Talking with Margaret Throsby

By Margaret Throsby

Allen & Unwin

Copyright © 2008 Margaret Throsby
All rights reserved.
ISBN: 978-1-74175-615-9

Contents

Foreword,
Oliver Sacks,
Jane Elliott,
Pat Dodson,
Paul Keating,
Patricia Routledge,
John le Carré,
Bill Henson,
Jonathan Franzen,
Gerry Adams,
Fiona Wood,
Chris Patten,
Maureen Dowd,
David Malouf,
Lincoln Hall,
Brenda Blethyn,
Jeffrey Tate,
Pauline Nguyen,
Michael Leunig,
Billy Bragg,

CHAPTER 1

Oliver Sacks

8 August 1997

Oliver Sacks once wrote, in a book about migraine headaches, that patients often feel that doctors look at them, investigate them, drug them, charge them and don’t listen to them. The concept of treating illness and disease from a perspective of the whole person has somehow been overtaken by science and Dr Sacks, a distinguished neurologist, has been a leader in the field of, as he puts it ‘asserting and affirming the living subject, to escape from a purely objective or robotic science, to find and establish what was missing — a living “I”‘. Oliver Sacks came to public prominence when he wrote up his extraordinary treatment of a group of surviving victims of sleeping sickness with a drug nicknamed Ldopa. Their arousal from a forty-year catatonia resulted in the best-selling book by Dr Sacks, and then a movie of the same name, called Awakenings. The findings by Oliver Sacks caused great controversy in the medical community, but found tremendous public acclaim. The Man Who Mistook His Wife for a Hat followed, and An Anthropologist on Mars and many more: stories about people with a variety of neurological disorders which cause odd, bizarre, often poignant behaviours. Well, Dr Oliver Sacks is our guest and music is of particular significance to him. We’ll find out why today. His selection for us starts with Bach.

BachMass in B Minor: ‘Et incarnatus est’ from the Credo — Leipzig Radio Chorus; New Bach Collegium Musicum, Leipzig / Peter Schreier

Margaret Throsby: ‘Et incarnatus est’ from Bach’sMass in B Minor, and chosen by our guest, Dr Oliver Sacks.

Good morning.

Oliver Sacks: Good morning.

You were lost in reverie listening to that?

It’s piercingly beautiful and it transports me. Ah, I love the anguished lyrical tenderness of the strings and the voices. I’m not a religious person in any formal sense — I don’t have any dogmatic credo myself — but the height of religious sensibility is here in Bach. I’m especially fond of vocal music and I’m especially fond of oratorios and Masses, which, for an old Jewish atheist like myself … Although a close friend and (exact) contemporary of mine, Jonathan Miller, another Jewish atheist, has just done a ravishing production of the St Matthew Passion. And perhaps even a Jewish atheist can be taken to the heights by something like this. I think I’ve loved Bach from the first. We used to have a piano teacher before the war and I remember, when I was five or six, I was asked, ‘What are your favourite things in the world?’ And I said, ‘Bach and smoked salmon.’

[laughter] You were a precocious lad, weren’t you?

Yes. And what with this — and Tasmanian smoked salmon — you know, sixty years later, I feel much the same.

I’d like to come a little closer to music and how you’ve been exploring the whole concept of, I think, music and the human mind a little bit later. But could we just, for a moment, deal with that dominant school of contemporary medicine which seems, or seemed — I don’t know whether it’s in the past now — to divorce body from mind and emotions from sickness? I believe that you repudiate that notion now. Is that right?

Well, it’s a notion which is forced on one perhaps at some stages in one’s training. When one does anatomy, one dissects a body — a lifeless body, a body devoid of its usual functions. And, to some extent, one has to learn one’s basic sciences in isolation. But then obviously they should all come together in the person of the patient.

Was it your exploration of migraine headaches that led you to this sort of thinking?

I think I probably felt this all the way through. There’s a much earlier experience I’ve never written about, but it haunts me. When I was a medical student I was asked to see an old chap who was an old tea planter from what was then called Ceylon. And he had uraemia; he was dying; he was delirious. And my boss said, ‘You know, go see him briefly. See what delirium is like. He’s just raving and makes no sense.’

But I spent hours and days with this man and, through his delirium, I started to see the shape of his life — people, places, scenes, passions, everything came out. And I had the strongest feeling of how a man’s experience and autobiography must be embodied in his nervous system and always there, even in the height of delirium or in a dementia or in anything else. And although it was a delirium, it was his delirium, it was his life. And this sense of the personal stamp of disease has always been with me since then.

Having a respect for that is one thing, but using that in the treatment of disease is interesting too?

Well, I think one has to. I mean, you mention migraine, which is never just a headache — it’s always much more. A migraine is a migraine — it’s a clear physiological event — but it’s set in the economy of a person’s life, of their physiology, of their emotions, of their relationships. You have people who have weekend migraines, or menstrual migraines, or migraines brought on by flickering lights. But you really have to get a biography of the person.

So you personalise the illness?

Well, they personalise the illness. The illness is set in a personal context.

But the treatment, or the treater — the physician — must personalise …?

Oh, it has to be individual. You find that at every level. Take migraine drugs: those that work with one person won’t necessarily work with another.

Which is not so much because they’re biochemically different, is it?

Well, they might be. There may be different ways of curing a migraine.

In your work in neurology, I’m fascinated by many of the cases that you’ve written about. You’ve written that, early on, you thought of patients with neurological disorders in terms of the loss of self, that the self had somehow become lost along the way in the course of this trauma to their nervous system. You then came to a way of thinking that it is an adaptation on the part of the nervous system. Can you explain what you mean by that?

Yes, it’s sometimes said when people are ill, you know, they are not themselves or whatever. This is especially said with something like Alzheimer’s disease or dementia. But I think that a form of self is always there and, for example, it can sometimes be reached by, and stimulated by, music, even if language is no longer possible. One of the cases — well, I call it The Case of the Colour-Blind Painter but I wanted to say one of the cases which is most dear to me, because of course I knew the man so well — was an artist who from a brain injury suddenly lost all colour perception and, since colour had been a crucial vehicle for his art and his life, and the vehicle of his emotions and meaning, this was so devastating for him that at first he found himself in a sort of meaningless world and he felt like committing suicide. He felt he wasn’t there. He felt something essential in him had been knocked out. But then — although there was no neurological recovery, although he never recovered colour — the black-and-white world became alive for him again and recharged with meaning and feeling. And he was able to go back to his art. So this is adaptation. And it first looked like destruction.

I read that story just in the last couple of days. And you write with such empathy for the man, because he was an artist whose visual world was of intense, immense importance to him. When I started reading it, I thought, ‘Well, wouldn’t it be like just looking at a black-and-white movie? And black-and-white movies are actually quite pleasant to look at, from time to time.’

Very.

But in fact it was a three-dimensional black-and-white world, and grey world, in which he lived.

Yeah. And if certain parts of the brain are knocked out, not only can you not perceive colour or motion, or whatever it is, but you can’t imagine it.

And you can’t remember it. That was the thing — he couldn’t dream in it?

No.

He couldn’t remember what red looked like.

He couldn’t even have a migraine in colour (sometimes in a migraine you have coloured fringes). And also he had had a rare thing called synaesthesia — so that, when he heard music, this would be accompanied by colours — and that disappeared for him.

Yes, so he was deprived, wasn’t he? And yet somehow he managed to create, out of that deprivation, a new experience.

Well, I think this creative power is present in everybody at every level.

It’s what allows one to survive and to forge a world with what one has.

I jotted a question down as I was reading it: do you think the body evolves with a capacity to cope with calamity?

Absolutely. I think it has to. You know, otherwise a broken spark plug [laughs] or whatever would do us in. Organisms are very, very resilient. If one limb is knocked out … If a dog loses a limb, it will use the other limbs. Animals regenerate limbs. We are tough creatures in some ways. So extremely fragile in others.

So if the nervous system is interrupted, it finds other paths, you say?

It tends to, if it can. And perhaps also there may be some regrowth of the nervous system, or regeneration. People used to think there wasn’t, but now I think there may be.

Let’s hear some more music. You’ve chosen Mozart,The Magic Flute.Tell me why.

Well, The Magic Flute is so magical and so joyful and lighthearted. And at the same time so, so profound. I mean the Queen of the Night is sort of a terrifying figure. But it’s the sheer joy of creation which sings for me in this duet.

Mozart The Magic Flute: ‘Pa-Pa-PaPapagena!‘ — Dietrich Fischer-Dieskau & Lisa Otto; Berlin Philharmonic / Karl Böhm

I’d like to discuss a couple of the cases that you have written about in your various books. One,Awakenings,is well known and the film has been made, so let’s leave that to one side and discuss some that perhaps people might not be so familiar with. I was fascinated by the painter who lost his colour sight. I was fascinated by the surgeon with Tourette’s syndrome. First of all, tell us what Tourette’s syndrome is.

Well, this is something one is born with, although it usually only shows itself at the age of four, or six or eight. There are sudden convulsive movements or tics, sometimes of a very elaborate sort. There are reachings, there are lunges, there are noises, there are vocalisations — sometimes obscenities, sometimes just other words burst out. There is an acceleration of thought and imagery in association. It’s an excited state.

Is it continuous during a day?

Well, this depends. I think the disposition is always there. Some things, like hunger and tension, may make it worse, but in some situations of concentration and performance, it completely disappears.

Very alarming for people who haven’t met it before, and who see it being expressed in someone in a restaurant or something?

Yes. I have a good friend, an artist in Toronto, who has this. He gets into fights almost, and the police arrest him, and he is continually misunderstood. Although in fact he’s rather like Papageno.

Is he?

Yes. And the sort of speed and impulse — his spontaneity, you know — which are delightful in a way, but can certainly be misinterpreted. Something like Tourette’s can cause a lot of suffering, stigma, isolation — people react to it. But I think it has another side, and sometimes this spontaneity and speed and energy and vitality can really transform a life. So much so that people with Tourette’s sometimes wish they could keep the good features and get rid of some of the others.

What about the surgeon — how on earth could a man be a surgeon and have Tourette’s?

Well, I wondered. When I first saw him at a meeting, he had quite extravagant movements. I mean one of his tics was … He was very agile, but suddenly he’d put his foot on top of someone’s head. And I wondered what sort of marginal existence this man had. And when he told me he was a surgeon, I said, ‘You’re joking! One move like this and you’d have the aorta in two!’ And he said, ‘Well no, it isn’t like that.

Come and visit me.’ I flew out and visited him. He works in a small town in western Canada, where he’s known to the whole community.

And sometimes, you know, if a general practitioner says, ‘I think you may need an operation, or a surgical opinion; I’d recommend Dr So-and-So,’ they will give the patient a little warning. They will say, ‘Well, he has some very strange sounds and movements, but don’t be alarmed.

He is a marvellous surgeon and human being. And when he operates there’s none of this.’

Now why is there none of this when he operates?

Well I scrubbed, you know, for a long operation with him myself and I saw this. And I almost want to think of it in musical terms. It was as if, with the complex operation and the many things to do, everything in him was focussed and orchestrated on what he had to do. There was a beautiful, simple stream of action. You see this with any sort of performance with Tourette’s, whether it’s a surgical performance, or a musical performance, or a sexual performance, or an athletic performance — and there are many, many good athletes with Tourette’s. But when the person is focussed the Tourette’s is there but, as one’s energies are cohered on the task it can make one superb.

Does that mean that, if this surgeon were having dinner with friends, he could actually control it himself spontaneously?

No, I think dinner with friends would be full of distractions and he would be tapping, he would be twirling his moustache, he would be touching a nearby light convulsively and there would be various verbal tics.

But you’d think that an operating theatre is full of distractions — people bustling around, its lights …?

He is not distracted. And incidentally I know a disc jockey in Iowa with very, very severe Tourette’s, and all sort of obscenities explode from him. But when he’s on the air live, it doesn’t happen, though someone had to take a big gamble [laughs] when he was put on the air for the first time.

My golly! A seven-second delay. Could your surgeon run a foot race and not have Tourette’s, do you think? I’m just wondering, if he were focussed on some other activity besides being a surgeon …?

Quite. Well, I didn’t see him running, but I know one patient of mine with Tourette’s who is a very good swimmer. He shows no ticcing when he’s in the even rhythm of swimming. In the moment of turning around, near the end of the pool, there may be a sort of sudden convulsion. He would have loved the pool I went to this morning — the big Bondi beach pool — because this is fifty metres or more long and you don’t have to turn very much.

Yeah. I suppose behind that question was: is it just being a surgeon that focusses this surgeon friend of yours? Or is it any focussed activity that he does — being a surgeon, swimming in a pool, whatever?

Well I also flew with him, and he’s fond of flying. But he told me he was the world’s only flying Tourette’s surgeon [laughs]. And I haven’t had any other bidders for the prize.

So he has a licence, has he?

He has a licence and he’s a very good aviator. He does tic a certain amount in the plane.

Do you know what that makes me think of? Ray Charles, the famous blind blues singer, who loves flying aircraft. He loves actually being the pilot and he says he can land an aircraft by the sound of the engines. Now [laughs], I don’t know whether he’s actually ever done that but, you know, it’s something that makes people say, ‘No, that’s impossible.’ But you never know, do you?

What about Anton’s syndrome — I’m fascinated by that. Can you describe that?

Yes. In Anton’s syndrome the visual parts of the brain have been knocked out, usually by a stroke. But you know we talked about the loss of self earlier; the person with Anton’s syndrome is blind, but they don’t know that they’re blind. And they may sort of blunder around, and bump into the furniture, but will find other explanations for this.

They think they can see?

They’re sure they can see.

Can they see something in their mind?

I think they probably can’t. It’s difficult to get an answer to this, but I suspect …

Your visual memory exists where the visual centres are in the brain?

Yes. As with the colour-blind artist, colour and imagination and memory were wiped out together. So I would think in the primary visual areas, in a sense the very idea of seeing may be wiped out. And yet the person will maintain that they can see. One has to be very tactful and delicate because too brutal a confrontation, I think, would really cause a panic.

But there are some very singular disconnection syndromes, as neurologists call them. Sometimes, for example, a stroke will knock out the left side of the body but the person will not know this. They will say they’re fine. You will say, ‘Give me your left hand,’ and they will give you their right hand. They may sometimes maintain that the left side has been lost or has been replaced. I remember I had one patient like this — a woman who had a stroke at breakfast and, when someone came in to collect the trays, she said, ‘Oh, by the way, there’s a hand on the tray. You might as well take that away as well.’ And people who are not neurotic or psychotic will sort of say the most extraordinary things in these body-image disturbances.

(Continues…)Excerpted from Talking with Margaret Throsby by Margaret Throsby. Copyright © 2008 Margaret Throsby. Excerpted by permission of Allen & Unwin.
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