Oliver, Ian and Me

[EricM]

Bumping this thread to add this story of Oliver Sack's life and work from Seed Magazine:
The Listener

[nari]

I think it would be almost impossible to do RCTs on this sort of thing, which may or may not be a disadvantage.

Sacks' point about the illusion of free-will is worth thinking about when it comes to treating patients with loss of self-efficacy.


Nari

[Barrett Dorko]

More from "A Leg to Stand On"

In this book Sacks suffers the “loss” of his injured leg. It’s still there visibly and palpably but he describes its bandaged presence post-operatively as “an inert, immobile, lifeless, white thing.” Understandably he cannot believe it will support him once he is freed from the bed. In a passage I’d like to paraphrase for clarity’s sake he speaks of his immobilization following surgery for his severe knee injury. Remember, this is the early 80s in England. He was in bed for 18 days. Early mobility was discouraged and the National Health Service was paying the bill.

“An injury had deprived me of will and now the sparks of returning innervation were to rekindle will in this limb. First I was will-less, unable to command; then I was willed, or commanded like a puppet; and now, finally, I could take over the reins of command, and say, “I will” with full truth and conviction.”

Me again: Sacks’ consequent struggle to “find” his leg is the meat of this book. He discovers repeatedly that it is through spontaneity and simple self-preservative motions that the limb once again fixes itself in his brain.

And what does he discover? Paraphrasing again: “When I thought of the gesture indicating “So?” it would occur to me to shrug my shoulders, to shrug them expressively. I found this experience amusing, fascinating – and somewhat shocking; for it showed, very clearly, that one could have a sense or an illusion of free-will, even when the impulse was primarily physiologic in nature.”

Later he recounts the progress of a man early in his recovery from a brain injury (From a book by A.R. Luria): “At first he proceeded as little children do when they first learn to write…”

Over and over Sacks describes true recovery from movement and motor problems in the same ways I would describe my own patient’s recovery from painful problems. Think there might be a lesson there? Can anyone see how such a recovery would be difficult to place within the confines of a randomized controlled trial of care?

[nari]

Barrett, I think you are right.
Haven't received the book yet.
I wonder why Sacks has not pursued this aspect of this recovery further in a book.....being the sort of curious fellow that he is.

Nari

[Barrett Dorko]

There’s more from Sacks as he begins to ruminate about the progression of his recovery, especially as it is manifest in movement and its relation to his intention.

He says, “Perhaps one needs to distinguish different sorts of will – a passive-compulsive and an active-deliberative.”

I gather from reading this carefully that Sacks relates the former to nonconscious motion and the latter to volitional movement. I say this because he goes on to question the effect of his willful effort thus; “I willed – and nothing happened: so that I was forced into a singular doubt, and kept asking myself…What has happened to my will?”

He realizes that his “willful” effort was unrelated to the movements that proved helpful and finally concludes: “…this inversion, or perversion, or subversion of will was precisely the means by which a recovery was effected.”

I don’t know about anybody else, but this sounds like a distinct recognition and use of ideomotion and Sacks realizes he won’t recover without it.

[nari]

I have ordered it - it is out of print according to one site but available from the publishers, overseas.

No doubt I will post some excerpts; the ones that leap out at me, anyway.

If anyone would like a gentle read and 'become' part of his travelling presence, Sacks' account of his journey in the Mexican highlands is ecology-writing at its best. It's called The Oaxaca Journal.


Nari

[Diane]

I doubt if many will read it.

I would say, many might read it, now that it's been mentioned here, and discussed. Many more than would have heard about it and read it otherwise. Maybe not every therapist in the world.. but these things are mustard seeds. (At least now we have a good quote to throw out at Walt et al. )

[nari]

I have all of Sacks' books except this one..and it is on the list. He is a great writer, because he is fun to read.

I doubt if many will read it.


Nari

[Barrett Dorko]

Still held hostage by software problems, Ian Stevens sends this my way instead of to the board:

I am in the middle of 'A leg to Stand On' by Oliver Sacks , has anyone read
it?

I am just at the point where Professor Sacks quadriceps is awakened by
ideomotor activity. Anyone in our profession should read this book.

One could read it as a health interest narrative or discover how creativity
inspires the awakening . It is interesting that routine Physiotherapy has
absolutely no effect .There are fascinating discussions on anasgonsia and
various neurological maladies but the ideomotor awakening caught my eye.
I agree with you on manipulation Barrett but I think one has to be aware of
the cultural ideas regarding mechanics amongst the public and health care
professionals alike . Having something 'out' is nice and simple to
administer and be suffering from?

I can create the effect of joint movement and 'release' by sitting in
meditation or standing doing some kind of tai chi ...I am convinced it is
all centrally mediated. It was Louis that influenced my thinking re defects and defense –thinking biologically makes so much sense . Acutely inflamed roots in the mouth
don't respond to wobbling them around so why do spines .....this is what
happens to many people in the acute phase of inflammation they get their
spines wobbled!?)

I personally think that if the deep neuromatrix model caught on then we
would probably account for our successes and failures via modulation and
gating and blend talk, touch and exercise without too much argument ?

Ian,

Upon receiving your email posted above I searched for Sacks’ book which I first read in ’84 when it was published. Finally I found it on a shelf in my office between The Zen of Oz by Joey Green and The Tao of Elvis by David Rosen. I’m not making this up. As you may have guessed I have no real “system” for arranging my books. I just let them sort of fall together. These three, amazingly, are all in the same genre. I think so anyway.

I opened A Leg To Stand On to page 130 (I can do this at times if I work hard not to try. It’s a complicated, simple task) where I found this: “The term “ideomotor” came spontaneously to mind. The flashes I had had previously were merely motor, fragmentary spasms and twitches of an irritable nerve-muscle – there being no correspondence with any inner impulse, idea or intention. They had nothing to do with me – whereas these flashes by contrast, involuntary, spontaneous, unbidden as they were, did most certainly, and essentially, and fundamentally involve me: they weren’t just “a muscle jumping” but “me remembering,” and they united my mind and my body; they exemplified, in a flash, their quintessential unity – the unity that had been lost since my disconnecting injury.”

Pretty good stuff. I wish I had written it. As it turns out, this insightful passage was published 22 years ago by one of the twentieth century's most highly regarded neurologists describing his own experience of recovery.

When do you suppose the therapy community might actually read it?