Passage IV

NATURAL SCIENCE: This passage is adapted from the Preface to neurologist Oliver Sacks’s collection of essays An Anthropologist on Mars (©1995 by Oliver Sacks).

Nature’s imagination, as Freeman Dyson likes to say, is richer than ours, and he speaks, marvellingly, of this richness in the physical and biological worlds, the endless diversity of physical forms and forms of life. For me, as a physician, nature’s richness is to be studied in the phenomena of health and disease, in the endless forms of individual adaptation by which human organisms, people, adapt and reconstruct themselves.

Defects, disorders, diseases, in this sense, can play 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. It is the paradox of disease, in this sense, its “creative” potential, that forms the central theme of this book.

Thus while one may be horrified by the ravages of developmental disorder or disease, one may sometimes see them as creative too—for if they destroy particular paths, particular ways of doing things, they may force the nervous system into making other paths and ways, force on it an unexpected growth and evolution. This other side of development or disease is something I see, potentially, in almost every patient; and it is this which I am especially concerned to describe.

Similar considerations were brought up by A. R. Luria, who studied the long-term survival of patients who had cerebral tumors or had suffered brain injuries or strokes—and the ways, the adaptations, they used to survive. He also studied deaf and blind children as a very young man (with his mentor L. S. Vygotsky). Vygotsky stressed the intactness rather than the deficits of such children:

A handicapped child represents a qualitatively different, unique type of development. . . . If a blind child or a 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 a handicap into the plus of compensation.

That such radical adaptations could occur demanded, Luria thought, a new view of the brain, a sense of it not as programmed and static, but rather as dynamic and active, a supremely efficient adaptive system geared for evolution and change, ceaselessly adapting to the needs of the organism—its need, above all, to construct a coherent self and world, whatever defects or disorders of brain function befell it. That the brain is minutely differentiated is clear: there are hundreds of tiny areas crucial for every aspect of perception and behavior. The miracle is how they all cooperate, are integrated together, in the creation of a self.

This sense of the brain’s remarkable capacity for the most striking adaptations, not least in the special (and often desperate) circumstances of neural or sensory mishap, has come to dominate my perception of my patients and their lives. So much so, indeed, that I am sometimes moved to wonder whether it may not be necessary to redefine the very concepts of “health” and “disease,” to see these in terms of the ability of the organism to create a new organization and order, one that fits its special, altered disposition and needs, rather than in the terms of a rigidly defined “norm.”

Sickness implies a contraction of life, but such contractions do not have to occur. Nearly all of my patients, so it seems to me, whatever their problems, reach out to life—and not only despite their conditions, but often because of them, and even with their aid.

The study of disease, for the physician, demands the study of identity, the inner worlds that patients, under the spur of illness, create. But the realities of patients, the ways in which they and their brains construct their own worlds, cannot be comprehended wholly from the observation of behavior, from the outside.

With this in mind, I have taken off my white coat, deserted, by and large, the hospitals where I have spent the last twenty-five years, to explore my subjects’ lives as they live in the real world, feeling in part like a naturalist, examining rare forms of life; in part like an anthropologist, a neuroanthropologist, in the field—but most of all like a physician, called here and there to make house calls, house calls at the far borders of human experience.