OLIVER SACKS:

1) Preface to: An Anthropologist on Mars” (Sacks, 1995)

-           1) Our actions have their meaning only from within a certain stream of life, so to speak - change that stream and you change their meaning.

-           Sacks, with a broken right hand - finds himself living in a new stream of life, a new world, with a new identity.

-           2) Thus: a subject of Nature's Imagination... The 'creative' potential of disease...

“The handicapped child represents a qualitatively different, unique type of development... If a blind or deaf child achieves the same level of development as a normal child, then the child with a defect achieves this in another way, by another course, by other means; and, for the pedagogue, it is particularly important to know the uniqueness of the course along which he must lead the child. This uniqueness transforms the minus of the handicap into the plus of compensation” (Vygotsky, 1993).

-           A new view of the brain: not just programmed and static, but as dynamic and active, creative.

-           3) The study of identity, the 'inner worlds' that patients under the spur of disease create.

-           4) How to study this: observation alone not enough... an intersubjective... or dialogical approach needed... "trying to 'see' with the eyes of the patient himself."

-           Objectivity: treating a friend as a stranger, something that's familiar as remote and mysterious... vs. Father Brown (G.K. Chesterton) "I don't try to get outside the man. I try to get inside."

-           5) Sacks’s doctor-father: Visiting people in their own 'natural settings'... 'house calls' at the far boarders of human experience.

2) Oliver Sacks (1985) “The President’s Speech.”

1) Receptive or global aphasia:

             •           Renders people incapable of understanding words as such (although strangely, they still seem to understand a great deal of what is said to them).

             •           “Thus, to demonstrate aphasia, one has to go to extraordinary lengths, as a neurologist, to speak and behave unnaturally, to remove all the extraverbal cues – tone of voice, intonation, suggestive emphasis or inflection, as well as all visual cues (one’s expressions, one’s gestures, one’s entire, largely unconscious, personal repertoire and posture): One had to remove all of this to reduce speech to pure words, speech totally devoid of ... ‘tone-color’ or ‘evocation’” (p.124).

2) Tonal agnosia:

             •           Such people the lack of any sense of expression or “tone”, while preserving unchanged their comprehension for pure words

             •           To understand, Emily D. had to pay extreme attention to exactness of words and word use: people must speak prose – “proper words in proper places” (p.126).

•           “Such tonal agnosias (or “atonias”) are associated with the right temporal lobe of the brain, whereas the aphasias are associated with left the temporal lobe”

•           “Something has gone, has been devastated, it is true – but something has come, in its stead, has been immensely enhanced, so that – at least with emotionally laden utterance – the meaning may be fully grasped even when every word is missed” (p.124).

The President’s Speech for aphasics:

             •           “It was the grimaces, the histrionisms, the false gestures and, above all, the false tones and cadences of the voice, which rang false for these wordless but immensely sensitive patients. It was to these (for them) most glaring, even grotesque, incongruities and improprieties that my aphasic patients responded, undeceived and undeceivable by words” (p.125).

For Emily D., with tonal agnosia, she was unmoved by his speech:

             •           “He is not cogent,” she said. “He does not speak good prose. His word-use is improper. Either he is brain-damaged, or he has something to conceal” (p.126).

Make comparisons here, by the way, with what Bateson (in Tannen) had to say about “double-binds,” and Goffman (1959) had to say about expressions “given” and those “given off.”

3) OLIVER SACKS (1985) The man who mistook his wife for a hat

Straightaway, we can note that when Sacks met Dr P., he found that there “was something a bit odd” (p.8) in Dr P.’s way of visually relating to him: “there was,” he says (p.8), “a teasing strangeness, some failure in the normal interplay of gaze and expression.”

Later, Sacks came to think that “he faced me with his ears... but not with his eyes” (p.8) - a hypothesis born out by other evidence, as we shall see.

Indeed, as Sacks notes, (slide1 Qt1): “... instead of looking, gazing, at me, ‘taking me in’, in the normal way, [he] made sudden strange fixations - on my nose, on my right ear, down to my chin, up to my right eye - as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, ‘me’, as a whole” (p.8).

In continuing his assessment of Dr P., Sacks asked him to describe some of the pictures of whole scenes in a copy of the National Geographic Magazine. Dr P.’s responses were again very curious, says Sacks (slide1 Qt2):

“His eyes would dart from one thing to another, picking up tiny features, individual features, as they [his eyes] had done with my face. A striking brightness, a color, a shape would arrest his attention and elicit comment - but in no case did he get the scene-as-a-whole. He failed to see the whole, seeing only details, which he spotted like blips on a radar screen. He never entered into relation with the picture as a whole - never faced, so to speak, its physiognomy. He had no sense whatever of a landscape or scene” (p.9).

Later, on a visit to his home, Sacks presents Dr P. with some of his own family photographs: by and large, he recognized nobody, neither his family, his colleagues, or his pupils. He recognized a portrait of Einstein, by picking up the characteristic hair and moustache; his brother Paul, from his square jaw and big teeth; and one or two others from their special features. But (slide1 Qt3):

“... he approached these faces - even those near and dear - as if they were abstract puzzles or tests. He did not relate to them, he did not behold. No face was familiar to him, seen as a ‘thou’, being just identified as a set of features, an ‘it’” (p.12).

Indeed, Dr P. had no problems with such abstract features at all: presented by Sacks with a glove, and asked:

“What is this?” He described it thus: “A continuous surface... infolded in on itself. It appears to have... five outpouchings, if this is the word” (p.13).

Only later, when he happened to get it on himself by accident, did he exclaim “My God, it’s a glove!” Previous to that point, however, even when prompted by being asked if it might fit or contain a part of his own body, he was quite unable to recognize it.

On the basis of this and other evidence, Sacks concluded that: (slide2 Qt4):

“Visually, [Dr P.] was lost in a world of lifeless abstractions... [He] functioned precisely as a machine functions. It wasn’t that he displayed the same striking indifference to the visual world as a computer but - even more strikingly - he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified - in an ‘identi-kit’ kind of way - without the reality being grasped at all” (pp.13-14).

Visually, Dr P. was ‘unmoved’ by the things around him, they did not ‘call out’ any relational responses in him, responses linking him to his surroundings in some way.

Dr P.’s deficit seemed to be due to right brain damage.

His abstract and categorical, left brain functions seemed to be intact - a remarkable conclusion, given that: “one of the most entrenched axioms or assumptions of classical neurology... [is] that brain damage, any brain damage, reduces or removes ‘the abstract or categorical attitude’ (in Kurt Goldstein’s term)” (Sacks, 1985, p.5).

Indeed, in this respect we might note two aspects of Sacks’s own special stance, two reminders of importance for us, in our concern with new relational practices:

1) One is that (as he remarks at the outset of his book), although neurology is primarily the study of deficits, “a disease is never a mere loss or excess - ... there is always a reaction, on the part of the organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be...” (Sacks, 1985, p.4).

2) The other is that, in understanding the cognitive sciences ‘personally’ in this way, Sacks also wants to remind us of our embodied, socially responsive embedding in the flow of living activity with the others around us. “If we delete feeling and judging, the personal, from the cognitive sciences, we reduce them to something as defective as Dr P.... By a sort of comic and awful analogy, our current cognitive neurology and psychology resembles nothing so much as poor Dr P.! We need the concrete and the real, as he did; and we fail to see this, as he failed to see it” (p.19).

Dr. P’s ‘way of going on’: music

Dr P.’s way of ‘going on’ was revealed, not in Sacks’s ‘official’ tests, as in events occurring when the tests were over: Mrs P. had set a meal of coffee and a spread of little cakes, and then....

“Hungrily, hummingly, Dr P. started on the cakes. Swiftly, fluently, unthinkingly, melodiously, he pulled the plates towards him, and took this and that, in a great gurgling stream, an edible song of food” (p.15).

Then, a peremptory knock at the door interrupted the flow, and Dr P. seemed suddenly lost, bewildered, no longer as if at a table laden with cakes.

However, his wife poured him some coffee, and he responded to the smell (earlier, he had shown he could recognize a rose by its smell); he was related to his circumstances again; the melody of eating resumed.

As a result of this ‘accidental’ but crucial observation, Sacks makes a suggestion to Dr P....

“Well, Dr Sacks,” he said, “”You find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?”

“I can’t tell you what I find wrong, “ I replied, “but I’ll say what I find right. You are a wonderful musician, and music is your life. What I prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the center, now make it the whole, of your life” (p.17).

“I think that music, for him, had taken the place of image [visuality]. He had no body-image, he had body-music: this is why he could move and act as fluently as he did, but came to a total, confused stop if the ‘inner music’ stopped” (p.17).

Indeed, if his students sat still, he could not recognize them; while if they moved, he would cry, “That’s Karl, I know his body-music” (p.17) - just as, of course, we recognize people from their ‘voice-music’ over the telephone, or the deaf-blind Helen Keller could reputedly recognize people by their hand-shake-music’ up to two years after first meeting them.

But without access to the ‘musicality’ of people and things, their body-music, the ‘rhythms’ that ‘called out’ from him his next step, so to speak, Dr P. was lost.

Thus, about Dr P., Sacks concludes that, visually: “... he could not make a cognitive judgment, though he was prolific in cognitive hypotheses. A judgment is intuitive, personal, comprehensive, and concrete - we ‘see’ how things stand, in relation to one another and oneself. It was precisely this seeing, this relating, that Dr P. lacked..” (Sacks, 1985, p.17).

A social poetics

Now there is something very special in Sack’s way of relating himself to Dr P..

As a result of his responsive involvements with Dr P., he comes a grasp of an ‘inner world’ that is, as he himself says, so strange that, literally, it is all but unimaginable both to us and to him!

How is this possible?

How can Sacks be ‘told’ by Dr. P of a world to which he has never before had access? And how can he convey a ‘sense’ of that strange reality to us?

He writes in the first-person, out from within his own involvements with Dr.P, talking both of Dr.P’s responses and reactions to his, Sacks’s behavior, and of his own evaluative reactions to Dr.P’s behavior - the “teasing strangeness” (p.8) of Dr. P’s gaze; Dr.P “seeming baffled” (p.9) in the shoe-episode; and so on.

And Sacks gives us a ‘sense’ of what these strange involvements were ‘like’ for him by the use of various ‘as if’ constructions and comparisons: Dr.P’s looking at Sacks’s face was “as if [Dr.P was] noting (even studying) [my] individual features, but not seeing my whole face...” (p.8); while his looking at a beach-scene was “as if the absence of features in the actual picture had driven him to imagine the river and the terrace and the colored parasols” (p.10); or, “he functioned precisely as a machine functions” (pp.13-14); and so on.

These ‘as if’ metaphorical, comparison constructions, enable us to rehearse what such a circumstance might be like for us, to relate something very unfamiliar to what is familiar.

It is this emphasis on the living, embodied, gestural aspect of our social practices, and the direct and immediate, sensuous responses that they call out of us, that gives us a clue as to the non-informational, ‘poetic’ nature of the unique events that give us access to worlds utterly unfamiliar to us.

Their function is not so much to help us see, in contemplation, what the supposedly true nature of a certain thing or event actually is, as with drawing our attention, practically, to the possible relations and connections such things or events might have with other aspects of our lives... and, in the case of Dr.P, through a grasp of the limited, reactive or responsive ‘musical’ dimension in which such relations had their being.

It is a form of speaking and writing not unconnected with science fiction. Indeed, in writing of cases like Dr P., Sacks himself says that they are about “travelers to unimaginable lands - lands of which otherwise we would have no conception. This why their lives and journeys seem to me to have a quality of the fabulous... [and] I feel compelled to speak of tales and fables as well as cases... [and my friend] Luria liked to speak here of ‘romantic science’” (Sacks, 1985, p.xi).