Oliver Sacks

I read Oliver Sacks’ obituary almost a year ago. He was what he called an “existential neurologist”, a scientist whose clinical work took him to considerations of human consciousness and the mystery of psycho neurological anomalies. In the intervening year, I’ve intended to write about him, particularly after having seen several documentaries about music and cognitive function, but other bright, shiny conversations pulled me off course.

Sacks began radiation treatment of uveal melanoma in2005, quickly losing sight in his right eye. He wrote about his own compromised vision in The Mind’s Eye, adding case studies of others who had been forced to adapt in order to move through the world with significant challenges to vision or communication. As he had in his previous work, the presentation of the cases, including his own, was precise, compassionate, and fascinating. Eight years later, the cancer metastasised to his liver and brain. He wrote about that as well, essentially taking his leave in an article published in The New York Times. Anticipating his death, Sacks wrote, “Above all I have been a sentient being, a thinking animal on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

Sacks wrote well, expressing complex neurological observation in language an untrained reader could understand and appreciate, detailed and metaphoric; The New York Times would call him, “…the poet laureate of contemporary medicine”.** Although they travelled very different intellectual pathways, Sacks and Sigmund Freud shared keen powers of observation, the ability to ask questions that delivered useful information, and authentic interest in the patients who appear in their case studies. Freud approached cases with a set of convictions about the psyche; Sacks was content to let the cases speak, for themselves. The neuropsychiatric information assembled by Sacks was based on his close observations of the methods his patients used to describe their condition; generalized judgments came after observation of specific behaviors. .

A quick summary of Sacks’ publications indicates the process by which he worked and with which he developed his theoretical (metaphorical) framework: Migraine, Awakenings, A Leg to Stand On, The Man Who Mistook His Wife for a Hat, An Anthropologist on Mars, Seeing Voices, The Island of the Colorblind, Hallucinations, Musicophilia: Tales of Music and the Brain, and The Mind’s Eye. His own experience of disability allowed him to organize information about the disabilities of others, and his clinical experience drove him to suggest therapeutic strategies for treatment. The documentary, Alive Inside: A Story of Music and Memory, and the establishment of the Institute for Music and Neurologic Function bear witness to Sacks’ conviction that music opens pathways to expression for patients otherwise considered unresponsive, particularly those at late-stage Alzheimer’s or Parkinson’s Disease. Sacks wrote about phantom limbs, Body Dysmorphic Disorder, postencephalitic catatonia, Autism Spectrum Disorder, deafness, Tourette’s Syndrome, visual agnosia (the inability to recognize objects, i.e. wife and hat), color blindness, aphasia, and Charles Bonnet Syndrome (vivid hallucinations) with curiosity leavened with an appreciation of the adaptive processes of the brain.

I won’t try to assess the place that Sacks played or will play as a neuroscientist; some critics find his work anecdotal and hyper-sensationalized, an odd choice of word as most of the work does have to do with sensation and perception. I’m interested in three strands of thought that come to me as I read Sacks.

The first is the obvious understanding that the brain is one mysterious, uncharted universe, accessibility to which is limited by the singular experience of every brain owner.

The second is that the only access we have outside of our own paltry sensation is in the accounts of those who have developed a serious, often disabling, brain anomaly; in other words, something in a brain has to be disturbed before we can even begin to conceptualize how it works when no anomaly is present. If pressed, Sacks might have said that neural puzzles, such as phantom limb disorder or hallucinations offer virtually the only opportunity to find out how perception and expression actually work.

The third has less to do with neurobiology and more to do with conceptualization itself, and it is to that strand that I will return after setting the mind stage with a few autobiographical properties.

I fell into my first job, teaching in a boarding school, largely as result of having waited too long to begin applying for graduate school in history, or English, or film, or journalism, or theater, or foreign affairs. I’d rushed through a postponed senior year, grabbing credits where I could and hoping that the GI Bill wouldn’t run out before I managed to get a degree in something. So, newly minted graduate (English and history), I took a breather on Cape Cod for a few weeks and began the laborious process of writing to every school I knew of, with the knowledge that all reasonable posts had been filled, hoping, however, that some debilitating illness had carried off a sizable slice of the faculty, leaving a panicked administrator no choice but to pencil me in as a late hire. I threw in an application to one of the outfits accustomed to placing candidates but prepared myself for the prospect of returning to my former job as a floor slave in a steel slitting factory. Against all odds, I was asked to interview for a teaching job and was offered a position, teaching psychology.

Teaching psychology, an assignment that made me wish I’d taken more than one course in the subject at some point in my many years in college.

OK, it was 1970, and things had become slightly goofy in schools everywhere, including the old New England academies, and the search for “relevance” allowed this bumbling neophyte to trade on his recent experience as late-adolescent college guy. Coats and ties had given way to tie-dyed t shirts; I could only hope things had become loose enough that my vague recollection of Freud and Jung could see me through the first weeks. I grabbed the last six edition of Psychology Today, got at least one chapter ahead in the textbook, and counted on the Socratic Method to see me through the first semester; by Socratic Method, I mean answering every question with a question.

I’d read Walden Two, Brave New World, and seen A Clockwork Orange so I knew all about classical conditioning, operant conditioning, eye-blink conditioning, covert conditioning, and social conditioning. Between Psychology Today, Pavlov and the Skinner box, I was pretty well set for the first term. In the second, we read I Never Promised You a Rose Garden by Joanne Greenberg. My plan was to spend the third generally chatting about personality theory; after all, a theory is just a theory and I figured we all had a personality. I dug out my old copies of The Psychopathology of Everyday Life, Beyond the Pleasure Principle, and The Ego and the Id. Freud’s fingerprints were all over “modern” thought as I understood it in my college days; the celebration of unconscious motivation and compulsion was the stuff of every well informed conversation.

So, I taught personality theory from the Freudian point of view, with a tip of the hat to the behaviorists. I drew diagrams on the board, drew lines from one stage of development to the next, rattled on about Libido, the Death Wish, Id, Ego, and Superego, as if they were all demonstrable facts.

My first encounter with Sacks came only a few years later, with the publishing of Awakenings, documenting his work with patients suffering from encephalitis lethargica at Beth Israel Hospital; these patients were virtually frozen until Sacks administered doses of a newly discovered psychoactive drug, L-Dopa. The story of their liberation is exhilarating, and this early introduction to the complexity of brain chemistry fascinating, but it was the dedication of the book to poet, W.H.Auden and the inclusion of his poem, “The Art of Healing” that attracted me to Sacks as a doctor of rare compassion.

‘Healing’

Papa would tell me,

is not a science

but the intuitive art

of wooing Nature.

I’ve come to admire Freud as a conceptualist, and the identification of unconscious propulsion of our behavior was certainly significant, but my admiration for Oliver Sacks has led me to see Freud’s elaborate psychic architecture as a sort of mythology.

Did I BELIEVE in Freud? Was I a true believer?

I think I was, and that recognition has allowed me to see other examples of mythological expression in a new light. I’ve never dismissed mythology; I’ve long believed that it expressed truths that could not otherwise be expressed.

For the most part.

Greek and Roman gods? I loved the stories, but always felt the Greeks and Romans (pretty clever people) were amusing themselves with fanciful, gossamer tales of riot and romance. Hmmm. As I think about my wholesale adoption of Freudian terminology to explain the working of the human mind, however, I see it as, well, fanciful. There was enough to it to allow me to begin to express the inexplicable, and I have to assume that’s what the accounts of Athena and Minerva accomplished with comparable strength of conviction.

Oliver Sacks chronicled the ways in which the mind works without words, and as a prisoner of words, I’m endlessly fascinated by how language affects self-awareness. I’m grateful for the work he left behind and for his willingness to woo Nature rather than force his will upon it.

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