Monday, May 1, 1995

Interview: The Casebook of Oliver Sacks

The Casebook Of Oliver Sacks
The Boston Book Review

We are in strange waters here, where all the usual considerations may be reversed -- where illness may be wellness, and normality illness, where excitement may be either bondage or release . . . It is the very realm of Cupid and Dionysus.
"The Man Who Mistook His Wife for a Hat"

OS: People ask, are you still a doctor, do you still see patients, or are you just a writer? As you just saw for yourself [when a man in a wheelchair left Oliver Sacks's hotel room] I see patients. It is my life and I never want to stop.

HB: In "A Leg to Stand On," you write, "If my attention is engaged, I cannot disengage it . . . It makes me an investigator. It makes me an obsessional. It makes me, in this case, an explorer of the abyss . . . "

Do you have a neurological disorder that compels you to examine neurological disorders?

OS: I feel very distracted much of the time, darting from one thing to another but I think there is some sort of consistency or tenacity to it.

HB: And in "An Anthropologist on Mars" you describe yourself as a physician called "to make house calls, house calls at the far borders of human experience." That would seem to apply to all your work.

OS: This man in the wheelchair was a house call. It was exactly what my father would have done when I was a kid. I used to love to go with my father on house calls. He was often called a whiz at diagnosis. It got around and if he went to Edinburgh or Lisbon someone would know and phone him up. He would see them in his hotel room.

HB: So you carry on the tradition. But I hope you won't be offended if I say that your work brings to mind P.T. Barnum and the age old fascination with borderline human experiences.

OS: I think it does, although I'm obviously vulnerable and sensitive to the notion of Sacks's freak show. Museums started partly as cabinets of curiosities -- wonders, marvels, and prodigies.

HB: The boundary conditions of being human have always been of interest.

OS: For me it's a way of looking at being human rather than being inhuman.

When I was young my mother, who was a surgeon, used to take me to the Royal College of Surgeons Museum. That was Hunter's original eighteenth century museum. It still had a skeleton of the Irish giant, the Sicilian dwarf and the skulls of Turgenev and Anatole France next to each other. And my father would tell me, when he had been a young man at the London hospital the Elephant Man was still a memory for many people. So if you want, looking for prodigiousness is in me but always to illustrate the extent of humanity, of human capacity and diversity.

I very moved some years ago in a Mennonite village in northern Canada where a fifth of the population has Tourettes. I was wondering how this deeply religious community would deal with it. Basically, their attitude was similar to that expressed in an old Jewish blessing to be said on seeing a strange person: you praise God for the diversity of Creation.

HB: In "A Leg to Stand On," which is about your own accident and recovery, you describe turning to the Psalms at a certain point; you describe the Psalms as case histories. This applies, in reverse, to your own work. You turn your case histories into psalms; you look for the redemptive value in people's experience of suffering and anomaly.

OS: Somewhere I quote Nietzsche from the preface to "The Gay Science" where he says suffering doesn't make us better but it may make us more profound; it makes us descend into our depths; it makes one question more severely than one has questioned before. I am certainly very conscious of this deepening and pensive quality, this reflective quality in many patients. There are also those who are destroyed -- devastated, embittered, maddened. But there are those who are strengthened, who discover other resources, and who are transformed in some sort of way, physiologically and neurologically. But I certainly would not, as it were, prescribe an affliction for its redemptive power.

HB: Though in "A Leg to Stand On" there is a sense in which you feel privileged to have undergone that journey.

OS: I think I did, and this is partly what A.R. Luria [a Russian neurologist] said to me when I wrote to him -- and he is, in a way, my mentor, both spiritual and neurological. He said, I'm sorry this happened to you but since it did, since you have this power of introspection and articulation, describe it from the inside as it's never been described before. That is what I tried to do. But some of the other patients in hospital said to me, you lucky bugger, we're suffering and you're turning it into a book.

HB: "A Leg to Stand On" is a story of descent, a literal descent down a hill and a descent into the self. You look into the face of a bull near the top of the hill. The bull doesn't do anything; he doesn't chase you.

OS: No, no he was probably sitting there placidly.

HB: And all of a sudden you see the devil. You flee and severely injure yourself.

OS: I found that the most difficult of all books, partly because every time I worked on it I would be thrown back into an unbearable reliving of the situation.

HB: One minute it's "The Sound of Music" -- there you are, striding confidently uphill -- and then it's suddenly "The Cabinet of Dr. Caligari" where everything is dark, grotesque, disassociated, fragmentary.

OS: I was haunted by this experience. I was in danger of having it again if I couldn't get it out.

I suggest half-facetiously that the book should be read under spinal anesthesia so the reader will know in himself what I'm talking about. These things are really quite unimaginable. When you have it, you cannot imagine it otherwise, and when it's not there you can't imagine it. The absolute unimaginability of all sorts of terrible neural knowledge which comes and goes is what I'm talking about.

A very Parkinsonian patient of mine managed, before he froze up, to inject himself with medication. A minute later he straightened and said, "I have forgotten how to be Parkinsonian." Then he added, "In forty or fifty minutes, when it wears off, the terrible knowledge of how to be Parkinsonian will come back."

HB: "A Leg to Stand On" is a portrayal of a nightmare, a story of being lost in one's alienation.

OS: This particular sort of nightmare, alienation from one's limbs, is extremely difficult, first of all, for the person to communicate to the doctor. But if a communication can be made, it is then very difficult for the doctor to communicate it further.

William Mitchell, the first to describe phantom limbs, originally used a fictional form. But the negative phantom -- the absence, the alienation -- has never made its way very well into the medical literature.

HB: Though it's the kind of thing twentieth century literature is so good at portraying.

OS: And it existed under Hippocrates.

HB: You describe "A Leg to Stand On" as a neurological novel. In what sense is it a novel?

OS: I don't know. Actually, I'm not a novel reader or writer and I'm no good at plot design and character; I'm a chronicler. Genre is not a word I use a lot. I don't know what is meant by deconstruction. I'm ignorant of literary theory and indifferent to it. I don't think of myself as a writer or an artist. Well, I do and I don't.

HB: In "Awakenings" you prescribe art as a remedy for your patients. Art seems central to your work.

OS: At all sorts of levels, including the level of the man I just saw, who often can't walk but he can dance. Certainly the case history itself has to be almost equally art and science.

I don't know who my models are. Like many people of my generation, I adored the H. G. Wells's short stories and was also very fond of Chesterton. I footnote Wells's "Country of the Blind," though strangely that footnote has only become relevant in an experience I've had subsequently, when, last summer, I went to an island of the colorblind and saw a whole community who for two centuries have had no perception and no conception of color. They've organized their lives in completely different terms and regard us so-called color normals as distracted by chromatic hallucinations.

My tastes are rather conventional. I was brought up with Dickens and Trollope. My mother used to read D.H. Lawrence stories to me when I was young. I just came across a marvelous poem of D.H. Lawrence in which he speaks of how red is essentially sensuous and how "even God can't think of red."

Writers who may have been a model for me -- I still love reading them -- are the naturalists. I love Humboldt's personal narratives, Darwin on the Beagle, Wallace in Malaya, the notion of the scientific adventure. For that matter, I'm fond of Conan Doyle, not only Sherlock Holmes but the Challenger books, especially "The Lost World."I used to know it by heart.

HB: You talk about Sherlock Holmes as possibly an autistic personality. It's also tempting to think of you as a Sherlock Holmes type setting out to unravel mysteries.

OS: It's not clear that Holmes's cases form an oeuvre, that there's a movement, that they're connected one with the other, that he becomes wiser, that he develops in any way. And I hope for something like that. I do feel called to a case here and a case there and I like being on the case but I do hope at a deeper level, which Holmes doesn't have, there's something happening.

HB: Doyle sends Holmes off to demystify the world, to solve all mysteries and leave none intact. And then, of course, Doyle himself becomes a spiritualist.

OS: I'm very much, myself, for mystery. I'm very much against mysticism. I feel for example that Stephen Wiltshire, in "An Anthropologist on Mars," is quite mysterious; I don't know what goes on in him. I don't know that I mean mysterious like the Trinity, which is merely incomprehensible. I don't understand mystery in that sense. But it may be mysterious like late Beethoven.

HB: Dreams play a crucial role in so much of your work.

OS: I have published a paper called, "Neurological Dreams," which examines the level at which neurological events enter dreams. For example, I describe such a dream in "A Leg to Stand On" where there's an annihilation bomb that is a migraine entering the dream. I also approached this in "The Last Hippie." Physiologically, one sees there's less and less difference, in some ways, between the waking and the dreaming state, and there's the notion that waking is, in fact, dreaming in the world; it's dreaming within the constraints of external perception. So I do think of dreaming as almost the most fundamental mode of being a human being. I have sometimes said that I think of Tourettes as form of public dreaming, in which outer events and inner events join in manifest dreaming, visible and audible.

I don't believe in prognostication in any deep sense, although I think that work may be done in dreams which may alter reality. I give an example of that in "A Leg to Stand On" when I was asked to put down a crutch and walk. I tried and fell over. Then I had a dream in which I threw the crutch away. I woke up and immediately did so; it had been rehearsed in the dream. Why or how Magda, in "Awakenings," dreamed she was going to die the day she did, I don't know.

I go along with Freud about the occult; I'm very fond of mystery; I hate the occult.

HB: You have a romantic notion that the distinction between illness and health is blurred, and that illness can be not a deficit but an enhancement, as in Thomas Mann's "Dr. Faustus."

OS: Indeed, I quote it at length the "Leg"  book.

HB: In "The Man Who Mistook His Wife for a Hat" you wrote, "What a paradox, what a cruelty . . . that inner life and imagination may lie dull and dormant, unless released, awakened, by an intoxication or disease!"

OS: Yes, that was about Natasha, who said I feel so well I must be ill.

And I think of that last novella of Thomas Mann, "The Black Swan," where a post-menopausal woman at a spa feeling fortyish and sad meets a young man who's very attentive. She falls in love and starts to feel marvelous. Then, strangely, she bleeds again. Perhaps her periods are coming back, her youth returning. Everyone compliments her. Then she starts to feel ill and gets a bad color and has a huge hemorrhage. In the last scene, she is on the operating table. The surgeons are talking. She has a secreting tumor in her ovary, which has metastasized everywhere. One of them says, something like this would produce a great surge of estrogen, of hormones, and might produce an aphrodisiac state. Another says, perhaps it's the other way around; perhaps falling in love can cause the ovarian tumor.

Certainly with something like Tourettes, whatever the suffering and disability, there may also be energy and spontaneity. I was just in Toronto seeing a friend of mine, a very Tourettic artist. Sometimes the Tourettes can tear him apart; it can be full of a pantomimic impulse. Other times it can all rush together in the form of creativity. He doesn't want medication because he fears it will take the edge off, although when I see how terrifying it is I fear for him.

People have called me on romanticizing illness and there may be some truth to it; I'm prepared to retract that somewhat. But what interests me, especially now, is that new health is to be achieved through reorganizing. So that in the case of the colorblind artist, he first of all finds himself in an impoverished, ugly, abnormal world drained of meaning and feeling because color had been such a vehicle for him. At that point he is suicidal; he feels it's the end of him and his art. Then, the change occurs. What had been hideous and ugly and impoverished becomes fascinating, privileged, and beautiful.

HB: So the implication may be not, say, that Beethoven only coped well with silence but perhaps that he learned from silence, heard something new in it.

OS: Perhaps became a different sort of composer. I thought of this most deeply in regard to the colorblind artist, who clearly went through a descent and a redemption but the redemption was to a different form of being, into a quite different life of art and the imagination. It's one of the clearest examples for me of loss in one way, and redemption through reorganization.

HB: At the end of the piece on Stephen Wiltshire in "An Anthropologist on Mars," you ask, "Was not art, quintessentially, an expression of a personal vision, a self? Could one be an artist without having a 'self?'" Are you prepared to answer question?

OS: No. That's why I left it as a question. The whole book is full of questions. I'm an inquirer more than an answerer.

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