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Ideating and Prototyping at Ninety-Three

Mr. MacGregor, a 93 year old resident at the neurology clinic of St. Dunstan’s went to see Dr. Sacks, an in-house psychologist at the time, for a problem that he was told to have, but hadn’t recognized it himself. Dr. Sacks examines Mr. MacGregor and realizes that Mr. MacGregor has a tilted posture, a result of Mr. MacGregor’s Parkinson’s.

The following is taken from chapter 7, On the Level, from Oliver Sacks’ The Man Who Mistook His Wife for a Hat.

It is nine years now since I met Mr. MacGregor, in the neurology clinic of St. Dustan’s, an old-people’s home where I once worked, but I remember him—I see him—as if it were yesterday.

‘What’s the problem?’ I asked, as he tilted in.

‘Problem? No problem—none that I know of… But others keep telling me I lean to the side: “You’re like the Leaning Tower of Pisa,” they say. “A bit more tilt, and you’ll topple right over.”‘

‘But you don’t feel any tilt?’

‘I feel fine. I don’t know what they mean. How could I be tilted without knowing I was?”

‘It sounds a queer business,’ I agreed. ‘Let’s have a look. I’d like to see you stand and take a little stroll—just from here to that wall and back. I want to see for myself, and I want you to see too. We’ll take a videotape of you walking and play it right back.’

‘Suits me, Doc,’ he said, and, after a couple of lunges, stood up. What a fine old chap, I thought. Ninety-three—and he doesn’t look a day past seventy. Alert, bright as a button. Good for a hundred. And strong as a coal-heaver, even if he does have Parkinson’s disease. He was walking, now confidently, swiftly, but canted over, improbably, a good twenty degrees, his centre of gravity way off to the left, maintaining his balance by the narrowest possible margin.

‘There!’ he said with a pleased smile. ‘See! No problems—I walked straight as a die.’

‘Did you, indeed, Mr. MacGregor?’ I asked. ‘I want you to judge for yourself.’

I rewound the tape and played it back. He was profoundly shocked when he saw himself on the screen. His eyes bulged, his jaw dropped, and he muttered, ‘I’ll be damned!’ And then, ‘They’re right, I am over to one side. I see it here clear enough, but I’ve no sense of it. I don’t feel it.’

‘That’s it,’ I said. ‘That’s the heart of the problem.’

The old man suddenly became intent, his brows knitted, his lips pursed. He stood motionless, in deep thought, presenting the picture that I love to see: a patient in the actual moment of discovery—half-appalled, half-amused—seeing for the first time exactly what is wrong and, in the same moment, exactly what there is to be done. This is the therapeutic moment.

‘Let me think, let me think,’ he murmured, half to himself, drawing his shaggy white brows down over his eyes and emphasizing each point with his powerful, gnarled hands. ‘Let me think. You think with me—there must be an answer! I tilt to one side, and I can’t tell it, right? There should be some feeling, a clear signal, but it’s not there, right? There should be some feeling, a clear signal, but it’s not there, right?’ He paused. ‘I used to be a carpenter,’ he said, his face lighting up. ‘We would always use a spirit level to tell whether a surface was level or not, or whether it was tilted from the vertical or not. Is there a sort of spirit level in the brain?’

I nodded.

‘Can it be knocked out by Parkinson’s disease?’

I nodded again.

‘Is this what has happened with me?’

I nodded a third time and said, ‘Yes. Yes. Yes.’

‘So that’s it, is it?’ asked Mr. MacGregor. ‘I can’t use the spirit level inside my head. I can’t use my ears, but I can use my eyes. Quizzically, experimentally, he tilted his head to one side: “Things look the same now—the world doesn’t tilt.” Then he asked for a mirror, and I had a long one wheeled before him. ‘Now I see myself tilting,’ he said. ‘Now I straighten up—maybe I could stay straight . . . But I can’t live among mirrors, or carry one round with me.’

He thought again deeply, frowning in concentration—then suddenly, his face cleared, and lit up with a smile. ‘I’ve got it!’ he exclaimed. ‘Yeah, Doc, I’ve got it!’ I don’t need a mirror—I just need a level. I can’t use the spirit levels inside my head, but why couldn’t I use levels outside my head—levels I could see, I could use my eyes?’ He took off his glasses, fingering them thoughtfully, his smile slowly broadening.

‘Here, for example, in the rim of my glasses . . . This could tell me, tell my eyes, if I was tilting. I’d keep an eye on it at first; it would be a real strain. But then it might become second-nature, automatic. Okay, Doc, so what do you think?’

‘I think it’s a brilliant idea, Mr. MacGregor. Let’s give it a try.’

The principle was clear, the mechanics a bit tricky. We first experimented with a sort of pendulum, a weighted thread hung from the rims, but this was too close to the eyes, and scarcely seen at all. Then, with the help of our optometrist and workshop, we made a clip extending two nose-lengths forward from the bridge of the spectacles, with a miniature horizontal level fixed to each side. We fiddled with various designs, all tested and modified by Mr. MacGregor. In a couple of weeks we had completed a prototype, a pair of somewhat Heath Robinsonish spirit spectacles: ‘The world’s first pair!’ said Mr. MacGregor, in glee and triumph. He donned them. They looked a bit cumbersome and odd, but scarcely more so than the bulky hearing-aid spectacles that were coming in at the time. And now a strange sight was to be seen in our Home—Mr. MacGregor in the spirit spectacles he had invented and made, his gaze intensely fixed, like a steersman eyeing the binnacle of his ship. This worked, in a fashion—at least he stopped tilting: but it was a continuous, exhausting exercise. And then, over the ensuing weeks, it got easier and easier; keeping an eye on the instrument panel of one’s car while being free to think, chat, and do other things.

Mr. MacGregor’s spectacles became the rage of St. Dustan’s. We had several other patients with Parkinsonism who also suffered from impairment of tilting reactions and postural reflexes—a problem not only hazardous but also notoriously resistant to treatment. Soon a second patient, then a third, were wearing Mr. MacGregor’s spirit spectacles, and now, like him, could walk upright, on the level.

As of July 1st, I’m more than half way through the book, The Man Who Mistook His Wife for a Hat and I highly recommend it. It’s brought a greater level of empathy for me especially with those that are going through any sort of psychosis. Also, check out Oliver Sacks’ site for his other books (also highly recommend Musicophiia).

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  • 25 Jun 2010

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