A Leg to Stand on

I should stress from the start that this book is extremely well written. It requires a special talent to combine scientific, clinical prose with personal, emotional and philosophical insight. This book is remarkable on many counts, but its value lies in Sacks' honesty, uninhibited rendering of the personal, by and while incorporating his desire to see his profession, neurology and psycho neurology, evolve from a largely `veterinary business", the dualistic approach to the mind as `mental' or `physical', to a science combining both approaches, in what he would like to call the "neurology of identity". In his terms, he would like to see neurology take "a great jump - to jump from the mechanical model, the "classical" model, it has espoused for so long, to a totally personal, self-referential model of the brain and mind". (p.189) This text eloquently strives in this direction.In the early seventies, Sacks experienced a hiking accident that severely damaged his left leg. This near death experience (he was stranded alone on a mountain miles away from civilization) began a journey of a profound personal nature, existential, professional, philosophical, spiritual and physical, which changed his views about many things. The first chapter, `The Mountain', has all the suspense and narrative style of a well-written thriller. To a large extent, in the next chapter, "Becoming a Patient", has all the hallmarks of the familiar insensitive doctor as mere technician, evolving a more empathetic view of the patient, developing that essential `bedside manner' that can be so lacking, though essential, in the medical profession. Sacks describes his thoughts and feelings as a patient, having to relate his condition and feelings to his carer's, and the utter dread, loneliness, frustration, and alienation that comes with becoming ill and having to be institutionalized as a result. Anyone who has been ill and hospitalized will relate to this chapter.The essential aspects of the text are the medical insights Sacks' gained as a result of his damaged leg. He experienced first-hand the phenomenon of intense loss of `body-image', that is the damaged leg became entirely `alienated' from his primary consciousness. This is more than just forgetting how to use one's leg after damage, but an actual vanishing of awareness of the limb itself. In his terms, a total collapse of memory/identity/space, "...an abyss or hole: a hole in memory/identity/space" of the limb. He goes on to write, "A Leg to Stand On is not just a story of a leg, but an account, from inside, of what primary consciousness is like; an account such as the experience of alienation..." (P.187)This book is a splendid tale about the journey of healing. As all great philosophical writing does, it asks us to question ourselves, question our environment and attempt to see what has been right before our eyes from the beginning. It also affirms that human experience is a community affair, that we all share these experiences

I must disagree with the reviewer who says Sacks is better when not writing about himself. His whole point in this book, it seems to me, is that we must speak from the "I" (the present consciousness) if we are to understand what he calls a neurology of the self. I think Sacks is one of the best writers working--he embodies the ideal of combining the humanities and the sciences in his eloquent, incisive prose. I found this book quietly revolutionary in its attempt to write a new kind of narrative of the self. I read it in 24 hours and could not put it down.

On one level, this is a doctor-becomes-patient story, with the many revelations that come to those in medicine who suddenly find themselves at the other end of the stethoscope. For anyone who's been a patient, there's some satisfaction in reading stories like this in which an ill or injured doctor finds out "what it's really like" to be in a hospital bed and more or less at the mercy of the medical profession. I suppose Oliver Sacks isn't quite a likely candidate for this tables-turned scenario. In his books and TV interviews (e.g., "Glorious Accident"), and in Robin Williams' portrayal of him in "Awakenings," he comes across as anything but the stereotypical doctor. But he learns plenty from his experience anyway, and not just from the imperious surgeon who insists that there's nothing wrong with Sacks now that his leg has been repaired or the jolly hockey-stick nurse who is copeless when he does not respond to physical therapy.He also learns first hand the terror of being injured, alone, and far from any other humans to rescue him. He experiences the helplessness that can overwhelm a person who not only loses the use of a limb, but as a "patient," loses his identity as an independent person. Sacks' descriptions of his feelings as a patient, sometimes soaring, sometimes despairing, are vividly told and are a reminder to any healthcare worker of the wild fluctuations of emotions that a patient can experience, even from one hour to the next.Another fascinating aspect of the book is its account of the mystery of healing. Sacks describes in great detail the slow and unpredictable experience of recovering the ability to walk again. And he gives special consideration to the process of "re-entry," as he spends time in a sanatorium, among others who are healing, finally venturing out into the world on his own to rediscover himself and his lost independence.Sacks is a vivid and analytical writer, with a rich gift of language. This is a slender book, but much is packed into it. It is a journey through the looking glass for any healthcare worker who has never been hospitalized with a serious and debilitating injury or illness, and should be required reading.

Those who gave this book a negative review have probably never understood up-close the nature of severe neurological problems. Moreover, they must have failed in their reading of his other books to recognize Oliver Sacks' consistent respect, fascination, sensitivity, and intellectual humility when dealing with the neurological complexities of his patients. Here he IS the patient. In other words, this book is operating on several levels, and Sacks is now not only identifying at a clinical distance with what others experience but he is inside the neuro-beast himself and describing with great literary power and sensitivity the horrific inner struggles of that subjective experience! In my opinion, the only Sacks book better than this one is The Man Who Mistook His Wife for a Hat. Sacks is a master storyteller, and A Leg to Stand On is one unique story. No, it's not strictly a neurologist's textbook analysis, but here Sacks walks (or limps?) his talk.

In this the most personal of all his books, neurologist Oliver Sacks tells the story of an injury he sustained while climbing a mountain in Norway and the terrifying, bizarre aftermath when he realized with horror that his leg felt alienated. It did not feel like it was part of his body, but a foreign object somehow attached to him. This sort of disembodiment, with alterations in the mind-body image that affected Sacks deeply, was as confusing as it was frightening. When he finally recovered, he experienced unbounded joy and a new wonder for being properly "oriented" to his body. With insight, learning, and an unusually unbuttoned metaphysical self-revelation in which he discusses his religious background and doubts, Sacks shows how the soul is stirred by the changes in the body. This is an eminently readable book, free from the conglomeration of footnotes and asides that accompany most of Sacks' other books. I read it in one day, fascinated and entertained throughout the reading. Besides being an autobiographical, neurological novel, this book also explores what it is like for the physician to become a patient, how experiencing something firsthand can change the way a physician views and practices medicine, and how the mind-body image so strongly affects our worldviews.