Oliver is back from London, and it looks like the Leg book is at long last locked into place.
And sure enough, while in London, Oliver, rid of that albatross, was on a tear, completing three new pieces: the review of a book on nineteenth-century neurology and psychiatry; that piece about his musical ladies; and another essay on that young woman who lost her proprioception.
He also visited Harold Pinter and Antonia Frasier, who greeted him with, “Oh, Dr. Sacks, do tell us some more neurological ghost stories.” And he did—for three hours!
As I watched a special on TV the other evening about Jane Goodall and her wild chimpanzee subjects (Oliver and I often talked about Goodall), Oliver’s perennial dilemma about the warring clinical versus naturalist tendencies within himself became somewhat clearer for me—this combination of scientific distance, reserve, observation as against the tendency toward empathy, emotion, touching. Indeed, touching itself became a seminally important moment: how remarkable that day when Goodall’s chimps would let her touch them.
But beyond that, consider Goodall’s ambivalent situation when the chimpanzees started killing each other: Should she intervene to stop the carnage? Or should she just observe this remarkable dark epiphany? She just observes. But on the other hand, when they contract polio: She laces their food with vaccine.
The key moment, though, in the Goodall enterprise came when she started giving the chimps names. It wasn’t simply that an It became a Thou. In the process, description became truer. All sorts of things that were blurred in a merely statistical (more scientifically conventional) survey became vividly apparent once the chimps were seen as individuals.
Goodall’s, like Sacks’s, is thus a glorious example of romantic science: It can be accused of the same flaws (projection, anthropomorphizing the otherwise mute)—but finally, it evinces the same triumph (getting to places “objective” science could never reach, thereby limning the attenuated limits of such science).
Over lunch at my apartment, Oliver continues discoursing on his musical ladies and some other recent case histories he has been working on—indeed, he has no sooner arrived at my door than he has papers and drafts spread all about the dining table.
“Coming to look at the subject of nostalgia—the neurology of nostalgia—the only good reference I could find was myself.
“The theme here is mother love and home …
“I’ve added a footnote to ‘The Lost Submariner,’” he says, stabbing for the New York Review galleys so as to show me. “Talking to Isabelle Rapin about Korsakoff syndrome, she told me about rare cases where such a retrograde amnesia appears in young children—with devastating results. They lose everything and in particular the memory of the early experiences of mother love and in such cases revert to deep autism.”
A somber pause at the horror of that prospect, his eyebrows raising. Then, brightening: “I myself had a fit of musical nostalgia in London a few weeks ago. Eric suddenly said to me, Sherlock-like, ‘So, you’ve been thinking of going to Vienna?’ I was astonished, for yes, indeed, I had been.
“‘How did you know?’ I stammered, to which he replied, ‘You’ve been humming The Third Man theme all morning.’
“I associate The Third Man with my first adolescent freedom—my first time abroad, a youthful foray.”
From out of the pile of papers, Oliver now spears an essay by Esther Salaman (“both an aunt of Jonathan Miller’s and a niece of Proust’s”1) entitled “A Collection of Moments.”
“She’s a novelist and this is a study of involuntary memory, and of autobiographies of childhood written in later life, and here, listen, she writes, ‘Marcel says that the echo of his tears, in his traumatic memory of demanding his mother’s kiss, never ceased, but was not audible until life grew quiet, like those convent bells which are drowned in the noise of daytime, and sound out again in the silence of the evening.’”2
In much the same way, Oliver himself, in writing about the second of his musical ladies, noted how she spoke of “a sense of impending presence” drifting back into the landscape of early childhood. A throwback to songs her mother had sung.
Neurologists, he points out, have spoken of epileptics in terms of “dreaming states” (Hughlings Jackson) and “psychical seizures” (Penfield).
“But I would like to speak of spiritual seizures as being significant and not merely trivial. In Awakenings, how when Rose sang ‘Love’s Old Sweet Song,’ of course it was self-referential, but it was also a song precisely about the nostalgia of singing.
“My mother after age eighty used to be surprised by an upsurge of Edwardian song—to me, this evoked a feeling of imminent death.”
Oliver now reaches into his satchel and pulls out a huge volume of the journal Brain. (“Brain as you can see was edited by Lord Brain! Which is to say that two of the greatest figures in twentieth-century neurology were Lord Brain and Sir Head!”)
Flipping through Brain, Oliver now alights on an essay by Théophile Alajouanine on Dostoyevsky’s epilepsy. “All you healthy people,” Dostoyevsky once wrote, “cannot imagine the happiness we epileptics feel in the moment before our fit.”
To which Oliver adds, “And everything which occurs in epilepsy can occur in migraine. Migraine aura, indeed, is a sort of slow-motion epilepsy.”
From migraine and epilepsy, our conversation drifts to drug-induced extremities. Did he ever consider himself addicted?
“Of course. Late in my California period, and then early on in New York, I was a full-out amphetamine addict.”
How had he functioned as a doctor during all that time?
“The very worst period was in the autumn of ’66 when I didn’t even go to the hospital for two or three weeks.” A pause. “Actually, December ’65 was the worst of all. I was suffering from a bizarre broken heart I’d contracted the previous summer before I arrived in New York.”
Presumably the German theater guy in Paris, I thought to myself. I’d been taking furious notes but now asked him: Did he want any of this talked about?
“I am very certain that I want no mention of my sexuality,” he replied fiercely, “it’s not relevant.”
He was quiet for a moment. “Auden once told me of Paul Tillich’s closet, how after his death, as they were emptying the rooms, they came upon a closet teeming with pornography of the lewdest sort—Auden told them to throw it out: It wasn’t relevant.
“Well, I myself have always felt that Tillich, like Sartre, was something of an intellectual pervert. But I like to think of myself as having struggled hard and successfully at not being an intellectual pervert.
“I am well aware of the problem of the irritating continued existence on this planet of the person about whom one writes. I am vexed to my roots that I can’t write about John the Touretter: furious that a perhaps major work is prevented from completion by the maniacal injunction of a paranoid psychotic.
“The drugs, yes, I can see where that might be relevant, though I’m not eager to see them written much of.
“The sex though …
“Well, finally, you will just have to write what you will and we’ll see then.”
Speaking of which …
“I’ve been reading The Magic Mountain,” declares Oliver. “I am increasingly bothered by Mann—he is on the side of disease. He writes about pathology and calls it life. Hardly ever is normality portrayed except as a form of dullness. I react to the philosophy of morbidity more violently than to anything else.
“Hume, mechanical philosophy I find morally neutral.
“Kant and Leibniz allow for philosophy from the viewpoint of life.
“But romantic philosophy, and romanticism generally, is obsessed with death, whereas I am not.” (This as opposed to his and Luria’s notion of “romantic science,” which is something else altogether.) “This exalting of disease and death. Mann, for instance, finds the world behind the music to be that of death, but how absurd to speak this way of Schubert!
“Nietzsche once said of Schopenhauer, ‘He is an assassin of life.’ And I think Mann’s a killer. I think Sartre’s a killer. And I think I’m fanatic enough to know whereof I speak!
“Hume was too sane to imagine a sick fantasy. With Freud and Schopenhauer, you come to a conception of religion springing out of morbidity and melancholy. But it’s possible to imagine a religion arising from health, and oddly enough Nietzsche did that best.
“What I love in Tolstoy, for that matter, is precisely the existence of health and happiness alongside the morbid and tormented. Dostoyevsky understood the latter in a deeper way and he did not become the sort of nut Tolstoy was, but still …
“The point is, there’s good magic and black magic. I know all about black magic. And I will have none of it anymore.”
Two beats. “My own doctor has suggested I write a book on medicine from the point of view of health.”
The New York Review of Books “Lost Mariner” piece is at the press. At the last minute, Oliver had added an addendum to a footnote based on the stuff Isabelle told him about Korsakoff syndrome in infants. Only now it turns out she was relating something Norman Geschwind at Harvard had told her, and even so Oliver seems to have embellished on the report.
And Oliver is freaking out!
As he tells me over the phone, he has “an enormous superego which is sometimes raised to psychotic dimensions,” going on to say, “I have a terrible combination: an expansive generous imagination hooped to a wicked, recriminatory superego. Everything gets generalized into the accusation of forgery and lying. But it’s not that I invent the truth,” he tries to defend himself. “Rather, I intuit or imagine it.
“When I speak of that patient at Brooklyn Little Sisters who is afraid of light and sight, I know this is so even though he is aphasic. Or rather, I powerfully feel it to be so, and so do others.
“I sometimes articulate what the inarticulate would say if they could and will someday if they can.”
At which point, a complete shift in tone: “By the way, I’ll send you the last orthodox neurological study I ever wrote, in Brain in 1968: ‘Oligodendroglioma with Remote Metastases.’ In fact, it’s the only neurological paper I’ve ever written, something of an homage to T.G.I. James, my chief at university in London, of whom I was fond, and who wrote up the only other such case.”
Then again, perhaps not such a shift.
“It turns out that in that same volume of Brain I found a hilarious case study of a man who suffered from facial agnosia—couldn’t even recognize himself in the mirror, had to stick out his tongue to confirm his intellectual surmise—and could only recognize his wife when she wore a hat!
“I do greatly appreciate this sort of corroboration, of validation.
“My pieces, if not precisely truthful descriptions, are veridical imaginations or extrapolations. Still, it’s good to get corroboration in the media.”
Dear Ren,
Thank you for your sense and sensibility, your sanity, last night. I have written to Isabelle, and to Geschwind of Harvard, letters which (without being “confessional”) are models of clarity, courtesy, candour, and with this (I think) the matter should be over, and I should feel free to turn back to my own concerns and work.
Over—but not over: I must take warning, and make resolve, because this sort of thing raises charged, and potentially quite dangerous issues and feelings—for me, at least, if not for others; in phantasy, at least, if not reality. This sort of thing, this realm—what is it? It embraces matters of quoting (or misquoting), of alluding to, of my relation to … the alive, be they patients, colleagues, or friends. And yet, being in the world myself, perhaps I have to make such allusions to others … or do I?
[…]
This business with Isabelle/Geschwind though brings home to me that I must take extreme care in ever quoting, or alluding to, a contemporary—a contemporary who is alive, and perhaps touchy and vulnerable. And, by the same token, that others must take extreme care with me … because I am alive, and touchy, and vulnerable …SB
Noted.
Oliver is thrilled with a new patient, a woman (at one of the Little Sisters residences) who, virtually blind, is suffering or at any rate entertaining an elaborate visual hallucinosis.
He pulls out a copy of The New Yorker scrawled over with notes.
“As you see, I’m now using The New Yorker to test for cognitive recognition.
“Do you,” he asks me, “ever have trouble keeping focused while taking notes of somebody talking?”
(Ha!)
“I could have killed today for a tape recorder. What a wonder!”
He gives me a copy of his typed notes: a summary.
“It’s definitely in the visual apparatus or situation—something makes her hallucinate, and it’s not cerebral. Most interestingly, though, she is psychically organizing her peripheral hallucinations. She is giving them personal shape and meaning. Fascinating.
“I once saw an older history professor from Harvard with a horror of a case of diabetes: He’d had both eyes removed. After the second removal, he suffered brilliant bright visual storms. I asked my father if he’d ever heard of this, and he immediately said, ‘Yes, nine times,’ and gave me a sixty-year history. It may have been the optic nerve got damaged in the eyeball’s removal. It could also be that there’s a visual starvation and the mind starts generating its own.
“The tragedy for this sad man, though, was that he furthermore had neuropathy of the arms, so that neither could he feel what he could no longer see.
“My father’s favorite bedside reading is the Dictionary of Musical Themes. He loves music indiscriminately and he goes to sleep with a concert ringing in his ears.
“My early Tourette’s piece, well before John, ‘Witty Ticcy Ray’ was the only piece I ever wrote in one go—I wrote it, sent it off to Mary-Kay at the London Review, and it was published as drafted—no second thoughts. Usually there are second, third, fifth, and tenth thoughts.”
Dessert has arrived: a cheese plate. Presently only the square of hard cheddar remains, which, over the next several minutes, Oliver proceeds to efface by way of a sequence of infinitesimal symmetricalizing subtractions: He takes a narrow slice of hard cheddar, then three more to reestablish the square, then another, then three more, till at considerable length, somehow there is none left.
Meanwhile: “The first thing of any length I wrote my first year at Oxford was an essay on Theodore Hook, the early-nineteenth-century composer, writer of six hundred comic operas. He was a charming man, a genius, but somehow he had no center. In a way this essay was a precursor of my later case studies. I didn’t do it for any class—simply the result of a month’s reading in the Radcliffe Library. It is the study of a comic, not unhappy, genius that left no residue, that strangely aborted. Hook didn’t exactly peter out; he just never coalesced.
“Both Jonathan and I are haunted by the notion that we throw off an infinite number of brilliant ephemera but nothing else, nothing of permanent value.
“Ah well,” sighs Oliver, “perhaps I’ve become duller and deeper …
“Hook, though, was a prodigy. And the prodigy is under terrible pressure. The pressures of vanity, narcissism. He has to struggle through his facility to reach poetic depths. And usually doesn’t. Early on I read a book on musical prodigies—twenty case histories of which only three made it.
“I must have felt such pressure, even then.”
Oliver goes and breaks his other leg!
Or so I now hear from Joanna by phone (I am again in LA for the week)—she gives me his phone number at Montefiore, where I reach him, in traction.
And indeed, he has badly broken his right leg, shattered his kneecap, and dislocated his shoulder, when simply falling on a sheet of ice, walking to the post office on City Island. (He notes that he is so big these days that whichever bones were fractured upon contact with the ground were completely pulverized by the sheer reverberation of the subsequent crush of flesh.) He is all plastered up, his right arm strapped to his body for the next month at least to allow the shoulder to heal. After that, he won’t be able to use a crutch since he mustn’t jam pressure against the armpit.
“Silly damn thing to happen,” he understates, “but at least now I’ll be symmetrical! You remember how I symmetrized our cheese the other night?”
Come to think of it, back in 1963, Oliver had dislocated his left shoulder in a surfing accident!
What is your immediate horizon? I ask him.
“Oh, about two inches off the ground.”
He relates how he called Colin Haycraft in England to tell him, and without missing a beat, Colin simply retorted, dryly, “Oliver, you’d do anything for a footnote.”
And indeed, the whole psychopathology of the incident is striking: In 1972 his mother dies, he finishes Awakenings, which gets published the following year, he goes to Norway where he is attacked by a bull (cow?), his leg is demolished, for months it lies there, a doughy ghost (castration), it takes him ten years to finally come to grips with the experience (the paralysis may not have been psychosomatic, but the blockage certainly was), he finally finishes the damn book about the incident, the blockage lifts, case studies start pouring forth, and now he goes and breaks the other leg! And the right arm gets disabled to boot. Oh, Oliver!
And yet everything about this time seems different—in the city versus the wilderness, immediate versus delayed care, quick recovery—and, as Oliver (mercifully) says, “In a way I’m not terribly interested in this experience.”
Meanwhile, he has finished “The Disembodied Lady,” his piece on proprioception dysfunction, he tells me, by way of a tiny cramped scrawl with his right hand and a single finger-poke at the typewriter with his left.
I’m back in New York, and over the phone, Oliver complains: “Waves of basilisk-like boredom are flowing over me. The last time I was like this, I was too anxious to be bored. This time recovery seems to be going well (my present surgeon says he’s never seen anyone recover muscle strength so quickly), but the boredom is debilitating.”
I visit Oliver at Montefiore Hospital—his old haunt. He is decked out like Bacchus, or like the god Tiberinus, his plastered leg outstretched, his furry barrel chest hunched on one elbow (the other arm strapped tight to his side), a swath of white sheet draped across his midriff.
A friendly doctor is just leaving. They have agreed to keep him on heparin, a blood anticoagulant, partly to compensate for the rigidity of the leg (to avoid thromboses and phlebitis), and partly to provide an excuse for his continued residence in the hospital. Thus, for the moment, Oliver is an artificial hemophiliac.
“I’ve got hypermobile blood,” he crows. “A nosebleed would kill me!” He laughs.
“It’s funny,” he says, “if you gaze down from the window over there, you can see the Headache Unit, where both my creativity and my descent into American medicine began.”
A few days later, another bedside visit.
“This leg is boring to me,” Oliver announces. “It’s of no interest whatsoever.
“In fact, I begin to see how someone last time might have said, ‘What’s the problem?’ and when I replied, ‘My leg is depoeticized, dis-exalted, etc.,’ they’d have replied, ‘But that’s normal!’
“Although my morbid and creative preoccupations last time did verge occasionally toward somewhat excessive heights, at least then my imagination had a leg to stand on. Here there is nothing to exercise my imagination, and imagination is different from fantasy.
“Back then, the thing with the surgeon”—the surgeon who’d attended Oliver when he arrived in London, and whom he assigns the name “Mr. Swan” in the book, had seemed to Oliver singularly officious, imperious, and oblivious to any and all of his concerns, deeming the whole operation and its sequelae, to hear Oliver tell it, utterly ordinary and beneath concern—“no doubt had the effect of inflaming though not distorting the experience. Had he behaved differently, I might have been able to let the experience cool. Instead, his attitude invested everything with a sense of fundamental doubt and misgiving (while Luria invested everything with a sense of unexplored territory).
“But still sometimes I wonder: Was it just a scotoma? Did I in fact inject neuropsychology with metaphysics?
“Still and all, it’s one thing to have a scotoma, another to experience it as a focal godforsakeness … or is it?”
Our conversation turns to the Grumman buses that are all being recalled by the MTA—fully a fifth of NYC’s bus fleet!
“I know,” Oliver exults, “I love it! I have a Grumman car. I’m staying in a Grumman hospital. I have been having a Dunciad-like vision of all the world reduced to Grummandry!”
A few days after that, back at Oliver’s bedside, trying to entertain him, or rather maybe to get him to entertain both of us, I ask, “What about your debacle with that larcenous colleague of yours during the mid- and later seventies? You’ve never told me that story.”
Oliver veritably harrumphs. “Well,” he says, “Dr. F was a decent, ordinary doctor colleague who, with the advent of Medicare and Medicaid, went quite mad with cupidity.”
Oliver had all along been quite hopeless with regard to the Medicare bureaucracy so that at first after he’d been fired from Beth Abraham, a partnership in which Dr. F would handle all the paperwork seemed an ideal solution. Oliver averted his gaze: Dr. F handled all business details and Oliver signed whatever he was given.
This state of affairs, Oliver explains, presently led to a Medicare audit.
“Under strenuous questioning as to EEGs which I had signed off on, I averred to the auditors that I couldn’t possibly remember every one—but outside I confronted Dr. F: ‘That’s not true. I can remember every one, and I did not remember four-fifths of those. You ought to know that you’ve been naughty.’ He had me signing blank bills. I should have known, I should have realized, but I was oblivious.
“After 1976, far from drawing back, Dr. F lurched forward. He had me going to scandalous, so-called ‘adult manors’—deplorable places, many of them run by Hasidic Jews (which provided a further turn of the screw)—mass-production assembly lines of sub-adequate care—many of which would subsequently be shut down …
“In the summer of ’77, Isabelle Rapin, my conscience and my reality, told me, ‘This man Dr. F is grossly criminal and you simply must dissociate yourself from him.’
“The final blowout came by way of my EEG technician, Chris. The EEG machine at one of these places was in terrible shape (broken pen spikes and so forth) and Chris told him, ‘Dr. F, these readouts are simply unacceptable, they must be done again,’ and he refused. Which led to the blowup.
“By Christmas 1977, we accomplished a legal separation, at immense cost. And then, several months later, there came another Medicare audit, this time of me alone. I didn’t even connect the two. I went there proudly with my ninety-nine out of a hundred requested files. (Oddly, the only one I couldn’t track down was for a patient called Sacks.)
“The first meeting, they complimented me on my thoroughness. The second meeting, though, quickly began to seem a kangaroo court. The questions were palpably dripping with insinuation: ‘Dr. Sacks, you depart from medical protocol.’
“‘That’s only for children.’
“‘Dr. Sacks, I can’t read your records.’
“‘Well, then you differ from everyone else who comes in contact with them. People not only read them, they positively relish them!’
“Then, during a break, a little bearded man came up to me and confidentially confided, ‘As one beard to another, we’re not interested in any of this but rather in what came before, in Dr. F…’
“At that moment I realized that all this was profoundly improper and that I needed a criminal lawyer. I got one—a good lawyer, who charged accordingly. Luckily letters from Dr. F existed, detailing our arrangement, and it quickly became obvious that though I may be ingenuous to a fault, I was no prime mover.
“I thought it was all over until a year ago when I got a $5,000 bill in triplicate, denying an earlier 1975 tax credit. My lawyer called Dr. F, who refused to pay.”
A long sigh, a vacant gaze out the window.
“The thing, all told, has cost me $50,000 and years of moral misery. But this whole business with Dr. F was only possible because one charges per service. I mean, myself I do one EEG for every six patients. I find it harder and more tedious to earn money that way—to be done properly they should take an hour each. Dr. F would have them done in five minutes and read in thirty seconds, which was easy because they were in fact utterly unreadable.
“As a doctor working principally on the Medicare circuit, one is paid relatively too little for clinical exams and too much for tests: $7 for a clinical visit, but $35 for an EEG.
“Medicare and Medicaid insurance have had a baneful influence because they’re organized on the basis of payment for service or commodity. A boy with a cold walks into a Medicaid clinic and $200 later—having been x-rayed and this and that—he walks out still sniveling. In Britain, by contrast, they have a capitation fee, which works out well—there isn’t the temptation or the potential for unnecessary testing.
“Here CAT scans at $300 a pop are being ordered up like blood tests. When I’m off driving and my car radar device goes off, it’s generally either because I’m passing a microwave oven or a CAT scan center. Unscrupulous doctors and unscrupulous patients collude in this mad, excessive testing.”
What about rising medical costs, more generally? I ask.
“I recently received a bill for $200 following a three-minute appointment with a specialist,” he replies. “I sent him a copy of the Hippocratic oath, underlining its prohibition against charging fellow doctors, and went on to ask, somewhat sarcastically, whether he really felt his time was worth $70 a minute. He apologized by return mail, saying the bill had been sent out by mistake and that the fee was artificially inflated, pushed up for insurance.”
Meanwhile, Oliver goes on, truly vital medical research is falling by the wayside. “I just got word that over at Beth Abraham, R.B., our dear old postencephalitic piano player, has died and, incredibly, there has been no postmortem. Indeed, there has been no postmortem since 1972 on any of the postencephalitics. Ninety percent of our postencephalitics have died without any pathological study performed on these unique nervous systems.
“Postmortems—the classical way of learning pathology—are disappearing from the American scene. It’s hard enough having to request permission to perform a postmortem from a relative without having to charge them for it …
“The only postmortems I’ve had for that matter have been with the Little Sisters. For example, Mother Genevieve at Queen of Peace once allowed us to do a postmortem on a twin with Huntington’s disease—very important. There are patients at Beth Abraham of whom we will never know the cause of their illness!”
He shakes his head plaintively, muttering, “Unbelievable.”
A few days later, and now Oliver is really bored. I have an idea. I call my friend Robert Krulwich, the (at that time) comically flecked business correspondent at National Public Radio (remember the mouse opera with which he contrived to explain interest rates?). As it happens, I’d gotten to know him over the past several months, since I am regularly dropping in to NPR’s New York offices to opine on things Polish (I’d become one of their Rolodex pundits as well). Anyway, so now I call him and tell him to grab his tape recorder and come meet me at Montefiore: trust me. I then get Oliver to start telling Krulwich some stories for a change. And Scheherazade-like, across a series of sessions, Oliver starts lavishing him with oral versions of some of his recent case studies, which in turn now start showing up on All Things Considered (effectively seeding the ground for what will be Oliver’s first bestseller, once we finally get past the release of the Leg book).
A few days later, he wants me to bring books.
I ask him if he’d like some of Martin Gardner’s books of mathematical curiosa.
“Absolutely not!” he interrupts brusquely. “I know you and Eric love that sort of thing, but I can’t abide it. I have consuming curiosity about nature but none about mathematics as such. For me, the delight and relish of problem-solving has to occur in a natural context and cannot be numbered one through twenty inclusive.”
He also tells me how during the night he suffered a terrible fright, a night hypochondria, perhaps—spasms in his calf transmogrifying into imagined thrombosis, just waiting to dislodge and engulf his heart. In his ensuing night panic, he composed a new last will and testament, naming as his heirs his “literary children” and decreeing that his entire fortune should be given over to their care, Eric Korn and I (!) to be the executors of the estate. He hopes I won’t mind.
Thankfully, nothing thrombotic or otherwise occurs, and the will in the meantime has been superseded many times over.
I call to ask Oliver if I can visit him at Montefiore later in the day. Will he be around?
“Will I be around?” he blusters, exultantly. “Will I be around? You might as well ask the question of the Grand Canyon! My dear boy, I am geologically immobile.”
In the event, two of the nurses from Beth Abraham, the Costello sisters, are at Oliver’s bedside when I arrive, having delivered turkey sandwiches.
“Does Doctor like turnips?” one of them inquires.
He grimaces. “Oof, I’m afraid not. They remind me too vividly of my days at Braefield: It was mangel-wurzel and swedes. The turnip is a delicate sedate cousin of the mangel-wurzel. A swede is a ten-pound, monstrous, misshapen turnip, and the mangel-wurzel a forty-pound, overblown swede. Well, at Braefield it was swedes for breakfast, mangel-wurzel for lunch, and swedes and mangel-wurzel combined for dinner. For four years! So: No, thank you. But thank you for the thought.”
Oliver recalls how Jonathan Miller, in his production of Eugene Onegin, included a minor character who “never seemed to be eating but by banquet’s end had devoured the whole place—grape by grape. ‘That’s me, isn’t it?’ I said to Jonathan afterwards, and he just smiled.
“Sometimes,” Oliver muses by way of association, “I do grow cannibalistic of my patients, I suppose. I become voraciously interested. I hold my breath with excitement.”
Oliver feels his days of bodybuilding and weight lifting back in LA may have contributed to both of his leg accidents—this time, for instance, the ligaments around the knee simply snapped.
Another weight-lifter friend from that period, whom Oliver recently reencountered, currently has two plastic hips.
He asks me the next time to bring him that picture of himself squat-lifting at the California State Heavyweight Championship.
“I am thinking of writing a short sad piece for a weight lifters’ magazine; I will call it, ‘The End of a Squatter.’”
Meanwhile, by his bedside, Oliver has Nietzsche’s The Will to Power (edited by Walter Kaufmann). He has clearly been through it dozens of times. There are layer upon layer of margin scribblings.
There is a passage (on page 428) where Nietzsche describes the exalted sensitivity of the artist, comparing it with a sick person’s, in language that directly applies to John the Touretter. Oliver reads it to me, adding, “When he wrote this passage, he was already himself in a state of physiological exaltation.
“At my best, reading Nietzsche is like hearing myself think—only more exalted. I know so exactly what Nietzsche is thinking there.”
Oliver is reading Alan Turing: The Enigma, the biography of the British computer and cipher scientist, pilloried in the fifties for his homosexuality. “A young genius driven to anxious suicide by his sexuality,” says Oliver. “He reminds me of someone I know.
“When I was eighteen or nineteen, I read Harrod’s biography of Keynes—it was the official biography, so there was no overt discussion of his homosexuality but one could, or at any rate I could, tell reading between the lines, and it was greatly heartening—as it was later with Thom Gunn and Auden—to find someone in whom integrity and distinction were melded to the homosexual. It helped dissipate the taint of the morally squalid …
“For all that, I don’t have the feeling, though, that either Keynes’s or Turing’s mind was different for being homosexual.”
Typewritten letter from Colin Haycraft at Duckworth, responding in his own delicious way to my letter to him about the galleys of the Leg book:
Re: A LEG TO STAND ON by Oliver Sacks
Dear Ren,
Very many thanks for your letter of February 27th. We had found most of the “literals” ourselves, but I was glad to have your reaction to the overuse of the word “joy” and its derivations. I remember removing hundreds of them in the typescript. I have now removed virtually all of them!
All the best.
Yours,
[signed] Colin
Pauline Kael on John Candy in Splash in the March 19 issue of The New Yorker:
There’s a certain amount of aggression built into a frame as big as Candy’s: he simply occupies more space than other people do. But Candy doesn’t have anything like John Belushi’s insane volatility or the gleam in his eyes that told you he was about to go haywire and smash things up; Candy is the soul of amiability—it’s just an awfully large soul.
Oliver is now home again, although he continues to return to the Burke rehabilitation center for daily outpatient therapy sessions.
He is terribly agitated because Mary-Kay has sent back galleys for the London Review version of his musical women piece, and it has undergone, to hear him tell it, “a terrible metamorphosis.” It has been stripped of its neurological meditation, and the bare case studies, thus unadorned, have indeed been reduced to the “Two Gothic Tales” of the new title.
“Yes,” Oliver huffs, “but do they have any interest beyond the Gothic? They do, or rather they did, when it was clear that they illustrated the nature of experience and the organization of individuality and of personal originality in the brain—the interaction of a crude electrical explosion and an individual memory … Now, it reads like a couple of pieces of inadequate fiction. People will think I’ve entered my anecdotage, retailing bizarre tales of no significance.”
He wonders if he is being punished for the disloyalty of having also begun to publish pieces in The New York Review of Books.
The fact is that what with his increasing visibility, in both the London Review of Books and The New York Review of Books—and the general upsurge of case studies he has been publishing as he emerges from the penumbra of the Leg blockage—and now, too, the conversations with Krulwich over NPR, Oliver is becoming steadily more well known among the cognoscenti. And three months ago Bob Silvers arranged for him to give the prestigious Gallatin Lecture at the New York Public Library, now coming up next week.
“I have to avoid anticipation,” Oliver tells me. “I’m fine on five minutes’ notice or no notice whatsoever, but three months of anticipation wears me out in the extreme.
“I need to write another piece on Luria’s and Goldberg’s favorite subject: frontal lobe syndrome. I realized this and thought, who shall I choose? And immediately realized it was Harry, this engineer who blew an aneurism at age thirty-one and has since been a patient of Beth Abraham, a man who will score extremely well on an IQ test, is good at problems and puzzles, but who is not there as a person and because of that shows extraordinary lapses in judgment—defecating in the middle of conversation, violent outbursts, etc.
“It’s different each time: with the two musical ladies, the case study generated the meditation; with frontal lobe, the meditation demanded an example; with ‘Witty Ticcy Ray,’ the two impulses were simultaneous.”
We attend the Manhattan Theatre Club’s production of Pinter’s Other Places (with “A Kind of Alaska” as its last act, and Dianne Wiest in the Judi Dench role). Afterwards we all go out for a drink at the Churchill Tavern.
Oliver recounts how in 1973 Colin received a letter from Pinter telling him how moved he had been by Awakenings and how though he was now going to let it “submerge” beneath conscious attention, he expected that someday it would “resurface” in some creative form. Years passed without his giving it much thought and then one morning, suddenly, on waking, the line “Something … is … happening” was in his mind, and the rest of the composition occurred fairly quickly.
Oliver as inveterate naturalist: He recounts how he was recently undergoing his physical therapy for his leg, commenting to his therapist how his thigh muscle had long seemed especially adapted to powerful, consistent, but slow exertions; the therapist seemed interested, commented on the different kinds of muscle tissue, and jokingly suggested that they ought to perform a biopsy on the thigh to learn more.
“Yes, let’s!” Oliver immediately insisted. “Pluck out a wedge, do take a pound of my flesh! Let’s examine it together!” He was at most only half joking.
“I myself have always felt that terror is reduced by active investigation,” he goes on to explain.
He also feels that no matter how grim the situation, laughter can be a palliative. “This is because the self who laughs is greater than the self who suffers—is momentarily outside the suffering self, liberated from it, laughing at it.
“Indeed,” he goes on, “I’ve often had students who were rather astonished at my ‘unprofessionalism’ when suddenly I’d be laughing merrily at the bizarre exertions of an obviously suffering patient—but they were even more astonished when my laughter was quickly joined by that of the attending nurses and presently by the patient himself—and it was clear that if only for a moment, the pall of affliction, in Simone Weil’s sense, had been lifted.”
A walk through the city, and then back to my apartment. He comes in for coffee before heading home.
“I knew delirium as a child with my fevers and migraines and perhaps this is why as an adult, delirium does not so much threaten me. At any rate, I feel myself frayed at the edges but still whole at the center, although the fraying is definitely edging in, or perhaps subjacent to, the integrated part—I just hope the center can hold out till I have finished all my work.”
Oliver calls, nervous about the lecture he is to give tomorrow night. “I suppose it’s procrastination,” he surmises, “but instead of preparing for the talk, I’ve launched out on a new story…”
I tell him I don’t have time to hear the whole thing right now, I’m just rushing to an appointment, but could he summarize it? “Ah yes,” he exudes. “Sudden unexpected outbreak of genius and salaciousness in an eighty-nine-year-old woman brought on by neurosyphilis.”
All right then. Can’t wait.
Later he explains: “This one concerns an eighty-nine-year-old Albanian lady who came into clinic with her ninety-two-year-old husband. She’d been enjoying a slow, dignified winding-down sort of existence, but now she was complaining that she was all abuzz, and indeed she was—she displayed a remarkable efflorescence, flirtatiousness, salaciousness, wit, intelligence, an absurd, dizzying vitality. ‘Do you think,’ she presently confided, ‘that it could be Cupid’s disease?’ She explained that sixty-five years before, she had worked in a brothel in Salonika from whence she’d been rescued by her husband. Up to now, she’d had no complaint, but … We tested her, and her hunch proved correct: Spirochetes were rioting in her brain. It was a complex situation because in some ways she was enjoying her rejuvenescence, although in other ways she felt it undignified and she worried about the illness’s progress into the future, that she might go right past the border into dementia. And what she wanted to know was, could we keep her just as she was?
“Well, as things developed, the question proved moot because a few weeks later she contracted pneumonia and quickly died …
“But it all reminded me of Mann’s last story, The Black Swan—have you read it? About a menopausal woman in a sort of grief over the lapsing of her menstrual flow who seeks solace at a spa where she falls passionately in love, insanely in love, with a young man, whereupon her menstrual flow resumes. A few weeks later, she is dead, and in the autopsy they discover a huge tumor in her ovaries. And the question is, did her passion create the tumor, or the hormonal imbalance brought on by the tumor create her passion?”
Two beats: “A truly wicked old man, the late Mann.”
The next morning over the phone, Oliver tells me that, still concerned about the coming talk, he’d decided to photocopy a few things in preparation (Descartes, Pascal, Nietzsche)—only now he has two hundred pages!
At the New York Public Library, Susan Sontag introduces Oliver as “one of the best living writers in the English language,” following up in particular with an evocation and celebration of his “writerly style.” She describes Awakenings as a “cascade of ideas” and “the most interesting speculation on allegory since Walter Benjamin” with “prose of an incandescent intensity,” and Oliver’s life meditation as focusing on “morbid processes and metaphysical sobriety.”
Jasper Johns is seated behind me: it’s that sort of crowd.
Oliver begins: “It’s lovely and terrifying to be here.
“The title I’ve chosen for this talk, ‘Neurology and the Soul,’ is provocative and possibly mad. It self-consciously echoes James’s ‘Reflex Action and Theism,’ and to the extent it contrasts materialism and vitalism, scientism and religion, body and soul, it is the oldest subject in the world, although it is particularly new today, what with the rise in such notions as artificial intelligence, robots, computers, etc.”
Continuing on: “The Modern Age is traceable to Descartes, with his early insistence on viewing man as a machine, quoting the Meditations: ‘I regard the human body as a machine, so built, put together of bone, nerve, muscle, vein, blood, and skin that still although it had no mind it would not fail to move in all the same ways as at present since it does not move by direction of its will or mind but only by arrangement of its organs.’
“And indeed, he was the first to consider that a human being just might be an automaton,” though there would be many to follow, from Sherrington through Pavlov, all of them completely alienated from notions of soul, imagination, and the like.”
On the other hand, Oliver suggests, if one has a mechanical view of human nature, a sort of dissociation may occur and one may oneself become more machinelike. He goes on to quote “a passage of great pathos from Darwin’s autobiography” where the great man speaks of his loss of interest in music, how he has become “a machine for grinding particulars into theorems.”
Throughout the lecture, Oliver props his glasses on his forehead, then drops them back down.
“Enough of an introduction,” he finally says. “Now on to some neurological stories!
“For as a doctor, one is constantly confronted with neurological preparations, on the one hand, and existential stories and dramas, on the other.
“William James,” he interrupts himself, “referred incessantly to ‘the soul’ in his conversation but banished the word from his physiology. ‘Some day, though,’ he nevertheless mused, ‘perhaps souls will have their innings.’
“And I want to give souls their inning.”
He then moves through a series of stories—many of the ones he’d been regaling his friends and colleagues and increasingly his readers with over the past several months, before eventually beginning to wrap things up.
“Perhaps two final examples,” he suggests.
“People with Parkinsonism indeed begin to walk like robots. I recall a music teacher unmusicked by her Parkinsonism. But precisely to the extent that, as Eliot reminds us, ‘You are the music while the music lasts,’ just so the antidote to Parkinsonism is music. If the Parkinsonian suffers from inertia, the remedy at times can consist, precisely, in artfulness, art-fusedness.
“And then as well there is my own story.” He goes on to rehearse some of the stations along his Leg journey (the book being due out now within a few weeks), concluding by noting how during recovery, he began to experience an almost hallucinatory in-playing of Mendelssohn, whereupon he recovered his own kinetic melody. “Nietzsche says one listens to music with one’s muscles—that one is, precisely, moved.
“Walking is a melody and not just a mechanical consecution. It is mechanical but not just mechanical.”
William Harvey as a young man, Oliver recalls, went to Galileo’s lectures and the first part of his book on animal motion was a Galilean analysis. But, in his second half, he concluded that such an analysis was necessarily incomplete. Because animal motion is essentially graceful, musical, transcendental.
Pulling things together, Oliver now soars to his conclusion: The Cartesian notion of man as a machine is tremendously powerful, and indeed was absolutely necessary for the rise of an empirical, objective science.
But it is not enough. It cannot tell us about the personal, the “I,” inside the physiological. A purely physiological explanation offends common sense and one’s own egotism. Mechanistic neurology needs to be complemented by an existential neurology—of face, internal landscape, the individual.
“Until we achieve such a conjunction, we can never hope to fathom the mysteries of perception and action but will remain lost in the empty labyrinths of empiricism.
“We need, if it’s not a contradiction in terms, a science of the individual, or at the very least one that does not do violence to the individual.”
Much applause followed by a truly vivid and vivifying question-and-answer session.
One person asks what Oliver makes of the question of the transcendence of the soul.
“I can provide no sense to the notion of a dismembered soul. I am speaking precisely of the embodiment of the soul.”
And what of Freud?
“Early Freud seemed focused on a drive theory, even though a drive theory is contradictory to human nature since a person would then merely be the algebraic sum of the drives. And yet, clearly, Freud was obsessed, enraptured by art. And Freud and Spinoza both conceived of analysis as a means of reducing bondage and liberating the soul, discussed as such.”
And behaviorism?
“Ach, the infernal science: puppetry. Behaviorism deals with an impassive ‘It’ and makes no attempt to bring out the active ‘I.’ An active science would give support for the idea of freedom, provide the frame for the picture. Indeed, we’ve spent a century building the scaffolding. Now it’s time to paint a few pictures.”
Any influence from Susanne Langer?
“It’s many years since I read Susanne Langer, or for that matter since I read anyone.” (“Ha!” write I, in the margin of my notes.)
Do you believe in God?
“I believe in the divine: Mendelssohn is divine.
“I believe in grace: All natural movements are graceful.
“I believe in the mystical mathematics of heaven, which is to say grace beyond the algorithm of causality.”
What about out-of-body experiences in those just returned from death’s brink?
“Hell, one has a vision of heaven all the time!”
Later that night, a group of us walk over for supper at a Brazilian restaurant on Forty-Seventh. (On the way, Oliver complains to me of having been a bit disconcerted by Sontag’s celebration of his “writerly style,” insisting “I’m not conscious of having a style; hell, I’m not conscious of being a writer, since I only try to express my thoughts.”) Once there, as if at the Last Supper, Oliver starts passing out his two hundred photocopied pages of passages to us, his disciples.
“Oh damn,” he says, “I was going to say something about Simone Weil and roots and being neurologically uprooted.” “I’m getting exceedingly fond of Coleridge, all about the wonder of synthesis.” “Oh bugger, I was going to read the first three pages of the Pensées.” “Oh,” finally, “oh, oh well.”
“The thing that upsets people about a frontal lobe patient is his indifference until they realize that he is truly indifferent; that he means no harm, although he means no good; that he is precisely meaningless.
“In this way, such patients remind me of bureaucracies.”
Bureaucratic inertia as a frontal lobe syndrome?
“Well, perhaps I wouldn’t react as violently to bureaucracies if I could just see them as frontal lobe syndromes … I mean, I send out two thousand bills a year and encounter Arendtian error constantly—the banal absence of thought, feeling, sense—moral indifference.
“State law, appallingly, allows for the disposal of records after five years. There is, therefore, usually no medical record deeper than five years.
“On the other hand, one of the reasons for the growing uninhabitability of this house is that I myself have notes on every patient I have ever seen!”
From Hermine Wittgenstein’s recollection of her brother, included in Recollections of Wittgenstein:3
I said to him during a long conversation we had at that time that when I thought of him with his philosophically trained mind as an elementary school teacher it seemed to be like somebody wanting to use a precision instrument to open crates. Ludwig replied with an analogy that reduced me to silence. He said, “You remind me of somebody who is looking out through a closed window and cannot explain to himself the strange movements of a passerby. He cannot tell what sort of storm is raging out there or that this person might only be managing with difficulty even to stay on his feet.”
John the Touretter?
Oliver?
Oliver also has me rereading William James’s Gifford Lectures,4 especially the one on “Religion and Neurology”:
But any object that is infinitely important to us and awakens our devotion feels to us also as if it must be sui generis and unique. Probably a crab would be filled with a sense of personal outrage if it could hear us class it without ado or apology as a crustacean, and thus dispose of it. “I am no such thing,” it would say; “I am MYSELF, MYSELF alone.”
Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate …
And medical materialism then thinks that the spiritual authority of all such personages is successfully undermined.
Insane conditions have this advantage, that they isolate special factors of the mental life, and enable us to inspect them unmasked by their more usual surroundings. They play the part in mental anatomy which the scalpel and the microscope play in the anatomy of the body.
“I was speaking with my youngest postencephalitic today, a man who must have contracted the illness at birth, recovered, and then years later lapsed. He was talking about the hallucinations which infest his experience whenever he is administered certain drugs. He is phenomenally sensitive—the very slightest dosages provoking the very wildest, most vivid hallucinations. ‘But they’re okay with me,’ he said, ‘as long as they don’t become so vivid that I feel compelled to participate. That way madness lies.’”
Which in turn gets Oliver talking about “Lilliputian hallucinations, in fever or drug states, accompanied by affect of dreadless curiosity. I had a patient,” he continues, “who told me he saw the floor before him covered over with tiny musical instruments—infinitesimal violins, minuscule tubas. Such hallucinations often take the form of elves.”
Question: Did hallucinations of elves precede their appearance in fairy tales, or do our feverish hallucinations rather order themselves into entities previously suggested by such fairy tales?
Meanwhile: “At Beth Abraham today I had an amazing conversation with a ‘Yiddishe mama,’ as she calls herself, who has been progressively disintegrating toward schizophrenia. Last month she’d told me that she believed the head nurse was head of the world and that she kept Negroes in a state of sexual suspense to prey on Yiddishe mamas.
“Today she told me that she herself was turning into a Negro.
“I asked her how long she’d been having these thoughts, and she vehemently protested, ‘Don’t ask me how long I’ve been having these thoughts—ask me how long has this been happening, how long have I been turning into a Negro.’
“‘All right,’ I asked, ‘how long has this been happening?’
“‘Eighteen days,’ she replied.
“She’d been metaphysically offended by my reducing her calamity to L-DOPA or whatever.
“‘In the whole history of the universe, never has such a thing happened,’ she proclaimed. ‘Have you ever heard of Yiddishe mamas turning into Negroes, just like that?’
“And of course her illusions were grounded in a sociological reality there at Beth Abraham, where the lower staff is indeed almost entirely black, simultaneously degraded and in a position of power.”
Oliver drops by, lavish with ghost stories. Mainly he tells me of a patient he once saw during medical school while doing rounds at Middlesex Hospital. This was a patient of Richard Asher’s, the doctor teacher he respected who later committed suicide. The year was 1957.
Asher had been paying a house call on another patient one afternoon when he saw a seated figure in the corner, unearthly still.
“What’s that?” he asked.
“That’s Uncle Toby,” came the reply. “He hasn’t moved in seven years.”
And sure enough, it seemed the family spoon-fed him slop from time to time, he moved his bowels every couple of months, they moved his limbs about every once in a while, but other than that he was immobile.
He was also very cold to the touch.
In fact, a few hours later when they got him to the hospital, his temperature on admission proved to be sixty-eight degrees! All his vital metabolic signs were way down, and his thyroid registered zero—absolutely nothing (a possible cause of the low metabolism).
Slowly, over a period of weeks, the staff at the hospital “warmed him up”—both with regard to body temperature and the synthetic thyroid substitute with which they now “topped him off.” And gradually, he came around. The first few days the sounds coming out of his mouth were like a 78 rpm record being played at 16. But day by day, he pepped up to regular speed and seemed to be getting better.
When Oliver saw him, he recalls, the med students were being pushed to make a special effort not to mention the date or accidentally leave newspapers or the like—it was thought the shock would be too overwhelming. As far as Toby was concerned, he’d been out for maybe a day and it was still 1950.
“Fascinating,” mused Oliver, recollecting the case. “Fascinating. Only sadly cut short.”
Within a week or so of coming to, Uncle Toby began coughing blood. An X-ray revealed an intensely proliferating bronchial carcinoma—a virulently expanding lung cancer. And he was dead within two months.
Looking back through Toby’s file, doctors came upon a 1950 chest X-ray. In hindsight, yes, they could notice the slightest trace, a dark smudge, of an incipient tumor. Lung cancer, Oliver explained, is one of the fastest-growing cancers. Apparently the carcinoma had been metabolically suspended, like Toby, for seven years. Perhaps the shutdown itself had constituted the body’s own response to the only just blossoming carcinoma? And awakening him had awoken it …
Talking about Asher puts Oliver in mind of James Purdon Martin (1893–1984), who did his best work after retirement in 1960, during thirty years at Highlands Hospital in North Finchley (including work with a population of postencephalitics there). “He had been a humble, unnoticed neurologist,” Oliver recalls, “no luminary and dismissed because of this—and yet he may have done the finest work of the lot of them. His book was finally published in 1967: The Basal Ganglia and Posture. A typically self-effacing title. I’d have given it a more dramatic title.”
Like what?
“Oh, The Salvation of Mankind!”
On the dangers of overinterpretation: Oliver relates how back in his California days he once had a dream of a crowd chasing him, throwing a mirror at him, which upon breaking, shattered into a spangle of shards, each reflecting fragments of his face.
He’d told his shrink at the time about the dream and they’d hazarded the various obvious interpretations.
The next day, however, as he was watching himself pump iron at his gym, he suddenly noticed, in the reflection, that the ceiling mirror had come dislodged, was hurtling toward him, and indeed was shattering onto his leg—eventually requiring eighteen stitches.
He lets out a huge leonine yawn, then wonders, “Have you ever noticed how just prior to the yawn, our consciousness becomes a vast wide yawn-scape?”
Oliver talks about a conversation he had with Isabelle concerning learning and teaching, how a primary language cannot be taught through a system of rules and applications but rather must be learned through direct experience and inference.
“In this sense,” he suggests, “I believe I am almost unteachable although I am a very good learner. This may be one of the reasons I’m ungrateful to my education …
“One of the things that struck me in coming to America was the richness of idiom combined with the paucity of vocabulary.”
Another time he tells of a man in a Duncan Dallas film who, much as with the man who mistook his wife, could for example draw the spool of cotton thread placed before him in exacting detail and yet not identify what it was. “Which raises the question: Can you have a percept without a concept?
“Hughlings Jackson felt that aphasics could not form propositions or use propositional logic internally. One of the reasons Hughlings Jackson is generally unreadable, however, is precisely that he writes only in propositions.
“There is something about school which tends to hypertrophize the clever (which is required for test-taking) in a way that must be superseded if one is going to get on with living. I myself had a burst of the imaginative between the ages of ten and fourteen, which was then bludgeoned into cleverness for years thereafter and was not recovered—I did not really feel again, that is—until years later when, escaping school, I was rescued by the world of my patients.
“I was originally going to write the Leg book in kabbalistic terms, that is, beginning with tsimtsum—contracture (breakage), the plunge into nothingness—followed by the iridescent chaos of conceptual hypotheses, followed at long last by the phase of tikkun, with its redemptive action. And though in the end I decided not to be quite so explicit about that arc, you can still see it there inside, beneath the lineaments.”
At dinner with some friends:
“I eat with a strange combination of appetite, inertia, and compulsion.
“Removed from my patients, I am like Antaeus removed from the earth.
“When I first reported to Shengold and he asked me in a word what my problem was, I replied, ‘Changelessness.’
“For all my love of the case history, history itself came late within my own purview. My earliest passions were all for the eternal verities, the changeless, the starscape. In Migraine I spoke of the firmament of neurology, the constellations. What initially attracted me to the Parkinsonians was their stillness—the way they were like inert planets. It was only later that I became entranced by change—the Touretters, after all, are pure changefulness. A case history—any narrative for that matter—is about how freedom interacts with fate.”