Oliver Sacks

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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