The River of Consciousness

by Oliver Sacks

  Going along with the sense that a few words, a few steps, may last an unconscionable time, there may be the sense of a world profoundly slowed, even suspended. Louis J. West, quoted in the 1970 book Psychotomimetic Drugs (edited by Daniel Efron), relates this anecdote: “There is a story about two hippies who are sitting in Golden Gate Park. Both are high on ‘pot.’ A jet aircraft goes zooming overhead and is gone; whereupon one hippie turns to the other one and says, ‘Man, I thought he’d never leave!’ ”

  But while the external world may appear slowed, an inner world of images and thoughts may take off with great speed. One may set out on an elaborate mental journey, visiting different countries and cultures, or compose a book or a symphony, or live through a whole life or an epoch of history, only to find that mere minutes or seconds have passed. Gautier described how he entered a hashish trance in which “sensations followed one another so numerous and so hurried that true appreciation of time was impossible.” It seemed to him subjectively that the spell had lasted “three hundred years,” but he found, on awakening, that it had lasted no more than a quarter of an hour.

  The word “awakening” may be more than a figure of speech here, for such “trips” have surely to be compared with dreams or near-death experiences. I have occasionally, it seems to me, lived a whole life between my first alarm, at 5:00 a.m., and my second alarm, five minutes later.

  Sometimes, as one is falling asleep, there may be a massive, involuntary jerk (a “myoclonic” jerk) of the body. Though such jerks are generated by primitive parts of the brain stem (they are, so to speak, brain-stem reflexes) and as such are without any intrinsic meaning or motive, they may be given meaning and context, turned into acts, by an instantly improvised dream. Thus the jerk may be associated with a dream of tripping or stepping over a precipice, lunging forwards to catch a ball, and so on. Such dreams may be extremely vivid and have several “scenes.” Subjectively, they appear to start before the jerk, and yet presumably the entire dream mechanism is stimulated by the first preconscious perception of the jerk. All of this elaborate restructuring of time occurs in a second or less.

  There are certain epileptic seizures, sometimes called experiential seizures, when a detailed recollection or hallucination of the past suddenly imposes itself upon a patient’s consciousness and pursues a subjectively lengthy and unhurried course to complete itself in what, objectively, is only a few seconds. These seizures are typically associated with convulsive activity in the brain’s temporal lobes and can be induced in some patients by electrical stimulation of certain trigger points on the surface of the lobes. Sometimes such epileptic experiences are suffused with a sense of metaphysical significance, along with their subjectively enormous duration. Dostoyevsky wrote of such seizures,

  There are moments, and it is only a matter of a few seconds, when you feel the presence of the eternal harmony….A terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you….During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly.

  There may be no inner sense of speed at such times, but at other times—especially with mescaline or LSD—one may feel hurtled through thought-universes at uncontrollable, supraluminal speeds. In The Major Ordeals of the Mind, the French poet and painter Henri Michaux writes, “Persons returning from the speed of mescaline speak of an acceleration of a hundred or two hundred times, or even of five hundred times that of normal speed.” He comments that this is probably an illusion but that even if the acceleration were much more modest—“even only six times” the normal—the increase would still feel overwhelming. What is experienced, Michaux feels, is not so much a huge accumulation of exact literal details as a series of overall impressions, dramatic highlights, as in a dream.

  But, this said, if the speed of thought could be significantly heightened, the increase would readily show up (if we had the experimental means to examine it) in physiological recordings of the brain and would perhaps illustrate the limits of what is neurally possible. We would need, however, the right level of cellular activity to record from, and this would be not the level of individual nerve cells but a higher level, the level of interaction between groups of neurons in the cerebral cortex, which, in their tens or hundreds of thousands, form the neural correlate of consciousness.

  The speed of such neural interactions is normally regulated by a delicate balance of excitatory and inhibitory forces, but there are certain conditions in which inhibitions may be relaxed. Dreams can take wing, move freely and swiftly, precisely because the activity of the cerebral cortex is not constrained by external perception or reality. Similar considerations, perhaps, apply to the trances induced by mescaline or hashish.

  Other drugs (depressants, by and large, like opiates and barbiturates) may have the opposite effect, producing an opaque, dense inhibition of thought and movement, so that one may enter a state in which scarcely anything seems to happen and then come to, after what seems to have been a few minutes, to find that an entire day has been consumed. Such effects resemble the action of the Retarder, a drug that Wells imagined as the opposite of the Accelerator:

  The Retarder…should enable the patient to spread a few seconds over many hours of ordinary time, and so to maintain an apathetic inaction, a glacier-like absence of alacrity, amidst the most animated or irritating surroundings.

  That there could be profound and persistent disorders of neural speed lasting for years or even decades first hit me when, in 1966, I went to work at Beth Abraham in the Bronx, a hospital for people with chronic illness, and encountered the patients whom I was later to write about in my book Awakenings. There were dozens of these patients in the lobby and corridors, all moving at different tempos—some violently accelerated, some in slow motion, some almost glaciated. As I looked at this landscape of disordered time, memories of Wells’s Accelerator and Retarder suddenly came back to me. All of these patients, I learned, were survivors of the great pandemic of encephalitis lethargica that swept the world from 1917 to 1928. Of the millions who contracted this “sleepy sickness,” about a third died in the acute stages, in states of sleep so deep as to preclude arousal, or in states of sleeplessness so intense as to preclude sedation. Some of the survivors, though often accelerated and excited in the early days, had later developed an extreme form of parkinsonism that had slowed or even frozen them, sometimes for decades. A few of the patients continued to be accelerated, and one, Ed M., was actually accelerated on one side of his body and slowed on the other.*1

  In ordinary Parkinson’s disease, in addition to tremor or rigidity, one sees moderate slowings and speedings, but in postencephalitic parkinsonism, where the damage in the brain is usually far greater, there may be slowings and speedings to the utmost physiological and mechanical limits of the brain and body. Dopamine, a neurotransmitter essential for the normal flow of movement and thought, is drastically reduced in ordinary Parkinson’s disease, to less than 15 percent of normal levels. In postencephalitic parkinsonism, dopamine levels may become almost undetectable.

  In 1969, I was able to start most of these frozen patients on the drug L-dopa, which had recently been shown to be effective in raising dopamine levels in the brain. At first, this restored a normal speed and freedom of movement to many of the patients. But then, especially in the most severely affected, it pushed them in the opposite direction. One patient, Hester Y., showed such acceleration of movement and speech after five days on L-dopa that, I observed in my journal,

  if she had previously resembled a slow-motion film, or a persistent film frame stuck in the projector, she now gave the impression of a speeded-up film, so much so that my colleagues, looking at a film of Mrs. Y. which I took at the time, insisted that the projector was running too fast.

  I assumed at first that Hester and other patients realized the unusual rates at which they were moving or speaking or thinking but were simply unable to control themsel
ves. I soon found that this was by no means the case. Nor is it the case in patients with ordinary Parkinson’s disease, as the English neurologist William Gooddy remarked at the beginning of his book Time and the Nervous System. An observer may note, he wrote, how slowed a parkinsonian’s movements are, but “the patient will say, ‘My own movements…seem normal unless I see how long they take by looking at a clock. The clock on the wall of the ward seems to be going exceptionally fast.’ ”

  Gooddy refers here to “personal” time, as contrasted with “clock” time, and the extent to which personal time departs from clock time may become almost unbridgeable with the extreme bradykinesia common in postencephalitic parkinsonism. I would often see my patient Miron V. sitting in the hallway outside my office. He would appear motionless, with his right arm often lifted, sometimes an inch or two above his knee, sometimes near his face. When I questioned him about these frozen poses, he asked indignantly, “What do you mean, ‘frozen poses’? I was just wiping my nose.”

  I wondered if he was putting me on. One morning, over a period of hours, I took a series of twenty or so photographs and stapled them together to make a flick-book, like the ones I used to make to show the unfurling of fiddleheads. With this, I could see that Miron actually was wiping his nose—but was doing so a thousand times more slowly than normal.

  Hester, too, seemed unaware of the degree to which her personal time diverged from clock time. I once asked my students to play ball with her, and they found it impossible to catch her lightning-quick throws. Hester returned the ball so rapidly that their hands, still outstretched from the throw, might be hit smartly by the returning ball. “You see how quick she is,” I said. “Don’t underestimate her—you’d better be ready.” But they could not be ready, because their best reaction times approached a seventh of a second, whereas Hester’s was scarcely more than a tenth of a second.

  It was only when Miron and Hester were in normal states, neither excessively retarded nor accelerated, that they could judge how startling their slowness or speed had been, and it was sometimes necessary to show them a film or a tape to convince them.*2

  With disorders of time scale, there seems almost no limit to the degree of slowing that can occur, and the speeding up of movement sometimes seems constrained only by the physical limits of articulation. If Hester tried to speak or count aloud in one of her very accelerated states, the words or numbers would clash and run into each other. Such physical limitations were less evident with thought and perception. If she was shown a perspective drawing of the Necker cube (an ambiguous drawing which normally seems to switch perspective every few seconds), she might, when slowed, see switches every minute or two (or not at all, if she was “frozen”), but when speeded up, she would see the cube “flashing,” changing its perspective several times a second.

  Striking accelerations may also occur in Tourette’s syndrome, a condition characterized by compulsions, tics, and involuntary movements and noises. Some people with Tourette’s are able to catch flies on the wing. When I asked one man how he managed this, he said that he had no sense of moving especially fast but rather that, to him, the flies moved slowly.

  If one reaches out a hand to touch or grasp something, the normal rate is about 1 meter per second. Normal experimental subjects, when asked to do this as quickly as possible, reach at about 4.5 meters per second. But when I asked Shane F., an artist with Tourette’s, to reach as quickly as he could, he was able to achieve a rate of 7 meters per second with ease, without any sacrifice of smoothness or accuracy.*3 When I asked him to stick to normal speeds, his movements became constrained, awkward, inaccurate, and tic-filled.

  Another patient with severe Tourette’s and very rapid speech told me that in addition to the tics and vocalizations I could see and hear there were others of which—with my “slow” eyes and ears—I might be unaware. It was only with videotaping and frame-by-frame analysis that the great range of these “micro-tics” could be seen. In fact, there could be several trains of micro-tics proceeding simultaneously, apparently in complete dissociation from one another, adding up to perhaps dozens of micro-tics in a single second. The complexity of all this was as astonishing as its speed, and I thought that one could write an entire book, an atlas of tics, based on a mere five seconds of videotape. Such an atlas, I felt, would provide a sort of microscopy of the brain-mind, for all tics have determinants, whether inner or outer, and every patient’s repertoire of tics is unique.

  The blurted-out tics that may occur in Tourette’s resemble what the great British neurologist John Hughlings Jackson called “emotional” or “ejaculate” speech (as opposed to complex, syntactically elaborate “propositional” speech). Ejaculate speech is essentially reactive, preconscious, and impulsive; it eludes the monitoring of the frontal lobes, of consciousness, and of ego, and it escapes from the mouth before it can be inhibited.

  Not just the speed but the quality of movement and thought is altered in tourettism and parkinsonism. The accelerated state tends to be exuberant in invention and fancy, leaping rapidly from one association to the next, carried along by the force of its own impetus. Slowness, in contrast, tends to go with care and caution, a sober and critical stance, which has its uses no less than the “go” of effusion. This was brought out by Ivan Vaughan, a psychologist with Parkinson’s disease, who wrote a memoir called Ivan: Living with Parkinson’s Disease. He sought to do all his writing, he told me, while he was under the influence of L-dopa, for at such times his imagination and his mental processes seemed to flow more freely and rapidly, and he had rich, unexpected associations of every sort (though if he was too accelerated, this might impair his focus and lead him to tangents in all directions). But when the effects of L-dopa wore off, he turned to editing and would find himself in a perfect state to prune the sometimes too exuberant prose he had written while he was “on.”

  My tourettic patient Ray, while often beleaguered and bullied by his Tourette’s, also managed to exploit it in various ways. The rapidity (and sometimes oddness) of his associations made him quick-witted; he spoke of his “ticcy witticisms” and his “witty ticcicisms” and referred to himself as Witty Ticcy Ray.*4 This quickness and wittiness, when combined with his musical talents, made him a formidable improviser on the drums. He was almost unbeatable at Ping-Pong, partly because of his sheer speed of reaction and partly because his shots, though not technically illegal, were so unpredictable (even to himself) that his opponents were flummoxed and unable to answer them.

  People with extremely severe Tourette’s syndrome may be our closest approximation to the sorts of speeded-up beings imagined by von Baer and James, and people with Tourette’s sometimes describe themselves as being “supercharged.” “It’s like having a five-hundred-horsepower engine under the hood,” one of my patients says. Indeed, there are a number of world-class athletes with Tourette’s—among them Jim Eisenreich and Mike Johnston in baseball, Mahmoud Abdul-Rauf in basketball, and Tim Howard in soccer.

  But if the speed of Tourette’s can be so adaptive, a neurological gift of sorts, then why has natural selection not served to increase the number of “speeders” in our midst? What is the sense of being relatively sluggish, staid, and “normal”? The disadvantages of excessive slowness are obvious, but it may be necessary to point out that excessive speed is equally freighted with problems. Tourettic or postencephalitic speed goes with disinhibition, an impulsiveness and impetuosity that allow “inappropriate” movements and impulses to emerge precipitately. In such conditions, dangerous impulses such as putting a finger in a flame or darting in front of traffic, usually inhibited in the rest of us, may be released and acted on before consciousness can intervene.

  And in extreme cases, if the stream of thought is too fast, it may lose itself, break into a torrent of superficial distractions and tangents, dissolve into a brilliant incoherence, a phantasmagoric, almost dreamlike delirium. People with severe Tourette’s, like Shane, may find the movements and thoughts and reactions of o
ther people unbearably slow, and we “neuro-normals” may at times find the Shanes of this world disconcertingly fast. “Monkeys these people seem to us,” James wrote in another context, “whilst we seem to them reptilian.”

  In the famous chapter in The Principles of Psychology on “Will,” James speaks of what he calls the “perverse” or pathological will and of its having two opposite forms: the “explosive” and the “obstructed.” He used these terms in relation to psychological dispositions and temperaments, but they seem equally apposite in speaking of such physiological disorders as parkinsonism, Tourette’s syndrome, and catatonia. (It seems strange that James never speaks of these opposites, the “explosive” and “obstructed” wills, as having, at least sometimes, a relation with each other, for he must have seen people with what we now call manic-depressive or bipolar disorder being thrown, every few weeks or months, from one extreme to the other.)

  One parkinsonian friend of mine says that being in a slowed state is like being stuck in a vat of peanut butter, while being in an accelerated state is like being on ice, frictionless, slipping down an ever steeper hill, or on a tiny planet, gravityless, with no force to hold or moor him.

  Though such jammed, impacted states would seem to be at the opposite pole from accelerated, explosive ones, patients can move almost instantaneously from one to the other. The term “kinesia paradoxa” was introduced by French neurologists in the 1920s to describe these remarkable if rare transitions in postencephalitic patients who had scarcely moved for years but might suddenly be “released” and move with great energy and force, only to return, after a few minutes, to their previous, motionless states. When Hester Y. was put on L-dopa, such alternations reached an extraordinary degree, and she was apt to make dozens of abrupt reversals a day.