Health

The Community, the Clinic, and the Road Not Taken

In holding out for an ethos of community while never evading the concerns of diagnosis, Oliver Sacks offered something extraordinary both to medicine and to the promise of a collective life

Oliver Sacks, 1935-2015 Credit: Mars Hill Church Seattle/Flickr, CC BY-NC-ND 2.0

Oliver Sacks, 1933-2015
Credit: Mars Hill Church Seattle/Flickr, CC BY-NC-ND 2.0

Oliver Sacks, the neurologist and author who died on August 30, wrote poignantly of the entangled lives and diagnoses of his patients through his development of the neurological essay. Over the past year he followed up publication of a revelatory memoir, On the Move, with essays, sad and unexpected, on his recent diagnosis of metastatic cancer and the likelihood of his imminent death.

In the last of these pieces, published just before he died, Sacks reflected on the solace of the Jewish Sabbath and on the religious road not taken.

Sacks grew up in the London suburb of Cricklewood, home to generations of migrant families, including, some decades later, the writer Zadie Smith. Recently the neighbourhood has been in the news for the challenges faced by a group of residents who produce a website supporting Egypt’s banned Muslim Brotherhood, the residents investigated by national state security and protested by a far-right organisation, Britain First.

The question of sustaining the particular ethical and political commitments of a religious life was a challenge for the young Sacks, if in distinct ways at mid-century and given the entwining of his family’s learned German-Jewish religiosity with the moral and ascetic norms of the English professional middle class. Sacks’s family and its relations – both consanguineous and affinal, as anthropologists would put it – extended back and crosswise to include many noted rabbis, scholars, and artists, several of whom were leading members of the founding Ashkenazi elite governing the nascent state of Israel. The writer and Israeli foreign minister Abba Eban was a first cousin and President Chaim Herzog a relation by marriage: the Israeli newspaper Ha’aretz called the extended family “Israel’s answer to the Kennedys.”

Sacks would, in a moment of some personal chaos in 1955, travel to Israel and spend several enjoyable months working on a kibbutz. But he wrote in his final essay on the Sabbath that “the politics of the Middle East disturbed me, and I suspected I would be out of place in a deeply religious society.”

That sense of discomfort was elsewhere evoked by Sacks, across a lifetime of essays and interviews, through his intense and intimate but yet at times estranged relation with his parents and particularly his mother. Psychoanalysis, Sacks noted in On the Move, would save his life in the early 1960s in New York when he was living with a methamphetamine addiction. The drug in some ways had enabled an extraordinary and even beautiful form of life during his advanced medical training in California but his use of it was leading him ever closer to disintegration and death. His psychoanalyst was central, he would later write, to his survival. Whether the arguable narrative conventions of the psychoanalytic treatment of the time help make sense of how he would later narrate his family history and in particular his relation to his mother is uncertain, of course. But Sacks in recounting his own life as with his clinical stories conveys a sense of scrupulous regard for gesture, word, and intensity: one is seduced, honourably, into taking his recollection as fact in the writing of obituary. In any event, one might also note that despite his own writing helping to undo regnant, and in hindsight deeply troubling, psychoanalytic conceptions of autism and other conditions, Sacks maintained a lifelong interest in what psychoanalytic thought could offer.

Coming out

This discomfort with what he understood as religious speech registered for Sacks in several ways. There is the trauma of what we might anachronistically call his moment of coming out. Sacks writes of this in On the Move, and again in his last essay on the Sabbath, so it is worth paying some attention:

I was 18. It was then that my father, inquiring into my sexual feelings, compelled me to admit that I liked boys. “I haven’t done anything,” I said, “it’s just a feeling — but don’t tell Ma, she won’t be able to take it.” He did tell her, and the next morning she came down with a look of horror on her face, and shrieked at me: “You are an abomination. I wish you had never been born.” (She was no doubt thinking of the verse in Leviticus that read, “If a man also lie with mankind, as he lieth with a woman, both of them have committed an abomination: They shall surely be put to death; their blood shall be upon them.”). The matter was never mentioned again, but her harsh words made me hate religion’s capacity for bigotry and cruelty.

Both of Sacks’s parents were talented physicians, and his mother in particular would become an important figure he would turn to in crafting a clinical idiom as a writer.

Oliver_Sacks_8.150But though some of his discussions of home life were of its burdens of accusation and subsequent silence, as often its challenge lay in passion and noise. “I would hear them from my bedroom upstairs,” Sacks recalled in a 2002 interview with the Guardian’s Oliver Burkeman, “raised voices, endless argument, passionate poundings of the table. I longed for the quiet discourse, the rationality, of science.” Burkeman’s interview was on the occasion of the publication of Sacks’s first extended memoir, Uncle Tungsten, which centred on young Oliver’s love for chemistry and the order and parsimony of the Periodic Table, and his relationship with one of his uncles – whose business made light filaments out of tungsten which for Uncle Dave was the metal of the future.

Uncle Tungsten takes its reader through Sacks’ experience being sent away to boarding school during the evacuation of the Second World War, and of the violence and sadism of its headmaster. Chemistry was a particular solace, and it provided a language both for Sacks’s retreat from the violence of relationships, including the passionate attachments of the Zionist nation, and for his yearning for an often unattainable community and connection.

Natalie Angier’s 2001 review of Uncle Tungsten in the New York Times brings out this use of chemistry:

in the course of an otherwise matter-of-fact disquisition on the chemical nature of inert gases like helium, neon and xenon, which cannot combine with other elements to form compounds, Sacks inserts the sad and simple little footnote that he “identified at times with the inert gases . . . imagining them lonely, cut off, yearning to bond.”

Angier takes as a bit of a mystery Sacks’s late adolescent turn away from the rationalising solace of chemistry back to the heated parental field of medicine.

A clue, or maybe a red herring, to the mysteries encountered in reading Oliver Sacks is his frequent invocation of a need to be in motion. On the Move is organised around the theme and opens with a lovely set of pages on his early fascination with motorcycles. He discovers an unexpected community of fellow riders in the open roads around a London whose growth had not yet curtailed the possibilities of empty roads and fast riding.

The pleasures of roaming

Oliver Sacks on a BMW motorcycle, 1961. Credit: OliverSacks.com

Oliver Sacks on a BMW motorcycle, 1961. Credit: OliverSacks.com

Motion works in interesting ways across Sacks’s writing, allowing him refuge from the harsh commitments of institutional community or the dangers of punishing ties (the psychosis of a beloved brother, most notably): on the outskirts of London, and later in California, with his fellow riders Sacks encounters something like the anthropologist’s communitas, queer in its tending to emerge for him apart from normative structures of kin, couple, or community, and full of adventure.

And before motorcycles, there was Kipling:

Here, on the lower shelves so I could easily reach them, were the adventure and history books belonging to my three older brothers. It was here that I found The Jungle Book; I identified deeply with Mowgli, and used his adventures as a taking-off point for my own fantasies.

Even more than the boyhood pleasures of his parents’ library was the local public one, which offered a particular kind of fellowship in solitude. In an essay on libraries from which the previous quotation was taken, Sacks wrote that

I was not a good pupil, but I was a good learner, and in Willesden Library—and all the libraries that came later—I roamed the shelves and stacks, had the freedom to select whatever I wanted, to follow paths which fascinated me, to become myself. At the library I felt free—free to look at the thousands, tens of thousands, of books; free to roam and to enjoy the special atmosphere and the quiet companionship of other readers, all, like myself, on quests of their own.

Roaming would characterise Sacks’s third decade of life, lived mostly in San Francisco and Los Angeles during his Residency and Fellowship in neurology. America was a dream of lives in motion, Mowgli’s adventures for grown-ups. Sacks would travel with a trucker and his disabled friend across the country, relishing road stories offered in a new uncouth and sexed-up idiom. He would take ever longer and ever more solitary motorcycle rides across the Western deserts. He kept diaries – both his friend the poet Thom Gunn and one of his close aunts with whom he shared his writings were for different reasons not enamoured of these experiments in ventriloquism. Sacks would discover different possibilities for attending closely to the lives of others in the clinic, and his writing would begin to mark the particular urgency of his mode of engagement.

Pushing body and mind

Still in California, Sacks would work on his body. He had discovered body-building in London, taking part in a Jewish sports club, the Maccabi. If Sacks was becoming, as he would later confess to Burkeman, an “atheist with unkind things to say about Zionism,” he grew up amid the variety of early- to mid-20th century projects of a “muscular Judaism,” including the Zionism he did not take to and the psychoanalysis to which he did.

In the United States, muscularity opened Sacks to a more multicultural and apparently secular world, and each day he would leave the hospital in Los Angeles that he was training in to go work out on Muscle Beach in the nearby town of Venice.

Both Muscle Beach and his clinical practice exposed Sacks to the transformative possibilities of psychoactive drugs. Before his controversial experiments on the long term near comatose victims of the 1920s epidemic of “sleeping sickness,” which would be chronicled in his popular book Awakenings and the Hollywood film that followed, Sacks engaged in pharmaceutical self-experimentation.

Drugs enabled and enhanced his relation to his motorbike and the stranger socialities of fellow aficionados of the road: when he moved to New York and began to find a way forward in clinical medicine that had eluded him in the laboratory, his by then highly addicted use of speed enabled productive flights of thinking and windows into the challenges of neurological illness.

But the drugs also limited his access to such contingent fellowship: if the pleasures of the public library were somehow akin to the philosopher Leibniz’s monads, pleasures of isolates finding each other within themselves through reading, amphetamines revealed the periodic table – Sacks’s old chemical romance – pushing at and going over the edge of human capacity. In California, the road trips had become entirely solitary exercises in limit experience; in New York, some of Sacks’s close friends who helped him through his own crises of self-medication worried he would not long survive.

Before his controversial experiments on the victims of the 1920s epidemic of “sleeping sickness,” Sacks engaged in pharmaceutical self-experimentation

Sacks would later write of one of these friends, Carol Burnett, an African-American physician whose example in responding to the everyday racism and sexism she faced in the clinic troubled the limits of community among physicians. In On the Move, he wrote of racist remarks about her in Yiddish made by two senior preceptors and her responding to the two men, in Yiddish. If Jews had fought their way into clinical positions and institutional preeminence, despite considerable anti-Semitism in American medicine across much of the twentieth century, their own communal solidarity could turn on other yet more-devalued minorities. Burnett’s responding in Yiddish, some of which as a native New Yorker she could speak, in a sense offers the language as a vehicle that breaks open boundaries – realising both an African-American and a Jewish commitment to justice otherwise foreclosed by the two surgeons.

The neurologist’s method

Oliver Sacks, seen here at a TED talk in 2009. Credit: Steve Jurveston/Flickr, CC 2.0

Oliver Sacks, seen here at a TED talk in 2009. Credit: Steve Jurveston/Flickr, CC 2.0

Sacks’s clinical life and growing fame and influence is well chronicled. His writings on his patients and others would powerfully extend his own efforts both to rethink the confines of conception, diagnosis, and treatment for conditions like autism.   The prominent author Temple Grandin, arguably the first autistic celebrity making possible both a politics and an identity for persons diagnosed with the condition, achieved her stature in part given Sacks’ writing about her in his 1995 collection, An Anthropologist on Mars.

Sacks’s own totalising method has been termed anthropological, drawing on this title. Indeed, across his work – from his early book on migraine headaches through Awakenings and the essay collections – there is a continuous broadening of the gaze of a clinical discipline that had become intensively focused on the localisation of the lesion, armed with the dominant 20th century neurological conception of the adult brain having lost its early plasticity and capacity for healing.

But the figure of life-as-anthropology was that of Grandin, in describing learning to live in a world whose norms were not organised around one’s own practices of thought or regions of comfort.

In an interview published after Sack’s death, Grandin told Wired magazine reporter Sarah Zhang of her reading her friend’s last essay on the Sabbath and her thoughts on his getting to known yet another of his prominent cousins, the Nobel-winning economist Robert John Aumann, who was an Orthodox Jew. Aumann’s example offered Sacks the possibility of a life steeped in the Orthodox religious commitment of his childhood that was nonetheless scientific in the way his uncle’s passion for tungsten had promised. Sacks asked himself, in the essay, whether there might have been another way to hold on to the embrace of community and the ethics of religious commitment while becoming a clinical scientist.

In the interview, Grandin responded:

At the end of the article he writes, “What if A and B and C had been different? What sort of person might I have been? What sort of a life might I have lived?” I just burst into tears in front of the computer reading that. I was crying so much I couldn’t even print it out. I sent him this card just before he died: “I started crying at the end of the article when you said, ‘What if A and B and C had been different?’ If that had happened our paths probably would have never crossed. You have made a big difference in my life. Your life has been worthwhile, and you helped many people doing things to enlighten and help others to understand the meaning of life.” If Oliver had decided to stay an Orthodox Jew, his whole life of writing would have never happened. He just gave people so much insight into how the brain works. He just added so much to the literature of how the mind works, especially when the mind is a so-called not normal mind. He really got inside these minds. He got inside my mind.

Grandin knows her friend in a way other readers of the Sabbath essay may not. But perhaps Sacks’s last essay is less a disavowal of the road taken than a questioning of the easy divisions we are continually invited to make between the secular and the religious, between the modern and our historic attachments. Sacks is not repudiating his lifetime refusal of the seductions of community or of religious nationalism when they devalue or do violence to others. But he is holding, at the last, to the possibility of something beyond the care of the clinic.

In his own anthropology, Sacks brought insights from the humanities and psychoanalysis back into a science that had worked to purify itself from these in an often but not entirely successful search for greater understanding and rigour. In his clinic, he formed close attachments with patients and developed a passionate commitment to undoing the frequent violence of their institutional care. At times this humanism and its mode of writing produced claims that would lead to understandable frustration by clinical scientists with Sacks’s seemingly undisciplined approach. The figure of the maverick physician is no more innocent than the Company Man against which she offers an alternate clinical ethic, and the swell of praise literature that has come with Sacks’s metastatic cancer diagnosis and subsequent death, including this essay, may merit critical attention.

And yet in holding out for an ethos of community that simultaneously refuses and honours its seductions, in never evading the solicitudes of diagnosis and category while pressing medicine toward a larger totality, Sacks offered and offers something extraordinary both to medicine and to the promise, variably realised at home or in the library, on the road and in the clinic, of a collective life.

Lawrence Cohen is a medical anthropologist and the Sarah Kailath Professor of India Studies at the University of California, Berkeley.  He is the author of No Aging in India: Modernity, Senility, and the Family (OUP 1990) and numerous articles including “Song for Pushkin,” “The Gay Guru,” and “The Other Kidney.”