A Leg to Stand On (review)

Book Reviews 163 applying the lens of medicine to Keats's poems and letters, Goellnicht has made visible dozens upon dozens of new conceptual relationships. —Joanne Trautmann Banks The Milton S. Hershey Medical Center The Pennsylvania State University Oliver Sacks, A Leg to Stand On. New York: Summit Books, 1984. 222 pp. $14.95. A Leg to Stand On is a marvelous mixture of neurological observation , psychological insight, mystical experience, and speculative vision. Throughout, music is the metaphor of action, and acknowledgment of the uncanny, the intuitive counterpart to body-facts. The book begins with accident and injury (the author's own), proceeds through a meticulous account of the experience of being a patient and of convalescence, and ends with provocative reflections on the need for "a neurology of the soul." We are incarnate and we experience ourselves as embodied. Physical illness and bodily injury threaten to undermine our sense of who we are. So it was for Oliver Sacks when, having survived a harrowing hiking accident, a new horror began to dawn in the form of a radical breach in his settled perception of his own body. The relation between his left leg, which dangled "like a piece of spaghetti," and the rest of his body was obscure and puzzling. It was not simply that the quadriceps had visibly atrophied beneath the cast following surgery, but that the muscle was completely atonic. Try as he might, the patient could not contract the muscle. Thus, the frustration attendant upon physical incapacity was compounded by a sense of impotence and futility. Still more troubling was the thought that beyond or behind this physical incapacity was a vacancy of mind where once there had been tacit knowledge of how to flex the muscle. "I had the feeling that something had happened ... to my power of 'thinking'—although only with regard to this one single muscle ... I had 'forgotten' something . . . ." And no strenuous effort of will availed in retrieving that lapsed memory. Then Sacks's experience took an uncanny turn. The patient was awakened from nightmarish sleep by an alarmed nurse to find that unbeknownst to him the "dead" left leg had fallen half off the bed. He could not believe his eyes. He could see that the "cylinder of chalk" had moved, but he had no sense that that was so. "I knew not my leg." 164 BOOK REVIEWS It was as if, absent its familiar feeling and function, the leg had become an unrecognizable member of the body commonwealth. Sacks decided to explore this experience of alienation in all its detail, or rather to peer into the hole in his personal reality where once there had been a leg to stand on. Medically, his condition continued to improve. Anatomically, healing was occurring predictably. But spiritually —personally, existentially—the leg was lifeless and alien. This much he now knew: "It was not a problem but a mystery which I faced." Mendelssohn's Violin Concerto provided an early clue to fathoming the mystery. Music promised renewal and indeed seemed "the very score of life." Attempts at rehabilitation advanced falteringly and the mystery remained. Eventually, "with the return of my own personal melody which was somehow elicited by, and attuned to, the Mendelssohnian melody," Sacks remembered how to walk—not by calculation or deliberation but by recollection. The mystery, though not dispelled, was displaced by grace, "the prerequisite and essence of all doing." Now convalescence was possible—putting behind the moral infancy of patienthood, returning to fluency of motion, and celebrating the sacrament of thanksgiving. One of the two great merits of this book (the other being that it is an engaging story, well told and felicitously written) is that it richly reintioduces the patient and his experience of ailing into the drama of injury and recovery in a way that prompts a reconsideration of the diagnostic art. Confronted with an experience of severence, of absence, analysis is of limited use. Needed in addition to the dissecting, disconnecting activities of analysis are painstaking attentiveness to the detail and pattern of experience, appreciation for nuance in that experience , and constructive imagination, even in the face of the uncanny. A Leg to Stand On is a...