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An interview with Oliver Sacks, The Guardian, 19 October 1996
Imagine — if you don’t know it — Oxford Street before 8.30 on a weekday morning, a time when you can feel the cut of the early, unblunted air, when the Londoners on the broad pavements are reflected as individuals in the windows of closed boutiques. Enjoy the paradox of the long rising and falling street, by day a famous latitude of blind, inescapable shoals: outside trading hours, early morning and late evening, a very pleasant place to stroll. Unbothered by tourists and barkers and men handing out leaflets for language schools and free haircuts, there is no urge to ask why public space in the city is so often alienating.
Step into any one of the tributaries running at right angles to find a café. Picture this one, fifty yards from Bond Street tube, Italian, brown-panelled and spacious and a little sticky: a community of office workers, couriers, tradespeople crystallising in brief encounters and ‘Mornings!’ in the queue for cappuccino and Danish. There’s something happily connective in the meetings between newcomers who tap others on the shoulder and smile in greeting, effortlessly creating that most difficult of urban categories: a sense of identity. As if, in short, they are creating a world.
Twenty minutes later I am three floors above the warm, damp atmosphere of the café in another down-at-heel room, a large equipment-strewn space, bordering on chaos, of the kind beloved of film production companies — it’s always a surprise how the romance of film requires such cumbersome baggage — and the same subject comes up.
‘I was wandering around here last night with E–, my oldest friend,’ Oliver Sacks says, ‘and I kept stopping at restaurants and peering in because there was an odd feeling of being an outsider and suddenly wondering, What is life?’
Dr Sacks’s voice is unusual on first hearing, pitched enthusiastically but very soft, full of soft r’s; rather — to make a purely vocal observation — like a sponge pudding with the fruit pecked out of it. Yet the quality of the question is in keeping with Dr Sacks’s boyish candour. Or is candour exactly right? Rhetorical questions are a funny habit. They go sideways, crab-like. The questioner puts the question, flexing his pincers thoughtfully, then scuttles away — and the neurologist who has turned the neuropsychological case history into an extremely successful literary form is a very scuttling human being. While we talk he fiddles incessantly with a white toothpick. Perhaps what he is talking about is not life but his own restlessness, his sense of not belonging in London, in the city where he was born.
‘I don’t know whether I should say this or not. This week, instead of staying at a hotel, I’m staying at a club which has a large swimming pool, because I have a passion for swimming, and I feel very intensely an outsider there — I think I partly ran out of England because I wanted to get away from a class mentality.’ He smiles past fingers and toothpick through his Freudian beard. The black teeshirt gives the game away, as do the earth-shoes and that eyrie of a beard, above which perch other eagle-like components: egg-shaped dome, beaky nose dividing undeflectable gaze. Sacks is not one of those tweedy Anglican academics who at forty-five settle into a groove reproducing their dusty variations on a theme, those gentlemen of the Pall Mall clubs.
‘I’ve actually been unable to eat there,’ he confesses, ‘because one can’t even have breakfast without a tie and jacket.’
Sacks the non-establishment figure is a seeker after truth whose work, like Harold Bloom’s or George Steiner’s, has been a metaphor for his self, visibly and palpably driven, if not tortured. Though he is more diffident than either: he refuses to be drawn when I suggest that his explorations into neural illness — chronicled in collections such as The Man Who Mistook His Wife For A Hat, Seeing Voices, An Anthropologist on Mars and his new title, The Island of the Colour-Blind — are really experiments in existential medicine, in the bridge between neurology and identity that becomes visible in the dawn of illness. ‘I don’t know what I do. My work may be in some ways a random investigation: a man phones me up with colour-blindness, someone sends me a letter with something else, and people sometimes say, “Sacks, where’s your general theory? Stop telling us stories….”’
And what was his answer?
‘My answer is partly, I’m content to give examples, you provide the general answer. I am not terribly good at general theories; my strength is in pursuing individual narrative investigation. Yet wherever one goes, whether it is through migraine or colour-blindness or whatever, these are windows or perspectives in the same central area of how the brain works, what it ‘s like to be human, how we construct a world, the nature of individuality, etcetera.’
Susan Sontag has pointed out how cheap is the trick of metaphor. But Sacks’s restlessness is evidently partner to his explorations of the human brain-map. He constantly slips into the tropes of travel (‘wherever one goes…’) when talking about disease. In fact, travel was his first inspiration when he qualified, quit the Middlesex hospital in 1958 and spent a year zigzagging around America on a motorbike; one of his early medical peregrinations was to repeat this trip with a friend, a photographer with Tourette’s syndrome (the affliction of convulsive tics, echolalia and involuntary obscenities delineated by Freud’s friend Gilles de la Tourette in 1885), visiting other people with the condition.
‘I had a notion then that a picture of America and being on the road would be combined with a sort of Tourettology, which is why I say, half-jokingly, they’re the same.’
Speaking, he walks over to the window, stops, comes back, turns through 360 degrees twice, twiddling his toothpick all the time. ‘The symbol of travel is there all the while for me. But I would never want to stop being a practising neurologist.’
Sacks was a pioneer in a new kind of neurology. Neurology’s favourite word, as he points out in The Man Who Mistook His Wife for a Hat, is ‘deficit’. Early neuropsychology, beginning in the Second World War in the Soviet Union under Alexander Luria, was revolutionary but dealt only with the deficits of the left hemisphere of the brain. There was a reason for this: while it is easy to demonstrate the effects of lesions in the sophisticated, computer-like left side of the brain, the right hemisphere’s activities which control the ‘primitive’ powers of recognising reality, of consciousness, cannot be ‘known’ either by the patient or by the classical diagnostician. They are unimaginably remote from anything he or she has experienced. The famous instance is the case of the musician Dr P, gifted and resourceful, who couldn’t see that he couldn’t see.
Sacks, who corresponded with Luria for five years before the Russian’s death in 1977, picked up the baton for a ‘romantic’ neuropsychology — detailed case histories written as narratives, stories in which the effort to understand, via the telling, was paramount.
There is another metaphor here. The neurological difference between the left and right sides of the brain is comparable to the difference between the schemes of daily life, between our ability to categorise the world and our ability to feel and judge the world at the time it is happening to us.
This is the territory of Forster’s ‘Only connect’, which hits the mark that classical empirical neurology misses. There is self -evidently a physical foundation to the self, which cannot be revealed by empiricism alone. The ruthless empirical science of Dawkins and Gould with its DNA-worship, its twin mantra of ‘DNA just is’ and ‘the only doctrine is, there is no doctrine’ misses the same mark. On the subject of empiricism, it is worth remembering that in the brain’s cortical mantle — the size of a large table napkin when it is spread out — the number of possible combinations of nerve connections is of the order of ten followed by several million zeros. By contrast, there are only ten followed by eighty zeros’ worth of positively charged particles in the known universe.
The worlds Sacks creates are rich and strange. W.H. Auden called his famous account of the survivors of the sleepy-sickness encephalitis epidemic of the 1920s, Awakenings, ‘a masterpiece’. (The film made from the book, starring Robin Williams and Robert de Niro, was pure Forrest-Gump emotionalism. It’s a token of the book’s power that the movie was nonetheless horribly engrossing.)
In all his chronicles — of blindness, deafness, the world of the deaf-blind, of those who lose proprioception (the body’s awareness of itself), and of the sets of symptoms that gather into the many syndromes of brain disease — the patients are, to an onlooker, wildly over the bar of normality. Sometimes the sufferer returns temporarily, as in the case of the Awakenings patients prescribed the Parkinsonian drug L-DOPA, who found themselves hurled forward in time to 1969; sometimes the return produces a dépaysement (the French word meaning ‘homesickness’ is more exact than ‘disorientation’) which is too hard to bear. Virgil, a masseur who regained his sight after 40 years, became disgusted by the visible blemishes on skins that had seemed perfectly smooth to his hands.
One of my favourite cases is that of Jonathan I, a painter who became completely colour-blind at 65, because it shows so clearly (though Sacks does not refer to this) the profound emotional network of the brain. Losing colour first put Jonathan I into despair and rage. Colour, as it were, had walked out on him. A couple of months later, he began to adjust to his ‘night vision’ and to painting in monochromatic shades. Later still, when it was suggested to him that he might be able to retrain his colour vision, he refused, saying that he had found the world again, coherent and complete. He had adjusted, neurologically and psychologically. The lover betrayed by colour had found his new, black-and-white love.
The Island of the Colour-Blind deals with a congenital form of this achromatopsia on an island in the midwest Pacific. In the rest of the world, this disease’s incidence is less than one in 30,000; on Pingelap it is one in twelve. Achromatopsia involves more than colour-blindness; more disabling is the painful hypersensitivity to light and poor daylight acuity. Sacks travelled to Pingelap with a Norwegian scientist called Knut Nordby, himself an achromatope. There is an instant of recognition as the two white men alight from their plane and, blinking in the Pacific glare, Nordby comes face to face with a crowd of inquisitive Pingelapese children, their faces painfully screwed up, eyelids strobing with the same tic as his own.
Montaigne said, ‘A man must have experienced all the illnesses he hopes to cure and all the accidents and circumstances he is to diagnose…. Such a man I would trust.’ For achromatopes and for many suffering from the other afflictions that fascinate Sacks, there is no cure, only adaptation, which has a compensatory value: many who have lived with disease — not belittling its terrors and miseries — might concede the exchange between the disease and the normal self, because by it a new identity is created.
Among the Pingelapese, the adaptation is part of their cultural identity, visible in the secret art of their weaving, of patterns so subtle it is difficult for their complexity to be detected by the ordinarily sighted person. Language can owe the same debt to disease. Achromatopes move better at the scotopic hours between dusk and dawn; the Pacific twilight must be one of the acid tests of a prose style, and while Sacks’s is always fluent and elegant, his description of night-fishing in Pingelap’s lagoon doesn’t possess the rapture of his companion’s: ‘The cloudscapes on the horizon, the clear sky, the decreasing light and deepening darkness, the nearly luminous surf at the coral reefs, the spectacular stars and Milky Way, and the shining flying fishes soaring over the water in the light from the torches.’
Readers of Sacks’s books have trusted him for more than his experience. His mastery of unbroken ground in the territory of self-identity and its loss is a result of personal involvement in Luria’s ‘realms of wonder’. He goes to British Columbia to watch the Tourettic surgeon, Dr Carl Bennett, remove a melanoma from a woman’s buttock. He travels to Moscow with the autistic boy Stephen Wiltshire, to see if he can discern a ‘self’ as well as an extraordinary draughtsman of buildings. He discusses, over three months, the consequences of prescribing the drug haldol to Witty Ticcy Ray to curb his Tourette’s. He travels to California to visit an autistic family given to bouncing on trampolines and screaming, and to other places where there are crops of genetic isolates: a deaf community on Martha’s Vineyard, a Mennonite community of Tourettics in Alberta, the paralysed of Guam.
Disease is to be viewed in a new light. Interference with it, any effort to cure it, can introduce a possibly artificial balance. Thus Ray, the weekend jazz virtuoso, is disabled by haldol into a drummer who can no longer improvise; Natasha K., suffering at 88 from a very late onset of neurosyphilis, does not want to be cured — the spirochaetes have made her friskier, more flirtatious than she has been in years. Disease has its seduction. As Nietzsche noted, ‘Are we not almost tempted to ask whether we could get along without it?’
To read Sacks provokes another question: are we not almost tempted, seeing his insatiable curiosity for the sick, to wonder whether he could get along without them? And another: ‘If we wish to know about a man’ — this is Sacks himself writing — ‘we ask, “What is his story, his real, inmost story?”’
The personal details are revelatory. He earths his need for the journeyman aspect of medicine in hospital routine: twice a week he goes to the Beth Abraham Hospital in New York where he has practised since 1966.
‘There are some people I’ve known there for thirty years now. There are times when one is idle or depressed or feels worthless, when simply doing a clinic, sorting things out, advising people, one can say, I’ve been a good workman. I have a strong feeling for the job.’
Brought up in Kilburn, not the Irish Kilburn but the compact, middle-class Jewish one that existed until the Fifties, he was evacuated during the war to a boarding school near Northampton, which was bad luck because the school’s headmaster was a sadist — so crazy that the school was eventually closed. He was able to get away for brief periods to another school in Cheshire, run by his aunt, and which he loved. The good and the bad institution have been powerful symbols for him.
One’s first conclusion about the T-shirt rebellion is probably wrong: the revolt against conformity that began when he finished medical school, and came face to face with the bitter reserve of the English professional classes, was not to do with a sense of feeling himself the Jewish interloper (both parents were already doctors) but the pure product of enthusiasm, and an associated distaste for the straitjacket of English class mentality, which, in the decline of England’s old identity, has been positively the last thing to go. ‘I wanted to be able to speak freely to everyone,’ he says.
There is something conciliatory about the attempt to re-insert himself into the establishment on this trip to London, but his non-conformity defeats it — as does his unassertiveness. Bizarrely, he is also a member of the Athenaeum club, ‘though I’ve never dared go there. I feel it’s for bishops, judges and generals, and I don’t feel comfortable there.’
One imagines him more at home on the streets of New York, where personalities can suddenly flower at both ends of the sanity-spectrum. He tells an anecdote about a recent night in the Village.
‘Last week there was a total eclipse of the moon and I ran out with my monocular — I who am sort of shy spoke to all sorts of people in the street, saying, “Look! Look!” I even intervened in a quarrel where in the parking lot the attendant was quarrelling with a woman who said he had charged her too much, and I said’ — his tone deepens and his beard becomes prophetic — ‘”Stop your quarrel! Look at the heavens! You won’t see this again in your lifetime”, and they actually stopped quarrelling and looked at the heavens, they were so taken aback.’
Yet I feel this story has more to do with transcendence than with nutty-professor enthusiasm. He mentions the name of Kierkegaard, and I remember a passage from the philosopher’s journals. Standing alone on the Danish coast at Sortebro, 160 years ago, Kierkegaard wrote:
I did not as so frequently happens to me lose myself in the moment, but saw everything as a whole and was strengthened to understand things differently, to admit how often I had blundered, and to forgive others… the power of the sea and the battle of the elements reminded me of my own nothingness.
A strikingly similar passage comes at the end of The Island of the Colour-Blind, when he talks of swimming each June among the horseshoe crabs that crawl up the beach of City Island in New York to mate, as they have done every summer for 500 million years. He quotes Melville observing the giant tortoises of the Galapagos: ‘The great feeling inspired by these creatures was that of age — dateless, indefinite endurance. They seemed newly crawled from beneath the foundations of the world.’
The same feeling comes upon him in the Pacific.
The sense of deep time brings a deep peace with it, a detachment from the timescale, the urgencies of daily life. Seeing these volcanic islands and coral atolls… has given me an intimate feeling of the antiquity of the earth, and the slow, continuous processes by which different forms of life evolve and come into being. Standing here in the jungle, I feel part of a larger, calmer identity: I feel a profound sense of being at home, a sort of companionship with the earth.
Identity, in its widest sense, has been Sacks’s quest, the subject that has defined — and defied — him. As Kierkegaard has also unhelpfully pointed out, everything resolves itself into contradictions. His own answer to the Great Rhetorical Question is that our life is an investigation of itself — that is its meaning, if it has any meaning — yet one ought at some level to remain a mystery. Professionally, the doctor has of course tapped successfully into that rich Eighties and Nineties development, the medicalisation of identity. We are less stoical than our parents; we are all beginning to see ourselves as case histories. Even travel seems to be today a symptom of illness: a mass mobility that equals a mass restlessness. Travel has become the developed world’s mass Tourettic tic.
Sacks himself exhibits symptoms of this Tourettism. Escape from the English class mentality notwithstanding, his restlessness did not abate when he found himself established in a nation with a visible dream of democracy and equality. He travels constantly. ‘The last time I travelled to Australia, the hostess said I was the most restless passenger she had ever seen.’
Sitting down from one of his tours of the room, he makes a sudden movement. ‘I should have thrown that away an hour ago!’ His toothpick is hurled into the bin. Then, immediately, he picks up his miniature telescope and begins unconsciously garrotting its metal casing with the carrying cord.
I wonder whether there might not also be something as obsessive, repeated, ritualistic as this action in his constant communication on one subject — a borderline autism? The doctor’s identification with his subjects on a human and medical level is nothing if not engaging. But to borrow another phrase of his, ‘the inner and outer narratives here, as everywhere, must fuse’. Where exactly is Sacks taking us, once he has shown us this new perspective on identity? Where is he taking himself?
As Kierkegaard nobly, if indirectly, pointed out, the seeker after truth must eventually investigate himself, and there is a point the neurologist reaches where he doesn’t reveal himself any further. We are back to the problem of his general theory.
When not travelling, the doctor lives alone on New York’s City Island. ‘I don’t quite know that I feel comfortable or at home anywhere. I really don’t know whether I feel English or American or what now.’ He felt, he says, rather comfortable in New Zealand briefly — there was something about it that reminded him of an England to which the war hadn’t happened.
The discomfort is a sensation that has intensified over time. ‘The London of the mid-Nineties is very different from the London I knew. This is less so in the country. I’m very, very fond of ferns, and a couple of years ago I went on a tour of fern gardens, especially in Shropshire, and I loved that and I felt quite at home there. Though of course, I could talk about ferns with other fern-lovers, and this again became something rather transcendent.’
He disavows the transcendence of religion, but with an interesting uncertainty, equal to his willingness to leave a general theory of the mind to others. ‘At some level I find religion unintelligible. Yet like everyone else I need that feeling of thanksgiving and awe.’
Seeing him move around the room, I feel constrained to ask: does he get periods of boredom? The answer is revealing. ‘I didn’t used to. But I do now.’ Is it connected to his restlessness?
‘There are so many sorts of levels of boredom! One could have a whole Kierkegaardian treatise on it. One thinks of Sherlock Holmes between cases. When he’s on a case, he’s like a hound, he follows the scent, he’s excited; then he gets enervated, shoots up cocaine, plays the violin drearily, and regresses until the next case comes along. There is some of that sort of between-boredom… at the moment I have a slight sort of vacuous feeling: the book done. Next I want to write about Williams syndrome. I’m also committed to do something on Freud and neuroscience. I also want to do something on the history of museums and botanic gardens and their degeneration.’
What about the existential variety of boredom? Does he get that too?
‘Oh yes.’ He was listening to Barbara Castle on t.v., he says, after the Blackpool conference, when the interviewer asked her if she was tired. ‘And she said, “I know I look tired and it’s been an exhausting week, but” — what was the phrase she used? — conviction? She had some sustaining thing.’ He continues to throttle his telescope as he thinks about Baroness Castle’s fiery self-belief.
‘I sometimes feel that with the absence of religious attitude and of much evangelical attitude, not being one of the world’s crusaders or warriors, or projectors as Swift would say, that a yawning sense of pointlessness and meaninglessness and motivelessness is there. You know, awaits people like me.’
From someone who has given generously of his skill and experience in case-work and writing for three decades — and achieved wide recognition — this seems an astounding admission, which I’m temporarily embarrassed to pursue. He is a committed neurologist, a sympathetic observer. ‘There’s many a spectacled sod, Who prefers the British Museum to God,’
wrote Auden; but Sacks is not one of them.
Perhaps it is simple: faced with the irreligion of science, what we who are sceptical about science’s hijacking of explanations have felt most keenly is the lack of a philosophy of science, a lack of the ultimate necessity to make both philosophy and science personal. (Wherein Dawkins’ gleeful assertion that we just dance to DNA’s music is about as much use to us as a spell-checker to Pushkin in the composition of Eugene Onegin.) Among scientists, Richard Feynman is almost alone in admitting this necessity, in a passage about connections of reverberant brilliance:
Which end is nearer to God; if I may use a religious metaphor. Beauty and hope, or the fundamental laws? I think that the right way, of course, is to say that what we have to look at is the whole structural interconnection of the thing; and that all the sciences, and not just the sciences but all the efforts of intellectual kinds, are an endeavour to see the connections of the hierarchies, to connect beauty to history, to connect history to man’s psychology, man’s psychology to the working of the brain, the brain to the neural impulse, the neural impulse to the chemistry, and so forth, up and down, both ways. And today we cannot, and it is no use making believe that we can, draw carefully a line all the way from one end of this thing to the other, because we have only just begun to see that there is this relative hierarchy.
And I do not think either end is nearer to God.
Equally, Luria’s ‘romantic science’ that Sacks started out with has missed the point that we ordinary men and women are dark enough horses. He fashions his neurological patients into fabulous creatures of a new mythology — heroes, victims, martyrs, warriors. But myths require the moral or scriptural crystallisation of myth; without that candour, we’re left feeling that something is missing from these compelling fragments of a freak show — that instead of understanding new fables, we might have been watching a kind of neurological How Do They Do That?
In one sense, that of the case-work guided by the ‘good institution’ and his modest journeyman-philosophy, Sacks is a remarkable seeker. But I wonder whether, in looking after the illnesses that have been his constant companions for 30 years, he has neglected himself, whether the seeker’s imperative to turn his work into an investigation of his own life is something at which he has both succeeded, and failed.
‘Do you think you will ever -’ I ask.
‘Accept the universe and come to grips with life?’
‘Yes.’
‘When I am in a chapel and I see, say, these Giotto frescoes all round, I think how nice it would be to be in a compact intelligible world, but I think that was rather blown apart in the 17th century. Then every so often an odd feeling of peace comes upon me and I don’t know what that’s about. I’m not happy to see it in a Freudian sense as the absence of instinctual tensions; I want to call it the peace of God, although that’s also meaningless. Yet the phrase keeps coming to me.’
This is Kierkegaard’s final teasing contradiction. After the revelation, the mystery, always the mystery. ‘One ought to be a mystery, not only to others, but also to one’s self. I study myself; when I am weary of this, then for a pastime I light a cigar and think: the Lord only knows what He meant by me, or what He would make out of me.’
© Julian Evans 1996
