Mrs. O'C was somewhat deaf, but otherwise in good health. She lived in an old people's home. One night, in January 1979, she dreamed vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang. When she woke up, the music was still going, very loud and clear. "I must still be dreaming", she thought, but this was not so. She got up, roused and puzzled. It was the middle of the night. Someone, she assumed, must have left a radio playing. But why was she the only person to be disturbed by it? She checked every radio she could find - they were all turned off. ...
And Mrs. O'C. also saw and heard me, through the much profounder anamnestic seizure of her childhood in Ireland: "I know you're there, Dr. Sacks. I know I'm an old woman with a stroke in an old people's home, but I feel I'm a child in Ireland again - I feel my mother's arms, I see her, I hear her voice singing." Such epileptic hallucinations or dreams, Penfield showed, are never fantasies: they are always memories, and memories of the most precise and vivid kind, accompanied by emotions which accompanied the original experience. ...
As she got better, and recovered from her stroke, Mrs. O'C. had a period of wistfulness and fear. "The door is closing", she said. "I'm losing it all again." And indeed she did lose, by the middle of April, the sudden irruptions of childhood scenes and music and feeling, her sudden epileptic "transports" back to the world of early childhood - which were undoubtedly "reminiscences", and authentic, for, as Penfield has shown beyond doubt, such seizures grasp and reproduce a reality - an experiential reality, and not a fantasy: actual segments of an individual's lifetime and past experience.
But Penfield always speaks of "consciousness" in this regard - of physical seizures as seizing, and replaying, part of the stream of consciousness, of conscious reality. What is peculiarly important, and moving, in the case of Mrs. O'C. , is that epileptic "reminiscence" here seized on something unconscious - very early, childhood experiences, either faded, or repressed from consciousness - and restored them to full memory and consciousness. And it is for this reason, one must suppose, that though, physiologically, the "door" did close, the experience itself was not forgotten, but left a profound and enduring impression, and was felt as a significant and healing experience. "I'm glad it happened", she said when it was over. "it was the healthiest, happiest experience of my life. There's no longer a great chunk of childhood missing. I can't remember the details now, but I know it's all there. There's a sort of completeness I never had before."
These were not idle word, but brave and true. Mrs. O'C.'s seizures did effect a kind of "conversion", did give a centre to a centerless life, did give her back the childhood she had lost - and with this a serenity which she had never had before and which remained for the rest of her life: an ultimate serenity and security of spirit as is only given to those who possess, or recall, the true past. ...
Peter Smith Publisher Inc, 1990.
Parkinson's Disease as a means to understand our ("normal") mind. Excerpts
[I]t was Parkinson who [...] who presented [the illness] as a distinctive human condition or form of behaviour .... moving from an empirical to an existential position. ...
[W]e see Parkinsonians as bodies-in-transit, moving like comets or stars. Soon, moreover, [Parkinson] came to recognize that certain stars form a constellation, that many seemingly unrelated phenomena form a definite and constant 'assemblage of symptoms'. ...
The two basic perversions delineated by [the philosopher Henry] James are the 'obstructive' will and the 'explosive' will; when the former holds sway, the performance of normal actions is rendered difficult or impossible; if the latter is dominant, abnormal actions are irrepressible. Although James uses these terms with reference to neurotic perversions of the will, they are equally applicable to what we must term Parkinsonian perversions of the will. ...
This power of music to integrate and cure, to liberate the Parkinsonian and give him freedom while it lasts ('You are the music / while the music lasts', T.S. Eliot), is quite fundamental, and seen in every patient. ... Equally striking, and analogous, was the power of touch. ... In her long years of illness, she had observed her own propensities and symptoms with a minute curiosity, and had devised many ingenious ways of reducing, overcoming, or circumventing these. ... Many of the symptoms and features of Parkinsonism, especially 'freezing', are due to getting stuck in a Parkinsonian 'world', or rather in a Parkinsonian emptiness, or vacuum, or unworld ('I freeze in empty spaces', as Lilian T. says in the documentary film 'Awakenings').
Parkinsonian Space and Time
Festinant clock, warped by Parkinsonian pressure,
- lilliputian handwriting, unwarped but minute.
Both were felt as 'normal' by tbe patient ...
It is, indeed, literally shocking, because of the clarity with which it shows that what Aaron E. clearly perceives in others, he cannot perceive in himself, that he may use a frame-of-reference (or coordinate-system, or way of judging space-time) which departs from 'the normal' in an ever-increasing and accelerating way; and that he may be so enclosed within his own (contracting) frame-of-reference, that he is unable to perceive the contracting scale in his own movements. ... [I]ndividuals may have varying experiences of space and time - and [...] their experiences are themselves hypotheses or conjectures. ...
[Miss D.] once said of her 'freezing': 'It's not as simple as it looks. I don't just come to a halt, I am still going, but I have run out of space to move in ... You see, my space, our space, is nothing like your space: our space gets bigger and smaller, it bounces back on itself, and it loops itself round till it runs into itself.'
The essence of this passivity lies in peculiar difficulties of self-stimulation, and initiation, not in the capacity to respond to stimulation. ... The problem, then, is to provide a continual stimulus of the appropriate kind - and if we can achieve this we can recall Parkinsonians from inactivity (or abnormal activity) into normal activity ...
We have repeatedly referred to the usefulness of steps, lines, ticks, clocks, routines, pacings, etc. - scales, measures, series, patterns, disposed in a fixed and regular and conventional space-time. All of these can provide (in Luria's terminology) 'syntagms' or 'algorithms' for the structuring and coordination of experience and behaviour; they provide (again in Luria's terms) 'logico-grammatical' or 'quasispatial' paradigms or schemes.
All of us (by 'us' l mean human animals, as opposed to non-human animals, who are so admirably guided by their own, biological 'clocks' and 'scales') require and use artificial, abstract, conventional measures - standards - of this sort, standards for consensus and communication. The Parkinsonian, who is 'far out', whose behaviour has become so different from, so incommensurable with, ordinary conduct, stands in special need of such formalities and conventions; but he also stands in special peril from them. A subtle and sensible balance is needed, a propriety of relation, so that the Parkinsonian patient can have the mechanical and the systematic at his service, witbout himself becoming enslaved to them.
We have seen, again and again, that patients' own kinetic melodies can
be given back to them, albeit briefly, by the use of an appropriate flow
of music: one is reminded here of Novalis's aphorism: 'Every sickness is
a musical problem, and every cure a musical solution.'
Other 'natural' motions of Nature and Art are equally potent if experienced visually or tactually. Thus, I have known patients almost totally immobilised by Parkinsonism, dystonias, contortions, etc., capable of riding a horse with ease - with ease and grace and intuitive control, forming with the horse a mutually influencing and natural unity; indeed, the mere sight of riding, running, walking, swimming, of any natural movement whatever - as a purely visual experience on a television screen - can call forth by sympathy, or suggestion, an equal naturalness of movement in Parkinsonian patients.
[I]s consciousness really discontinuous and does it only seem continuous to itself by an illusion analogous to that of the zoetrope?
[S]ome described extraordinary "standstills," sometimes hours long, in which not only visual flow was arrested, but the stream of movement, of action, of thought itself. Such standstills showed that consciousness could be brought to a halt, stopped dead, for substantial periods, while automatic, nonconscious function -maintenance of posture or breathing, for example- continued as before. ...
Neural Darwinism: Instead of seeing the brain as rigid, fixed in mode, programmed like a computer, there is now a much more biological and powerful notion of "experiential selection", of experience literally shaping the connectivity and function of the brain. Such a selection of neuronal groups ..., and its effect on shaping the brain over the lifetime of an individual, is seen as analogous to the role of natural selection in the evolution of species; hence Gerald M. Edelman, who was a pioneer in such thinking in the 1970s, speaks of "neural Darwinism".
Time Halos (Hysteresis) Connecting Pieces of Consciousness - [Francis Crick's and Christof Koch's] search for the neural basis of consciousness: Mechanisms of visual consciousness [...] are an ideal starting point, because they are the most amenable to investigation at present, and can serve as a model for investigating and understanding higher and higher forms of consciousness. ... [C]oalitions of neurons [...] can form and dissolve in a fraction of a second, and involve reciprocal connections between the visual cortex and many other areas of the brain. ... [T]he activity of a coalition, or coalition of coalitions, if it is to reach consciousness, must not only cross a threshold of intensity, but must be held there for a certain time - roughly a hundred milliseconds. This is the duration of a "perceptual moment". ... The sense of continuity, in other words, results from the continuous overlapping of successive perceptual moments. It may be that the forms of cinematographic vision I have described -with either sharply separated stills or blurred and overlapping ones- represent abnormalities of excitability in the coalitions, with either too much, or too little, hysteresis. ...
We consist entirely of "a collection of moments," even though these flow into one another like Borges's river ... [C]onsciousness is always active and selective - charged with feelings and meanings uniquely our own, informing our choices and interfusing our perceptions. So it is not just [New York's] Seventh Avenue that I see, but my Seventh Avenue, marked by my own selfhood and identity.
Feeling At Home in the World, pages 272 - 275 of Awakenings
'Deep' accomodation, rest, care, ingenuity - all of these are essential ... But more important than all of them, and perhaps a prerequisite for all of them, is the establishment of proper relations with the world, and - in particular - with other human beings, or one other human being, for it is human relations which carry the possibilities of proper being-in-the-world. Feeling the fullness of the presence of the world depends on feeling the fullness of another person, as a person; reality is given to us by the reality of people; reality is taken from us by the unreality of un-people; our sense of reality, of trust, of security, is critically dependent on a human relation. A single good relation is a life-line in trouble, a pole-star and compass in the ocean of trouble: and we see, again and again, in the histories of these patients, how a single relation can extricate them from trouble. Kinship is healing; we are physicians to each other -'A faithful friend is the physic of life' (Browne). The world is the hospital where healing takes place.
The essential thing is feeling at home in the world, knowing in the depths of one's being that one has a real place in the home of the world. The essential function of such hospitals as Mount Carmel - which house several millions of the world's population - is that they should provide hospitality, the feeling of home, for patients who have lost their original homes. To the extent that Mount Carmel acts as a home, it is deeply therapeutic to all of its patients; but to the extent that it acts as an institution, it deprives them of their sense of reality and home, and forces them into the false homes and compensations of regression and sickness. And this is equally true of L-DOPA, with the unreal 'miraculous' expectations which attend it, with its false promise of a false home in the bosom of a drug. Tribulations of every kind were at a maximum for our patients in the autumn of 1969 - a time when the hospital changed its character, when human relations of all sorts became strained or undermined (including my own relation with our patients), and when neurotic hopes and fears reached exorbitant heights. At this period, patients who had attained accommodations previously, who had felt reasonably at home with themselves and the world, were deprived of their accommodations, and profoundly unsettled: unsettled socially, physiologically, at all possible levels.
Many of these patients have now re-settled, re-accommodated, re-attained good relations, and with this are doing much better on L-DOPA. One sees this, with great clarity, in the case of Miron V., as he was restored to his work, his place in the world; and one sees it, most movingly, with regard to Magda B., Hester Y., and Ida T., who were restored to their children, and the love of their families. One sees it in all patients, insofar as they are able to love themselves and the world.
One sees that beautiful and ultimate metaphysical truth, which has been stated by poets and physicians and metaphysicians in all ages - by Leibniz and Donne and Dante and Freud: that Eros is the oldest and strongest of the gods; that love is the alpha and omega of being; and that the work of healing, of rendering whole, is, first and last, the business of love.
And so we come to the end of our tale. I have been with these patients for almost seven years, a considerable part of their lives and mine. These seven years have seemed like a single long day: a long night of illness, a morning awakening, a high noon of trouble, and now a long evening of repose. They have also composed a strange sort of odyssey, through the deepest and darkest oceans of being; and if our patients have not reached an ultimate haven, some of them have fought through to a staunch, rock-girt Ithaca, an island or home against the perils around them.
It is given to these patients, through no wish or fault of their own, to explore the depths, the ultimate possibilities of human being and suffering. Their unsought crucifixions are not without consequence, if they afford help or illumination to others, if they lead us to a deeper understanding of the nature of affliction and care and cure. This sense of genuine and generous, if involuntary, martyrdom is not unknown to the patients themselves - thus Leonard L., speaking for them all, wrote at the end of his autobiography 'I am a living candle. I am consumed that you may learn. New things will be seen in the light of my suffering.'
What we do see, first and last, is the utter inadequacy of mechanical medicine, the utter inadequacy of a mechanical worldview. These patients are living disproofs of mechanical thinking, as they are living exemplars of biological thinking. Expressed in their sickness, their health, their reactions, is the living imagination of Nature itself, the imagination we must match in our picturing of Nature. They show us that Nature is everywhere real and alive and that our thinking about Nature must he real and alive. They remind us that we are over-developed in mechanical competence, but lacking in biological intelligence, intuition, awareness; and that it is this, above all, that we need to regain, not only in medicine, but in all science.
James Joseph Sylvester, poet and mathematician, student of Leibniz and Goethe, speaking of an analogous awakening in mathematics ( ... if the day only responds to the promise of its dawn ...') depicts in unforgettable terms the real, spacious, and alive quality of mathematical thinking:
'Mathematics is not a book confined within a cover and bound between brazen clasps, whose contents it needs only patience to ransack; it is not a mine, whose treasures may take long to reduce into possession, but which fill only a limited number of veins and lodes; it is not a soil, whose fertility can be exhausted by the yield of successive harvests; it is not a continent or an ocean, whose area can be mapped out and its contour defined: it is limitless as that space which it finds too narrow for its aspirations; its possibilities are as infinite as the worlds which are forever crowding in and multiplying upon the astronomer's gaze: it is as incapable of being restricted within assigned boundaries or being reduced to definitions of permanent validity, as the consciousness, the life, which seems to slumber in each monad, in every atom of matter, in each leaf and bud and cell, and is forever ready to burst forth into new forms of vegetable and animal existence' (Address on Commemoration Day at Johns Hopkins, 1877).
In the years I have known them - and, most of all, in their years on L-DOPA - those patients have been through a range and depth of experience that is not granted to, or desired by, the majority of people. Many of them, by superficial criteria, appear now to have come full circle, and to be back where they were, in their starting position; but this, in actuality, is by no means the case.
They may still (or again) be deeply Parkinsonian, in some instances, but they are no longer the people they were. They have acquired a depth, a fullness, a richness, an awareness of themselves and of the nature of things, of a sort which is rare, and only to be achieved through experience and suffering. I have tried, insofar as it is possible for another person, a physician, to enter into or share their experiences and feelings, and, alongside with them, to be deepened by these; and if they are no longer the people they were, I am no longer the person I was. We are older and more battered, but calmer and deeper.
The flash-like drug-awakening of summer 1969 came and went; its like was not to be seen again. But something else has followed in the wake of that flash - a slower, deeper, imaginative awakening, which has gradually developed and lapped them around in a feeling, a light, a sense, a strength, which is not pharmacological, chimerical, false, or fantastic: they have - to paraphrase Browne - come to rest once again in the bosom of their causes. They have come to re-feel the grounds of their being, to re-root themselves in the ground of reality, to return to the first-ground, the earth-ground, the home-ground, from which, in their sickness, they had so long departed. In them, and with them, this is the home-coming I have felt. Their experiences have guided me, and will guide some of my readers, on that endless journey which leads to home:
He found, on his arrival at Waldzell, a pleasure at homecoming such as he had never experienced before. He felt ... that during his absence it had become even more lovely and interesting - or perhaps he was now seeing it in a new perspective, having returned with the heightened powers of perception . . . 'It seems to me,' he confided to his friend Tegularius ... . . 'that I have spent all my years here asleep ... It is now as though I have awakened, and can see everything sharply and clearly, bearing the stamp of reality.'
HERMANN HESSE, Magister Ludi
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time ...
With his Theory of Neuronal Group Selection (also called Neural Darwinism in analogy to the Darwinism in the immune system) Gerald Edelman presents a biological theory of mind. He and his colleagues at the neurosciences Institute at Rockefeller University have been developing it over the past 15 years. He imagines a comprehensive theory of a dozen disciplines of neuroscience. Oliver Sacks gives a fascinating and well understandable outline of the theory.
Alexander Thomas, Stella Chess and Herbert G. Birch