The Mind's Eye

  • Oliver Sacks
Alfred A. Knopf/Picador: 2010. 288 pp/ 272 pp. $25.95/£17.99 9780330508896 | ISBN: 978-0-3305-0889-6

Eight days before Christmas Day 2005, neurologist Oliver Sacks — author of Awakenings (1973), The Man Who Mistook His Wife for a Hat (1985) and other popular collections of case histories — went to the movies. Sitting in the dark theatre, he noticed an incandescent flickering to his left, which he took to be the first signs of a migraine. But as a blind spot appeared and grew, the 77-year-old physician started to panic.

Credit: ILLUSTRATIONS BY G. POTENZA

When the floor lights pointing to the exit abruptly vanished, he burst out of the cinema and phoned a colleague, who urged him to see an ophthalmologist. The diagnosis was sobering: Sacks had a melanoma in his left eye that would require prompt treatment. Thus the neurologist took his first steps on a harrowing course of transformation, mirroring those of his patients. The Mind's Eye is Sacks's frank and moving account of that journey.

Sacks has written about neurological disorders — such as autism, colour blindness and synaesthesia — as a way of talking about the higher orders of the human mind since he published Migraine in 1970. At a time when the brain's plasticity was barely acknowledged in medicine, Sacks saw its reparative power in the lives of his patients, guiding them toward wholeness and vitality after a traumatic loss of ability. Defects, disorders and diseases, Sacks wrote in An Anthropologist on Mars (1995), can have a paradoxical role, “by bringing out latent powers, developments, evolutions, forms of life, that might never be seen, or even be imaginable, in their absence”.

In The Mind's Eye, Sacks probes visual dysfunctions — including alexia (an inability to make sense of words), prosopagnosia (a failure to recognize faces) and his own ocular melanoma — to examine the complex roles of sight in human life and the constitution of personal identity.

He considers the case of Lilian Kallir, a concert pianist who became increasingly unable to make sense of her world visually. She lost the ability to read musical scores because of a rare degenerative condition called posterior cortical atrophy. Many elements of Kallir's story will be familiar to readers of Sacks's other books: her letter to the doctor seeking advice of last resort, the elusive diagnosis and the lofty cultural milieu of the patient. Also familiar are Sacks's attempts to comprehend the scope of Kallir's condition by visiting the vivacious 67-year-old musician at home.

Part of the appeal of Sacks's books is his depiction of an idealized world of thoroughly personalized medicine. Few physicians have the time or inclination to make house calls any more. Fewer still would say to a visually impaired patient, as Sacks does, “Let's go out, let's wander” — and then dress in red so that the patient can spot him in the bustling crowds of Manhattan.

This is not merely Sacks showing off. One of his role models, the late French neuropsychiatrist Jean Lhermitte, advised accompanying patients to a bistro to observe how they were coping with their illness. After Sacks visits the apartment that Kallir shares with her devoted husband, he writes about the ad hoc methods that the couple devised to make the pianist's illness less disabling. In the kitchen, for example: “Things were categorized not by meaning but by color, by size and shape, by position, by context, by association, somewhat as an illiterate person might arrange the books in a library. Everything had its place, and she had memorized this.”

Like most of Sacks's case studies, Kallir's story does not come to any satisfying therapeutic resolution. There is no breakthrough, no wonder drug and no hope of lasting recovery. But the ability of the pianist and her husband to maintain a shared sense of continuity in increasingly disordered circumstances is testimony to the resilience that is Sacks's overarching theme. Rather than being about disease, his tales are more about his patients' astonishing capacities to adapt — and even thrive — in radically transformed worlds. His books resonate because they reveal as much about the force of character as they do about neurology.

The Mind's Eye also relates how an Australian psychologist named Zoltan Torey, rendered blind at 21 by a splash of acid, cultivates his photographic memory to the point that he shocks his neighbours by replacing the gutters of his house alone at night. In another chapter, Canadian novelist Howard Engel discovers that his morning Globe and Mail has been rendered into Cyrillic or Korean; it is his brain, of course, that has been translated by a stroke. After years of exhausting effort to engage language in new ways — composing by dictation, learning to scan words by linking adjacent letters — the novelist teaches himself to write books again.

For Sacks, disorders of vision, including his own, open a window on the brain's surprisingly active role in the authoring of experience. While under treatment for the ocular melanoma, the neurologist undertook a series of fascinating self-experiments. In one exercise, for example, he tested the limits of his brain's ability to fill in temporary gaps in his visual field caused by radiation treatment. Sacks found that repetitive patterns such as brickwork, and even clouds and trees, readily appeared to preserve the illusion of a seamless panorama around him. Faces, however, were beyond the conjuring ability of his visual cortex. “I've learned that the brain is always busy,” he told me in an interview last summer.

Thankfully, Sacks's tumour has not returned, but he is still learning to cope with the aftermath, including a possibly permanent loss of three-dimensional vision — a poignant turn of events for a proud member of the New York Stereoscopic Society.

To maintain his own sense of continuity in the face of these challenges, Sacks will have to draw inspiration from the patients he has written about for 40 years. “The problems never went away,” he quotes Engel as saying, “but I became cleverer at solving them”.