Oliver Sacks: Death of a double-crosser
With his absorbing and accessible yet profound accounts of neurological cases and conditions, Oliver Sacks, who has died aged 82, brought the clinical science of the brain to life for countless readers. Although his first book, Migraine (1970), marked a relatively conventional beginning, Sacks’s decision to write about a neurological disorder with complex psychological precipitants and concomitants, and one from which he himself suffered, pointed in the direction of his future interests.
His second book, Awakenings (1973), crucially encouraged by his publisher Colin Haycraft at Duckworth, appeared when Sacks was 40 and brought his work to a wide audience. Effusively praised by the critics, it describes the effects of L-Dopa, then recently recognised as an effective treatment for Parkinson’s disease, in a group of patients who had lived in something close to suspended animation since the epidemic of the “sleeping sickness”, encephalitis lethargica, swept the world at the end of World War I.
In the words of metaphysical poet John Donne, one of Sacks’s literary masters, Awakenings depicts his patients’ “preternatural birth, in returning to life, from this sickness” – a birth sometimes fraught with awful tribulations.
Awakenings became the subject of the first documentary in the ITV Discovery series (1974), and a successful film, starring Robert de Niro and Robin Williams.
Sacks’s many subsequent books ranged across and beyond the territory of clinical neurology, but his work always remained rooted in his fascination with the brain. The Man Who Mistook His Wife for a Hat (1985) and An Anthropologist on Mars (1995) are collections of essays on patients with disorders of sensation and perception (such as the agnosic Dr P, who mistook his wife for a hat, and the colour-blind painter Mr I); of memory, language and movement (like “Witty Ticcy Ray” and the surgeon Dr Carl Bennett, both sufferers from Tourette syndrome, with its combination of intense physical tics and psychological compulsions); and of “social cognition” more broadly, as in the case of the autistic academic Temple Grandin, who described herself feeling as if she were “an anthropologist on Mars”, so mysterious did she find the ways of her fellow humans.
In Seeing Voices (1989), Sacks explored the experiences of the deaf; in The Mind’s Eye (2010), he returned to disorders of vision, a subject rendered highly personal for him by the loss of vision in one eye to a retinal melanoma, the ultimate cause of his final illness. Hallucinations (2012) allowed Sacks to explore the territory of the imagination, drawing partly on his own experience of migraine, LSD and drug withdrawal. Musicophilia (2007) is a neurologist’s tribute to a lifetime’s enjoyment of music, illustrating its power using Sacks’s usual method – the arresting, emotionally muscular, case history.
The importance of individuality in medicine
He also wrote prolifically for periodicals including the New Yorker and the New York Review of Books and inspired an abundance of work in other media. He appeared in documentaries, winning recognition as a highbrow but appealingly bearish TV personality. His extensive televised travels took in the Western Pacific island of Guam, famed in neurology for its high prevalence of a complex neurodegenerative disorder that Sacks and others have attributed to exposure to an environmental toxin.
The films At First Sight (1999) and The Music Never Stopped (2011) grew out of clinical tales from An Anthropologist on Mars. Stage adaptations of his writings include A Kind of Alaska (1982), a play by Harold Pinter based on Awakenings. His influence extends to woodwork: Theodore Gray’s Periodic Table Table is a magnificent repository of the Earth’s elements, inspired by Sacks’s memoir, Uncle Tungsten (2001).
The animating theme of Sacks’s work is the importance of individuality in medicine. He quoted Sir William Osler with approval – “Ask not what disease the person has, but rather what person the disease has” – and wrote in Awakenings: “There is nothing alive which is not individual: our health is ours; our diseases are ours; our reactions are ours – no less than our minds or our faces.”
It follows that “mechanical medicine” that considers only the “weapons” of therapy but never the “person who is ill” is “utterly inadequate”. Sacks’s natural sympathy for people with neurological disorders or impairments, so powerfully felt and expressed, permeates his writings. It helps him to describe, with deep interest and insight, the “accommodations” by which people learn to get along with – sometimes even benefit from – their illnesses.
Yet Sacks was such a resonant writer precisely because his sense of the importance of the personal and human, learned partly from his humane medical parents, is tempered by an equal attraction toward the abstract and scientific. His writing inhabits the tension, constantly present in medicine, between art and science, the warmth of individual lives and the cooler strength of general principles.
A grounded man
His intellectual and family background help to explain how he managed this. His grandfather, Marcus Landau, was a “boot and shoe manufacturer, kosher slaughterer, grocer, scholar, mystic, mathematician and inventor” who fathered 17 children. Seven of Marcus’s sons worked as mining consultants in Africa, among them “Uncle Tungsten”, Sacks’s favourite uncle (real name Dave), a geologist-turned-light-bulb-manufacturer.
He inspired Sacks’s childhood love of chemistry, fostering a sense of the marvellous, which Sacks evoked in his book about him, quoting the 19th-century introduction to chemistry he read as a child: “The common life of man is full of wonders, chemical and physiological. Most of us pass through this life without seeing or being sensible of them.”
Sacks wrote that, at times, he “felt a sort of ecstasy at the formal intellectual beauty of the universe”. But despite his intense passions as a child, his down-to-earth family grounded him, and in his teens a new hunger for “the human, the personal” was satisfied in part by encounters with poetry, music and visual arts, which later gave his writings on neurology their broad cultural and historical perspective.
He was born in North London. His father, Samuel, was a general practitioner, his mother, Muriel, a surgeon and pathologist. His future interests and talents were shaped and nurtured by his large, rumbustious, cultivated, polymathic Jewish family, evocatively described in his memoir. Apart from a painfully lonely period at boarding schools, in exile from his family, during the Blitz, Sacks grew up in London.
He was an independent and sometimes eccentric child – baking a biscuit for his Scout master with concrete rather than flour led to the loss of teeth (his master’s) and reputation (his). His education at St Paul’s school introduced him to Jonathan Miller, later, like Sacks, also a doctor and writer. Sacks, Miller and Eric Korn, his oldest friend, must have made a formidable trio of – as Sacks put it – “noisy, clever, Jewish boys”, equally at home in the sciences and the arts.
The thriving literary society they founded became the victim of its own success when the high school’s headmaster decided enough was enough: “Sacks, you’re dissolved … you don’t exist, you don’t exist anymore,” he said.
Sacks was understandably indignant – this was not the only time that his ebullient personality would collide with British reserve.
From St Paul’s, he moved on to study medicine at Queen’s College, Oxford, and later the Middlesex hospital, graduating in 1958. After completing his house posts in Britain, in 1961 he moved to the United States to train in neurology.
A “neurological freak show”
The atmosphere of British neurology in the early 1960s, somewhat elitist and oddly isolated from its sister disciplines of psychiatry and psychology, was probably uncongenial to Sacks, with his wide-ranging interests and cosmopolitan background; rumour has it that influential London neurologists had corresponding misgivings about allowing Sacks to join their number.
Following his internship at Mount Zion hospital, San Francisco, and a residency at the University of California, Los Angeles, Sacks moved in 1965 to New York, which was to be his main home from then on. From 1966 he worked as a consulting neurologist for the Beth Abraham hospital in the Bronx, and he held academic posts at New York and Columbia universities.
He received numerous awards and honours, including a Guggenheim fellowship in 1989 and being knighted by the British Empire in 2008. He was a shy man, and, Uncle Tungsten apart, his private life remained very private, until the publication of his compelling autobiography, On the Move (2015). It told of his early interest in gay sex and fascination with motorbikes, leathers and drug experiences, and his 35 years of celibacy until, in 2008, he became the partner of the writer Bill Hayes, who survives him.
His slightly bemused appearance in public may have been attributable to his striking, and apparently familial, prosopagnosia – an inability to recognise faces. In an article for the New Yorker, he described the comedy of a rendezvous with a similarly prosopagnosic colleague. True to form, Sacks identified and befriended prosopagnosic portrait painter Chuck Close, whose gigantic portraits depended on his idiosyncratic attention to the details of the faces the painter failed to recognise.
Sacks had his detractors. One common accusation is that his writings are a “neurological freak show” that allowed him to profit unjustifiably from his practice. His more numerous admirers find this accusation wide of the mark. Illness makes “freaks” of us all at one time or another: Sacks’s sympathetic insight into the human brain, and the human condition, through the medium of illness, heartened many more readers than it offended.
Sacks crossed the line
The accusation that Sacks wrote “fairy tales” is arguably more telling. Sacks’s case histories lack the meticulous measurements and experimental detail that contemporary science expects of its practitioners. Sacks undoubtedly drew from life in his writings though he may have used a measure of embellishment when it suited his purpose. But his readers turn to him, not for mathematical precision, but for his splendidly readable prose, sympathetic portraits of his patients, broad intellectual horizons and an abiding sense of wonder at the world.
“The sum of anecdote is not evidence”, as the advocates of evidence-based medicine like to remind softer-minded folk, and they are right that personal experience often misleads, particularly in the context of medical treatment. And yet, one can imagine Sacks reflecting, anecdote is in fact precisely where evidence begins. Sacks does a wonderful job of summoning up the human experiences and encounters that are the bedrock of medicine and everyday life.
A final criticism may be the most revealing: Sacks was transgressive. He wrote of his patients, potentially breaching expectations of confidentiality, and he often wrote of himself, his own afflictions, his migraine, his injured leg, his ocular tumour, his difficulty in recognising faces. He crossed the line that normally separates doctors from their patients, and he did so twice over.
But the truth, as Sacks knew well, is that this dividing line, important as it is, can be made an excuse for professional arrogance. Doctors need to bring something of themselves to their patients, to make a personal connection, if medicine is to be a healing science. – © Guardian News & Media 2015