This updated version of the autobiographical account by Dr Sacks of his experience of a short-term bout of inability to use his left leg allows Sacks to reflect possible causes for this condition. The updated version allows one to gain a unique perspective by Dr Sacks' of the turmoil of his illness. There are few autobiographical accounts of neurological disease by neuroscientists, and so such a view is to cherish.
This is a slim book which would not require more than a few days to complete. Unfortunately, the text is padded by ruminations and divergent passages that make getting through the text difficult. My attention wandered, wanting to learn, "What happened next?" The illness occupied only a few weeks.
Dr Sacks' prose of course is flowery, and he has a good grasp of diverse English literature. (I am writing in the present tense; Dr Sacks passed away in 2015. The illness in this book occurred in 1974.) When he sticks to describing the illness itself, one can have a vivid account of paralysis and self-identity.
The book was early in the long literary course of Dr Sacks. I cannot help imagining that if a later Dr Sacks had written the book, it would have been more direct. A good editor could have been used.
Close to the time of Dr Sacks' passing away, a debate occurred in the scientific literature what exactly had occurred to him. Dr Sacks speculates a loss of ability to mobilize his leg caused by some sort of a peripheral nerve injury, associated with a peculiar deficient of function in the spinal cord. Sacks himself witnessed similar (but still much different) phenomena in patients he had taken care of, and even reports a similar deficit in a pet dog. A different noted neurologist ventured that actually this was what is nowadays termed "functional neurological disorder," in earlier years termed hysteria, conversion disorder, or psychogenic disorder. Sacks rebutted the notion, but he left his mind open to the possibility.
As a publishing neurologist myself, I side with the view that this was a functional neurological disorder, but not one that is founded on a foundation of anxiety or other psychiatric turmoil. More reports are appearing in the literature that some patients encounter impaired neurologic function following abrupt injuries, without the association of verifiable nervous system structural damage. These accounts, including Dr Sacks' experience, point to a kind of neurological dysfunction that is still very poorly understood, but it is very common and disabling. The good news is that such disorders can respond to concentrated physical therapy, as indeed assisted Dr Sacks himself.
Regardless of one's own opinion what may have caused the difficulty, the account provides the reader the rare opportunity for a neurologist to visit his own nervous system dysfunction, a look from the "inside out" rather than the outside perspective of doctors looking at their patients, including Dr Sacks himself in his many other wonderful books.
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