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A Brain With a Heart

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When you ask Sacks about the extra-medical appeal of his writing, he takes it in stride, and tends to say the stories work as tributes to the marvelous adaptability of the human mind. “I think it’s important that nature can put a positive spin on so many awful-seeming situations,” he says. “People are scared of hallucinations—the very word immediately makes people aware of dementia or insanity. One of my more conscious motives is to provide some reassurance.”

“One of the key notions for Oliver is that the disease does not have the patient; the patient has the disease,” says Weschler, speaking especially of Sacks’s Awakenings experience at Beth Abraham—where “it was bumper cars of dereliction. And he would walk through and the place would just brighten up,” Weschler remembers. “The great moment of his genius was not giving those people the drugs; it was walking into that home for the incurable, that warehouse, and having the moral audacity to imagine that some of those patients were different from the other ones and that they were in fact alive.”

The writing was audacious from the very beginning. Most writing about the brain might as well have been about the colon, Sacks thought, it so missed the point. What he wanted to fashion was a “neurology of identity”—attentive to the nerve basis of disorders like face-blindness and phantom limb but focused much more sharply on the experience of affected patients, who built their identities in part through their battles with dysfunction. As he had done: a man eager to see his own life as something more than a footnote to a list of disorders and dysfunctions, who turned his congenital shyness and pathological inhibitions into a semi-shamanic clinical persona. We may be our brains, he wanted to say, but we also shape them as we backpack through the world with all our trinket-y neuroses. Neuroscience and evolutionary psychology offer insight, he suggested, but often at the cost of identity—we can find meaning in their discoveries, but only by acknowledging that one is primarily a species and only very trivially a person. In both his practice and his writing, he hoped to reverse that, to treat neurological disorder not as an extractable affliction but a mesmerizing, meaning-giving, and often benign peculiarity.

The result was an elaborate and idiosyncratic case-history archive, a folklore of mental disorder as rich and varied as Freud’s, but de-Freuded—wiped dry of any mention of sex and the implication that patients may be in some way responsible for their suffering. In fact, they seem often not to be suffering at all, but, with Sacks—like Sacks—marveling at their own disorders. “I am sometimes moved to wonder whether it may not be necessary to redefine the very concepts of ‘health’ and ‘disease,’ ” he wrote in An Anthropologist on Mars. “While one may be horrified by the ravages of developmental disorder or disease, one may sometimes see them as creative too.”

When I meet Sacks a second time, it is in his apartment, which overlooks a building-site stretch of Eighth Avenue and where he keeps a small farm of ferns, a particular love in his Victorian sideline of botany. He is squeezing me in before lunch with Robin Williams, now a friend who once rhapsodized about Sacks to Charlie Rose and whose cuddly portrait in Awakenings will surely, and spookily, outlive the standoffish doctor himself.

Sacks has now spent 50 years attending to patients damaged in ways that make it difficult for others, even doctors, to acknowledge their full personhood—those with Tourette’s, Asperger’s, the deaf, the blind, the hallucinatory and the self-disassociated. But perhaps his profoundest work has been with a population that goes nearly unnamed in his writing, though it supplies so many of the cases he writes about—and of which he himself is now, finally, truly a part. Neurological function declines over time, and many of the patients experiencing the most fantastical neurological symptoms are those typically dismissed, simply, as demented. Even as Sacks ages into the ranks of the very old, a remarkable number of his patients are older still than him; many of them approaching 100, birthdays he roots for. Often they persevere in the lonely carrels of nursing homes, navigating lives distorted by brain dysfunction in ways they’re terrified to acknowledge, worried they’ll be written off by physicians less sensitive than Sacks. He is like a village doctor, and the village is old age.

Nearing 80 and retreating from regular practice, he remains a hero to his patients and those suffering from similar disorders, and the way they worship him is a bracing suggestion that sometimes the dignity of real engagement can be more vital than therapy. “It teaches us that we are all flawed, and we find ways consistent with humanity to live with our illness, not just by popping pills but by somehow coming to terms with the illness,” says the chemist Roald Hoffmann, a Polish-born Holocaust refugee who’s become close with Sacks over the last fifteen years. “I think that we are all survivors.”

The night before, Sacks says, pushing a flyer across the broad worktable between us in his living room, he had been to a performance of Mozart’s Requiem by a chorus of medical students, and he remains entranced by it. “They were all young and dedicated, and I was carried away,” he says. “Thinking that I would like a performance of it in front of me as I was dying.”

We had talked quite a lot, in our earlier meeting, about his health, weight, and well-being, and it felt like he was doing me the favor of picking up the thread of that theme. “None of my inner organs are talking to me too much,” he said. “I’m aware of being what they call a cancer survivor, with luck I won’t hear from that.” Then he talked about his oldest friend, Eric Korn, an antiquarian bookseller in London now lost almost entirely to dementia, and paused for a long while remembering his shock at the death of Gunn, who died in 2004 at 74, “with an autopsy full of hard drugs.” Finally, he said, looking straight at me for the first time, “I don’t know whether there are any good ways to die.”


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