Oliver Sacks, the autonomic nervous system, and psychiatric drug withdrawal syndrome

Editors note: My husband, Paul Woodward, who has published quite a few essays on this blog, sometimes sends emails to me about his thoughts on my (and therefore, often, our) circumstance. Sometimes he’s incredibly helpful and insightful both. I’m sharing what he wrote to me yesterday. The below is most of the body of an email. I’ve edited out a couple of sentences that were directed to me more personally at the beginning and the end. Most of it is just as it was written. As way of introduction to those who perhaps are not familiar with this blog, the autonomic nervous system injury that Paul is referring to in myself is the one incurred by psychiatric drugs and their withdrawal. It is essentially a sort of chemical and pharmaceutical and, therefore, iatrogenic brain injury. It’s often referred to as psychiatric drug withdrawal syndrome and in some people can be a severe and debilitating condition. For more information visit: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

By Paul Woodward 

flowerOliver Sacks wrote about a recent phase of his treatment for terminal cancer and it seems to shed a lot of light on what you deal with every day.

Sacks: “The autonomic nervous system, sleeplessly monitoring every organ and tissue in the body, tells one how one is.

The ANS is thus the body’s system of self-awareness. As such, it can be seen as the seat of consciousness, because the experience of how we are, is intimately tied to our sense of who we are.


Curiously, the brain itself has no sense organs, which is why one can have gross disorders here, yet feel no malaise. Thus Ralph Waldo Emerson, who developed Alzheimer’s disease in his sixties, would say, “I have lost my mental faculties but am perfectly well.”

By the early twentieth century, two general divisions of the autonomic nervous system were recognized: a “sympathetic” part, which, by increasing the heart’s output, sharpening the senses, and tensing the muscles, readies an animal for action (in extreme situations, for instance, life-saving fight or flight); and the corresponding opposite—a “parasympathetic” part—which increases activity in the “housekeeping” parts of the body (gut, kidneys, liver, etc.), slowing the heart and promoting relaxation and sleep. These two portions of the ANS work, normally, in a happy reciprocity; thus the delicious postprandial somnolence that follows a heavy meal is not the time to run a race or get into a fight. When the two parts of the ANS are working harmoniously together, one feels “well,” or “normal.”

No one has written more eloquently about this than Antonio Damasio in his book The Feeling of What Happens and many subsequent books and papers. He speaks of a “core consciousness,” the basic feeling of how one is, which eventually becomes a dim, implicit feeling of consciousness. It is especially when things are going wrong, internally—when homeostasis is not being maintained; when the autonomic balance starts listing heavily to one side or the other—that this core consciousness, the feeling of how one is, takes on an intrusive, unpleasant quality, and now one will say, “I feel ill—something is amiss.” At such times one no longer looks well either.

Since wellness is a homeostatic baseline, it naturally becomes a kind of subliminal consciousness — something noticed only through its absence. (read more)

Unwellness, on the other hand, is inherently intrusive. One might learn how to cope with it, but we are not built to get used to it. The purpose of the ANS is to make it impossible to normalize unwellness.

An injury to the ANS has to be the worst kind of injury because it involves the very capacity to experience injury.

People can have all kinds of injuries and diseases in which their sense of malaise is intermittent, but there has to be something much more tormenting when it is your capacity to feel wellness that has itself been injured.

What seems to be saving you and guiding you on a path of healing has been your willingness to feel your unwellness. As you say, you can’t heal what you don’t feel.

I think that for “normal” people, it’s not only difficult to imagine constantly feeling unwell, but it’s also not something we even want to try to imagine.

I know you often say you feel broken, but paradoxically your feeling of unwellness indicates that your ANS is functioning as it should. But whereas other forms of healing can take place in the background, the healing of the ANS is inevitably a foreground process that captures all your attention.

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