A Leg to Stand On by Oliver Sacks

Our meeting to discuss Oliver Sacks’ A Leg to Stand On, spent a lot of time talking about the man himself.

One member had read a few others of Sacks’ books and felt that this book was a key to his later works. In the book, Sacks, a British neurologist, becomes a patient after an encounter with a bull on a lonely mountain in Norway which leaves him with a severely damaged leg. After struggling to save his own life on the mountain, going through an operation in London and during recuperation, he discovers his leg no longer feels to be a part of his own body and he describes it as a "cylinder of chalk".

His detailed description of being a patient, having his concerns largely dismissed by his surgeon, the stages of his recovery and who he meets and talks to along the way, may have led to the sympathetic insight and compassion he expresses in subsequent books towards his patients and their difficult neurological illnesses.It is also the start of a recurrent theme in many of his books about the almost mystical importance of music in our lives.

Book club members felt that having Dr Sacks as a patient in your hospital might be difficult. There are descriptions of his room being filled with books and papers and how he is desperate for his visitors to provide him with music (he is given Mendelssohn’s Violin Concerto on cassette). The fact that he questions his surgeon (who described him, possibly sarcastically, as “unique”), where maybe the rest of us would quake before the great man and his retinue of students, gives clues.

Several members felt that he inserted himself in the book rather too much, described his writing as “florid" and some thought he was an over-thinker, self-indulgent, neurotic and a hypochondriac. Indeed, Sacks himself is worried in the book that he may appear to suffer from hysteria and writes to a medical colleague, Alexander Luria,in Russia who reassures him.

Despite this, a subsequent paper in the Neuropsychiatry Journal (2012) describes Sacks’ writing of his experience as a “unique insight into a genuinely experienced functional/ psychogenic leg paralysis following injury”. The authors of this paper conclude that his detailed description was invaluable for patients and doctors alike. Patients are still recommended the book to see that their own unusual depersonalisation symptoms are not unique and that recovery is possible with the right approach.

This all sounds very heavy but members referred to a number of humorous moments in the book where his first doctor performs gymnastic ballet movements to show him how he could recover; how he struggles to walk to a cafe near the hospital only to be told by the owner that it “took him long enough"; how he is forced to swim after being pushed into a pool.

One member was so intrigued by Oliver Sacks, who sadly died last year, that she researched his life. She found out that he was the youngest of four children born in England to Jewish parents: Samuel Sacks, a Lithuanian Jewish physician and Muriel Elsie Landau, one of the first female surgeons in England and herself one of 17 children. He had a large extended family of scientists, physicians and other highly gifted individuals. In his first autobiography, Uncle Tungsten, (yes, he wrote more than one) he talks about being evacuated with his brother from London to escape the Blitz.

During adolescence he became intensely interested in biology and eventually medicine. The book, Uncle Tungsten, describes how he also had a keen interest in rocks and minerals and used to be indulged in conducting chemical experiments at home which sometimes exploded. He went to Oxford to obtain a degree in physiology and biology and later attended medical school, graduating in 1958. He made his way to the United States, specialising in neurology and beginning a prestigious, acclaimed career, both in medicine and the arts. He was appointed a CBE in 2008, among a host of awards.

He was also a champion weightlifter, a keen motorcyclist and a pretty serious experimenter with hard drugs for a time (detailed in his book Hallucinations). He never married, was celibate for 35 years and declined to share personal details until late in his life when he admitted he was homosexual and in a relationship with writer, Bill Hayes.

Together with his eldest brother he suffered from prosopagnosia - face blindness - and could not even recognise his own reflection, which contributed to his acute shyness. He also had difficulty recognising his own home and would walk past it unless a companion drew his attention to it.

A Leg to Stand On was Sacks' fourth book of 12, after Ward 23 (1967, later burned by Sacks at a time of self doubt), Migraine (1970) and Awakenings (1973) - the later being probably his most well known book and which was subsequently made into a play by Harold Pinter and a film staring Robert De Niro and Robin Williams.

His books are largely detailed narrative case histories of his patients and were inspired by the work of the Russian neuropsychologist A.R. Lucia, previously mentioned. After The Man Who Mistook His Wife for a Hat (1985) came out, one critic described him as The Man Who Mistook his Patients for a Literary Career but his books are compassionate, sympathetic and hopeful about the ways in which people can adapt to their situations.

They also focus on maladies that might otherwise never be discussed and can make us grateful that our own lives are (hopefully) not challenged in these ways. As one member said, they can, however, be troubling, and do make you think about how you think. If you are a hypochondriac, they can have you rushing for Dr Google.

For a great article about how Sacks got himself down the mountain by using music, search for Musicked Down the Mountain: How Oliver Sacks Saved His Own Life by Literature and Song by Maria Popova (Brainpickings.org)

To listen to Mendelssohn’s Violin Concerto visit https://www.youtube.com/watch?v=K67o86CS5uo