“‘Clinical notes crashing?’”
Here he becomes eloquent; the matter is clearly close to his heart.
“Meaning wishing one would have beautiful, thoughtful, sensitive, often handwritten descriptions of what people are doing through their lives, of significant things in their lives. And now if you use them without rushing to a diagnosis or [DSM] coding for which one would be paid—in the psychiatric charts you’re liable to see a list of criteria and then say these meet the criteria for schizophrenia, manic depressive Axis III or whatever...”
He laments turning the patient’s mind into a commodity for the pharmacology and health insurance industries. “One may need clarification and consensus ... but not at the expense of what [anthropologist] Clifford Geertz used to call ‘thick description’”—the kind of description that doesn’t lump patients together but looks carefully at their individuality. “And I’m worried about it and my mentor Dr. A.R. Luria worried about it. He would say that the art of observation, description, the comments of the great neurologists and psychiatrists of the 19th century, is almost gone now. And we’re saying it must be revived. I try to revive it after a fashion and so, too, are an increasing number of others who feel that in some ways the DSM has gone too far.”
This is personal for him in two ways.
As a writer and as a scientist, Sacks justly places himself in the tradition of natural scientists like “the great neurologists of the 19th century,” putting “thick description” ahead of rigid prefab diagnosis. It’s a tradition that looks at mental phenomena as uniquely individual, rather than collapsible into classes and codes.
And then, most personal of all, there was the case of his own brother.
“You know, I sort of saw this at home,” he tells me. “I had a schizophrenic brother and he spent the later 50 years of his life heavily medicated and I think partially zombified by this.”
Wishfully, almost wistfully, he tells me about “a little town in Belgium called Geel,” which is “extraordinary because every family has adopted a mad person. Since the 13th century, since 1280,” he says. “I’ve got a little thing I wrote about it, I visited there.”
I’m fairly sure this solution isn’t scalable, as they say, but clearly he believes it’s much more humane than “zombification.” And what an amazing model of communal, loving attentiveness to stricken souls.