We thought for a while, and our course, mercifully, was clear. We have given her penicillin, which has killed the spirochetes, but can do nothing to reverse the cerebral changes, the disinhi-bitions, they have caused.
And now Mrs K. has it both ways, enjoying a mild disinhibi-tion, a release of thought and impulse, without any threat to her self-control or of further damage to her cortex. She hopes to live, thus reanimated, rejuvenated, to a hundred. ‘Funny thing,’ she says. ‘You’ve got to give it to Cupid.’
Very recently (January 1985) I have seen some of these same dilemmas and ironies in relation to another patient (Miguel O.), admitted to the state hospital with a diagnosis of ‘mania’, but soon realised to be suffering from the excited stage of neurosyphilis. A simple man, he had been a farmhand in Puerto Rico, and with some speech and hearing impediment, he could not express himself too well in words, but expressed himself, exhibited his situation, simply and clearly, in drawings.
The first time I saw him he was quite excited, and when I asked him to copy a simple figure (Figure A) he produced, with great brio, a three-dimensional elaboration (Figure B)—or so I took it to be, until he explained that it was ‘an open carton’, and then tried to draw some fruit in it. Impulsively inspired by his excited imagination, he had ignored the circle and cross, but retained, and made concrete, the idea of ‘enclosure’. An open carton, a carton full of oranges—was that not more exciting, more alive, more real, than my dull figure?
A few days later I saw him again, very energised, very active, thoughts and feelings flying everywhere, high as a kite. I asked him again to draw the same figure. And now, impulsively, without pausing for a moment, he transformed the original to a sort of trapezoid, a lozenge, and then attached to this a string—and a boy (Figure C). ‘Boy flying kite, kites flying!’ he exclaimed excitedly.
I saw him for the third time a few days after this, and found him rather down, rather Parkinsonian (he had been given Haldol to quiet him, while awaiting final tests on the spinal fluid). Again I asked him to draw the figure, and this time he copied it dully, correctly, and a little smaller than the original (the ‘micrographia’ of Haldol), and with none of the elaborations, the animation, the imagination, of the others (Figure D). ‘I don’t “see” things any more,’ he said. ‘It looked so real, it looked so alive before. Will everything seem dead when I am treated?’
Excited elaboration (‘an open carton’)
The drawings of patients with Parkinsonism, as they are ‘awakened’ by L-Dopa, form an instructive analogy. Asked to draw a tree, the Parkinsonian tends to draw a small, meagre thing, stunted, impoverished, a bare winter-tree with no foliage at all. As he ‘warms up’, ‘comes to’, is animated by L-Dopa, so the tree acquires vigour, life, imagination—and foliage. If he becomes too excited, high, on L-Dopa, the tree may acquire a fantastic ornateness and exuberance, exploding with a florescence of new branches and foliage with little arabesques, curlicues, and what-not, until finally its original form is completely lost beneath this enormous, this baroque, elaboration. Such drawings are also rather characteristic of Tourette’s—the original form, the original thought, lost in a jungle of embellishment—and in the so-called ‘speed-art’ of amphetaminism. First the imagination is awakened, then excited, frenzied, to endlessness and excess.
What a paradox, what a cruelty, what an irony, there is here— that inner life and imagination may lie dull and dormant unless released, awakened, by an intoxication or disease!
Precisely this paradox lay at the heart of Awakenings; it is responsible too for the seduction of Tourette’s (see Chapters Ten and Fourteen) and, no doubt, for the peculiar uncertainty which may attach to a drug like cocaine (which is known, like L-Dopa, or Tourette’s, to raise the brain’s dopamine). Thus Freud’s startling comment about cocaine, that the sense of well-being and euphoria it induces ‘. . . in no way differs from the normal euphoria of the healthy person ... In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.’
The same paradoxical valuation may attach to electrical stimulations of the brain: there are epilepsies which are exciting and addictive—and may be self-induced, repeatedly, by those who are prone to them (as rats, with implanted cerebral electrodes, compulsively stimulate the ‘pleasure-centres’ of their own brain); but there are other epilepsies which bring peace and genuine well-being. A wellness can be genuine even if caused by an illness. And such a paradoxical wellness may even confer a lasting benefit, as with Mrs O’C. and her strange convulsive ‘reminiscence’ (Chapter Fifteen).
We are in strange waters here, where all the usual considerations may be reversed—where illness may be wellness, and normality illness, where excitement may be either bondage or release, and where reality may lie in ebriety, not sobriety. It is the very realm of Cupid and Dionysus.
12. A Matter of Identity
‘What’ll it be today?’ he says, rubbing his hands. ‘Haifa pound of Virginia, a nice piece of Nova?’
(Evidently he saw me as a customer—he would often pick up the phone on the ward, and say ‘Thompson’s Delicatessen’.)
‘Oh Mr Thompson!’ I exclaim. ‘And who do you think I am?’
‘Good heavens, the light’s bad—I took you for a customer. As if it isn’t my old friend Tom Pitkins. . . Me and Tom’ (he whispers in an aside to the nurse) ‘was always going to the races together.’
‘Mr Thompson, you are mistaken again.’
‘So I am,’ he rejoins, not put out for a moment. ‘Why would you be wearing a white coat if you were Tom? You’re Hymie, the kosher butcher next door. No bloodstains on your coat though. Business bad today? You’ll look like a slaughterhouse by the end of the week!’
Feeling a bit swept away myself in this whirlpool of identities, I finger the stethoscope dangling from my neck.
‘A stethoscope!’ he exploded. ‘And you pretending to be Hymie! You mechanics are all starting to fancy yourselves to be doctors, what with your white coats and stethoscopes—as if you need a stethoscope to listen to a car! So, you’re my old friend Manners from the Mobil station up the block, come in to get your boloney-and-rye . . .’
William Thompson rubbed his hands again, in his salesman-grocer’s gesture, and looked for the counter. Not finding it, he looked at me strangely again.
‘Where am I?’ he said, with a sudden scared look. ‘I thought I was in my shop, doctor. My mind must have wandered . . . You’ll he wanting my shirt off, to sound me as usual?’
‘No, not the usual. I’m not your usual doctor.’
‘Indeed you’re not. I could see that straightaway! You’re not my usual chest-thumping doctor. And, by God, you’ve a beard! You look like Sigmund Freud—have I gone bonkers, round the bend?’
‘No, Mr Thompson. Not round the bend. Just a little trouble with your memory—difficulties remembering and recognising people.’
‘My memory has been playing me some tricks,’ he admitted. ‘Sometimes I make mistakes—I take somebody for somebody else . . . What’ll it be now—Nova or Virginia?’