“Common,” he said, “but never common. There is a genuine love in these casual encounters.” As the decorous stranger discreetly retired, I asked Wystan how he experienced the world, whether he thought of it as being a very small or very large place.
“Neither,” he replied. “Neither large nor small. Cozy, cozy.” He added in an undertone, “Like home.”
He said nothing more; there was no more to be said. The loud impersonal call blared out, and he hurried to the boarding gate. At the gate, he turned and kissed us both—the kiss of a godfather embracing his godsons, a kiss of benediction and farewell. He suddenly looked terribly old and frail but as nobly formal as a Gothic cathedral.
—
In February 1973, I was in England, and I went to Oxford to see Wystan, who by then had lodgings in Christ Church. I wanted to give him the galleys of Awakenings (he had asked for these, and in fact he was the only person who saw the galleys, other than Colin and Auntie Len). It was a beautiful day, and instead of taking a cab from the station, I decided to walk. I arrived somewhat late, and when I saw Wystan, he was swinging a watch. He said, “You’re seventeen minutes late.”
We spent a good deal of time discussing an article in Scientific American which had greatly excited him—Gunther Stent’s “Prematurity and Uniqueness in Scientific Discovery.” Auden had written a reply to Stent, contrasting the intellectual histories of science and art (this was published in the February 1973 issue).
Back in New York again, I got a letter from him. It was dated February 21—“my birthday,” he added—short, and very, very sweet:
Dear Oliver,
Thanks so much for your charming letter. Have read Awakenings and think it a masterpiece. I do congratulate. My only query, if you want laymen to read it—as they should—is that you should add a glossary about the technical terms you use.
Love,
Wystan
I wept when I received Auden’s letter. Here was a great writer, not given to facile or flattering words, judging my book “a masterpiece.” Was this, however, a purely “literary” judgment? Was Awakenings of any scientific worth? I hoped so.
Later that spring, Wystan wrote to me again, saying his heart had been “acting up a bit” and that he hoped I could come to the house he shared with Chester Kallman in Austria. But I did not go, for one reason or another, and I deeply regret that I didn’t visit him that summer, for he died on September 29.
—
On June 28, 1973 (Awakenings’s publication day), The Listener published a wonderful review of Awakenings by Richard Gregory and, in the same issue, my own article about Luria (I had been invited to review The Man with a Shattered World and to expand my review to include Luria’s entire oeuvre). The following month, I was thrilled to receive a letter from Luria himself.
He later described how as a young man, a nineteen-year-old who had founded the grandiloquently titled Kazan Psychoanalytic Association, he had received a letter from Freud (who did not realize that he was writing to a teenager). Luria was hugely excited at receiving a letter from Freud, and I felt a similar excitement receiving one from Luria.
He thanked me for writing the article and dealt at length with all the points I had raised in it, indicating in very courteous but no uncertain terms that he thought I was deeply mistaken in various ways.11
A few days later, I got another letter in which Luria spoke of receiving the copy of Awakenings which Richard had sent him:
My dear Dr. Sacks,
I received Awakenings and have read it at once with great delight. I was ever conscious and sure that a good clinical description of cases plays a leading role in medicine, especially in Neurology and Psychiatry. Unfortunately, the ability to describe which was so common to the great Neurologists and Psychiatrists of the nineteenth century is lost now, perhaps because of the basic mistake that mechanical and electrical devices can replace the study of personality. Your excellent book shows, that the important tradition of clinical case studies can be revived and with a great success. Thank you so much for the delightful book!
A. R. Luria
I revered Luria as the founder of neuropsychology and of “romantic science,” and his letter gave me great joy and a sort of intellectual reassurance I had never had before.
—
July 9, 1973, was my fortieth birthday. I was in London, Awakenings had just been published, and I was having a birthday swim in one of the ponds on Hampstead Heath, the pond in which my father had dunked me when I was a few months old.
I swam out to one of the buoys in the pond and was clinging to it, taking in the scene—there are few more beautiful places to swim—when I was groped underwater. I started violently, and the groper surfaced, a handsome young man with an impish smile on his face.
I smiled back, and we got talking. He was a student at Harvard, he told me, and this was his first time in England. He especially loved London, had been “seeing the sights” of the city every day and going to plays and concerts every evening. His nights, he added, had been rather lonely. He was due to return to the States in a week. A friend, now out of town, had lent him his flat. Would I care to visit?
I did so, happily, without my usual cargo of inhibitions and fears—happy that he was so nice looking, that he had taken the initiative, that he was so direct and straightforward, happy, too, that it was my birthday and that I could regard him, our meeting, as the perfect birthday present.
We went to his flat, made love, lunched, went to the Tate in the afternoon, to the Wigmore Hall in the evening, and then back to bed.
We had a joyous week together—the days full, the nights intimate, a happy, festive, loving week—before he had to return to the States. There were no deep or agonized feelings; we liked each other, we enjoyed ourselves, and we parted without pain or promises when our week was up.
It was just as well that I had no foreknowledge of the future, for after that sweet birthday fling I was to have no sex for the next thirty-five years.12
—
Early in 1970, The Lancet had published my four letters to the editor about my postencephalitic patients and their responses to L-dopa. I assumed these letters would be read only by fellow physicians and was startled, a month later, when the sister of Rose R., one of my patients, held up a copy of the New York Daily News, which had reprinted, indeed highlighted, one of my letters under a headline.
“Is this your medical discretion?” she asked, waving the paper in front of me. Though only a close friend or a relative could have recognized the patient from the description, I was as shocked as she was—it did not occur to me that The Lancet would release an article to a news agency—I had thought professional writing had only a very limited circulation, not in the public sphere at all.
I had written a number of somewhat more technical papers in the mid-1960s—for journals like Neurology and Acta Neuropathologica—and there were no leaks to the news agencies then. But now, with my patients’ “awakenings,” I had entered a much broader arena, and this was my introduction to a very delicate, sometimes ambiguous area—a borderline or borderland between what can be said and what cannot be said.
I could not, of course, have written Awakenings without the encouragement and permission of the patients themselves, who had an overwhelming feeling of having been disposed of by society, put away, forgotten, and wanted their stories to be told. Nonetheless, I was hesitant, after the episode with the Daily News, to publish Awakenings in the United States. But one of my patients somehow got wind of the English publication and wrote to Colin, who sent her a copy of Awakenings. And then it was out.
—
Unlike Migraine, which had earned good opinions from both general reviewers and medical reviewers, the publication of Awakenings was greeted in a puzzling way. It was very well reviewed in the press generally. Indeed, it was awarded the 1974 Hawthornden Prize, a venerable award for “imaginative literature.” (I was thrilled by this, as I joined a list including Robert Graves and Graham Greene,
among others—to say nothing of James Hilton for Lost Horizon, a book I adored as a boy.)
But there was not a murmur from my medical colleagues. No medical journals reviewed it. Finally, in January of 1974, the editor of a rather briefly lived journal called The British Clinical Journal wrote that he thought that two of the strangest phenomena in England in the preceding year had been the publication of Awakenings and the complete lack of medical response to it, what he called the “strange mutism” of the profession.13
Nonetheless, the book was voted Book of the Year by five eminent writers, and in December of 1973 Colin threw a combined publication and Christmas party. There were many people at the party I had heard of and admired but had never met or thought to meet. My father, who was just recovering from a year of mourning for my mother, came to the party, and he, who had been so anxious about my publishing, saw all sorts of eminent people there and was greatly reassured. I myself, who had felt so lost, so unknown, now felt rather lionized and feted. Jonathan Miller was at the party too, and he said to me, “You’re famous now.”
I didn’t really know what that meant; no one had ever said anything like this to me before.
—
I had one review in England which irked me, although it was quite positive in most ways. I had of course given the patients pseudonyms in the book and had given Beth Abraham a pseudonym as well. I called it Mount Carmel and located it in the fictitious village of Bexley-on-Hudson. This reviewer wrote something like, “This is an amazing book, the more so since Sacks is talking about non-existent patients in a non-existent hospital, patients with a non-existent disease, because there was no worldwide epidemic of sleepy sickness in the 1920s.” I shared this review with some of the patients, and many of them said, “Show us, or the book will never be believed.”
And so I asked all the patients how they would feel about a documentary. They had encouraged me, earlier, about publishing the book: “Go ahead; tell our story—or it will never be known.” And now they said, “Go ahead; film us. Let us speak for ourselves.”
I was not sure of the propriety of showing my patients on film. What passes between physician and patient is confidential and even to write of it, in some sense, is a breach of this confidence, but writing allows one to change names and places and certain other details. Such disguise is impossible in a documentary film; faces, voices, real lives, identities, are all exposed.
So I had misgivings, but I was approached by several documentary film producers and was particularly impressed by one of them, Duncan Dallas of Yorkshire Television, especially by his combination of scientific knowledge and human feeling. Duncan came to Beth Abraham for a visit in September of 1973 and met all of the patients. Many he recognized from having read their stories in Awakenings. “I know you,” he said to several of them. “I feel I’ve met you before.”
He also asked, “Where’s the music therapist? She seems to be the most important person around here.” He was referring to Kitty Stiles, an unusually talented music therapist. It was quite unusual, in those days, to have a music therapist—the effects of music, if any, were considered no more than marginal—but Kitty, working at Beth Abraham since the early 1950s, knew that patients of all sorts could respond strongly to music and that even the postencephalitics, although often incapable of initiating movements voluntarily, could respond to a beat involuntarily, as we all do.14
Almost all of the patients warmed to Duncan and realized he would present them with objectivity and a discreet compassion, neither over-medicalizing nor over-sentimentalizing their lives. When I saw how quickly a mutual understanding and respect was established, I agreed to the filming, and Duncan returned with his crew the following month. Some of the patients, of course, did not want to be filmed, but most of them felt it was important to show themselves as human beings who had been forced to dwell in a deeply strange world.
Duncan incorporated some of the Super 8 film I had shot in 1969 showing the patients’ awakenings as they were given L-dopa and then as they suffered bizarre tribulations of all types, and he added moving interviews with the patients as they looked back on these events and described how they were now living their lives after having been out of the world for so many years.
The documentary film of Awakenings was broadcast in England early in 1974. It is the only documentary account of these last survivors of a forgotten epidemic and how their lives were transformed for a while by a new drug; of how intensely human they were, throughout all their vicissitudes.
1. Macdonald Critchley, in his biography of William R. Gowers, the Victorian neurologist (and amateur botanist), writes, “To him the neurological sick were like the flora of a tropical jungle.” Like Gowers, I sometimes see my patients with unusual disorders as different and extraordinary beings, forms of life.
2. Around this time, I had a discussion with my chief at Einstein, Labe Scheinberg. “How many patients do you have on L-dopa?” he asked me.
“Three, sir,” I replied eagerly.
“Gee, Oliver,” Labe said, “I have three hundred patients on L-dopa.”
“Yes, but I learn a hundred times as much about each patient as you do,” I replied, stung by his sarcasm.
Series are needed—all sorts of generalizations are made possible by dealing with populations—but one needs the concrete, the particular, the personal too, and it is impossible to convey the nature and impact of any neurological condition without entering and describing the lives of individual patients.
3. In August of 1969, the “awakenings” of my postencephalitic patients hit The New York Times in the form of a long, illustrated article by Israel Shenker. He described what I called a “yo-yo effect” in some of my patients—sudden oscillations of drug effects—a phenomenon not described by other colleagues, or in other patients, until several years later (and then called an “on-off effect”). While L-dopa was presented as “a miracle drug,” I commented in the article how crucial it was to pay attention to the entirety of patients’ lives and situations and not just the effects of a drug on their brains.
4. And fear, for as I read it, I thought, what place is there for me in the world? Luria has already seen, said, written, and thought anything I can ever say, or write, or think. I was so upset that I tore the book in two (I had to buy a new copy for the library, as well as a copy for myself).
5. Perhaps I was influenced here by something William James had written of his own teacher Louis Agassiz—how Agassiz “used to lock a student up in a room full of turtle shells, or lobster shells, or oyster shells, without a book or work to help him, and not let him out till he had discovered all the truths which the objects contained.”
6. This would not be the case in a 1984 strike, in which no one was allowed to cross the picket line for forty-seven days. Many patients suffered; thirty of them, I wrote in a letter to my father, died from neglect during that time, even though temporary employees and administrators came in to care for them.
7. Raymond Greene, of Heinemann (who had reviewed Migraine warmly when it came out in early 1971), wanted to commission me to write a book on parkinsonism “just like” Migraine. This both encouraged and discouraged me, because I did not want to repeat myself; I felt a quite different sort of book was called for, but I had no idea what sort of book it should be.
8. When I returned to London a few months later, however, Uncle Dave himself was mortally ill. I visited him in his hospital room, but he was too weak now to talk at any length, so this, sadly, was a farewell visit to an uncle who had been so important, such a mentor, to me in my own boyhood, and I never did learn what my mother was like in her early days.
9. With the death of my mother and the completion of Awakenings (it was still untitled), I felt a peculiar compulsion to read and see Ibsen plays; Ibsen called to me, called to my condition, and his was the only voice I could bear.
Once I returned to New York, I went to every Ibsen play I could, but I could not find a performance of the play I most wanted to see, When
We Dead Awaken. Finally, in the middle of January, I found that it was being performed at a small theater in northern Massachusetts and drove straight up to see it; the weather was nasty, and the smaller roads were treacherous. It was not the best of performances, but I identified with Rubek, the guilt-stricken artist. In that moment, I decided I had to title my own book Awakenings.
10. He left his stereo and all of his records—a vast number of 78s as well as LPs—in New York, asking me if I would “look after them.” I kept and played them for many years, though it got harder and harder to replace the tubes in the amplifier. In 2000, I gave them to the Auden archive at the New York Public Library.
11. His letter then moved into a different mode and related an astonishing story of his meeting with Pavlov: the old man (Pavlov was then in his eighties), looking like Moses, tore Luria’s first book in half, flung the fragments at his feet, and shouted, “You call yourself a scientist!” This startling episode was related by Luria with vividness and gusto in a way that brought out its comic and terrible aspects equally.
12. In 2007, as I was starting a five-year stint as a professor of neurology at Columbia, I had to complete a medical interview to be cleared for working in the hospital. Kate, my friend and assistant, was with me, and at one point my interviewer, a nurse, said, “I have something rather private to ask you. Would you like Ms. Edgar to leave the room?”
“Not necessary,” I said. “She is privy to all my affairs.” I thought she was going to ask me about my sexual life, so without waiting for her question, I blurted out, “I haven’t had any sex for thirty-five years.”