Please tell Auntie Len, also, that I have sent her a birthday present by surface mail.

  GENUG.[*2] Love to all,

  To Elsie and Samuel Sacks

  March 26, 1969

  234 East 78th St., New York

  Dear Ma and Pa,

  I hope you are keeping well and in good spirits. […]

  Things at Beth Abraham continue on their blundering course. The DOPA still never came (my chief, a schnorrer[*3] at heart, is trying to beg for some, instead of buying it, despite the fact that he is rolling in funds specially donated for its purchase), and I can hardly bear to face my poor Parkinsonian patients who have been promised and promised, and let-down and lied to, a dozen times in the past six months. You will not be surprised that this stupid situation fills me with rage and guilt. Fortunately, there are a few other patients whom I can study quietly, in my own time, in my own way. It is obvious, however, that I can depend on Beth Abraham for nothing, or rather nothing more, and I shall be seeing […] this week about getting myself another (additional) part-time job elsewhere—preferably in a State Hospital (i.e. the equivalent of Shenley).[*4] […]

  Yes, before I forget, thank you, Ma, for the motorcycle leathers which arrived a few days ago.

  I imagine Spring is arriving in England, and things are bursting from the ground.

  Keep well, write soon, say a special hello to Michael, Auntie Len, David and family, etc.

  Love,

  To Elsie and Samuel Sacks

  [ca. April 1969]

  234 East 78th St., New York

  Dear Ma and Pa,

  […] My three patients are doing extraordinarily well on the DOPA: one of them, who was virtually unable to talk or move, a very severe post-encephalitic, is now chatting and toddling down the corridors. I am inclined to think that DOPA may indeed turn out to be as useful for Parkinsonians as insulin for diabetics, or nearly so. In the meantime, I have been studying the three patients closely, and am gathering some novel and fascinating insights into their state. I will be putting another five patients on the drug shortly. Although a great deal has been written on Parkinsonism, as it has on migraine, I think that by the summer I shall be in a position to write a short monograph which may be of some use. Anyhow, whatever I say, I have my own distinctive style of saying, and this should help.

  As I had reiterated many times before, I need patients at all times, and conditions which allow me to work quietly and gather together the information for monographs. I do not demand a glittering, “stimulating,” highly competitive, academic environment—indeed, I can hardly survive in such conditions, even were they within my reach. However, sooner or later, if I make my mark in my books, the most desirable posts will be offered to me, and I will finally be released from the vicious circle of abjection and failure.

  For time is on my side: in the civil war between creativity and destructivity, between talent and neurosis, time is on my side. And each day and week and month and year that I can hold off my devils (depression, self-hate, self-destruction, etc.), I am further from perdition, and closer to some fulfilment.

  E. M. Forster, in a brilliant essay on Cardan,[*5] remarks that to him “the greatest things in life were work, self-examination, and the hope of immortality. Human intercourse was unimportant beside these.” I do not compare myself too closely to Cardan, but I do have to concede that the chances of satisfactory human relationships of any kind are most difficult for me to believe in. I am, by turns, credulous and distrustful; I fear proximity and intimacy, seeing it as a dangerous invasion, a potential annihilation of my own identity; and then again, in the tally of contradictory feelings, I expect constantly to be abandoned or deprived of what I have—these things may be softened by analysis, but they are too fundamental in my character to permit radical change. But, I have a great compensation: I can think, I can sublimate, I can channel my thwarted ardours into work. And it is in terms of work that most of my hopes lie.

  As usual, I have said more than I should; but you will gather, if nothing else, that the emotional Barometer (to which all other things are secondary) has moved to FAIR: occasional showers, but sunny intervals.

  Do write soon,

  Love to everyone (as the Hippies say),

  To Elsie and Samuel Sacks

  May 17, 1969

  234 East 78th St., New York

  Dear Ma and Pa,

  […] I now have 15 patients on DOPA, and am staggered and gratified at its ability (in many though not all cases) to re-animate patients who had been virtually petrified for years: they are literally (like Dr. Manette after his eighteen years in the Bastille) “restored to life.” This, of course, in turn leads to a very complex state of affairs: one cannot restore the potential of movement and independence to someone who has been helpless and dependent for decades without creating a most complex, unprecedented situation for them and everyone associated with them; I am fascinated by this aspect, amongst others.

  My hours and salary have been raised to ¾ time at Beth Abraham, which means that I can now break even financially: more would be desirable, but is not necessary at the moment. In point of fact, I have been working like a madman for the last fortnight, staying at hospital till 9 or 10 in the evenings. The usual working hours are full of fuss and hysteria, and I can work tranquilly and alone in the evenings. I am gathering almost more information than I can deal with and starting to nibble on the huge Parkinson literature, which is even larger than the Migraine literature. There are times when I feel overwhelmed by how much has been said and thought on the subject, and think: Who am I? What can I contribute? Everything which can be said has already been said! etc. Other times when I feel the greater part of this literature is garbage, and that there is always room for saying something new on an old subject. I begin to have the feeling that ten weeks of intense work will put me in possession of the facts and thoughts I need to write a first draft on a Parkinsonism monograph—and I begin to feel that I will be in a position to do this (in London) in August.

  It makes me furious to think that, in effect, six months were wasted before I could get to grips with the subject, and this largely through the folly and stubbornness and indecision of a fond[*6] old man who happens, alas, to be my Director: and as largely due to my own inability to handle same old fool. However, things are going OK now. And if I complain of the six months I have wasted, I could as well bewail the thirty-five years I have wasted. Moreover, my methods of work at all times tend to be sudden and peculiar—and perhaps I can do more in ten weeks of concentrated effort than in ten months of regular work.

  Messeloff[*7] still wants to get everyone involved with these patients—Dr. X and Dr. Y and Mr. A and Miss B—in his stupid American concept of a Big Deal and a Multidisciplinary Approach, etc. I try to ignore all this and arrogate the patients to myself. I am a superb clinical observer, and I neither want nor need anyone’s help. I find more and more that if I am to accomplish anything it is necessary to regard virtually everyone about me as either stupid or hostile obstructions to my own activities. I am not impolite, but I have to go my own way. Dependence on other people is lethal for me—for my work, for my self-image, for even the possibilities of independent existence.

  I have very little to say otherwise, for I have indeed had very little life outside the hospital lately. […]

  I hope you are all keeping well.

  Love,

  To Mike Warvarovsky

  May 25, 1969

  234 East 78th St., New York

  My dear Mike,

  I should have replied earlier to your charming letter written in Venice, all bubbling with the freshness and joys of travel. I adore the wide-openness, the innocence, with which you see the world—it is an innocence which exposes you to all sorts of dangers and fears, and wilde phantasies, but an innocence, also, which nineteen people out of twenty have never known, save in their lost and forgotten childhoods. How right you are about catacombs and secret thoughts!

  Everything we build is an allegory of ourselves: the whole human world a metaphor of the human state. My own love is for city walls (oh, they were so beautiful in San Juan where I went for a weekend), those high stone walls which enclose, defend, and unify a city, as we wall off the citadel of ourselves: but then again, the opposite is true, and they symbolize the prison in which we spend our lives (“The world is a prison from which the prisoners are daily led forth to die”—Pascal). […] I love privacy and walled gardens: yet how much more, perhaps, would one love a world without walls, an infinite garden. Music is an infinite timeless garden: all art, and love, and God. We long to be as solid and substantial as stones, and, then again, to diffuse into the universe like the finest aether. I find my whole life torn between these opposite desires, and I am sure that the same is true, in even greater degree, of yourself.

  I last wrote to you, I believe, in early March, when I was in an ugly frame of mind, bereft of work, poisoned with rage and hate, and longing to be—not dead—but asleep, away, for a while. I am in a much happier mood now, for I have started the intensive work on my Parkinson patients […] and I have had the intoxication of seeing l-DOPA, a ravishing drug, restore to an incredible life those pitiable patients who had been almost literally turned to stone, speechless, motionless, and even thoughtless, for twenty years or more by the horror of their disease. My first patient, a man of fifty, who had had the severest Parkinsonism since the age of fifteen and had not spoken or moved for more than ten years, said (his first words): “I am reborn. I have been in prison for thirty-three years. You have released me from the custody of my symptoms.” And I could not stop myself from weeping. And in using the drug, I have learned what I suspected before, the nature of the WILL. There is no such thing as “pure will,” a sort of switch which one turns on by choice. Will is the ability to create stimuli to which one must react: to create them, and then to subordinate them. One cannot conceive of action, pure action, active action: all action is passive (and I include thought as action) and follows from certain stimuli. The Parkinsonian patient may complain (like a psychotic patient) that he is deprived of will power, that his muscles will not obey him, etc.; with DOPA, and with methods which I am learning, we can restore to him the ability to create stimuli to which he will then react. Too many stimuli, and he will be driven to incessant motion (akathisia) as before he was held in immobility (akinesia).

  At their highest levels, these forced reactions to stimuli are felt as fascination and compulsion: the Parkinsonian who cannot move his eyes from an object says, “My eyes are magnetized by the object. They are transfixed and fascinated by it. I cannot move them. But the chance passage of someone walking in front of me will break the spell.” Similarly, he may be compelled to make certain movements, although knowing, and saying, that the movements have no intention, no content, no goal. Thus the nature of drive in the nervous system unlocks the secret of will. And here I am enchanted by my work, for neurophysiology shows what poetry and philosophy have always known: that we are—in a very fundamental sense—automata, reflex-machines; and also that we are composite. Knowing that we are necessarily passive and composite, we can then make ourselves, for daily purposes, active and unified. But there is no “soul” and no “will”—these are fictions, universal fictions, like the Garden of Eden.

  Oooh! I am sorry, I didn’t mean to ramble ahead like this, and monologue at you. But I am suddenly so caught up in work—working at the hospital till late at night, every night, and then dreaming of my work when I go to sleep, that, in turn, I feel myself fascinated and compelled, and almost devoid of other life. But this is a good compulsion. And only good compulsions can save one from evil and tragic compulsions, to which we are driven for so much of our lives. I have been inexpressibly shocked and saddened (but perhaps, also, excited) by the fate of a friend and former colleague—I knew him in San Francisco, many years ago, and once wrote a little story about him entitled “Dr. Kindly.”[*8] He was deeply sadistic in his sexual life, but exquisitely controlled and tender: he understood, better than anyone I have ever known, that pain and humiliation can redeem from guilt and confusion. Three years ago (and this is my guilt) he was introduced to Methedrine, and trapped in its excitement. He started to give his lovers and patients—victims all—huge shots of Methedrine, and to tie them up and beat them in sadomasochistic orgies. They, perhaps, survived: but he became the final victim of himself, lost the razor edge of control, and finally disintegrated into a demoniacal madness: he saw his cat as the devil, murdered it, cut it up into little pieces, and asked his friends round. He is in a state hospital now, their most dangerous patient, consumed with a murderous frenzy. And my shock etc. is due to identification: the feeling that there, but for the love of God, go I. Except it is not the love of God, but creative work and insight which can save one from such a drama exciting one, and drawing one, to destruction. […]

  To get more chatty: No, I didn’t finally go to California. First it was shortage of money (now remedied), and now it is involvement in work. I will have to leave it to the summer, I think. […] My bike is fine—I try to find some tranquil country to drive to every Sunday, away from this shit-filled, hate-filled monster of a city: but mostly I am so wrapped up in work and thinking at the moment, that I hardly notice my environment. So I have very little other news. […]

  * * *

  —

  In April 1969, OS had cautiously begun giving small amounts of L-dopa to a handful of patients, and when they did well, he offered it to several more. At first the drug did seem miraculous, enabling nearly motionless patients to walk by themselves again, to talk, even to dance and sing. But over the next few months, unpredictable side effects began to occur, and it became more and more difficult to modulate the effects of the drug and find the right dose for each patient. These reactions put OS in a profound predicament on a human and therapeutic level, but he knew that they also presented him with a rare chance to document and understand the workings of the brain. As he writes in the next letter, to his parents, “what I started, reluctantly, as a trial of just another drug, has proved an almost incredible tool for the dissection of a vast range of human behaviour, from the most primitive postural reflexes to the most complex psychotic reactions.”

  To Elsie and Samuel Sacks

  July 30, 1969

  234 East 78th St., New York

  Dear Ma and Pa,

  A very brief note, whose arrival I may myself precede.

  You sound like you enjoyed Malta very much—islands have something lovely about them, and churches and villages give one a sort of feeling which Cannes and Parnes[*9] can’t. Do read (if you haven’t done so) one of the most beautiful books ever written about an island: D. H. Lawrence’s Sea and Sardinia—it’s Lawrence at his lyrical best (as opposed to his ranting worst), and full of exquisite descriptions of little hill-towns and people. I would so much love to go to Malta, or Sardinia, or the Greek Islands, or a Scottish (otter) island, for a week or two this summer. I nearly blue [sic] everything I had to go for a voyage to the Galapagos Islands with the Darwin Society, but alas! have had to content myself with reading The Voyage of the Beagle as my bedside book—but I do not feel entitled to take any holiday. Indeed, I have not felt entitled, since about May 1, to go out for an evening, to take off a weekend, to go to a show, to go out to a dinner, or anything. I used to be the idlest person who ever lived: but now I seem to live for work. The last three months will turn out to have been, I suspect, the most interesting and productive in my entire life: what I started, reluctantly, as a trial of just another drug, has proved an almost incredible tool for the dissection of a vast range of human behaviour, from the most primitive postural reflexes to the most complex psychotic reactions. I have been too busy with the daily discovery of new things, and their immediate meanings, to be able to do much reading or writing. This is one of the essential reasons why I must come back[*10] and write for a month. I have the material for three monographs and about twenty papers: the three monographs I see my way to combining into a single book—it will be a whopper, I could not condense my material and thoughts into less than about 500 pages (its title and substance will be something like: “Coercion, Compulsion, and Compunction: A clinical study of primitive and forced behaviour in post-encephalitic Parkinsonism and psychosis, and its modification by l-DOPA”).[*11] My case-histories alone, which will constitute the first third of the book, will occupy about 150 pages—say, fifteen minutely-detailed histories of ten pages each. […]

  I hate to leave my patients for a month: partly because they will not be adequately looked after in my absence, partly because I am still, as it were, in the acute phase of observation and discovery. But I must leave now, because various stresses, exacerbated by the absence of Shengold,[*12] are tending to push me towards breakdown (breakdown in me, as in Pavlov’s dogs, takes the form of alternating exhaustions and excitements, with unstable and rapidly-shifting attitudes), and because I am almost literally bursting with the need to sit down and organize and present what I already have. It is most unfortunate that all this didn’t get started right back in October, as it should have done, but there is no point bewailing this now. Messeloff nags me to try and get out a couple of snappy papers quickly, so as to get priority in the literature etc: his urgings arouse my defiant refusals, for I am realizing, more and more clearly, that my own metier lies in pondering, and expressing myself monographically when I feel ready to. Whenever I am nagged to produce something quickly, I remind myself of the attributes which Bacon recommended: “patience to doubt, fondness to meditate, slowness to assert, readiness to reconsider, carefulness to dispose and set in order.” […]