Customer Reviews

Leg to Stand on

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Sacks has made his reputation by writing insightfully about his patients and their neurological disorders. Most readers will come to this book after having read one of his better known collections, such as "The Man Who Mistook His Wife for a Hat", though in fact I believe this precedes all of them except "Awakenings". "A Leg to Stand On" has much in common with those books, but it is much more personal, and it tells a unified story.

The first chapter, "The Mountain", tells how Sacks suffered a terrible injury to his left leg while hiking high above Hardanger Fjord in Norway. He was alone, and nobody knew where he was; he would certainly die of exposure if he didn't reach help by nightfall. The chapter is as gripping as anything in a thriller, and much more believable.

The next chapter, however, "Becoming A Patient", is the one that will give readers of Sacks' other work a frisson of recognition. Many times Sacks has taken the reader through the doctor-patient relationship from the doctor's side, but now he must experience it from the patient's side, and it is a revealing chapter. It ends with an extraordinary transition: Sacks has realized that he has a neurological problem with his leg--he can't "locate" it; it feels like it's made of wood--but the surgeon who operated on him refuses, point-blank, to accept that there is a problem.

The remainder of the book--about half--is devoted to the path to Sacks' ultimate recovery. Sacks has deep powers of observation, and there are luminously informative sequences here--my favourite is perhaps the exchange with the physiotherapists, when they are trying to show him how to walk, but he has forgotten how. The book closes with a chapter of musings on the nature of Sacks' experience and its relationship with his work.

This is a thoughtful book, and a good introduction to Sacks' work, but I think readers of Sacks' other books will like it the most.

In this the most personal of all his books, neurologist Oliver Sacks tells the story of an injury he sustained while climbing a mountain in Norway and the terrifying, bizarre aftermath when he realized with horror that his leg felt alienated. It did not feel like it was part of his body, but a foreign object somehow attached to him. This sort of disembodiment, with alterations in the mind-body image that affected Sacks deeply, was as confusing as it was frightening. When he finally recovered, he experienced unbounded joy and a new wonder for being properly "oriented" to his body. With insight, learning, and an unusually unbuttoned metaphysical self-revelation in which he discusses his religious background and doubts, Sacks shows how the soul is stirred by the changes in the body.

This is an eminently readable book, free from the conglomeration of footnotes and asides that accompany most of Sacks' other books. I read it in one day, fascinated and entertained throughout the reading. Besides being an autobiographical, neurological novel, this book also explores what it is like for the physician to become a patient, how experiencing something firsthand can change the way a physician views and practices medicine, and how the mind-body image so strongly affects our worldviews.

On one level, this is a doctor-becomes-patient story, with the many revelations that come to those in medicine who suddenly find themselves at the other end of the stethoscope. For anyone who's been a patient, there's some satisfaction in reading stories like this in which an ill or injured doctor finds out "what it's really like" to be in a hospital bed and more or less at the mercy of the medical profession.

I suppose Oliver Sacks isn't quite a likely candidate for this tables-turned scenario. In his books and TV interviews (e.g., "Glorious Accident"), and in Robin Williams' portrayal of him in "Awakenings," he comes across as anything but the stereotypical doctor. But he learns plenty from his experience anyway, and not just from the imperious surgeon who insists that there's nothing wrong with Sacks now that his leg has been repaired or the jolly hockey-stick nurse who is copeless when he does not respond to physical therapy.

He also learns first hand the terror of being injured, alone, and far from any other humans to rescue him. He experiences the helplessness that can overwhelm a person who not only loses the use of a limb, but as a "patient," loses his identity as an independent person. Sacks' descriptions of his feelings as a patient, sometimes soaring, sometimes despairing, are vividly told and are a reminder to any healthcare worker of the wild fluctuations of emotions that a patient can experience, even from one hour to the next.

Another fascinating aspect of the book is its account of the mystery of healing. Sacks describes in great detail the slow and unpredictable experience of recovering the ability to walk again. And he gives special consideration to the process of "re-entry," as he spends time in a sanatorium, among others who are healing, finally venturing out into the world on his own to rediscover himself and his lost independence.

Sacks is a vivid and analytical writer, with a rich gift of language. This is a slender book, but much is packed into it. It is a journey through the looking glass for any healthcare worker who has never been hospitalized with a serious and debilitating injury or illness, and should be required reading.

I must disagree with the reviewer who says Sacks is better when not writing about himself. His whole point in this book, it seems to me, is that we must speak from the "I" (the present consciousness) if we are to understand what he calls a neurology of the self. I think Sacks is one of the best writers working--he embodies the ideal of combining the humanities and the sciences in his eloquent, incisive prose. I found this book quietly revolutionary in its attempt to write a new kind of narrative of the self. I read it in 24 hours and could not put it down.

I should stress from the start that this book is extremely well written. It requires a special talent to combine scientific, clinical prose with personal, emotional and philosophical insight. This book is remarkable on many counts, but its value lies in Sacks' honesty, uninhibited rendering of the personal, by and while incorporating his desire to see his profession, neurology and psycho neurology, evolve from a largely `veterinary business", the dualistic approach to the mind as `mental' or `physical', to a science combining both approaches, in what he would like to call the "neurology of identity". In his terms, he would like to see neurology take "a great jump - to jump from the mechanical model, the "classical" model, it has espoused for so long, to a totally personal, self-referential model of the brain and mind". (p.189) This text eloquently strives in this direction.

In the early seventies, Sacks experienced a hiking accident that severely damaged his left leg. This near death experience (he was stranded alone on a mountain miles away from civilization) began a journey of a profound personal nature, existential, professional, philosophical, spiritual and physical, which changed his views about many things. The first chapter, `The Mountain', has all the suspense and narrative style of a well-written thriller. To a large extent, in the next chapter, "Becoming a Patient", has all the hallmarks of the familiar insensitive doctor as mere technician, evolving a more empathetic view of the patient, developing that essential `bedside manner' that can be so lacking, though essential, in the medical profession. Sacks describes his thoughts and feelings as a patient, having to relate his condition and feelings to his carer's, and the utter dread, loneliness, frustration, and alienation that comes with becoming ill and having to be institutionalized as a result. Anyone who has been ill and hospitalized will relate to this chapter.

The essential aspects of the text are the medical insights Sacks' gained as a result of his damaged leg. He experienced first-hand the phenomenon of intense loss of `body-image', that is the damaged leg became entirely `alienated' from his primary consciousness. This is more than just forgetting how to use one's leg after damage, but an actual vanishing of awareness of the limb itself. In his terms, a total collapse of memory/identity/space, "...an abyss or hole: a hole in memory/identity/space" of the limb. He goes on to write, "A Leg to Stand On is not just a story of a leg, but an account, from inside, of what primary consciousness is like; an account such as the experience of alienation..." (P.187)

This book is a splendid tale about the journey of healing. As all great philosophical writing does, it asks us to question ourselves, question our environment and attempt to see what has been right before our eyes from the beginning. It also affirms that human experience is a community affair, that we all share these experiences and can ultimately learn from them.

Neurologist Oliver Sacks was startled by a bull while climbing a mountain in Norway and fell, tearing his quadriceps muscle entirely free from the knee. This horrible injury was life threatening, occurring as it did high on a cold mountain, but he managed to splint his leg and crawl down the mountain to be rescued.

He was airlifted to a London hospital and had surgery to reattach the muscle. After the surgery he was shocked to discover that he had completely lost the "image" of his left leg. He couldn't feel it or move it -- couldn't even think how to move it. He was like a one-legged man with an unknown "chalk column" lying next to him in bed. In vintage Sacks style, "A Leg To Stand On" discusses this phenomenon with reference to music, philosophy, literature, and of course neurology, since this is what he calls a "neurological novel." While learning to use crutches, he suddenly regained the concept of his leg and how to use it; in his words, "...suddenly...I believed in my leg, I knew how to walk."

"A Leg To Stand On" explores from his own point of view what it means to be a patient and to have this devastating though not uncommon loss of body image. His synthesis of the experience delves into the basis of the "old" neurology, focused on neural function, and the "new" neurology which he describes as neuropsychology, studying what people do and how they do it.

I recommend this to anyone who has read and enjoyed other books by Oliver Sacks. If you are new to his work, you may like to start in the shallower end of the pool with Man Who Mistook His Wife for a Hat (Picador) or An Anthropologist on Mars.

Linda Bulger, 2008

I'd not read any of Sacks' books before, so was unprepared for his writing style. The first chapter is perfect, detailing the frightening encounter with a bull in Norway. In his frenzy to elude it, Sacks terribly injures his leg. He describes his ordeal where he transports himself laboriously down the mountain using his two arms and one good leg.

Reappearance of the bull or getting trapped in the cold mountain area overnight would mean death. His rescue at the eleventh hour completes this part, which could stand alone as a short story.

His hospital stay puts the doctor in the role of patient, and not a very patient one. The impersonal setting, discovery of any lack of feeling or movement in his leg and his active mind dominate this section of the book. He vividly recalls his thoughts, actions and every nightmare from this time. It's a frightening experience to find one's leg insensate and alien to one's self.

I've been reading quite a few biographies about paralysis (Best Seat in the House, My Stroke of Luck, etc.) and this one is in a category by itself. It's extremely cerebral, literary and alternately fascinating and off-putting. At moments you feel his horror at the situation while at other times you think, "pull yourself together."

Since each reader brings their own perspective to reading a book, I still recommend it. See what you think.

Those who gave this book a negative review have probably never understood up-close the nature of severe neurological problems. Moreover, they must have failed in their reading of his other books to recognize Oliver Sacks' consistent respect, fascination, sensitivity, and intellectual humility when dealing with the neurological complexities of his patients. Here he IS the patient. In other words, this book is operating on several levels, and Sacks is now not only identifying at a clinical distance with what others experience but he is inside the neuro-beast himself and describing with great literary power and sensitivity the horrific inner struggles of that subjective experience! In my opinion, the only Sacks book better than this one is The Man Who Mistook His Wife for a Hat. Sacks is a master storyteller, and A Leg to Stand On is one unique story. No, it's not strictly a neurologist's textbook analysis, but here Sacks walks (or limps?) his talk.

This book draws on Dr Sack's personal experience of trauma and recovery. It is an interesting perspective for the doctor to view things from the standpoint of the patient, and it drives home the point that apart from professional competency, excellent interpersonal skills are vital. One must never forget that in dealing with a patient, you relate to him/her as a person first, and as a doctor second. This insight is conveyed clearly here, and as obvious as it might seem, it is often relegated as being of a lesser importance by most medical professionals.

The experience recounted though is overtly detailed and can become rather heavy to digest and a challenge to get through at some parts of the book.

A Leg to Stand On has a solid story. Despite the age of this book, written in 1984, it is not antiquated. While technology and knowledge in the field of neuropsychology has progressed, the questions asked and the process for studying disorders are still the same. This book touches on many things still mysterious and relevant today, wrapped in an enjoyable relate-able character, Oliver Sacks, himself. This book was quite enjoyable to read. Well written, it contains a perfect combination of scientific background and personal thought.

Synopsis

In this book, Dr. Oliver Sacks, a neurologist, shares his strange medical experience in 1974. After ignoring a sign "BEWARE OF THE BULL!", Dr. Sacks severely injures his leg requiring a extensive surgery. In his recovery, he is startled to find that his leg no longer feels to be part of his body. Not only does Dr. Sacks struggle in his patient-hood as a doctor, but he also begins to struggle with his mind and body-ego. Most of the second half of the book details his slow recovery in body and mind. The last part discusses in full the neuropsychological disorder he experienced as a patient and his related research done after his recovery.

Style and Structure

Written in first person, this book is divided into seven parts, of unequal length. Each transformation Dr. Sacks goes through is punctuated by the end of a chapter. As this book is a journey through his mind, each chapter shows a little more insight building until the last chapters, aptly entitled Convalescence and Understanding. The chapter, Understanding, and the Afterword are much more technical as they explain the prevalence and scientific background of body-image disorders, similar to Oliver Sacks' experience.

Review

The first chapter is filled with action! Oliver Sacks, hiking alone, encounters a bull high on a mountain and seriously injured his leg. He will freeze to death if he waits for help and night falls, so he begins his descent down the mountain. As he describes his injuries, I found myself squirming in my seat, and even set the book down a few times. So close to death, Oliver Sacks shares his deepest thoughts, scattered and startling. It is nothing like have ever read or experienced, but it rings as a genuine experience. This is not a Hollywood script, but a real self-dialogue.

A Leg to Stand On follows his slow recovery and his relationship with his injured leg. Have you ever woken up to find your arm asleep and for just a few seconds, think you have lost your arm? Without looking, you don't even know where your arm is located. This is the same feeling Oliver Sacks experienced persistently after his surgery. In fact, when he looked down, he could not recognize his leg as his own. Sacks cannot move the leg. He lays in bed, and eventually cannot recall how to move the leg at all. His mind would like him to believe that he had never used that leg.

Dr. Sacks relationship with his doctor is very interesting. Although Dr. Sacks is a well learned man and can speak the highly technical language of medicine, he is largely ignored by the surgeon. Just as other patients, Dr. Sacks seeks reassurance from the surgeon, but the surgeon has no interest in such a game. It is somewhat satisfying to see a doctor experiencing patient-hood and learning the fear and confusion involved - and the desire for someone to listen.

Besides the relationship between patient and doctor, other aspects of patient-hood are explored. Long term hospitalization is not an easy stay. His injury forces him to stay in bed for over a month, an imposed helplessness. Dr. Sacks finds his physical recovery a long journey and his reentrance into the freedoms of the real world daunting psychologically. There is safety and security in a hospital; the outside world can be frightening, complex, and hurried. When Sacks began to walk on crutches he is transfered to a convalescence home, a sort of rehabilitation live-in clinic. Sacks accounts his attempt to climb to the roof the night prior to relocation. It was not until he was intercepted that he realized he was attempting to have an accident to remain in the hospital because he was scared to leave. The next day as he travels with other patients to the home, he finds that they all had similar experiences.

Oliver Sacks is a remarkable writer. He can translate his experiences into something you can experience. I thoroughly enjoyed eavesdropping on his thoughts. He has an enjoyable sense of humor. You will laugh with him, feel scared with him, admire his insight, and other times you will wish he would pull himself together.

This slender book contains a lot. Oliver Sacks thoughts are peppered with culture and philosophy. He occasionally recalls past psychological cases he has treated. His conversations with family, the nurses, and others are a delight to read. He integrates poetry, prose, medicine, and philosophy with his emotions and experiences. My background in philosophy is shallow, and ocassionaly I had trouble understanding. However, even if you lose a few paragraphs here and there, it does not take away his relate-ability.

The last part of the book covers the specific neuropsychological and existential phenomena accompanying his injury. After his recovery, he studied hundreds of patients with disorders of body-image and body-ego. The last part of the book discusses his work and his findings. He then analyzes some of the current neurological thought, and what the future may bring for the field.

A neuropsychologist greatly admired by Oliver Sacks (the book is dedicated to him) told Oliver Sacks that he should write about his experience as a patient because "such syndromes are perhaps common, but very uncommonly described". Oliver Sacks writes uncommonly well in his neuroscientific partial biography. While you could learn these disorders online, it is nothing like vicariously experiencing it yourself through Oliver Sacks' A Leg to Stand On.