A Leg to Stand On 
by Oliver Sacks.
Duckworth, 168 pp., £8.95, May 1984, 0 7156 1027 9
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Oliver Sacks is the Jules Verne of the neurological interface. Knowledgeable about science, he also wishes to summon a host of readers to a great adventure, a journey to the centre of the body and ways of knowing about bodies. As with Verne’s skilful use of half-understood scientific symbols, the project that Sacks has come to make his own has brought into public view a gallery of exotic events and phenomena that, precisely in their strangeness, remain memorable to the untrained reader. People have slept, and have been awoken. Others have mistaken people for hats and failed to recognise their nearest and dearest. News has come, too, from inside, and not just outside, other people. People, people who have to be thought of as patients, have been pushed to the side of their own lives; they have lost parts of their body, and started to lose themselves. The neurological sciences, as written up by Sacks for a wide audience, have opened up the abyss: under the impact of certain physical injuries, individual men and women become gaps in their own nature.

From the appearance of Awakenings, in 1976, one aspect of the reception of Sacks’s work has been striking, and it bears on the nature of A Leg to Stand On, which is a piece of autobiography. This is that Sacks’s writings have particular attractions for literary society, and indeed for practitioners of literature. It is not just a matter of the exotic world itself, a world of lost creatures, or suddenly saved souls, that distinguishes the books and articles of Doctor Sacks. A collection of excellent essays on equally weird events, like Macdonald Critchley’s The Divine Banquet of the Brain, published in 1979, does not seek the same literary place, or share the same desire to link neurones to Novalis which is among Sacks’s aspirations. Sacks’s standing with literary people is not just due to the regard in which W.H. Auden is known to have held him. Like Verne before him, Oliver Sacks has produced a metaphorical vision, indeed, in some readings, a neurological version, of fiction. The interest of A Leg to Stand On is that it is a story about something which happened to Sacks himself, and about which he has now chosen to write. The aspiration to the condition of literature that his previous neurological case-studies sometimes showed signs of is now to be realised from his own experience. Bearing in mind all the ground rules that medicine will have given him – the commitment to careful, even mundane observation, the sceptical business of listening and feeling – Doctor Sacks is now to write about himself: and that, as everybody knows, is a damned hard business.

Before asking whether this conjunction of the medical and the literary has worked or not, whether we can actually believe the story, it is necessary to see how Oliver Sacks thinks of the history of neurology, of its happy and unhappy phases, and how he sees his own work fitting into it. To put it very crudely, he greatly admires the pioneering work of the 19th-century American physician S. Weir Mitchell, who witnessed considerable amounts of physical damage in the years of the American Civil War. What is attractive to Sacks about a man like Mitchell was his freedom from the strait-jacket of scientific specialism, a freedom that allowed him to write medical short stories, on themes of amputation, say, or phantom limbs, in places like the Atlantic Monthly. Mitchell was a literary doctor, free to speculate, to imagine, before the age of scramble. In the 20th century, there are two crucial further developments: the work of Henry Head in the 1920s, in England, and then the great Russian advances of later decades, culminating in the work of R.A. and A.R. Luria in the 1950s. Sacks sees the work of Henry Head as having a classic style, detached, cool, interested in the science of function, but without being too concerned about the patient’s experiences, or the totality of events that might have made up the whole story of a neurological event. Head would listen to his patients, but would not, so Sacks alleges, include the patient’s story in his neurological model. The move toward a unified explanation, one that would seek to integrate a science of observing with a science of doing, was essentially a Soviet achievement, born out of the need to redeem victims of war injury. This initiative Sacks calls neuropsychology, stressing its commitment to ‘performance’, as laid out by the Lurias, Leontev, Bernstein and others.

Sacks is suggesting, then, that neurology itself has had its own gaps. In ways that historians of neurology might well find interesting but highly selective, he is proposing an absence, an existential space that ought to have been filled, but wasn’t, and which has held the science back. The full involvement of patients themselves, in the practical task of recovering the self that has been damaged or lost, is the largest of these missing parts. To complete the progress that the Russians started, Sacks calls for ‘a neurology of the self, of identity’, a task of neurological completion which he (unconvincingly) proposes was resolved in the history of philosophy when Kant dealt with Hume’s philosophy of identity and restored ‘the self’ to an existence that was not fleeting or transitory.

These are large, even rabbinical claims and hopes. They are intensely human, since they seek for nothing less than the discovery of the lost person that is ‘oneself’, the damaged double removed by injury and then gone from sight and from touch. Almost any reader, as indeed any television viewer of Sacks’s L-DOPA patients, will start out longing for this completion to work out. This is a matter of resurrection, not only of the individual medical case, but of neurology itself, since Sacks’s own science, in his version, has been missing a limb, as I have been saying, has had a gap in its own nature. A lot is riding on 168 pages of a Duckworth book.

What ‘happened’ to Oliver Sacks to make him become one of the patients at the neurological interface that he believes now exists? Basically, he behaved like a silly twit. He went on a holiday in Norway, in the peak of health, and went walking in the mountains. He was (like all prophets) alone, and had not bothered to tell anyone his whereabouts. He came to a field, which had a huge sign saying ‘BEWARE OF THE BULL!’ He ignored it, came face to face with a large white bull (which appears to have resembled the Devil), panicked and ran. In flight, he fell, twisted his left leg, and had considerable difficulty getting himself back down the mountain. Fortunately, a night in the open was avoided when two passing Norwegians picked him up.

The main part of Sacks’s tale follows from this incident, an incident that, as it were, turns one into the Doctor’s mother, making one want to give this burly man a hug and tell him not to go to Norway and have no one know where he is. This sense of protectiveness towards a man bent on resolving all the mysteries of human knowledge is reinforced when we learn that he has ‘fifty books’ in his rucksack and no change of clothes.

Dr Sacks becomes ‘a patient’: he is taken from Bergen to London, troubled by what damage has been done to his leg, and already starts to feel a certain hostility to unimaginative doctors. The journey to the centre of Oliver Sacks has begun, going from the Mountain, to the Hospital, to the Operation, to the Abyss: ‘I phoned up my family and friends, to let them know what had happened, and was happening, and to say that if I should, by malchance, die on the table, I wished and willed them to make suitable extracts from my notebooks, and other unpublished writings, and publish these as they thought fit.’

The story of his ‘becoming a patient’ is partly the story of losing a sense that his left leg existed, but is partly also a story of being ‘unmanned by medicine’. It would be wrong to make too much of the Freudian possibilities at this point, but Sacks’s hostility to the male surgeon, ‘a Mr Swan’, and a conception of medicine (from the patient’s viewpoint) as unfeeling and masculine, are noticeable. Once the operation was over, Sacks tried to use his leg muscles again – ‘to tense the quadriceps’, to feel again that earlier power that took him to Norway, that took him to the bull. And it is gone. It’s being gone also allows Sacks to reconnect himself to his internal account of the history of neurology, since he has become a sufferer from Babinski’s and/or Pötzl’s syndrome, with its painful (and comic) signs, where patients fail to recognise one side of their body, feel that parts of it belong to somebody else, or suggest that a nurse take away an arm that has become a nuisance.

Now at this point, in the maternal way that the distressing if overblown story makes one come to feel, the advice might be: ‘Ollie, sit tight.’ But this would be useless, since, Verne-like, the journey must get stranger. Limbo awaits, introduced by a suitable quotation from the Book of Job. There is no longer a way round the fact that if Sacks’s account of himself has now degenerated, into, most noticeably, literary ostentation and generalised exaggeration, then this matters. By not adhering, with some care, to the delicacy of the necessary linguistic account, by insisting on the glamorous nightmare of his experience, at the expense of its odd mixture of strangeness and mundanity, Sacks is jeopardising the very connection between outer and inner, surgical and perceptual, neurological and metaphysical, upon which the claims for his ‘existential neurology’ must rest. And, at least for me, the middle parts of A Leg to Stand On are indeed thus jeopardised, by a painful combination of unbelievable anecdote, cultural name-dropping and simple craziness. It surely must be crazy for a distinguished doctor to ask us to believe the following prominently displayed quotation: ‘ “Every disease is a musical problem, every cure a musical solution.” Novalis.’

The doubts about Sacks’s sentences set in quite early on in his story, back at the fjord in Norway. At one point he writes: ‘I could no longer hear myself’ (his emphasis). Now, in no doubt very ordinary, clumsily intuitive ways, I simply don’t believe that that is possible, not even for Oliver Sacks. It is of course all too possible not to recognise sounds that seem to be to do with – even to be uttered by – oneself. And there must be a self that hears the silence, in silence. But, in ways that matter because these are issues that matter, Sacks is typically asking us to believe the mega-thing, the Absolute proposition, the complete disappearance.

The middle parts of the book, which might in a modest, Chekhovian manner have described distressing things (a foul migraine, with eerie results, a perfectly understandable despair) instead appear in an unbelievable 3D. He is sinking; he is in the abyss; and yet ‘I kept reading Dr Faustus at this time, especially its passages on Hell – and Music.’ (When?) It is all John of the Cross, Nietzsche, Eliot, John Donne, Leibniz, Kant and, of course, music. The determination to exaggerate leads to two dreadful things: the reader, irony of all ironies, starts to disbelieve the writer. And worse, the truthful tension that must hold, between the organic experience and the psychological experience, between the science and the subject, starts to fail, and a dreadful thought enters, as the second thing: that a man who is having a bad time, who one wants to get well, is making this stuff up. By the time we read another, later sentence, a strange sadness is creeping in. Sacks writes: ‘Not the least part of the terror was that I experienced no terror.’

But his body comes to the rescue, quietly and without fuss. The leg comes back, and, secretly and delightfully, the memory of how to walk comes back as well: this marks a ‘turning-point’ similar to that of Zazetsky, in Luria’s The Man with a Shattered World. Sacks remains upset that, as seen from outside, by the clinical gaze, his recovery has been deemed ‘uneventful’. He himself feels reborn, back from the Abyss: but it is typical of the philosophical thinness of his account that he never discusses how the outsider’s gaze is meant fully to comprehend the cinematic grandeur that he himself has experienced. No doubt doctors are guilty of a weary lack of interest in much of a patient’s inner experience, and the use of ‘uneventful’ is a tired shorthand for that. Sacks makes one shift uneasily, by again going too far the other way, when, during convalescence, he decides that all the patients he is among (about whom he is strangely uninteresting) are ‘much wiser than the doctors who treated them’.

The story effectively ends with an incident that is instructive in its simplicity. Oliver Sacks goes to see an orthopaedist in Harley Street after his convalescence in Kenwood, a ‘Mr W.R.’ (who might, one guesses, understand the mysteries of the organism). ‘Mr W.R.’ recommends that Sacks goes swimming but has mischievously (and yet carefully) arranged for the lifeguard at the pool to take Sacks’s stick from him and push him into the water. This outrages Sacks, but completes his return to a full body-image, since he ‘kept up a fast crawl for four Olympic lengths’, and only stopped then, he says, because the lifeguard yelled ‘Enough.’

The possibility that Oliver Sacks’s ‘existential neurology’ is simply a way of talking about important things in unbelievable ways lingers in the mind. There must be many other experiences – strange and neurological, to be sure, but which can be shaped and understood in less grandiose ways, and which might put to use a different combination of Henry Head’s classicism and the neuropsychology of the Lurias. By writing about himself as he does here, Sacks swamps the various dimensions – surgical, neurological, psychological – in his zeal for a unitary hypothesis. Such distinctions are important: otherwise he might, for example, end up mistaking his patients for himself, seeing himself as the historical apotheosis of all their experiences. When he himself ‘becomes a patient’, he is so determined to solve the riddle of neurological history that his story is less well observed, and less potent, than one might have hoped.

The vexed relationship between subject and object that existentialism concerns itself with remains distressingly unclarified after A Leg to Stand On. Florid, fictive, without sufficient respect for the worldliness of pain and illness – let alone the need to be careful about what you say – the book takes its place among the more harmless products of medical egomania. I am very glad that Oliver Sacks got better, and I also wish that his autobiographical tale did not seem so full of the loneliness that comes with intellectual messianism.

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