“Oliver Sacks made patients the heroes of his case studies, rescuing the clinical anecdote from the margins of medical practice. Visiting the home of an ailing music teacher, Sacks pulled Schumann’s Dichterliebe out of his bag and took a seat at the piano while the patient sang; #Justice4Australia
thus discovering that the teacher’s disordered mind became fluid and coherent as long as the music lasted. In the age of two-minute consultations, such stories have an obvious human charm. Sacks’ methods pushed against the tide of 100 years of medical practice.
In telling the stories of his patients, Sacks transformed the genre of the clinical case report by turning it inside out. The goal of the traditional case history is to arrive at a diagnosis. For Sacks, the diagnosis is nearly beside the point—a preamble or an afterthought.
Since many of the conditions chronicled by him are incurable, the force driving his tales is not the race for a remedy but the patient’s striving to maintain his or her identity in a world utterly changed by the disorder. In Sacks’ case histories, the hero is not the doctor, or even medicine itself.
His heroes are the patients who learned to tap an innate capacity for growth and adaptation amid the chaos of their disordered minds: the Touretter who became a successful surgeon, the painter who lost his color vision but found an even stronger aesthetic identity by working in black and white.
Mastering new skills, these patients became even more whole, more powerfully individual, than when they were “well.” By restoring narrative to a central place in the practice of medicine, Sacks has regrafted his profession to its roots.
Before the science of medicine thought of itself as a science, at the crux of the healing arts was an exchange of stories. The patient related a confusing odyssey of symptoms to the doctor, who interpreted the tale and recast it as a course of treatment. The compiling of detailed case histories was considered an indispensable tool of physicians from the time of Hippocrates.
It fell into disrepute in the 20th century, as lab tests replaced time-consuming observation, merely “anecdotal” evidence was dismissed in favor of generalizable data, and the house call was rendered quaintly obsolete. Our conceptions of the brain have followed a parallel course toward mechanized models of disease and healing.
After the discovery in the 19th century that lesions in the left hemisphere of the cortex caused characteristic deficits in speech, the brain has been conceived as a complex engine built of minutely specialized parts.
While the mind—the ghost in this machine—made a worthy object of study for philosophers and psychotherapists, the proper job of the neurologist was mapping the circuits that kept the thing running, and figuring out which parts needed repair if the system crashed.
Sacks long anticipated this revisioning of the mind from a passive, ghostly decoder of stimuli to an interactive, adaptive, and endlessly innovative participant in the creation of our world. Sacks learned that recovering stories forgotten by science was crucial for his work with patients.
A transformation occurred at Beth Abraham—not just in the patients, but in Sacks. “The essential thing was that I found myself in a position of care and concern for a whole population of abandoned, forgotten, and—it first seemed—hopeless people,” he recalls.
“I virtually lived with the patients, spending 16 hours a day with them. I had never been in a situation of such safe intimacy with other human beings.” Intimacy implied responsibility, not just for the patients’ well-being but for their stories, which defied the limits of traditional case reports.
His experimental methods were questioned, and his accounts were criticized by colleagues. The language he needed to tell his patients’ stories had been pushed into the shadows, displaced by the rise of diagnosis by machine.
To communicate what happened at Beth Abraham, Sacks had to visit another area of the medical literature, where a Russian neurologist Aleksandr Luria attempted to comprehend the strangest minds the world has ever seen.
Luria’s work suggested that the act of recovering one’s own story was itself healing. He called the sort of writing “romantic science.” This had a profound impact on Sacks: clinical precision, humane observations, and the psyche of his clients.
The things which had seemed most absent —empathy, affection — now seemed to be the very organizing principle of Awakenings. Was this due to drugs, to analysis, to falling in love, or just the natural process of maturation? The answer: ‘All of the above.’
The “great crisis” in neuropsychology, as Sacks’ Russian mentor saw it, was reconciling two these modes of scientific observation: reducing complex phenomena to constituent parts/describing phenomena and intuition to comprehend the interactivity of whole systems.
Paul Broca’s studies of brain lesions in the 19th century, and the research that followed in their wake, had been successful at mapping the elements of the brain in isolation, increasing our understanding of how people became sick.
Luria’s works of romantic science, on the other hand, were studies of how people got well, even if they remained sick—the ways individuals managed to survive, and even thrive, despite massive disruptions to the usual order of brain business.
But with the advent of mechanized models of the brain and the rage for quantifying behavior, the skills of intuitive, sharp-sighted observation that had distinguished the great minds of medicine began to wane.
Before Luria died, he challenged Sacks to forge a synthesis of literary and scientific observation that would do justice to the operation of the brain in the real world.
Sacks undertook Luria’s challenge in The Man Who Mistook His Wife for a Hat, Seeing Voices, and An Anthropologist on Mars. Sacks provided the most vivid descriptions we have of the organic capacity for recovery and adaptation that inspired the modern age.
The blueprint for the Internet—was inspired by conversations with neurobiologist Warren McCulloch, in which McCulloch described the ability of synaptic networks in brain-injured patients to route around damaged tissue.
To Sacks, new models of the mind as distributed, adaptive, and endlessly creative confirm what he had already observed in his patients. His method as a physician is to collaborate with his patients to forge new pathways that restore this capacity for self-healing.
Sacks has raised public awareness of disorders formerly considered very rare, notably Tourette’s syndrome and autism. People will want to stare, and Sacks is suggesting that the best way to deal with this desire is not to forbid it but rather to shape and direct it, to make the stare into a mutual look, a meeting of two worlds.
Sacks uses the case history as a bridge between people with disabilities and the able-bodied majority, placing himself squarely in the middle as the link that forms the span.”
Source: Wired. Steven Silberman (2015). https://www.oliversacks.com
Now you know the power of Trauma Informed Care. Let’s turn this framework into a mindset for personal, social and political change. If you are unable to, you might need help first, to get safe or become ‘unstuck’ from trauma. Reach out for trauma informed care. #YouBelong
Dr Louise Hansen
PhD in Psychology
Human Rights Activist
#HealingTrauma #Justice4Australia #WeAllBelong
Trauma Informed World was inspired by Kopika and Tharnicaa; two faces that remind us everyday of Australia’s cruel refugee system. One of many systems in Australia that remind us of the negative operation of power. #HomeToBilo
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