A Leg to Stand On

A leg to Stand On, Oliver Sacks, 1984: 0330325108 (Blackwell’s, amazon.com, amazon.co.uk).

Going for a walk on a Norwegian mountain, Oliver Sacks came across a dangerous bull. He turned and fled. As he was running away down the steep muddy slope he slipped and fell. He tore the huge muscle in his thigh and severed the nerves. A moment ago he was a walking biped; now he was a slug, crawling on two hands and one knee dragging a useless lump of meat down the mountain behind him. At length he reached a farmhouse; he was taken to hospital and operated on; the nerve was reconnected; and he woke up in a hospital bed.

He had lost his leg.

Make no mistake: he was whole, complete and healthy. Every part of his body was present and correct. His head, his trunk, his arms and his leg. And then, on the other side from his leg, a strange large object was attached to his body and sharing his bed with him.

What you hear on the phone when there is silence is not an absence of sound but a faint hiss, put there by the phone companies so that you know you haven’t been disconnected. What your brain feels when nothing is happening to your body is not nothing, but a faint hiss of gravity pulling you this way and that, of warmth and cold, of the skin reporting what it is touching, possibly even of the blood flowing through your veins. Your brain notes all this, and tells your mind, “nothing to report”.

But cut off that connection from a part of the body and the faint hiss disappears – and so too does the body part. Your brain doesn’t say “nothing to report from left leg”, because there is no longer any left leg for nothing to be reported from. Your body doesn’t feel incomplete, any more that it feels incomplete because you can’t feel anything from your third hand or your fourth ear. No wonder having an unexplained extraneous object in the same bed to you, attached to you, is so unnerving. It’s large and organic, but what is it? It isn’t part of you, so why is it there? Patients have been known to fall out of bed, trying to escape these illogical attachments.

At one level this is the story of how that leg came back. First as a surge of overwhelming sensation, sensation pure and simple with no meaning and no origin, for after all there was nowhere for the sensation to come from, no part of the body it could belong to. Then, as it squeezed its way back to the brain’s map of the world, it became a leg; but what a leg! One moment it was six inches long, another it was six feet long, then six inches again. And people came and told him that he was ready to walk on it… how could they talk such nonsense?

This is a story of what it is like to be a patient in the true sense of “passive, helpless, something that people do things to” and of the slow recovery of autonomy and humanity. It is all the more powerful because it is written by a medical man, a psychologist who has seen the very phenomena he is now experiencing, had them described to him by his patients, but who now understands those descriptions for the first time. Interwoven with the narrative is Sacks’s growing understanding of what is happening – at the time, to some extent, and far more afterwards as he corresponds with the world’s greatest psychologists and re-reads some of the books that he read in the past without having realised that this was the experience they were talking about.

It takes humility to accept that one knows nothing, and the more one knows, the harder it is to accept one’s real ignorance. Oliver Sacks has great wisdom but he has greater humility, and he conveys the joy of discovery along with the joy of recovering health.

This is a book full of joyous moments. When it seems impossible that he should ever walk on this constantly shape-shifting lump of jelly that is hardly his, he hears in his head the music of Mendelssohn, and the imagined interior music activates the inner music of his physical being. One moment he is unable to imagine ever being able to walk, or even what walking might be; the next, he cannot imagine that state of inability, for the music has driven it away for ever.

Again, when he has left hospital, passed through the convalescent home, come home and resumed a normal life, the injury means that he can hardly bend his knee. Or does it? His Harley Street specialist sends him round the corner to a swimming pool “for some therapy”. The young lifeguard listens to his story and in the middle, without warning, throws him into the water. Sacks is furious and begins to swim length after length, just to put the whippersnapper in his place; then his rage turns to laughter because in the shock of the sudden splash the knee has forgotten about not being able to bend and has started to work just like any ordinary knee.

There is a pernicious world-view that treats mind and body as two separate things that have become entangled even though they don’t really belong together – and that consequently the body doesn’t really count. The mind is higher than the body, made to contemplate celestial matters; the Enlightenment was built on this idea, and if you are a Buddhist the whole business of having material bodies at all is a ghastly mistake that we need to escape from. A Leg to Stand On is a triumphant refutation of this idea. We are not “mind and body” separately or “body and mind”, but one thing. If we talk about “space-time”, of which space and time are merely aspects, should we talk about “body-mind”?

Whatever the word, we should celebrate it. As well as a heartening narrative of sickness and recovery; as well as a deep and wise reflection on the meaning of the experience; as well as a significant contribution to psychological knowledge and medical practice – this book is that celebration.