Summary
In “Incontinent Nostalgia,” Sacks shares a letter to the editor he sent to the Lancet, a medical journal, about his experience administering L-DOPA to patients. He rehashes the case of Rose R., a 63-year-old woman who had spent most of her life in a hospital ward–conscious, but barely able to move or express herself. After taking L-DOPA, Rose experiences “a dramatic release from her Parkinsonism” (151) and for the first time in her adult life finds herself able to move and speak freely. Rose reports that she is suddenly able to recall memories and sing songs from the 1920s, many of which she hadn’t thought of for over forty years. Sacks surmises based on this account that Rose “(like everybody) is stacked with an almost infinite number of ‘dormant’ memory-traces, some of which can be reactivated under special conditions, especially conditions of overwhelming excitement” (152). L-DOPA not only excites Rose’s motor functions; it also transports her to the world that existed before her condition set in.
“A Passage to India” is a brief vignette about a patient with a malignant brain tumor that is beyond cure. Bhagawhandi P. is a 19-year-old young woman who grew up in India. She is admitted to hospice care after having multiple seizures, knowing that she has only a few weeks more to live. Sacks remarks that despite the tragedy of her situation, she remains in good spirits. As the tumor continues to expand, her seizures become more frequent. However, instead of fully losing consciousness during her seizures, Bhagawhandi becomes “dreamy,” experiencing vivid, sweeping visions of landscapes, gardens, and homes from her childhood. Sacks wonders if these visions are due to temporal lobe seizures, or if perhaps Bhagawhandi is hallucinating from the massive dose of steroids in her bloodstream. This does not seem to be the case either; her dream-states don’t appear to be excited or over-cathected. Gradually, her visions occur more often and grow deeper, until they occupy most of Bhagawhandi’s day. Although she remains lucid, she holds “a faint, mysterious smile” all day (155). Eventually, she becomes unresponsive, still with a look of calm happiness on her face. “Three days later she died,” Sacks writes, “or should we say she ‘arrived’, having completed her passage to India?” (155).
In “The Dog Beneath the Skin,” Stephen D., a 22-year-old medical student on cocaine and amphetamines, has a vivid dream that he is a dog. When he awakes, he suddenly has an acute and powerful sense of smell, a condition termed hyperosmia. “I awoke to an infinitely redolent world,” Stephen reports, “a world in which all other sensations, enhanced as they were, paled before smell” (156). This sudden realignment of the senses makes Stephen’s environment “overwhelmingly concrete, of particulars” (157). He recognizes each of his twenty patients by his or her smell alone, and he feels an impulsive urge to sniff everything in his path. After three weeks, his normal senses suddenly return. Years later, now a young colleague of Dr. Sacks, Dr. D. says that he is nostalgic for the “smell-world.” “So vivid, so real!” he remarks. “It was like a visit to another world, a world of pure perception, rich, alive, self-sufficient, and full” (158). Sacks notes that Sigmund Freud has called smell our most repressed sensation, as it evokes primitive, pre-genital sexuality. Stephen’s hyperosmia likely came from a period of reduced inhibition brought on by his use of excitants.
In the postscript to “The Dog Beneath the Skin,” Sacks writes about an unnamed man who loses his sense of smell after severe damage to his olfactory tracts. The man remarks that life without smell is more bleak and distressing than he ever could have imagined. Months after his injury, the man is shocked and overjoyed when he begins catching whiffs of his morning coffee and his pipe. After running tests, doctors conclude that he still has complete anosmia (blindness to smell). Sacks posits that the man’s cortex, which was not damaged in the injury, is producing controlled olfactory hallucinations in situations that were previously fraught with associations of smell, such as smoking or having coffee in the morning. Although these mental compensations are reported often among the blind and deaf, Sacks writes that he has no idea how common they are among those with anosmia.
Analysis
Rose and Bhagawhandi’s experiences mirror each other in various ways. Both have developed an intimate relationship with death; Rose just barely survives a viral epidemic in the 1920s and remains immobile for the next forty years, and Bhagawhandi knows that her tumor is affording her only a few more weeks to live. Strikingly, the key feature of their transports is nostalgia -- a rich and detailed tapestry of memories from a simpler time in their lives. It is as if their brains have developed an emergency parachute of sorts, triggered by the excitatory function of L-DOPA in the case of Rose, and seizures in the case of Bhagawhandi.
The other key factor among them is that they are both being monitored closely in a clinical setting. Sacks remarks that as Bhagawhandi’s dreamy-states intensifies, “there was, even among the most down-to-earth staff, a feeling that she was in another world, and that we should not interrupt her” (155). Bhagawhandi’s dreamy-states conveniently keep her nurses and doctors at a distance from her. In a similar vein, Rose’s singing and dancing temporarily transform her environment from what it is to what she’d prefer it to be, blocking out the ongoing operations of the clinic. If Sacks had approached these stories from a purely objective standpoint, they would both be about patients who are disassociating from their harrowing environments. However, by presenting these narratives from the subjective standpoint of his patients, they become beautiful and touching stories of experiencing nostalgia in the face of death. Panning back, both stories are equally about Sacks’ own journey into the depths of Rose and Bhagawhandi’s experiences.
Stephen’s moment of transport as a healthy 22-year-old is not nostalgic; rather, it brings him deeper into the concreteness of the present moment. Sacks writes that although Stephen was “[s]omewhat intellectual before, and inclined to reflection and abstraction, he now found thought, abstraction, and categorisation, somewhat difficult and unreal, in view of the compelling immediacy of each experience” (157). As a medical student who we might infer is using amphetamines in part to cope with his busy schedule, it follows that Stephen would eventually reach a breaking point in his constant exertion of rational thought. We can see Stephen’s hyperosmia as an unconscious break from a reality that was wearing him down. Further, it is noteworthy that the author decides to include the point of view of Stephen’s older, more nostalgic self at the end of the story. Those two weeks of hyperosmia seem to have even more importance in hindsight to Stephen than they did when he was 22. Sacks follow this thread in the postscript when he mentions the unnamed man with nose-blindness. This man’s sense of smell becomes more precious to him when it takes the form of nostalgia.
