Medical Tuesday Blog
A Neurologist’s Notebook: THE CATASTROPHE
By Oliver Sacks, MD
THE NEW YORKER | April 27, 2015
In July of 2003, my neurological colleague Orrin Devinsky and I were consulted by Spalding Gray, the actor and writer who was famous for his brilliant autobiographical monologues, an art form he had virtually invented. He and his wife, Kathie Russo, had contacted us in regard to a complex situation that had developed after Spalding suffered a head injury, two summers earlier.
In June of 2001, they had been vacationing in Ireland to celebrate Spalding’s sixtieth birthday. One night, while they were driving on a country road, their car was hit head on by a veterinarian’s van. Kathie was at the wheel; Spalding was in the back seat, with another passenger. He was not wearing a seat belt, and his head crashed against the back of Kathie’s head. Both were knocked unconscious. (Kathie suffered some burns and bruises but no permanent harm.) When Spalding recovered consciousness, he was lying on the ground beside their wrecked car, in great pain from a broken right hip. He was taken to the local rural hospital and then, several days later, to a larger hospital, where his hip was pinned.
His face was bruised and swollen, but the doctors focused on his hip fracture. It was not until another week went by and the swelling subsided that Kathie noticed a “dent” just above Spalding’s right eye. At this point, X-rays showed a compound fracture of the eye socket and the skull, and surgery was recommended.
Spalding and Kathie returned to New York for the surgery, and MRIs showed bone fragments pressed against his right frontal lobe, though his surgeons did not see any gross damage to this area. They removed the fragments, replaced part of his skull with titanium plates, and inserted a shunt to drain away excess fluid.
He was still in some pain from his hip fracture, and could no longer walk normally, even with a braced foot (his sciatic nerve had been injured in the accident). Yet, strangely enough, during these terrible months of surgery, immobility, and pain, Spalding seemed in surprisingly good spirits—indeed, his wife thought he was “incredibly well” and upbeat.
Over Labor Day weekend of 2001, five weeks after his brain surgery, and still on crutches, Spalding gave two performances to huge audiences in Seattle. He was in excellent form.
Then, a week later, there was a sudden, profound change in his mental state, and Spalding fell into a deep, even psychotic, depression.
Now, two years after the accident, on his first visit to us, Spalding entered the consulting room slowly, carefully lifting his braced right foot. Once he was seated, I was struck by his lack of spontaneous movement or speech, his immobility and lack of facial expression. He did not initiate any conversation, and responded to my questions with very brief, often single-word, answers. My first thought, and Orrin’s, was that this was not simply depression, or even a reaction to the stress and the surgeries of the past two years—to my eye, it clearly looked as if Spalding had neurological problems as well.
When I encouraged him to tell me his story in his own way, he began—rather strangely, I thought—by telling me how, a few months before the accident, he had had a sudden “compulsion” to sell his house in Sag Harbor, which he loved and in which he and his family had lived for five years. He and Kathie agreed that the family needed more room, so they bought a house nearby, with more bedrooms and a bigger yard. Nonetheless, Spalding had resisted selling the old house, and they were still living in it when they left for Ireland.
It was while he was in the hospital in Ireland following his hip surgery, he told me, that he finalized a deal to sell the old house. He later came to feel that he was “not himself” at the time, that “witches, ghosts, and voodoo” had “commanded” him to do it.
Even so, despite the accident and the surgeries, Spalding remained in high spirits during the summer of 2001. He felt full of new ideas for his work—the accident, even the surgeries, would be wonderful material—and he could present them in a new performance piece, entitled “Life Interrupted.”
I was struck, and perhaps disquieted a little, by the readiness with which Spalding was prepared to turn the horrifying events of the summer to creative use. Yet I could also understand it, because I had not hesitated, in the past, to use some of my own crises as material in my books.
Indeed, using one’s own life (and sometimes others’ lives) as material is common among artists—and Spalding was a very special sort of artist. . . He wondered sometimes if he did not create crises just for material—an ambiguity that worried him. Had he sold his house as “material”?
One of the special features of Spalding’s monologues was that, onstage at least, he rarely repeated himself; the stories always came out in slightly different ways, with different emphases. He was a gifted inventor of the truth, of whatever seemed true to him at the moment. . .
Ever since, Kathie told me, Spalding had been sunk in depressive, obsessive, angry, guilty rumination about selling the house. Nothing could distract him from it. Scenes and conversations about the house replayed incessantly in his mind. All other matters seemed to him peripheral and insignificant. Previously a voracious reader and a prolific writer, he now felt unable to read or write.
Spalding had had occasional depressions, he said, for more than twenty years, and some of his physicians thought that he had a bipolar disorder. But these depressions, though severe, had yielded to talk therapy, or, sometimes, to treatment with lithium. His current state, he felt, was different. It had unprecedented depth and tenacity. He had to make a supreme effort of will to do things like ride his bicycle, which he had previously done spontaneously and with pleasure. He tried to converse with others, especially his children, but found it difficult. His ten-year-old son and his sixteen-year-old stepdaughter were distressed, feeling that their father had been “transformed” and was “no longer himself.”. . .
In September of 2002, Spalding jumped off his sailboat into the harbor, planning to drown himself (he lost his nerve and clung to the boat). A few days later, he was found pacing on the Sag Harbor bridge, eying the water, until the police intervened and Kathie took him home.
Soon after this, Spalding was admitted to the Payne Whitney Psychiatric Clinic, on the Upper East Side. He spent four months there, and was given more than twenty shock treatments and drugs of all kinds. He responded to none of them, and, indeed, seemed to be getting worse by the day. When he emerged from Payne Whitney, his friends felt that something terrible and perhaps irreversible had happened. Kathie thought that he was “a broken man.”. . .
In July, when Spalding first came to see Orrin and me, I asked him if there were any other themes besides the sale of his house that he ruminated about. He said yes: he often thought about his mother and the first twenty-six years of his life. It was when he was twenty-six that his mother, who had been intermittently psychotic since he was ten, fell into a self-torturing, remorseful state, focused on the selling of her family house. Unable to endure her torment, she had committed suicide.
In an uncanny way, he said, he felt that he was recapitulating what had happened with his mother. He felt the attraction of suicide and thought of it constantly. He said he regretted not having committed suicide at the U.C.L.A. hospital. Why there? I inquired. Because one day, he replied, someone had left a large plastic bag in his room—and it would have been “easy.” But he was pulled back by the thought of his wife and his children. Nevertheless, he said, the idea of suicide rose “like a black sun” every day. He said the past two years had been “gruesome,” and added, “I haven’t smiled since that day.” . . .
There was a brief, dramatic break in Spalding’s rumination just a week before he came to see us, when he had to have surgery because one of the titanium plates in his skull had shifted. The operation took four hours, under general anesthesia. Coming to from the anesthesia and for about twelve hours afterward, Spalding was his old self, talkative and full of ideas. His rumination and hopelessness had vanished—or, rather, he now saw how he could use the events of the past two years creatively in one of his monologues. But by the next day this brief excitement or release had passed. . .
But the frontal lobes also exert an inhibiting or constraining influence on what Pavlov called “the blind force of the subcortex”—the urges and passions that might overwhelm us if left unchecked. (Apes and monkeys, like children, though clearly intelligent and capable of forethought and planning, are relatively lacking in frontal lobes, and tend to do the first thing that occurs to them, rather than pausing to reflect. Such impulsivity can be striking in patients with frontal-lobe damage.) There is normally a beautiful balance, a delicate mutuality, between the frontal lobes and the subcortical parts of the brain that mediate perception and feeling, and this allows a consciousness that is free-ranging, playful, and creative. The loss of this balance through frontal-lobe damage can “release” impulsive behaviors, obsessive ideas, and overwhelming feelings and compulsions. Were Spalding’s symptoms a result of frontal-lobe damage or severe depression, or a malignant coupling of the two?
Frontal-lobe damage can lead to difficulties with attention and problem-solving, and impoverishment of creativity and intellectual activity. Although Spalding felt that he had not had any intellectual deterioration since the accident, Kathie wondered whether his unceasing rumination might not, in part, be a “cover” or “disguise” for an intellectual loss that he did not want to admit. Whatever the case, Spalding felt that he could no longer achieve the high creative level, the playfulness and mastery, of his pre-accident performances—and others felt this, too. . .
January 10, 2004, Spalding took his children to a movie. It was Tim Burton’s “Big Fish,” in which a dying father passes his fantastical stories on to his son before returning to the river, where he dies—and perhaps is reincarnated as his true self, a fish, making one of his tall tales come true.
That evening, Spalding left home, saying he was going to meet a friend. He did not leave a suicide note, as he had so often before. When inquiries were made, one man said he had seen him board the Staten Island Ferry.
Two months later, Spalding’s body was washed up by the East River. He had always wanted his suicide to be high drama, but in the end he said nothing to anyone; he simply disappeared from sight and silently returned to the sea, his mother.
Read Dr. Oliver Sacks’ entire medical narrative of Spalding Gray’s frontal lobe injury in The New Yorker, April 27, 2015. . .
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