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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Photograph by Doron Gild

Sacks was deeply moved by these frozen patients. “It was the experience of Beth Abraham that changed me,” he says. “It was where I really came alive, almost for the first time in twenty years. I didn’t just care for these patients. I lived with these patients.” There was no medical treatment for sleeping sickness, and Sacks had nothing to offer the patients but unconditional kindness. “All I wanted was to give them a sense of being people again,” he says, “to let them forge human relationships again, even if it was only with me.”

In 1969 Sacks began a 90-day clinical study of L-DOPA, a new drug that was heralded as a miracle cure for Parkinson’s patients. One group of his patients received the drug, while the other group received a placebo. The effects were immediate and profound. There was an “astonishing, festive ‘awakening,’” as the L-DOPA patients suddenly emerged from their timeless limbo.

But the drug wasn’t a cure. After a few months of treatment, Sacks’s patients began to develop serious side effects, as their diseased brains adjusted to the increased levels of dopamine. And then, one by one, the patients began to sink back into their restless sleep. The “miracle” was temporary.

The following summer, Sacks sent a letter to The Journal of the American Medical Association, documenting the tragic results of his clinical study. His short letter provoked a storm of criticism. Some neurologists declared that the side effects never occurred, and that L-DOPA really was a cure. Others assailed Sacks for being “against L-DOPA” and for not properly controlling his study.

In his defense, Sacks wrote a detailed report describing the personal experiences of his patients, but every major medical and neurological journal rejected it. That’s when Sacks realized the problem wasn’t L-DOPA; it was the way medicine treated the mind. Modern neurology had become a hard science, a subject of mechanical circuits and anatomical anomalies. Treating patients meant fixing their matter. But Sacks had become acutely aware of what such brute materialism left out. It treated symptoms, not people, and had lost a sense of basic human empathy. The same quality that Thom Gunn had found lacking in Sacks’s journals, Sacks now found lacking in modern medicine.

The inability to publish a medical article led Sacks to explore a new kind of medical writing. He was initially inspired by the work of A.R. Luria, a Soviet neurologist who had published two extended case histories that boldly merged clinical descriptions with, as Sacks puts it, “an empathic entering into patients’ experiences and worlds.” (When Sacks first read Luria’s work, he assumed it was fiction.) “When I began writing,” Sacks says, “I realized that I was going against the trend. Few doctors wrote case histories anymore. But I had been moved by these patients—I suppose I had fallen in love with them, you might say—and so I needed to tell their stories.”

In the summer of 1972, Sacks returned to London, renting a small flat on the edge of Hampstead Heath. He had grown close to W.H. Auden, the British poet who occasionally visited Sacks at Beth Abraham. Auden encouraged Sacks to “transcend medical writing, to find some radically new and very personal form.” And so, with Luria as his model and Auden as his mentor, Sacks wrote Awakenings, the story of his patients’ experiences on L-DOPA. The prose poured out of him, and he wrote most of the book in just a few weeks. It was a strange composition, equal parts neurology and biography, filled with erudite digressions into dopamine, Leibniz, and the perception of time. The science of the disease was delicately interwoven with descriptions of his “intense sense of fellow-feeling” for the patients. Sacks had found his form.

The book was greeted with high literary acclaim and scientific disdain. (Auden declared it a “masterpiece.”) “There was one particular review which stung me greatly,” Sacks says now. “It said ‘Dr. Sacks is clearly imaginative, and he’s invented a set of impossible patients.’” Other doctors were dismissive of Sacks’s admission of empathy. What kind of neurologist fell in love with his patients?

The work, however, has outlived the criticism: Sacks’s writerly form is now its own literary genre. It’s easy to take his originality for granted, to forget how unlikely it is that a book about neurological disorders would become a bestseller, or that a bearded neurologist would become a cultural icon. Sacks has used the broken brain as a point of entry into the mind, so that readers learn about the perception of colors from a color-blind painter, or about the structure of memory from a man who has none. But the real lesson of Sacks’s work goes far beyond the confines of scientific knowledge. His case histories are essays in empathy, sincere attempts to enter into the experience of someone else, to know the individual and not just the disease. Sacks wants the kind of knowledge that can be known only through love, through listening.

Eighteen months ago, Sacks noticed a looming shadow in his field of vision. The darkness was ocular melanoma, a rare type of eye cancer. The cancer slowly spread, and Sacks felt his sight recede. As a neurologist, he is morbidly fascinated by his own condition and keeps detailed notes on all of his visual problems. “My scotoma [blind spot] is Australia-shaped,” Sacks says, “about thirty degrees across. It’s almost like a window, and there are constantly hallucinations inside it. Just this morning I was staring at my clock radio and saw a crowd of tiny people inside it.”

Sacks shows me his “melanoma journals”—“Melanoma is such a lovely word,” he remarks—which are full of rough sketches of his visual sensations. There is one drawing that shows a torso with a scratched-out face, just a slew of horizontal lines. “That’s my first horrified sketch of when I couldn’t see my own head,” Sacks says. “I looked in the mirror one morning, and there was just a shadow there.” Sacks is also fascinated by how his mind compensates for the blind spot, automatically “filling in” the new void in his senses. “If I wait for a few moments,” he says, “The form just creeps in from the periphery, like ice crystallizing. And then I look away, and the scotoma returns.”

There is something deeply poignant about watching Sacks deal with his decaying sight. It’s as if he’s become a character from one of his books, bewildered by his own brain. He can’t help but continually interrupt himself in conversation, remarking on the strangeness of what he’s just experienced. His desk is littered with typewritten pages about his blind spot, which he struggles to type since he can’t see the keys. “I’ve always had a great fear of losing central vision. Especially in the past few weeks, it seems to get worse each day,” Sacks says. “But now I’ve come to a deal with the melanoma. If it takes my vision and leaves me my life, that’s okay with me.”

In his books, Sacks often describes his patients in heroic terms, as they struggle to maintain their identity in the face of disease. Sacks is no exception. The illness hasn’t diminished his charming eccentricities. He remains obsessed with the periodic table, ferns, and cephalopods. He swims every day. When Sacks is talking about something that excites him, his voice slips into a slight stammer, as his mouth struggles to keep up with his thoughts. Although he calls his shyness a “disease,” he is as exuberant as ever, eager to celebrate the world and its wonders.

Music brings out this romantic side of Sacks, providing him with a deep sense of comfort as cancer erodes his sight. He tends to get passionate about particular pieces of music and will listen, almost exclusively, to the same song or symphony for weeks at a time. Sacks revels in the mysteriousness of music and likes to quote Schopenhauer on its “inexpressible depth…so easy to understand and yet so inexplicable.”

One of the final stories in Musicophilia is that of Clive Wearing, an English musician and musicologist who was struck by a severe brain infection that decimated his memory. As a result, Clive lives inside brief parentheses of time, just a few seconds long. “Desperate to hold on to something,” Sacks writes, “Clive started to keep a journal. But his journal entries consisted, essentially, of the statements ‘I am awake’ or ‘I am conscious,’ entered again and again every few minutes.”

The only thing that comforts Clive is music. When he is playing the piano, Clive is suddenly “himself again.” A Bach prelude can’t recover his past, but it does allow him to be fully immersed in the present tense. He can share, if only for a moment, the emotions of the melody. The music is a “bridge across the abyss,” a temporary relief from the terrifying loneliness of his amnesia.

Sacks relays numerous similar stories of musical healing—in many instances, an awareness of music is a person’s last awareness. “I have seen deeply demented patients weep or shiver as they listen to music,” Sacks writes. “Once one has seen such responses, one knows that there is still a self to be called upon, even if music, and only music, can do the calling.” He likes to quote a shard of a T.S. Eliot poem: “We are the music while the music lasts.” For Sacks, the line is literally true. He knows that music is often the final means of human connection, our closing form of comfort. It is what we have when we have nothing else.

Originally published October 29, 2007

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