Q&A: An Interview with Oliver Sacks

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Dr. Oliver Sacks, a neurologist and professor at Columbia University Medical Center, may be better known to many as a literary pioneer. His books, which include Awakenings and The Man Who Mistook His Wife for a Hat, introduced readers to indelible tales of patients with almost outlandishly peculiar brain disorders.

But in Sacks’s compassionately rendered stories, at once heartbreaking and hilarious, these patients are not freaks; rather, they are real people — and a window into the inner workings of everyone’s mind and brain.

Now 77 and recovering from an ocular cancer that was successfully treated but left him blind in one eye, Sacks has just released his 10th book, The Mind’s Eye. It is more autobiographical than many of his other recent works. In it, he explores his experiences with cancer and also discusses his prosopagnosia, or “face blindness,” a disorder that prevents him from recognizing faces, sometimes, even his own reflection in the mirror. (More on Time.com: See more from the Mind Reading series)

I won’t lie: Dr. Sacks is one of my literary and scientific idols, so it was no small thrill to interview him in his book-filled, pleasantly cluttered West Village office. This is the first part of our conversation.

The first thing I want to ask is, how is your vision?

I see nothing with my right eye. I walk more cautiously because I don’t see curves yet: things are flat for me and I don’t see or expect things on the right side. But I accommodate.

You have said that you sometimes “fill in” areas that you can’t really see.

I had a very early experience, when I was first in hospital. My right eye was being irradiated and covered. For some reason, I was washing my hands. And I closed my left eye and saw everything perfectly clearly.

I thought, “That’s strange. This must be a transparent bandage over the right eye.” Of course, it wasn’t; it was a huge wad of stuff. But this persistence of vision was unlike anything I’d ever experienced before. (More on Time.com: Special Report: Kids and Mental Health)

You’ve written about two opposite responses to losing one’s sight. In one, it goes away entirely, even the idea of seeing. But in the other, visual images inside the mind are enhanced and used to guide daily life. Which way do you think you would go if, God forbid, you lost your other eye?

My world is a very verbal one. This showed up on brain scans.

I wanted to see what went on in the visual cortex when I had this “filling in” phenomenon. Those studies weren’t terribly clear-cut, but what was visible was the speech areas of my brain: [they] were chattering away nonstop during the entire procedure. So there’s a lot of internal speech, probably less internal imagery.

But [how] would I change [if I became completely blind], I don’t know. I think I would probably grow even more word-oriented.

Do you still have hallucinations?

I can see some at the moment, say, on the wall there. They mostly look like letters or numbers, with predominantly sharp edges. They flicker in and out, they’re random. Occasionally I see a V or a W. I suppose I should call them hallucinations because I didn’t order them. They get projected on surfaces, according to how far the surface is away; [up close] I get tiny little tiny letters and if I look at the sky, they’re huge.

I wanted to talk about your prosopagnosia, which you write about in The Mind’s Eye. How do you think your inability to recognize faces affected the development of your social life?

I was and remain somewhat shy. I don’t readily open conversations; I certainly think difficulty recognizing people plays a part there. I have been said to suffer social phobia [or] Asperger’s [but I think] that overstates it. (More on Time.com: The ‘Mommy Brain’ Is Bigger: How Love Grows a New Mother’s Brain)

A person’s response to prosopagnosia seems as varied as the response to vision loss. Heather Sellers, whose recent book discusses her own face blindness, became very social.

With someone like [the artist] Chuck Close, he responds [that way, too]. He’s exuberantly extroverted. He bursts into conversation with people, partly to deal with the fact that he doesn’t recognize them. Or he rapidly finds out what they’re doing, what their interests are, what their job is, who they are.

So you don’t think you have a touch of Asperger’s?

[People say] I’m an honorary Tourette’s because I tend to jerk and I occasionally [suddenly say something]. I am also an honorary Asperger. And I’m an honorary bipolar. I suspect we all have a bit of everything.

But I know with someone like Temple Grandin [who has autism], I really do see her as a different sort of being.

I also wanted to ask you about your experiences with amphetamine use, which you recently spoke about publicly.

I wish I’d never opened my mouth about that. However, since I have…

Do you think you were addicted?

Certainly, it became a habit and I had a ritual. It was my weekend treat for two or three years. And then, mercifully, that was it.

What changed?

An odd experience, which I’ve written about. In 1966, I started working with migraine patients. I didn’t enjoy neurological training that much but when I started working with real patients and I had responsibility — that, I loved. They would tell you all sorts of things, which were mysterious to me and not well described in the current literature. (More on Time.com: The Lab Rat: How to Improve Memory in 15 Minutes)

I went back and found an old book on migraines from the 1860s. I took it out on a Friday evening. [I took amphetamine.] With an almost catatonic concentration, almost without blinking or licking my lips, I read the entire book from first to last word without stopping. I thought it was a marvelous example of Victorian medicine.

Then, I thought, it’s the 1960s — we need such a book now. Who should [the author] be? Now a disingenuous clamor of names went through my mind, followed by a very loud internal voice that said, “You, you bugger. You’re the man.”

I would usually come down from these amphetamine highs with a sense of folly, exhausted and empty-handed. But this time, the sense of revelation and resolution persisted and I wrote my own book and I never took another amphetamine again.

From your experience, it sounds like you are lucky not to have gotten more attached to the drug.

Very. I had friends who O.D.’ed on that stuff, and I was lucky not to myself. I don’t know that I recommend any drugs, but I think amphetamines are particularly dangerous and seductive. Whether addictive is the right word I don’t know.

How would you define addiction?

I’ve never attempted to. I regret now that I used the word. I think one defining characteristic could be requiring a larger and larger dose to get the same effect, and having severe withdrawal effects if you don’t take it. I don’t actually think that either of those was the case with amphetamine.

The DSM now defines it as compulsive use despite negative consequences, essentially.

I very much like “compulsive use despite negative consequences”; it’s a very concise definition. It puts it well. (More on Time.com: The Authentic Self: How Do You Know If You’re ‘Really’ Racist or Sexist?)

When I had knee replacement and then, almost on top of it, back surgery, we were told there was a window of no more than eight weeks in which you have to move; [otherwise], you will not get any more range of flexion. However, they said, bending the leg and knee is going to be very painful. In fact, it will be 10 out of 10 [on a scale of pain]. But you must do it. We are happy to give you morphine.

Now, one wonders, “Will I become addicted to the stuff?” But my own experience, like many people’s, was that when there was less pain there was less interest [in taking the drug].

My behavior with opiates was nothing like my behavior with amphetamine. I now have a large bottle of 30 or 40 [opiate] tablets that I didn’t use and have no interest in using, whereas I wouldn’t dare have any amphetamine in the house, even though it has been more than 40 years. I wouldn’t want a taste of it — well, I would want! I suspect there are some long lasting brain changes.

But I think its very cruel and ignorant to deny pain medication to people, especially people with intractable or permanent pain. It’s monstrous.

You have a pretty long view of the field of neuroscience. What is the most important advance you’ve seen?

At a gross, technological level, I think imaging, especially functional imaging of the brain. Even 20 or 30 years ago, no one would have imagined that you could get detailed pictures of people’s brains when they are listening to music or composing music or making up their mind to do something, or hesitating or, I don’t know, in love or rage.

At a finer level maybe just [understanding] the sheer complexity of 100 billion neurons, each of them with 1,000 or 10,000 dendrites [connecting them to each other]. I think now we can begin to understand some of the powers and some of the potentials of the brain as never before. But I think we can only do it in a rudimentary sort of way.

More on Time.com:

What Goes on Inside the Brain of a Misbehaving Boy?

Amnesia and a Camera: Photos as Memories

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