The Neurology of the Soul and the Patient’s Case History

Johnathan Cott made a name for himself by conducting interviews with well-known artists, musicians, and authors. A collection of select pieces previously published from 1970 through 1989 were published last year in a book titled Listening: Interviews, 1970-1989.

In 1985, an interview by Jonathan Cott titled “Oliver Sacks: The Neurology of the Soul” appeared in New Age Journal. You won’t be able to find it by searching online, because the New Age Journal changed its name in 2002 to Body & Soul Magazine. New Age Journal first appeared in 1974, and was considerably ahead of its time. Mythologist Joseph Campbell; spiritual teacher Ram Dass; integrative medicine proponent Andrew Weil, M.D.; women’s health pioneer Christiane Northrup, M.D.; renowned author Deepak Chopra; and life coach Cheryl Richardson all appeared in New Age Journal long before their ideas became popular with the general public. I tend to believe that Cott’s interview prompted Oliver to pen his own essay on the subject of Neurology and the Soul that would appear five years later in The New York Review of Books.

At the time of Cott’s interview in 1985, Sacks had just authored his third book, The Man who Mistook his Wife for a Hat and Other Clinical Tales. Cott writes: “Unpretentious, courteous, jolly, and humane, he is a doctor who embodies and combines the ‘old-fashioned’ qualities of wisdom teacher, healer, and artist; who speaks openly and unembarrassedly about a ‘neurology of the soul’; and whose prose style displays a remarkable sense of grace, strength, exactitude, and passion.”

In his clinical vignettes, Sacks is so involved with the patient’s psyche that one of Cott’s first soft tosses to him is the question as to why Oliver didn’t want to become a psychiatrist instead of a neurologist. To which Sacks replies: “Of course I’m interested in the psyche and in being. But, finally, I’m much too interested in the organic – in the relation between body and mind, between organs and being. It is insufficient to consider disease in purely mechanical terms; in must be considered equally in biological or metaphysical terms … In present-day medicine, by contrast, there is an almost exclusively technical or mechanical emphasis, which has led to immense advances, but also intellectual regression and a lack of proper attention to the full needs and feelings of patients.”

Cott poses the question to Sacks: “As a physician, how do you define your role in the patient’s narrative?” In the course of answering that, Sacks comments: “Hippocrates was called the father of medicine, but he was also the father of medical stories, the father of case history. He gave us words like ‘prognosis’ and ‘prodrome’ – words that indicate that illness has a story and a narrative. And I think that, as at old-fashioned medical schools, you should be able to open any patient’s chart and find his or her story. Of course, there’s always a complex mixture between the patient’s story and the doctor’s rendering of that story. And the more that one can put the patient’s own words in quotes, the better. But then it all has to be deepened and suffused with – though, one hopes, not distorted or reduced by – a physician’s interpretation.”

Kellen Robertson, O.D., wrote a nice piece last year contemporizing the importance of case history. Dr. Robertson observes: “Patient history is a very critical piece to an exam, but is unfortunately often underemphasized and under-appreciated.” It is a useful reminder of checklist or buzzword phrases that prompt the doctor to entertain specific differential diagnoses. But as Dr. Sacks would remind us, it is only the beginning of a clinical dialogue that will set the stage for a productive doctor/patient collaboration and relationship. A complete and effective case history must speak to the neurology of the soul.

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