights and not on their real needs— deprived many patients of an important form of therapy, something that could give them incentives and identities of an economic and social sort. Work could “normalize” and create community, could take patients out of their solipsistic inner worlds, and the effects of stopping it were demoralizing in the extreme. For many patients who had previously enjoyed work and activity, there was now little left but sitting, zombielike, in front of the now-never-turned-off TV.

We forgot the benign aspects of asylums, or perhaps we felt we could no longer afford to pay for them: the spaciousness and sense of community, the place for work and play, and for the gradual learning of social and vocational skills—a safe haven that state hospitals were well equipped to provide.

The anthropologist Eugeen Roosens has studied Geel in depth for over thirty years; he first published his observations in 1979 (Mental Patients in Town Life: Geel—Europe’s First Therapeutic Community).

It is not clear whether life has to “advance,” whether evolution must take place, if there is a satisfactory status quo. Brachiopods, lampshells, for instance, have remained virtually unchanged since they first appeared in the Cambrian period, more than five hundred million years ago. But there does seem to be a drive for organisms to become more highly organized and more efficient in retaining energy, at least when environmental conditions are changing rapidly, as they were before the Cambrian. The evidence indicates that the first primitive anaerobes on Earth were prokaryotes: small, simple cells—just cytoplasm, usually bounded by a cell wall, but with little if any internal structure.