Sea of Troubles

“It is characteristic of many neurologists (and patients) that they mistake intransigence for strength, and plant themselves like Canutes before advancing seas of trouble, defying their advance by the strength of their will. Or, like Podsnaps, they deny the sea of troubles which is rising all around them: “I don’t want to know about it; I don’t choose to discuss it; I don’t admit it!” Neither defiance nor denial is of the least use here: one takes arms by learning how to negotiate or navigate a sea of troubles, by becoming a mariner in the seas of one’s self. “Tribulation” dealt with trouble and storm; “Accommodation” is concerned with weathering the storm.” – Oliver Sacks, Awakenings

In our lifetime of troubles big and small, we must learn to accept and manage every situation as it arrives. It must be done so with as little ego as possible, for trouble is trouble enough.



Beware of Progression into Non-humanism

This world is a growing pool of humans: labels and numbers. The increasing use of technology allows data analysts to put us like points on the map, record our behaviour and for what purpose? The predominant answer is profit.

It was and is still true to say that ‘money makes the world go round’. Data analysts use our charted behaviour to find our trend of spending, and sell this data to corporations that can afford it. These corporations then work in stealth to influence and coax our spending. Of course, governments use big data, to monitor and supervise our behaviour, and rules change without us really understanding why.

One must question if anomalies pop up on these charts. If yes, then are these the ones who are left out, marginalised and vulnerable in our society? Then do we do anything with this data, to help them? If anomalies do not show, then are we excluding people from our view, our consideration and our humanity?

In the book, Awakenings, late Dr Oliver Sacks propounds the folly of medicine to reduce complex human experience to data, and warns of our reduction of humanism:

“The whole of this book is concerned with these questions – ‘How are you?’. ‘How are things?’ – as they apply to certain patients in an extraordinary situation. There are many legitimate answers to this question: ‘Fine!’, ‘So-so’, ‘Terrible!’, ‘Bearing up’, ‘Not myself’, etc.; evocative gestures; or simply showing how one is […] All of these are intuitively understood, and picture for one the state of the patient. But it is not legitimate to answer this metaphysical question with a list of ‘data’ or measurements regarding one’s vital signs, blood chemistry, urinalysis, etc. A thousand such data don’t begin to answer the essential question; they are irrelevant and, additionally, very crude in comparison with the delicacy of one’s sense and intuitions.

[…] Folly enters when we try to ‘reduce’ metaphysical terms and matters to mechanical ones: worlds to systems, particulars to categories, impressions to analyses, and realities to abstractions. This is the madness of the last three centuries, the madness which so many of us – as individuals – go through, and by which all of us are tempted. It is this Newtonian-Lockean-Cartesian view […] which reduces men to machines, automata, puppets, dolls, blank tablets, formulae, ciphers, systems and reflexes. It is this, in particular, which has rendered so much of our recent and current medical literature unfruitful, unreadable, inhuman and unreal.

There is nothing alive which is not individual: our health is ours; our diseases are ours; our reactions are ours – no less than our minds or our faces. Out health, diseases and reactions cannot be understood in vitro, in themselves; they can only be understood with reference to us, as expressions of our nature, our living, our being-here (da-sein) in the world.”

Hence with our increasing reliance on technology, we must not forget the importance of paying attention to human experience. We must view with circumspect, our progression towards non-humanism, towards exclusion of people in need. 

Time is not immutable

Time is not immutable. Our experience of time – our perception of hours and minutes – follows a largely regulated and cohesive system. Hence, we’re able to organise our lives and let late-comers pay.

There’re two instances whereby we lose sense of time.

Firstly, when one is deprived of his/her senses. In the mid-20th century, scientists carried out extensive sensory deprivation experiments which reduced what their subjects could hear, see and touch. Due to the deprivation of senses, the restless minds eventually conjured hallucinations and subjects began to lose emotional stability and suffered deterioration of mental function. 

In 1993, Maurizio Montalbini, a sociologist, spent 366 days in an underground cavern to simulate space mission. When he emerged, he thought he had only passed 219 days as his sleep-wake cycles have almost doubled. In 2008, the BBC aired “Total Isolation” which depicted the experience of six individuals under 48 hours of partial sensory deprivation. Two individuals who have been placed in complete darkness lost their sense of time in less than 24 hours. In Mind Field: Isolation, host Michael Stevens subjected himself to 72 hours of isolation in a sound-proof, fully-lit room. In less than 8 hours, after a nap, he perceived it be about 9am when it was in fact only about 5am.

The above shows how important environment is for accurate perception of time. Once our senses are warped, time moves out of alignment. 

Secondly, when one suffers from physiological damage. In Awakenings, late Dr Oliver Sacks recounted on Mr. V who seemed to be stuck in frozen “poses”. In the morning, he would observe Mr. V standing against the door, with his right hand apparently motionless a few inches from his knee. Later, in the middle of the day, his hand would be “frozen” halfway to his nose. Then, a few hours later, his hand would be “frozen” on his glasses or on his nose.

After Mr. V was awakened and accelerated by L-Dopa, Dr. Sacks mentioned the above observations and Mr V. responded:

Mr. V: “What do you mean, “frozen poses”? I was merely wiping my nose!”

Dr. Sacks: “But Miron, this just isn’t possible. Are you telling me that what I saw as frozen poses was your hand in transit to your nose?”

Mr. V: “Of course. What else would they be?”

Dr. Sacks: “But Miron, these poses were many hours apart. Do you mean to tell me that you were taking six hours to wipe your nose?”

Mr. V: “It sounds crazy and scary too. To me they were just normal movements, they took a second. You want to tell me I was taking hours instead of seconds to wipe my nose?”

The above experience shows how our perception of time can be incredibly different if our brain suffers damage from illness.

Henceforth we shall consider “time” in a wider scope, beyond Back to the Future or The Time Machine. 

Gratitude by Oliver Sacks

This collection of four essays written by the late Dr Sacks is one finished in a breath – so compelling a read that one finds her heart palpitating at the end of it, and hoping for more of his words.

It is also a book I wish to gift to my family and friends closest to me, for its wisdom is never too early or late to learn. 

I shall but quote shortly:”I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written.”

His ruminations about life – of what it means to have lived – inspire one to be nervous about living. Are we living fully? Are we living consciously and honestly (to ourselves)? 

Will we be filled with gratitude when our time is up?

A Forgotten Epidemic

Encephalitis, also known as acquired brain injury, is an inflammation of the brain. Most of the types of encephalitis are caused by viral infection. 

Between 1915 and 1926, an epidemic of encephalitis lethargica spread throughout the world, affecting five million people, a third of whom died in acute stages. Those who survived were conscious but not fully awake – sitting motionless and speechless all day, lacking motivation to do anything. 

In the spring and summer of 1969, the late Dr Oliver Sacks began to use the drug, L-Dopa at Mount Carmel – a total palliative care centre. This sparked the “awakening” of fifty individuals. They emerged from their decades-long isolation and find themselves back in the world. They all began to dance and talk together, and delighted in each other’s daily-increasing health and vitality. There was communal health, of shared excitement and hope.

However, in September, there emerged tribulations of all sorts. Some suffered treacherous side-effects of L-Dopa, such as respiratory crises, while others to their own regressive needs. In the small wards, the despondency would spread from one to another. Every setback then aroused fear in others and every discouragement a blow to the morale of the community. The atmosphere of the ward, its mood, became all important.

The condition of encephalitis lethargica is poignantly expressed in the following recounts.

“Nothing, just nothing.” Miss R would say when asked what she was thinking about.

“I think of a thought, and it’s suddenly gone – like having a picture whipped out of its frame. Or I try to picture something in my mind, but the picture dissolves as fast as I can make it. I have a particular idea, but can’t keep it in mind; and then I lose the general idea; and then the general idea of a general idea; and in two or three jumps my mind is a blank – all my thoughts gone, blanked out or erased.” – Miss R

“She seems to have no appetite for anything, really no appetite for living.” wrote the speech-pathologist, Miss Kohl.

It is a wonder how the world can forget such a moment in history – when a strange disease stole the lives of millions, and for which a cause has yet to be determined. Also, it serves the question of “Should life be sustained, when all hope seems lost? Especially since these cases have shown that recovery is possible after a frozen state of 50 odd years.”

Sleep and Consciousness

Sleep occurs in regulated cycles of NREM and REM. For every 90 minutes of sleep, we drift into stages of NREM and REM: N1 -> N2 -> N3 -> N2 -> REM. During REM sleep, the body is paralysed, except for shallow breathing and eye movements. For most of us, REM stage occurs ninety minutes or so after falling asleep.

However, people with narcolepsy or sleep deprivation may fall into REM at the very start of sleep, plunging into dreaming and sleep paralysis. They may also wake at the “wrong” time, so that the dreamlike visions and the loss of muscle control persist into the waking state. At this stage, the person is wide awake but suffers from nightmare like hallucinations and be unable to move or speak. These hallucinations may be visceral, auditory or tactile as well as visual and are accompanied by a feeling of suffocation or pressure on the chest, the sense of a malignant presence, and an overall sense of absolute helplessness and abject terror.

Yet one need not have to have narcolepsy to experience sleep paralysis with hallucinations. Research has shown that about a third and half of the general population has had at least occasional episodes of this. In fact, folklore across cultures share a common experience: supernatural figures that assault the sleeper, some paralysing the victim and even sucking away his soul. While these frightful experiences have led many to believe in supernatural forces, there is in fact a physiological basis for this occurrence. Where our minds fail to comprehend, we can always look to science.

For me, I have had an experience of awakened consciousness in sleep, accompanied with bodily movements. On 25 August 2013, I woke mid-sleep at what may have been 3am. I found myself scratching my legs and told myself to stop. Yet, I knew I could not will myself to do so. I even mused to myself, as if one half of my brain was talking to the other, as I observed my bodily movements. I heard sounds as I made them. Then, I got off the bed and made my way to the washroom. As I sat on the toilet seat, I heard myself hum a tune. I found it funny that I was humming, and yet I knew I could not will myself to stop. I do not know if I saw myself in the mirror, or how I made my way back to bed. Yet, all these observations were remembered clearly when I woke fully the next day. It impressed upon me that we know so little about our consciousness, about our minds. It was an unforgettable experience. I never had the same experience since then.

Nevertheless, there were several times I woke to realise that I had sent a message mid-sleep, with absolutely no recollection of having unlocked the phone, and sending one. It would seem right to say that I had sent a message unconsciously, but that offends logic. It would then seem appropriate to say that I sent it subconsciously, while asleep.

Sleep, dreams, our consciousness and our minds continually interest me over the years and this curiosity will never be satiated.

For more information on narcolepsy (and cataplexy), hallucinations and sleep paralysis, do read Hallucinations by Oliver Sacks.


Oliver Sacks was a Druggy

As gleaned from Hallucinations:

His first drug experience was in 1953 when his childhood friend, Eric Korn went up to Oxford to visit him. They each took 25 micrograms of LSD and felt nothing, for the dosage was too small.

Starting a neurology residency in 1962, he became increasingly curious about the effects of hallucinogenic drugs.

He began with cannabis. He took two puffs of a friend’s joint and saw that his hand was getting larger and larger and moving away from him. He could see a hand stretched across the universe, light-years or parsecs in length. It looked like a human hand yet it seemed like the hand of God. His first pot experience was a mix of the neurological and the divine.

Then, he began to sample LSD and morning glory seeds as they were readily available. Once, a friend told him to try Artane for a “really far-out experience’, asserting that one will still be in partial control with a dose of twenty pills. So one Sunday morning, Oliver took twenty pills. He expected disorganisation and paranoia but besides a dry mouth, large pupils and finding it difficult to read, he felt nothing. Then, he heard a knocking on his door and found his friends Jim and Kathy dropping by for breakfast. He made them ham and eggs, walked to the living room and found it completely empty. He had not thought that Jim and Kathy’s “presences” were unreal. He was shocked and frightened, as this did not happen with LSD and other drugs. He said to himself “Take yourself in hand. Don’t let this happen again.” Then, he heard the sound of a chopper and thought his parents had flown from London to give him a surprise visit. As he rushed out to greet them, he found that it was empty. The silence and emptiness, the disappointment, reduced him to tears. He then went back into the house and a spider on the kitchen wall caught his attention. It began to speak to him and they had a conversation on analytic philosophy.

As he was working as a resident at UCLA’s neurology department, he avoided drugs during the week and often experimented with them during the weekends.

One Saturday in 1964, he developed a concoction of amphetamine, LSD and cannabis. After about twenty minutes, he saw the colour of indigo. He was overwhelmed as he thought it a colour of heaven, of which Giotto had spent a lifetime trying to get but never achieved. He thought it was the colour of the Palaeozoic sea, the colour the ocean used to be. Suddenly, the colour disappeared and he was left with an overwhelming sense of loss and sadness.

One day, he took a hefty dose of Heavenly Blue morning glory seeds with vanilla ice cream. After about twenty minutes, he found himself in a realm of paradisiacal stillness and beauty. At this time, he saw an a taxi backing up the steep trail to his house. An elderly woman got out of the taxi and he ran towards her shouting “I know who you are – you are a replica of Augusta Bonnard… You look like her but you are not her. I am not deceived for a moment.”  Augusta then got back into the taxi and took off. The next time Augusta met Oliver, she asserted that his failure to recognise her was psychotic. Also, his habit of taking mind-altering drugs every weekend, alone and in high doses, testified to some intense inner needs or conflicts.

In the summer of 1965, he had three months of break. In this idle time, Oliver descended deeper into drug taking, no longer confining it to weekends. He tried intravenous injection of several vials of morphine. Then, he hallucinated hundreds, thousands of men – two armies, two nations – preparing to battle. He did not realise he was merely staring at a spot on the sleeve of his dressing gown and laying in bed. He felt that the drug effect was fading fast, yet when he woke, it was ten, the next day. He had been gazing, motionless, for more than twelve hours. This shocked and sobered him, and it became his first and last opium experience.

In the December of 1965, he was having a difficult time. He was depressed and insomniac, and was taking ever-increasing amounts of chloral hydrate to get to sleep. It was up to fifteen times the usual dose every night. One Tuesday, a little before Christmas, he ran out supply. He went to bed without the usual knockout dose and had poor sleep. The next day, after a brain-cutting session in the hospital, he went across the road to get lunch, as usual. Suddenly, the coffee turned green then purple. He looked up and saw a customer with a huge proboscidean head. Realising that he was hallucinating, he quickly made his way home (suffering frightening hallucinations along the way). Thinking that he had lost his mind, he phoned his friend, Carol and told her “I want to say goodbye. I’ve gone mad, psychotic, insane.” Luckily, Carol knew that he was just suffering from DT – delirium tremens as he had just stopped taking chloral hydrate (in huge doses). For the next ninety-six hours, he continued hallucinating and when it finally stopped, he fell into exhausted stupor.

In February 1967, he had amphetamine and started reading Edward Liveing’s book on migraine. In ten hours, he read steadily through the five hundred pages. At times, he was unsure if he was reading or writing the book. He was moved by Liveing’s humanity and social sensitivity, the mix of science and humanism, and heard a very loud internal voice telling him to be the Living of his time. The next day, he began to write his own book. The joy he got from writing was real – infinitely more substantial than the vapid mania of amphetamines- and he never took amphetamines again.