Oliver Sacks and caring for the whole person

Margaret Marcum
Boca Raton, Florida

 

The body of a woman in grayscale representing the patient as a whole person.

Body shapes, female. Credit: Martin Addison. CC BY 4.0. Accessed via the Wellcome Collection.

The neurologist Oliver Sacks—“The Poet Laureate of Medicine” according to The New York Times—developed an effective clinical method of treating the patient as a complete person rather than as a defective body part. He wrote that clinicians “are concerned not simply with a handful of ‘symptoms,’ but with a person, and his changing relation to the world.”1 He based his method on four dimensions of the patient’s personhood: the bodily, the mental, the emotional, and the spiritual.

Sacks’ notion of personhood was holistic rather than fragmentary in that each dimension of personhood depended on and was integrated with one another. He saw the mental not just as a separate function of the brain, but rather as the comportment of the entire person, including both the emotional and spiritual dimensions. A person would be mentally sharp not only if the brain is functioning properly but also if the emotional dimension is stable and the spiritual dimension is sound.

The first dimension of Sacks’ notion of personhood, the bodily, is exemplified by his experience with administering L-dopa to post-encephalitic patients. The clinical stories Sacks narrates in Awakenings consistently begin with the post-encephalitic patient’s frozen bodily state. For instance, Sacks paints a picture of Hester’s condition as “dense immobility” in which the patient “was virtually motionless and speechless at all times,”2 her immobility so severe that she could no longer eat solid food. Hester’s reaction to L-dopa was dramatic. After receiving the drug she “suddenly jumped to her feet, and before incredulous eyes walked the length of the ward.”3 Her appetite for solid food returned and she cruised the ward talking to one and all.

Sacks rejected the reductionist assumption associated with the physicalism of modern neurology. Rather, he saw the bodily manifestation of disease and the response to treatment not simply as biochemical, but as unique for each patient’s illness experience. To that end, he incorporated mental, emotional, and spiritual dimensions into his clinical method.

The mental dimension of the patient’s personhood for Sacks included the psychological, the behavioral, and the cognitive. His description of the mental dimension of post-encephalitic patients mirrored his description of their bodily dimension. Just as these patients were bodily immobile, so too they were mentally immobile in that “often the stream of thought and the stream of consciousness had been stopped or splintered.”4 In other words, post-encephalitic patients were as motionless mentally as they were bodily. As one patient, Rose, told Sacks, after being awakened with L-dopa, “I can give you the date of Pearl Harbor . . . I can give you the date of Kennedy’s assassination. I’ve registered it all—but none of it seems real.”5 In other words, she was aware of events but was simply unable to incorporate them into her personal lifeworld because of her mental torpor.

Moreover, the mental dimension played an integral role in Sacks’ notion of the cognitive decision-making process—i.e. being mentally capable of making good decisions in life. For example, when Cecil responded favorably to L-dopa but experienced his jaw locking up so he could no longer eat, he chose to discontinue the drug. As he cogently argued,

I have had this condition for more than thirty years and I have learnt to live with it. I know exactly where I am, what I can do, and what I can’t do. Things don’t change from day to day—or at least they didn’t change till I was given L-DOPA. Its effect was very pleasant at first, but then it turned out more troubling than it was worth. I can get along perfectly well without it—why should I try L-DOPA again? 6

Thus, the mental dimension is essential for treating patients effectively—for as patients change their minds, so often their worlds change.

Sacks incorporated both the patient’s emotional and spiritual dimensions in his clinical method. He included emotions as an important dimension of personhood even though it may be considered at odds with the mental dimension, especially cognitive function. Persons, he insisted, are not simply constituted bodily or mentally but also emotionally. The impact of illness, as observed from his clinical experience, not only robs patients of bodily or mental health but also of their emotional health. As an example, when Margaret in her post-encephalitic state became so depressed that she could no longer walk or even dress herself, her mood after receiving L-dopa became “exalted,” her eyes “bright,” and “she smiled readily.”7 For Sacks, love was essential, especially a caring family and healthcare professionals. He observed that the post-encephalitic patients who responded best to L-dopa treatment had loving and supportive families and caregivers; and concluded 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.”8

The final dimension of Sacks’ clinical method was the spiritual. Although Sacks himself was an atheist, he acknowledged the impact of the spiritual on the patient’s illness experience and the power it had for possible healing. The suffering associated with illness could lead to enhancing a patient spiritually, such as when Sacks described Margaret as “spiritualized with suffering” during the last days of her life.9 For Sacks this represented the patient’s discovery of meaning in the adversity of illness to recreate the patient’s lifeworld. For Margaret, such meaning was found through music so that on her deathbed she requested to hear Mozart’s Requiem.

Moreover, Sacks regarded the soul as not just a transcendental entity infused into a person by the divine, but rather as the dynamic plasticity of the neural circuits that accommodates illness. For Sacks the soul was not a separate ontological entity—”an immaterial soul, floating around in a machine”—rather representing the complex adaptive neural functions underlying a patient’s lifeworld.10 As Alan Wasserstein interprets him, “[T]he symptom, deficit, or process is not reduced to component mechanisms but explained by higher processes, as an aspect of the self or soul.”11 The spiritual dimension of the patient’s illness is illustrated through Sacks’ clinical experience with L-dopa treatment when the patient Leonard called dopamine the brain’s agent in response to the drug, “resurrectamine.”12

In sum, Sacks’ method was embedded in the physical, mental, emotional, and spiritual dimensions of the patient’s personhood. Its main goal was to reestablish for the patient a world that illness had fragmented. “Our health, diseases, and reactions,” claimed Sacks, “cannot be understood in vitro, in themselves, they can only be understood with reference to us, as an expression of our nature, our living, our world.”13 According to Martin Halliwell, Sacks sought “to restore the patient from the ‘statistical entity’ of medical records to a narrative account of an experiencing being.”14 By using the four dimensions of personhood, Sacks could restore wholeness to a lifeworld shattered by illness. In this clinical method, the science of medicine and the art of healing complemented each other.

 

References

  1. Oliver Sacks, Awakenings (New York: Vintage Books, 1999), 233.
  2. Sacks, Awakenings, 97.
  3. Sacks, Awakenings, 99.
  4. Oliver Sacks, “Awakenings Revisited,” Sacred Heart University Review 12, no. 1 (February 2010): 47-58, 48.
  5. Sacks, Awakenings, 83.
  6. Sacks, Awakenings, 203.
  7. Sacks, Awakenings, 153.
  8. Sacks, Awakenings, 273.
  9. Sacks, Awakenings, 296.
  10. Oliver Sacks, “Neurology and the Soul,” New York Review of Books (November 22, 1990).
  11. Alan G. Wasserstein, “Toward a Romantic Science: The Work of Oliver Sacks,” Annals of Internal Medicine 109 (September 1988): 440-4, 442.
  12. Sacks, “Awakenings revisited,” 50.
  13. Sacks, Awakenings, 228.
  14. Martin Halliwell, Romantic Science and the Experience of the Self: Transatlantic Crosscurrents from William James to Oliver Sacks (Brookfield, VT: Ashgate, 1999), 199.

 


 

MARGARET M. MARCUM graduated from the University of Redlands, where she was a member of the Proudian Interdisciplinary Honors Program and the Johnston Center for Integrative Studies. Currently, she is a graduate student in the MFA Program in Creative Writing at Florida Atlantic University in Boca Raton. Her scholarly interests include the intersection of the humanities with medicine.

 

Fall 2019  |  Sections  |  Neurology