Summary
In “Cupid’s Disease,” Natasha K. comes into Sacks’ clinic worried that she feels “too well.” A historically shy woman, Natasha reports that soon after her 80th birthday she “felt young once again. I took an interest in the young men. I started to feel, you might say, ‘frisky’ ” (102). Her friends had expressed surprise and concern at how she giggled and flirted with men much younger than her. Sacks is confused as to why this is of any concern—until Natasha explains that, nearly seventy years ago, she contracted syphilis while working for a brothel. Although the syphilis had long vanished, she worries that the latent neurological effects of the disease are finally catching up with her. Amazed at the suggestion, Sacks checks Natasha’s spinal fluid and indeed she tests positive for neurosyphilis, which had been stimulating her cerebral cortex. She is treated with penicillin, which eradicates the harmful spirochetes bacteria in her brain, but as the damage had been irreversible, Natasha’s feelings of friskiness and euphoria, to her relief, don’t subside.
In the postscript to this story, Sacks describes Miguel O., who comes to the clinic with a considerably further developed case of neurosyphilis. A farmhand from Puerto Rico with both speech and hearing impairments, Miguel communicates best with Sacks through drawing. Sacks shares four different figures demonstrating Miguel’s attempts at a simple exercise where he is instructed to copy a drawing of a square with a circle and an X inside of it. Miguel ignores the instructions and uses the original drawing as a jumping-off point for an entirely different drawing: first of a three-dimensional box, then of a boy flying a kite. Sacks describes him as surging with energy, with “thoughts and feelings flying everywhere” (104). After Miguel begins taking Haldol, however, he dutifully completes the drawing exercise “with none of the elaborations, the animations, the imagination, of the others” (105). Feeling down, Miguel asks Sacks if everything will feel “dead” when he is treated.
William Thompson, the subject of “A Matter of Identity,” is a patient with Korsakoff’s syndrome who reaches a frenzied state of “confabulatory delirium” (110) after suffering a high fever. Like Jimmie G. in “The Lost Mariner,” Mr. Thompson has almost no short-term memory; however, he is also stuck in a continually excited state of narrative invention. He ceaselessly invents facts about who he is, where he is and who he is talking to, at first addressing Dr. Sacks as a customer at his grocery store, then as his “old friend Tom Pitkins” (108), then as a kosher butcher, and so on. Sacks writes that Mr. Thompson comes across at first as a cheerful comic, who constantly has an amusing story or character on the tip of his tongue. However, as he continues to talk, he becomes disquieting to others. Tragically, his sense of personhood has been lost in a kaleidoscopic array of illusions and inventions. Sacks describes his stream of narration to be both excited and indifferent, “as if it didn’t really matter what he said, or what anyone else did or said; as if nothing really mattered anymore” (112).
In the midst of his stream of falsehoods and confabulations, Mr. Thompson looks out the window and says “[a]nd there goes my younger brother Bob, past the window,” (112). Sacks is dumbfounded when a minute later, the man peeks his head through the door and introduces himself as Mr. Thompson’s younger brother Bob. Although Mr. Thompson recognizes his brother initially, he does not maintain his recognition, losing him in his ongoing whirl of confabulations.
Analysis
We see Sacks here coming up against the limits of what neurology can do to help its patients. Miguel and Natasha have both gotten a taste of the seductive excitement and exuberance caused by conditions of excess, and although they know that they need to seek treatment, they don’t want their positive symptoms to go away. Mr. Thompson ostensibly has no problem with his confabulatory delirium either; Sacks describes him as an “ebullient comic” (113), always in an excited state of chatter. The only thing Sacks can do for these three patients is prescribe them drugs that take away their high. Miguel, the only subject who receives neurological treatment, is the only one depicted as despondent at the end of his story. It is a relief that there is nothing Sacks can do to help Natasha, and the only thing that calms Mr. Thompson down is being left alone in the hospice garden. These three stories largely reinforce the author’s claim that disorders of excess challenge the foundations of the field of neurology.
Mr. Thompson is only very thinly characterized by the author, with large swaths of his background and identity left a mystery. This is suited to the central crisis of Mr. Thompson’s condition; his unending confabulations have degraded his actual identity to a point of no return. As a result of this, Sacks turns the spotlight of this story onto himself in a new way. Mr. Thompson’s story has much more to do with Sacks’ reaction to his confabulations than it has to do with Mr. Thompson himself. Sacks wonders what this condition must be like for Mr. Thompson, going on at length about the importance of one’s inner-biography, the ongoing story that tells us who we are. Over the course of the essay, Sacks’ own self-image shifts from being a clinical practitioner to being a helpless defender of truth: “if only he could stop the ceaseless chatter and jabber; if only he could relinquish the deceiving surface of illusions– then (ah then!) reality might seep in; something genuine, something deep, something true, something felt, could enter his soul” (114). In the case of Mr. Thompson, we see why Sacks finds it necessary to step away from his role as a neurologist and write about his experiences. Only as an author can he collect and control the swirling, troubling mess of real life that surrounds his clinical work.
