He was a menace in the lab, but Oliver Sacks’ clinical compassion and insightful way with words inspires Clare Watson to keep an open mind while finding her own niche.
Winding through the countryside on a bicycle, having escaped the concrete heat of New York City for the weekend, a young Oliver Sacks sipped gradually and symmetrically from the two-litre jugs of cider hanging off each handlebar, keeping himself both hydrated and slightly tipsy. This image is one of many of the famous neurologist: one part sensible, one part impulsive, and almost always absorbed in the fine details.
Sacks’ life was a deviant exploration of identity and a sharp survey of the human mind: his own and others’. He has made an impression on me, subtly and threefold: as a scientist, as a writer, and on a personal level.
Oliver Wolf Sacks was born in London in 1933, but he was more at home in the United States. Sacks was one of four brothers; the eldest two were also doctors, like their parents, but he carved a unique path in neurology. As a specialist in the human mind, Sacks would encounter peculiar illnesses few had seen before. By his own words, Sacks used the combined powers of observation, theoretical depth and human warmth in his practice. However, he truly made his mark as a prolific writer. His books chronicle tales of people living with neurological disorders — not case studies — and capture Sacks’ deep compassion and respect for his patients.
I was first prescribed a Sacks paperback for a neuroscience class while studying abroad at the University of Colorado. The Man Who Mistook His Wife for a Hat was a memorable book but at the time I was distracted by other novelties. The book, together with the class, connected the inner workings of the brain to the behaviour of a person. I have since been drawn to medical research that borders the lab and the clinic, not wanting to be too far removed from the people that research is seeking to help.
The compassionate clinician
In his practice, Sacks was observant and attentive to his patients, who presented with assorted problems in learning, memory, perception and awareness. Often their connection to the world was distorted; some were reclusive and others blissfully unaware. Upon meeting one patient, Sacks noticed that Dr P, a musician, faced him not with his eyes – which made “sudden strange fixations” and darted from one thing to another – but with his ears. The man was compensating for his visual shortfalls with his hearing.
In the same book, Sacks described another patient, Christina, who by his account was “a strapping young woman … self-assured, robust, in body and mind.” She had lost all proprioception and had no sense of her body and position in space: “The collapse of tone and muscle posture, from top to toe; the wandering of her hands, which she seemed unaware of; the flailing and overshooting, as if she was receiving no information from the periphery, as if the control loops for tone and movement had catastrophically broken down.”
Sacks’ acuity and compassion was ahead of his time. He believed that society lacked the words and sympathy for states of mental disorder, and countered this with his own practice. This may partly be attributed to his personal life. In the 1940s, Sacks’ younger teenaged brother was diagnosed with schizophrenia, a one-word verdict that left their parents reeling with “alarm, pity, horror, and above all bewilderment.” I suspect that from this early experience, Sacks formed his holistic practice as a neurologist: “It is a question of not just medication but the whole business of living a meaningful and enjoyable life – with support systems, community, self-respect, and being respected by others – which has to be addressed.”
Sacks himself was intimately familiar with cognitive disorders, as he was face blind and could not recognise familiar faces. This is called prosopagnosia – a disconnect between perception and recognition. Faces are not a blur for people with face blindness, but rather, each is an assembly of features, and the difficulty is joining the dots to form a whole picture to which they can put a name. Sacks recounts with humble laughter mistaking another bearded man as a reflection of himself, the stranger too similar to distinguish as foreign, but oddly not stroking his beard in return. To counter this, he trained his eye to recognise a person’s idiosyncratic features: their large out-sticking ears or hooked nose, their posture or gait – and it’s with this humane inquiry that Sacks also formed his clinical sketches.
The bench scientist, for a time
Until I read his frank memoir, I had only considered the professional Dr Sacks. Sacks, I thought, was clearly a skilled doctor for the intricate histories he would tease out of his patients and his remarkable empathy. I did not anticipate the coevolution of characters that was revealed in his autobiography, On the Move: A Life.
The sense of discovery was exhilarating and kept me going through what might otherwise have been rather fearful and demoralizing years, as did my continuing seeing patients and writing.
- Oliver Sacks
Before settling into neurology, Sacks had dabbled in lab research. His undergraduate studies had concentrated on physiology and biology, but only twice in his career he settled into lab work. The first was after graduating from Oxford when he took up a short-lived research position at the university, the second ten years later. The focus of both projects was myelin – the fatty substance that encases nerves, insulating them so that they function optimally. The latter study involved smashing up buckets of earthworms to extract an ounce of myelin, which Sacks proceeded to misplace – one of several mishaps. He was dutiful to research but a “menace in the lab,” according to one of his supervisors.
That’s not to say Sacks wasn’t a good scientist. He was inquisitive and thorough, but I feel his skill was best applied outside of the lab. When I’m doubtful of my aptitude for lab research, Sacks has reminded me to not sweat the benchtop mistakes. His story also encourages me to keep looking for my niche (I’ve hopped around a little). Different scientific disciplines call for different qualities, but a thirst for understanding and knowledge is common to all breeds of scientist.
The fruitful writer, to the end
Sacks’ curiosity was insatiable and this fuelled his writing. As an example of his flair with words, as a precocious student he won the Theodore Williams Scholarship in Human Anatomy by answering only one of the seven required questions, having stumbled into the exam drunk. By contrast, he later rewrote an essay for The Listener, a weekly paper published by the BBC, no less than nine times. According to his editors, his footnotes could equate to supplementary novels.
Sacks wrote with honesty and urgency. He was prolific but on point. He could find the words to describe the “unimaginable realms” to which his patients were confined, and I imagine this knack transpired in his consultations. To witness the loss of a person within the depths of their own mind is alarming. Sacks, able to tenderly explain what he suspected was going on, would have made it less frightening.
To this end, Sacks endeavoured to communicate with his patients by whatever means necessary. He would sit to the side, observe first, and then devise a way to get through to them. Once he met a pair of twin savants, John and Michael, who had what Sacks referred to as an unlearned skill of numbers and dates – that is, they never used arithmetic but could ‘see’ large figures and projected dates. Sacks was mesmerised by their purely numerical conversation. They passed six-figure numbers back and forth, each savoured with a smile. Sacks returned the next day with a book of prime numbers, offered an eight-figure number and was accepted as a third in their world.
I find Sacks’ lessons in empathy comforting, especially when it comes to a member of my family with bipolar disorder. Sacks approached the human mind and all its quirks with admiration for the spectrum of abilities and possibilities. He believed that “our [neurological and psychological] tests, our approaches, our ‘evaluations’ … they only show us deficits, they do not show us [a person’s] power.” With my own brother’s diagnosis in mind, I wonder how far we have come with respect to the stigma towards mental health. We might have a better vocabulary to diagnose conditions, but empathy – in patient care and in conversations about mental health – is still in short supply.
It seems to me that I discover my thoughts through the act of writing, in the act of writing… [But] I get intoxicated, sometimes, by the rush of thoughts and am too impatient to put them in the right order.
- Oliver Sacks
Many articles have been written about Sacks’ character and influence since his death last year; this will be yet another. Sacks responded to a terminal diagnosis of an ocular melanoma with sincere contemplation, and an intention to achieve new levels of understanding and insight in his final months. In a series of candid essays on life, death and dying published in the New York Times, he vowed to “live in the richest, deepest, most productive way I can.” Above all else, it is this attitude to life-long learning that moves me.
Although he became an authority in the field of neurology, Sacks never assumed a position of authority over his patients. He thought of himself more of a general practitioner than a specialist. He welcomed patients into his home at all hours, and was dedicated to understanding each person’s unique neurological narrative. His own story is just as remarkable.
Edited by Nicola McCaskill and Tessa Evans