The Listener

Brain & Behavior / by Jonah Lehrer /

As Oliver Sacks observes the mind through music, his belief in a science of empathy takes on new dimension.

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“I had no intention of writing a book devoted to music,” Sacks says. “I’m not a musician or an expert on music…but this book found me. I began to revisit all of these older stories and present them in an explicitly musical light. That’s the way writing is sometimes. One doesn’t know what story one is telling until the story is told.”

At first glance, music seems like an unlikely theme for Sacks. He’s hard of hearing, and has to turn down his beloved air conditioner during our conversation. There’s also something distinctly unmusical about Sacks’s movements. He is charmingly clumsy, and his fingers are constantly fumbling with things, be it a mug of tea or that rod of tungsten. Sacks bears the scars of numerous falls, and says that he’s so accident-prone his friends were convinced he wouldn’t make it past the age of 30. It’s hard to imagine his hands playing a piano (which, very occasionally, they do).

And yet, Sacks has always been enthralled by music. One of his earliest childhood memories is the sound of his mother singing Schubert Lieder in the drawing room. As a teenager, he spent endless hours “trembling” to Mozart symphonies, transfixed by feelings he couldn’t comprehend.

Music has also played a crucial role in Sacks’s work as a neurologist. In his writings, he uses music as a metaphor for his unusual approach to medicine. He cites a Novalis aphorism—“Every disease is a musical problem; every cure is a musical solution”—in several books, usually when discussing the therapeutic powers of music. But it’s clear that Sacks also believes in a deeper, less literal connection between medicine and music, which is why Musicophilia reads like a retrospective. Music encapsulates two of the most essential aspects of his work: listening and feeling. The art form is the model for his method. As a doctor, Sacks is exquisitely attentive, not just to the symptoms, but also to the person. He treats each patient like a piece of music, a complex creation that must be felt to be understood. Sacks listens intensely so that he can feel what it’s like, so that he can develop an “intuitive sympathy” with the individual. It is this basic connection, a connection that defies explanation, that allows Sacks to heal his patients, letting them recover what has been lost: their sense of self.

Of course Sacks is still a neurologist, intimate with the folds of the brain and the advances in neuroscience toward understanding our relationship with music. He knows that how we experience music is just an emanation of the temporal lobe, a side effect of neural electricity. But Sacks remains most interested in what anatomy lessons alone can’t explain. “There is also a certain danger here,” he observes. “A danger that the art of observation may be lost, and the richness of the human context ignored.”

Sacks relays in Musicophilia, for example, the case of Dr. P, the infamous patient who mistook his wife for a hat. Dr. P’s surreal condition left him unable to perceive objects and people, so that he was “lost in a world of lifeless abstractions.” One of the most telling lines in the case history comes at the end, when Sacks is presenting his formal clinical diagnosis: “a massive tumor or degenerative processes in the visual parts of the brain.” That single sentence, an ambiguous afterthought, is Sacks’s sole nod to “classical, schematic neurology.” Instead of looking for the physical source of the illness, Sacks immerses himself in the life of the patient. He describes Dr. P’s experiences as a music teacher and the ways in which the sound of music eases his sensory confusion. (In order to get dressed, Dr. P had to sing to himself.) When Dr. P asks Sacks what’s wrong with his brain, Sacks replies, “I can’t tell you what I find wrong, but I’ll say what I find right. You are a wonderful musician, and music is your life. What I would prescribe is a life which consists entirely of music.” It’s an astonishing prescription, wholly focused on preserving Dr. P’s tenuous identity. This is what Sacks tries to treat: not the disease, not even the brain afflicted by it, but the person. Any science of the mind that “neglects the personal,” Sacks says, “misses out on our most essential aspect.” Although he meticulously follows the latest advances in neuroscience and applies that knowledge to his patients, Sacks is ultimately guided by his sympathetic instincts, his uncanny ear for the consonances and dissonances of being. “We underestimate the power of listening,” Sacks says. “It is by listening to our patients that we can discover their humanity. It is the only way to grasp what they are going through.”

Sacks was not always such a sympathetic character. Empathy was an epiphany for him, a late revelation. Long before Sacks was a famous neurologist, he was a struggling writer. After he received his medical degree from Oxford, Sacks decided to wander the world. He began, in 1960, with America. His parents thought his trip was just a brief vacation, but once he arrived, Sacks sent them a one-word telegram: “Staying.” He traveled across the continent by motorcycle, racking up more than 10,000 miles on an “erratic, zigzag” journey. He fought wildfires in British Columbia and hitchhiked across Alabama with a trucker named Mac. He called himself “Wolf.”

At the time, Sacks despaired of ever becoming a doctor. In a journal entry written in the summer of 1960, Sacks confessed that medicine wasn’t his chosen profession. “Others chose it for me,” he wrote. “Now I only want to wander and write. I think I shall be a logger for a year.” While Sacks rarely talks about these years of his life—“They remain a bit of a mystery, even to me,” he says—excerpts from his immense travel journals, which he reads aloud to me in a vintage British accent, provide a window into his development, both as a writer and as a person. Many of the entries resemble early Kerouac, filled with odes to the open road and vaguely mystical encounters with nature. His prose is loose yet lucid. And yet, this isn’t the writing of the Oliver Sacks the world knows. Something is different.

Sacks had begun sending his journals to his friend Thom Gunn, a British poet living in San Francisco. While Gunn enjoyed Sacks’s acutely observed travelogues, he found parts of the journals to be a “little nasty,” full of “sarcasms and grotesqueries.” Gunn would later write Sacks a letter in which he confided that, after reading Sacks’s early prose, he had “despaired of your [Sacks] ever becoming a good writer…I found you so talented, but so deficient in one quality—call it humanity, or sympathy, or something like that.”

In 1961, after a year on the road, Sacks finally “settled down” and began an internship at Mount Zion Hospital in San Francisco. After completing a residency at UCLA, he moved to the Bronx and got a job in New York working in a neuropathology lab at the Albert Einstein College of Medicine. “I was awful at bench science,” Sacks says. “Truly awful. I think the final straw was when I dropped some food into the ultracentrifuge. They said to me, ‘Sacks, get out, you’re a menace. Go see patients: You won’t be able to do much harm to them.’ That’s when they sent me to Beth Abraham.”

Beth Abraham was a chronic hospital, an asylum for patients for whom there was no cure. In this hopeless place, Sacks ended up working with the most hopeless patients. He was drawn to the “sleeping sickness” ward, filled with people who had been locked in a Parkinsonian trance for decades. An aftereffect of the 1920s encephalitis epidemic, the disease left the patients in an “ontological death,” numb to everything around them.

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