Oliver Sacks

At atime when C. P. Snow’s “two cultures” of art and science seem to bedrifting further apart, Oliver Sacks remains a one-man bridge between them. Duringa writing career spanning nearly 40 years, Sacks has blended his medicalpractice of neurology with his narrative efforts to bring his readers closer tothe wondrous mysteries of consciousness and physical existence. Beginning withhis well-known 1973 account in Awakenings of long-frozen Parkinsonian patients who “wokeup” when given the then-new drug L-Dopa, Sacks has written aboutamnesiacs, prodigies, people living with autism and Tourette’s Syndrome, andthose who are blind, deaf, and both. He has recounted the “paradoxicaltales” of colorblind and memory painters, of musical prodigies who cannotadd two numbers, of those whose memories are frozen in time.

Celebrated for his focuson remarkable “cases,” Sacks has also been criticized by disabilityscholars and activists who have accused him of insensitivity to the humanity ofhis subjects. Sacks has never responded directly to these charges, but his workhas evolved against their backdrop and become more detailed, as heconceptualizes physical difference amid a more elaborated social context. Remarkably,some of Sacks’s views on disability have become indistinguishable from thoseheld by his antagonists.

Sacks writes in his newbook, The Mind’s Eye, that his histories “enlarge the imagination”even as they show the people courageously facing “neurological challengesthat are almost impossible for the rest of us to imagine.” For Sacks thereare no cures, miraculous or otherwise. His subjects live with theirdifferences, and their differences enrich them—and sometimes disable them atthe same time. Even blindness turns into addition by subtraction, a change thatmay deepen one’s awareness of the world.

 

The Mind’s Eye is a collection of case studies unified by the theme of vision. Sacks’ssubjects continue to fascinate: there is the novelist who—as a result of asmall stroke localized in a particular part of his brain—loses his ability toread, but oddly, not to write. He adapts to his condition (called alexia) byteaching himself to read all over again: he traces the shape of each letter inhis mind, sometimes even moving his fingers as he does so. Thus does he read,as it were, by writing. A woman loses the ability to read and to speak, a conditioncalled aphasia, which she masters through her own expressive sign language. Anotherwoman slowly loses the ability to recognize what her eyes are seeing, as a formof brain damage progressively destroys her perceptual faculty; her worldbecomes an alien place through which she learns to cannily maneuver. Incontrast, there is the woman who, after years of monocular vision due tochildhood eye problems, learns to work her eyes in concert, suddenly gainingdepth perception and seeing the world anew.

Andthen there is Sacks himself, who is the main subject of two of his own casestudies in The Mind’s Eye. In one, hewrites about face blindness, a neurological condition (technical name:prosopagnosia) that prevents people from recognizing individual faces. Faceblindness creates social difficulties because it’s so little known—and peoplewith face blindness report awkwardness when they fail to recognize people whomthey have already met. Sacks knows this by experience because he is face blindhimself, and his discussion of prosopagnosia  centers on himself and his own experience.

So does the longestchapter of the book, an account of the author’s treatment for a melanoma of theeye, a regimen that has left him for the moment (and probably forever) withoutthe depth perception that he has actively prized. Indeed, Sacks is anenthusiast of depth perception who has long reveled in the texture thatbinocular vision gives to the visual world. He belongs to clubs of those whoshare his interest, and he collects the stereopticon photos that are theprecursor of 3-D movies, as well as other objects that highlight the depth of avisual field. His medical narrative of his loss of “stereo” vision isat once both poignant and, like all of his writing, methodically matter-of-fact—forSacks values facts as the route that we must follow if we hope to comprehendthe ineffable.

Sacks welcomed me into hiscluttered Greenwich Village office, which is filled with invitingbric-a-brac—something like how I imagined his parents’ London house might havelooked after I read his 2001 autobiography of his youth, Uncle Tungsten. There are brightly-colored mineral samples,magnets and weights, and books and photos and notebooks everywhere.

Lean and trim at 77 thanksto a lifetime long-distance swimming regimen, Sacks betrays his age onlythrough the deliberateness with which he undertakes certain movements, such asrising from a chair. He refers to his advancing years without embarrassment inhis writing and his conversation. He offered me a reading glass—acquired in thewake of the vision problems that he writes about in The Mind’s Eye—when I had to squint at the controls of my voicerecorder (my difficulty focusing being a sign of my own aging eyes), and hemade casual reference to his hearing loss at one point in our conversation. Insome ways, I thought, The Mind’s Eyeis a book about aging as well as vision, for as Sacks gets older he ranges lesswidely and digs more deeply into things.

What follows is an edited transcript of our conversation.

                                                                                              —LeonardCassuto

Leonard Cassuto: Let’s start with your new book. I was reminded while reading The Mind’s Eye that some of your pastcase studies, like “The Case of The Color Blind Painter,” “ToSee and Not See,” and “The Landscape of His Dreams” [from An Anthropologiston Mars (1993)], have centered on vision as well. What made youdecide to return to the subject?

Oliver Sacks: I’m never through with the subject. It’s always there for me torevisit and reconsider. The interest in vision goes back earlier to my firstbook, Migraine. A third of that book was concerned with thevisual disorders of migraine. I think my interests in vision really go rightback to boyhood, and were partly combined with attacks of migraine in which allsorts of visual phenomena could occur. A color could be heightened orattenuated, and things could become flattened or deepened, or disappear to oneside. I’ve had these since I was four or five, and I was frightened of them atfirst, but my mother, who also had these sorts of symptoms, explained them tosome extent. So one of my precocious initiations into neurology comes partlyfrom visual migraines.

LC:Understanding your own special effects, as it were.

OS:Yes. And I was very fascinated by photography as a boy, in particular by stereophotography and color photography and scenic photography as parallels to depthand color and emotion, visually.

LC:And of course you write in The Mind’s Eye about your longtime interest in stereo vision. In one of thecase studies, “Stereo Sue” gains it, while you also write of losingit yourself. Are you deliberately positioning those two stories against eachother?

OS: Weconsidered all possible orderings in the book, but I think the answer is yes.

LC: Itseems that you’re becoming more phenomenological in your recent work. For example, the case of Lillian in “SightReading” [in which a woman gradually loses the ability to recognize thevisual world] leads us to ask whether we really see something if we can’t nameit. I was wondering whether this phenomenological turn reflects any particularorientation on your part.

OS: Idon’t think it’s entirely new. I always have wanted to enter into people’sexperiences as much as one can. Although I think it’s the nature of differentneurological experiences that one can’t enter into them. All of the emotions wecan enter into, we know. We can imagine what it’s like to be King Lear orCordelia or whatever, but I think it’s not easy to imagine being agnosic [i.e.,without the ability to interpret stimuli such as images].

LC:The case of the Tourettic surgeon in Anthropologiston Mars was almost a sociological case study with a very strong emotionalcomponent. It seemed to me that you were asking, “What is it like to livein this guy’s skin?” and trying to communicate that, perhaps based on yourown lifelong interest in Tourette’s.

Some of the case studiesin The Mind’s Eye are going beyond that to ask, “What can weunderstand about the meaning of notbeing able to do a certain thing and having to do something else instead?”  That’s the movement I’m tracing here.

OS: Ithink I’m very much concerned with meanings now, and any abnormality of thepathology of seeing immediately makes me wonder how any of us see, and what it’sabout. I think I am going deeper, but I’m unhappy with the word “phenomenological.”I’m never quite sure what it means, just as I’m slightly unhappy with the word “sociological.”I’m passionately attached to phenomena and sometimes would leave things at thelevel of describing phenomena.

LC:Are you unhappy with “anthropological” as well?

OS:Slightly, although I’ve used it, too.

LC: Weoften have no choice.

OS:Yes, right. I started inventing or using the word “neuroanthropology.”But I can’t exactly say what I’mdoing. I just do it. I have sharp antennae for anomaly and for theunexpected, which has tormented me and forced me to think and maybe go deeperin a way. I think of how paradox is built all the while into everything.

LC:Your earliest books were built around medical case studies, which are in someways a showcase for anomaly. Then your writing often departed from that format,ranging from botany to autobiography. With Musicophilia [2007] and The Mind’s Eye you’ve returned tocase study.

OS:For the moment. (Chuckles.)

LC:Could you talk about The Mind’s Eye in relation to your own career-longorbit around the case study?

OS: Ithink in various ways I’m taking it deeper now. Lillian [the subject in "SightReading" in The Mind's Eye] is amusician, unlike Dr. P. [the title character of Sacks's The Man Who Mistook His Wife for a Hat (1985); both Lillian and Dr. P have agnosia, and sohave trouble processing the information they receive about the world aroundthem]. It was very crucial for me, for example, to visit Lillian at home to seehow she functioned and how she had discovered other ways of doing things.

LC:You are more of a patient and case study subject in The Mind’s Eye than in any book that you’ve written since A LegTo Stand On [1984], excluding your autobiography of course. In TheMind’s Eye, you appear as the main subject in the chapter on face blindnessand in the longest chapter of the book, “Persistence of Vision,” youraccount of your treatment for ocular melanoma and its effect on your vision. Howdoes it affect your approach to a case when you are your own subject?

OS: Idon’t know if it is all that different. I hope that I can treat myself as Itreat my patients, with some sort of mixture of empathy and detachment. Ofcourse there’s more to say in an autobiographical thing because you have directaccess to your unconscious, which you don’t have with anybody else.  

I don’t keep diaries, butwhen I’m on journeys of one sort or another I keep a journal. It may be anexternal journey like Oaxaca Journal or an internal journey like A Leg to Stand On or the story of my eye.  Let me show you how The Mind’s Eye got started.

Here Sacks paused and went to fetch a large armfulof notebooks—his journals—which he thumped on his desk in front of us as aconcrete example. They stayed there for the remainder of the interview.

OS: Doyou feel there’s a fundamental difference between my way of treating myself andtreating others?

LC:The short answer is yes. In your work you’re trying to figure out what it feelslike to have agnosia, for example, and you just noted that when you treatyourself, you know yourself, and so you know what it feels like to havewhatever you have. But one of the formal aspects that struck me here was youruse of a journal format when you describe your cancer and treatment. That chapterabout your illness is arguably the thematic center of The Mind’s Eye, andit’s written in a radically different format than you normally use to talkabout people and their bodies and brains. Why did you make the choice topresent this account as a journal?

OS:Well, the journal is there and continuous. Every so often I depart from thejournal and move more rapidly or the thing would be intolerably detailed. I’mhaunted by what I’ve left out.

LC:Such as?

OS: Idon’t think I’ve adequately described what the world is like for someone whowas intensely stereo-biased and is now stereo-defective. At times I really haddifficulty recognizing common objects because I do not see them as objects inspace anymore but as colored surfaces opposed to one another. I’ve indicatedthis in a way, but perhaps I could have said more. There are ridiculous errorsand conflations. For example, putting on my hearing aid this morning, I waspuzzled by seeing a red flap attached to the hearing aid. I then realized thatit was a red tab which was a foot behind it on the box. I was struck by thefact that the mind would make such an absurd construction. I probably also wenteasier on what I’d written there on some of the emotional aspects of having acancer. But I wanted to concentrate on the visual.

LC:You mean the terror you described at the beginning of the chapter uponreceiving your diagnosis?

OS:Yes.

LC:Why did you leave the story in such raw form?

OS: Ithought it was more authentic and would appear less to be made up, and by thesame token, for the first time I included some Xerox pages with drawings. [Note: These appear as illustrations in The Mind's Eye.] But I don’t know ifthis is entirely new. There are entire pages of my handwritten Oaxaca journalthat are almost identical with the printed page. Now of course that means they’refaithful to the journal. That doesn’t mean that the journal is faithful to myexperiences.

LC: Itsounds like you’re seeking more emotional connection. I found your chapters onyourself in The Mind’s Eye to be more emotional than even yourautobiography in many ways. UncleTungsten is a kind of club sandwich that alternates slices of your personalexperience with the history of science, whereas The Mind’s Eye is alwaysdeeply focused on the experience you’re having, not only ocularly, but alsoemotionally.

OS:  It’s in the moment, and of course UncleTungsten was retrospective, looking back. Although in writing it, I did in fact have to reconstruct various things.

At this point Sacks walked me into the kitchen ofhis atelier. The cabinets were covered with photographs and pictures, withvarious gadgets standing on top of the refrigerator and elsewhere.

OS:  When I was writing Uncle Tungsten, I was sort of papering the walls, very much as mybedroom was papered, and I sort of had to have old electrical machines andthings. I had to reconstruct some sort of actuality around me. I’m veryconcrete in a way. I very much like it when Wittgenstein says a book shouldconsist of examples.

What I said specificallyin The Mind’s Eye about my ownexperience, in condensation from 90,000 words to perhaps 10,000 or so, is veryinadequate to me. I’m tantalized by the inadequacy of all description. Forexample, with Parkinsonism, I think that an adequate description of  someone with Parkinson’s getting up andwalking across the room would require 600 pages of dense prose, and it wouldn’thave an extra word in it. It would also be enthralling and gripping. I likeClifford Geertz’s notion of thick description. Things are never thick enough. Ilike the way how in a novel, ten seconds of consciousness, or thirty seconds ofconsciousness, can take fifty pages to describe.

LC:Then if I follow your thinking, the concrete is the plumb line that leads youinto any sort of useful description of consciousness.


OS: Yes. By the same token I amsomewhat tormented by the linearity of writing in a book. It would be nice if Icould present a globe, with plumb lines dropping from every place, which ispartly why I like footnotes. Kate [Sacks's assistant and frequent collaborator,Kate Edgar] has to restrain me from writing footnotes to footnotes. I thinkanything you look at deeply enough will take you to a great many things.

LC:Let’s shift gears a little bit. You’ve written in the past about your ownshyness, and it figures prominently in the segment of your 1998 PBS series, The Mind Traveler, that’s devoted toWilliams syndrome. The title of the episode was “Don’t be Shy, Mr. Sacks.”Back to The Mind’s Eye now:is your shyness related to your face blindness?

OS:Somewhat, although I think I’m probably overstating the matter defensively. Butwhat is called my shyness, or social phobia, or Asperger’s or whatever, is alarge measure of it. I think I’m shy in addition to being face blind.

LC:Were you aware that you were face blind when you were filming The Mind Traveler?

OS:Yes. I’ve always known I wasn’t very good at this. And I think the crucialthing for me was meeting my brother in Australia in ’85 and finding an almostcomic similarity. We would both get lost and fail to recognize things andpeople.

LC: Ithink one of the great values of your account of face blindness in The Mind’sEye is the way that you discuss how the condition, although increasinglywell understood, is not well known, and therefore constitutes a fairly serioussocial disability. You contrast face blindness to dyslexia, which has attaineda high profile in the public consciousness and is therefore considerably lessstigmatized than it once was. Your job puts you into contact all the time withpeople who are dealing with disabilities both obscure and well-known,conditions that can’t be cured.

OS:You’ve written about this. This has allowed some people to see me as aconnoisseur of freaks.

LC:Yes. How has your thinking about disability evolved over the course of yourcareer as a doctor and writer, and also patient?

OS:Disability is not a word I use very much. I would certainly call Tourette’sSyndrome a disorder, and it is a disorder that may in turn produce variousdisabilities. But it may also produce various abilities, and more and more Iregard Tourette’s syndrome as a whole mode of being. I feel similarly aboutautism. I feel similarly now about blindness and deafness. When [John] Hullwrites of his own blindness, that he sees “deep blindness” as one ofthe concentrated human conditions, I like that way of putting it. I think it’svery important. I partly think of myself, having repudiated all the other “ologies,”as a “clinical ontologist.”

Something I think wascrucial to me was with regard to Deaf people, particularly going to Gallaudetand being sharply reproved for using the phrase “hearing-impaired” bysomeone who said, “you’re sign-impaired.” [Sacks writes of his visitto Gallaudet, a university for the deaf and hearing-impaired, in Seeing Voices (1989).] Deaf people use “deafness” witha small “d” for its medical pathologizing of hearing impairment, butwith a big “D” as denoting a linguistic and ethnic minority and alsoa whole mode of being. By the same token I like the word “mad,”whereas I dislike the word “insane.”

LC:Why so?

OS:Because mad makes no presupposition about deviance or abnormality.

LC:Whereas “insane” is in relation to “sane.”

OS: Yes.And I don’t think that the phenomenon of madness can be fully described as anegation.

LC:This brings to mind the line of Emily Dickinson: “Much madness is thedivinest sense.”

OS: Ilived on City Island for twenty years and there was a woman there, Mary. I don’tknow what her formal diagnosis was, schizophrenic or manic depressive. Butevery so often she would go mad and stand on top of her car and bellow atpeople. But she was a woman of remarkable penetration and toughness and commonsense and humor whom I felt had somehow been seasoned by going through hell, orpossibly heaven and hell. She knew things at a deeper level than most of us.And she was very respected. No one saw her as a patient. She had a sort ofcharisma. Now, I don’t want to romanticize this too much, and no doubt therewere times when she was dangerous or disabled and perhaps had to betranquilized or put away. But I think when she was not acutely psychotic, onecould see the depth of personality and experience and wisdom which perhaps hadsomething to do with what she’d been through.

LC: Itseems to me that some of that awareness may be informing your treatment ofFranco Magnani, the painter in “The Landscape of His Dreams,” whopaints his childhood town entirely from memory, and who has no desire to paintanything else. [In Anthropologist,Sacks writes that Magnani's visions of his childhood home may result from acertain kind of epilepsy.] Magnani is in no way psychotic, but his experienceis informed by a place that most people never get to, whether as a result ofepilepsy or whatever else.

You started this line ofthought as a riff on Tourette’s Syndrome. In a preface you wrote to an omnibuscollection of four of your books in 1990, you talk about how those books relateto your quest to write a book about Tourette’s. It seems that, instead ofwriting the book about Tourette’s, your interest in it has spawned book afterbook.

OS: Ihad forgotten I wrote that preface. I much regret that for various reasons Ididn’t write a book about Tourette’s. I have written six or eight other thingsabout Tourette’s, but I’ve been overtaken and the time has passed.

LC:How has your aging affected your work as a doctor and a writer?

OS: I’mmore and more conscious that time is limited. I feel huge pressure from theunwritten and uncollected work of my own; I think that if I have enoughstrength, I have at least half a dozen books to write. So I’m aware of being alittle frayed around the edges. I have difficulty thinking of proper names. Ithink I’m still intact centrally, I just hope I remain so. I want to go onseeing patients and corresponding and gathering experience to the last. Myfather retired at seventy but went back to work. He re-retired at eighty andagain went back. At ninety, he said he would give up everything except housecalls. I also want to feel free to write about other things. Correspondence isa very crucial part of my life now, especially since, as I get older, I canonly see a limited number of patients. I was seeing patients yesterday, but Itake my time doing that. I love it when people give me detailed descriptions ofhow it is for them and what meaning their condition may have for them.

LC: Doyou think that your treatment of a subject like Lillian, for example, isinflected by your position as an older person now?

OS: Isuspect so. Perhaps this is “Sacks’s later work.”

LC: InSacks’s own view, how does Sacks’s late work compare to Sacks’s early work?

OS: Ithink things are being pondered more deeply, though also in a specific way. Isomewhat fault myself in The Man WhoMistook His Wife for a Hat for being too phenomenological andinsufficiently concerned with process and physiology. I’m now much moreconcerned with this.

LC:Can you describe that distinction between process and physiology?

OS:One of the people I dedicate Musicophilia to is Ralph Siegel, who is aneurophysiologist, a visual neuroscientist. Now, I would sometimes take Ralphwith me to see the colorblind painter, to see Virgil [the subject of "ToSee and Not See": a man who went blind as a child and then regained hissight in middle age with decidedly mixed consequences], and to see “StereoSue” [whose recovery of binocular vision as an adult is detailed in The Mind's Eye]. But he also brings meto his lab to see his monkeys and his work and his experiments. I want as muchas I can to combine some explanation at the cellular level, the chemical level,the systems level, and the neuroscience level, as well as at the clinicallevel. This desire is becoming stronger in me.

LC: Sothese are different forms of the concrete?

OS:Yes, you could put it that way. But to put it another way, I’m more consciouslyplacing myself at the intersection of biology and biography, of mechanism andperson, of universal processes and the individual.

LC:Last question. You say in the preface to Awakeningsthat you were trying to found a romantic medicine. Is that still the way youthink of your goal?

OS: That was very grandiose of me. [Neurologist and Sacks mentor A. R.]Luria talks very beautifully about a romantic science, whatever is meant bythat. It is some sort of deep dealing with the whole and the individual. But atthe same time, I’m very drawn to reductionism and to saying which systems areinvolved. A colleague and friend of mine, Christof Koch, has written anautobiography which has the subtitle “Memoirs of a Romantic Reductionist,”and that sort of describes me as well. I like the way, at the end of the Treatise on Human Nature, Hume contrasts the artist with the anatomist. Theanatomist may not be an artist or become one, but the artist has to know hisanatomy. However, the language and the tone of anatomy are different from thatof art. And yet I want to combine them somehow.

On my way out, Sacks showed me a raised cardboardpanel diagram of a house.

“Cover one eye andlook at this,” he advised, “if you want a sense of what stereo visiongives you.” Now, I’ve read a good deal about stereo vision—not just in The Mind’s Eye—and have often coveredone eye to see if I could perceive the flatness that accompanies a lack ofdepth perception. I’ve never noticed much difference, presumably because mybrain automatically compensates for the lost visual information. But Sacks’sdiagram contained an ingenious optical illusion, and when I covered one eye,the house instantly and dramatically reversed its shape.

“Oh, wow!” Iexclaimed. Sacks looked at me knowingly. “All of my writing,” hesaid, “is devoted to conveying the essence of that ‘Oh, wow.'”

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