In Chapter Ten, Sacks discussed a mild case of Tourette’s. However, Tourette’s can also cause more severe cases, in which the patients seem to be possessed and become violent. Around the time that he was studying Ray, while walking through the streets of New York, Sacks noticed many people who were clearly suffering from Tourette’s. One reason why Tourette’s patients went undiagnosed for most of the 20th century is that Tourette’s in its severest forms is hard to study in a lab—to really get a sense for it, you have to watch it in a public place. One could say that there are certain conditions, such as Parkinson’s and Tourette’s, for which “street neurology” is the best way of understanding them. Indeed, James Parkinson, the doctor who identified Parkinson’s disease, noticed the disease for the first time while walking through the streets of London.
In this section, Sacks implicitly critiques the practice of neurology as it exists in America in the 1970s and 1980s. As he sees it, neurology has become too clinical, too mechanical, and too concerned with observing patients in a laboratory setting. As a result, neurologists failed to understand disorders like Tourette’s Syndrome—both how it worked and how common it really was. There are some disorders that can only be fully understood with “street neurology,” and Tourette’s is only one example.
While walking through New York after meeting with Ray, Sacks came across a woman in her sixties who seemed to be having some kind of fit. On closer inspection, Sacks realized that she was caricaturing passersby, albeit in a convulsive, not entirely intentional way. Sacks was so struck by the elderly woman that he proceeded to spend hundreds of hours talking to and observing Tourette’s patients.
The behavior of the woman is important for Sacks’s understanding of Tourette’s because it’s not entirely intentional or unintentional. In a counterintuitive way, the woman’s behavior is analogous to the nonchalant affect adopted by Mrs. B. in the previous chapter—like Mrs. B., the elderly woman seems to be using forms of humor to distance herself from her own illness and maintain some control over her own life.
From his research, Sacks concluded that, not unlike a Korsakov’s patient, a “super-Tourette’s” patient like the elderly woman is driven by strong impulses, and can choose to give into the impulse or repudiate it. Where most people’s minds shield them from a constant stream of impulses, super-Tourette’s patients’ minds are bombarded with impulses. The life of a super-Tourette’s patient is a flux-state, in which there is no stable “I.” In the face of this constant flux, the patient is forced to fight to claim any identity. The miracle is that, in many cases, the super-Tourette’s patient finds successful ways of doing so.
Sacks interprets the elderly woman’s behavior as a struggle for identity, not unlike the struggles of William Thompson or Mrs. B. The elderly woman finds ways to adapt to her neurological problems, at once embracing her erratic, tic-like behavior and distancing herself from her own behavior with humor and performance. Sacks sees Tourette’s patients’ behavior as nothing short of heroic—they’re fighting for a self, and, unbelievably, they often succeed.