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An Interview With Oliver Sacks
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10971 |
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BOOK WORLD
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6 / 1986 |
1,590 Words |
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Ronald Leifer, M.D.
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Leifer: In your book you propose a new discipline of the neurology of identity, or the neural foundations of self. Would you say a few words about your concept of identity of self and how brain function may relate to it?
Sacks: I may have used a resounding phrase for nothing very new but something I suppose, which all of us are concerned with as physicians. I think I've been especially interested in things which may undercut or challenge identity. I suppose there are various sorts of selections in the book and maybe a central one is the challenge to identity in some of the more difficult patients who find some way of holding on despite an interminably changing world. I think the sort of language of faculty and function makes it difficult to talk about self and the way a person perceives. It makes it, for example, difficult to talk about the strange, impersonal way that Dr. P. [in "The Man Who Mistook His Wife for a Hat"] would see. I'm not very much of a theorizer or at least I haven't any theories. They would have to be implicit or come after my observations. So I don't exactly know what I'm getting at. But I think that case histories of this kind are sort of suggestive, hopefully suggestive to other people.
Leifer: Yes, the concepts of self and identity are notoriously difficult to define. It is interesting that psychiatry has a project similar to what you call the neurology of self, namely biological psychiatry's effort to define the biology of mental illness. I was struck by the fact that with all the dramatic neurological deficits and excesses of your patients there weren't any traditional mental illnesses caused by these drastic neurological problems. As a neurologist, what are your views on the neural basis of mental illness, on the theories of biological psychiatry that schizophrenia and depression are caused by brain disease?
Sacks: Well, I sort of see organic determinants. A very early one I used to see was when reserpine, or serpasil, was used much more freely for controlling hypertension, and both depressive and Parkinsonian symptoms were caused by it. I remember one patient in particular who was sort of nihilistic, suicidal, and melancholic every morning, but then so to speak the sun came perceptibly out around the middle of the day. This odd periodicity made us look at things and suspicion fell on the serpasil and the serpasil was stopped and she was no longer suicidal every morning.
A lot of the patients when they became rather animated, sometimes exalted on L-dopa, would ask, "Is it the drug? Or is it my state of mind?" I think Parkinsonism would definitely go with depression in a way which is organically integral. Parkinsonian patients are often more depressed than, so to speak, equivalently disabled patients.
With the post-encephalitic patients, von Economo called a quarter of them schizophreniform, or "as if schizophrenic." And one of the things in which, in some ways, the phenomenology can be so similar and yet the person can be sort of strongly there at the same time. In oculogyric crisis, people may sometimes have ideas of reference or hallucinations at which they laugh. I've got a patient on L-dopa at the moment who has to have a hallucinogenic level to be therapeutic, but he says he doesn't mind so long as he is merely a spectator. But if the becomes an actor or participator then he feels the risk of being
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