Oliver Sacks The Ecology of Writing Science

Modern Language Studies
Oliver Sacks: The Ecology of Writing Science

Author(s): William Howarth
Source: Modern Language Studies, Vol. 20, No. 4, Literature and Science (Autumn, 1990),
pp. 103-120
Published by: Modern Language Studies
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Oliver Sacks: the Ecology of Writing Science
William Howarth
When I was young, I was torn between two passionate, conflicting

interests and ambitions-the pursuit of science and the pursuit of art.
I found no reconciliation until I became a physician. I think all physicians
enjoy a singular good fortune, in that we can give full expression to both
sides of our natures, and never have to suppress one in favour of the
other.
-Oliver Sacks, Awakenings'
Writing Science
In 1956, when C.P. Snow wrote that science and letters had split
into two cultures, divided by a "gulf of mutual incomprehension," he felt
that this schism expressed opposite views of time:
The non-scientists have a rooted impression that the scientists are

shallowly optomistic, unaware of man's condition. On the other hand,
the scientists believe that the literary intellectuals are totally lacking in
foresight, peculiarly unconcerned with their brother men, in a deep sense
anti-intellectual, anxious to restrict both art and thought to the existential
moment.2
The hostility of Snow's dialectic reflects its origin in Cold War strife, when
competing ideologies offered rival visions of past and future, theory and
practice, natural law and human need. Since then, science has opened
new realms-DNA, computing, space travel-that have led to a "global"
era of broader cultural and disciplinary alliance. Snow might have
glimpsed this trend emerging in the literary work of two scientists, Aldo
Leopold and Loren Eiseley, who wrote with great fluency and dimension
about the ecology of natural relations, the dynamic and cyclical bonds
that have evolved between species and habitats, earth history and human
culture.3
This development confirms that science and letters have long
enjoyed a necessary union. Science properly began with writing, the first
scratchings on clay being a record of natural data, and the founders of
science-Aristotle, Galileo, Linneaus-all used linguistic structures to
arrange and interpret phenomena. Without the cases and declensions of
Latin we might lack binomial nomenclature, the symmetrical naming of
species; and without the rhetoric of Baconian essays-proposition, proof,
conclusion-scientific method would have no convenient form of exposi-
tion. Early writers such as Goethe, Thoreau, and Ruskin wrote scientific
papers; and according to one observer, writing gave Darwin the theory
of natural selection, found while he edited his Beagle notes into the
Journal of Researches (1839).4
? 1990 by William Howarth
103
Recently the best science writers have emerged from interdisci-
plinary fields, whether in ecology, anthropology, or microbiology; where
new modes of inquiry have prompted reflective essays on ethical and
cultural problems. As R. Lane Kaufmann has noted, the essay lends itself
to such speculation through its casual yet principled form, an "unme-
thodical method" that departs from the strictly logical mode of con-
ventional science.5 Hence science writing today includes many authors
who effectively use poetic and narrative devices. Witness James Watson's
The Double Helix (1968), which sets his story of modeling DNA against
a mundane background of meals, weather, and smoky British pubs: "I
felt slightly queasy when at lunch Francis winged into the Eagle to tell
everyone within hearing distance that we had found the secret of life."6
Such writers necessarily sense that science is a social and linguistic
enterprise, possessing habits of speech and grammar that strongly affect
its content. Stephen Jay Gould often ponders the images and metaphors
of natural history, while Lewis Thomas maintains that words are more
important to science than "getting all the numbers together." Literature,
he notes, is a discipline that invites multiple ways of thinking, in concert
with a nature where no facts are "hard," only mutable and moving. The
recognition of quantum physics is that the universe is ever changing, an
insight that corresponds to ecology and its scheme of energy moving
constantly throughout the web of nature.7
Although "ecology" as a term dates from the mid-nineteenth cen-
tury, its origin probably lies in ancient concepts of medicine. In early
Asian and Hellenic times a healthy body was thought to contain elements
poised in careful equilibrium, while illness was a disturbance that
required healing rites to restore harmonic balance. Healers worked
through prayers and magic, then later by compiling systematic records
of diagnosis and therapy, the writings that preserved clinical knowledge
from the age of Hippocrates down to the Renaissance. The great explo-
sion in medical thought after 1600 sprang from Cartesian dualism, which
relegated the soul to a mysterious limbo while examining the body as
a physical, statistical mechanism. Yet even as biomedicine grew more
technical and specialized, it found that the body is an intricate, delicate
network of nerves, organs, and their chemical regulators. To explain these
complex relations, medicine in the late 20th century has drawn on other
disciplines-botany, zoology, and biochemistry-to challenge a host of
problems that are themselves of a broadly environmental nature.
Because of this history a division has gradually emerged in medical
thought between "classical science," a majority that deduces general laws
from individual cases, and "romantic science," a small faction that studies
particular cases to write complex, detailed narratives. The two paradigms
have quite opposite uses for writing: classical, to analyze and systematize;
romantic, to dramatize and individualize. In either case, writing nec-
essarily qualifies the ancient Hippocratic mandate for a physician's
discretion. "I will keep my silence thereon," the oath declares, "counting
such things to be as shared secrets."
Many recent writers have busily shared their medical secrets,
especially about the afflictions that Susan Sontag calls "the nightside of
104
life." Literary journalists frequently write on disease, and several authors
have published "illness narratives," autobiographies of their sufferings.
Each infirmity has its laureate: cancer, for Norman Cousins, Anatomy
of an Illness (1979); hypertension, for May Sarton, After the Stroke (1988);
and the dreaded AIDS, recorded by Paul Monette in Borrowed Time
(1989). Various doctors have also written on what medicine grimly terms
"pathogenesis," the origin and course of disease, including Lewis Thomas,
The Lives of a Cell (1975); Richard Seltzer, Moral Lessons (1976); and
A. R. Luria, The Man with a Shattered World (1987).8
Luria, a Soviet neuropsychologist and early proponent of
"romantic science," has greatly influenced the development of Dr. Oliver
Sacks, the most gifted and problematic of recent medical writers. Born
and educated in England, where both his parents were doctors, Sacks
has since childhood been a "natural" writer, given to compiling massive
journals of his travel, reading, and daily experience. Since 1960 he has
lived and taught mainly in California and New York; currently he is
Professor of Clinical Neurology at the Albert Einstein College of Medi-
cine. Author of many research papers, Sacks is best known to general
readers for five books: Migraine (1970), Awakenings (1973), A Leg to
Stand On (1984), The Man Who Mistook His Wife for a Hat (1987), and
Seeing Voices (1989). These studies all focus on the human dimension
of therapy, expressing Sacks's desire to treat neurological disorder
through healing communities rather than purely empirical medicine.
Neurology deals with medical problems of enormous complexity
and subtlety, the dysfunctions that spread through brain and nerve net-
works to affect a wide range of behavior, from perceptual and muscular
action to emotions or memory. The symptoms are curious and individual,
often quite unpredictable, a situation that forced early neurologists to
diagnose through sensitive reading and interpreting of patients' symp-
toms. With the advent of computer-driven CAT-scanning, diagnosis has
shifted radically toward technical, statistical study and away from earlier
holistic views, what Sacks calls "the inseparability of a patient's illness,
his self, and his world" (A, 21). In taking this position, he has resisted
the current separation of neurology and psychology and called for greater
integration of their interpretive methods.
That attitude accounts for his own evolution as a writer, especially
as he moved away from classical medicine. His early publications were
devoted to etiology, explaining the origin and course of disease; but in
time he came to view clinical research in the contexts of philosophy and
art, "some feeling of a whole being" that he might convey through poetic,
meditative tales about mind-body relations. The stylistic change reflects
his enthusiasm for the ideas of Luria, a figure well-regarded in psychol-
ogy, if not neurology, but Sacks has avoided alliance with holistic "fringe"
practices. Instead he has sought to become what Brom Anderson calls
"a vernacular philosopher" of medicine, devoted to translating academic
abstraction into ethical and spiritual experience.9
After publication of Migraine and Awakenings Sacks found him-
self regarded as a professional apostate. As he noted in a 1983 issue of
the British Medical Journal, peers greeted him with "disapproving or
105
uncomprehending silence" because his books abandoned charts and
tables to pursue "considerations beyond the strictly clinical: human,
scientific, existential, philosophical." Medical journals shunned him
completely, refusing to review Awakenings and rejecting all further
articles, even quite conventional ones.'0 Any professional faces this
difficulty in publishing unrefereed research for popular audiences. To
Sacks, the writing represented a synthesis he had sought in medicine, to
reconcile his passion for both science and art by giving "full expression
to both sides of our natures, and never hav[ing] to suppress one in favour
of the other" (A, 253-54). Luria's romantic science affirmed that ecological
holism, yet it transgressed the medical profession's strongly Cartesian
boundaries.
Sacks's writings may be regarded as attempts to define a field,
but not without the aid of effective mentors. "If one is blessed (or cursed)
with originality," he wrote in 1983, the problem is "to define how one
stands in relation to tradition." His traditions are both clinical and literary,
for he consciously identifies with post-Renaissance writers of meta-
physical, natural history, and phenomenological prose, from Donne and
Browne down to Humboldt, Darwin, William James, and Vygotsky.
Their free-flowing, meditative discourse gave him literary models of
curious power, obedient to disciplinary thought yet impatient with its
conventional forms. Hence Sacks has often sought narrative structures
that relate clinical procedures-which themselves tend to inhibit creative
story-telling.
In medicine the prevailing verb is present; a patient presents
symptoms and the doctor presents a course of diagnosis, prognosis, and
treatment. This process begins with a patients' stories, but doctors often
regard that data as incomplete and capricious. Stories may be untruthful,
misleading or biased; in taking a patient's history, the doctor must hear
a text but also see its subtext, the visible and mute signs of malady. A
doctor with "the eye" for diagnosis is constantly deforming narrative into
science. This situation repeats the cultural schism defined by C. P. Snow.
Science is prospective; it recasts past events into logical and predictable
sequences of causation. Narrative is more retrospective, faithful to the
eccentric pace of memory and understanding. Wanting to trust his
patients' stories, yet also to speak them in his own voice, Sacks has
struggled to reconcile the aims of science and art, despite their opposite
versions of history.
Reference Book
Migraine, which Sacks describes as "a detailed, if somewhat
discursive, reference book," (Mi, xviii) cautiously straddles the domains
of both classical and romantic science. While Sacks provides a compre-
hensive summary of migraine symptoms and therapy, he also expresses
strong sympathy for patients, based on his own childhood experience
of the disease's pain and perceptual distortions. This "constellation of
disorders," as Dr. William Gooddy notes in his preface, creates a rapid
and total physiological crises that arises from the complex interplay of
genetics, personality, and life habits (Mi, xi). Hence the best way to
illuminate the "grand scheme" of migraine is to stress its variables, which
106
Sacks provides through classic case histories. Each of these narratives
offers a brief, formulaic statement of an anonymous patient's condition:
"Case 5: A 36-year old woman who suffers from both classical migraines
and cluster headache. Her attacks of migrainous neuralgia are invariably
nocturnal, and are remarkable for the profuse and viscid salivation which
accompanies them" (Mi, 114).
The overall form of Migraine, however, derives from a rhetoric
that approaches broader narrative principles. Arranged in four parts, the
chapters describe what symptoms are, when and why they occur, and
how they may be treated. The first half is descriptive, the second
explanatory and speculative; a pattern that follows classic therapy
(observe, describe, analyze, prescribe) but toward a romantic end, the
"continuous double vision" that sees migraine as both a structure and a
strategy, reflecting "the absolute continuity of mind and body." The
effect is simultaneously inductive and deductive, using a frame of
reference that grows steadily wider to encompass "many, various, and
sometimes very strange facts we are forced to consider" (Mi, xviii).
As a work of science, Migraine rests on an assumption that its
knowledge is accurate yet mutable, because later findings require Sacks
to alter his text. Two subsequent editions, published in 1981 and 1985,
both add and subtract material. The reductions mainly eliminate or
condense "lengthy academic discussion" to highlight patients' emotional
problems as a large causative factor. The expansions add new obser-
vations or reflections, identified as "Addenda," which tend to emphasize
the utility of self-therapy in milder cases, and to draw conclusions that
Sacks sees as broader, deeper and more personal (Mi, xvi). These include
an epilogue, "The Long Road," a chapter title repeated from his then-
recent memoir, A Leg to Stand On. He did not alter or omit a 1970 dis-
claimer, "I have at all times moved freely, perhaps too freely, between
the statement of facts and the questioning of their meaning" (Mi, xvii).
The words were prophetic, for in each of his subsequent books Sacks
persistently sought ways to develop an appropriate motion between facts
and questions, patients' stories and his own.
Case History
Awakenings also evolved through several editions after it first
appeared in 1973, as Sacks added prefaces and epilogues, appended
reading lists and glossaries, and throughout stitched an elaborate
embroidery of notes, sometimes annotating themselves. Nearly one-third
of the 1976 version consists of footnotes, an abundance Sacks trimmed
back in the 1982 edition, leaving a cleaner but "radically impoverished"
text, but in a 1990 edition he has restored or added many notes, along
with seven new appendices. In all these versions he presides as a genial
and indefatigable clinician, monitoring the evidence and argument
closely, offering at the end his latest updates on patients' case histories
(A, 256-79). The book thus seems unfinished and continuing, very like
a series of medical charts waiting for new entries. In that sense Awak-
enings remains true to its origins in classical science, as Sacks takes pains
to incorporate later findings about his subject.
Two aspects of the book's elaborate apparatus also identify its
107
status as romantic science, where methods are even more provisional.
His glossary of "unfamiliar words" acknowledges that the book is for non-
specialists, but also that medical language is imprecise, since the terms
"merge and overlap in meaning, as do the disorders they denote" (A, 324).
His footnotes verify this heterodoxy by offering digressions on poetry
and philosophy, copies of patients' drawings, and lengthy anecdotal
narratives which, like the patient who takes six hours to wipe his nose,
may puzzle or frustrate empiricist readers (A, 288-306). Writing in a voice
that is at once playful and willful, Sacks remains deeply absorbed in his
learning and confident of its appeal. His later books would subdue this
autonomy, but never disavow its habits.
The redactive nature of Awakenings arises not just from science
but also art, for its story line describes a series of shifting, tentative clinical
situations. Over several years Sacks examined patients who had con-
tracted viral encephalitis and sustained various effects of Parkinson's
disease: palsy, trance, continuing coma. By administering the drug
levadopa (L-DOPA) Sacks could trace the patients' sudden "awakening"
to more normative states, and then their gradual adjustment to those
profound changes. During the course of treatment he presented his
findings in print and film, and later provided post-mortems. He describes
that early work as providing a "model" or "miniature" for Awakenings
(A, 322-23), the germinating culture that defined the etiology of his own
writing methods.
As Sacks explained in 1983, his original intent was to write a classic,
prospective account of a medical experiment: "a double-blind trial of
levadopa in a large group of patients who had become institutionalized
after having encephalitis." Soon he found that the patients had complex
symptoms and histories, since many had been in comas some thirty or
forty years. Such long-term survivals were unprecedented, and results
with the drug were unpredictable. Patients dosed with L-DOPA came
hurtling back into conscious life, bursting with excessive vitality, and then
modulated into regressive states. "Thus I was impelled," Sacks recalled,
"to a presentation of case histories or biographies, for no 'orthodox'
presentation, in terms of numbers, series, grading of effects, etc., could
have conveyed the historical reality of the experience.""
Since the patients represented a historical paradox, distorting the
usual links of past and future, the doctor's narrative method had to relate
his process of discovery. Their awakenings roused him, led him from
empirical to narrative presentation. His case histories therefore became
fully retrospective stories, replete with character, event, and dialogue.
In August of 1969 he wrote nine such accounts but set them aside,
reverting to studies with statistics and tables. He published these in
medical journals, chiefly Lancet, in 1969-71. Then he turned to more
popular media. Late in 1972 Sacks wrote an informal account of his work
for The Listener, the BBC cultural weekly. Encouraged by a warm re-
ception from readers, he returned to the early project and in two weeks
wrote eleven more case histories. When published in 1973, his 20
narratives comprised 50,000 words, nearly 170 pages of print written in
just six weeks' time.
108
This burst of creativity, remarkably like the experiences of his
awakened patients, seemed to be spontaneous and unmediated. "The
case histories were the easiest to write," Sacks recalled in 1983, "they
wrote themselves, they stemmed straight from experience and I have
always regarded them with especial affection as the true and unassailable
centre of Awakenings." Whether that source was a muse or his journal,
he had gained access to new powers of verbal eloquence. Thus released,
his narrative voice soared with incantatory revelations: "They appeared
to be releases or exposures or disclosures or confessions of very deep and
ancient parts of herself . . . they called to her with Siren voices, they
enticed her, they thrilled her, they terrified her, they filled her with
feelings of guilt and punishment, they possessed her with the consuming,
ravishing power of nightmare" (A, 53).
This passage describes both patient and doctor, and it rises from
his empathic power to imagine or picture her inner life. Often his mythical
allusions carry similar personal undertones: He identifies "Rose R" with
Sleeping Beauty, awakened to wake no more (A, 79); while "Frances D"
identifies Sacks as the "devious and Janus-faced physician," a redeemer-
devil who promises deliverance but only inflicts more torture (A, 53).
By learning to see as his patients see, Sacks affirms his doubled role as
healer, the reader/writer who deciphers what patients feel but cannot
speak or explain. Hence his case histories must not be statistical, but
intensely subjective and metaphorical. One patient is "consumed in her
own metabolic furnace"; another speaks a garbled "word salad .. . like
Finnegans Wake run backward on tape"; yet another's mind resembles
"a clock shop gone mad" (A, 85, 86, 98). By describing organic disorders
with mechanical analogies, he reinforces just how involuntary the
afflictions feel.
According to Debra Journet, Sacks's narratives have the same
literary motive as Freudian case history, to individuate patients rather
than blur them into data.'2 Standard neurological journals prefer a
mechanical discourse: dry, storyless, governed by abstract nouns, tangled
clauses, and passive verbs-the inert style of so-called "life sciences."
Even direct statements, such as "Parkinson's disease primarily involves
degeneration of dopaminergic neurons in the human brain,"'3 describe
disease as chemical actions rather than human events. Sacks instead uses
anecdotal material for its local and eccentric properties, as specifics that
assess the validity of suffering. As he notes in closing, "the whole lesson"
of Awakenings lies in understanding Nietzche's dictum that pain will not
make us better, only subtler and more profound (A, 255).
Awakenings is also Janus-faced in its thematics, at once gentle and
loving toward patients but fiercely critical of mechanical, assembly-line
medicine that fails to grasp their plight. This split characterizes not just
Sacks's divided allegiance to art and science, but also his persistent need
for dialectics. Repeatedly he challenges standard etiology by arguing that
Parkinson's disease has "a coherent inner logic and order of its own" (A,
7), a push-pull absence and presence that breaks down distinctions be-
tween voluntary and involuntary behavior. He also decries the author-
itarian nature of medical administration, which organizes hospitals into
109
coercive prisons instead of his ecological model, a collaborative com-
munity that is "single, organic, and self-governing" (A, 25).
The driving force in Sacks's romantic science is his sense of
sacramental wonder at the mysteries of health. For him medicine is a
human enterprise that pretends to be rational but has its roots in meta-
physics, myth, and magic. Healing is thus a sacred matter, for although
life does verge toward ever-encroaching death, between them lies an
equitable art, a true medicine that "will restore to us our lost health and
wholeness, and give us a sense of perfect well-being" (A, 28). Within this
transcendental holism lie the harmonic dualities of patient and doctor,
journal and story, text and notes. Health serves human beings not merely
for biological survival, but also for spiritual redemption. Some patients
sense this purpose in their affliction. As "Leonard L." writes in his journal,
"I am a living candle. I am consumed that you may learn. New things
will be seen in the light of my suffering" (A, 240).
In his closing "Perspectives" Sacks summarizes his findings and
defends case-history narrative as the best means of displaying illness and
treatment. Yet his science training also requires a final summary of L-
DOPA and its effects, which he describes as a triadic process of
Awakening, Tribulation, and Accommodation: a change of awareness,
problems and troubles, and returning to the real, the possible. The last
stage he finds most mysterious, for it presents the aspect of nature that
seeks balance, not through adaptive mechanisms but a flow of tran-
scendent energy. Viewed in this light, medicine becomes the human
rendering of nature's ecology: "Health is infinite and expansive in mode,
and reaches out to be filled with the fullness of the world; whereas disease
is finite and reductive in mode, and endeavours to reduce the world to
itself" (A, 209).
According to Sacks, early reactions to Awakenings either attacked
it as poor medicine or praised it as fine art,'4 but in fact his book never
abandons its roots in classical science. He persistently uses a clinical
vocabulary, and each case history has an orthodox form, beginning with
an account of the patient's disorder and ending with a summary of find-
ings. The book's larger frame repeats this pattern, going from opening
history to closing appendices and notes. Only his patients' narratives are
unconventional, both in their inclusion of broad humanistic issues and
their projection of Sacks's personal discoveries. For in his patients' stories
the doctor clearly found a large measure of himself. "Diseases have a
character of their own," he writes, "but they also partake of our own
character" (A, 206).
Neurological Novel
Much of his own character dominates A Leg to Stand On (1984),
the most personal work Sacks has published, a "neurological novel" (L,
11) that is less fiction than autobiography. Autobiography is a doubled
form of retrospection in which the author plays both character and
narrator, one to whom events happened and one who now relates that
history. In this case, Sacks is recalling an injury and recovery that
occupied nine weeks of 1974. While hiking in Norway he fell, tore the
110
nerves and muscles in his left leg, and after surgery lost for some time
all feeling or recognition of the damaged limb. These events he recorded
in a journal and letters but postponed writing for publication until 1982,
when "The Leg" appeared in the London Review of Books. That article
prompted his 1984 book, which discards the compendious format of
Awakenings yet sustains many of its principal themes. The story of A
Leg to Stand On projects two selves, patient and physician, who emanate
from the single being of a writer. At the same time, Sacks insists that
the case he describes is not unique but common; a claim verified by the
research of Luria, whom Sacks honors in the book's dedication.
In this text Sacks turns from annotation to situate his ideas entirely
in a story. Freed of the Latinate diction of medical diagnosis, he describes
his symptoms briefly and in supple, vigorous English, driving forcefully
along the course of a narrative plot. The story's seven chapters recount
his medical history: trauma; ensuing illness or loss of wholeness; stages
of despair, revival, and reunion; recovery through himself and others;
and afterthoughts on a "new medicine." The book actually has a double
plot, original events and subsequent thoughts, which form the twin axes
of its query into the relation of action and ideas. Thus although an accident
opens his story, a book actually launched his writing. As Sacks reports
in his final chapter, reading the early neurologist Henry Head taught him
to understand the two modes of thought that govern science and art: "The
abstracting and analyzing mind breaks up movement, sees it as a
sequence, a series of complex procedures. The intuitive, esthetic sen-
sibility perceives it as continuous, indivisible, a stream akin to melody"
(L, 200).
Writing a neurological novel entails balancing these two forces of
order and history, analysis and intuition, the prospective series and the
retrospective stream, for they represent the sides of Sacks's sensibility
that generate his work and give it complexity. Repeatedly in the narrative
he represents himself as a divided entity: athlete and intellectual, child
and adult, frightened victim and cool professional, who must come to
see these parts as entire: "I realized that this 'fascinating case' was me-
me myself, fearfully disabled, and quite likely to die" (L, 23). With this
shock he senses how indifferently death surrounds and shapes life, as
unresponsive to his will as the atonic muscles of his atrophied leg. The
collapse of that limb produces a correspondent lesion in his mind,
prompting a series of obsessive dreams, hallucinations, and morbid
visions; yet he reports these moments from a whole and entire per-
spective, the self who made its rite of recovery.
This position is necessary and strategic, for it gives Sacks the
twinned character roles of patient/physician yet retains his options as
narrator. He can thus relate an interval of complete unconsciousness (L,
51), recall a meditative flow of thoughts (L, 67), insert pertinent quo-
tations (L, 73), anticipate ironic surprises (L, 83), and recollect a patient's
history-a ten-minute reverie that fills several pages (L, 79-84). Yet often
these controls appear to vanish as Sacks re-enters his once-broken state,
dreaming again of legs and non-legs, images that tell no story, just remain
fixed and static (L, 94-95); or through migraine attacks, losing half his
111
field of vision and seeing mosaic auras (L, 99-102). He is far more directive
when dealing with the story's characters, either casting them as Kafka-
like apparitions (Swan, The Caster, Nurse Sulu, Sister, Surgical House-
man), or inventing delighful "imaginary meetings and dialogues" (L, 87)
with his favorites, such as the maiden aunt who urges him to emulate
his mother's surgical aplomb, "that essential balance of the technical and
the personal" (L, 89).
Surgery and writing both require anatomy, the system of "tension
and connection" (L, 39) that provides structure, and much of the drama
in A Leg to Stand On emerges through Sacks's discovery of narrative
coherence. The accident and recovery he initially saw as "two separate
stories, and it was only gradually that I came to see they were essentially
connected" (L, 40), an insight generated largely by the process of retro-
spection. In writing he converts absolute clinical history into the relative
dimensions of story, expanding the flow of time until nearly two-thirds
of his text covers fourteen days of events. His verdict about this period
of crisis and regeneration, "Recovery was an exercise in nothing short
of birth" (L, 161), may seem exaggerated, since his trauma hardly com-
pares with the duress of a difficult pregnancy; but Sacks's moral concerns
are in fact generous.
For ultimately he sees that his illness dwells in isolation, that he
recovers by turning outward to others, sensing bonds with them, learning
again to find "essential connection and communion with nature" (L, 163).
Living outside himself is the surest sign of health, just as rising and walking
are his strongest steps toward liberty. The moment Sacks again walks
is the story's turning point, moving him to recognize the power of change
and his need to share it: "'This is the most wonderful thing I have ever
known,' I thought. 'Never must I forget this marvelous moment. Nor can
I possibly keep this to myself.'... In that moment I knew I must describe
my experiences" (L, 141). The patient's pilgrimage is toward a forgotten
unity, linking his ghostly, depressed, and Descartean mind back to the
joyous vitalities of Kant and Leibnitz (L, 149). Even in less complex minds
this journey still occurs, for the burden of illness is to reveal depths never
glimpsed in health: "as a patient one's experience forces one to think"
(L, 172).
The end of A Leg to Stand On reflects upon what the experience
taught Sacks, as both physician and writer, and suggests the direction
his future work will take. With the approval of his mentor, A. R. Luria,
who condoned an early account as "surprising, yet ultimately coherent-
with the unity one would expect" (L, 196), Sacks realizes that this interval,
full of "wild extremities & epiphanies" (L, 197), compressed into its brief
span a destiny that he should pursue. Luria told him he was building "a
new field" in neuropsychology (L, 197), but Sacks finds precedents in
the writings of Henry Head and Weir Mitchell, an American Civil War
surgeon. Their narratives emphasize "doubleness, as if two modes of
thought, two realms, had conjoined" (L, 200), creating a form that
Mitchell called "clinical fiction" (L, 205) written for the benefit of non-
professional readers.
In writing a neurological novel, Sacks fully sensed that classic
112
medicine is bad narration. Each time he was obliged to tell his history
to doctors, they demanded only the "salient facts," which proved not
impartial but hopelessly partial, anything but the whole story (L, 47).
Once, in Norway, an apparition appeared to him, a young doctor with
a powerful empathy for patients: "He didn't talk like a textbook. He
scarcely talked at all-he acted. He leapt and danced and showed me
his wounds, showing me at the same time his perfect recovery. His visit
made me feel immeasurably better" (L, 44). This full being, both artist
and scientist, remains Sacks's ideal for neuropsychology, a human,
romantic science that is not confined either to mechanisms or procedures
but studies both, especially their relation and interaction, for in that
ecology lies revealed the dynamism and unity of natural health, "a
magnificent, self-activating, self-regulating automaton" (L, 211-12).
Clinical Tale
Sacks's absorption with these themes quickly produced his 1987
book, The Man Who Mistook His Wife for a Hat, a collection of stories
sub-titled And Other Clinical Tales. This oddly arresting main title,
playing on the notion of taking a wife, reflects his increasing confidence
in reaching general readers. Of these twenty tales, eight previously
appeared in the London Review of Books and the New York Review
of Books. The latter publication has promoted serious but lively
commentary since 1963, when a newspaper strike gave editors an
opportunity to rebuff the New York Times Book Review for its years
of inflicting "tired hacks, lame professors, and breezy illiterates" on the
reading public.1'5 This venue may have encouraged Sacks to write more
spontaneously, in the style of his personal journal, for The Man Who
Mistook His Wife for a Hat features strong story qualities of scene,
character, and dramatic event; while its technical apparatus (missing
entirely from A Leg to Stand On) consists only of a few amending
footnotes and a brief annotated bibliography.
In the preface, Sacks advises that his narratives are not studies or
cases, but stories with an ethical and moral point: "To restore the human
subject at the centre-the suffering, afflicted, fighting, human subject-
we must deepen a case history to a narrative or tale; only then do we
have a 'who' as well as a 'what,' a real person, a patient, in relation to
disease in relation to the physical" (M, viii). Since the days of Hippocrates,
he recalls, medicine has been a "tradition by which patients have always
told their stories to doctors," and the physician's task is to make both
temporal and spatial sense of their accounts. His metaphor for such
narration has become cartography, for these stories map the brain and
body relations of otherwise unsurveyed minds, "travellers to
unimaginable lands" (M, viii-ix).
Like the pilgrimage in A Leg to Stand On, travel provides a form
for this collection, for Sacks arranges his clinical tales into a four-part
journey, each segment focused on a "presenting feature" of neurological
disorder. He begins with "Losses" and "Excesses," abnormalities
afflicting healthy persons, then moves to "Transports" and "The World
of the Simple," states of vision and retardation. The passage is from
113
normal to impaired, familiar to alien; a reversal of Faulkner's story-telling
progress in The Sound and the Fury (1929), which begins in idiocy and
ends with rational order. Sacks probably acquired this narrative scheme
while writing his eight early tales, since the book builds through a
sustained presentation of its dominant themes.
"Losses" describes not the loss of major faculties such as vision
or hearing, but subtler and more complex "disorders of the hidden senses"
(M, 51) some of which Sacks had personally experienced: the
proprioception that allows for alignment and balance; the perception of
left and right, part and whole, mind and body. In the absence of these
sensory systems only images remain, phantoms so powerful they
challenge conventional ideas of the difference between illusion and
reality. In each story, Sacks works toward revealing "the therapeutic
moment" (M, 72) when a patient discovers his loss and, conversely, the
doctor and reader gain a fuller perception of health. Contrary to classical
medicine, Sacks must see, hear, and believe his patients' stories in order
to heal them. In cartographic terms, retrospective narration gives him
three-dimensional relief; it draws contour lines that separate solid land
from the ever-stirring sea.
"Excesses" explores the reverse of loss: hyperactivity in speech,
sexual drive, memory, or mimicry; the ever-frisky, shifting pulses of
mental activity that, in more controlled minds, generate creativity and
inspired improvisation. One patient, caught in the seething caldron of
Korsakov's syndrome, must continually invent a world and self to replace
those constantly forgotten and lost. In a therapeutic moment of his own,
Sacks sees that this "confabulatory genius" lies at the heart of human
identity; that the mind constantly and unconsciously takes all experience
and constructs it into story: "Biologically, physiologically, we are not so
different from each other; historically, as narratives, we are each of us
unique" (M, 110-11). In other words, science elicits unitary law, while
art conjures up multiple stories. Sacks's role as doctor/surveyor is to
proportion his narratives, make their individual and universal scale of
dimension apparent.
"Transports" explores the dream states that produce mysterious
visions, states of being that are extra-real: a radio playing in the head,
childhood memories of home and parents, old jokes long forgotten. These
are the states of doubled sense that induce dfid vue, hallucination, and
profoundly mystical rapture, all reported to the conscious mind in
voluminous and uncannily accurate deatil (M, 151). In this section Sacks
begins to map tentative thoughts about how the brain functions through
imagination, something neurology has not understood via purely
empirical study. The ability to think in pictures is a peculiar mental
faculty, common to both science and art. A man who mistakes his wife
for a hat poses ontological questions: while reality contradicts his
"mistake," imagination constantly makes just such leaps-to see what is
not, to observe and create anew, however "abnormal" the vision may
seem to orthodox viewers.
"The World of the Simple" poses a final opposition, the retarded
patients whom Sacks loves for their concreteness and immediacy. Yet
114
their lack of abstraction is also profoundly ambiguous, challenging
"romantic science" to explore a neural wilderness, "the almost subhuman
swamplands of the concrete" (M, 174). This cartographer's oxymoron
poses a central problem for mind-mappers, who depend on the brain
to discern ambiguity even in vivid, actual particulars. The same gift is
shared by defectives, who lack concepts but can still forcefully
apprehend symbols. All are people with low IQs, unable to conduct a
broad range of mental activity, yet possessing documentary memories
that allow them to intuit grand patterns of design: "Rebecca," who sees
the face of nature, "Martin," the totality of music (he has memorized all
nine volumes of Grove's Dictionary); and the Twins, amazing
mathematical savants who cannot calculate but create their answers
through unconscious algorithms (M, 181-95).
Being a "number brooder" as a boy (M, 202), Sacks identifies
strongly with the Twins, and this connection prompts one of his mos
beautifully told stories, of playing in a mathematical trio:
After a few minutes I decided to join in, and ventured a number, an

eight-figure prime. They both turned towards me, then suddenly
became still, with a look of intense concentration and perhaps wonder
on their faces. There was a long pause-the longest I have ever known
them to make, it must have lasted a half minute or more-and then
suddenly, simultaneously, they both broke into smiles (M, 203).
Proceeding through its contrapuntal exchanges, the tale climbs steadily

upward to the heights of 25-figure primes, dramatizing as it goes the very
qualities of mind that the Twins possess: not intellect but a share
harmonic sensibility, akin to music, and experienced only when they
work together, in concert-a pathos doubled by Sacks's report of thei
later separation and loss of powers (M, 210).16
In the hands of an "objective" empirical narrator, The Man Who
Mistook his Wife for a Hat might seem only a collection of sideshow
freaks. Sacks agrees that these patients are bizarre, for they lack th
ordinary properties of vision, memory, or muscular tone that provide
most human beings with space-and-time locators. Yet the partialness of
his patients also fulfills the physician. His impulse to tell the clinical tales
emerges from sensing "a certain doubleness" in himself, a man "equally
interested in diseases and people" (M, vii). That sense of identity clearly
rises to the surface of his closing tale of Jose, "The Autist Artist," wh
releases himself through the act of drawing, not by copying forms bu
by inventing his own (M, 225). In such story-telling, Sacks sees that th
"simple" offers a gifted mind its greatest challenge: to escape the narrow
bounds of ego and explore another's realm: "Of course I do not suggest
that all autists have genius, only that they share with genius the problem
of singularity" (M, 231).
Sign Language
With each of his books Oliver Sacks has grown increasingly self-
referential, until in Seeing Voices (1989) he faces a writer's ultimate con-
115
cern, the nature of language. His most speculative work, Seeing Voices
deliberately explores a field of medicine where he lacks clinical authority.
Although most of his writing derives from a personal journal, his text is
journalistic, consisting of two pieces for the New York Review of Books
and a central essay on the nature of language. The result is not seamless,
for Sacks has returned to his practice of inserting long, discursive
footnotes throughout the text. The arrangement produces a meandering
stream of thought and afterthought, often less focused than the notes in
Awakenings and lacking the strong portraiture of his clinical tales. In a
review of Seeing Voices, novelist Paul West assailed it as "a ramshackle
job" that still "has its heart in the right place." But Sacks believes in his
method, which he sees as preserving the course of intellectual discovery:
"you must see it as a deliberate strategy, and not a consequence of mere
laziness or carelessness or distraction."'7
The central subject in Seeing Voices is language, viewed partly
from the perspective of neurology, with its tendency to see words as
measuring the "plasticity and symphony" of the nervous system (S, 26).
But Sacks's study is of how the deaf acquire language,unaided by aural-
oral clues, and their "deprived" condition reveals (as did the Simples)
how in medicine absence constitutes a curious presence. A pure abstrac-
tion, language creates thought and knowledge through systematic sym-
bols that also form their perceiver's identity. Recognizing a fundamental
tautology, that we cannot define thought or language independent of their
forces (S, 73), Sacks sees in the deaf an opportunity to slip that barrier
and explore how words provide the basis for identifying an inner, mental
reality: "What is naming for? It has to do, surely, with the primal power
of words, to define, to enumerate, to allow mastery and manipulation;
to move from the realm of objects and images to the world of concepts
and names" (S, 48).
His secondary proposition is that language defines "our human
estate and culture" (S, 8), since we receive it from parents and can only
sustain it through constant interchange or transaction with others. In the
ecology of mind, language is the energy cycle that flows to, through, and
from an environment. Hence children must acquire words at a critically
early stage of development, between the ages of three and ten (S, 83).
If they remain "dumb" their existence is also a blank, trapped in an
"unworld" of silence as "nonpersons" (S, 18, 39). Sacks here expresses
a scientist's positive faith in the ability of language to order existence and
make "sense" of the world, an idea now under vigorous attack by post-
Structural theorists. As a writer he believes in the inherent structure of
language, the grammar and syntax that allow him to describe, re-
organize, and reason about the world's possibilities (S, 67, 74). For him
language is not merely an arbitrary formal device, but "the most exact
expression of our thoughts, our aspirations, our view of the world" (S,
119). His response to Derrida is therefore implicitly genial; indeterminacy
lies not in language but in conflicting discourses (S, 109).
In Seeing Voices Sacks chooses once more to frame this conceptual
matter in a sequential narrative, as indicated by his sub-title, A Journey
Into the World of the Deaf. This time neurology and cartography have
116
acquired a third discipline, anthropology. By exploring the deaf "world,"
Sacks's journey recounts both his education and introduction to a new
ethnic culture. The deaf lead him toward phenomenology and ethnology,
for in learning to "read" their conditon he moves from a medical to a
cultural diagnosis, seeing "a community with a complete language and
culture of its own" (S, 127). In other words, the deaf are themselves a
Sign he must decipher, and this experience provides yet another
awakening to his own identity, the cantor/bard who wanders afar,
singing in reasoned eloquence: "They were no longer just individuals,
with an individual's plights or triumphs; they were a people, with their
own culture, like the Jews or the Welsh" (S, 137).
What Sacks learns has been told by others, that after centuries of
enduring fruitless attempts to learn speech or signed phonics, the deaf
have regained Sign as an indigenous language, one that is abstract,
symbolic, and three-dimensional (S, 87). The implication of this history
may be that Sign is humanity's first language, an active, iconic form of
expression that promoted speech, with its emphasis on abstraction and
metaphor (S, 120). By suggesting this path, Sacks also justifies the shape
of his own journey. Beginning as a novice, he gradually reaches a point
of view from within Sign, by acquiring its language in the first two
chapters, and then in the third depicting a paradoxical epiphany at
Gaudallet College: isolated in a sea of signing students, he grasps their
isolation from the hearing world: "There is conversing everywhere, and
I can understand none of it; I feel like the deaf, the voiceless one today-
the handicapped one, the minority, in this great signing community" (S,
132). As in his previous works, this process yields a vision of "a unanimous,
communal mind ... the calm strength of union" (S, 133-34), the ecology
of health that sustains patient-doctor transactions.
But in this story Sacks is not a physician, obedient to the calm logic
of diagnosis; instead he is an outsider with collaborators-a normal role
for journalists, but unsettling to a scientist (S, xii-xiii). By daring to enter
that world and experience it as a novice, Sacks has departed from his
early stance of authority. This shift tends to make Seeing Voices a partial
work, which examines the origin of writing's tools, but only occasionally
from a neurological perspective (S, 103). Although thematically consis-
tent with his previous studies of impaired minorities (S, 136), in form this
account is often repetitious in the extreme, achieving in its long part II
the effect of litany and never integrating all three parts. The book seems
less a serial journey than a broken set of signs, offered with great enthu-
siasm by a recent learner: "And when Klima and Bellugi themselves
turned to the study of Sign, in 1970, they had the feeling of virgin soil,
of a totally new subject (this was partly a reflection of their own
originality, the originality that makes every subject seem totally new)"
(S, 142).
Yet originality does not fully animate his narrative. Few stories
accompany the expository development, so that the book wavers be-
tween essay and reportage, some of it bent on popularizing intellectual
work (S, 92), and some quite the reverse, intellectualizing an episode of
popular dissent (S, 125). Equally troubling are the frequent notes, many
117
of them lucid and passionate, Sacks's own "signs" of comprehension and
involvement, yet vexing because they break the reader's journey into
staccato, tic-like fits and starts. Some might have been omitted, on the
grounds of obscurity or self-evidence (S, 51, 90), while others could well
stand in the main text, where they offer fine narrative detail or dramatic
history (S, 130). Like one deaf writer's memory of youth, they "thirst for
connection" (S, 117), gropings toward expression instead of fully
rendered thoughts.
Despite their unpopularity with some readers and editors, Sacks
regards his annotations as necessary-hence he has added 20 more
footnotes to the 1990 edition of Seeing Voices. His defense of this practice
leans on both scientific and artistic rationales. In his many editions, he
leaves the text untouched and then adds generations of notes, "because
my writing (and thinking) is like a palimpsest." That is also a standard
clinical procedure, as physicians "work up" notes on patients through
multi-layered, serial commentary. Yet a deeper motive is Sacks's desire
to preserve in his writing a sense of colloquy, the play of mind upon the
margins of original text:
I have rather strong feelings about holding the integrity and movement
and form of the text, and holding its voice, unimpeded, uninterrupted,
undistracted, and as originally written. And yet I want to give expression
to the profusely (and sometimes chaotically!) flowering afterthoughts
I always have . . . I know no way of preserving the tight flow and
simplicity of the original text without putting these afterthoughts
separately.
The source of this conviction possibly lies in his personal journals, where
the narrative is spontaneous and autonomous, yet also monitored by the
frequent addition of later commentary, no doubt penned in all available
margins.'8
Transforming this inchoate matter into print always entails risks.
Faced with describing how he learned about the learning of Sign, Sacks
recognizes that successful tuiton rises from active exchange, as many
mothers know: "Some talk with their youngsters and participate primarily
in dialogue; some primarily talk at their children" (S, 65). Missing
from Seeing Voices are the sessions of talking with patients, the dialogues
that inform his previous narratives, shape them with the lessons that
powerful mentors give to others (S, 68). Certainly, he does bear witness
to his own acquisition of "the world" of the deaf, moving from outer
to inner recognition of their particular speech and sign system. That
account is touching but also alien, for it asks readers to share an advocate's
passion for a complex, deeply codified system of notation, yet never fully
imparts his pleasure in that passion.
Oliver Sacks's journeys as a writer are far from over, for he is now
well launched on opening science to readers who need to grasp its energy
and many contingencies. In his literary response to the classical and
romantic paradigms for science, he has looked for ways to express past
and future, logic and emotion, series and flow, within narrative forms.
118
His more successful works have recounted the process of discovery that
rises from relations with patients, through intense Socratic dialogues. He
stumbles when caught in isolation, on unfamiliar ground, and without
a set of cases to present. Patients have always represented to him the
opportunity to establish a full ecology of healing, a view that emphasizes
dynamic exchange, recurring cycles, the balance and integrated harmony
of health. Anatole Broyard aptly praises Sacks for this genius: "He
reconciles afflicted people to their environment."'9 Writing is clearly his
best means to that end, for it unites his native cultures of art and science:
"The essential thing is feeling at home in the world, knowing in the depths
of one's being that one has a real place in the home of the world" (A,
239).
Princeton University
NOTES
1. Abbreviated references to Oliver Sacks's writings are:
Mi Migraine (Berkeley: University of California Press, 1970, rev

A Awakenings (New York: E. P. Dutton, 1974, rev. 1983).
L A Leg to Stand On (New York: Summit Books, 1984).
M The Man who Mistook his Wife for a Hat (New York: Harper,
S Seeing Voices (Berkeley: University of California Press, 1989)
2. C. P. Snow, Two Cultures and a Second Look (Cambridge: Cam

University Press, 1969), p. 33.
3. See Sherman Paul, "The Husbandry of the Wild" and E. Fred Carlis
Literary Achievement of Loren Eiseley," in Essays on the Essay: Red
the Genre, ed. Alexander J. Butrym (Athens: University of Georgi
1989), pp. 168-91.
4. John Tallmadge, "From Chronicle to Quest: The Shaping of D
Voyage of the Beagle," Victorian Studies 23 (1980), 324-45. As Olive
notes, Darwin's autobiography reports that his early imaginat
formed through literature, art, and music; while science later tur
mind into "a machine for grinding general laws out of large collect
fact" (A, 254).
5. R. Lane Kaufmann, "The Skewed Path: Essaying as Unmetho
Method," in Butrym, pp. 221-40. See also Alexander Butrym's pref
1-7), which notes that essays by their indirection encourage readers t
formal boundaries.
6. James Watson, The Double Helix (New York: Atheneum, 1968), p. 189.
7. Lewis Thomas, "Humanities and Science," Late Night Thoughts on
Listening to Mahler's Ninth Symphony (New York: Viking, 1983), 255-56;
opinions echoed in Heinz R. Pagels, The Dreams of Reason (New York:
Bantam, 1988); an optimistic account of how "complex sciences" may
humanize culture. Two other examples of recent "literary science" are
Tracy Kidder, The Soul of a New Machine (1981), and Richard Preston,
First Light: the Search for the Edge of the Universe (1988). For background
on ecology, see Donald Worster, Nature's Economy: A History of
Ecological Ideas (Cambridge: Cambridge University Press, 1985).
119
8. Susan Sontag, Illness as Metaphor (New York: Farrar, Straus, & Giroux,
1978), p. 8. Literary journalists writing on medicine include Susan Sheehan,
Is There No Place on Earth for Me? (1982), on schizophrenia and sedatives;
Mark Kramer, Invasive Procedures (1984), on surgery; and John McPhee,
Heirs of General Practice (1986), on family medicine. For a survey of recent
medical writings, see Anatol Broyard, "Good Books About Being Sick,"
New York Times Book Review (April 1, 1990), 1, 28-29.
9. Brom Anderson, "Two Healers," Yale Review 77 (March, 1988), 172.
10. "The Origin of 'Awakenings,"' British Medical Journal 287 (December,
1983), p. 287. One consequence of fame is the popular press interview. See
Holly Brubach, "Talking to Oliver Sacks," Vogue (November, 1987), 230-
32.
11. For a textual history of Awakenings, see its "Select Bibliography" (A, 320-
23). Oliver Sacks supplied other bibliographical details in letters to W.
Howarth, May 13-15, 1990.
12. Debra Journet, "The Role of Narrative in Neurological Case Histories:
Oliver Sacks and A. R. Luria," paper delivered at Modern Language
Association annual meeting; December, 1987.
13. Franz Hefti and Eldat Melamed, "L-DOPA's Mechanism of Action in
Parkinson's Disease," Trends in Neuro-Sciences (October, 1980), 230a.
14. Another tribute was imitation: see Harold Pinter's Some Kind of Alaska
(1982), a play directly inspired by Awakenings.
15. "Shot in the Dark," Newsweek (February 25, 1963), p. 88.
16. In his film Rain Man (1989), screen writer and director Barry Levinson
adapted several elements of the Twins' story to create Raymond Babbitt,
an autistic savant gifted with mathematical powers.
17. Paul West, "Say it with Signs," New York Times Book Review (September
17, 1989). Oliver Sacks, letters to W. Howarth, April 13-15, 1990; quoted
by permission.
18. Sacks, letters to W. Howarth, April 13-15, 1990; quoted by permission.
19. Broyard, 28.
POSTDOCTORAL FELLOWSHIPS IN
COLONIAL LATIN AMERICAN STUDIES
With the assistance of a grant from the NEH, the Cente

Advanced Studies of the Americas in Seville, Spain, anno
postdoctoral fellowships, each for a minimum of four and m
six months, for projects in all fields of colonial Latin Americ
requiring research in the archival resources in Seville. Eligi
include, in general, any area relevant to the history of Spa
Americas. Fellows will receive round-trip airfare from thei
residence in the U.S.A. to Seville, and a stipend of $2291 per
Fellows must reside in Seville between April and Octob
Application deadline: January 1, 1991. For information, conta
for the Advanced Study of the Americas, Columbian Quince
Committee, 322 Dulles Hall, Ohio State University, Colum
43210.
120

Oliver Sacks The Ecology of Writing Science

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Modern Language Studies

Oliver Sacks: The Ecology of Writing Science

When I was young, I was torn between two passionate, conflicting

The non-scientists have a rooted impression that the scientists are

? 1990 by William Howarth

After a few minutes I decided to join in, and ventured a number, an

Proceeding through its contrapuntal exchanges, the tale climbs steadily

1. Abbreviated references to Oliver Sacks's writings are:

Mi Migraine (Berkeley: University of California Press, 1970, rev

2. C. P. Snow, Two Cultures and a Second Look (Cambridge: Cam

With the assistance of a grant from the NEH, the Cente

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