Listen to the interview this piece is based on. Download this podcast Oliver Sacks embarked on a career in neurology because, he says, “the brain both shapes us and is shaped by us—it is who we are.” For several decades he has treated people with all-consuming disorders, such as the inability to create new memories. He has written various books of detailed, empathic case histories, including Awakenings (adapted into a film starring Robin Williams) and The Man Who Mistook His Wife for a Hat. His latest, The Mind’s Eye, chronicles his patients’ and his own problems with sight. Are people hardwired to have certain jobs? In families of musicians, and sometimes mathematicians, I think the genetic component is very strong. The Bach family was so famous for its musicality that musicians in Germany used to be called Bachs. Certain minds may be analytically inclined from the start, and this may draw them toward science. But family influence is important. Nine uncles on my mother’s side were all chemists or physicists, and I thought I wanted to follow them, until I was about 14. My parents were both physicians, and eventually I followed them. But how much it was destined, I don’t know. There was another part of me which wanted to get away from it all and just be a writer. If people want to try something completely new in their second act, how can they prepare their brains for the transition? Being very advanced in age, I’ve been thinking of act three rather than act two. I believe it may just come on one spontaneously—as with, say, Lewis Thomas, who was a very good biologist. When he was 50 or 60, he could look with some pride at his 200 or so tightly argued and highly admired scientific articles and think, “These have not expressed me. I am not fulfilled. Life doesn’t just consist of technical articles.” And then suddenly he started writing essays of a completely different sort. What helped him make that shift? I think he just got tired of what he was doing. He’d done enough. So it’s just a matter of sheer will? And opportunity. And luck. And having other gifts, which sometimes one isn’t aware of. In my last book I described a surgeon who, after being struck by lightning and almost killed, developed a sudden passion for music, which he hadn’t had before. This gave him a new career and a new life in his forties. Can you identify any crossroads in your career? Coming to America, when I was 27. An older brother went to Australia at exactly the same age. We both left England on our 27th birthdays, I think with the idea of a sharp change. I thought of British society as rigid and hierarchical. You were classified as soon as you opened your mouth. I imagined America would be socially and culturally and morally spacious, as much as it was physically spacious. And I thought that I would probably have an odd life, and that I would be able to survive better in America because it was larger, and that I could find a little hospital and hide there and do my own thing, which is what I did. What I’m still doing. How does getting to know patients and telling their stories enrich your understanding of the brain? It allows me to understand much better what is happening with them physically. This may be less clear with the heart or a kidney, but it is extremely clear with something like a language disorder produced by the brain, because disorders of this sort always have a strong personal quality. The case history, or telling their story, is the most detailed way of communicating—but also apprehending—what goes on with people. The Mind of a Mnemonist, by the great Russian psychologist A.R. Luria, was very influential for me. Luria had followed the mnemonist, a man of prodigious memory and powers of imagery, for 30 years. When I started the book, I thought it was a novel. It had the power, pathos, and drama of a novel. I then realized it was a scientific case history, the richest I’d ever read. Narrative may be an essential part of scientific understanding. I’m not a physician and a storyteller. I regard the two things as linked. Do you ever hit on a diagnosis as you’re writing about a patient? Yes, it may come to me as I write. I think, “I’ve been going in the wrong direction. This is what’s been happening. Why didn’t I realize it?” Writing gives one a way of reflecting and reexperiencing. Why do people at their most vulnerable give you and your readers such intimate access? The business of writing about people is a very delicate matter, one which never occurs to me until I’ve known them for a long time. I will then discuss it with them at length. I am not satisfied with a formal consent. I have to be convinced that they feel it is a good thing. I always show them what I write. Would they change it? Have I omitted things? Would they put the emphasis differently? It becomes almost a collaborative effort, a dual authorship. They know that if I write, it will be in a mode of sympathy and respect, and not anything else. It will not be a painful disclosure. You draw a lot of insight from memoirs and letters, not just from the patients you see. Are those points of view more useful than objective observation? Let’s say they’re equally useful, in another mode. I don’t know whether I would have written about Jimmie, “the lost mariner” in The Man Who Mistook His Wife for a Hat, had I not by chance picked up a memoir by Buñuel, the filmmaker, in which he describes how his mother lost her memory and to some extent her identity. This immediately made me think of my own patient, and within minutes I had started writing a case history, with an epigraph from Buñuel. So memoirs and biographies can get me going, but then all sorts of objective things can get me going as well. Do patients view you as a therapist? I think a physician should be seen as a therapist. A good physiotherapist should have some idea of the patient’s psyche. And a good psychotherapist should be observant of the way the patient moves around. A potential doubleness I have to deal with is being “the investigator” versus “the therapist.” A part of me wants to know more and more, and I have to say to myself, “Go easy. Don’t push too far.” There’s a nice example of this: A famous neurologist who actually had a very suitable name for a neurologist—Henry Head—was deeply interested in nerve injuries and their effects, and the sensations which might come along as a nerve was healing. He saw hundreds of people with nerve injuries, but there was a limit to how much he would quiz them. He felt that if he needed to investigate more, he should have one of his own nerves cut. So he arranged for a surgeon friend to cut two nerves in his arm. He then wrote a most extraordinary memoir describing the effect of cutting the nerves and their recovery over 18 months. I very much admire Henry Head for many reasons, and that is one of them. Has your struggle with ocular cancer changed how you think and work? I’m very sorry to have this thing. But since I do, I’ve been trying to make useful observations. In writing about it, I can sometimes achieve a sort of detachment. I’m getting it at the same time it is getting me. I also kept a journal when I was in the hospital in 1974 with a broken leg and ruptured quadriceps. Some other patients who had similar problems saw me, apparently, happily occupied with a large notebook. And they said, “You lucky sod. We merely have a messed-up leg, but you’re making a book of it.” It’s just the same impulse as writing about my patients. We all know that we are going to die sometime. But when you have something like this, you know it’s there. I speak more easily to people with cancers and other illnesses now, because I can speak as one of them. In this way, there can be no condescension or looking at a distance. They know that I too am a patient. We’re all patients. Regarding spectrum disorders like OCD or Asperger’s, would it be farfetched to say that almost everybody has a “little bit” of this or that? No, I think one could say that. And I think one could also say that in people with florid mental illness, some things which are normal have become hugely exaggerated or distorted or deficient. This may be why all of us can empathize with forms of mental illness and, for that matter, with all of Shakespeare’s characters. Now, I don’t think we all have a little bit of Parkinson’s in us. One can’t imagine one’s way into hard neurological stuff nearly so easily. Your new book, The Mind’s Eye, is largely about how the brain adapts when seeing is compromised. As a physician and scientist interested in the nervous system and in patients, I learn more when things go wrong. It’s very difficult to learn when everything goes right. I mean, you think, for example, that the whole world—full of color and depth and movement and meaning—is given to you, but it’s not. It’s dependent on the goodwill, and good functioning, of 40 or 50 different parts of the brain, which are all linked together. Any one of these can go wrong and knock out a single thing, like color. One of the case histories in the book is about a writer who lost the ability to read. The piece appeared, somewhat shortened, in the New Yorker. At first, naturally, the experience was an absolute catastrophe for him. What worse could happen to a writer? But then various things came to his aid, and in a mysterious way. He thought that he was improving, that he was gaining back the normal visual ability to read, but he wasn’t. Rather, he was unconsciously copying the shapes of letters with his tongue. He was converting what his eyes saw into a motor activity, writing it with his tongue, and that worked. I would absolutely not have thought such a thing was possible. Does physical vision have a neurological impact on metaphorical vision, like big-picture thinking and foresight? Yes. There’s a book by Alan J. Rocke, called Image and Reality, about this very question. And I think such forms of metaphoric visualizing are crucial in science, as they are in art. Rocke speaks of how in the 1850s Kekulé, the great chemist, had a vision of a snake swallowing its own tail. This led to his understanding of the structure of benzene as a closed ring of carbon and hydrogen atoms—an insight that opened up a vast new domain of structural chemistry. Here insight came in the form of a vision when he was half asleep on a London bus. That seems to be a good place for visions.
