Sunday, August 30, 2015

Oliver Sacks (1933-2015)


"Oliver Sacks, the world-renowned neurologist and author who chronicled maladies and ennobled the afflicted in books that were regarded as masterpieces of medical literature, died Aug. 30 at his home in Manhattan. He was 82."

"You are an abomination. I wish you had never been born."
-- an observation made to Olliver Sacks, quoted by Emily Langer

by Ken

The death of Oliver Sacks can't have surprised anyone, least of all Oliver Sacks himself, since he had gone as public as a person can (writing in the New York Times) with the news that he had terminal cancer. But that doesn't make it any less earth-shaking. For a lot of us, an overwhelming amount of what we've come to learn about the workings (and nonworkings) of the human brain, and even the human mind (i.e., the brain in working context) have come through his prolific and deeply felt writings.

In August 2010, for example, I wrote -- in some awe -- a post called "Oliver Sacks opens a window, personally, on the condition of 'face-blindness,'" about Sack's just-appeared New Yorker piece about prosopagnosia, whose sufferers are unable to recognize faces. In the piece he made me see how this goes to the heart of the way we perceive and make sense of the world around us -- and also startled me with the revelation that his knowledge of the condition began at first hand.

Here's a bit more of Emily Langer's WaPo obit:
An Englishman who made his life in America, Dr. Sacks devoted his career to patients with rare, seemingly hopeless conditions of the nervous system. He distinguished himself both in the clinic and on the printed page and was often called a “poet laureate” of modern medicine.

His books, many of which were bestsellers, generally took the form of clinical anecdotes. A man who mistakes his wife for a hat, an artist who can no longer see in color, a hospital full of patients gloriously, but fleetingly, “awakened” from years-long catatonia: In each case, Dr. Sacks sought to uncover some wisdom, medical or moral.
Not surprisingly, the obit is mostly admiring, but Emily does cite two general, quite harsh criticisms. The one I've quoted above is buried pretty deep in the piece; we'll come back to it. Here's the other:
Dr. Sacks discomfited some readers, who maintained that he capitalized on his patients’ suffering to form handy parables. Tom Shakespeare, a British disability rights activist, called him “the man who mistook his patients for a literary career.”
Now I haven't read the source, and I don't especially care to seek it out. It's possible that in context Tom Shakespeare isn't a total nincompoop and is conjuring a trap that the kind of writing Oliver Sacks did has to guard against. It doesn't sound like that's what he meant, but let's entertain the possibility that he's not the total nincompoop this quote would make him out to be. If you were to make up a list of writers -- neurological professionals or otherwise -- who had the largest positive impact on understanding of and care for the neurologically impaired, my guess is that Oliver Sacks would occupy the top 50 positions, at a conservative estimate.

For a fuller appreciation, we're going to turn to his longtime New Yorker and medical colleague Jerome Groopman, the magazine's great writer on medical subjects. So let's turn back to the other judgment rendered about Sacks, which as it happens came from the subject's mother. Now when a man has been called "an abomination" by his mother, who further expressed the wish that he had never been born, you would think it might have a certain, um, piquancy, a certain resonance, in his life's story.

Even if you didn't know what might have produced such a judgment, I'm guessing you wouldn't have much difficulty guessing. Here's the quote again, with a bit more context:
Oliver Wolf Sacks, one of four sons in an observant Jewish family with many scientists, was born in London on July 9, 1933.

Both his parents, he said, were “medical storytellers.” He went on house calls with his father, a Yiddish-speaking family doctor, and studied anatomy with his mother, a surgeon who sought to instill in her son a love of anatomy by performing dissections with him.

She also instilled in him what he described as a sense of shame about his sexuality.

“You are an abomination,” she told him, Dr. Sacks recalled, when she learned of her son’s homosexual leanings. “I wish you had never been born.”

Dr. Sacks reflected on the exchange years later in “On the Move,” a memoir that would be his last volume published in his lifetime.

“We are all creatures of our upbringings, our cultures, our times,” he wrote. “My mother did not mean to be cruel, to wish me dead. She was suddenly overwhelmed, I now realize, and she probably regretted her words or perhaps partitioned them off in a closeted part of her mind. But her words haunted me for much of my life and played a major part in inhibiting and injecting with guilt what should have been a free and joyous expression of sexuality.”
Now, as promised, here's the beautiful piece Jerome Groopman put up this afternoon on the New Yorker website:

Oliver Sacks, a dear colleague of mine at The New Yorker and in the world of medicine, was an inspiration to me and to countless physicians. A great deal will be said in the coming days about Oliver’s unique literary output -- masterful books including “An Anthropologist on Mars,” “Awakenings,” and “The Man Who Mistook His Wife for a Hat.” But we should remember that he also embodied in his medical practice a kind of ideal approach -- creative, sensitive, and large-hearted -- to his many patients. He was an extraordinary and exemplary doctor.

Neurology is often depicted as a discipline of great detachment. Sacks, who was eighty-two when he died, trained in the field before the advent of the CT scan and the MRI. He learned to observe his patients in extreme detail, calling on his professional training and uncanny perception to make meticulous analyses of motor strength, reflexes, sensation, and mental status; in doing so, he arrived at a diagnosis that might locate a lesion within the anatomy of the brain or spinal cord. And yet, because medical technology had only gone so far in those days, once this intellectual exercise was completed, there was often very little that could be done to ameliorate most neurological maladies.

Sacks showed that it was possible to overcome this limited perspective. He questioned absolutist categories of normal and abnormal, healthy and debilitated. He did not ignore or romanticize the suffering of the individual. He sought to locate not just the affliction but a core of creative possibility and a reservoir of potential that was untapped in the patient. There was case history, for instance, of a color-blind painter who lost all perception of color discovered he could capture the nuances of forms and shapes in hues of black and grey with great mastery.

As both a physician and as a writer, Oliver’s two great themes were identity and adaptation. Illness, he made plain, need not rob us of our essential selves -- and this was something he exemplified in his final months, as a he continued to write remarkable essays even as cancer began to sap his strength and overwhelm him. Sacks understood our frequent ability to adapt, and emphasized that the capacity for someone to adapt to a particular condition -- amnesia, blindness, deafness, migraines, phantom-limb syndrome, Asperger’s syndrome, and countless other conditions -- cannot be known from the outset. These concepts grew from his study of zoology and evolution at Oxford. He similarly saw in medicine a great diversity among individual patients, and the inherent uncertainty of the outcome of a particular disorder. These unknowns gave hope to patients guided by the right doctor -- a hope he captured in his description, in “Awakenings,” of catatonic-seeming encephalitis patients at Beth Abraham Hospital, in the Bronx, who had been written off as “locked in” and then revived, at least provisionally, by drugs like L-Dopa.

Sacks was a contrarian who refused to compromise this approach to the sick and the suffering. He resisted the powerful current of modern practice that seeks the generic. He rejected a monolithic mindset, and retrieved the individual from the obscuring blanket of statistics. This put him outside of the academy, exiled to chronic-care institutions. Through his writing, Sacks ultimately received recognition for advancing a unique form of clinical scholarship that was largely abandoned: the study of the single person within the context of his own life. Ever the acute observer, his case histories confirmed that under a single diagnostic term was a spectrum of human biology. No two patients are ever the same, he emphasized. When examining patients on the autistic spectrum, for example, he highlighted, and informed the public about, individuals with the capacity to draw precisely from memory, the capacity to make calculations nearly at the speed of a computer, or the ability to listen to a piece of music and reproduce it on the piano.

Sacks made house calls, not only in California and New York where he practiced, but globally, visiting Dr. “Bennet,” a surgeon with Tourette’s syndrome in rural Canada or the autistic artist Stephen Wiltshire on a tour of Europe. In these visits, he practiced what might be called the medicine of friendship, showing genuine interest and respect to people who are often shunned. This was the therapeutic intervention when neurology lacked effective pills or procedures.

This did not mean Sacks was a Luddite. He was an avid reader of scientific journals, fascinated by scientific advancements in imaging the nervous system at work. He engaged in dialogue with Nobel laureates and lab scientists about the nature of consciousness, providing what they lacked -- the insights of a naturalist, a field worker.

Sacks also embodied an attribute that can be lost after people become famous: a boundless generosity of spirit. He encouraged young doctors and scientists to record their experiences and communicate them in prose, celebrating their endeavors rather than seeing them as a form of competition or threat. I believe his intense curiosity and boundless energy moved him to want to learn from the succeeding generation, as great teachers do.

Over the past years, Oliver revealed a part of his life that was once considered a debility and disorder -- his sexual orientation. The demeaning of this part of his person, he believed, was the cause for his descent into amphetamine abuse. Drugs may well have killed him decades ago, before his contributions to medicine and writing. It was clinical work, caring for others with competence and compassion, that proved therapeutic for the doctor, giving him the strength to break the powerful grip of drug use. After decades of celibacy, Oliver shared the last eight years of his life with the writer Billy Hayes.

In May, after I had reviewed “On the Move: A Life,” his autobiography, he sent me a letter about what he wanted to accomplish in the time left to him. “In whatever time remains,” he aimed to “pull together another book of case histories–some large … some small, even miniature.” Every dimension of the patient was meaningful in his thinking.

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