APRIL 2008
VOLUME 5 NO. 4

PATIENTS & PRACTICE

The Interview

Being Oliver Sacks

Dr Oliver Sacks is the ultimate polymath. The British neurologist-author has written about everything from encephalitic lethargia to ferns. In his latest book, Musicophilia, the self-described "deplorable" pianist explores why our brains love music so much. Dr Sacks spoke to NRM from his Manhattan practice about brain shame, hitchhiking across Canada in the 60s and his strange trip with the Hell's Angels and LSD.



Photos of Oliver Sacks: Random House

Why do we have music? I think music, starting with rhythmic music, is an essential sort of instrument for social bonding. People sing and dance together, work and play together. And one doesn't see any other animal except human beings who get synchronized by beat, who dance to external or internal music. I think music, rhythm as a form of mimesis, must have appeared early in human evolution.

You write about Chopin a lot in Musicophilia. In fact, the book could have been titled Chopinophilia. I'm only a pianist. I can't play other instrument. I tried violin once — it didn't go well. For pianists, Chopin is our man, the most pianistic of composers. I sort of had an adolescent crush on the mazurkas and polonaises. I can still play a lot of them in a clumsy, well meant but deplorable fashion.

Does the fact that you're a scientist influence your taste in music? Your other faves are Bach and Mozart - two very mathematical, patterned composers. Yes, for me Bach is where it began. In [my memoir] Uncle Tungsten, I wrote when I was five my favourite things were smoked salmon and Bach — but I had just come from the deli. That was partly because the house was full of Bach. Two of my older brothers had a piano teacher passionate about Bach. I think the miracle of combining proportion, symmetry, pattern, repetition, with enormous feeling — I love it cognitively but it also makes me swoon.

Do you listen to other kinds of music? No — I'm sorry. I am ashamed of these answers. I am sounding so square. No, I am very conscious of my limitation here — music for me is European and North American music, from Monteverdi to Stravinsky. Sorry about that. Maybe if we talk in a year, maybe I will have had a conversion.

Are you a vinyl man, or do you prefer CDs or MP3s? I used to have a lot of records and a wonderful old record player which I rather reluctantly I gave up. I didn't have room for the huge speakers and things. I have CDs. I've never gone over to an iPod but perhaps I should. But I was almost killed a few months ago when someone walked in front of me with headphones. I was on my bike and I flipped over and got hurt. I have something against functional deafness.

But you're wearing earphones on the cover of Musicophilia. Do you like that photo, by the way? No. A one-syllable answer. Everyone else seems to but I hated the picture. I feel I was tricked into it. I never look like that normally. I never wear earphones. I feel like tearing the cover off. I like the calligraphy in the title though.

In the preface to your new book, you sound a little sceptical about the current mania for new diagnostic technologies taking over from old-fashioned observation. I used to think I was a member of an extinct species, but I think in neurology and psychology, the importance of the long, studied case is coming back. No one denies the use of statistics, but a long, single longitudinal study is equally important.

Are observational skills undervalued by modern medicine? I know my father, who was a GP in London, felt this years ago. He was a master of percussion and auscultation and he felt he could learn more about a chest than an x-ray could. He wondered what we would do if there was no x-ray. There's always a danger of the classical skills being forgotten. I was just in the local deli to get a few things and they had trouble adding up the bill! This old grocer we had, he could add a whole column in his head.

Malcolm Gladwell wrote in Blink that snap judgements are often as good as long-studied decisions. Have you found that to be true in your practice? I think one needs both. One of my former chiefs wrote a paper about sitting, standing and walking — how much one might judge of a patient before they even speak. It's good to have intuitions, but you can't have the wrong ones, as well. [laughs] I am for intuitions and also for algorithms, both.

When you left England for North America after med school, you landed in Montreal and then hitchhiked across Canada. What was that like? I kept a journal, called Canada Pause, in 1960. Canada Pause because travelling in Canada, especially in the Rockies, was sort of an interim for me. I had left England but was not sure what to do, not sure I wanted to stay in medicine. I wanted to write, but I had no idea what about. I love going back to Canada.

You served as a firefighter in British Columbia, right? I was dragooned into that for a while.

I understand that at one point you thought about joining the Canadian Air Force. What stopped you? I had a romantic desire to fly — still do. I contacted the Air Force and they said, "You are a trained physiologist" and offered me a position in Toronto. I hesitated and said thank you, no. I met a remarkable man there who said, "We are not sure of your motives. Think about it and contact us back." I can't imagine any other armed forces doing that.

After you left Canada, you headed for California, tried LSD and served as a consulting physician to the Hell's Angels in California in the 60s. How did that happen? I wouldn't put it as formally as that. I had a motorcycle and sometimes joined them. I was neutral and a medical opinion was handy occasionally, but I wasn't a consultant. I am not particularly judgmental. One shouldn't be. Doctors on the battlefield look after the other side as well. Criminals and psychopaths get good medical treatment.

And how about the LSD? We're getting away from Musicophilia here...

OK. In the book, you come across as incredibly insightful about yourself and the way you think. What's your favourite aspect of your brain? Did I hear you correctly? [laughs] Those wonderful times, which I can't command, when ideas seem to string up, bounce together, collide, coalesce, form larger structures. For me this is considerably verbal, as well. Things come into being and I feel I can think and write, I feel something neurologically extraordinary. Not pathological — I think it is health, the brain is doing what it should do.

And your least favourite? The thing I am sorry about — but, as it were, not annoyed about — is that my visual imagery is so poor compared to most people. I can't conjure what people look like, indeed I have trouble recognizing people. Also, I used to curse myself for being so slow-minded compared to my witty colleagues and friends, but if I am slow then I am tenacious, I hold on for a long time to ideas and brood. Excessive doubt is what I dislike in myself. It infects everything, saps my self-confidence. Another thing is shyness. Pathological shyness.

When you think about those things, do you imagine the inner workings of your own brain, the way you do when you discuss patients' cases? To some extent. I recently read some interesting studies about itch and simply mentioning this now caused me to itch a bit. I'm imagining parts of my brain lighting up now. Sudden changes in the brain do make me long for a built-in fMRI, something even more sensitive. I'm very curious about that lump in the head.

In Musicophilia, you write about some research carried out by McGill neuroscientist Daniel Levitin as well as physicians at the Montreal Neurological Institute. Did you ever visit Montreal to consult with them? Yes indeed. I regard Montreal as the musical neuroscience capital of the world. All the people there are musicians in their own right; they know it from inside as well as outside.

What will your next book be about? I was not sure until three weeks ago. My next book will be narratives and essays on visual perception, illusion and hallucination. People are terrified when these things happen. They wonder if they're going nuts, so it's immensely reassuring to people to know it's a physical reaction to visual or auditory impairment, maybe it's temporary or not, but they can live with it and it's OK. Sometimes the doctor's function is not to cure things but to say it's OK. And, on the topic of LSD, though I avoided your question before, one learns a lot about visual cortex with some mild dabbling.

Interview conducted by Sam Solomon

5 things you didn't know about Dr Oliver Sacks

His first love Chemistry. [Dr Sacks bangs two pieces of metal together] That little noise — iridium on tungsten.

His latest crush Pteridology — the study of ferns. It's a relief when I have had enough of human beings. Tomorrow morning I am going to the American Fern Society, and we're all going to tell our favourite summer fern experience. I'll talk about when I saw moonworts in Iceland. They're very beautiful.

His role model I'm too old to have any living ones. [The great Russian neuropsychologist] A R Luria was close to a mentor. When I saw The Mind of a Mnemonist in '68 it made me feel Awakenings could be written. We never met, but we corresponded in detail for years.

What he and his pal Robin Williams [who played him in Awakenings] do for fun We have long aquatic dialogues. I do backstroke, he kayaks, and we talk for hours on the water. He's a dear friend — entirely different one-on-one than the eruptive persona that people know.

His favourite place in Canada Manitoulin Island, on Lake Huron. I've been there several times.

 

 

 

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