Beyond the Ouija board: dialogue and heteroglossia in the medical narrative.

Abstract

^Beyond the Ouija Board: Dialogue and Heteroglossia in the Medical Narrative* John Wiltshire In the case history of "Leonard L," the last of the narratives about patients that form the central core of Oliver Sacks's Awakenings, Leonard, lying paralyzed in bed, communicates with the outside world by means of "a small letter board."1 Though deprived almost totally of voluntary motion and speech by the effects of viral encephalitis, bereft of normal expressive capacity, Leonard has been able to continue to read, to write reviews—even, so one is told, to run the hospital's library. There is no suggestion that he is in a coma or "dead inside": his ability to write, to communicate by means of his board, assures the reader of that. In Penny Marshall's film version of Awakenings,2 released in 1990, Leonard is a very different figure. He cannot use an alphabet board because he has no movement in his fingers. In fact, he has no movement at all. No longer in the least an intellectual, Leonard is totally wooden, inert. He sits or lies like a zombie, moved, dressed, and manicured by his mother, visually incarnating absence, blankness, and intellectual death. But young Dr. Sayer—the movie's version of Sacks—believes that beneath their post-encephalitic, Parkinsonian inertia the patients are intellectually alive, despite all the scorn the hospital administration pours on this idea, and despite the eminent older neurologist's emphatic declaration that such a possibility is "unthinkable." The film makes much of the patients' capacity for movement if they "borrow the will" of something else—a ball, perhaps, or music. For Leonard, that will evidently is Dr. Sayer's. He provides Leonard, for the first time, * The author thanks Dr. Paul Komesaroff for his helpful comments and suggestions . Literature and Medicine 13, no. 2 (Fall 1994) 211-228 © 1994 by The Johns Hopkins University Press 212 DIALOGUE AND HETEROGLOSSIA IN THE MEDICAL NARRATIVE with a means of communication with the outside world, and the spelling board becomes a ouija board, the traditional means of communicating with the dead via a medium.3 In a close-up shot, we see the hands of the patient on the board, and the hands of the doctor guiding them. Under his hands, Leonard's fingers spell out the letters rilke's PANTHER, which is all that Sayer needs to confirm his faith that Leonard is indeed, despite all signs, fully alive inside, a caged animal pacing behind the bars of his illness. Through the medium of the doctor, under his healing hands, Leonard the patient gains the power of expression, language, a voice. Dr. Sayer is the means through which the patient speaks and, through his speaking, is discovered to experience an inner life. This patient is a distinct individual with a story of his own. Yet at the same time his own voice comes to him through the doctor, who is thus Dr. say-er indeed. This dramatic incident raises a question that is central to modern medicine. What is the status of the patient's story or the patient's voice? As presented in the film, the patient's access to language, to a form of speech, is routed through the doctor. It might, to a skeptical observer, be doubtful whether Leonard does indeed express himself when his words are, literally, in the hands of the physician. The film's visual metaphor defines a difficulty that critics have noted in Sacks's writings themselves. He declares of his patients: "They themselves encouraged me, and said to me from the first, 'Tell our story—or it will never be known.'"4 His patients cannot tell their own stories, yet in transcribing their speech the doctor-narrator often, as commentators have remarked, seems to conflate or merge his imagination and words with theirs.5 In Sacks's earlier writings there is a tendency for the speech of patients to take on the cadences and idiom of the doctor, so that we experience the patient less as an independently existing point of view and experience than as a vehicle of the physician's own construction and understanding of the case. He becomes, like the...