Neuro visions

Oliver Sacks is thinking about reassurance. It’s something he gives in person to his patients and something he offers through insight and words to readers who contemplate the mysteries of the brain. But knowing as much as he does about how the brain works, is it something, when needed, he can give to himself?

The unassuming British neurologist, celebrated author of The Man Who Mistook His Wife For a Hat and Awakenings, leans forward, squints slightly through his round wire spectacles as he stares down at his New Balance trainers.

Above, a ceiling fan turns slowly but there is no breeze and despite the movement, there is a placid stillness in the room. The only sound is ambient traffic noise from the street a few floors below. A giant chart of electromagnetic radiations hangs on the wall and I’m struck by the brightness of his turquoise socks.

Sacks spends most of his time here in his Greenwich Village office, or at his apartment in the building next door. Both are set up for living and working and, in his solitary world, it seems there is little that divides the two. In 2006, he had ocular melanoma diagnosed in his eye. He has just told me that he was terrified when he heard the diagnosis and when asked if he was able to find a way to comfort himself – given the vast scope of knowledge he has about medicine, science, illness and emotional perspicacity – he pauses.

“It depends,” he begins softly but clearly, having thoroughly contemplated the question. “When I was a medical student, melanoma spelt death within a few months. But when the eye surgeon told me it was different – it was much more benign and it could be treated, I was enormously reassured. So an expert had to reassure me.”

He subsequently lost vision in that eye and wrote about it in his 11th book, The Mind’s Eye. He admits he does indeed worry a lot but can generally be reassured by reality. The other eye is what concerns him. He is putting off cataract surgery because he doesn’t have an eye to spare and, should something go wrong, he would be completely blind.

So with plaintive acceptance, he says he lives with one clouded eye and an eye filled with blood. A few seconds pass. Then, with Yoda-like wisdom, he states: “Better an eye full of blood than a liver full of metastasis.”

Sacks, who turns 80 this year, is probably the most recognisable neurologist on the planet. His beautifully written books tell the stories of his patients (through case histories) and sometimes himself (through memoir) as he explores the puzzling and captivating incidents of the brain.

Robin Williams and Julie Kavner in the film (1990) based on Oliver Sacks’s book ‘Awakenings’ (1973)

Though he wrote his second book, Awakenings, (1973) about catatonic patients given the drug L-dopa who awoke after decades of “sleep”, it was nearly 20 years later that Robin Williams played him in the film of the same name and catapulted Sacks into the public’s psyche as the compassionate and intelligent doctor we feel we know. But in person, though he is friendly and polite – often apologising when long answers go off the subject – what’s most distinctive is a remoteness; a self-contained quality that suggests he would be known by very few.

Dressed in a crisp white shirt and sensible khaki pants, Sacks writes in longhand and a yellow legal pad and pen are just out of reach, awaiting his return to making notes. He cuts and pastes pieces on to the paper from past works and printed matter. “This is what they tend to look like,” he says, holding up a piece of paper that resembles an extensive ransom note.

He picks up a magnifying glass on his desk to demonstrate how he reads. He used to use a typewriter but couldn’t see what he was writing and also, he says, “I like the slowness of writing and I can gather my thoughts and not feel pushed along by the machine. It doesn’t go with any Luddite feeling.”

Still, the only computer he uses is the ATM machine; he gets his emails printed out and he dictates the reply.

Most notable, however, is that his desk is covered with heavy metals. They are not arranged in any special order – and he rearranges them constantly.

“At the moment I’m very fond of this piece of hafnium,” he says, lifting a hunk of what looks like solid concrete. “It’s an element. One of the very last elements to be discovered.”

He speaks with great affection about these inanimate objects.

“I like paperweights made of heavy metal. I am fond of heavy metals.”

There are tubelike cylinders of tungsten and tantalum, and a square of iridium. He got it in a powder form and went to a special place to have it melted.

“It is not an easy metal to melt,” he says proudly. To reveal its density, he hands me zinc by comparison.

And the appeal of having them nearby?

“They give me a sense of reality. If you drop the tungsten on your foot …” He places the metal in my hand – it is indeed so substantial that the centre of my palm aches instantly. “This one is heavy as well,” he says, exchanging the metal for a jagged crystal. “It’s three or four times denser than glass. It’s a lead mineral. I like dense things. I don’t know why.”

He is in touch with a subspecies of metal lovers all over the world and they exchange specimens.

“I love their solidness and their sense of reality but they also remind me of a happy period in my life when I was in love with chemistry and my Uncle Tungsten.”

Born in July 1933, Sacks grew up in north London, the son of formidable Jewish doctors. His father was a GP who made house calls and his mother was one of the first female surgeons in London. He was sent to boarding school to escape the Blitz and, in his boyhood memoir Uncle Tungsten, he writes about his early childhood fascination with metals and, later, biology.

There is an active comparison between life in his twenties and now.

“I’ve been looking through my archives. A huge mass of papers accumulated over a lifetime. I pulled out a journal I wrote when I was 26 – my farewell to Europe, my hello to the United States.”

In 1960, Sacks went on holiday to Canada, sent a telegram back to England that said, simply, “Staying“, and then made his way back to San Francisco.

He refers to himself as “an inveterate journal keeper” and always has been. The Oaxaca Journal is the only one that made its way to publication. It’s a detailed account of his trip to Mexico – a fern enthusiast’s journey and an example of botanical and travel writing.

There are two huge boxes on a table which, it turns out, are folders of travel writing. Six thousand folders, he tells me, some with 100 pages in them. “There’s a lot of stuff,” he sighs.

What led Oliver Sacks to neurology – and, eventually, to his most recent book Hallucinations, is that he began getting severe migraines at the age of four. His first book, Migraines, was on the subject and the visual hallucinations that accompanied them held particular interest.

Hallucinations are widely associated with madness and thought of as frightening; the brain being out of control. But his newest book explores all sorts of hallucinations – which he describes as “a sensation of something being there, without being there”.

Oliver Sacks in London, 1958

Sacks is not at all sympathetic to religious views (“I think that religious fanaticism coupled with existing technology is the most dangerous thing on the planet”) and the piece that he is writing now addresses religious hallucinations – an area he concedes he is sceptical about.

“People may accord [them] supreme value which may change their lives. Some of these are ecstatic hallucinations in epilepsy but there are also other ones like so-called out-of-body experiences and near-death experiences. One has to recognise hallucinations as valid and interesting forms of consciousness without attributing any external reality to them. Hallucinations can’t prove anything. I don’t think you should believe hallucinations any more than you can believe dreams.”

Those who are hearing-impaired have hallucinations and he writes poignantly about an elderly patient – Rosalie – who is mentally intact but who is hearing and seeing things. She was scared and bewildered when he first saw her and there is an obvious bond and intimacy that comes through. Are the emotional attachments to patients inevitable?

“I wept when Rosalie died,” he recalls. “I was very fond of her. The professional distance – the relationship of doctor/patient – also allows for a sort of intimacy. Patients can say things that would not occur in ordinary social intercourse. I think a patient can become a friend. But, on the other hand, I think one mustn’t be a doctor to one’s friends. I think one mustn’t have judgment undermined as it might be a friend. But no, I didn’t call Rosalie by her first name for the first two years I saw her. She never called me by my first name. I was always Dr S.”

There has been a lot of attention paid to a chapter in the book in which Sacks has written of his own personal experience with drug-induced hallucinations in the 1960s.

He didn’t intend to talk about it and explains: “I was in hospital with a broken hip and bored and irritable. A friend visited me and said you sometimes mention the 1960s – would you like to tell me in more detail what happened? And I said, well, OK – and thought aloud. He was taking it down on a pad and brought me back the typescript the next day.” He pauses.

“A similar thing happened with Awakenings in 1972 when I had a neck injury and was partly paralysed in both hands and I couldn’t write or type but I got a shorthand typist – a species that is probably extinct. I would settle myself on the couch and she would be there with a pad and I would tell her stories. It was like Scheherazade in reverse.”

One might assume that his experimentation with drug-taking would enable him to relate to patients in a more sympathetic way when they describe hallucinations that are frightening and isolating and lonely. Was this part of the motivation?

“I’d like to be able to say that but in honesty, I was curious. I was hungry for experience. And one can get a sense of a transformed world and a lot of pleasure out of such things. But then one needs to come back to reality.”

Yet having had the experience firsthand gives credibility to their stories. Isn’t having this empathy important?

In California in the early 1960s

“I think for me, moderately important,” he replies. “For example – some of my patients would describe losing visual continuity. Instead of movement they would see snapshots, stills. I might say, how could that be? But I’ve had it myself. I know it can occur. So I was open to this. I don’t think they would or could have made up things like this. These things are strange. Normally, everything is continuous. Having said that – I would not recommend drugs to anyone. I am lucky to have survived that time. Several of my friends did not survive.”

When Sacks reflects on where he is now in his life, what has surprised him most is that he’s a writer. He thinks of himself as a physician and scientist first but writing is something he has to do.

“In some ways an experience isn’t complete unless I write about it,” he says. “A lot of my writing is to discover and clarify my feelings. Such writing is not necessarily about or for other people. It’s for myself. Although I usually never look back on it.”

One of Sacks’s early ambitions was to be a “bench” scientist – a neurophysiologist. “The word neuroscience didn’t exist in the 1950s,” he says.

But as he goes on to explain, his experiences – three of them – with bench science were all disasters. The self-effacing portrayal is of a bumbling and somewhat clumsy scientist who lost specimens and caused damage in the lab.

The last one occurred in New York in 1965, at which point he was told to get out and go see patients. “I don’t think I have the mindset for minute work – experiments repeated again and again. Although I fully recognise the value of that. And I stand in awe of good science. A friend and colleague of mine had the opposite experience – patients felt that he didn’t treat them right. He was told to do research, which he did, and he won the Nobel prize.”

He is referring to neuroscientist Richard Axel, whose work on the olfactory system won him the Nobel prize for medicine in 2004.

Though he admits he feels disappointed that he is not the bench scientist he’d hoped to be, Sacks’s life as a writer is something he never expected and, ultimately, provided him with a sense of purpose.

“Perhaps one has to find what they are not suited for in order to find what you are suited for. When I got out of the lab in ‘66 and started to see patients, I felt enormous relief and I realised this is what I’m made for.”

Just then, there is a knock on the door and Kate Edgar, whom Sacks calls “my friend and collaborator for 30 years” and to whom Hallucinations is dedicated, lets me know we’ve been talking too long and he will need to get back to work.

When I ask if we can continue a bit longer, a sheepish look crosses his face and he lowers his voice to a whisper. “I would, but I don’t think she’ll let me.”

‘The Man Who Mistook His Wife for a Hat’ (1985)

Though his routine seems fixed – seeing patients, swimming every day, reading and writing in the morning – he says there are times when he feels blocked and “the spirit isn’t in me”.

And what happens then? “I watch Star Trek: The Next Generation. Or I might write letters. I’m sorry that the Post Office is collapsing.”

After all the years of investigating and reassuring others, I ask if he feels accomplished?

“Yes and no,” he responds, without hesitation. “I have failed to do all sorts of things I had hoped to do. But on the other hand, I feel very grateful to have done something.”

He has always lived alone – it’s in his nature – and has described himself as having been celibate for decades. There is a reference in his current book to a love affair that didn’t work out and that seemingly ended his romantic life in the mid-1960s.

His books reveal, through dedications, the people who matter the most. His patients, his protectors – and The Man Who Mistook His Wife for a Hat is dedicated to his long-term psychoanalyst.

“He is Dr S and I am Dr S and we have been for 47 years.”

He continues to see him twice a week and there is reassurance that comes from going through one’s life with someone who in many ways knows his mind better than he knows himself.

“The unspoken can be recognised by someone who is an expert. I regard him as a lifesaver.”

When asked if there is a graduation date, he smiles. “Yes, 50 years.” He lets out a burst of gentle laughter. “We’re beginning to get somewhere.”

Oliver Sacks’s’ latest book, ‘Hallucinations’, is published by Picador

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