The Mind's Eye

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Overview

In The Mind’s Eye, Oliver Sacks tells the stories of people who are able to navigate the world and communicate with others despite losing what many of us consider indispensable senses and abilities: the power of speech, the capacity to recognize faces, the sense of three-dimensional space, the ability to read, the sense of sight. For all of these people, the challenge is to adapt to a radically new way of being in the world.

There is Lilian, a concert pianist who becomes unable to read music and is eventually unable even to recognize everyday objects, and Sue, a neurobiologist who has never seen in three dimensions, until she suddenly acquires stereoscopic vision in her fifties.

There is Pat, who reinvents herself as a loving grandmother and active member of her community, despite the fact that she has aphasia and cannot utter a sentence, and Howard, a prolific novelist who must find a way to continue his life as a writer even after a stroke destroys his ability to read.

And there is Dr. Sacks himself, who tells the story of his own eye cancer and the bizarre and disconcerting effects of losing vision to one side.

Sacks explores some very strange paradoxes—people who can see perfectly well but cannot recognize their own children, and blind people who become hyper-visual or who navigate by “tongue vision.” He also considers more fundamental questions: How do we see? How do we think? How important is internal imagery—or vision, for that matter? Why is it that, although writing is only five thousand years old, humans have a universal, seemingly innate, potential for reading?

The Mind’s Eye
is a testament to the complexity of vision and the brain and to the power of creativity and adaptation. And it provides a whole new perspective on the power of language and communication, as we try to imagine what it is to see with another person’s eyes, or another person’s mind.

From the Hardcover edition.

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Editorial Reviews

From Barnes & Noble

For most of us, seeing is so intrinsic that it seems closer than our fingertips. When we lose our sight or it is altered in some unexpected way, our perceptions are often reconstructed in radical ways. Oliver Sack's The Mind's Eye ventures into this dark terrain through the case histories of six individuals whose lives have been affected by changes in their vision. The neurologist/ psychiatrist includes himself among the subjects, discussing his experiences after a tumor appeared in one of his eyes. As always, the author who approaches subjects with freshness of an anthropologist on Mars (a title of one of his books) illuminates a topic close at hand. A bestseller in a new paperback and NOOK Book.

Publishers Weekly
Sacks, a neurologist and practicing physician at Columbia University Medical Center, and author of ten popular books on the quirks of the human mind (The Man Who Mistook His Wife for a Hat) focuses here on creative people who have learned to compensate for potentially devastating disabilities. From the concert pianist who progressively lost the ability to recognize objects (including musical scores) yet managed to keep performing from memory, to the writer whose stroke disturbed his ability to read but not his ability to write (he used his experience to write a novel about a detective suffering from amnesia), to Sacks himself, who suffers from "face blindness," a condition that renders him unable to recognize people, even relatives and, sometimes, himself (he once confused a stranger's face in a window with his own reflection), Sacks finds fascination in the strange workings of the human mind. Written with his trademark insight, compassion, and humor, these seven new tales once again make the obscure and arcane absolutely absorbing. (Oct.)
Library Journal
Sacks (neurology & psychiatry, Columbia Univ. Medical Ctr.;The Man Who Mistook His Wife For a Hat) continues his successful stream of books on the quirky aspects of psychiatry with this latest, which explores the fascinating stories of six people who have learned to navigate the world and communicate with others despite losing one of their key senses and abilities, e.g., the power of speech, the capacity to recognize faces, the sense of three-dimensional space, and the ability to read. Also revealed is the author's own dramatic story of a tumor in one eye that left him unable to perceive depth. As in all Sacks's works, readers will learn about fundamental facets of the human experience while better understanding the unpredictable new ways the brain can find to perceive, which allows it to create complete images of the world. Sacks delivers a richly detailed examination of various paradoxical medical conditions while he wrestles with more fundamental clinical questions, such as how humans really see and think. VERDICT The author's well-known style creatively balances complex medical discussion, which will appeal to professionals on the one hand, with solid, down-to-earth prose, which will attract his legion of fans interested in the human condition on the other.—Dale Farris, Groves, TX
Kirkus Reviews

Sacks (Neurology and Psychiatry/Columbia Univ.; Musicophilia: Tales of Music and the Brain, 2007, etc.) once again uses the experiences shared with him by patients and others to probe "the complex workings of the brain and its astounding ability to adapt and overcome disability."

The author provides six case histories of patients with intriguing vision problems, beginning with the story of a 67-year-old concert pianist who consulted him over her loss of the ability to read music—although she could still perform it brilliantly from memory, and even transpose a Haydn string quartet piece which she played on the piano. She also suffered from increasing spatial disorientation and difficulty recognizing everyday items. MRI tests showed increasing neurologic damage, but this did not lessen her keen insight into her own condition, even though her ability to manage independently declined. In "Face-Blind," Sacks examines his own congenital difficulty—"trouble with faces and places"—which remains a problem for him at age 76. He even once confused the face of a man seen through a window with a supposed mirror image of his own face—both sported heavy beards. The author compares his adult experience losing stereoscopic vision after suffering a tumor in one eye to that of a previously cross-eyed woman who gained it after a correction allowed her to focus both eyes. Both described a flattened perception of depth when using only one eye. Similarly, Sacks ponders the ability of the blind to visualize scenes that are described to them in vivid detail. "If there is indeed a fundamental difference between experience and description," he writes, "between direct and mediated knowledge of the world, how is it that language can be so powerful?"

As usual with Sacks, an absorbing attempt to unravel the complexities of the human mind.

Annie Murphy Paul
The Mind's Eye is a collection of essays—some of which have already appeared in The New Yorker—but it has a remarkably graceful coherence of theme, tone and approach. Once again, Sacks explores our shared condition through a series of vivid characters…Sacks would seem to be the ideal doctor: observant but accepting, thorough but tender, training his full attention on one patient at a time. For the patient's benefit and for ours, he illuminates every uncanny detail, brings out every excruciating irony.
—The New York Times
Library Journal
Neurologist Sacks (www.oliversacks.com), who in Musicophila (2007) explored the human sense of hearing, once again mines his practice for fascinating case studies, this time to explore another sense, that of sight. In discussing the experiences of six individuals whose vision-related maladies force creative and often astonishing coping and adaptive behaviors, he talks of patients' inability to recognize faces, their late acquisition and loss of three-dimensional vision, and more. Sacks introduces each story, which is then read matter-of-factly by actor Richard Davidson. Sacks poignantly reads the chapter titled "Persistence of Vision"—about his own gradual loss of vision in one eye as the result of ocular cancer. A strong choice for nonfiction collections. ["The author's well-known style creatively balances complex medical discussion…with solid, down-to-earth prose," read the review of the zNew York Times best-selling Knopf hc, LJ 10/1/10.—Ed.]—Kristen L. Smith, Loras Coll. Lib., Dubuque, IA
From the Publisher
A Financial Times Best Book
A Globe and Mail Best Book
A New York Times Notable Book
 
“Compelling. . . . Uplifting. . . . One more chance to bask in an extraordinary man’s irrepressible belief in the human potential to do more than survive the travails of our fragility.”
Edmonton Journal
 
“Awe-inspiring. . . . A deeply moving book.”
—Norman Doidge, The Globe and Mail
 
“Graceful.”
—The New York Times Book Review (Editor’s Choice)
 
“Sacks invites readers to imagine their way into minds unlike their own, encouraging a radical form of empathy. . . . The Mind’s Eye expresses a stubborn hope.”
Los Angeles Times
 
“Frank and moving. . . . His books resonate because they reveal as much about the force of character as they do about neurology.”
Nature
 
“It is a measure of his artistry that Sacks slots such funk and anxiety into a book that’s mostly about the plasticity and adaptability of the human brain; a book that busily celebrates the indomitability of people.”
The Telegraph
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Product Details

  • ISBN-13: 9780307272089
  • Publisher: Knopf Doubleday Publishing Group
  • Publication date: 10/26/2010
  • Pages: 288
  • Product dimensions: 5.80 (w) x 8.20 (h) x 1.30 (d)

Meet the Author

Oliver Sacks
OLIVER SACKS is a practising physician and the author of ten books, including Musicophilia, The Man Who Mistook His Wife for a Hat and Awakenings (which inspired the Oscar-nominated film). He lives in New York City, where he is a professor of neurology and psychiatry at Columbia University Medical Center, and Columbia's first Columbia University Artist.

From the Hardcover edition.

Biography

"I think writing and language are not just to articulate or communicate, but they are also to investigate," the writer and neurologist Oliver Sacks once said. "For me, writing and medicine, writing and science, are not separate: they entail each other." Sacks grew up in a large and prodigiously gifted family of scientists; with their encouragement, he set up his own chemistry lab and spent his days in a swirl of sulfurous fumes and smoke. He was also fascinated by biographies, and spent hours poring over the lives of great scientists like Dmitri Mendeleev, Humphrey Davy,and Marie Curie. When the chaos of World War II and traumatic experiences at boarding school intruded on the "lyrical, mystical perceptions" of Sacks' childhood, he clung to scientific knowledge as a means of ordering and understanding the universe.

After his medical training at Oxford, Sacks migrated to the States to pursue a career in neurology research. But he made a clumsy lab researcher. "I was always dropping things or breaking things," he explained in a lecture, "and eventually they said: 'Get out! Go work with patients. They're less important.'" Sacks went to work at Beth Abraham Hospital in the Bronx, where he was struck by the sight of patients who had survived encephalitis lethargica, the "sleeping sickness." The patients were nearly immobile, but the nurses who cared for them insisted that there were living personalities behind the frozen masks, and Sacks believed the nurses. The story of his work with these patients is told in Sacks' 1973 book Awakenings, which inspired a movie starring Robin Williams and Robert DeNiro and also formed the basis of a play by Harold Pinter.

But Sacks is perhaps best known for his collections of case histories (The Man Who Mistook His Wife for a Hat, An Anthropologist on Mars et al.), which probe the experiences of people with disorders and rare neurological conditions. In telling their stories, he often questions our assumptions about the nature of human consciousness. Part what distinguishes Sacks' work from the traditional case study is his interest in how a patient functions with a disorder, not just how he or she is impaired by it.

Sacks has also drawn on personal experience for wonderfully resonant scientific memoirs that recall his remarkable family, people who have influenced and inspired him, and his lifelong love of medicine and physical science. Meanwhile, he continues to work with patients, to understand them through writing about them, and to point his readers toward new ways of understanding themselves. As Thomas P. Sakmar, interim president of Rockefeller University, said in awarding Sacks the Lewis Thomas Prize: "Sacks presses us to follow him into uncharted regions of human experience -- and compels us to realize, once there, that we are confronting only ourselves."

Good To Know

As a child, Sacks was fascinated by the periodic table of the elements at the Science Museum in London. His boyhood love of chemistry hasn't waned: according to an article in Wired, Sacks owns half a dozen T-shirts with the periodic table printed on them, along with periodic-table coffee mugs, tote bags and mousepads.

Sacks's memoir Uncle Tungsten inspired the creation of Theodore Gray's Periodic Table Table, a wooden table representing Mendeleev's table of the elements and containing samples of each element. Sacks later paid a visit to see the Periodic Table Table -- wearing, of course, one of his periodic-table T-shirts.

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    1. Hometown:
      New York, New York
    1. Date of Birth:
      1933
    2. Place of Birth:
      London, England
    1. Education:
      B.M., B.Ch., Queen's College, Oxford, 1958

Read an Excerpt

Sight Reading

In January of 1999, I received the following letter:

Dear Dr. Sacks,

My (very unusual) problem, in one sentence, and in non-medical terms, is: I can't read. I can't read music, or anything else. In the ophthalmologist's office, I can read the individual letters on the eye chart down to the last line. But I cannot read words, and music gives me the same problem. I have struggled with this for years, have been to the best doctors, and no one has been able to help. I would be ever so happy and grateful if you could find the time to see me.

Sincerely yours,
Lilian Kallir

I phoned Mrs. Kallir-this seemed to be the thing to do, although I normally would have written back-because although she apparently had no difficulty writing a letter, she had said that she could not read at all. I spoke to her and arranged to see her at the neurology clinic where I worked.

Mrs. Kallir came to the clinic soon afterward-a cultivated, vivacious sixty-seven-year-old woman with a strong Prague accent-and related her story to me in much more detail. She was a pianist, she said; indeed, I knew her by name, as a brilliant interpreter of Chopin and Mozart (she had given her first public concert at the age of four, and Gary Graffman, the celebrated pianist, called her "one of the most naturally musical people I've ever known").

The first intimation of anything wrong, she said, had come during a concert in 1991. She was performing Mozart piano concertos, and there was a last-minute change in the program, from the Nineteenth Piano Concerto to the Twenty-first. But when she flipped open the score of the Twenty-first, she found it, to her bewilderment, completely unintelligible. Although she saw the staves, the lines, the individual notes sharp and clear, none of it seemed to hang together, to make sense. She thought the difficulty must have something to do with her eyes. But she went on to perform the concerto flawlessly from memory, and dismissed the strange incident as "one of those things."

Several months later, the problem recurred, and her ability to read musical scores began to fluctuate. If she was tired or ill, she could hardly read them at all, though when she was fresh, her sight-reading was as swift and easy as ever. But in general the problem worsened, and though she continued to teach, to record, and to give concerts around the world, she depended increasingly on her musical memory and her extensive repertoire, since it was now becoming impossible for her to learn new music by sight. "I used to be a fantastic sight reader," she said, "easily able to play a Mozart concerto by sight, and now I can't."

Occasionally at concerts she experienced lapses of memory, though Lilian (as she asked me to call her) was adept at improvising and could usually cover these. When she was at ease, with friends or students, her playing seemed as good as ever. So, through inertia, or fear, or a sort of adjustment, it was possible for her to overlook her peculiar problems in reading music, for she had no other visual problems, and her memory and ingenuity still allowed her a full musical life.

In 1994, three years or so after she had first noticed problems reading music, Lilian started to have problems with reading words. Here again, there were good days and bad, and even times when her ability to read seemed to change from moment to moment: a sentence would look strange, unintelligible at first; then suddenly it would look fine, and she would have no difficulty reading it. Her ability to write, however, was quite unaffected, and she continued to maintain a large correspondence with former students and colleagues scattered throughout the world, though she depended increasingly on her husband to read the letters she received, and even to reread her own.

Pure alexia, unaccompanied by any difficulty in writing ("alexia sine agraphia") is not that uncommon, although it usually comes on suddenly, following a stroke or other brain injury. Less often, alexia develops gradually, as a consequence of a degenerative disease such as Alzheimer's. But Lilian was the first person I had encountered whose alexia manifested first with musical notation, a musical alexia.

By 1995 Lilian was beginning to develop additional visual problems. She noticed that she tended to "miss" objects to the right, and, after some minor mishaps, she decided that she had best give up driving.

She had sometimes wondered whether her strange problem with reading might be neurological rather than ophthalmological in origin. "How can I recognize individual letters, even the tiny ones on the bottom line of the eye doctor's chart, and yet be unable to read?" she wondered. Then, in 1996, she started to make occasional embarrassing mistakes, such as failing to recognize old friends, and she found herself thinking of a case history of mine she had read years before, entitled "The Man Who Mistook His Wife for a Hat," about a man with visual agnosia. She had chuckled when she had first read it, but now she started to wonder whether her own difficulties might be eerily similar in nature.

Finally, five years or more after her original symptoms, she was referred to a university neurology department for a full workup. Given a battery of neuropsychological tests-tests of visual perception, of memory, of verbal fluency, etc.-Lilian did particularly badly in the recognition of drawings: she called a violin a banjo, a glove a statue, a razor a pen, and pliers a banana. (Asked to write a sentence, she wrote, "This is ridiculous.") She had a fluctuating lack of awareness, or "inattention," to the right, and very poor facial recognition (measured by recognition of photographs of famous public figures). She could read, but only slowly, letter by letter. She would read a "C," an "A," a "T," and then, laboriously, "cat," without recognizing the word as a whole. Yet if she was shown words too quickly to decipher in this way, she could sometimes correctly sort them into general categories, such as "living" or "nonliving," even though she had no conscious idea of their meaning.

In contrast to these severe visual problems, her speech comprehension, repetition, and verbal fluency were all normal. An MRI of her brain was also normal, but when a PET scan was performed-this can detect slight changes in the metabolism of different brain areas, even when they appear anatomically normal-Lilian was found to have diminished metabolic activity in the posterior part of the brain, the visual cortex. This was more marked on the left side. Noting the gradual spread of difficulties in visual recognition-first of music, then of words, then of faces and objects-her neurologists felt she must have a degenerative condition, at present confined to the posterior parts of the brain. This would probably continue to worsen, though very slowly.

The underlying disease was not treatable in any radical sense, but her neurologists suggested that she might benefit from certain strategies: "guessing" words, for example, even when she could not read them in the ordinary way (for it was clear that she still possessed some mechanism that allowed unconscious or preconscious recognition of words). And they suggested that she might also use a deliberate, hyperconscious inspection of objects and faces, making particular note of their distinctive features, so that these could be identified in future encounters, even if her normal "automatic" powers of recognition were impaired.

In the three years or so that had elapsed between this neurological exam and her first visit to me, Lilian told me, she had continued to perform, though not as well, and not as frequently. She found her repertoire diminishing, because she could no longer check even familiar scores by vision. "My memory was no longer fed," she remarked. Fed visually, she meant-for she felt that her auditory memory, her auditory orientation, had increased, so that she could now, to a much larger degree than before, learn and reproduce a piece by ear. She could not only play a piece in this way (sometimes after only a single hearing); she could rearrange it in her mind. Nonetheless, there was, on balance, a shrinkage of her repertoire, and she began to avoid giving public concerts. She continued to play in more informal settings and to teach master classes at the music school.

Handing me the neurological report from 1996, she commented, "The doctors all say, 'Posterior cortical atrophy of the left hemisphere, very atypical,' and then they smile apologetically-but there's nothing they can do."

When I examined Lilian, I found that she had no problem matching colors or shapes, or recognizing movement or depth. But she showed gross problems in other areas. She was unable now to recognize individual letters or numerals (even though she still had no difficulty writing complete sentences). She had, too, a more general visual agnosia, and when I presented her with pictures to identify, it was difficult for her even to recognize pictures as pictures-she would sometimes look at a column of print or a white margin, thinking it was the picture I was quizzing her about. Of one such picture, she said, "I see a V, very elegant-two little dots here, then an oval, with little white dots in between. I don't know what it's supposed to be." When I told her it was a helicopter, she laughed, embarrassed. (The V was a sling; the helicopter was unloading food supplies for refugees. The two little dots were wheels, the oval the helicopter's body.) Thus she was now seeing only individual features of an object or picture, failing to synthesize them, to see them as a whole, much less to interpret them correctly. Shown a photograph of a face, she could perceive that the person was wearing glasses, nothing else. When I asked if she could see clearly, she said, "It's not a blur, it's a mush"-a mush consisting of clear, fine, sharp but unintelligible shapes and details.

Looking at the drawings in a standard neurological test booklet, she said of a pencil, "Could be so many things. Could be a violin . . . a pen." A house, however, she immediately recognized. Regarding a whistle, she said, "I have no idea." Shown a drawing of scissors, she looked steadfastly at the wrong place, at the white paper below the drawing. Was Lilian's difficulty in recognizing drawings due simply to their "sketchiness," their two-dimensionality, their poverty of information? Or did it reflect a higher-order difficulty with the perception of representation as such? Would she do better with real objects?

When I asked Lilian how she felt about herself and her situation, she said, "I think I am dealing with it very well, most of the time . . . knowing it is not getting better, but only slowly worse. I've stopped seeing neurologists. I always hear the same thing. . . . But I am a very resilient person. I don't tell my friends. I don't want to burden them, and my little story is not very promising. A dead end. . . . I have a good sense of humor. And that's it, in a nutshell. It is depressing, when I think of it- frustrations daily. But I have many good days and years ahead."

After Lilian left, I was unable to find my medical bag-a black bag with some similarities (I now remembered) to one of the several bags she had brought. Going home in the taxi, she realized that she had taken the wrong bag when she saw a red-tipped object sticking out of it (my long, red-tipped reflex hammer). It had attracted her attention, by its color and shape, when she saw it on my desk, and now she realized her mistake. Returning, breathless and apologetic, to the clinic, she said, "I am the woman who mistook the doctor's bag for her handbag."

Lilian had done so badly on the formal tests of visual recognition that I had difficulty imagining how she managed in daily life. How did she recognize a taxi, for example? How could she recognize her own home? How could she shop, as she told me she did, or recognize foods and serve them on a table? All this and much more-an active social life, traveling, going to concerts, and teaching-she did by herself when her husband, who was also a musician, went to Europe for weeks at a time. I could get no idea of how she accomplished this from seeing her dismal performance in the artificial, impoverished atmosphere of a neurology clinic. I had to see her in her own familiar surroundings.

The following month, I visited Lilian at home, home being a pleasant apartment in upper Manhattan where she and her husband had lived for more than forty years. Claude was a charming, genial man about the same age as his wife. They had met as music students at Tanglewood nearly fifty years earlier and had pursued their musical careers in tandem, often performing on stage together. The apartment had a friendly, cultured atmosphere, with a grand piano, a great many books, photographs of their daughter and of friends and family, abstract, modernist paintings on the wall, and mementos of their trips on every available surface. It was crowded-rich in personal history and significance, I imagined, but a nightmare, a complete chaos, for someone with visual agnosia. This, at least, was my first thought as I entered, negotiating my way between tables full of knickknacks. But Lilian had no difficulty with the clutter and threaded her way confidently through the obstacles.

Since she had had such difficulty on the drawing-recognition test, I had brought a number of solid objects with me, wondering if she would do better with these. I started with some fruit and vegetables I had just bought, and here Lilian did surprisingly well. She instantly identified "a beautiful red pepper," recognizing it from across the room; a banana, too. She was momentarily uncertain whether the third object was an apple or a tomato, though she soon decided, correctly, on the former. When I showed her a small plastic model of a wolf (I keep a variety of such objects, for perceptual testing, in my medical bag), she exclaimed, "A marvelous animal! A baby elephant, perhaps?" When I asked her to look more closely, she decided it was "a kind of dog."

Lilian's relative success in naming solid objects, as opposed to drawings of them, again made me wonder whether she had a specific agnosia for representations. The recognition of representations may require a sort of learning, the grasping of a code or convention, beyond that needed for the recognition of objects. Thus, it is said, people from primitive cultures who have never been exposed to photographs may fail to recognize that they are representations of something else. 

From the Hardcover edition.

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Table of Contents

Preface
 
Sight Reading
Recalled to Life
A Man of Letters
Face-Blind
Stereo Sue
Persistence of Vision: A Journal
The Mind’s Eye
 
Bibliography
Index

From the Hardcover edition.

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First Chapter

The Mind's Eye


By Oliver Sacks

Knopf

Copyright © 2010 Oliver Sacks
All right reserved.

ISBN: 9780307272089

Sight Reading

In January of 1999, I received the following letter:

Dear Dr. Sacks,

My (very unusual) problem, in one sentence, and in non-medical terms, is: I can't read. I can't read music, or anything else. In the ophthalmologist's office, I can read the individual letters on the eye chart down to the last line. But I cannot read words, and music gives me the same problem. I have struggled with this for years, have been to the best doctors, and no one has been able to help. I would be ever so happy and grateful if you could find the time to see me.

Sincerely yours,
Lilian Kallir



I phoned Mrs. Kallir-this seemed to be the thing to do, although I normally would have written back-because although she apparently had no difficulty writing a letter, she had said that she could not read at all. I spoke to her and arranged to see her at the neurology clinic where I worked.

Mrs. Kallir came to the clinic soon afterward-a cultivated, vivacious sixty-seven-year-old woman with a strong Prague accent-and related her story to me in much more detail. She was a pianist, she said; indeed, I knew her by name, as a brilliant interpreter of Chopin and Mozart (she had given her first public concert at the age of four, and Gary Graffman, the celebrated pianist, called her "one of the most naturally musical people I've ever known").

The first intimation of anything wrong, she said, had come during a concert in 1991. She was performing Mozart piano concertos, and there was a last-minute change in the program, from the Nineteenth Piano Concerto to the Twenty-first. But when she flipped open the score of the Twenty-first, she found it, to her bewilderment, completely unintelligible. Although she saw the staves, the lines, the individual notes sharp and clear, none of it seemed to hang together, to make sense. She thought the difficulty must have something to do with her eyes. But she went on to perform the concerto flawlessly from memory, and dismissed the strange incident as "one of those things."

Several months later, the problem recurred, and her ability to read musical scores began to fluctuate. If she was tired or ill, she could hardly read them at all, though when she was fresh, her sight-reading was as swift and easy as ever. But in general the problem worsened, and though she continued to teach, to record, and to give concerts around the world, she depended increasingly on her musical memory and her extensive repertoire, since it was now becoming impossible for her to learn new music by sight. "I used to be a fantastic sight reader," she said, "easily able to play a Mozart concerto by sight, and now I can't."

Occasionally at concerts she experienced lapses of memory, though Lilian (as she asked me to call her) was adept at improvising and could usually cover these. When she was at ease, with friends or students, her playing seemed as good as ever. So, through inertia, or fear, or a sort of adjustment, it was possible for her to overlook her peculiar problems in reading music, for she had no other visual problems, and her memory and ingenuity still allowed her a full musical life.

In 1994, three years or so after she had first noticed problems reading music, Lilian started to have problems with reading words. Here again, there were good days and bad, and even times when her ability to read seemed to change from moment to moment: a sentence would look strange, unintelligible at first; then suddenly it would look fine, and she would have no difficulty reading it. Her ability to write, however, was quite unaffected, and she continued to maintain a large correspondence with former students and colleagues scattered throughout the world, though she depended increasingly on her husband to read the letters she received, and even to reread her own.

Pure alexia, unaccompanied by any difficulty in writing ("alexia sine agraphia") is not that uncommon, although it usually comes on suddenly, following a stroke or other brain injury. Less often, alexia develops gradually, as a consequence of a degenerative disease such as Alzheimer's. But Lilian was the first person I had encountered whose alexia manifested first with musical notation, a musical alexia.

By 1995 Lilian was beginning to develop additional visual problems. She noticed that she tended to "miss" objects to the right, and, after some minor mishaps, she decided that she had best give up driving.

She had sometimes wondered whether her strange problem with reading might be neurological rather than ophthalmological in origin. "How can I recognize individual letters, even the tiny ones on the bottom line of the eye doctor's chart, and yet be unable to read?" she wondered. Then, in 1996, she started to make occasional embarrassing mistakes, such as failing to recognize old friends, and she found herself thinking of a case history of mine she had read years before, entitled "The Man Who Mistook His Wife for a Hat," about a man with visual agnosia. She had chuckled when she had first read it, but now she started to wonder whether her own difficulties might be eerily similar in nature.

Finally, five years or more after her original symptoms, she was referred to a university neurology department for a full workup. Given a battery of neuropsychological tests-tests of visual perception, of memory, of verbal fluency, etc.-Lilian did particularly badly in the recognition of drawings: she called a violin a banjo, a glove a statue, a razor a pen, and pliers a banana. (Asked to write a sentence, she wrote, "This is ridiculous.") She had a fluctuating lack of awareness, or "inattention," to the right, and very poor facial recognition (measured by recognition of photographs of famous public figures). She could read, but only slowly, letter by letter. She would read a "C," an "A," a "T," and then, laboriously, "cat," without recognizing the word as a whole. Yet if she was shown words too quickly to decipher in this way, she could sometimes correctly sort them into general categories, such as "living" or "nonliving," even though she had no conscious idea of their meaning.

In contrast to these severe visual problems, her speech comprehension, repetition, and verbal fluency were all normal. An MRI of her brain was also normal, but when a PET scan was performed-this can detect slight changes in the metabolism of different brain areas, even when they appear anatomically normal-Lilian was found to have diminished metabolic activity in the posterior part of the brain, the visual cortex. This was more marked on the left side. Noting the gradual spread of difficulties in visual recognition-first of music, then of words, then of faces and objects-her neurologists felt she must have a degenerative condition, at present confined to the posterior parts of the brain. This would probably continue to worsen, though very slowly.

The underlying disease was not treatable in any radical sense, but her neurologists suggested that she might benefit from certain strategies: "guessing" words, for example, even when she could not read them in the ordinary way (for it was clear that she still possessed some mechanism that allowed unconscious or preconscious recognition of words). And they suggested that she might also use a deliberate, hyperconscious inspection of objects and faces, making particular note of their distinctive features, so that these could be identified in future encounters, even if her normal "automatic" powers of recognition were impaired.

In the three years or so that had elapsed between this neurological exam and her first visit to me, Lilian told me, she had continued to perform, though not as well, and not as frequently. She found her repertoire diminishing, because she could no longer check even familiar scores by vision. "My memory was no longer fed," she remarked. Fed visually, she meant-for she felt that her auditory memory, her auditory orientation, had increased, so that she could now, to a much larger degree than before, learn and reproduce a piece by ear. She could not only play a piece in this way (sometimes after only a single hearing); she could rearrange it in her mind. Nonetheless, there was, on balance, a shrinkage of her repertoire, and she began to avoid giving public concerts. She continued to play in more informal settings and to teach master classes at the music school.

Handing me the neurological report from 1996, she commented, "The doctors all say, 'Posterior cortical atrophy of the left hemisphere, very atypical,' and then they smile apologetically-but there's nothing they can do."

When I examined Lilian, I found that she had no problem matching colors or shapes, or recognizing movement or depth. But she showed gross problems in other areas. She was unable now to recognize individual letters or numerals (even though she still had no difficulty writing complete sentences). She had, too, a more general visual agnosia, and when I presented her with pictures to identify, it was difficult for her even to recognize pictures as pictures-she would sometimes look at a column of print or a white margin, thinking it was the picture I was quizzing her about. Of one such picture, she said, "I see a V, very elegant-two little dots here, then an oval, with little white dots in between. I don't know what it's supposed to be." When I told her it was a helicopter, she laughed, embarrassed. (The V was a sling; the helicopter was unloading food supplies for refugees. The two little dots were wheels, the oval the helicopter's body.) Thus she was now seeing only individual features of an object or picture, failing to synthesize them, to see them as a whole, much less to interpret them correctly. Shown a photograph of a face, she could perceive that the person was wearing glasses, nothing else. When I asked if she could see clearly, she said, "It's not a blur, it's a mush"-a mush consisting of clear, fine, sharp but unintelligible shapes and details.

Looking at the drawings in a standard neurological test booklet, she said of a pencil, "Could be so many things. Could be a violin . . . a pen." A house, however, she immediately recognized. Regarding a whistle, she said, "I have no idea." Shown a drawing of scissors, she looked steadfastly at the wrong place, at the white paper below the drawing. Was Lilian's difficulty in recognizing drawings due simply to their "sketchiness," their two-dimensionality, their poverty of information? Or did it reflect a higher-order difficulty with the perception of representation as such? Would she do better with real objects?

When I asked Lilian how she felt about herself and her situation, she said, "I think I am dealing with it very well, most of the time . . . knowing it is not getting better, but only slowly worse. I've stopped seeing neurologists. I always hear the same thing. . . . But I am a very resilient person. I don't tell my friends. I don't want to burden them, and my little story is not very promising. A dead end. . . . I have a good sense of humor. And that's it, in a nutshell. It is depressing, when I think of it- frustrations daily. But I have many good days and years ahead."

After Lilian left, I was unable to find my medical bag-a black bag with some similarities (I now remembered) to one of the several bags she had brought. Going home in the taxi, she realized that she had taken the wrong bag when she saw a red-tipped object sticking out of it (my long, red-tipped reflex hammer). It had attracted her attention, by its color and shape, when she saw it on my desk, and now she realized her mistake. Returning, breathless and apologetic, to the clinic, she said, "I am the woman who mistook the doctor's bag for her handbag."

Lilian had done so badly on the formal tests of visual recognition that I had difficulty imagining how she managed in daily life. How did she recognize a taxi, for example? How could she recognize her own home? How could she shop, as she told me she did, or recognize foods and serve them on a table? All this and much more-an active social life, traveling, going to concerts, and teaching-she did by herself when her husband, who was also a musician, went to Europe for weeks at a time. I could get no idea of how she accomplished this from seeing her dismal performance in the artificial, impoverished atmosphere of a neurology clinic. I had to see her in her own familiar surroundings.

The following month, I visited Lilian at home, home being a pleasant apartment in upper Manhattan where she and her husband had lived for more than forty years. Claude was a charming, genial man about the same age as his wife. They had met as music students at Tanglewood nearly fifty years earlier and had pursued their musical careers in tandem, often performing on stage together. The apartment had a friendly, cultured atmosphere, with a grand piano, a great many books, photographs of their daughter and of friends and family, abstract, modernist paintings on the wall, and mementos of their trips on every available surface. It was crowded-rich in personal history and significance, I imagined, but a nightmare, a complete chaos, for someone with visual agnosia. This, at least, was my first thought as I entered, negotiating my way between tables full of knickknacks. But Lilian had no difficulty with the clutter and threaded her way confidently through the obstacles.

Since she had had such difficulty on the drawing-recognition test, I had brought a number of solid objects with me, wondering if she would do better with these. I started with some fruit and vegetables I had just bought, and here Lilian did surprisingly well. She instantly identified "a beautiful red pepper," recognizing it from across the room; a banana, too. She was momentarily uncertain whether the third object was an apple or a tomato, though she soon decided, correctly, on the former. When I showed her a small plastic model of a wolf (I keep a variety of such objects, for perceptual testing, in my medical bag), she exclaimed, "A marvelous animal! A baby elephant, perhaps?" When I asked her to look more closely, she decided it was "a kind of dog."

Lilian's relative success in naming solid objects, as opposed to drawings of them, again made me wonder whether she had a specific agnosia for representations. The recognition of representations may require a sort of learning, the grasping of a code or convention, beyond that needed for the recognition of objects. Thus, it is said, people from primitive cultures who have never been exposed to photographs may fail to recognize that they are representations of something else. 

Continues...

Excerpted from The Mind's Eye by Oliver Sacks Copyright © 2010 by Oliver Sacks. Excerpted by permission of Knopf, a division of Random House, Inc.
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Interviews & Essays

Oliver Sacks talks with Leonard Cassuto for The Barnes & Noble Review

At a time when C. P. Snow's "two cultures" of art and science seem to be drifting further apart, Oliver Sacks remains a one-man bridge between them. During a writing career spanning nearly 40 years, Sacks has blended his medical practice of neurology with his narrative efforts to bring his readers closer to the wondrous mysteries of consciousness and physical existence. Beginning with his well-known 1973 account in Awakenings of long-frozen Parkinsonian patients who "woke up" when given the then-new drug L-Dopa, Sacks has written about amnesiacs, prodigies, people living with autism and Tourette's Syndrome, and those who are blind, deaf, and both. He has recounted the "paradoxical tales" of colorblind and memory painters, of musical prodigies who cannot add two numbers, of those whose memories are frozen in time.

Celebrated for his focus on remarkable "cases," Sacks has also been criticized by disability scholars and activists who have accused him of insensitivity to the humanity of his subjects. Sacks has never responded directly to these charges, but his work has evolved against their backdrop and become more detailed, as he conceptualizes physical difference amid a more elaborated social context. Remarkably, some of Sacks's views on disability have become indistinguishable from those held by his antagonists.

Sacks writes in his new book, The Mind's Eye, that his histories "enlarge the imagination" even as they show the people courageously facing "neurological challenges that are almost impossible for the rest of us to imagine." For Sacks there are no cures, miraculous or otherwise. His subjects live with their differences, and their differences enrich them -- and sometimes disable them at the same time. Even blindness turns into addition by subtraction, a change that may deepen one's awareness of the world.

The Mind's Eye is a collection of case studies unified by the theme of vision. Sacks's subjects continue to fascinate: there is the novelist who -- as a result of a small stroke localized in a particular part of his brain -- loses his ability to read, but oddly, not to write. He adapts to his condition (called alexia) by teaching himself to read all over again: he traces the shape of each letter in his 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 condition called aphasia, which she masters through her own expressive sign language. Another woman slowly loses the ability to recognize what her eyes are seeing, as a form of brain damage progressively destroys her perceptual faculty; her world becomes an alien place through which she learns to cannily maneuver. In contrast, there is the woman who, after years of monocular vision due to childhood eye problems, learns to work her eyes in concert, suddenly gaining depth perception and seeing the world anew.

And then there is Sacks himself, who is the main subject of two of his own case studies in The Mind's Eye. In one, he writes about face blindness, a neurological condition (technical name: prosopagnosia) that prevents people from recognizing individual faces. Face blindness creates social difficulties because it's so little known -- and people with face blindness report awkwardness when they fail to recognize people whom they have already met. Sacks knows this by experience because he is face blind himself, and his discussion of prosopagnosia  centers on himself and his own experience.

So does the longest chapter of the book, an account of the author's treatment for a melanoma of the eye, a regimen that has left him for the moment (and probably forever) without the depth perception that he has actively prized. Indeed, Sacks is an enthusiast of depth perception who has long reveled in the texture that binocular vision gives to the visual world. He belongs to clubs of those who share his interest, and he collects the stereopticon photos that are the precursor of 3-D movies, as well as other objects that highlight the depth of a visual field. His medical narrative of his loss of "stereo" vision is at once both poignant and, like all of his writing, methodically matter-of-fact -- for Sacks values facts as the route that we must follow if we hope to comprehend the ineffable.

Sacks welcomed me into his cluttered Greenwich Village office, which is filled with inviting bric-a-brac -- something like how I imagined his parents' London house might have looked 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 thanks to a lifetime long-distance swimming regimen, Sacks betrays his age only through the deliberateness with which he undertakes certain movements, such as rising from a chair. He refers to his advancing years without embarrassment in his writing and his conversation. He offered me a reading glass -- acquired in the wake of the vision problems that he writes about in The Mind's Eye -- when I had to squint at the controls of my voice recorder (my difficulty focusing being a sign of my own aging eyes), and he made casual reference to his hearing loss at one point in our conversation. In some ways, I thought, The Mind's Eye is a book about aging as well as vision, for as Sacks gets older he ranges less widely and digs more deeply into things.

What follows is an edited transcript of our conversation.

                                                                                               --Leonard Cassuto


Leonard Cassuto: Let's start with your new book. I was reminded while reading The Mind's Eye that some of your past case studies, like "The Case of The Color Blind Painter," "To See and Not See," and "The Landscape of His Dreams" [from An Anthropologist on Mars (1993)], have centered on vision as well. What made you decide to return to the subject?

Oliver Sacks: I'm never through with the subject. It's always there for me to revisit and reconsider. The interest in vision goes back earlier to my first book, Migraine. A third of that book was concerned with the visual disorders of migraine. I think my interests in vision really go right back to boyhood, and were partly combined with attacks of migraine in which all sorts of visual phenomena could occur. A color could be heightened or attenuated, and things could become flattened or deepened, or disappear to one side. I've had these since I was four or five, and I was frightened of them at first, but my mother, who also had these sorts of symptoms, explained them to some extent. So one of my precocious initiations into neurology comes partly from 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 stereo photography and color photography and scenic photography as parallels to depth and 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 the case studies, "Stereo Sue" gains it, while you also write of losing it yourself. Are you deliberately positioning those two stories against each other?

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

LC: It seems that you're becoming more phenomenological in your recent work. For example, the case of Lillian in "Sight Reading" [in which a woman gradually loses the ability to recognize the visual world] leads us to ask whether we really see something if we can't name it. I was wondering whether this phenomenological turn reflects any particular orientation on your part.

OS: I don't think it's entirely new. I always have wanted to enter into people's experiences as much as one can. Although I think it's the nature of different neurological experiences that one can't enter into them. All of the emotions we can enter into, we know. We can imagine what it's like to be King Lear or Cordelia 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 Anthropologist on Mars was almost a sociological case study with a very strong emotional component. It seemed to me that you were asking, "What is it like to live in this guy's skin?" and trying to communicate that, perhaps based on your own lifelong interest in Tourette's.

Some of the case studies in The Mind's Eye are going beyond that to ask, "What can we understand about the meaning of not being able to do a certain thing and having to do something else instead?"  That's the movement I'm tracing here.

OS: I think I'm very much concerned with meanings now, and any abnormality of the pathology of seeing immediately makes me wonder how any of us see, and what it's about. 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 the level of describing phenomena.

LC: Are you unhappy with "anthropological" as well?

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

LC: We often have no choice.

OS: Yes, right. I started inventing or using the word "neuroanthropology." But I can't exactly say what I'm doing. I just do it. I have sharp antennae for anomaly and for the unexpected, which has tormented me and forced me to think and maybe go deeper in 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 some ways 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 to case study.

OS: For the moment. (Chuckles.)

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

OS: I think in various ways I'm taking it deeper now. Lillian [the subject in "Sight Reading" in The Mind's Eye] is a musician, 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 so have trouble processing the information they receive about the world around them]. It was very crucial for me, for example, to visit Lillian at home to see how 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 Leg To Stand On [1984], excluding your autobiography of course. In The Mind's Eye, you appear as the main subject in the chapter on face blindness and in the longest chapter of the book, "Persistence of Vision," your account of your treatment for ocular melanoma and its effect on your vision. How does it affect your approach to a case when you are your own subject?

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

I don't keep diaries, but when I'm on journeys of one sort or another I keep a journal. It may be an external 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 armful of notebooks -- his journals -- which he thumped on his desk in front of us as a concrete example. They stayed there for the remainder of the interview.

OS: Do you feel there's a fundamental difference between my way of treating myself and treating others?

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

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

LC: Such as?

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

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

OS: Yes.

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

OS: I thought it was more authentic and would appear less to be made up, and by the same 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 if this is entirely new. There are entire pages of my handwritten Oaxaca journal that are almost identical with the printed page. Now of course that means they're faithful to the journal. That doesn't mean that the journal is faithful to my experiences.

LC: It sounds like you're seeking more emotional connection. I found your chapters on yourself in The Mind's Eye to be more emotional than even your autobiography in many ways. Uncle Tungsten is a kind of club sandwich that alternates slices of your personal experience with the history of science, whereas The Mind's Eye is always deeply focused on the experience you're having, not only ocularly, but also emotionally.

OS:  It's in the moment, and of course Uncle Tungsten 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 of his atelier. The cabinets were covered with photographs and pictures, with various 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 my bedroom was papered, and I sort of had to have old electrical machines and things. I had to reconstruct some sort of actuality around me. I'm very concrete in a way. I very much like it when Wittgenstein says a book should consist of examples.

What I said specifically in The Mind's Eye about my own experience, in condensation from 90,000 words to perhaps 10,000 or so, is very inadequate to me. I'm tantalized by the inadequacy of all description. For example, with Parkinsonism, I think that an adequate description of  someone with Parkinson's getting up and walking across the room would require 600 pages of dense prose, and it wouldn't have an extra word in it. It would also be enthralling and gripping. I like Clifford Geertz's notion of thick description. Things are never thick enough. I like the way how in a novel, ten seconds of consciousness, or thirty seconds of consciousness, can take fifty pages to describe.

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


OS: Yes. By the same token I am somewhat tormented by the linearity of writing in a book. It would be nice if I could present a globe, with plumb lines dropping from every place, which is partly why I like footnotes. Kate [Sacks's assistant and frequent collaborator, Kate Edgar] has to restrain me from writing footnotes to footnotes. I think anything 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 own shyness, and it figures prominently in the segment of your 1998 PBS series, The Mind Traveler, that's devoted to Williams 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. But what is called my shyness, or social phobia, or Asperger's or whatever, is a large 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 crucial thing for me was meeting my brother in Australia in '85 and finding an almost comic similarity. We would both get lost and fail to recognize things and people.

LC: I think one of the great values of your account of face blindness in The Mind's Eye is the way that you discuss how the condition, although increasingly well understood, is not well known, and therefore constitutes a fairly serious social disability. You contrast face blindness to dyslexia, which has attained a high profile in the public consciousness and is therefore considerably less stigmatized than it once was. Your job puts you into contact all the time with people 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 a connoisseur of freaks.

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

OS: Disability is not a word I use very much. I would certainly call Tourette's Syndrome a disorder, and it is a disorder that may in turn produce various disabilities. But it may also produce various abilities, and more and more I regard Tourette's syndrome as a whole mode of being. I feel similarly about autism. I feel similarly now about blindness and deafness. When [John] Hull writes of his own blindness, that he sees "deep blindness" as one of the concentrated human conditions, I like that way of putting it. I think it's very important. I partly think of myself, having repudiated all the other "ologies," as a "clinical ontologist."

Something I think was crucial to me was with regard to Deaf people, particularly going to Gallaudet and being sharply reproved for using the phrase "hearing-impaired" by someone who said, "you're sign-impaired." [Sacks writes of his visit to Gallaudet, a university for the deaf and hearing-impaired, in Seeing Voices (1989).] Deaf people use "deafness" with a small "d" for its medical pathologizing of hearing impairment, but with a big "D" as denoting a linguistic and ethnic minority and also a 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 a negation.

LC: This brings to mind the line of Emily Dickinson: "Much madness is the divinest sense."

OS: I lived on City Island for twenty years and there was a woman there, Mary. I don't know what her formal diagnosis was, schizophrenic or manic depressive. But every so often she would go mad and stand on top of her car and bellow at people. But she was a woman of remarkable penetration and toughness and common sense and humor whom I felt had somehow been seasoned by going through hell, or possibly 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 of charisma. Now, I don't want to romanticize this too much, and no doubt there were times when she was dangerous or disabled and perhaps had to be tranquilized or put away. But I think when she was not acutely psychotic, one could see the depth of personality and experience and wisdom which perhaps had something to do with what she'd been through.

LC: It seems to me that some of that awareness may be informing your treatment of Franco Magnani, the painter in "The Landscape of His Dreams," who paints his childhood town entirely from memory, and who has no desire to paint anything else. [In Anthropologist, Sacks writes that Magnani's visions of his childhood home may result from a certain kind of epilepsy.] Magnani is in no way psychotic, but his experience is informed by a place that most people never get to, whether as a result of epilepsy or whatever else.

You started this line of thought as a riff on Tourette's Syndrome. In a preface you wrote to an omnibus collection of four of your books in 1990, you talk about how those books relate to your quest to write a book about Tourette's. It seems that, instead of writing the book about Tourette's, your interest in it has spawned book after book.

OS: I had forgotten I wrote that preface. I much regret that for various reasons I didn't write a book about Tourette's. I have written six or eight other things about 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'm more and more conscious that time is limited. I feel huge pressure from the unwritten and uncollected work of my own; I think that if I have enough strength, I have at least half a dozen books to write. So I'm aware of being a little frayed around the edges. I have difficulty thinking of proper names. I think I'm still intact centrally, I just hope I remain so. I want to go on seeing patients and corresponding and gathering experience to the last. My father retired at seventy but went back to work. He re-retired at eighty and again went back. At ninety, he said he would give up everything except house calls. I also want to feel free to write about other things. Correspondence is a very crucial part of my life now, especially since, as I get older, I can only see a limited number of patients. I was seeing patients yesterday, but I take my time doing that. I love it when people give me detailed descriptions of how it is for them and what meaning their condition may have for them.

LC: Do you think that your treatment of a subject like Lillian, for example, is inflected by your position as an older person now?

OS: I suspect so. Perhaps this is "Sacks's later work."

LC: In Sacks's own view, how does Sacks's late work compare to Sacks's early work?

OS: I think things are being pondered more deeply, though also in a specific way. I somewhat fault myself in The Man Who Mistook His Wife for a Hat for being too phenomenological and insufficiently concerned with process and physiology. I'm now much more concerned 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 a neurophysiologist, a visual neuroscientist. Now, I would sometimes take Ralph with me to see the colorblind painter, to see Virgil [the subject of "To See and Not See": a man who went blind as a child and then regained his sight in middle age with decidedly mixed consequences], and to see "Stereo Sue" [whose recovery of binocular vision as an adult is detailed in The Mind's Eye]. But he also brings me to his lab to see his monkeys and his work and his experiments. I want as much as 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 clinical level. This desire is becoming stronger in me.

LC: So these are different forms of the concrete?

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

LC: Last question. You say in the preface to Awakenings that you were trying to found a romantic medicine. Is that still the way you think 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 by that. It is some sort of deep dealing with the whole and the individual. But at the same time, I'm very drawn to reductionism and to saying which systems are involved. A colleague and friend of mine, Christof Koch, has written an autobiography 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. The anatomist may not be an artist or become one, but the artist has to know his anatomy. However, the language and the tone of anatomy are different from that of art. And yet I want to combine them somehow.

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

"Cover one eye and look at this," he advised, "if you want a sense of what stereo vision gives you." Now, I've read a good deal about stereo vision -- not just in The Mind's Eye -- and have often covered one eye to see if I could perceive the flatness that accompanies a lack of depth perception. I've never noticed much difference, presumably because my brain automatically compensates for the lost visual information. But Sacks's diagram contained an ingenious optical illusion, and when I covered one eye, the house instantly and dramatically reversed its shape.

"Oh, wow!" I exclaimed. Sacks looked at me knowingly. "All of my writing," he said, "is devoted to conveying the essence of that 'Oh, wow.'"

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