Amazing Neurological Tales, by Arthur Quinn
[This essay by a fabulous former professor of mine made an impression on me at the time. Capturing it here for posterity.]
A London reviewer of an earlier of an earlier clinical tale by Oliver Sacks made an apparently serious charge against him. It couldn’t have happened the way Sacks said it did. Perhaps Sacks fibbed to make his tale more appealing, perhaps he was deluding himself–but the tale was simply not true.
There was in this denunciation the faint whiff of sour grapes. Sacks, after all, has become an immensely successful writer. Most of the present collection of essays, for instance, were first published in intellectually fashionable magazines like The New York Review of Books. Sacks has become for neurology what Stephen Jay Gould is for paleontology or Lewis Thomas for general medicine, someone who can transform the technicalities of his science into best-sellers that still command the respect of our intelligentsia.
There is one fundamental difference between Sacks and the other two, though, and this difference is one legitimate source of suspicion. Gould and Thomas usually write essays; Sacks writes stories. Worse, he openly admits that these stories are intended to be read like The Arabian Nights, for he is seeking in his patients’ case histories new fables, new myths, new symbols for our scientific age. Such an admission could raise questions in the mind of even the most docile reader: should we care whether or not these fables are completely truthful? Does Sacks himself feel free to introduce the equivalent of flying carpets when he thinks a tale would be improved by them? Questions of this kind the London reviewer thought crucial in dismissing Sacks.
Of course, despite their obviousness, these questions still might not be the most important ones to ask of Sacks’ tales. Before trying to decide, let’s first look at Sacks’ stories as stories.
Neurology as Comedy
Most of Sacks’ case histories do have very similar plots, such as one would expect from a tightly organized collection of short stories. Oliver Sacks clearly likes to write up his case histories as comedies. By a comedy I mean not a story that is humorous but one that is contrived to work out well in the end, sometimes for the best. The frisky octogenarian with Cupid’s disease can gain the benefits of advanced syphilis without suffering any debilities. Witty Ticcy Ray finds a way to hold down a steady job (thanks to medication) while still banging out mean drum solos on the weekends (thanks to his disease). Rebecca struggles against her many disadvantages only to find her true calling as a thespian. This is life as we would like it to be, and as it occasionally is–if not the best of all possible worlds, a reasonable facsimile thereof.
Take the title episode of the collection (not excerpted above): “The Man Who Mistook His Wife for a Hat.” Just reading the title makes one smile. We are led by it to expect a comedy, a happy ending. Imagine how this expectation would be disappointed, cruelly disappointed, if at the story’s end the wife in question ran off with someone more appreciative of her charms, or if the man who mistook his wife for a hat one day mistook her for an apple and slit her throat. Well, Sacks is no Kafka.
The patient in question was losing his ability to recognize visual objects. Strangely, he could still describe with extraordinary precision their geometrical shapes; he simply could not tell what they were. Ask him to pick up his hat, and he was as likely to reach for his wife. A terrible loss? Well, no, not for him. He was blessed with a very flexible wife who did not seem to mind his mistakes–and, most importantly, he was a music teacher by profession. Therefore, when Sacks finally determined that this degenerative neurological condition was incurable, he could cheerfully exhort his patient, “Music has been the center, now make it the whole of your life.” This disease had enabled the man who mistook his wife for a hat to concentrate exclusively on what gave the deepest meaning to his life. Rather than a burden, his disease could be seen as a release. And so we are told in the very last sentence of this particular tale that the patient lived happily ever after–or, more precisely, he “lived and taught music to the last days of his life.”
Of course, a cynic might be inclined to ask what would have happened if he had lived his life for his vision, if he had been a teacher of painting. How would such a disease have affected enrollment in his class on, say, portraiture? But to raise such a question is to underestimate the resources within Sacks’ own apparently incurable optimism.
The man who mistook his wife for a hat did in fact also paint. His music school regularly exhibited his paintings. As he gradually lost his ability to recognize visual objects, he did not give up his painting–far from it. He just became a less and less traditional painter, finally ending up as a full-blown abstract expressionist. His dutiful wife (Hattie?) believed these last paintings to represent the culmination of his artistic development–and, I suspect, so would the storyteller Oliver Sacks if he had not had the music to make for us an better happy ending.
The Possibility of Reintegration
The immediate appeal of Sacks’ clinical tales is obvious enough. Sacks’ patients, at least as he portrays them, are all attractive persons, full of spunk and resourcefulness. Has Sacks ever met a patient he didn’t like? He is continually showing us how much he is learning from them, which is, of course, very flattering to us as prospective patients. His publishers are not unaware of how appealing we will find this characteristic in a doctor, for they specify on the dust jacket that “he feels his real education came only with the care of patients.” A recent Newsweek article has praised Sacks as epitomizing how the growing estrangement between doctors and their patients can be eased. And all this is very appealing, but most appealing of all is Sacks’ persistent cheerfulness even when confronted with neurological horrors.
One such horror is the case of “The Lost Mariner,” Sacks’ name for the retired navy man whose memory of the immediate past, even the past few minutes, has been destroyed by alcoholism. The tale of oblivion of this lost mariner cannot help but have the effect of a tragedy on us: pity for the mariner himself, fear for ourselves as also vulnerable to a similar personal catastrophe. (I myself tentatively decided to give up my nightly cocktail, a resolution I had mercifully forgotten by that evening.)
Yet Sacks, fully realizing that we will respond this way, will still not leave us alone for the catharsis of a good cry. He is too damned cheerful to let one of his clinical tales end on a tragic note. So we are informed that Jimmy, the sailor who got lost in the drink, is not totally lost. He is reconciled with his long-distant brother, he finds great satisfaction in his gardening, and his attention during Mass verges on the beatific. The nuns who take care of him certainly do not regard him as a lost man.
Moral: “However great the organic damage and humane dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.”
This is a wonderfully uplifting message, just the right bedside manner for a neurologist, and just what we would want to hear if we were numbered among those unfortunate souls who had been struck down. Sacks, of course, does not deny that there are irretrievable losses. The disembodied lady has permanently lost her sense of having a body, and this loss truly impoverishes her life. Yet Sacks’ way of telling her tale leaves us more in wonder and admiration than in horror. We wonder at her loss and admire her for coping and continuing to find meaning in her life despite this extraordinary deprivation. We can still have a humanly meaningful life, Sacks seems to be insisting, without a sense of our bodies, without our memories, without a dog’s sense of smell, without being able to distinguish our wives form hats.
Romantic Medicine
The nuns who took care of Sacks’ forgetful mariner would not have been surprised at this insistence. The good Doctor Sacks was just reminding his materialistic readers that they have souls with immortal destinies that transcend their associated bodies. But at such plain talk I suspect Sacks would blush, as would his sophisticated readers in The New York Review of Books.
Sacks does everything he can to avoid this simple word “soul,” loaded as it is with centuries of religious and metaphysical baggage. Sacks look for other words to say the same thing. “Human spirit” is one, “personhood” another, “essential being” another. Sacks does correctly characterize himself as a “romantic scientist,” a phrase that is neither as unusual nor as paradoxical as it might seem. The original romantics, far form being opposed to science, wanted to use it to reintroduce the uniquely spiritual into a world that had become depersonalized by mathematical abstractions. In reading Sacks I was continually reminded of M. H. Abrams’ characterization of romanticism as “natural supernaturalism.”
Sacks wants us to see his stories as demonstrating that our “personhood” somehow transcends our bodily functions while still being intimately dependent upon them. Illness brings this paradox home to us most powerfully. And hence the aptness of Sacks’ quotation of Nietzsche: “As for sickness: are we not almost tempted to ask whether we could get along without it?” In an acute illness, especially a neurological illness, the self discovers its own dependence upon the body, and yet in that very process can begin to define itself as something distinct form the body, as something that can even use the infirmities of this body to its own personal ends.
As one after another of Sacks’ comedies play itself out, as we become accustomed to his neat resolutions, the temptation is to ask harder questions than Sacks is inclined to. Is there really a ghost or a soul in this machine we call our body? Or, in celebrating a personhood that somehow transcends material relations, are we deluding ourselves, failing to face hard, unpleasant facts?
Gould, in one of his essays, confronts a recent attempt to rediscover purpose in the universe as science describes it. He forthrightly rejects such a romantic alternative. Gould concludes that he will seek his own hope elsewhere, but certainly will be pleasantly surprised if he turns out to have been wrong. Such candor is lacking in Sacks.
“Privileged Consciousness”
The closest Dr. Sacks comes to facing the dilemma posed by the intersection of science and metaphysics is in “The Visions of Hildegard.” Here avoiding it is almost impossible, but Sacks still does his best. The cheerfulness of the other tales–at times forced, usually persuasive–becomes here merely Dr. Sacks patently wanting to have his cake and eat it too.
Sacks the clinician can easily explain away the religious visions of the medieval mystic Hildegard as “indisputably migrainous.” Or, more precisely, they can be explained as caused by “a shower of phosphenes in transit across a visual field, their passage being succeeded by a negative scotoma.”
Sacks, the cheerful storyteller, cannot leave it at that, however logically sufficient such a reduction might seem. Rather, he adds an uplifting note that far exceeds anything he wrote about the lost mariner. These migraines were “instrumental in directing her towards a life of holiness and mysticism. They provide a unique example of the manner in which a physiological event, banal, hateful, or meaningless to the vast majority of people, can become in a privileged consciousness the substrate of a supreme ecstatic inspiration.”
To me the phrase “privileged consciousness” is pure weaseling, a verbal magic carpet designed to wisk the mind away before we start to think hard. Privileged in what way? Privileged in that she could delude herself into thinking that a banal physiological event that should be abhorred is really of inestimable worth? Or are we to believe that Hildegard had genuine contact with a transcendent realm? There is a world of difference between these two. We may believe what we like, but the text provides no serious clue as to what Sacks himself thinks. He is apparently determined to permit us to have it both ways. Not either way, mind you, but both ways, just as a ghost story will allow us to experience the eeriness of the spiritual world without fully committing ourselves to its existence. Ghost stories are, after all, what is left to a romantic after he loses his conviction.
Sacks made a mistake by introducing Dostoyevski at the end of the “The Visions of Hildegard,” for hers is a ghost who, once invoked, will ask hard questions, just as he spent his life asking hard questions of himself. Dostoyevski would want to know what Sacks thought of St. Paul’s contention that if what he preached was false then he and his fellow Christians were “of all men to be most pitied.” Dostoyevski would want to know if his own religious vision was for Sacks merely an unusual compensation for having epilepsy. And if he, Dostoyevski, had somehow lost his faith, would that for Sacks have been any different from the amphetamine-popping medical student’s loss of his heightened sense of smell? Dostoyevski is not a name to invoke in a book of tales that in the end function as philosophical analgesics.
In this context, who cares whether or not Sacks has been precisely truthful in rendering the details of his clinical stories? Almost certainly he presented us with an unrepresentative selection of his patients. He might have also prettied them up before exposing them to the world. If these are breaches of medical decorum, they are only the foibles of a storyteller shaping his tales to emphasize what he thinks is important about them.
But when these stories, as he chooses to tell them, raise important questions about our common, permanent human condition, then he has an obligation to us and to himself to confront these questions squarely, to offer us more than the entertainments of The Arabian Nights.
This is an obligation that Oliver Sacks, despite his obviously humane care for his patients, despite his own considerable literary gifts, steadfastly refuses to meet, and that is why these stories seem to me finally to lack seriousness as literature. Sacks writes his cheerfully humane clinical comedies; but when his sympathetic readers ask for more, then they find Sacks retreating behind the eerie ambiguities of the ghost story, a spiritual world invoked only for the sake of special effects. Amazing neurological tales.
