Feb 10, 2021
“To See and Not See”: Vision, Understanding, and Oliver Sacks
The science behind Brian Friel’s MOLLY SWEENEY and the article that inspired the play
In Lantern Theater Company’s newly filmed production of Molly Sweeney by Brian Friel, streaming January 22 through March 7, 2021, Molly’s blindness is part of her fulfilled and happy life. Blind since infancy, Molly finds joy in her perception of the world, whether through the scent of flowers and the feel of their petals or the movement of the water around her as she swims. When her husband Frank convinces her to try surgery to restore her sight, she agrees but finds that what she gains in sight may not make up for the loss of the world she knew.
The human eye is made up of many parts, all of which must work precisely in order to produce sight. Light enters through the eye’s outer layer, called the cornea. The pupil contracts or dilates to control how much light enters, and the lens — the clear inner part of the eye that sits behind the iris and pupil — focuses it further before it hits the retina to process the light into images. The retina is the light sensitive tissue that lines the back of the eye.
Embedded in the retina are millions of light sensitive cells, which come in two main varieties: rods and cones. When light strikes either the rods or the cones of the retina, it is converted into an electric signal that is relayed to the brain via the optic nerve. The brain then translates the electrical signals into the images a person sees via the cerebral cortex, which is crucial in perception, memory, and consciousness, among other important neural functions.
In Molly’s case, issues with both her lenses and retinas impact her sight. She has cataracts — a clouding of the normally clear lens caused when tissues within the lens break down and clump together, blocking light. She also has retinitis pigmentosa, a group of rare, genetic disorders that involve a breakdown and loss of rods and cones in the retina. Common symptoms include loss of peripheral and night vision, often progressing to tunnel vision and then low vision. Molly’s case is extreme in that blindness, if it comes at all, usually comes in adulthood rather than infancy; her case starts very early and progresses very quickly.
Cataracts can be treated with routine surgery to replace the damaged lens with an artificial one. But there is no cure for retinitis pigmentosa, only experimental therapies to extend vision. In this video, an RP patient who lost his sight later in life discusses the disease in the context of his firm sense of independence and his marriage — all things Molly navigates as well.
Molly’s particular eye issues are inspired by and mirror those of a man named Virgil, the patient at the center of To See and Not See, an article in The New Yorker by Oliver Sacks that inspired Brian Friel to write Molly Sweeney. Virgil’s fiancée convinced him to have cataract surgery in attempts to restore his sight, which doctors thought was irrevocably lost, and in a medical miracle it succeeded in giving him some sight. His underlying retinitis pigmentosa meant that perfect sight would be impossible, but the cataract removal resulted in a significant improvement.
But the restoration of sight proved to be its own kind of destruction. After the initial excitement and novelty wore off, life as a newly sighted adult proved challenging. Sacks frames Virgil’s dilemma as the difference between seeing and understanding — while Virgil’s eyes could now process light into images, he did not have the visual frameworks to decode those images. His new sight did not correlate with the tactile way he experienced the world for decades, and that purely tactile world was now unreachable. Eventually, his vision worsened again, both from underlying health conditions and, potentially, from his cerebral cortex becoming overwhelmed with the new visual language it was attempting to build and shutting down as a result. Sacks last sees Virgil ill and effectively blind.
Virgil’s troubled voyage into the world of sighted people is consistent with the experiences of the few others who experienced a similar “miracle” over history. Sacks relays the findings of scientists and philosophers from as early as the 17th century, charting the experiences of the few recorded adults who had their sight restored after a lifetime of blindness. There are common themes — especially the challenge of perceiving something sequentially, as one who experiences the world via touch would, and perceiving something in its totality as sighted people do. Virgil and his historical compatriots also have trouble with distance, shadows, and a sense of place.
After the initial euphoria wears off, another common theme is disappointment or aversion to imperfection, such as skin blemishes. This complicated Virgil’s job as a massage therapist (a profession Molly Sweeney shares): seeing the blemishes on the bodies of people he knew so well by touch was upsetting, and he sometimes massaged with his eyes closed to try and access his former way of being. Almost all of the recorded adult patients experienced initial joy followed by enormous difficulties and emotional crises. A few adapted and did well. The rest withdrew, and some fell into deep depression.
In the New Yorker article, Sacks describes the collapse of the “perceptual self.” The worlds each of us perceive are highly individualized, which can be as small as the ways individuals see the same color and as large as experiencing the world through sight versus touch. When the perceptual systems collapse, as they do when one must move from a tactile system to a sighted one, the perceptual self may too, leading to something called Anton’s syndrome: psychic blindness, where one is oblivious to their own ability to see or lack thereof. Sacks theorizes that the overload on the brain in trying to learn to see is so intense that it can shut down and lead to this psychic blindness. It afflicts Virgil in real life, and Molly onstage.
Learning to see is not as simple as learning a new skill, or even like a newborn first learning to see. Unlike newborns, newly sighted adults have to completely reorder their brain’s processing functions, which have been built without the ability to see. Essentially, they have to totally unlearn one way of being and perceiving in order to attempt to build another way of doing so — without the benefit of the newborn brain’s plasticity. For Oliver Sacks’ Virgil and Brian Friel’s Molly, seeing and not seeing are two entirely different ways of being, and the movement from one to the other is a profound neurological and emotional task.
Go behind the scenes: Lantern Artistic Director Charles McMahon on filming Molly Sweeney and bringing theater alive safely onscreen
Molly Sweeney was filmed at St. Stephen’s Theater in Center City Philadelphia in fall 2020, with strict adherence to all CDC, state, and local health and safety guidelines, and is streaming January 22 — March 7, 2021. Visit our website for tickets and information.
