The strange case of Dr Oliver Sacks

“I’ve had a lot of losses and destructions in my time.” Author and neurologist Oliver Sacks in 2002. Photo: Ray Kennedy

First published in Good Weekend on October 20, 2007

Oliver sacks has seen the same manhattan psychiatrist twice a week for the past 42 years. They meet at 6am. 

So had he known such a love? “Ah, um … I don’t know,” he says with a distance – or is it distress? – that makes it clear we are to move on. 

This suggests several things. One, that the Englishman is thoroughly at home among the neurotic of New York. Two, that he is a man of precise habits, further evidenced by his practice of mostly eating the same foods every day and, when he used to take amphetamines, taking them only on Friday evenings. Three, that he has a lot to work through. 

A young Oliver Sacks, second from left, with his family in 1940 Photo: From Uncle Tungsten: Memories of a Chemical Boyhood

There are the current anxieties. There is also the complicated and not unrelated legacy of an agonised childhood, the source of strange and sometimes calamitous impulses. “I’ve had a lot of losses and destructions in my time,” the world’s most famous neurologist will say later, and they include burning a manuscript and falling off a cliff. “This is one of the reasons I see an analyst. It’s not entirely finetuning. It stops some rather bad things happening.”

Then there is his florid dream life, in which he sometimes becomes an inanimate object. He dreams often about chemistry, the great love of his boyhood. In his favourite chemical dream, he is a heavy transition metal, hafnium to be precise, sharing a box at the Metropolitan Opera with other metals, his “old and valued friends”, tantalum, rhenium, osmium, iridium, platinum, gold and tungsten. 

Does he think it peculiar he is actually an element?

“I think in some ways I am an obsessively controlled person…” Dr Oliver Sacks at the launch of the Centre for the Mind in 1997. Photo: Andrew Taylor

“Oh well, that always happens,” he says airily. “I identify with different ones, but in that dream and in general, I tend to identify with the heavy transition metals. Now I have reason to do so because I’m just in that age group. I associate all numbers and ages with elements.” He is referring to the numbers on the periodic table of elements. 

Now that he’s 74, he is tungsten and he already has a rod of rhenium on his desk, for when he turns 75. He suggests with boyish glee that I might like to stir my glass of water with it. 

The periodic table has been a consolation for Sacks most of his life. Its order and the eccentric qualities of its elements mirror his own personality. In his pleasant, curiously shaped suite of rooms in Manhattan’s Greenwich Village, charts of it lurk behind doors and hang above filing cabinets; a ­version worked into a Happy Hanukkah card by a 10-year-old fan is pinned to his noticeboard. Little collections of rare metals, including the “opera people”, glitter on his desk. He compulsively handles one piece or another as he talks, in a voice still very English and burred endearingly with a slightly lisping R, so he says “bwown” instead of brown.

He has the European intellectual’s standard-issue clipped grey beard and wire-rimmed glasses, but he looks fitter than most and wears a T-shirt, pale chinos and black running shoes. He’s like the sports model of Sigmund Freud. He was once a competitive weightlifter and still swims and cycles most days, despite a spectacular crash recently. 

Newspaper articles often describe him as mild-mannered and “bear-like”, which makes him sound bland and avuncular. There is a gentleness about him, but he is too thin now to be properly bear-like and he is not, thankfully, unremittingly mild-mannered. Mostly he is charming and surprisingly funny, but he can abruptly pack that away when he doesn’t like a line of questioning, and he has been known to be prickly. 

Perhaps it’s related to his personal shyness, which he says can be chronic even though he is a confident public performer. “If I have to go to a cocktail party, I will end up in a corner alone and not speak to anyone. My mother was the same.”

He has also had to conquer the family aversion to celebrity. Talking about Freudian “slips”, he ­recalls his rather remote father, also a doctor, marching into his bedroom after a glowing review of Oliver’s first book, Migraine, appeared in 1971. “He came in trembling, ashen, holding The Times in his hands. He said, ‘You’re in the paper.’ He saw this as simply shocking – as exposure, as advertising. You keep your head low, don’t be public. So for 30 years, whenever I saw the word ‘portrayal’, I read it as ‘betrayal’, and whenever I saw the word ‘public’, I would read it as ‘punish’. Clearly motivated Freudian mistakes.

“On the other hand, as one gets deafer, one mishears things more and more. At a recent fern meeting [he belongs to the American Fern Society] I was amazed to hear people talk about a fern toxic to housewives. Then I realised they must have said houseflies.”

Ferns is only one of his interests. There are also cephalopods, minerals, music, motorbikes, swimming and stereoscopic vision, this last having taken on a certain sad irony because he has recently lost much of the sight in one eye. 

Sacks’s bulging catalogue of personal eccentricities, his oblique way of perceiving the world, his own lifelong sense of being at odds with it, must be enormously useful for someone in his line of work. To understand those trapped in alien worlds it helps to be something of an alien oneself.

From 1965, when he moved to New York, until recently, he worked as a clinical professor of neurology at the Albert Einstein College of Medicine, an adjunct professor at the NYU School of Medicine and a consultant neurologist to the Little Sisters of the Poor. In July he was appointed to Columbia University Medical Centre as professor of clinical neurology and clinical psychiatry and, in a first, as a Columbia “artist”, an acknowledgement of his great talents as a writer.

He has made a television series and written 10 books, of which the best known are The Man Who Mistook His Wife for a Hat and Awakenings, later made into a film with Robin Williams and Robert De Niro, about patients trapped in conscious but “frozen” states for decades after catching sleeping sickness (a form of encephalitis that swept the world in the 1920s) and then “awoken”, sometimes disastrously, with the drug L-dopa. 

Drawing on the 19th-century tradition of the clinical anecdote, Sacks specialises in writing up bizarre, informal case studies of people whose lives and selves have been transformed, mostly after illness or accident has caused cerebral or neurological damage. People like the wife/hat man with visual agnosia, who could no longer identify the simplest of objects; the painter who, after he was concussed, became completely colour­blind; the man who lost all sense of time passing and was trapped on a particular day in 1945.

They are dreadful conditions, and one reads the books with sympathy, as well as a certain sideshow curiosity. Indeed, writing in The Nation, Alexander Cockburn once accused Sacks of being in the same business as the supermarket tabloids, at bottom taking readers on “a visit round the [loony] bin, looking at the freaks”. 

Arguably, he does the opposite, particularly in his later books. Sacks’s observation is so acute, his narratives so engaging, he introduces us to real, suffering human beings who come to represent more than their illness. As one academic noted, “Sacks uses the case history as a bridge between people with disabilities and the able-bodied ­majority, placing himself squarely in the middle as the link that forms the span.” 

The stories would be unbearably tragic, or even merely comic, were it not that they show the ­miraculous adaptability of mind and spirit. The colourblind artist finds new inspiration in black and white. The autistic vet can’t understand human social exchanges but has an intuitive understanding of animals. The doctor plagued by the compulsive tics of Tourette’s syndrome finds they disappear when he operates. It is these adaptations, these other ways of being and of distinguishing the “I” from the illness, that most interest Sacks, perhaps because of his own struggles. 

Sacks’s latest book (to be published in Aust­ralia next month by Picador) is Musicophilia: Tales of Music and the Brain. There is the case of the previously unmusical ­orthopedic surgeon who, after being struck by lightning at a tele­phone booth, developed a sudden and insatiable desire to listen to Chopin and play the piano. He began hearing compositions in his head as if he were tuned to a radio frequency. It led to divorce, but he’s still playing. 

There are accounts of people with absolute pitch, like Frederick Ouseley, Oxford professor of music, who at five remarked, “Only think, Papa blows his nose in G”; and references to famous figures like Che Guevara who suffered from rhythm deafness and might be seen dancing a mambo while the orchestra played a tango (he was also tone deaf). 

There are people tormented by a catchy tune or “brainworm” that almost drives them mad; there are the “frozen” victims of Parkinsonism who can move only when they hear music and freeze again when it stops; and there is a whole chapter on musical hallucinations, experienced by people who are not psychotic. 

Sacks first encountered these when his mother, at the age he is now, woke and told him she had heard Boer War songs from her childhood. She was not a very musical person, unlike Sacks and his father, yet they were so vivid, she was able to sing them for him, “slightly off pitch but she knew all the words. She said she had not given these a thought in 65 years.”

Musical hallucinations occur, Sacks believes, when the auditory brain isn’t getting enough outside input, perhaps because of hearing loss, although seizures can also trigger them. 

“Since the auditory brain has to keep active, it starts to fish down into memory. Everyone’s brain, even if they call themselves rather unmusical, is stocked with tunes which get engraved on the mind, in the brain, early in life.” 

Sacks has always been passionate about music and is very musical himself. He knows the classical repertoire and is an accomplished pianist. Music has even helped save his life, although not music he would have chosen.

In 1974 he set off alone on a stiff mountain walk in Norway and nearly didn’t return. It had been a traumatic year all round and he suspects that at some “super-ego” level the accident was self-induced – one of those destructive impulses.

“I’d seen a notice at the bottom of the walk, which I dismissed. It said ‘Beware of the bull’ and had a comical picture of a bull tossing something. I thought it was a classic Norwegian joke. So I went up and came around a corner and came practically snout to snout with a bull, which was startled and jumped to its feet. Rather elegantly, as if I had just decided to end my walk at that point, I wheeled through 180 degrees and started down.”

Sadly, elegance gave way to panic and as he ran, all dignity lost, he slipped and fell off a cliff. 

“I ended up with the leg in a grotesque position and the whole muscle mass torn off.” Here he lifts his trouser leg to reveal a pale weal of scar tissue running up a hairless thigh.

Fortunately, being English, he had an umbrella with him. And being a doctor, he thought to snap the top off and tear his anorak in two and bind up the leg. He began to heave himself agonisingly down the cliff, which is when the Song of the Volga Boatmen began to play in his head. He dragged himself to its barge-haulers’ rhythm. 

“Again, an example of motor synchronisation to a rhythm,” he says, picking up on an earlier point he had made about some of the practical purposes of music. 

It’s one of the questions that runs through the book, never quite answered, perhaps because there is no answer: what is the point of music? 

Sacks disagrees with evolutionary scientists like Steven Pinker and even one of his heroes, William James (brother of novelist Henry), who wrote Principles of Psychology in 1890. 

“James says music is of no zoological utility, ­it has no teleological significance … But music occurs in every culture known to us. It is central and important for religion, for marching, for social bonding, all sorts of things. Lullabies. And there are bone flutes going back 50,000 years.

“There certainly seem to be some aspects of music, in particular the beats, the pulses, which do not have equivalents in language or speech and which are demonstrably confined to human beings. All children will start to keep time with the beat, whereas no non-human animal will do so.”

But why does music have such emotional power? Why can it make us weep?

Particular smells can evoke deep memories and emotions, and music may operate similarly, processed by similar parts of the brain. In other words, there may be an anatomical explanation for how it happens, if not why. Sacks acknowledges that the whole business of art and rapture remains something of a mystery, but he is not troubled by that. He is not a religious man – he calls himself a Jewish atheist – but he is sensitive to the transcendent power of art, just as he has always been awake to the human side of science: the lives of scientists, the case studies, the psychology that accompanies discovery. 

Humanity has always appealed to him intellectually. The difficulty seems to have been in finding the courage to join it.

In 2001, sacks wrote a memoir called Uncle Tungsten: Memories of a Chemical Boyhood. It could also have been called The Boy Who Mistook Heavy Metals for His Friends.

The youngest of four boys, he was born in London in 1933 into an extended Jewish family (his mother was one of 18 children) rich with doctors, scientists, inventors and intellectuals. It is not surprising the young Oliver became entranced, in every sense of that word, with chemistry. He also possessed all the classic attributes of nerdiness – he was curious, he was clever, he was clumsy. Too clumsy, in fact, to ever fulfil his dream of becoming a bench scientist.

“All my attempts have ended comically or catastrophically,” he says now. “In 1965 I spent a year as a bench scientist at Einstein doing neurochemistry and neuro­pathology. Everything went wrong. In neuropathology I would screw the immersion lens through the slide and destroy priceless slides, and with neurochemistry I lost specimens. And there was one awful time when I was eating a sandwich over the $50,000 ultra-centrifuge and crumbs got into it. They said, ‘Sacks, get out. You’re a menace. Go see patients.’ In fact, this was the inglorious beginning of a clinical career.”

As a child, his ease with science was matched only by his unease with the world. He was a solitary and sensitive boy traumatised by years in a brutal English boarding school; an unquiet child given to strange fears and fancies who found comfort in the safety of objects. Science offered both a sense of control and a sense of excitement, its reassuring rationality tinctured with the possibility of explosion. His own nature was similar: strange, inchoate passions rippling beneath a taut surface. It still is to an extent. It’s why he often dreams of tidal waves.

“A tidal wave stands for what is beyond one’s control, either in a delicious ­voluptuous way or a terrifying way. I think in some ways I am an obsessively controlled person, therefore I have to have dreams about un-control. Un-control generally strikes me as both the most delicious and the most seductive thing and the most dangerous.”

Sacks seems always to have been aware at some level of his own tenuous grip on ordinary life. In the memoir, he writes of his terror of being seduced into madness as he watched one of his three brothers, now dead, become psychotic. 

“I became terrified of him, for him,” he writes, “of the nightmare which was becoming reality for him, the more so as I could recognise similar thoughts and feelings in myself, even though they were hidden, locked up in my own depths.”

In panicked retreat, the young Oliver set up his own laboratory in the house and closed the doors against his brother’s encroaching schizophrenia. 

“It was not that I was indifferent to Michael,” he continues, “I felt a passionate sympathy for him, I half-knew what he was going through, but I had to keep a distance also, create my own world from the neutrality and beauty of nature, so that I would not be swept into the chaos, the madness, the seduction, of his.”

Sacks attributes much of the blame for their fragile states of mind to their years at Braefield, the Midlands boarding school, run by a sadistic headmaster, that the boys had been sent to during the Blitz. Oliver was six when he arrived and was rarely visited by his parents in the four years he spent there. Apart from being beaten, starved and humiliated, he suffered a deep sense of abandonment. It broke his spirit and turned confidence into diffidence. 

His parents, of course, must have meant well. Did Sacks not feel he could tell them of his misery?

“For some reason I couldn’t,” he says, toying with the silvery square of iridium on his desk. “My analyst has written a book called Soul Murder, about intolerable circumstances which are likely to crush people’s spirit, but we can’t always complain of this to others. Orwell also writes about this. Dickens couldn’t complain about the blacking factory. There are certain things one can’t complain about and one only hopes – De Quincey talks about this, the pressure on the heart of the incommunicable – one only hopes someone will notice it is happening.”

Both in his memoir and in real life, Sacks is curiously frank about some subjects and closed about others. In Uncle Tungsten he details his first orgasm, experienced alone, floating on a cork board in a municipal swimming pool, and describes the onset of puberty, yet there is no mention of girlfriends, or boyfriends, or even romantic longings, apart from a peculiar, semi-erotic feeling for a silky barrage balloon, one of those zeppelin-like things used in World War II: “my first love object, the precursor, when I was 10”, he writes enigmatically, leaving the reader to wonder whether he means precursor to breast, phallus, other barrage balloons or none of the above. 

Earlier, we had talked about the terribly sad case in Musicophilia (also reported in Good Weekend in 2005) of Clive Wearing, an eminent English musician and musicologist blighted with such severe amnesia he forgets what happened an eye-blink ago.

Unimaginably, he constantly feels all experience is happening for the first time. 

The remarkable thing is that Wearing’s musical powers remain virtually unchanged, as does his love for his wife, Deborah, who has stood by him in the 20 years since he fell ill, although he greets her afresh every few seconds. 

It is a moving story and I had asked Sacks, who has never married, if he had ever known a powerful love like that, but he was not to be drawn. While he has acknowledged in another interview that he is afraid of intimacy, it’s not something he seems comfortable discussing. 

So had he known such a love? “Ah, um … I don’t know,” he says with a distance – or is it distress? – that makes it clear we are to move on.

It is not such an impertinent question, however, because it echoes one he posed in one of the most startling sections of his memoir. 

Because both his parents were doctors, it was assumed Oliver would enter the profession. By way of introduction, his mother, a surgeon, began bringing home stillborn or malformed foetuses for him to dissect when he was 11. 

When he was 14, she enrolled him in the anatomy class at London’s Royal Free Hospital, which is where he was put to work on the already partially dissected corpse of a girl his own age. 

His guide was an anatomy manual at the head of the table, “its page yellowed and greasy with human fat”. It took him a month to do a leg.

He remembers moments of wonder at the anatomical complexity, but mostly this overly sensitive boy was nauseated, horrified and filled with foreboding. 

“I did not know,” he writes, “if I would ever be able to love the warm, quick bodies of the living after facing, smelling, cutting the formalin-reeking corpse of a girl my own age.” 

Did that prove true?

“Not entirely,” he says softly, “but it was certainly a fear at the time.”

One of his brothers felt Sacks should have “drawn a discreet veil” over the dissecting business. 

Says Sacks, “I had certainly drawn a veil over other things. People have said that if you look, there’s a subtext, an angry subtext. I’ve said, don’t look. Just look at the text.” Strange advice from someone so devoted to psychoanalysis.

Perhaps his brother felt it showed their mother in a bad light?

“I think it just made him uneasy. It has made a lot of people uneasy and I occasionally wish I hadn’t put it in myself ­because I don’t want interviews to be domin­ated by it,” he says rather pointedly. “It’s not that unusual in a medical family.”

Adolescence was not a happy time for him. he developed a strange skin condition, which left him covered in weeping sores, and, worse, chemistry had begun to lose its magic. He became ­interested in other things, but the waning of this great love left “a sort of emptiness or aridity” and it took him many years to recover. 

He went on to do medicine at Oxford, before escaping to Canada and then San Francisco, where he did a residency and an internship at UCLA. But he was still troubled.

Sitting in his office today, he looks like a most unlikely speed freak but that, it seems, is what he became, although only on weekends. (Of course, he was not alone in using pharmaceuticals to alter consciousness. It was the ’60s, after all.) “When that early passion [for science] collapsed,” he says, “it ushered in a long period in which I merely functioned. I don’t know that life had much pleasure or clear direction between the ages of about 16 and 32, a long time … I mean, it’s youth. I was at the age that Dante is in the middle of his dark wood, the years of wandering and mistakes.

“I longed for, I was nostalgic about, the early passions and partly for that reason I took various drugs – marijuana, LSD, mescalin, but especially ­amphetamines – hoping they would somehow get me out, get me going.”

And in a sense they did, in as much as he had ingested a great deal when he stumbled across the subject for his first book, Migraine, a condition he also suffers from. 

“It was early in 1967,” he says. “I took my usual overdose of amphetamines but instead of the idle fantasy which usually would go with this, I happened to have taken from the library a book from the 1860s on migraine. With the sort of catatonic concentration you can get when you have a couple of grams of amphetamines in your system, I read this whole 600-page book with a sense of extraordinary exhilaration and a sort of serenity. 

“It seemed to me that the neurological heavens were opening – these were the hyperbolic terms I used – and that migraine was shining there like a constellation.”

The book was by Edward Liveing and its style appealed to Sacks: a broad medical sensibility that mixed the scientific with social observation.

“I put it down and thought, this is a wonderful book of the 1860s but now it’s the 1960s. I thought, who will be the Liveing of our time? A disingenuous clamour of names came to my mind, followed by a very loud ­internal voice which said, ‘You silly bugger, you’re the man.’ “

By then, he had also escaped the grind of medical school and was working in New York. “It was only then, when I started to see my own patients and be fascinated by them and form relationships with them, that I started to come to.”

As for the drugs: “It is not recommended. I am lucky to be alive and many of my friends did not survive. With a dose like that, you run a pulse of 200 for 48 hours, the blood pressure doubles. You are a good candidate for heart attack or stroke.”

He doesn’t say who the friends were, but when he worked in San Francisco, the motorbiking doctor was in thrall to the acid-loving, gay poet Thom Gunn, also a motorcycling enthusiast. Sacks also acted as a sort of “medical adviser” to the Hell’s Angels, a perfect example of his tendency to combine prudence with a walk on the wild side. 

These days, as far as one knows, he indulges only his milder predilections. Herrings, ferns, Bach, Star Trek, swimming. He has been a “waterbaby” all his life and for decades a compulsive distance swimmer. In a competition in the 1970s, the judges had to plead with him to get out of the pool after he swam 500 lengths. He has crisscrossed lakes, circled islands, tracked rivers. In the water, he experiences “a sort of joy”, a sense of extreme wellbeing. It also stimulates his thinking. When he doesn’t swim he feels fretful.

It is a lovely image, to think of this clumsy, querulous, remarkable man swimming. You ­picture him stepping off land to a place where he is fluid and buoyant, washed clean of worry. You see him taking charge of his journey as he makes his stroke, and after a while surrendering to this magical element, knowing it will hold him; the bearded professor carried surely on a swift current of water and thought.

First published in Good Weekend on October 20, 2007