The Fully Immersive Mind of Oliver Sacks
Pioneering neurologist and author Oliver Sacks died Sunday, August 30 at age 82. In his writings about patients’ sometimes bizarre case studies—which he would call “neurological novels”—Sacks was able to draw out the humanity in pathology. Steve Silberman wrote about Sacks’ own case study in 2002.
The thermite bomb was the second of two delivered to Mapesbury Road during the war. The first, a 1,000-pound monster, landed next door, but failed to explode. Sacks remembered both scenes vividly while writing the memoir he published last October, Uncle Tungsten: Memories of a Chemical Boyhood. After the book was published, however, the neurologist and author learned that his memory had deceived him, as memories made unreliable by disorders of the brain had played tricks on the minds of the subjects of his books. His brother Michael told him that, on the night the thermite bomb fell, in fact, they were both away at boarding school.
“I told him, ‘But I can see it now in my mind. Why?’” Sacks recalled last November. Michael explained that it was because their brother David had written them a dramatic letter about the incident. Even after Sacks accepted this as fact, a visual image of the second bomb still burned in his memory. Looking more deeply, however, he noticed a curious difference between his memories of the two bombs. “After the first one fell”—the bomb that didn’t explode—“Michael and I went down the road at night in our pajamas, not knowing what would happen. In that memory, I can feel myself into the body of that little boy. And in the second memory”—the thermite bomb—“it’s as if I’m seeing a brilliantly illuminated scene from a film: I cannot locate myself anywhere in the scene.”
Sacks has been turning his analytical gaze inward more often these days, after four decades of studying the minds of those with such disorders as autism, Tourette’s syndrome, loss of proprioception, and the sudden onset of color blindness. His tales from the borderlands of the mind, translated into 21 languages, have earned Sacks a worldwide readership. This month, he will be awarded the Lewis Thomas Prize by Rockefeller University, given to scientists who have made a significant achievement in literature, and his insights have been ported to a broader range of media than those of any other contemporary medical author. His 1973 book, Awakenings, inspired both a play by Harold Pinter and a 1990 film starring Robin Williams and Robert De Niro. Two years ago, a chapter from An Anthropologist on Mars also got the Hollywood treatment in a movie called At First Sight. His first best-seller, The Man Who Mistook His Wife for a Hat (published in 1985), has been turned into a one-act play, an opera, and a theatrical production in French staged by Peter Brook.
It’s easy to see why directors snatch up the rights to dramatize his patients’ histories. Visiting the home of an ailing music teacher, Sacks pulled the score of Schumann’s Dichterliebe out of his bag and took a seat at the piano while the patient sang, thus discovering that the teacher’s disordered mind became fluid and coherent as long as the music lasted. In the age of two-minute consultations, such stories have an obvious human charm. But less obvious are the ways that Sacks’ methods have pushed against the tide of 100 years of medical practice.
In telling the stories of his patients, Sacks transformed the genre of the clinical case report by turning it inside out. The goal of the traditional case history is to arrive at a diagnosis. For Sacks, the diagnosis is nearly beside the point—a preamble or an afterthought. Since many of the conditions chronicled by him are incurable, the force driving his tales is not the race for a remedy but the patient’s striving to maintain his or her identity in a world utterly changed by the disorder. In Sacks’ case histories, the hero is not the doctor, or even medicine itself. His heroes are the patients who learned to tap an innate capacity for growth and adaptation amid the chaos of their disordered minds: the Touretter who became a successful surgeon, the painter who lost his color vision but found an even stronger aesthetic identity by working in black and white. Mastering new skills, these patients became even more whole, more powerfully individual, than when they were “well.”
By restoring narrative to a central place in the practice of medicine, Sacks has regrafted his profession to its roots. Before the science of medicine thought of itself as a science, at the crux of the healing arts was an exchange of stories. The patient related a confusing odyssey of symptoms to the doctor, who interpreted the tale and recast it as a course of treatment. The compiling of detailed case histories was considered an indispensable tool of physicians from the time of Hippocrates. It fell into disrepute in the 20th century, as lab tests replaced time-consuming observation, merely “anecdotal” evidence was dismissed in favor of generalizable data, and the house call was rendered quaintly obsolete.
Our conceptions of the brain have followed a parallel course toward mechanized models of disease and healing. After the discovery in the 19th century that lesions in the left hemisphere of the cortex caused characteristic deficits in speech, the brain has been conceived as a complex engine built of minutely specialized parts. While the mind—the ghost in this machine—made a worthy object of study for philosophers and psychotherapists, the proper job of the neurologist was mapping the circuits that kept the thing running, and figuring out which parts needed repair if the system crashed.
Until the past decade, the prevailing view of memory among neurologists hadn’t evolved far beyond the ancient idea that traces of experience are embedded as literal images in the cortex—the way a signet ring would make an impression in soft wax, as Plato described. In recent years, however, advancements in cognitive neuroscience have suggested that memories unfold across multiple areas of the cortex simultaneously, like a richly interconnected network of stories, rather than an archive of static files. These subliminal narratives actively shape perception, and are open to retranscription—as when Sacks’ brain revised the memory of his brother’s letter into the image of a bomb. In his books, Sacks has long anticipated this revisioning of the mind from a passive, ghostly decoder of stimuli to an interactive, adaptive, and endlessly innovative participant in the creation of our world.
Now Sacks has turned his healing instrument on himself. In both Uncle Tungsten and a just-published book called Oaxaca Journal—an account of a fern-finding expedition in Mexico—the psyche under examination is his own.
Caption: A periodic table with vials of each element … John Midgley
Caption: …in a neon bulb. John Midgley
Caption: Drawings of early filament lightbulbs. John Midgley
Caption: Photos of scientist-heroes Bohr, Faraday, et al. John Midgley
Caption: A spiraling periodic table underneath a shrine to the element formerly known as “Wolfram”–tungsten. John Midgley
When Sacks agreed to take me along on his expedition into what Henry James called the unvisitable past, I asked what he was most looking forward to seeing in London. “Something that I know will not be there,” he replied. “The great periodic table at the Science Museum in South Kensington.”
In the stratum of memories Sacks mined for Uncle Tungsten, the Science Museum still stands as a temple to the 19th-century heroic tradition in chemistry, when a boy scientist like Humphry Davy could hope to isolate new elements (he eventually discovered six) and devise experiments to overturn theories that had reigned for hundreds of years. When the museum reopened in 1945, the 12-year-old Sacks made eager pilgrimages to its chemistry galleries, which contained flasks, balances, and retorts that had been employed by Davy, Joseph Priestley, and others in the pantheon. Michael Faraday’s own chemical cabinet was on display, along with burners built by Robert Bunsen himself. But it was the sight of the periodic table that came as a revelation to Sacks.
The periodic grid of the elements first appeared in a dream to the Russian chemist Dmitri Mendeleev in 1869. Before falling asleep at his desk, the white-bearded chemist played several rounds of solitaire, and his ordering scheme may have been influenced by the arrangement of suits in the game. The table in South Kensington was an unusual one, containing not only the atomic weight, number, and symbol for each element but also samples of the elements themselves sealed in jars, bequeathed to the museum by one of Napoléon’s heirs.
To the young chemist and neurologist-to-be, this grand display was an irrefutable confirmation that there was order underlying the apparent chaos of the universe, and that the human mind had been keen enough to perceive it. Now Sacks owns half a dozen T-shirts with the periodic table printed on them, along with periodic coffee mugs, tote bags, and mousepads. To spur his memories while writing the book, he filled his rooms in New York with other mnemonic triggers, including X-ray tubes, bits of amber, UV lamps, and a static electricity generator. (His unflappable personal assistant and editor, Kate Edgar, drew the line at radioactive minerals: She feared for the safety of her 9-year-old son and fretted that the hunk of pitchblende might burn a hole in the piano.)
The morning of our visit to the museum, Sacks climbed into our cab carrying what looked like a sleek gray laptop, which seemed out of character—he still writes his books by hand, or on a typewriter. “It’s my cushion,” he explained, adding wistfully, “it’s my companion.” The previous day, his companion had wandered off in a cab without him. Thankfully, the driver returned it to the hotel. Sacks isn’t always so lucky. “I have a great gift for losing things,” he admitted.
Sacks’ propensity for accidentally tossing out checks has resulted in his being banned from opening his own mail at the office. He estimates that he has lost or destroyed as many manuscripts as he’s published. In 1963, he wrote a short monograph about myoclonus, the involuntary twitching of muscles that in its most severe form can be totally debilitating and in its mildest form gives rise to hiccups. He gave his only copy of the paper to a leading expert in the field, C. N. Luttrell, who committed suicide a few weeks later. Sacks was too embarrassed to ask the family for the manuscript. In 1978, another text, written on Alzheimer’s disease, was given to a colleague who misplaced it while moving his office; and a briefcase containing Sacks’ account of watching his first space launch (the shuttle Atlantis in 1991) was stolen by a hotel thief.
“There’s a metaphysical dimension to loss,” Sacks observed in the cab. “I don’t feel like I just left these things somewhere, I feel like there’s an annihilation field around me—they vanish into the abyss. And once they vanish, I have to wonder if they ever existed.”
He reached into the pocket of his sports jacket and produced a Japanese fan—the first of several startling objects to emerge from there, so that I came to think of the coat as having magic pockets. It was a mild winter morning, and the heat was off in the cab, but Sacks commenced fanning, explaining that he had just gotten out of a pool. Water is his native element. He swims two hours a day when he can, as he has for most of his life, scouting out pools on reading tours like a junkie cultivating reliable scores. On dry land, he is made uncomfortable by any excess of heat: He insists that the thermostats in his apartment and hotel rooms be kept at 65 degrees and has been known to show up at his office in swimsuits. As we navigated through the London traffic, he also became anxious about time. He had to be back at the hotel in a couple of hours for a telephone session with his psychoanalyst, who he’s been seeing twice a week for 35 years and who addresses him as Dr. Sacks in classical Viennese fashion.
Sacks’ voice is the voice of his books—precise, probing, and epigrammatic—softened by the slight anomaly that phonologists call the gliding of liquids, so that “bronze” comes out “bwonze,” which gives his speech an endearing boyish quality. Age has mellowed his appearance. Back in 1961, when he was a consulting physician for the Hell’s Angels in California, he set a state weightlifting record for the 600-pound squat. At age 68, with his snowy beard and gold-rimmed spectacles, he still has the cherubic countenance and robust frame of a Reform rabbi who inspires a resurgence of faith in the congregation wives.
Arriving at the museum, we found the entrance dominated by a billboard advertising a new Imax theater (T-REX IN 3-D!). On the second floor, we navigated toward one of the quieter areas of the building—a gallery that seemed almost abandoned. Behind Burmese elephant weights and Chinese calipers, we found one of his old shrines intact: an exhibit devoted to the history of illumination.
Sacks was delighted and sank into a reverie. “We have a very strong feeling in my family about lighting. People take it so much for granted, but the streets were dark until about 1880,” he mused in front of a display of gas mantles invented by Carl Auer von Welsbach. “Welsbach was one of my heroes. I love gas mantles—their filigree becomes incandescent with a greenish-yellow light, which is hugely nostalgic for me.” Approaching a display of sodium lamps, he reached into his pocket and pulled out a spectroscope, comparing the emission spectrum of a high-pressure bulb—a muddy blur—with the distinct, saffron-yellow sodium line of an older low-pressure bulb. “Fuck these high-pressure ones!” he exulted, adding, “I have a sodium lamp in my bedroom. It’s my sun.”
As a boy, Sacks had explored these galleries with the same sense of freedom he felt in the natural world, seeing the periodic table as “the enchanted garden of Mendeleev.” Rather than being frozen in their cases, the museum’s exhibits were living manifestations of the ongoing progress of science. He would run from the museum to the library next door, where he devoured biographies of his heroes, wedding the factual underpinnings of science to the lives and personal quirks of the scientists themselves. Now the old stories awoke in him again. From behind a chunk of uranium (“You don’t have a Geiger counter on you, do you?” he asked), he excavated anecdotes of Marie and Pierre Curie—the walls of their laboratory incandescent with radioactivity, and a bicycle trip they took through France between the discoveries of polonium and radium.
Once Sacks became a neurologist, he learned that recovering stories forgotten by science was crucial for his work with patients. Tourette’s syndrome was considered an extremely rare and possibly fictitious disease when his Awakenings patients fell victim to tics and seizures caused by the experimental drug he had given them, L-dopa. He had to go back to the original reports of Gilles de la Tourette, written in the 1880s, to find useful references to the syndrome in the medical literature. It wasn’t that Tourette’s had been banished for nearly a century, but that the people who suffered from it had become invisible to the medical establishment. Its symptoms—tics and gusts of inappropriate language, elaborate obsessions and fantasies—were hard to pinpoint in the charts and graphs of 20th-century medicine. Only when a drug called haloperidol that could partially alleviate these symptoms came along was Tourette’s “remembered”—recognized as an organic disorder, chemically and genetically based and clearly real.
By exiling the clinical anecdote to the margins of medical practice—to stories passed down in hallways from attending physician to resident—the culture of medicine had blinded itself, forgetting things it had once known. Sacks calls these knowledge gaps “scotomas,” the clinical term for blind spots or shadows in the field of vision.
Our trip to London led to conversations about this period in his life. His twenties were devoted to wandering in Europe and America—often by motorcycle—with a stint in Canada in 1960, where he fought fires in British Columbia and considered joining the Canadian Air Force. That fall, he took an internship at Mount Zion Hospital in San Francisco. One of the things that drew him to the Bay Area was the presence of Thom Gunn, one of the brightest and boldest of the poets who came of age in England in the 1950s. Gunn had settled in San Francisco years earlier with his lover, an American soldier, but grew up a mile or so from the house on Mapesbury Road.
Gunn recalls the burly 27-year-old intern, who at the time went by his middle name, Wolf, telling him that he “wanted to be a writer like Freud or Darwin—someone who wrote literarily, but with scientific accuracy.” Soon, typewritten pages were piling up at Gunn’s door by the hundreds. “Remember when you were 17? When you’d start writing and keep writing through the day and night in fantastic bursts of energy? It’s a wonderful madness, to produce so much. This is how Ollie has been writing books for 30 years,” Gunn says. (The original manuscript of Uncle Tungsten was more than 2 million words long; only 5 percent of this text appeared in the final book.) Gunn enjoyed Sacks’ accounts of his trips across Europe and the North American continent, hitching rides with truckers who would invite him to stash his bike in the bodies of their trucks.
Also included in the journals that Sacks gave Gunn were sharply drawn portraits of the colorful characters who populated the city’s nocturnal underground. One called himself Chick O’Sanfrancisco and dressed in white leather to drive his white Harley up Polk Street; another, “Dr. Kindly,” was a handsome physician and sadist who once dissected his own cat and served the meat as canapés at a party. While these sketches were “horribly accurately sarcastic,” Gunn recalls, he also felt “there was a certain inhumanity to them, a rather nasty adolescent smart-assness, like early Aldous Huxley—getting off on people’s weaknesses. I said to him, ‘You don’t like people very much.’” Sacks was equally stung when someone he’d written about snapped, “Are you a human being or a tape recorder?”
After two years at Mount Zion, Sacks headed south to Los Angeles and then migrated to the Bronx in 1965. There, he met the two sets of patients who would open up his writing and his ability to empathize with his subjects: a group of migraine sufferers at Montefiore Hospital and patients at Beth Abraham who had fallen sick decades earlier with a disease that had been nearly forgotten.
At Montefiore, Sacks saw more than 1,000 patients with migraine. Their symptoms fascinated him: They reported disturbances of speech, hearing, taste, touch, and vision, often seeing geometrical “auras” just before the onset of an attack, which reminded Sacks of both the mystical visions of Hildegard of Bingen and his own experiences with LSD in California. He had to go to a rare-books shelf at a college library, however, to find references to migraine auras. He finally discovered rich descriptions of this phenomenon in a book by Victorian physician Edward Liveing, which in turn contained a reference to a paper written by astronomer John Herschel called “On Sensorial Vision.” Herschel, who himself suffered from migraines, spoke of a “kaleidoscopic power” that he believed was the raw precursor to perception—the brain’s assembly language, as we might say now, laid bare.
Sacks immersed himself in the neglected anecdotal literature of migraine, feeling that every one of his patients “opened out into an entire encyclopedia of neurology.” In a “sudden unintended explosion” in the summer of 1967, he wrote his first book in nine days—or rather, the first incarnation of Migraine, which became the victim of a particularly malevolent form of the annihilation field. When he showed the book to Arnold Friedman, the chief neurologist at Montefiore, in the hope that he would write a foreword, “Friedman’s face darkened,” Sacks says. “He practically snatched the manuscript out of my hands, and asked me how I could presume to write a book. I told him that I had written a book.”
Friedman locked up Sacks’ charts, making the clinical data inaccessible to him. “He told me that migraine was his subject, that it was his clinic, that I was his employee, and that any thoughts I had belonged to him. He said that if I proceeded with the book, he would see that I was fired, and that I would never have another job in neurology in the United States again”—not an idle threat, as Friedman held a senior post in the American Neurological Association. “I was very easily cowed. I mentioned the situation to my father, and he told me, ‘Friedman sounds like a dangerous man. You’d better lie low.’ I lay low, for six months, which were the most depressed, and suppressed, six months of my life.” Then Sacks hatched a plan. He conspired with a janitor at Montefiore to let him into the chart room every night between 1 and 4 in the morning, to transcribe all the data he could. He told Friedman he was returning to England for a vacation. “Are you going back to that book of yours?” Friedman replied ominously. The chief neurologist threatened to fire him—which he did, three weeks later, by telegram.
“I went back to London in a state of terror. Then, after 10 days, I had a change of mood. I thought, ‘I’m free. This man is off my back.’”
He redrafted the pages of Migraine in a week and a half, and took the book to Faber and Faber, who wanted to publish it immediately. Sacks walked directly from the publisher’s office for a celebratory stroll through the British Museum. “I had the most wonderful feeling, because despite internal and external forbidding, I had produced a work,” he told me.
A few months later, Sacks returned to the US, where he began working again at Beth Abraham with the patients he’d seen two years earlier—most of them poor, elderly Jews who had contracted “sleepy sickness” in the global encephalitis epidemic of the 1920s and then lapsed into Parkinsonian limbo. Abandoned by their families and friends, isolated from one another in the structure of the institution, they reminded Sacks of his own desolation at boarding school, where he was beaten repeatedly by a brutal headmaster.
But then L-dopa came.
He put his patients on the experimental drug. After only a few days, men and women who had been transfixed in time and space for nearly half a century, staring at the ceiling in images of living crucifixion, took steps out of their wheelchairs, danced, and sang. Then, as the limits of the drug’s effectiveness became apparent, their newly awakened state was overwhelmed by tics and seizures.
A transformation occurred at Beth Abraham—not just in the patients, but in Sacks. “The essential thing was that I found myself in a position of care and concern for a whole population of abandoned, forgotten, and—it first seemed—hopeless people,” he recalls. “Unlike the movie of Awakenings, where I was portrayed living at some distance away from the hospital, I virtually lived with the patients, spending 16 hours a day with them. I had never been in a situation of such safe intimacy with other human beings.”
Intimacy implied responsibility, not just for the patients’ well-being but for their stories, which defied the limits of traditional case reports. Sacks had transgressed the protocols of clinical practice with his L-dopa experiment: In the weeks after his first patients awakened, he abandoned the idea of a control group. Those given the drug came back into themselves, while those who took the placebo did not. Each patient responded to the drug in a unique way; they then stopped responding in ways that were also unique. “I had to try L-dopa in every patient; and I could no longer think of giving it for 90 days and then stopping—this would have been like stopping the very air they breathed,” he wrote later. “No ‘orthodox’ presentation, in terms of numbers, series, grading of effects, et cetera, could have conveyed the historical reality of the experience.”
He sent off a series of letters to the editors of the standard journals about what had happened at Beth Abraham. In his correspondence, you can hear Sacks straining at the boundaries of what could be said in the impersonal language of clinical observation: “Patient enthusiasm is likely to occur in the initial ‘good’ phase of drug response. Denial or minimization of adverse reactions may lead the doctor to underestimate and postpone necessary action. The requisite action, reduction, or withdrawal of the drug is likely to be strongly opposed by the patient. The third reaction is despair, seen especially during the withdrawal period.” Sacks’ reports were greeted with silence at first, and then with sharp criticism. His experimental methods were questioned, and his accounts were criticized by a colleague at Stanford for reporting “‘adverse’ effects of levodopa that are at variance with most clinical reports.”
The language he needed to tell his patients’ stories had been pushed into the shadows, displaced by the rise of “clinimetrics” and diagnosis by machine. To communicate what happened at Beth Abraham, Sacks had to visit another nearly forgotten area of the medical literature, where a Russian neurologist attempted to comprehend two of the strangest minds the world has ever seen.
Another book by Luria, The Man With a Shattered World, probed a mind in tragic disorder. In 1943, a Russian soldier was brought to Luria’s office in Moscow. A bullet had torn into the left occipito-parietal region of the young man’s brain, and scar tissue had eaten into the surrounding cortex. Waking up in a field hospital, the soldier had seen a doctor approach him and ask, “How goes it, Comrade Zasetsky?” The question made no sense to him. It was only after the doctor repeated it several times that the strange sounds resolved into words. When asked to raise his right hand, he was unable to find it. Luria asked him what town he was from, and he replied, “At home … there’s … I want to write … but just can’t.”
Clearly, Zasetsky’s brain had crashed. To help him, Luria needed to find a way in, conspiring with the only part of his mind that was still intact: the witnessing soul at the center of the storms in his cortex.
With tremendous effort, Luria and his assistants taught Zasetsky how to read and write again. At first, he couldn’t even hold a pencil. The breakthrough came when Luria suggested that he try writing without thinking, allowing the “kinetic melody” of the movements—still remembered in his muscles—to carry his hand along. Slowly, it worked, and Zasetsky began to write out what his mind felt like from the inside. It took him all day to finish half a page, but over the next three decades, he managed to complete a diary more than 3,000 pages long. The Man With a Shattered World was composed as a fugue for two voices: that of the doctor, with his comprehensive knowledge of neuroanatomy, and the other of his patient, who had written that he hoped one day “perhaps someone with expert knowledge of the human brain will understand my illness.”
Luria’s work suggested that the act of recovering one’s own story was itself healing. He called the sort of writing he had done in The Mind of a Mnemonist and The Man With a Shattered World “romantic science.” The two books had a profound impact on Sacks. They suggested a new form of writing that combined the clinical precision of 20th-century neurology with both the humane observations of the great Victorian physicians and the explorations of the psyche that Freud undertook in his own case histories.
In 1972, Sacks went back to London and rented a flat within walking distance of both 37 Mapesbury Road and Hampstead Heath. When he was a boy, his mother had told him long tales about her patients—stories that were, Sacks wrote, “sometimes grim and terrifying, but always evocative of the personal qualities, the special value and valour, of the patient.” His father had also regaled him with such stories. Throughout the summer, Sacks spent his mornings swimming in the ponds on the Heath and his afternoons writing the case histories that formed the heart of Awakenings. To understand what had happened in his patients’ minds, he consulted not only neurological texts but the work of another poet who had become a friend, W. H. Auden, and the meditations on will and identity by the philosopher-mathematician Gottfried Leibniz. At night, he would read the latest installments to his mother. She would interrupt him at points, saying, “That doesn’t ring true.” He reworked them until she said, “Now it rings true.”
After Awakenings was published in 1973, Sacks received a letter from Thom Gunn. “The letter obsessed me for months. I carried it with me. He said that he had been ‘dismayed’ by my early writings and ‘in despair for me as a human being.’ Then he went on to say that the things which had seemed most absent in those earlier writings—empathy, affection—now seemed to be the very organizing principle of Awakenings. He asked me was this due to drugs, to analysis, to falling in love, or just the natural process of maturation? I wrote back and said, ‘All of the above.’”
Sacks received two letters after the book’s publication that were postmarked from Moscow, from Luria himself. They began an intimate correspondence that lasted until Luria’s death in 1977.
The “great crisis” in neuropsychology, as Sacks’ Russian mentor saw it, was reconciling two modes of scientific observation. One reduces complex phenomena to their constituent parts—the way neurology had narrowed its focus from observation of behavior to specific areas in the brain and then to individual neurons—which Luria paralleled with the evolution of chemistry, from the study of gross matter to the study of compounds, to the study of individual atoms and elements. The other mode relies on the description of phenomena and intuition to comprehend the interactivity of whole systems. Either one, he thought, was inadequate without the other.
Luria felt it was particularly crucial to reconcile these two modes when the subject of study was the brain. The left hemisphere does seem to function like an elaborate computer, aggregating the often imprecise or corrupt data of the senses into a panorama of the world at any given moment. But the roles of the right, and of the more recently evolved prefrontal cortex, hinge on such distinctly human qualities as the ability to plan, to imagine, to conceive of past and future, and to adapt to novel conditions. Paul Broca’s studies of brain lesions in the 19th century, and the research that followed in their wake, had been successful at mapping the elements of the brain in isolation, increasing our understanding of how people became sick. Luria’s works of romantic science, on the other hand, were studies of how people got well, even if they remained sick—the ways individuals managed to survive, and even thrive, despite massive disruptions to the usual order of brain business.
These studies require the neurologist to observe the patient engaged in daily life in the world outside the clinic, as Sacks has done. What we call Parkinson’s disease was first noticed by physician James Parkinson in the tics and seizures of afflicted people on the streets of London, not inside the walls of a clinic. But with the advent of mechanized models of the brain and the rage for quantifying behavior, the skills of intuitive, sharp-sighted observation that had distinguished the great minds of medicine began to wane.
In a letter to Sacks, Luria mourned, “The ability to describe which was so common to the great neurologists and psychiatrists of the 19th century … is almost lost now.” Before Luria died, he challenged Sacks to forge a synthesis of literary and scientific observation that would do justice to the operation of the brain in the real world. Sacks undertook Luria’s challenge in The Man Who Mistook His Wife for a Hat, Seeing Voices, and An Anthropologist on Mars.
In these books, Sacks provided the most vivid descriptions we have of the organic capacity for recovery and adaptation that inspired the modern age of network computing. In a book called The Executive Brain, Elkhonon Goldberg marvels at the parallels between the recent evolution of the higher, distributed cortical functions and the growth curve of digital networks: “Computer hardware has evolved from mainframe computers to personal computers to network personal computers … a gradual departure from a predominantly modular to a predominantly distributed pattern of organization reshaped the digital world.” He puzzles over the fact that this “unconscious recapitulation” seems not to have been “guided by the knowledge of neuroscience.” Paul Baran’s original conception of a failure-resistant communications system, however—the blueprint for the Internet—was inspired by conversations with neurobiologist Warren McCulloch, in which McCulloch described the ability of synaptic networks in brain-injured patients to route around damaged tissue (see “Founding Father,” Wired 9.03).
To Sacks, new models of the mind as distributed, adaptive, and endlessly creative confirm what he had already observed in his patients. His method as a physician is to collaborate with his patients to forge new pathways in their brains that restore this capacity for self-healing. He conceives of this work as an act of deep listening, attending to the subtle harmonies and disharmonies in his patients’ behavior—as he wrote in Awakenings, “in an intuitive kinetic sympathy … an ever-changing, melodic, and living play of forces which can recall living beings into their own living being.”
Sacks has raised public awareness of disorders formerly considered very rare, notably Tourette’s syndrome and autism (see “The Geek Syndrome,” Wired 9.12). But in certain quarters, what Sacks “gives to his patients” by turning them into the subjects of best-selling books is still open to debate. A British academic and disability-rights advocate named Tom Shakespeare has christened Sacks “the man who mistook his patients for a writing career.” Alexander Cockburn flamed him in The Nation for being “in the same business as the supermarket tabloids (I MEET MONSTER FROM OUTER SPACE WITH TWO HEADS) only he is writing for the genteel classes and dresses it up a bit (I MEET MAN WHO THINKS HE’S A MONSTER WITH TWO HEADS). The bottom of it is a visit round the bin, looking at the freaks.”
Fordham University scholar Leonard Cassuto, however, points out that Sacks’ case histories have precisely the opposite effect of Victorian freak shows: “Medicine killed the old-time freak show by pathologizing its exhibits. Johnny the Leopard Boy inspires no wonder and awe if you say, instead, that ‘poor John is suffering from vitiligo.’ Sacks is unique because he’s reincarnated the freak show in precisely the same medical language that did so much to end it. People will want to stare, and Sacks is suggesting that the best way to deal with this desire is not to forbid it but rather to shape and direct it, to make the stare into a mutual look, a meeting of two worlds. Sacks uses the case history as a bridge between people with disabilities and the able-bodied majority, placing himself squarely in the middle as the link that forms the span.”
Part of the way Sacks forges that link, of course, is by being visibly weird himself. For an intensely private man, he is open, even exhibitionistic, about things others might find embarrassing, such as his absentmindedness, his ticcish idiosyncrasies, and his geeky ardor for ferns, cephalopods, and Star Trek. Once, while he was rushing down a crowded sidewalk in Manhattan, impatiently muttering, “Get out of my way, fucker,” a man in front of him turned around and glared. “I have Tourette’s syndrome, I can’t help it!” Sacks said, and the man backed down. “I was shielded behind a false diagnosis,” he told me, still amused by the incident.
Another aspect of Sacks’ visibly odd identity is his attachment to solitude. He has never married and has not had a relationship in many years. His two most recent books, however, give the lie to the other false diagnosis frequently aimed at him—that he is asexual. In this new writing, his romance with science has become openly erotic, mining sublimated libido everywhere, even in the cryptogamic botany of cycads and the antiaircraft balloons lofted over London during the war. In Oaxaca Journal, he admires the “charming modesty” of ferns, their “reproductive organs … not thrust out flamboyantly but concealed, with a certain delicacy, on the undersides of leafy fronds.” In Uncle Tungsten, he writes that his “first love object” was a balloon that safeguarded his neighborhood when he was 10: “I would steal over from the cricket pitch when nobody was looking and touch the gently swelling, shining fabric softly. … It recognized and responded to my touch, I imagined, trembled (as I did) with a sort of rapture.”
These polymorphous raptures extend even into the arid regions of the periodic table. After seeing the table in the Science Museum, he wrote in Uncle Tungsten, “I could scarcely sleep for excitement … I kept dreaming of the periodic table in the excited half-sleep of that night. … The next day I could hardly wait for the museum to open.” His love affair with the elements continues today in his dream life. In one recurring scenario, he is hafnium, sitting in a box at the Metropolitan Opera House alongside his companions tantalum, rhenium, osmium, iridium, platinum, gold, and tungsten. Awake, he identifies with the inert gases, a periodic group almost totally resistant to forming compounds. Also known as the noble gases, Sacks imagines them in Uncle Tungsten as “lonely, cut off, yearning to bond.” In Oaxaca Journal, Sacks refers to himself as a “singleton,” which itself sounds like the name of some elementary particle.
The neurologist may have lonely nights—he calls his shyness a “disease”—but he is not without companionship. He has scores of friends and colleagues all over the world who have written books and plays, parsed the language of the deaf, alleviated the misery of devastating disorders, and one, named Patrick, who is the former captain of the starship Enterprise. His walls in Greenwich Village are brightened with paintings by former patients and subjects who became friends, such as the autistic artist Stephen Wiltshire and Shane Fistell, the super-Touretter in An Anthropologist on Mars. His familial inner circle in New York includes his assistant Kate Edgar, his analyst, his swim coach, and his archivist, Bill Morgan, who kept Allen Ginsberg’s sprawling legacy in order for 20 years. (Hunting up missing missives and prodigal journals, Morgan is a human de-annihilation field.) A housekeeper comes in once a week to tame the tornado in his apartment, prepare the orange Jell-O along with the fish and tabouli he eats every day, and generally mother him, as many of his friends seem to do.
As teddybearish Sacks simulacra proliferate in movies like The Royal Tenenbaums, he receives hundreds of letters a month—if not quite so many marriage proposals from strangers as after the movie version of Awakenings. A significant portion of these envelopes contain medical records from people seeking to become patients in his small private practice; many are from those with baffling conditions who are contacting him as a physician of last resort. He still sees patients at Beth Abraham and at the Little Sisters of the Poor in Queens, for which he receives $12 per appointment. Since the publication of Uncle Tungsten, the daily deluge of letters, books, manuscripts, and CDs has been supplemented with specimens of mystery metals, lightbulbs, and periodic tables.
“It used to be here,” he said. “That blank space is where Ollie Sacks had his revelation of infinity and saw God. I identified Mendeleev with Moses, coming down from Sinai with the tablets of the periodic law. I visualize, and can still see as I talk, the inert gases in their huge hexagonal jars—the jars looked empty, but you knew they were there. There were translucent sticks of phosphorus in water, and a fist-sized lump of iridium. It must have been a pound. I adored it. There was chlorine, green and swirling in the jar. I had seen dirty bits of cesium before, but they had a lot of it; it’s the only other golden metal, golden and glinting. Masurium had no atomic weight—it was not clear whether this element had been discovered or not. And crystals of iodine, all sublimed at the top of the bottle.
“That’s where it was. As I close my eyes, I see the cabinet and the cubicles. Do I see a little boy standing there, or am I seeing it through the eyes of that little boy? Just yesterday. And it’s 55 years ago.”
As we got ready to leave, we paused to admire a display of photographs made to be seen through a stereoscope, the Victorian equivalent of a 3-D View-Master. (Sacks’ parents had a huge collection of these images in the house on Mapesbury Road, and now he collects them himself.) In recent years, he has taken pleasure in attending meetings of groups like the New York Stereoscopic Society, where the basis of affinity isn’t just a desire to mingle but a profound and exacting common interest—and one not shared by the mainstream. Oaxaca Journal is dedicated to the American Fern Society and to “plant hunters, birders, divers, stargazers, rock hounds, fossickers, [and] amateur naturalists the world over.” Perhaps in these congregations of loners, Sacks has discovered a kind of cloud chamber—one in which even inert gases, and other rare and noble elements in the human periodic table, might find ways to bond naturally.
By beginning to write his own case history in his recent books, Sacks may be discovering what his patients and readers learned long ago: By sharing the stories of our inner lives, we recover who we are and prepare ourselves for transformation.
“I rather like having the multiple affiliations,” Sacks said, as we stepped out of the museum into the street. “To go from a meeting of the Fern Society to the Mineralogical Club to the Stereoscopic Society. And then I remember I’m a neurologist.”