Sunday, 28 April 2019

the power of wish to distort and deny

From the Foreword to the 1990 Edition of Awakenings by Oliver Sacks:

In the summer of 1970, then, in a letter to the Journal of the American Medical Association, I reported these findings, describing the total effects of L-DOPA in 60 patients whom I had maintained on it for a year. All of these, I noted, had done well at first; but all of them, sooner or later, had escaped from control, had entered complex, sometimes bizarre, and unpredictable states. These could not, I indicated, be seen as ‘side-effects,’ but had to be seen as integral parts of an evolving whole. Ordinary considerations and policies, I stressed, sooner or later ceased to work. There was a need for a deeper, more radical understanding.
My JAMA letter caused a furor among some of my colleagues. I was astonished and shocked by the storm that blew up; and, in particular, by the tone of some of the letters. Some colleagues insisted that such effects ‘never’ occurred; others that, even if they did, the matter should be kept quiet, lest it disturb ‘the atmosphere of therapeutic optimism needed for the maximal efficiency of L-DOPA.’ It was even thought, absurdly, that I was ‘against’ L-DOPA — but it was not L-DOPA but reductionism I was against. I invited my colleagues to come to Mount Carmel, to see for themselves the reality of what I had reported; none of them took up my invitation. I had not properly realised, until this time, the power of wish to distort and deny — and its prevalence in this complex situation, where the enthusiasm of doctors, and the distress of patients, might lie in unconscious collusion, equally concerned to wish away an unpalatable truth.