Shedding Light Into Abyss of Brain Disorders

In the world of neurologist Oliver Sacks, there is a retired sailor whose memory lasts no more than a minute. A conversation between identical twins consists solely of prime numbers. A woman “loses” her body. A 93-year-old man walks tilted to one side yet thinks he is as upright as a flag pole. And a talented professor of music believes that a rose is not a rose but a “convoluted red form with a linear green attachment.”

These are not descriptions from a horror movie or the results of mind-bending initiation rituals by a bizarre cult. They are thumbnail sketches of the neurologist’s patients--victims of congenital, organic or accident-related brain disorders that produce alien forms of seeing and being.

Sacks, a native of London, is professor of clinical neurology at New York’s Albert Einstein College of Medicine. He is also a writer who has been praised by critics for bridging the gulf between medicine and literature. In his latest work, “The Man Who Mistook His Wife for a Hat” (Summit Books: $15.95), Sacks has collected 24 case histories of patients who have lost touch with the everyday world of faces and places or their own bodies but have retained what are generally thought of as “higher” mental functions such as abstraction, mathematical skill or capability on intelligence tests.

Troubling Hallucinations

In the book’s title case, for instance, Dr. P., “a musician of distinction,” gradually lost his ability to recognize faces of friends, students and relatives. More troubling, Sacks writes, “he saw faces where there were no faces to see . . . he might pat the heads of water-hydrants and parking meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture and be astounded when they did not reply.” During a visit to Sacks’ office, Dr. P. also “reached out his hand and took hold of his wife’s head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat!” Nonetheless, Dr. P. retained his musical and intellectual capacities, as illustrated by his ability to play a game of mental chess.

Sacks spins out the tale of this and other mainly incurable cases in prose that has been praised for its sensitivity, clarity and precision. But the neurologist, interviewed recently in Los Angeles, said he knows readers may initially react to these reports with “revulsion, fear, horror at the sight of so much disease and deformity.”

“Although it would seem I’ve written a book about disease and diseases, I would like it to be seen as a sort of book about survival and identity under extraordinary circumstances. . . .

“It just makes me realize how rich human nature is,” he said. “Sometimes you only see that in the act of destruction. You don’t realize how rich the world of appearances is until you’ve lost the world of appearances.”

Sacks, 53, is a man who seems to be in the sway of a perpetual amusement stimulated by his surroundings--an impression heightened by his huge, gray-streaked beard. Sitting on the roof garden of a West Hollywood hotel, he interrupts his train of thought to laugh at the curious shape of freshly trimmed palm trees and to guffaw at a photographer’s “gigantic lens,” noting that “lenses are getting stranger and stranger.”

But while everyday objects may tickle his sense of the absurd, Sacks is well aware that his patients are people who have gone an almost unreachable distance beyond common understanding.

“I love to encounter other forms of being and other minds,” he said, noting that his writing and his work with his patients are attempts “to enter lives and constitutions which are almost unimaginable.”

‘Philosophical Emergencies’

Sacks regards his patients as more than objects of medical interest.

“I think a lot of neurological emergencies, clinical emergencies, are philosophical emergencies,” he said. “If one has had a spinal anesthetic, say, you end here”--he placed his hand against his stomach--”you terminate, and what lies below is not flesh, not real, not anything, it’s not even dead . . . and it is a philosophically bewildering thing.”

Indeed, Sacks’ cases present a variety of quandaries that beg for moral as well as medical assistance.

For example, the patient Sacks calls “The Lost Mariner” is a retired U.S. Navy man whose drinking binges destroyed his capacity to remember anything that happened after about 1945. The sailor must live perpetually in the moment, unable to recognize people--including Sacks--he has seen a few minutes before, and incapable of completing any task that requires more than a minute’s worth of memory.

The Navy man’s medical problem may be that “two tiny relay stations, and that only, in his brain have gone,” Sacks said. But the consequence is that for the man “the whole world has changed, his being has changed, he is a different being. He is not just a man with memory problems, he is a different being in a different world.”

Stories Emerge Slowly

In delving into those different worlds, Sacks said he may take years to get to know a patient, to build a relationship that is both human and medical.

“I think it’s tremendously important to allow people to use their own words and their own metaphors and be spontaneous,” he said. “Somehow the story emerges as a sort of collaboration.”

Frequently, Sacks said, he writes about patients or topics only after he has had some kind of inspiration.

“I had a feeling last year I ought to write a piece on frontal lobe syndromes,” he said, adding that he couldn’t because he didn’t yet have the right example. Then he saw a patient whose malady “had turned him from a highly gifted, turbulent, difficult, rebellious adolescent--with the growth of a tumor and frontal lobe damage--into a sort of calm, bland, sweet, lobotomized man.”

The inspiration came from the boy’s father, Sacks recalled.

‘Who Needs Them?’

“There had been great family difficulties before (the tumor) and now his family visits him and all is fine. At one point, whether ironically or not, his father commented on this and said, ‘Frontal lobes, who needs them?’ ” and Sacks was provided with a point of takeoff.

As a writer, Sacks said his ambitions are strictly limited to his specialty and that most of his writing is done “quickly or not at all.” He considers each essay “a letter to anyone who might be interested” and he believes his urge to write dates from his childhood and his physician parents.

“I grew up in a house of medical stories,” he said, “and I think this made it very hard on people who came to visit and sort of turned pale and excused themselves. But I sometimes (remember) my mother, she would enchant the milkman or the gardener for hours on end with clinical stories.”

As a clinician interested in matters that border on the spiritual, Sacks said he is often regarded as a fish out of water. But to him, his interests and his career are affirmations that science and the soul are not separate.

Concerned With Mind, Spirit

“Sometimes people say to me, ‘Why aren’t you a psychiatrist, wouldn’t you like to be a psychiatrist?’ And the answer is that I’m too interested in the organic and the physical. There’s some part of one that would like to think the mind-spirit can float away into some sort of metaphysical stratosphere,” he said.

“It is the grounding of the mind and the spirit in the body at every level--but not in any reductive way--that interests me. . . . I don’t think that the dignity or spirit of man is in any way devalued by being associated with his body, with his brain. I am very much against reductive medicine, or a sort of behaviorism that sees people consisting of drives, nothing else.”

Sacks spent February at the University of California, Santa Cruz, participating in a series of philosophy seminars. He was invited to be there for three months but decided to return to New York early this month because “I couldn’t run out on my patients for that long. I’m a bit afraid of running out on them for a month.”

‘Extraordinary Experiments’

Sacks looked at the ground for a few seconds. “I’m covered professionally,” he continued, “but a lot of the patients I’ve known for 15 or 20 years, and we’ve sort of become friends and they can speak to me in a way that they can’t speak to others.” His voice faded before he went on.

“I don’t know. . . . It’s a great privilege working with patients like this. It’s also a great privilege seeing these, I don’t know what to call them, to see these extraordinary experiments of nature--that sounds rather awful--and the resources at every level, including moral, human and so forth that people bring to it.

“To some extent these are people in the abyss but they’re surviving, or most of them are. It’s surviving in the abyss that interests and inspires me.”