The hat, the leg and the footnotes

A conversation with Oliver Sacks—the Scheherezade of neurology

The hat, the leg and the footnotes
By John Ryle  •  28 January 1990  •  Independent on Sunday  •  Revised and expanded, with afterword  •  Posted 2016  •  2,602 words

What I f-find,” says the neurologist and writer Oliver Sacks, “is that as soon as I—ah—open my m-mouth, I no longer believe what I am going to s-say.”

“And,” he continues, “when I write I tend to write—ah—f-footnotes. And when I t-talk I feel my body saying: “On the other hand . . .”

We are discussing Sign, one of the languages of the deaf—the subject of Dr Sacks’ new book, Seeing Voices—and the relation of such languages to speech acts and written language.

“When I tried to l-learn Sign,” he says, “I found my f-fingers were—ah—constantly f-forming the gesture that means “but”.  

And in fact,” he adds, “the “but” gesture was the f-first and —ah—almost the only s-sign I ever learnt . . .”

Dr Sacks’s way of speaking is of a piece with his writing. There’s an italic intonation, simultaneously enthusiastic and equivocal, murmurous and authoritative—abetted by rhetorical stuttering, parenthetical syntax, and an engaging didactic chuckle. Both in his talking and in his writing there is the constant sense of the body, of physical experience as the ground for thought. Listening to him—and reading what he writes—you sometimes have the feeling that you, the reader, the interlocutor, are eavesdropping on an internal conversation, a dramatic monologue that began before you entered the room or opened the page—and one that is likely to continue aftR&C - The hat, the leg and the footnotes-1er you take your leave.

It does not come as a surprise, then, to find yourself talking to Dr Sacks in the flesh, as I did last week in London. There is a feeling that you may have met him already, even if you haven’t. What is a bit surprising, though, is to find him, on a chill winter’s morning, with the window flung open, wearing a short-sleeved shirt and fanning himself with a gaudy paper fan.

I ask him about the fan.

“I’m always hot,” he tells me. “I like to live in a breeze.”

“The fan—well I used to be shy about it,” he adds. “But I decided that a man of my age—and weight—should really do what he likes.”

Dr Sacks is indeed a big man, a former bodybuilder and champion swimmer. He still swims every day, he says. (“Oliver’s arms,” observes one acquaintance, “are like other people’s legs”). He has a huge chest and a beard that birds could nest in—if his hands were not so busy caressing it. They are physician’s hands, ready to take a pulse or palpate a spleen. According to friends, he has also been known to use them, in the absence of a can opener, to wrench apart a tin of sardines.

Two broken legs

Seventeen years ago Sacks wrote Awakenings, a luminous account of the survivors from the great 1940s epidemic of Encephalitis lethargica—sleeping sickness. The sleeping-sickness patients, inmates of a hospital in New York, catatonic for decades, were brought briefly and tragically to life by L-Dopa, the drug used to treat Parkinson’s disease. Twelve years later Sacks published The Man Who Mistook His Wife For A Hat, a collection of haunting case-studies of rare neurological disorders. Here were people with phantom limbs, violent tics and profane compulsions, amnesiacs with five-minute memories, people with no sense of their bodies at all. In all these cases Sacks’s emphasis is on the graceful adaptation to affliction his patients sometimes managed to achieve.

Awakenings and the Hat Book (as its author calls it) were critical successes, both in England and America. But Sacks’ A Leg To Stand On, published in 1984, was less of a hit. The Leg Book, as it may be called, is an autobiographical account of a near-fatal injury that befell Sacks in Norway, a “neurological novel” he calls it. In this book doctor and patient change roles: the book describes his experience in the orthopaedic ward of a London hospital, and his own reaction to temporary losses of sensation in his injured limb.

“Writing A Leg To Stand On almost killed me,” says Sacks. “But I felt certain that if I didn’t write it down it would happen again. In fact, as soon as I had delivered the final draft of the manuscript to my publisher in London, I fell in a gutter in the Bronx and broke my other leg.”

He rolls up his trouser-leg to show the scar.

“I rang my publisher to tell him. And what do you think he said?” Sacks gives a chuckle.

“He said this: ‘You’d do anything for a footnote.’”

The publisher in question, Colin Haycraft of Duckworth, who has published three of Sacks’s books, says publishing A Leg To Stand On almost killed him, too:

“Oliver produced a 300,000-word manuscript,” Haycraft tells me later on the phone. “Quite mad. Cutting it down to 50,000 took me two years. Enough said.”

Entering the world of the deaf

The Leg, The Hat and Awakenings can all be situated in the genre of the case history, the clinical narrative. But Sacks’s new book, Seeing Voices, is, on the face of it, a departure. Neither a case study, nor a medical text, it is a work of reportage about the world of profoundly deaf people and of advocacy on behalf of Sign. Unlike other languages of the deaf—which are signed versions of spoken languages—Sign is not a transliteration of speech, but a visual language with its own syntax that has no direct relation to the spoken word. For this reason Sign is favoured as a medium of instruction by deaf activists; and the climax of the book is Sacks’s visit to Gallaudet, an American university for the deaf, where a student protest in 1988 provoked the appointment of a deaf person, for the first time, as University President.

“I was tired of the clinical approach,” says Sacks. “I wanted to see people with disabilities living in the real world. I found that deaf people had a culture richer, in some ways, than our own. I was astonished. Seeing Voices is a book in praise of the deaf. In praise of their visuality.”

Sacks’s work currently extends in another sense beyond the hospital walls. Awakenings is currently being made into a feature film, with Robin Williams as Dr Sacks and Robert de Niro as his patient. Sacks is technical adviser on the film; he also has a walk-on part as Father Christmas. Last week he was on the set in New York with one of his patients, the lone survivor of the story of Awakenings, a patient who he calls Lillian T.

“It was very curious to see her watching de Niro,” says Sacks. “When he took up the catatonic position, she gave him a critical glance, then she relaxed, as though to say ‘You’ve got it’.”

“De Niro’s acting really is uncanny,” he says. “It disturbs me. I keep thinking he is having a respiratory crisis or, when he sways and falls, that he has, by some bizarre accident, lost all his postural reflexes. I don’t know how deeply acting of this sort can get into the central nervous system. I wonder. I’d like to hook him up to an EEG and see.”

Oliver Sacks in the 1960s

Oliver Sacks in the 1960s

Motorcycles and mind expansion

The road that has led Dr Sacks to play Father Christmas opposite Robert de Niro starts in north London. Sacks comes from a medical family: both his parents and his brother are, or were, doctors. He went to St Paul’s School, where he was a friend and contemporary of the writer and opera director Jonathan Miller, and from there to study medicine at Oxford University.

Sacks spent much of the 1960s in California where, by his own account, his main interests were mind-expansion and motorcycles. A photograph shows him clad in denim and leather, pectorals taut and hair greased back, posing luxuriously in a truck stop in Alabama. He had, he recalls with a characteristic combination of precision and extravagance, spent the night in the Travel Happy roadhouse, after his motorcycle blew a gasket, drinking 28 cups of coffee and eating seven bowls of black walnut ice-cream.

He cites a poem written by a friend of his from his California days, the poet Thom Gunn. The poem, “On the Move ‘Man you gotta go’”, is a biker’s torch song from Gunn’s now classic collection, The Sense of Movement:

On motorcycles, up the road, they come: 
Small, black, as flies hanging in heat, the Boy,
Until the distance throws them forth, their hum
Bulges to thunder held by calf and thigh.
In goggles, donned impersonality,
In gleaming jackets trophied with the dust,
They strap in doubt—by hiding it, robust—
And almost hear a meaning in their noise

In those days Sacks used his middle name, Wolf. (“It was my—ah—lycanthropic period,” he says.) But after coming to New York and starting work as a neurologist, Wolf Sacks shed his skin and became Oliver again, consultant at half a dozen hospitals and ultimately Professor of Clinical Neurology at the Albert Einstein College of Medicine, the post he still holds. But he traces his continuing restlessness, his urge to study the neurologically afflicted in their own communities, to his days in pursuit of Nirvana on the saddle of a Norton.

“Do you know about Mormon tea?” he inquires affably. “It was when the Mormons were on their trek from Nebraska to the Salt Lake. They found this—ah—simple herb by the wayside and made an infusion from it.”

“Tea and coffee were forbidden to them, of course. And the infusion they found”—he pauses to caress his beard—“fortified them remarkably. It was ephedra, which is full of ephedrine—a very powerful central nervous system stimulant.”

“So you see,” he concludes, “they were high all the time. Which might explain the prophets and their visions…”

“But can a drug can actually explain a vision?” I enquire.

“No, no,” says Dr Sacks. “And of course I wouldn’t at all want to reduce the content or the meaning of a vision to a biochemical substrate. I’ve written about St Hildegaard’s migraines, for example. The point is not to explain visions away, just to show how an organic affliction can provide the occasion for transcendence.”

The colour world

It can be the same with other neurological disorders, Sacks argues. One of his papers deals with an artist, a well-known abstract expressionist, who lost his sense of colour as the result of a head injury. “He woke up one morning,” Sacks begins,

and found himself in a grey mist. He drove to work, running several red lights, and found all the paintings in his studio were black and white. It was hard to embrace his wife because her flesh was grey. When he closed his eyes and tried to imagine the world as it had been before, he found his colour memory had gone too.

“This man was famous for his use of colour,” Sacks’s paper continues,

but slowly he came to appreciate what he called the shadow world. He painted a black sunset, grey lawns. Now art critics talk of his “black and white phase” in terms of a creative departure. This is a case of adaptation in the positive sense. It’s not at all clear whether he would accept the colour world back now.

Professionally speaking, Sacks has gone out on a limb, extending medical discourse to include subjective accounts of illness as well as self-doubt on the part of the physician, taking the genre of the case study into new territory. He is the Scheherezade of neurology. The writing is fertile with literary and philosophical reference. Some critics have suggested that he takes this literariness too far, to the point where his case-studies become a kind of fiction. Before our interview I’d been planning to raise the issue of factual accuracy with him. Somehow during the time I am with him, the right occasion does not present itself. As we approach the end of our conversation, though, I ask him what features of imaginative literature he considers appropriate in clinical narrative.

“It’s the very detailed representation of experience in fiction, I think. Its truth to life. Many novelists are masters of clinical description. Dickens, Dostoevsky . . . Tolstoy is an excellent clinician. In fact I wrote an essay about him once. I called it ‘Tics in Tolstoy’.”

“And I love Proust’s description of waking up,” says Sacks. “First the rudimentary consciousness like an animal, not knowing where or what or who one is. Then memory being let down like a rope from heaven . . .  I think one cannot describe physiological processes without this kind of phenomenological detail. Without it we actually cannot understand what it is to be alive.”

“For example,” he continues, “a lot of things to do with disease belong in the comic-dreadful mode. Ordinary clinical discourse is not too good at catching this. It’s not that one wants to import plot or character or meaning into clinical narrative. But it’s already there.”

Sacks is being generous with his time. And I have a sense that our conversation could go on indefinitely. But it is time to go. How, I ask him in conclusion, do his books, with their combination of reportage and extended case studies, relate to his clinical practice?

“My patients come to me with s-stories,” Sacks concludes, fanning himself again. (Once more the slight stutter, and the didactic chuckle.) “They have p-predicaments. They have p-p-plights. They come in searching for ways of dealing with these things. The stories help. Telling stories really does help them.”

Sacks pauses, then, in a phrase that could either be a conclusion to the conversation, or the start of a new one, he says: “and in all this there is something important, something that helps them, something—ah—essentially dramatic.”  ★

Oliver Sacks at work, 2015

Oliver Sacks at work, 2015

Afterword

Following the publication of the original version of this profile, in 1990, Oliver Sacks wrote me a letter in which he invoked his case-study of a man with Tourette’s Syndrome, an essay entitled “Witty Ticcy Ray”.

“When I wrote ‘Witty Ticcy Ray’,” he wrote in his letter, “I gave it to him—to Ray—to read.”

First he twitched and ticced, and exclaimed “You take a few liberties!”…  So I pulled out my red pencil and said “What shall I remove?”

“He snapped ‘Wait!’, finished [reading] it, and said ‘Remove nothing! It is entirely true.’”

And so it is,” Sacks’ letter concluded gracefully, “with your piece about me.”

Oliver Sacks died in August 2015, soon after the publication of his autobiography, On The Move (the title of the book is taken from Thom Gunn’s poem, quoted above). Six months before his death I met him at a party in New York—the first time since I had seen him since I interviewed him in 1990, twenty-five years earlier. In the course of conversation at the party I asked him if he still carried a fan to cool himself with. No, he said, he didn’t, but he always carried a card with the periodic table of the elements printed on it folded up in his pocket. And sometimes he took this out and fanned himself with it. (In an earlier memoir, Uncle Tungsten: Memoirs of a chemical boyhood, 2001, Sacks describes his childhood fascination with metals; and in his last book, Gratitude, published posthumously in 2015, there’s an essay, written shortly before his death, entitled “My Periodic Table”.)