A Famous Case of Spontaneous Recovery
A Famous Case of Spontaneous Recovery
Hidden in Oliver Sacks’ fascinating recent book, Hallucinations, is a surprising tale of recovery. If you aren’t paying attention you may not notice it, since the language typically used to describe such experiences is scrupulously avoided. That’s why stories like his—which are actually far more common than recoveries that involve rehabs or 12-step groups—often go unrecognized. But they are critically important if we want to truly understand addiction.
For those unfamiliar with him, Sacks is America’s neurologist, best known as the brilliant doctor portrayed by Robin Williams in the film version of his book, Awakenings. That book told the story of patients with a now-rare form of Parkinson’s disease. They were “frozen” in their bodies following a bout of encephalitis, often unable to move or to stop involuntary motions, until a drug Sacks was testing briefly freed them. For many, the drug’s side effects, sadly, soon proved worse than the illness. Sacks’ meditations on his patients’ experiences and what can be learned from people with brain diseases that affect the self and the will paved the way for many of today’s most popular writers on neuroscience.
His empathy for people suffering perturbations of the brain and nervous system is hard won.
Some of Sacks experiences of drugs certainly sound like they could end up in an NA qualification. Since hallucination—not addiction or drugs—is the main focus of the book, however, these are treated as asides rather than the main event they would be in your typical addiction memoir.
Take a visit he had with a psychoanalyst friend of his parents, who went to see him while he was doing his medical residency in California. She apparently had learned a bit about his regular use of marijuana and psychedelic drugs and said, “You need help, Oliver. You’re in trouble.” But his dismissal of this concern as “nonsense” was not later reframed as denial, even though he subsequently had a hallucinatory incident in which he mistook her for an imposter who had for some inexplicable reason posed as his family friend.
Sacks goes on to describe the summer of 1965, when he had a break between the end of his residency and the start of a brain research fellowship in New York:
“It was during this idle, mischievous time that I descended deeper into drug taking, no longer confining it to weekends. I tried intravenous injection, which I had never done before."
After starting the fellowship, he found it a bad fit for his skills:
“Depressed and insomniac, I was taking ever increasing amounts of chloral hydrate [a sedative] to get to sleep and was up to 15 times the usual dose every night.”
When he ran out, he found his hand shaking as he tried to cut a brain slice for an experiment. Leaving the lab to get coffee, he began hallucinating. It was only when he called a doctor friend that he realized that he was suffering from withdrawal: as with alcohol, abrupt cessation of chloral hydrate can produce delirium tremens, or the DTs. He hallucinated for 96 hours, getting medical support from the friend. But undeterred from drug use after this experience, he then began taking high doses of amphetamine every weekend.
If you are used to 12-step qualifications, you probably expect what came next to be a “bottom,” followed by an admission of addiction. Except Sacks’ drug story ends quite differently. One day, he had an intense experience while high on amphetamine that inspired him to write a book:
“On every previous occasion, when I had come down after two days of amphetamine-induced mania, I had experienced a severe reaction in the other direction, feeling an almost narcoleptic sense of drowsiness and depression. I would also have an acute sense of folly, thinking that I’d endangered my life for nothing—amphetamines in the large doses I took would give me a sustained pulse rate close to 200 and a blood pressure of I know not what; several people I knew had died from overdoses of amphetamines.”
Fortunately, however, this time was different:
“I retained a sense of illumination and insight…. Bit by bit, I started to write my own book. The joy I got from doing this was real—infinitely more substantial than the vapid mania of amphetamines—and I never took amphetamines again.”
In Sacks’ case, most of us know the rest of his story: he goes on to become a leading neurologist, bestselling author and New Yorker writer, though his fame comes long after the publication inspired by that experience, which was a book called Migraine, dealing with the hallucinations and other strange phenomena associated with the dreaded headaches.
Was Sacks an addict? By his own account, he likely would have met enough DSM criteria to be diagnosed, displaying tolerance, withdrawal and compulsive use of drugs despite negative consequences. And yet the neurologist and author never defined himself this way. When I interviewed him for Time in 2010, I asked him directly, and he replied, regarding his amphetamine use, “Well, it certainly became a habit.”
Is his story unique? Hardly—although the successful book-writing aspect is definitely rare. At least 60% of people who would qualify for an addiction diagnosis at some point in time never seek treatment, and most resolve the problem without total abstinence.
For example, a major study of some 43,000 Americans examined whether people had had a lifetime diagnosis of substance dependence or were actively addicted in the past year. 7.7% had at one time in life qualified for a drug addiction diagnosis, but only 1.4% were currently addicted. And only 38% had ever been treated (the definition of treatment included attending NA or other self-help groups). For alcohol, 12.5% of this group had at one time met full criteria for alcoholism, but only 3.8% were currently dependent. 76% had never attended AA or received any type of treatment.
Much of this recovery did not involve total abstinence: of the 48% of people in this sample who had alcoholism in the past year and recovered, 37% were considered “low-risk” drinkers, 25% didn’t have symptoms of dependence but were considered at high risk for relapse, and just 38% were complete abstainers.
What this means is that the path to recovery that most people think is most common—attending 12-step meetings either with or without some additional treatment, completely abstaining from all psychoactive substances that aren’t prescribed—is actually the unusual one. Between two-thirds and three-quarters of people who recover don’t receive any type of treatment, and only about 40% abstain entirely, at least with the legal drug alcohol.
Moreover, people who take the path of what researchers variously call “natural recovery,” “maturing out” or “spontaneous remission”—like Sacks—tend not to identify as addicts. Although this is the opposite of what people who are helped by AA generally find, for many people, taking on this stigmatized identity can have a crippling effect. Believing that being an addict means being powerless over the problem makes matters worse in these cases: a study by pioneering alcoholism researcher William Miller found that such belief made any relapses that occurred far more dangerous.
Oliver Sacks' ability to take joy in this work replaced the “vapid mania of amphetamines."
Thinking that you can’t stop once you have started, after all, provides little incentive to try. And seeing yourself as an addict, with all the negative qualities our society projects onto us—lying, manipulative, untrustworthy, selfish—can produce despair rather than an attempt to confront the stereotype.
So how do people recover without treatment or support groups? Here Oliver Sacks’ story is also instructive. As a young man, Sacks had many things going for him. His parents were both doctors—so he didn’t exactly come from poverty. He had become a physician himself: he is both extremely intelligent and highly educated. Both having financial resources and being well educated are linked with greater success at any type of recovery.
But probably most importantly, Sacks found in writing an alternative source of pleasure and purpose. His ability to take joy in this work—even when it was not his primary source of income—replaced the “vapid mania of amphetamines”; more critically, writing was more meaningful than taking drugs.
“Natural recovery” is often called “maturing out” in part because as people grow up, they tend to find a place for themselves in society, one that ideally gives them a sense of being useful and engaged. It’s a lot easier to binge-drink in college and miss a few classes than it is to do so if it means possibly losing a job; similarly, being in a committed relationship—especially with kids—entails responsibilities that aren’t easily avoided without conflict but that one has often chosen and wants to fulfill.
Some addicted people are lucky enough to see their alternatives and recognize that they can provide equal or better sources of what they seek in their drugs—options that can channel compulsive drives but don’t have to become destructive addictions. Some are also lucky enough not to be caught in illegal activities and punished in ways that limit their future options and lower the odds of recovery.
Oliver Sacks has given the world great gifts through his writing about neuroscience and his compassionate treatment of patients. He says, in fact, that his drug experiences were important to his ability to empathize: having had hallucinations, for example, made him better able to understand his patients who struggled with them. Imagine what not only he but the rest of us would have lost if he had just been written off as a drug addict, a danger to medicine who should never be allowed to practice.
Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).