After one week of treatment (and on a dose of 2 gm. L-DOPA daily), Mrs B. started talking -quite audibly for the first time in many years, although her vocal force would decay after two or three short sentences, and her new-found voice was low-pitched, monotonous, and uninflected…With raising of the dose to 3 gm. L-DOPA daily, Mrs B…now showed considerable spontaneous activity…She was much more alert, and had ceased to show any drowsiness or ‘dullness’ in the course of the day. Her voice had acquired further strength, and the beginnings of intonation and inflection: thus one could now realize that this patient had a strong Viennese accent, where a few days previously her voice had been monotonous in timbre, and, as it were, anonymously Parkinsonian.
– Oliver Sacks in his book ‘Awakenings,’ pp. 69–70
The above excerpt comes from one of several case studies Oliver Sacks conducted as a young physician in the spring of 1969 at Mount Carmel, an institution housing post-encephalitic patients who contracted encephalitis lethargica or sleeping-sickness, only to suffer from “post-encephalitic parkinsonism” for decades, lasting until the end of life. Sleeping-sickness was an epidemic that lasted for a brief time after World-War One and “disappeared” in 1926, however it left affected individuals in a perpetual state of a severe kind of quasi-immobility, only able to make the subtlest of movements with great and concentrated effort.
The story of Dr. Sacks’ exciting time in 1969, when after administering the newly discovered ‘miracle drug’ L-DOPA he witnessed patients who had been thought of as ‘extinct volcanoes’ suddenly come alive with vibrance and vitality was dramatized in the 1990 film “Awakenings” starring Robert DeNiro and Robin Williams.
Although the story itself is fascinating, something I found intriguing was Sacks’ falling out with the medical community and the difficulty he had in publishing the dramatic descriptions of his patients’ awakenings which were however followed by a complex aftermath of “sometimes bizarre, and unpredictable states,” too unpredictable and complex to be simply considered as “side-effects.” Sacks emphasized:
“These could not, I indicated (in a letter to the Journal of the American Medical Association published in 1970), be seen as ‘side-effects,’ but had to be seen as integral parts of an evolving whole. Ordinary considerations and policies, I stressed, sooner or later ceased to work. There was a need for a deeper, more radical understanding” (p. xxxi).
He received ample backlash from the medical community, some saying he was against the ‘miracle drug’ L-DOPA by mentioning its ‘side-effects’ while some claiming he was just making it all up. He wrote up his year’s worth of research findings on his patients at Mount Carmel into a properly formatted medical article, complete with “statistics and figures and tables and graphs” and then submitted it to various medical journals: all rejected his paper, sometimes with “vehemently censorious, even violent, rejections, as if there were something intolerable in what I had written…”
“This confirmed my feeling that a deep nerve had been struck, that I had somehow elicited not just a medical, but a sort of epistemological, anxiety — and rage.”
Sacks would later publish the full account of his time at Mount Carmel a few years later in his 1973 book Awakenings, with several descriptively rich case-studies of over a dozen patients. And although it was well-received by the general public, according to Sacks it elicited a heavy silence — or as he put it, “a mutism” on the topic– from his colleagues in the medical field which left Sacks feeling alienated from the medical community.
However, during this time amid the silence from his colleagues, Sacks received a morally uplifting and supportive letter from the famous Soviet neuro-psychologist A.R. Luria who applauded Sacks’ efforts, writing:
Frankly said, I myself like very much this type of ‘biographical study’…firstly because it is a kind of ‘Romantic Science’…partly because I am strongly against a formal statistical approach and for a qualitative study of personality, for every attempt to find factors underlying the structure of personality…I was ever conscious and sure that a good clinical description of cases play a leading role in medicine, especially in neurology and psychiatry. Unfortunately, the ability to describe which was so common to the great Neurologists and Psychiatrists of the 19th century [is] lost now, perhaps because of the basic mistake that mechanical and electrical devices can replace the study of personality…Your excellent book shows, that the important tradition of clinical case studies can be revived and with a great success.
— A.R. Luria in his July, 1973 letter to Sacks
In light of Luria’s encouraging letter, Sacks reconsidered the reasons why his detailed case-histories, rich with ethnographic detail in their presentation, were so coldly received by his fellow doctors and physicians:
“The elaborate case-history, the ‘romantic’ style, with its endeavor to present a whole life, the repercussions of a disease, in all its richness, had fallen very much out of favor by the middle of the century — and this, perhaps, was one reason for the ‘strange mutism’ of the profession when Awakenings was first published in 1973…But as the seventies progressed, this antipathy to case-history diminished….there was a renewed sense that complex neural and psychic functions (and their disorders) required detailed and non-reductive narratives for their explication and understanding”
Considering the various reactions to his research and writings on the human events that took place at Mount Carmel in the late 60’s and early 70’s in both the general public and the scientific community, several years later in an epilogue to a new edition of the book, Sacks writes a profound meditation on the philosophical stances toward the scientific undertaking through the lens of music and the multiply sensing body, which deserves being quoted at length:
Can science, indeed, apprehend these phenomena, which are at once so real and so difficult to conceptualize? We tend to speak of the ‘eye’ of science — there is something visual and structural about any scientific edifice of concepts; whereas here we are dealing with the ear, in a way — with something essentially musical and tonal, something essentially action, not structure. Can the eye of science feel the true character of music, and its unique power to animate the person?…Even Kant felt this…and spoke of music as “the Quickening Art.” If science, if thought, considers music, what will it say? It will say precisely what Leibniz said: ‘Music is nothing but unconscious arithmetic…Music is pleasure the human soul experiences from counting without becoming aware that it is counting.’ And this is fine — but tells us nothing of the sense of music, its essential inner movement –and it capacity to move: precisely what makes it both quickening and quick. It tells us nothing of the life within music” (p. 283).
Continuing with this line of thinking on what a scientific inquiry into music might look like, Sacks asks us:
Are such considerations outside the proper domain of science? They are outside the domain of a purely empirical science, a Humean science, for this not only denies the ideal forms of experience, but disallows any ‘personal identity.’ But they point, or so I believe, to a greater and more generous conception of ‘science,’ which can embrace all the phenomena we have discussed. Such a ‘Kantian’ science, I think, is the science of the future. (p. 286)
This whole account that Oliver Sacks takes the reader through is a fascinating landscape of the personal textures of scientific inquiry by someone who, as he put it, “was torn between two passionate, conflicting interests and ambitions — the pursuit of science and the pursuit of art.”
Sharing similar conflicting interests in his autobiography, Charles Darwin grumbled over the struggle between his ‘artistic’ and ‘scientific’ personalities, wondering how it might affect his ‘intellectual rigor’:
In one respect my mind has changed during the last twenty or thirty years…formerly pictures gave me considerable, and music very intense delight. But now…I have almost lost my taste for pictures and music….My mind seems to have become a sort of machine for grinding general laws out of large collections of fact…The loss of these tastes, is a loss of happiness, and may possibly be injurious to the intellect, and more probably to the moral character, by enfeebling the emotional part of our nature.
One of the main reasons I find these discussions so interesting, discussions that try to arrive at a particular perspective on what it is we are are trying to understand about the world and how we should go about doing it, is that they echo a broader conversation that I hear in my own little corner of the academic universe in debate about how best to investigate human language.
This conversation (or argument) takes many forms, but most often arises as a debate between the value of cognitive vs. socio-cultural methods, the value of statistical methods over single case studies, or perhaps most vociferously in the realist vs. social constructionist approaches that plagued arguments in the social sciences in the 1990’s, chiseled into academic history with the hyperbolic title of ‘the science wars.’
Sacks, in his observation of his post-encphalitc patients and their diverse reactions to the ‘miracle-drug’ L-DOPA, soon discovered that the complexity of the phenomena he was trying to understand required including rich descriptions and steady observations that only qualitative case-studies of a narrative flavor could provide. And he knew that this ‘romantic’ style of science had a place, and a very important place at that, within the medical field of his day — although much to his chagrin, most of his colleagues saw his scribblings about the lived-details at Mount Carmel to be incommensurable with the ‘hard science’ of statistical generalization.
These ‘debates’ that Sacks came up against in the early 70’s with his groundbreaking “Awakenings” are echoed in an intriguing academic article I came across recently by the 19th century anthropologist Franz Boas writing way back in 1887. It’s clear he was dealing with similar anxieties of needing to justify ethnography as a legitimate mode of knowledge-making:
Which of the two [scientific] methods is of a higher value? as each originates in a different desire of the human mind. An answer can only be subjective, being a confession of the answerer as to which is dearer to him,–his personal feelings towards the phenomena surrounding him, or his inclination for abstractions; whether he prefers to recognize the individuality in the totality, or the totality in the individuality.”
Awakenings is a remarkable book, and really is a study of more than just one complex phenomenon: it not only explores the world of post-encephalitic patients and their complex processes of ‘awakening’ in the late 60’s and early 70’s. It also chronicles the early beginnings of Sacks’ life-long obsession with the workings of the human mind, his coming to terms with overwhelming rejection from his peers, and his perseverance to push the boundaries of what counts as legitimate knowledge in a field that at the time only privileged a narrow form of knowing.
Oliver Sacks’ work spans a huge range of topics — from the healing power of gardens to his “self-experiments in chemistry”— but always offering an insightful and unique vision of the world. This is especially the case when he writes on a topic that I’ve spent a good chunk of my brain power trying to figure out over the years: language,
“Language, that most human invention, can enable what, in principle, should not be possible. It can allow all of us, even the congenitally blind, to see with another person’s eyes.”
- Oliver Sacks in ‘The Mind’s Eye’ (2010)
There’s a great podcast on the always epic ‘Radio Lab’ that celebrated Sacks’ 80th birthday a couple years before his passing in 2015 by interviewing him about his career. In the interview, Sacks shares his experiences with his patients at Mount Carmel and the collective freak-out from the medical community after publishing his first book “Awakenings.” Definitely worth checking out if you’re at all interested in his life and work. You can find it here.