Albert Einstein College of Medicine, Bronx, NY

  My dear Marcus:

  You are the only brother, the only member of the family, with whom I can talk with any freedom. We have never seen too much of one another, but I am conscious, as you must be, of our similarity in many ways. This is hardly surprising, for we have been moulded by the same forces, and our reactions have been similar, though very different in degree. This is going to be a “shocker” of a letter; I can’t judge how well you will be able to stomach it; and I must leave it to your discretion as to whether you wish to show or discuss its contents with Gay; under no circumstance do I want you to divulge what I shall say to our darling, damnable, parents.[*6]

  I will try and give you some of the conventional “news” at the end, although, so far as I am concerned, this is subordinate, ghostly, compared to my inner “news.”

  Where shall I begin? I will begin with the first information available to me, chronologically: doubtless things go back further, but I am in no position to trace them. Marcus Landau, then, our maternal grandfather: a brilliant man, of overwhelming personality, who sired eighteen children from two passive cow-like women. Perhaps I am wrong about the women, but this is the impression I gain from Ma (a profoundly biased source, of course): of admiration amounting almost to reverence for her father, and little mention of her mother. […]

  And so, by a “commodious vicus of recirculation” (my mind is a sort of Finnegans Wake), to our own Mapesbury menage. Ma, of course, consists of two people, a normal and grossly pathological self. “Basically” simple, almost to ingenuousness, kindly, and very warm-hearted. This is what her patients see, and the rare strangers who ever come to Mapesbury: a charming hostess, though very shy. And they say: your mother is a marvellous woman—and so she is when she does not act out her appalling conflicts. Now there is the other side: the woman who is profoundly antisocial and desperately lonely, who alternates between a frigid-sadistic-obsessive hatred of her family and an overwhelming possessive engulfing love for them. A woman who is prone to explosive rage, outbursts of a profoundly irrational and destructive kind, and who is also prone to extravagant depressions, at least one of which, to my knowledge, was of plainly psychotic intensity. She is always bewildered, frightened and remorseful after her rages, when she is “herself” once again. She is a woman both overwhelmed and terrified by sexuality, so much so that she has made of it her profession: sexuality becoming a matter of rubber gloves, surgical instruments, and clinical detachment. Her medical stories (Jonathan Miller gives a beautiful imitation of how she always talks of food while she is operating, and “cases” at mealtimes: soup with the pus, pus with the soup) are a sort of repetition compulsion, a sort of exorcism or disguised return to a taboo but endlessly alluring subject. On the subject of homosexuality in particular, she has a fanatical horror, and I would surmise has much of this deeply repressed in her own make-up.[*7]

  But put her at home, in the garden, or reading a Somerset Maugham story: making gefilte fish, or presiding over the family on a Friday evening; give her what she needs and she becomes, once again, her simple and lovable self. This is our mother, or today’s formulation of her (my ideas are in a state of violent day-to-day, second-to-second, flux).

  Now, our father. Look at that photo of him when he was seventeen: look at the demanding yet over-protective attitude of his sisters to him (Lina especially), and one realizes that he must always have been rather bewildered, rather helpless, rather passive. There are many reasons for supposing that he was rather a gifted young man: he qualified at an unusually early age, he was Henry Head’s houseman,[*8] he was deeply interested in Ibsen, at a time when Ibsen must have been fairly esoteric. Then what happened to him? He swum into the centripetal whirlpool of our mother, and got sucked right in. When I was feeling somewhat overcharged a few days ago, I wrote in my journal: he was engulfed, leucotomized, murdered. What I would suspect to have been a very promising professional career was subordinated to the need to run second place to our mother. She was to be the brilliant woman, the well-known surgeon, he to be the dim, bumbling, general practitioner. There is much evidence to show that he was most exceptional, even as a G.P. I constantly hear stories of his excellent diagnostic acumen, and his versatility: it was not for nothing that he rapidly became one of the most prominent G.P.’s in the East End: the “King of Whitechapel.” But superimposed on this has been our mother’s contempt for him, incorporated in ourselves as the notion that Pa is really dim, a nonentity, or appendage of his brilliant wife. There is reason to suppose, as I have mentioned, that Pa was literate and versatile as a young man, but he has not opened a book (non-medical, or non-Hebraic) for forty years. One way and another he has tried to break away: with the childlike pleasures of his motorboat and motorbike, at one time; with the inordinate time he spends with his patients, an endeavour to get away from Ma; and, in the last ten years, increasing immersion in his Hebrew books, often till four or five in the morning. He has tried to be a good father to us all, and many of my happiest memories are of going with him on his calls, when I was a kid; of swims together; of playing duets together; and occasional, terribly rare, talks we have had together. He has tried, and he has been defeated. His life has been geared to failure, to being overwhelmed. His pathology is diametrically opposite to Ma’s: where she is demanding-obsessive, he is masochistic-conciliatory. He has been decapitated, castrated, by her, cut down to a bumbling old fool. And yet, how they have stuck together, how they have needed one another. They have formed what is almost a folie-a-deux, a symbiotic yet destructive relationship.

  Now what about us, the four Sacks Boys, those paragons of normality: what has happened, what is happening, what will happen, to us; and to our children, if we have any? What part, conscious and unconscious, will we play in the neurotic-psychotic transactions which have been transmitted and incorporated from one generation to the next?

  This is primarily why I am writing to you, for I am no longer able to keep my agonized introspection to myself. And though I tend towards hyperbole and a variety of other distortions, you will recognize what I saw as being essentially true, and have no doubt formulated this, to a greater or lesser degree, yourself.

  You then, the eldest of the four. You are of very superior intelligence, brighter than either of our parents. You were a Hebraic-Oriental-scholar-in-the-making during your schooldays, but “owing to the War,” as it was rationalized, took to Medicine instead. You did this, no doubt, with mixed feelings, although the degree of conflict may not have been, may not be, evident to you, being covered by denial and rationalization. Certainly, however, you would not have responded to the external pressure to enter medicine (parental pressures etc., family tradition), had it not been matched by an internalized pressure, an order almost, to the same effect. I know little of your student days, days as a young doctor, in the Army etc. Around 1950 you felt you had to leave, and not only to leave, but to go as far away as possible. And here again, you rationalized (as I did, in my flight, ten years later) that professional prospects were better in Australia, that you wanted to see the world etc. etc. No doubt these factors were also present, but the primary motive was flight, flight from a situation you obscurely felt as intolerable, as dangerous, as engulfing. […]

  I have just re-read your pathetic letter of a few years back, when you confess your inability to sustain relationships, your compulsion to break them off when they become too intimate, too threatening: I recollect also your self-depreciatory images as a little Jewish gefullte fish etc. You were deeply neurotic, deeply torn by internal conflicts: but functioning pretty steadily, and on the whole, with the aid of your intelligence and ego-strength, tending towards some tolerable modus vivendi, although a significantly crippled one in relation to your potentials. You mentioned that psychotherapy was of considerable assistance to you, and it is my dearest hope that you have met in Gay someone who will help restore your self-esteem, give you some much clearer image of yourself, and enable you to combat the near-lethal “inheritance,” you, we, have received from our family situation. I think it vital that you do not underestimate the degree of actual and potential disorder which is present in you, and I feel it is of the utmost importance that you enter, or continue, intensive analysis with an absolutely first-class man. […]

  I know this is an impudence for me to speak like this. But you may rest assured that marriage alone is not enough. It is vital for you to get at the roots of what is happening, otherwise you will be condemned to recapitulate certain situations over and over again; only by bringing the nature of these things to consciousness can one deflect the helpless and bewildered compulsion to act out, and repeat, the primal emotional confusion which has dominated our lives.

  David now, our “charming” brother, who dresses like an ambassador, and plays the heavy father with some conviction; who specializes, like some Leacock character, in diseases of the rich; who is ambitious, vain, frigid, and superficial—although there is genuine warmth, genuine kindness, somewhere underneath all this. David […] has adopted a radically different “solution” (pseudo-solution) to the conflicts which he too, undoubtedly, contains. […] Deep emotional conflict has been repressed, and replaced by a frightening blandness, an ingratiating, superficial, condescending, somewhat contemptuous, attitude—a terrible poverty or thinness of emotion. Superficially he functions extremely well, to the envy of us all. […]

  Now Michael: totally friendless and absorbed in phantasy from his earliest childhood, Michael became floridly deluded and psychotic at sixteen or seventeen. What is more serious is that he has never got really better. In fact, this isn’t in the least surprising, for shooting someone full of insulin or Thorazine, and then throwing them back into the unchanged environment which precipitated a psychotic reaction in the first place, is bound to have this effect. Michael continues psychotic because this is the only tolerable modus vivendi for him, and at some level, he is perfectly aware of this: he showed, last summer when I saw him, an amazing perspicacity, but one which was quite dissociated from his actual and continuing condition. Ma and Pa, but especially Ma, obscurely and unconsciously aware of their responsibility in his disease, display the most amazing denying obtuseness about it all. I remember vividly that ghastly Yom Kippur in 1959, when I came home from Birmingham, and was told that Michael was being “naughty” again. I went to see him, and the poor bugger was wildly deluded and hallucinating. Ma and Pa refused to accept what I said, and added that it was Yom Kippur in any case and no time to make any move. That very night, as you know, Michael ran out down Maida Vale, in his pajamas, full of Messianic delusions, was hauled in by the police—eugh, a terrifying business! Why do they (Ma, in particular) keep him at home, and why does he stay at home? By keeping him at home, by his staying psychotic, Ma has, in effect, a captive son, an appendage, a parasite, bound hand and foot, who has a snowflake in hell’s chance of ever getting away. We, at least, tried physical flight: Australia and California. David has taken refuge in the haven of denial, psychopathy. Michael, in whom the conflict was most blatant, least tolerable, was driven to delusion-formation, replacement of intolerable reality by substitute constructions (hallucinations are secondary to delusions, although they reinforce them by a positive feedback). You remarked on the intense, the desperate way, our parents put aside money for Michael. The reason is not mere altruism or solicitude, it is the intense though unformulated guilt of their part, their complicity, in the creation of his disease: the money they put aside is blood-money, a sort of penance. It is true that when they die Michael will not survive: he will either become permanently and profoundly catatonic, or he will commit suicide, probably the former.[*9] Let me add that the intense conviction of guilt is quite unrelated to any actual blame in the matter: it is really a delusion of guilt, which characteristically the parents suffer for the children’s psychoses, and the children for the parents’ psychoses. […]

  yrs,

  OLIVER

  To Seymour Bird

  Psychiatrist

  March 12, 1966

  Albert Einstein College of Medicine, Bronx, NY

  Dear Dr. Bird:

  I wonder if you would be kind enough to send me, for income-tax purposes, a receipt for money spent on psychotherapy between January and June of last year.

  I have often wanted to write to you, but refrained, characteristically, because of my inability to steer a middle course between a “nothing” letter and an exorbitant one. I live, as always, in the chaos of my self-created crises, but am undoubtedly moving in the direction of greater insight, diminished self-destructiveness and knowledge and control of reality. After a series of quasi-suicidal crises on returning from London, massively regressive reactions precipitated by the disruption of an extravagantly symbiotic and destructive “love affair” contracted in Europe, I went to see Austin Silber, who in turn referred me to his colleague Lionel [sic] Shengold. In the past two months with him we have got far nearer the volcanic heart of my problems than I could ever have consciously conceived before. This has involved the re-animation of the most atrocious, and frankly murderous, childhood memories, mostly associated with my mother, who of course “incorporated” almost as lethal a neurosis/psychosis as mine. But I venture to think that I am getting over the hump, so to speak, and will avoid, though by the narrowest margin, the “demanded” psychosis/suicide equivalent so rampant in the family, and make it as a human being. At the moment I am relating to everyone round me, friends and colleagues, with the incontinent, remorseless, violence I have always inflicted on myself, but some assurance and control are beginning to show through.

  I shall never forget the debt I owe you for puncturing the first crust of my denials and defences (intensely ambivalent, like all feelings of indebtedness!), and making possible the sort of Palaeozoic eruption which is going on at present.

  Warmest regards,

  Oliver W. Sacks

  To Elsie and Samuel Sacks

  March 14, 1966

  Albert Einstein College of Medicine, Bronx, NY

  Dear Ma and Pa,

  Thank you for your letters. I am sorry to have generated so much anxiety, but I am now, one way and another, getting “over the hump,” and will once more write fully and frequently. […]

  I had a call from an nth. cousin, a Mrs. Gardner,[*10] and will be going to supper with them in a few days’ time. Pesach maybe. I get nostalgic on the Seder nights. They embody a feeling of warmth, of oneness, I have almost forgotten. Jonathan Miller was here for a brief meteoric visit a month ago. He will be returning soon for a couple of months, casting and directing a play. I look forward immensely to his company. In some ways he has been my only friend. The rest seem like wraiths. I had a couple of well-meaning but utterly bizarre letters from Augusta Bonnard. I fear she is cortically hypoxic from emphysema. Incidentally, Ma: can you obtain and send me that enormous family tree drawn up by an industrious cousin in Jerusalem? I have become suddenly interested in genealogy and sociology and politics. Delayed social awakening: should have happened thirty years ago.

  Briefly, and sparing you gruesome details, my chronic state of crisis became acute for a while here, a sort of epilepsy of indecision. It was really quite impossible to communicate with anyone or do any work. I even lost forty pounds and became positively skeletal. Fortunately I have secured myself an excellent analyst, and we are really getting to grips with things. The last two weeks have witnessed an exhilarating restitution. I have become suddenly busy at hospital, and am simultaneously in the middle of four projects. In fact thoroughly manic, but this is better than depression. I seem to be writing and talking and arguing in an incontinently volcanic logorrhoea.

  I have actually written you a great many letters. Ditto also to Auntie Len. To everyone I know. They litter my room. I never try and post them, because I feel I will regret it. This is what I mean by an epilepsy of indecision. But now I am writing, you may surmise that my activity is becoming less chaotic, and more controlled.

  It is Spring, almost Spring. Tiny green leaves in Washington Square. Ice floes cracking on the Hudson, the river stretching like a man awakening. Warmth, sun, hope, germination. Finished the winter of discontent.

  Work. Clearly I should never have chosen neuropathology. Sheer perverseness, chronic and characteristic. I have such a hatred of anatomy. Next year I will be a junior Consultant on the Neurology wards, and continuing research in neurochemistry which I enjoy. Takes me back to happy chemistry days, eighteen years ago. Eighteen years! It seems like a second. No sense of time. The quality of a dream. I feel my bald spot and mutter, thirty-two. How little it seems to register. Past and present flow together in my mind.

  Ma, before I forget, I lost my driving licence in the washer. Could you conceivably get a duplicate for me from Middlesex County Council and forward it airmail. […] It is inordinately complicated getting a New York licence. Simpler to stay with my English one, as permitted for a year. […]

  I am exceedingly happy to hear that Michael has a job. He was astonishingly lucid, painfully lucid, about a lot of things when we talked together in the summer. I think he would be capable of a degree of restitution far greater than you imagine. His illness is nothing to do with “chemistry”; rather any chemical changes are secondary to the psychic ones, and these are at least partially and potentially reversible. He needs intensive treatment with a first-class analyst familiar with his sort of problem.

  As I do, for my analogous though milder problems. I may have to borrow some money from you, for I am spending most of my salary keeping sane. But I will be more detailed in a following letter. I am sufficiently glad to have written this one, which I shall undoubtedly post.