Oliver Sacks: 'I don't feel proud of anything'

He's written 12 best-selling books, inspired a play by Pinter, had his story adapted into an Oscar-nominated film, been awarded a CBE, and holds more honorary degrees and fellowships than I can count on the fingers of both of my hands – which is why I was surprised at how humane, gentle and warm Oliver Sacks was when I met him.  

The world-renowned neurologist, famous for his case studies detailing patients with neurological deficits (such as the man who mistook his wife for a hat), visited the University of Warwick, where I was a psychology student, to give a lecture on the importance of case studies in medicine. I was lucky enough to catch him for half an hour to talk about hallucinations, advances in neurology and his love of swimming.

As an 80-year-old physician, Sacks is no stranger to neurophysiological impairments himself. He has prosopagnosia, which means that his ability to recognise people by their faces is impaired; a factor which he says has contributed to his chronic shyness. He is also blind in his right eye, due to ocular cancer, and has tinnitus, a type of auditory hallucination in which one hears a constant ringing or hissing sound that may be intolerably loud. I was therefore a little apprehensive about whether he would be able to hear all of my questions and hoped I wouldn't have to awkwardly repeat myself. Quite the opposite. Not only did Sacks come across as extraordinarily bright, intelligent and insightful, he also was very friendly, leaving me wondering how it could be possible that he describes himself as being 'diseased' with shyness, social phobia or Asperger's syndrome.

I began by asking Professor Sacks what he was currently working on, and he told me that he was writing a book of essays on memory, imagination and psychology's greatest mystery, consciousness. However, unlike much of his other work, he mentioned that many of the case studies in this book will document the clinical details of historical figures, rather than his own patients – such as the likes of the Romantic poet Samuel Taylor Coleridge, Irish playwright Brian Friel and Helen Keller, a 20th-century humanitarian and the first deaf-blind person to earn a degree. This excited me: Coleridge is my five-times great uncle and I was fascinated to find out what Sacks knew about him.

I could not have anticipated such an answer – Coleridge, apparently, was an accidental plagiarist! He suffered from cryptomnesia, which is when one falsely thinks that someone else's material is their own. In his case, he incorporated lengthy passages originally written by German philosophers into his own work, believing he had generated such ideas. Helen Keller suffered from the same phenomenon, as an 11-year-old child, in which she wrote a book of 'delightful' short stories that she genuinely believed had been a product of her own imagination. Unfortunately the stories turned out to be extremely similar to ones that had been published three years earlier, and she faced a barrage of abuse for being a 'plagiarist' and a 'liar'.

I remarked that I had heard of this phenomenon occurring in eyewitness testimonies, and Sacks emphasised how 'very common it is for one to have an exciting new idea but be oblivious to the fact that it comes from somewhere or someone else.'

We moved on to hallucinations. Regarding the most surprising illusions he has come across, he told me, 'One can have hallucinations of their self, and see a mirror image of themself dressed the same way, mirroring their posture – it's very peculiar.' Realising he has his own experiences of hallucinations, I asked him whether he had ever experienced such a phenomenon: 'No, it's something I have always hoped to experience, but never have…', was his enthusiastic answer. 'I also hope to experience the so-called "out-of-body" hallucinations, where one is floating somewhere "up" there and looks down to see oneself. Normally we feel that we are so firmly "in" our own bodies, but in such an experience one feels vividly disembodied.'

'Would that happen when a person loses proprioception?' I enquired. 'Yes, it seems to be due to a "scrambling up" of visual and proprioceptive experience,' he said; 'Which is why people with very good proprioception, like athletes and dancers, are usually resistant to such experiences. Although, hallucinations of this sort can be caused by all sorts of situations, such as a migraine or seizure, or in cases in which the brain is deprived of oxygen, such as during a cardiac arrhythmia or arrest, or after taking certain drugs.'

At this point there was a temporary pause in the interview, as Sacks took a sip from his tea and exclaimed, 'This is remarkable tea – it seems to have needed three sweeteners! It must be an especially bitter sort of tea.' Bemused, I laughed and waited whilst several people fussed around him, offering to go and get him another cup. Shaking his head, he explained, 'I have a very, very sweet tooth, and I have to use sweeteners or else I put on weight.'

Back to the interview, in which he went on to enlighten me of the existence of dramatic 'out-of-body' and 'near-death' hallucinations that can stimulate non-religious people to believe in an afterlife and become spiritual: apparently, a patient with temporal lobe seizures had experienced the phenomenon on multiple occasions, resulting in her following five different religions! He chuckled that he would be extremely interested to know how such an experience would affect a 'hard-boiled atheist' like himself.   

Indeed, Eben Alexander, an American neurosurgeon and strict atheist, experienced an out-of-body and near-death experience whilst in a meningitis-induced coma, and wrote a book about it, entitled Proof of Heaven: A Neurosurgeon's Journey into the Afterlife. The book has been on the New York Times bestseller list for over five months and has caused controversy among the scientific community. Sacks told me of his objections to Alexander's claims: 'In the book, he insists that the brain is not necessary for experience, as his hallucinations occurred when he was in a deep coma (and therefore the brain was not really working). This suggestion, and his belief that consciousness occurs independently of the brain, outraged me!' He added, 'I think he rather grossly misuses his credentials as a neurosurgeon for claiming credibility. One doesn't question people's experience; one only questions their interpretation of it.'

The interview then moved on to discussing Sacks's proudest achievement – to which I received a startling, but humbling response. 'I don't feel proud of anything' he said, 'The most I feel is not ashamed. If I can write anything that I'm not ashamed of, then I'm happy.' Taken aback, I assured him that he should feel proud of his work, to which he somewhat reluctantly revealed, 'Well, the book that came from the deepest experience is Awakenings, but the one which I like the most is The Island of the Colorblind, because it's about travel, and exotic experiences. It has a licence which none of my medical books have.'

We then talked about Sacks's own time as an undergraduate student of biology and physiology at Oxford sixty years ago. The best thing about it was making new friends and experiencing new opportunities – 'the world opening up in all sorts of ways'. After completing a Bachelor of Medicine in 1958, he chose to specialise in neurology because he passionately believed that the brain was the most interesting thing in the universe, because it essentially makes every person who they are. Although he considered both psychology and psychiatry, the opportunity to understand the physical basis of behaviour particularly appealed to him.

Undoubtedly, Sacks has been a huge inspiration to many scientists, both young and old, but who inspired him? The Russian neurologist Alexander Luria, he told me, whose work he first came across as a medical student. 'I read an enchanting book of his called, The Mind of a Mnemonist – a mnemonist is someone with a remarkable memory – and I read 20 pages of it believing it was a novel. Then I realised it was a case history, but the most detailed I had ever read, but one with all the beauty and drama and feeling of a novel.' Profoundly inspired, he vowed to take on Luria's approach, describing the individual at the centre of a clinical story, in his own work. Indeed, this vivid technique has been precisely what has brought his writing to life, and sparked such compassion and awe from a wide audience of readers. And did he ever meet with Luria? 'Regretfully, no,' he said, 'but we corresponded over the years.'
When I asked him what advice he would give to students wanting to get involved with neurology, he exclaimed, 'Go for it! Fifty years ago I might have warned that it will not give one anything in the way of therapeutic satisfaction, as most neurological damage is irreversible and most neurological diseases are incurable, but that is less the case now.'

What has changed to make this possible? 'There have been discoveries at so many levels,' he said. 'But I think especially technical discoveries like recording from single nerve cells, recording activities in different areas of the brain in fMRI scanning, and being able to see how connected everything is in connectomes are advances which have been hugely beneficial.'

And where does he see neurology progressing in the next fifty years?  'Hopefully we will get a better idea of consciousness', he said; 'though some feel that such a finding will always be infinitely far away.' I asked whether it would necessarily be a bad thing if consciousness always remained a mystery. 'That depends on whether consciousness is a "problem" which can be solved, or a "mystery" which could be infinity,' he replied. 'I don't think anything is hurt by being understood, though. Blake would write about science "unweaving the rainbow" and destroying romance, but I think understanding increases one's admiration.'
What, in Sacks's eyes, could be the neurological basis of consciousness? 'I don't think there's any small localised centre for consciousness in the brain,' he said, 'I think very widespread, complex processes have to occur.'

With the interview drawing to a close, I couldn't resist asking Sacks about his passion for swimming. 'Do you swim every day?' I asked. He nodded, enthusiastically: 'I am clumsy on land and very much like to be in the water. I find in a long swim I can often get into a sort of trance-like, meditative state, which is very pleasant.'

'How many lengths do you swim?' I challenged, wondering whether this 80-year old man would beat my standard 50 lengths a go. 'Oh, I don't swim lengths, only a set time every day. My swim bag seems to weigh about a hundred tons, because it's full of things like swim fins which I need because I have a ruptured tendon in one of my feet.'

But for Sacks, neurology is always on the brain: 'Sometimes when I'm swimming I start writing case histories in my head, and then I have to land at intervals and write them down.' I laughed, imagining a notepad full of fervent scribbles getting splashed by his dripping hands, and told him that I was going swimming that day. 'As am I,' he said, 'I wear a green swim cap and fins – see you there.'

Reading

Books by Oliver Sacks (latest editions):
Hallucinations (Picador, 2012)
The Island of the Colour-Blind (Picador, 2012)
The Man Who Mistook His Wife for a Hat (Picador, 2011)
Awakenings (Picador, 2011)
The Mind's Eye (Picador, 2010)
Musicophilia: Tales of Music and the Brain (Picador, 2007)

See www.oliversacks.com