Those whose familiarity with Oliver Sacks extends only to his vivid book titles — “The Island of the Colorblind,” “An Anthropologist on Mars,” “The Man Who Mistook His Wife for a Hat” — may picture his writing as a gallery of grotesques, a parade of the exotically impaired. Sacks, a practicing neurologist, does specialize in case studies of highly unusual patients. But even as he entertains and diverts with his dramatic tales, Sacks has always been up to something else: he is gently educating us about the frailties and flaws — and the strengths and capacities — of “normal” people, those whose afflictions are of the most ordinary sort. You may never have confused your spouse for an item of outerwear, but have you ever failed to recognize the face of an acquaintance? Fumbled for a word that eluded your grasp? Read a sentence three times and still didn’t get it?
Such familiar slips, and how we handle them, are the stealth subjects of Sacks’ latest book. “The Mind’s Eye” is a collection of essays — some of which have already appeared in The New Yorker — but it has a remarkably graceful coherence of theme, tone and approach. Once again, Sacks explores our shared condition through a series of vivid characters: the woman who couldn’t talk, the man who couldn’t read, the “prosopagnosic” who couldn’t identify her own face in a photograph. (For those who wonder just how Sacks locates such people, it soon becomes clear that many of his patients find him, after recognizing themselves in his writing. They enter his care through the pages of his books, and in turn become characters in his next round of stories.)
The sufferers who write to Sacks receive a deeply empathetic response. Of one correspondent, a woman who has lost the capacity to read (but, remarkably, retains the ability to write), Sacks notes that he responded to her by telephone. “I normally would have written back,” he tells us, but in this case calling “seemed to be the thing to do.” Over time this patient, afflicted with a degenerative brain condition called posterior cortical atrophy, loses her ability to recognize objects and people, though she retains a keen sense of color and shape. When Sacks meets her in person to see how she navigates her everyday life, he dresses head to toe in red so she can keep track of him in a crowd.
Given to such un-self-consciously generous gestures, Sacks would seem to be the ideal doctor: observant but accepting, thorough but tender, training his full attention on one patient at a time. For the patient’s benefit and for ours, he illuminates every uncanny detail, brings out every excruciating irony. The woman for whom Sacks dresses in red, for example, is a virtuoso pianist, and the first sign of her malady is a sudden inability to read music. She is joined in these pages by a novelist who wakes up one morning unable to read, and an intensely sociable woman who is suddenly struck dumb. But Sacks is not primarily interested in documenting pathology, or even curing disease, which in most cases is impossible. There are no miraculous “awakenings” here.
Rather, he is most engaged by the process of compensation, how people make up for what they have lost, wresting new possibilities from their newly imposed limits. There’s the blind man who develops super-sensitive hearing, the deaf woman who catches tiny shifts in facial expression — and that pianist, who loses her ability to read music but gains new richness in her thinking about music. “She felt that her musical memory, her musical imagery, had become stronger, more tenacious, but also more flexible, so that she could hold the most complex music in her mind, then rearrange it and replay it mentally, in a way that would have been impossible before,” Sacks writes.
Sometimes these compensations are biological, he explains. The brain, plastic even into adulthood, reshapes itself to fit a new reality. In people who become blind as adults, Sacks notes, the part of the brain that once processed visual information does not atrophy, but is reallocated for another use. “The visual cortex, deprived of visual input, is still good neural real estate, available and clamoring for a new function.”
At other times, compensation takes the form of an ingenious tool. The social butterfly rendered mute by a stroke uses a lexicon, a book full of words to which she can point. (The lexicon is devised for her by a speech pathologist who is herself, Sacks notes in passing, a quadriplegic.) The novelist employs a journal-like “memory book” to teach himself how to read again. Such tools can help forge a new whole from patients’ shattered identities. As the novelist puts it, “The memory book returned a piece of myself to me.”
Sacks is most attuned to the psychological and emotional adjustments patients make to their new status; he clearly admires how they have gone on “to develop other ways of doing things, capitalizing on their strengths, finding compensations and accommodations of every sort.” In her piano playing, Sacks writes, the woman who could no longer read “not only coped with disease, but transcended it.”
So rewarding are the compensations of Sacks’ patients, in fact, that we begin to feel as if the tragedies that befell them were not tragedies at all, but — as the self-help books say — opportunities for growth. Then we arrive at the book’s penultimate essay, about Sacks’ own ocular cancer. His story is told in journal entries, dated from December 2005 to December 2009, which take on a deepening urgency as we experience along with him one event after another: the strange symptoms, the grim diagnosis, the painful treatment, the halting, incomplete recovery. Sacks’ jaunty confidence and sanguine attitude disappear, replaced by a panicked and sometimes piteous voice that is new to the reader and (if I may be so ungenerous) quite unwelcome. On Dec. 25, 2005, he writes: “Everyone says ‘Merry Christmas!’ and I reply in kind, but this is the darkest Christmas I have ever known. The New York Times today has pictures and stories of various figures who have died in 2005. Will I be among those figures in 2006?”
I found myself longing for the return of the ideal doctor of earlier chapters, and then I saw. He was right there, teaching us one more lesson: that compensation is meager consolation, that loss is painful, no matter what replaces it. Even those of us who have never lost our sight or faced a cancer diagnosis know how profoundly unsettling change can be. A move to a new job or a new neighborhood may make us, for a time, full of complaint and self-pity. It is characteristic of Sacks’ generosity to his patients that he allows only himself to be seen in this light.
Yet Sacks does eventually rally, his playful spirit intact. He notices that the blind spot, or scotoma, in his tumor-stricken right eye resembles the shape of Australia, “complete with a little bulge in the southeast corner — I thought of this as its Tasmania.” He observes that if he keeps his gaze steady for a few moments, his brain will “fill in” his blind spot with imagery borrowed from the parts of the scene he can see. The ever resilient brain, he remarks, “does not just fill in color, it fills in patterns too, and I enjoyed experimenting with my own scotoma, testing its powers and limitations.” Sacks calls this activity “scotomizing.”
Irrepressible though he may be, Sacks will not let us forget the sober lesson of his experience. He ends the essay not with a cheering paean to human resilience, but with a bleak new turn of events. A hemorrhage has further clouded his vision, leaving him with a gaping “nowhere” in his right visual field. “Time will tell whether I am able to adapt to this new visual challenge,” he writes.
Perhaps Sacks will take comfort from his novel-writing patient, who with great effort taught himself to read again. “The problems never went away,” the novelist reports, “but I became cleverer at solving them.”
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