Migraine Sufferer Who Missed Pain Set Doctor Thinking : Medicine: Physician and writer Oliver Sacks delves into ways patients adjust to illness--or even thrive on it.
What’s the use of a headache? You might be surprised.
Dr. Oliver Sacks faced that odd question early in his career when he successfully treated a migraine sufferer with drugs.
The patient was a 32-year-old mathematician whose week started with frenzied creativity, peaked to irritability and plunged into painful migraines by Sunday.
Once cured, the mathematician complained that he missed his weekly attacks. The drugs not only killed his headaches but his imagination as well, he said.
Shortly afterward, another migraine sufferer also cured by drugs phoned Sacks to complain.
“His Sundays had been previously filled with migraine. Now, he was bored and . . . didn’t know what to do. He said he really wanted his migraines back,” said Sacks, a professor of neurology at Albert Einstein College of Medicine in New York City.
Sacks returned recently to London, his hometown, to discuss the latest edition of his book, “Migraine.”
The ways in which patients adjust to illness, sometimes creatively, is a recurring theme in Sacks’ medical and literary work.
In his tales of neurological disorders, Sacks explores the intimate and murky relationship between traits triggered by disease and inherent personality. Does illness shape personality or vice versa? Is there a distinction between “true” personality and one altered by a chemical disorder?
Sacks by no means suggests that his patients are hypochondriacs, using their illness as an excuse to avoid daily activities.
Quite the contrary.
Some folks with lifelong disorders--but clearly not all of them--have become so accustomed to their condition that they couldn’t imagine life without it.
“There’s many people in whom chronic illness is simply an irritation. They want to get over it as soon as possible. And perhaps for others, it will become part of their identity,” said Sacks.
Charles Darwin, the father of the theory of evolution, wrote in his autobiography that he was grateful for being chronically ill.
No one knows what ailed Darwin, but Sacks said the great 19th-Century naturalist typifies those who cannot imagine being healthy.
“This sounds perverse, but he was grateful for a chronic illness that would excuse him from social and professional obligations. He spent hours of the day lying on the sofa, but his mind was intensely active,” Sacks said.
Patients who can’t cope with cures appear throughout Sacks’ books.
In “The Man Who Mistook His Wife for a Hat,” Sacks described a 24-year-old man with Tourette’s syndrome, a neurological disorder characterized by tics and at times involuntary verbal outbursts.
Sacks prescribed Haldol, a drug that mellows the tics. One week later the patient, Ray, returned in a rage because he missed his “ticcy” personality.
Ray told Sacks that he wasn’t sure whether his disorder was a gift or curse but nevertheless couldn’t imagine life without it. Finally, he agreed to take his medicine Monday through Friday.
“Now there are two Rays,” Sacks wrote. “There is the sober citizen . . . from Monday to Friday, and there is the witty ticcy Ray, frivolous, frenetic, inspired at weekends.”
Sacks said he met an autistic woman, the subject of a recent New Yorker magazine article, who told him, “If I could snap my fingers and be not autistic, I wouldn’t because it’s part of me.”
“So I think it’s not mystical to say if one has a recurrent or chronic disorder, it can’t not enter one’s life in some sort of way,” said Sacks, sipping tea and nibbling biscuits at a hotel in north London.
Sacks was born in London in 1933; his father was a general practitioner, his mother a surgeon. Two brothers are doctors in London.
Sacks studied physiology at Oxford University and medicine at Middlesex Hospital in London. But he always had a yearning to write.
“Never a desire to do plays or poetry, but to describe. I think this impulse to chronicle sort of combined with medicine,” he said.
In a sense, Sacks has become the Studs Terkel of medicine, chronicling the lives of the neurologically disordered.
His writing provides him with a sense of completion he does not get caring for patients with incurable disorders.
“I think a surgeon’s life can be particularly satisfying because what you do is so powerful, immediate,” said Sacks.
In neurology, “one is dealing with chronic, incurable things. Perhaps for me the fulfillment not available in reality is partly provided by my writing about things. So I couldn’t cure my patients who had migraines, but perhaps I could sort of write a decent book on the subject which at least would assist somehow.”
Sacks wrote “Migraine” in 1967. The latest edition includes up-to-date theories on potential chemical causes as well as current treatments. Like all of Sacks’ writings, it is replete with footnotes, prologues and addenda. He concedes he just doesn’t know where to stop.
“I guess it goes back to my Jewish background and the Talmud, which consists of innumerable commentaries,” he said.
“Sometimes people see these footnotes and things as mannerisms. But I do have a ‘returning to’ and an ‘adding to’ mind. I’m not a terribly clean writer. Perhaps I’m not a writer at all, but the project is never over.”
