Hallucinations - Oliver Sacks

Anne Fadiman wrote in Ex Libris that every bibliophile has a shelf (or shelves) of books that is somewhat off-kilter from the rest of their taste.  Mine might be my theology shelf, or my theatrical history shelf, but I think the books (few as they are) most likely to surprise the casual observer would be those on neurology.

When I told my Dad I'd bought and read Hallucinations by Oliver Sacks (after he'd spotted a review and told me about it), he asked "But will you be writing about it on your blog?"  "Of course," thought I - it hadn't crossed my mind that I wouldn't.  But I pondered on it, and thought - would blog-readers used to my love for 1930s novels about spinsters drinking tea also want to read about phantom limbs and Delirium Tremens?

Believe me, you will.  I have almost zero interest in science in all its many and varied forms.  I stopped studying it when I was 16 (except for maths) and found it all very dull before that point.  (Apologies, science-lovers.)  Biology was far and away my least favourite subject.  And yet Hallucinations is absolutely brilliant, as fascinating and readable as his popular work The Man Who Mistook His Wife For A Hat.  A predilection for scientific books is definitely not a prerequisite.  Sacks is just as much a storyteller as a scientist.

Before starting Hallucinations, I thought they were mostly terrifying, felt real, and came chiefly with a fever or drug abuse.  While hallucinations can be all these things, I was surprised to learn how often they are benign (even amusing or comforting) and easily recognised as fake.  Strangest still, I hadn't realised that (under Sacks' definitions) I had experienced hallucinations myself.

That's not quite true - I knew I'd had them when I had an extremely high temperature during flu, but I hadn't known that what I'd had repeatedly as a child were hypnagogic hallucinations - those that people get just before going to sleep.  Aged about 5, I often used to see chains of bright lights and shapes (and, Mum remembered but I did not, faces) in front of me - whether my eyes were open or closed - at bedtime.  It turns out hypnagogic hallucinations are very common, and (Sacks writes) rarely unnerving for the hallucinator.  Well, Dr. Sacks, aged five I found them incredibly frightening, and usually ran to mother!

There are so many types of hallucinations that Sacks has witnessed in decades of being a neurologist, encountering hundreds of people and hearing about thousands from his colleagues.  This book just includes the ones who gave him permission.  It would necessitate typing out the whole book to tell you all the illustrations he gives, but they range from fascinating accounts of Charles Bonnet Syndrome (basically seeing hallucinations, often highly detailed, for long or short periods) to hallucinated smells, sounds, and even a chapter on hallucinating doppelgangers.

Almost all of these hallucinations act alongside lives which are lived otherwise normally, and do not suggest any terrible neurological condition.  It is somewhat chilling that Sacks recounts a study which revealed that 12 volunteers, with otherwise 'normal' mental health histories, were asked to tell doctors they were hearing voices - and 11 were diagnosed with schizophrenia.  Sacks is keen to point out how many patients with hallucinations, even when voices, are not suffering from schizophrenia or any other sort of mental illness.  He is deeply interested in how people manage their lives when seeing hallucinations at any hour of the day, and offers up humble praise to those who take it in their stride.

This is what makes Sacks so special.  A few of the blurb reviews describe him as 'humane', which I suppose he is - but the word feels a little dispassionate.  Sacks, on the other hand, is fundamentally compassionate.  He never treats or describes people as case studies.  The accounts he gives are not scientific outlines, interested only in neurological details, but mini-biographies filled with human detail, humour, and respect.  Here's an example of all three factors combining:

Gertie C. had a half-controlled hallucinosis for decades before she started on L-dopa - bucolic hallucinations of lying in a sunlit meadow or floating in a creek near her childhood home.  This changed when she was given L-dopa and her hallucinations assumed a social and sometimes sexual character.  When she told me about this, she added, anxiously, "You surely wouldn't forbid a friendly hallucination to a frustrated old lady like me!"  I replied that if her hallucinations had a pleasant and controllable character, they seemed rather a good idea under the circumstances.  After this, the paranoid quality dropped away, and her hallucinatory encounters became purely amicable and amorous.  She developed a humour and tact and control, never allowing herself a hallucination before eight in the evening and keeping its duration to thirty or forty minutes at most.  If her relatives stayed too late, she would explain firmly but pleasantly that she was expecting "a gentleman visitor from out of town" in a few minutes' time, and she felt he might take it amiss if he was kept waiting outside.  She now receives love, attention, and invisible presents from a hallucinatory gentleman who visits faithfully each evening.

And with this respect and kindness definitely comes a sense of humour - the sort of humour exemplified by many of the people he met.  This detail, in a footnote, was wonderful:

Robert Teunisse told me how one of his patients, seeing a man hovering outside his nineteenth-floor apartment, assumed this was another one of his hallucinations.  When the man waved at him, he did not wave back.  The "hallucination" turned out to be his window washer, considerably miffed at not having his friendly wave returned.

Although Sacks does not compromise his scientific standing, Hallucinations is definitely (as demonstrated by me) a book which is accessible to the layman.  In the whole book, there was only one sentence which completely baffled me...

When his patient died, a year later, an autopsy revealed a large midbrain infarction involving (among other structures) the cerebral peduncles (hence his coinage of the term "penduncular hallucinations").

I'll take your word for it, Oliver.

But, that excerpt aside, Hallucinations was more of a page-turner than most detective novels, paid closer attention to the human details of everyday life than much domestic fiction, and certainly left me with more to think about than many books I read.  I hope I've done enough to convince you that, even if you think you won't be interested, you probably would be.

I have wondered whether my interest in neurology might, in fact, just be an appreciation of Oliver Sacks.  I've started other books in the field and not finished them, though I will go back to one on synaesthesia that I recently began.  Perhaps no other author combines Sacks' talents as scientist and storyteller... but I'm happy to be proven wrong, if anyone has any suggestions?

For now, though, I'm going to have to hunt out my copy of Sacks' Awakenings...

The Island of the Colourblind - Oliver Sacks

Every now and then I pick up something which couldn't be further away from my dual comfort zones of 1920s-housewife and quirky-domestic, and end up being captivated.  So... now for something completely different!

I already knew that I loved Sacks' book The Man Who Mistook His Wife For a Hat, and I have one or two of his books in various places - including The Island of the Colourblind (1997) (sorry, I can't bring myself to give the American title, blame my English student sensibilities).  I can't remember what it was that catapulted the book from shelf to hand - perhaps one too many novels with teacups and maids? - but it did indeed find its way there, and I whipped through it in a day or two.

The title and blurb both offer slightly false information - suggesting that there is an entire community of colourblind people on the 'tiny Pacific atoll' Pingelap.  It turns out that the incident of achromatopsia (symptoms are complete colourblindness - i.e. everything in greyscale - and a high sensitivity to light) is in fact one in 12 of the population.  It's still wildly more than the rest of the world - where achromatopsia is found in one in 30,000.  Even though it is not the isolated, uniform community which Sacks initially hoped to find, he does highlight the emotional benefits of this high incidence:

There was an immediate understanding and sharing between them, a commonality of language and perception, which extended to Knut as well. [...] When a Pingelapese baby starts to squint and turn away from the light, there is at least a cultural knowledge of his perceptual world, his special needs and strengths, even a mythology to explain it.  In this sense, then, Pingelap is an island of the colourblind.  No one born here with the maskun finds himself wholly isolated or misunderstood, which is the almost universal lot of people with congenital achromatopsia elsewhere in the world.

Amongst that number is the mentioned Knut - a Scandinavian scientist who both has and investigates the condition.  When Sacks offers Knut the chance to accompany him, Knut leaps at the chance - and his experience with the condition proves invaluable as a point of connection between the outsider Westerners and the inevitably intimate island society.  (Sacks is occasionally rather scathing about other Westerners who have visited, especially missionaries, but I suppose I couldn't expect him to share my views on them - and, unlike his view of other visitors, he never considers his own work and provisions as a colonial activity.)  Knut also provides a sophisticated, intelligent and thorough angle of living with achromatopsia amongst millions who don't.

Not thinking, I enthused about the wonderful blues of the sea - then stopped, embarrassed.  Knut, though he has no direct experience of colour, is very erudite on the subject.  He is intrigued by the range of words and images other people use about colour and was arrested by my use of the word "azure."  ("Is it similar to cerulean?")  He wondered whether "indigo" was, for me, a separate, seventh colour of the spectrum, neither blue nor violet, but itself, in between.  "Many people," he added, "do not see indigo as a separate spectral colour, and others see light blue as distinct from blue."  With no direct knowledge of colour, Knut has accumulated an immense mental catalogue, an archive, of vicarious colour knowledge about the world.

It reminded me somehow of Helen Keller's accounts of living as a blind, dumb, death woman in a world which is largely none of these things - and the sensitivity with which she perceives how others might perceive her world.

There is no cure for achromatopsia, but it is a condition which becomes much more manageable with the simple expedient of dark glasses and strong magnifying glasses.  The next island Sacks visits, Guam, has a more debilitating illness shared by much of the population: Lytico-Bodig disease.  (I'm just realising how unlike my normal posts this is!)  It's a neurological disease which manifests itself in symptoms like Alzheimer's and Parkinson's.  Despite decades of research, nobody has worked out what caused this - but nobody born in the past few decades has shown any symptoms.  Sacks gets a bit too involved in the history of research into the disease for my understanding, but more personal accounts of people living with the condition cannot but be moving.

Sacks is certainly a learned neurologist, but his books are not textbooks in their style.  He has the gift of interweaving the scientist and the storyteller.  His narrative is moving and personal, rather than the impersonal facts and figures one might anticipate from a scientific study.  Perhaps it is most poignant when Sacks realises the limitations of his work:

To calm her, the family started to sing an old folk song, and the old lady, so demented, so fragmented, most of the time, joined in, singing fluently along with the others.  She seemed to get all the words, all the feeling, of the song, and to be composed, restored to herself, as long as she sang.  John and I slipped out quietly while they were singing, suddenly feeling, at this point, that neurology was irrelevant.

I wouldn't ever browse the science sections of bookshops, and I don't remember how I first stumbled across The Man Who Mistook His Wife For a Hat, but I'm very glad I did.  The Island of the Colourblind (a play on Wells' The Island of the Blind, which I should mention before this post ends) isn't as captivating as that book, but it is a rather different kettle of fish.  Instead of many psychological disorders and fascinating patients, Sacks explores two communities - more slowly, more deeply, and even more sympathetically.  There was a danger in The Man Who Mistook His Wife For a Hat that it could feel a bit like giving a penny to see a freakshow (although I'm sure that's not what Sacks intended.)  The Island of the Colourblind invites the reader onto two islands, to become, however briefly, a concerned member of two very different communities - not watching from the outside, but sympathising from the inside.  The fascinating statistical aberrations are still there, as are some as-yet unexplained mysteries, but this is primarily a very human study - and a narrative which treads the path between science and storytelling, almost always with impressive success.