tag:theconversation.com,2011:/au/topics/oliver-sacks-17340/articlesOliver Sacks – The Conversation2021-02-16T17:31:29Ztag:theconversation.com,2011:article/1507752021-02-16T17:31:29Z2021-02-16T17:31:29ZProprioception, our imperceptible 6th sense<figure><img src="https://images.theconversation.com/files/371058/original/file-20201124-13-1qgykrx.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C1920%2C1253&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Proprioception makes it possible to situate the body in space.</span> <span class="attribution"><span class="source">Pixabay</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Vision. Hearing. Smell. Taste. Touch. Proprioception. Proprioception? Few people are familiar with this sense, although its pioneer studies in the 19th century were by some of the giants of neuroscience: Claude Bernard who had a French university named after him, Sir Charles Bell, and Sir Charles Sherrington who won the Nobel Prize in Physiology/Medicine in 1932 and who coined the term proprioception.</p>
<p>So what is proprioception? It is the sense allowing us to feel and locate our body parts. Close your eyes, ask someone to move your right foot, and you will still know where it is. In fact, you can describe your body posture thanks to the integration by the nervous system of neurophysiological signals from receptors – proprioceptors – in the muscles, tendons, joints and skin that are sensitive to muscle length and force, to joint rotation, and to local bending of the skin. Proprioception is a key component of our “global positioning system”, which is essential in our daily life because we need to know where we are in order to move somewhere. Proprioception enables us to determine each body part’s position, speed and direction, whether we see it or not, and so enables the brain to guide our movements.</p>
<p>To understand the role of proprioception, researchers have studied rare patients who are deprived of it by disease of their peripheral nerves. Those individuals are unable to perform coordinated movements. The reason for the motor impairment is made clear when a patient, asked to move the legs by a neurologist, answers “Sure, Doc, as soon as I find them”. Oliver Sacks described such a subject in the chapter, “The disembodied lady”, in the best-seller <a href="https://www.oliversacks.com/books-by-oliver-sacks/man-mistook-wife-hat/"><em>The Man Who Mistook His Wife for a Hat</em></a> (1985). There, Christina is a young woman who has lost proprioception. She can hardly stand and even if she observes her hands carefully, she can barely use them. Other related cases were studied by scientists: <a href="https://www.murrieta.k12.ca.us/cms/lib5/CA01000508/Centricity/ModuleInstance/8270/touch.html">Ian Waterman’s story</a> about his “<a href="https://www.youtube.com/watch?v=236y7EZgH_A">missing body</a>” was the basis of a 1997 BBC documentary, <a href="https://www.dailymotion.com/video/x12647t"><em>The Man Who Lost His Body</em></a>. It also appeared in two of Peter Brook’s plays, <em>The Man Who</em> (1993) and <em>The Valley of Astonishment</em> (2014), as well as Jonathan Cole’s books <em>Pride and a Daily Marathon</em> (1995) and <em>Losing Touch: A Man without His Body</em> (2016).</p>
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<figcaption><span class="caption">‘Losing touch and proprioception: The four-minute story of IW’.</span></figcaption>
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<p>Ian was 19 when he lost proprioception and touch as a result of an autoimmune reaction to a viral infection. It is difficult to understand his sensory deficit, since his loss cannot be simulated like a visual or hearing loss can be, by blindfolding or plugging one’s ears. The closest we come to it is in anaesthesia, in really cold weather when we cannot feel our fingers, or when we experience a “dead limb” from awkward positioning and cutting off the blood supply to the sensors. But none of these really match Ian’s permanent loss. Our inability to conceive of its absence may be one reason proprioception remains such a poorly known sense. Another is that much of its activity occurs automatically and unconsciously. But studying participants like Ian can highlight how crucial proprioception is in everyday life.</p>
<p>When Ian was deprived of proprioception and touch, he also lost his ability to control his body. He spent 17 months in a rehabilitation centre learning to move, sit, feed himself, dress and then stand and walk, all the time looking at each moving part and having to think his way into actions. His <a href="https://www.youtube.com/watch?v=B4Qs5wQTTec">need for vision</a> and mental concentration was absolute; if he sneezed he would fall over, daydreaming was out of the question, and a head cold sent him to bed. Forty years later, Ian still has to think out each action. Though his functional recovery amazed researchers, all his everyday actions still depend on attention and vision, and neither can completely compensate for the loss.</p>
<p>For the handful of similar cases known across the globe, standing and walking has been too perilous, so they live from a wheelchair. We are fortunate that several of them have collaborated with scientists, mostly in Europe and North America, to help uncover the effects of proprioceptive and tactile loss and exploring their ingenuity in recovering movement. Ginette and Wenche-Lise have a severe sensory neuropathy similar to Ian’s: they may need an hour to peel a few potatoes as their <a href="https://www.youtube.com/watch?v=SlZ5HAJQv74&t=7s">manual dexterity</a> is <a href="https://www.youtube.com/watch?v=4lllTKtV7cY&t=10s">impaired</a>. </p>
<p><a href="https://www.vox.com/the-highlight/2019/11/22/20920762/proprioception-sixth-sense">Sana</a> was born with a severe proprioceptive and tactile deficit and, at 31, has coordination issues as well. Movement is possible but far from normal when proprioceptive signals are missing.</p>
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<img alt="" src="https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=586&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=586&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384247/original/file-20210215-15-1lf05hj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=586&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Ginette, who has lost proprioception, was asked to hold a coffee cup. With eyes open (at left), the cup was well stabilized. When she closed her eyes (at right), she did not feel her arm descending and her wrist rotating.</span>
<span class="attribution"><span class="source">Author provided</span>, <span class="license">Author provided</span></span>
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<span class="caption">Two signatures of Ginette, top and bottom. Above, with eyes open (thus with visual feedback), the signature is well done. Below, with her eyes closed, we can see the beginning of the signature: the patient did not feel that her arm was rising, that she was no longer writing on the paper.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>Research has shown that the nervous system is a fairly slow processor and a critical aspect of movement is devoted to making predictions about the state of the body in the near future. Consider that when you interact with a friend, your perception of their words and movements occurs at least ¼ second after they act. Thus, we are always “behind the times”, and we solve this delay by making predictions of future events, using current information and stored memories. When someone throws you a ball, you predict where it will fall to place your hand at the right place at the right time to catch it. </p>
<p>It turns out that a big role of proprioception is to be able to quickly determine where our body parts are, so that we can make an appropriate motor plan. When you reach for your coffee cup, you don’t need to look at where you hand is before you move, you simply look at the cup and reach, employing an unconscious process to plan your movement. In contrast, Ian and Ginette must use vision to inform their brain of the state of their hand and body parts every time they move. Among other problems, this cognitive process is exhausting. Nor does it fully allow individuals deprived of proprioception to produce as accurate movements as those we produce with proprioception.</p>
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<figcaption><span class="caption">An experimental study with three patients who have lost touch and proprioception.</span></figcaption>
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<p>These participants’ efforts in laboratories have allowed researchers to unveil the paramount role of proprioception for motor coordination and can teach us not only about proprioception, but about the limits to rehabilitation for others too. For example, some of those with stroke, Parkinson’s and various neuropathies have proprioceptive deficits which contribute to their impairments and which are not always identified.</p>
<p>Society richly rewards those with the best motor coordination, whether they are athletes or artists. To achieve excellence, performers practice many hours per day. Ginette, Ian, Sana, Wenche-Lise and others have much in common with elite performers, practising and thinking about movement all day long, but are appreciated by a far smaller group of people – neuroscientists. While the loss of proprioception causes persistent deficits in posture and movement, the ingenuity and mental effort of these extraordinary people also reveals much about our capacity to explore the limits of what is possible in the face of previously unimagined impairment.</p><img src="https://counter.theconversation.com/content/150775/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fabrice Sarlegna has received funding from the CNRS and Aix-Marseille University.</span></em></p><p class="fine-print"><em><span>Chris Miall receives funding from the NIH and the Leverhulme Foundation. He has also been funded by the Royal Society and the Wellcome Trust. He is Emeritus Professor at University of Birmingham, UK. </span></em></p><p class="fine-print"><em><span>Jonathan Cole et Robert Sainburg ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur poste universitaire.</span></em></p>Proprioception is the sense that allows us to rapidly know without looking where each part of our body is.Fabrice Sarlegna, Chercheur/researcher CNRS @ Institut des Sciences du Mouvement, Aix-Marseille Université (AMU)Chris Miall, Professor of motor neuroscience, University of BirminghamJonathan Cole, Professor, Bournemouth UniversityRobert Sainburg, Professor of kinesiology and neurology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1510232020-12-04T01:05:47Z2020-12-04T01:05:47ZFilm review: the immoderate adventures of Oliver Sacks<figure><img src="https://images.theconversation.com/files/372708/original/file-20201203-17-pno4fz.jpg?ixlib=rb-1.1.0&rect=158%2C112%2C3143%2C3163&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Madman/Ken Shung</span></span></figcaption></figure><p><em>Review: <a href="https://www.imdb.com/title/tt10887164/">Oliver Sacks: His Own Life</a>, directed by Ric Burns</em></p>
<p>Apropos of nothing but a bowl of jello placed before him, a stifled laugh escapes from Oliver Sacks, the famed neurologist, writer and public intellectual.</p>
<p>“What are you thinking about?” asks a voice offscreen.</p>
<p>Sacks demurs at first — or perhaps feigns reluctance — then relents. </p>
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<p>Until a few years ago, I would wake up at night with an erection. Nothing to do with sexual excitement … But it was at times irritatingly persistent. So, I would sometimes cool my turgid penis in orange jello.</p>
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<p>Such vignettes from Oliver Sacks: His Own Life reveal the usually shy, but often cheeky and sometimes shockingly honest character of the late Sacks.</p>
<p>Shortly after receiving a fatal diagnosis in January, 2015, Sacks invited documentarian Ric Burns and crew for a series of interviews in his New York City apartment. Sacks’ second memoir, <a href="https://www.goodreads.com/book/show/24972194-on-the-move">On the Move</a>, would be published in April. He passed away just a few months later.</p>
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Read more:
<a href="https://theconversation.com/i-want-to-stare-death-in-the-eye-why-dying-inspires-so-many-writers-and-artists-128061">'I want to stare death in the eye': why dying inspires so many writers and artists</a>
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<h2>‘Immoderate in all directions’</h2>
<p>The film is structured around Sacks reading brief passages from his memoir, accompanied by archival footage of the avuncular physician in action. Also interspersed are pithy recollections from fellow neurologists, writers, editors, patients, family and friends.</p>
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<figcaption><span class="caption">Oliver Sacks reminded us to ‘treat the person and not the disease’.</span></figcaption>
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<p>Rather than retreading <a href="https://theconversation.com/celebrating-oliver-sacks-romantic-science-and-a-life-now-ending-42242">previous thoughts</a> on Sacks’ style of “romantic science”, it’s worth considering what the documentary offers that existing memoirs, biographies and other accounts do not.</p>
<p>Firstly, for those unfamiliar with Sacks, the film provides the most efficient but palatable — jello anecdotes aside — summary of his life, work and character.</p>
<p>Moreover, it reconciles how Sacks’ seemingly wild contradictions would (eventually) become complements. A recurring theme is that Sacks was “immoderate in all directions”, living a life that whiplashed between extremes of hedonism and self-discipline.</p>
<p>Sacks possessed a curious mix of extraordinary erudition, voracious appetite and self-destructive tendencies. This was leavened by seemingly boundless empathy for the neurologically marginalised, for whom he so poetically advocated.</p>
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Read more:
<a href="https://theconversation.com/how-oliver-sacks-brought-readers-into-his-patients-inner-worlds-46918">How Oliver Sacks brought readers into his patients' inner worlds</a>
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<h2>Sex, drugs and shyness</h2>
<p>By all accounts, including those <a href="https://www.amazon.com.au/Insomniac-City-New-York-Oliver/dp/1620404931">of his partner Bill Hayes</a>, Sacks could be painfully shy, yet effusively gregarious when taken by “sudden, ebullient outbursts of boyish enthusiasm”.</p>
<p>As a young man wracked with anguish regarding his sexuality and unrequited affections, Sacks once resolved never to live with anyone again. So began 35 years of celibacy, when Sacks took on an almost monastic dedication to his work.</p>
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<a href="https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young man with motorbike in retro black and white photo" src="https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372710/original/file-20201203-15-1tkhvt4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A need for speed. A handsome young Sacks with his beloved motorbike.</span>
<span class="attribution"><span class="source">Madman</span></span>
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<p>However, Sacks first turned to drugs “as a sort of compensation”, acquiring a fierce amphetamine habit that proved inspiring and corrosive.</p>
<p>Yet Sacks also sought mastery over his body, becoming an exceptional weightlifter.</p>
<p>Oscillating between roles as “Dr Squat” the athlete, “Wolf” the speedfreak biker, and “Ollie” the kindly but unconventional neurologist, Sacks often remained ill at ease. </p>
<p>Perhaps only in his very late years, through his relationship with Hayes — including a very late discovery of <a href="https://www.smh.com.au/entertainment/books/insomniac-city-review-bill-hayes-memoir-of-life-and-love-with-oliver-sacks-20170510-gw1fzs.html">French kissing on his 76th birthday</a> — did Sacks find comfort.</p>
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Read more:
<a href="https://theconversation.com/oliver-sacks-the-brain-and-god-47030">Oliver Sacks, the brain and God</a>
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<h2>A difficult childhood</h2>
<p>Born into a “typical, Orthodox Jewish, middle-class family” during the 1930s, Sacks’ father, Sam, was an affable GP, while his mother, Elsie, was a highly regarded gynaecologist, and among the first women surgeons in England.</p>
<p>Sacks reports an “an uneasy closeness” with his mother. </p>
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<p>I think she wanted me to be like her. Sometimes, especially when I was very young … she would bring a fetus home, and suggest I dissect it. That was not so easy for a child of ten or eleven.</p>
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<p>Later, upon discovering Oliver was gay, his mother declared him an “abomination”. Though they remained close, Sacks lamented that “her words haunted me for much of my life”.</p>
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<a href="https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white photo of young boy, who would become neurologist Oliver Sacks" src="https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=806&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=806&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=806&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1013&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1013&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372696/original/file-20201203-17-1202y9b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1013&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When she found out he was gay, Sacks’ mother called him ‘an abomination’.</span>
<span class="attribution"><span class="source">Supplied</span></span>
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<p>Sacks and his brother Michael were sent to boarding school during the Battle of Britain. Soon after this harrowing experience Michael was diagnosed with schizophrenia. Sacks became both “terrified of him, terrified for him” and retreated into a fondness for chemistry.</p>
<h2>Neurologist as naturalist</h2>
<p>Only after many years could Sacks work his way back towards contemplating the minds of others.</p>
<p>Famously clumsy, Sacks initially aspired to be a lab scientist, but after numerous calamities was instructed to “Get out, see patients, you’ll do less harm”. </p>
<p>His vocational approach as a neurologist often more resembled a naturalist than a clinician. For Sacks, observation and play trumped diagnosis and prescription.</p>
<p>Indeed, in a <a href="https://www.amazon.com/How-Are-You-Dr-Sacks/dp/0374236410">biography by Lawrence Weschler</a>, Sacks notes his “main neurological tool is the ball … You can learn much from how patients play”.</p>
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<figcaption><span class="caption">‘I’m very interested in how people adapt to extremes.’ Oliver Sacks in 1996.</span></figcaption>
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Read more:
<a href="https://theconversation.com/celebrating-oliver-sacks-romantic-science-and-a-life-now-ending-42242">Celebrating Oliver Sacks' romantic science and a life now ending</a>
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<p>To compress any life — let alone one as Forrest Gumpian as Sacks’ — into a two hour film is something of a fool’s errand.</p>
<p>Hence, narrative compromises were always likely. Sacks’ travels in Canada, where he briefly tried joining the Royal Canadian Air Force, are skipped entirely.</p>
<p>Similarly, perhaps in deference to a subject granting privileged access during his last days, the documentary veers ever so slightly into hagiography, framing Sacks as a unifying figure between the clinical and experimental neurosciences.</p>
<p>Still, Sacks’ influence is undeniably staggering, and His Own Life provides a compelling account of the empathetic labours needed for otherwise lost souls to be “storied into the world”.</p>
<p><em>Oliver Sacks: His Own Life is in cinemas now.</em></p><img src="https://counter.theconversation.com/content/151023/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Wade does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Though Oliver Sacks wrote two memoirs before his death in 2015, a new film brings his joys, hardships and excesses into affectionate focus.Matthew Wade, Lecturer in Social Inquiry, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/993162018-07-06T15:04:43Z2018-07-06T15:04:43ZDiscovering dopamine’s role in the brain: Arvid Carlsson’s important legacy<figure><img src="https://images.theconversation.com/files/226464/original/file-20180706-122256-vkxk93.jpg?ixlib=rb-1.1.0&rect=0%2C78%2C1159%2C622&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Swedish pharmacologist and Nobel laureate, Arvid Carlsson.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=15189015">Vogler/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Arvid Carlsson, the Swedish neuroscientist and Nobel laureate, died on June 29, 2018 at the age of 95. He had devoted his life to understanding how the brain works and was awarded the Nobel for his research into dopamine – an important chemical found in the brain. </p>
<p>So what is dopamine, and why did finding out about it merit the Nobel Prize?</p>
<p>Dopamine is a simple chemical, made in the body from an amino acid called tyrosine. Despite its simplicity, it plays an important role as a neurotransmitter – chemicals that brain cells use to communicate with one another. </p>
<p>What Carlsson did was to reveal exactly how significant dopamine is to the function of the brain. Before his research, most people thought that dopamine was just a precursor of a brain hormone called noradrenaline. By decreasing dopamine levels in the brains of rabbits in his lab in Gothenburg, Carlsson was able to show that if you don’t have the right level of dopamine in your brain, the circuits that determine how the brain controls movement don’t work properly. </p>
<p>Although Carlsson was investigating basic neuroscience, it wasn’t long before scientists and doctors realised that there were similarities between the problems with movement that Carlsson had observed in rabbits and the symptoms of Parkinson’s disease. </p>
<p>Parkinson’s disease is a neurodegenerative disorder, a type of disease where increasing numbers of brain cells die over time, causing patients to develop problems with their movement, including uncontrollable shaking, slowed movement and sudden freezing. </p>
<p>Following on from Carlsson’s research, doctors soon realised that if they examined the brains of people with Parkinson’s there was much less dopamine than you would find in a healthy brain. This is because the cells that make and use dopamine in the brain, dopaminergic neurons, are the cells that die in Parkinson’s disease.</p>
<p>This led researchers to propose a simple solution. If the symptoms of Parkinson’s are caused by too little dopamine, why not boost these levels, with a dopamine pill or injection, to help the brain work again? </p>
<h2>Awakenings</h2>
<p>Unfortunately, this approach didn’t work, as dopamine isn’t able to cross from the bloodstream into the brain. But providing people with Parkinson’s a precursor to dopamine, a chemical called levodopa that can get into the brain and is converted into dopamine, did work and provided relief from many of the symptoms of Parkinson’s. This was immortalised in the book Awakenings, written by neurologist <a href="https://en.wikipedia.org/wiki/Oliver_Sacks">Oliver Sacks</a> and later made into a film starring Robin Williams and Robert De Niro. </p>
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<p>In Awakenings, patients with post-encephalitic Parkinsonism (a viral disease similar to Parkinson’s disease) who were treated with levodopa, had almost miraculous improvements in their symptoms.</p>
<p>Unfortunately, levodopa, and other drugs that target dopamine levels in the brain, only treat the symptoms of Parkinson’s, they don’t slow down the loss of brain cells that underlie the disease. Despite this, and some serious side effects, they remain the frontline drug in our fight against the disease. But we wouldn’t have these frontline drugs if it wasn’t for the important work that Carlsson conducted in the 1950s, and for which he shared the Nobel Prize for Physiology or Medicine in 2000.</p><img src="https://counter.theconversation.com/content/99316/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Lewis receives funding from the Medical Research Council, Parkinson’s UK, the National Institutes of Health and the Biotechnology and Biological Sciences Research Council.</span></em></p>Unravelling the story of how a simple neurotransmitter led to the development of a drug for Parkinson’s disease.Patrick Lewis, Associate Professor in Cellular and Molecular Neuroscience, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/470302015-09-10T10:11:57Z2015-09-10T10:11:57ZOliver Sacks, the brain and God<figure><img src="https://images.theconversation.com/files/93802/original/image-20150903-8842-929q56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mysteries of the mind.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-208421536/stock-photo-doodles-brain-illustration.html?src=pp-same_artist-208421530-v0ihEpi_ZnQKHNUBZ5Z9tA-2&ws=1">Brain via www.shutterstock.com.</a></span></figcaption></figure><p>Oliver Sacks, the celebrated neurologic storyteller who died at the end of August at age 82, once described himself as “<a href="http://www.npr.org/sections/health-shots/2015/08/31/436289763/oliver-sacks-a-neurologist-at-the-intersection-of-fact-and-fable">strongly atheist by disposition</a>.” </p>
<p>Sacks could write sensitively about religion, including a recent article on <a href="http://www.nytimes.com/2015/08/16/opinion/sunday/oliver-sacks-sabbath.html">the role of the Sabbath</a> in his own life, but in writing about mystical experiences, he typically repaired to his professional lexicon, referring to them as hallucinations – seemingly authentic visual and auditory experiences traceable not to any external reality, but only to the brain itself. Sacks had witnessed in many of his patients the depths of human longing, including a deep hunger for God, but to him they revealed truths only about our own psyches. </p>
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<a href="https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=576&fit=crop&dpr=1 600w, https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=576&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=576&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=723&fit=crop&dpr=1 754w, https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=723&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/93960/original/image-20150904-14609-zo4dcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=723&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Oliver Sacks.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jurvetson/4182789146/in/photolist-7nBTuf-4rDeu1-azCc35-xJwMKq-xTHJ2N-5DmDCk-qAvCYJ-JCq7T-aYGa7-5YAqCy-6hQ2Cc-eebJLK-xHGBk3-3hG1gg-iPHH1-dwcXcc-dwiv7m-38qgC4-3qLVKx-7oacWs-8E715f-xZxgAJ-9XyTuf-9XySQ1-4mFq5M-ryPvM-cR3u63-bygmPn-eebK9n-dzvZj2-wBfLmj-jNn5BB-hLB1Fy-s5PHF1-jAL9P3-kUazL-ipa6hz-8mfLTG-wLm4Y8-5MqFJW-5PYDBm-wqpLm5-vF5Mq8-wqpxsN-wEGZJW-wGj3Tm-wkkZcU-wzCTFS-r5aTsK-wK8q39">Steve Jurvetson/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>The notion that God represents but a chimera, a projection of inner human needs, goes back at least to the 19th-century philosopher <a href="http://plato.stanford.edu/entries/ludwig-feuerbach/">Ludwig Feuerbach</a>, who wrote that our longing for God reveals nothing more than a desire to make gods of ourselves. </p>
<p>More recently, some philosophers and scientists have suggested that belief in God is nothing more than a delusion that springs from our need to discern patterns and even intentions in otherwise purposeless events taking place around us. Belief in God, they say, offers a refuge from the world’s cold incomprehensibility.</p>
<p>In a 2012 article in the Atlantic, “<a href="http://www.theatlantic.com/health/archive/2012/12/seeing-god-in-the-third-millennium/266134/">Seeing God in the Third Millennium</a>,” Sacks prefaces his discussion of religious epiphanies with accounts of two epileptic patients. The first, the great Russian novelist Fyodor Dostoyevsky, describes in his own words how, in the aura of a seizure:</p>
<blockquote>
<p>I felt the heaven was going down upon the earth and that it engulfed me. I have really touched God… . I don’t know if this felicity lasts for seconds, hours, or months, but believe me, for all the joys that life may bring, I would not exchange this one. </p>
</blockquote>
<p>The second patient Sacks describes is a bus conductor who, at the onset of a seizure:</p>
<blockquote>
<p>“was suddenly overcome with a feeling of bliss. He felt that he was literally in heaven. He collected the fares correctly, telling his passengers at the same time how pleased he was to be in heaven… . He remained in this state of exaltation, hearing divining and angelic voices, for two days.” </p>
</blockquote>
<p>Three years later, however, the man experienced a series of three seizures on successive days, during which his mind cleared. “During this episode,” Sacks reports, “he lost his faith.”</p>
<p>To Sacks as to others, the fact that such experiences are associated with unusual electrical activity in the brain constitutes powerful evidence that epiphanies are grounded in neurological physiology. Experiences of God are not useless, because they can tell us a great deal about how the mind works. But they are, at least scientifically speaking, false. This and similar assertions have been advanced in the form of claims that subjects who don a “<a href="https://en.wikipedia.org/wiki/God_helmet">God helmet</a>,” a device that produces low-level stimulation of the brain’s temporal lobe, experience similarly uncanny sensations.</p>
<p>While in no way directly refuting this line of argument, it is worth noting that the tradition of mystical experience is a remarkably rich and venerable one. Mary, the mother of Jesus, is reported to have been told by an angel that the Holy Spirit was upon her, and Francis of Assisi described a mystical experience of brotherhood with earthly creatures, extending even to the sun and moon. More recently, Mother Teresa wrote of the experience of “<a href="http://w2.vatican.va/content/john-paul-ii/en/homilies/2003/documents/hf_jp-ii_hom_20031019_mother-theresa.html">sharing in the passion of Jesus</a>,” and Thomas Merton described his sudden realization one day on the streets of Louisville that “<a href="https://books.google.com/books?id=1ZJxBgAAQBAJ&pg=PA75&lpg=PA75&dq=thomas+merton+%2B+i+loved+all+those+people+louisville&source=bl&ots=Z6-bJPxHX5&sig=Ls2v0QVIdTPCr1ENiIx6WbEtbxA&hl=en&sa=X&ved=0CD4Q6AEwBWoVChMI3-iBtrTZxwIVyBU-Ch0LLQ-w#v=onepage&q=thomas%20merton%20%2B%20i%20loved%20all%20those%20people%20louisville&f=false">I loved all those people</a>.”</p>
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<figcaption>
<span class="caption">The Annunciation, Paolo de Matteis.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Paolo_de_Matteis_-_The_Annunciation.jpg">Saint Louis Art Museum via Wikimedia Commons</a></span>
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<p>When we encounter mystical experiences, we come to a fork in the road. One path, the one toward which Sacks points, is to explain them away in neurological or even psychopathological terms. </p>
<p>What the mystic experiences is an unusual pattern of neuronal discharge, a peculiar imbalance in neurotransmitters, or the expression of a deep unmet longing for purpose in life. When it comes to God and experiences of the transcendent, the higher must be understood in terms of the lower, and all real explanations must finally come to rest in our neurologic equipment.</p>
<p>The other path leads in a radically different direction. We could, to paraphrase William James, insist that the harmonic reveries of a Bach or Mozart represent nothing more than the dragging of catgut across horses’ hairs, but doing so fails to respect something strikingly real and moving in the experience of such works. Admittedly, such sublime experiences depend on the drawing of a bow or the striking of a key, but even once the acoustic and neurologic explanations have been fully rendered, there is a residuum – the experience of the transcendent – that has not been adequately accounted for.</p>
<p>Which is more likely – that everything we experience can be fully explained in terms of the apparatuses of perception, feeling, and intellection, or that there are realities around us that we do not fully grasp? The mystics in our midst might remind us that we are an infinitesimally small part of a planet that makes up an infinitesimally small part of a solar system that makes up an infinitesimally small part of a galaxy that makes up an infinitesimally small part of a universe that may itself be an infinitesimally small part of an infinite number of multiverses. </p>
<p>From a mystic’s point of view, even our own bodies might appear complex beyond our imagining. Each adult human being consists of some 70 trillion cells, each one of which contains about 10,000 times as many molecules as the Milky Way has stars, and whose atoms in total number approximately 100 trillion. Even the most fundamental biochemical reaction in the body, the splitting of glucose to yield molecules of water, carbon dioxide and energy, occurs no fewer than <a href="http://www.biology-online.org/biology-forum/about24468.html?hilit=triazine+hydrolase">septillions</a> (10 followed by 24 zeroes) of times over the course of a single day. </p>
<p>Whether the mind is diseased or healthy, it seems exceedingly likely that there is more going on in the world, and even inside our own minds, than we are aware of. It is not unreasonable to predict that some aspects of it will forever exceed our grasp. </p>
<p>In telling the stories of patients whose afflictions reveal a glimpse of this complexity, Oliver Sacks was a master at evoking a sense of wonder. How strange, then, that this exceptionally imaginative human being seems to have eschewed all nonscientific explanations of the transcendent phenomena he so brilliantly described.</p><img src="https://counter.theconversation.com/content/47030/count.gif" alt="The Conversation" width="1" height="1" />
Oliver Sacks, the celebrated neurologic storyteller who died at the end of August at age 82, once described himself as “strongly atheist by disposition.” Sacks could write sensitively about religion, including…Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/469182015-09-01T19:49:52Z2015-09-01T19:49:52ZHow Oliver Sacks brought readers into his patients’ inner worlds<figure><img src="https://images.theconversation.com/files/93567/original/image-20150901-13392-1oy94dy.jpg?ixlib=rb-1.1.0&rect=0%2C191%2C752%2C490&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Oliver Sacks died of cancer this past week.</span> <span class="attribution"><a class="source" href="https://c2.staticflickr.com/4/3078/3256398629_019f3444aa_b.jpg">Joshua Wanyama/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Oliver Sacks achieved global public renown because his writings melded two particular traits that cut across his dual role as doctor and writer: his focus on single patients rather than large populations and his profound empathy.</p>
<p>These unique characteristics underpinned the distinctive contribution that the famed neuroscientist – <a href="http://www.nytimes.com/2015/08/31/science/oliver-sacks-dies-at-82-neurologist-and-author-explored-the-brains-quirks.html?_r=0">who this week died of cancer at age 82</a> – made to the public’s understanding of medicine. </p>
<p>Like no other writer, he showed readers how a compassionate doctor can treat the most misunderstood and marginalized patients by accessing their mysterious inner worlds.</p>
<h2>People over data</h2>
<p>Scientists who study neurological conditions such as Parkinson’s will often study the condition across hundreds or thousands of patients, searching for common traits that will lead clinicians to the core of the disorder.</p>
<p>The more patients in a study, the stronger the evidence for scientists to draw general conclusions about the condition. One case is viewed as the <a href="http://www.ncbi.nlm.nih.gov/pubmed/12897592">weakest form of evidence</a>. (Old joke: what is the plural of anecdote? Data.)</p>
<p>But Sacks, in contrast, saw the nature of neuroscience written in the lives of single patients. And he rendered those lives in vivid prose.</p>
<p>Dr P, the eponymous character in his bestselling collection of essays <a href="http://www.lrb.co.uk/v05/n09/oliver-sacks/the-man-who-mistook-his-wife-for-a-hat">The Man Who Mistook His Wife for a Hat</a>, was not a generalized abstraction. He was a charming man, a singer and music teacher. </p>
<p>But, wrote Sacks, a massive tumor or degenerative process in the visual parts of the brain meant he could not recognize objects in the world. When asked by Sacks to put on his hat, he reached and grabbed his wife’s head. </p>
<p>Through a step-by-step process of observation and reflection, Sacks shows readers how Dr P used music to navigate the world: he could only perform tasks, like getting dressed, while singing quietly to himself.</p>
<p>Sacks’ focus on the detailed description of single cases also differentiated him from other scientist-writers. Stephen Hawking’s <a href="http://www.amazon.com/Brief-History-Time-Stephen-Hawking/dp/0553380168">A Brief History of Time</a> and Richard Dawkins’ <a href="http://www.amazon.com/The-Ancestors-Tale-Pilgrimage-Evolution/dp/061861916X">The Ancestor’s Tale</a> are examples of books that presented sweeping narratives, taking place over eons. </p>
<p>Sacks, instead, went for vivid description of the single life. </p>
<p>For Sacks, it was both a scientific method and a literary device. Its wider consequence was that popular science books became ways to transmit original, compelling scientific evidence and ideas to mainstream audiences.</p>
<h2>Penetrating the mind</h2>
<p>The second characteristic that underpinned his success as a doctor and writer was his uncanny empathy. </p>
<p>As Sacks wrote in <a href="http://www.amazon.com/An-Anthropologist-Mars-Seven-Paradoxical/dp/1480530360">An Anthropologist on Mars</a>: </p>
<blockquote>
<p>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.</p>
</blockquote>
<p>In order to do this, he needed to infiltrate their consciousness. He needed to see the world as they did. He needed to understand them from the inside.</p>
<p>In one chapter, Sacks introduces readers to Dr Carl Bennett, a surgeon with Tourette’s. Sacks travels to Bennett’s house and hospital in British Columbia, where he witnesses the surgeon’s incessant tics and twitches at home – but flawless composure in the operating room.</p>
<p>Sacks shows readers how the manifestations of Tourette’s vanish once Bennett assumes the role of surgeon and engages in the rhythmic routine of surgery.</p>
<p>On a personal level, I identified with this technique, and in a way, <a href="http://bigthink.com/age-of-engagement/diagnosing-a-migraine-how-popular-science-helped-a-writer-cope">Sacks diagnosed me through popular science</a>. Browsing in a bookstore as a student, I flipped through Sacks’ <a href="http://www.oliversacks.com/books-by-oliver-sacks/migraine/">Migraine</a>, first published in 1970. I read descriptions of patients with the condition. I saw in its pages drawings by migraine sufferers showing how their vision was disturbed at the onset of a crippling headache. </p>
<p>For years, I’d had the same (then unexplained) headaches, the same visual disturbances – zigzag lines in front of my face, half my vision blurred. </p>
<p>Sacks had described my experience perfectly – from the inside. </p>
<p>The New York Times once <a href="http://www.nytimes.com/1990/04/01/books/good-books-abut-being-sick.html?pagewanted=2">called Sacks</a> “a kind of poet laureate of contemporary medicine.” But that description, for me, does not fully describe Sacks’ distinctive ability to move between the roles of doctor and writer, putting the individual at the center of medicine and understanding one single patient at once objectively and subjectively.</p>
<p>The preface to An Anthropologist on Mars describes his work best. There, Sacks explains that he gave up much of his hospital work in order to visit patients where they lived their lives, offering “house calls at the far borders of human experience.”</p>
<p>His distinctive sensibility as a doctor-writer explains why one million copies of his books are still in print in the United States – and will continue to be read and used as models for future forays by other writers into the human condition.</p><img src="https://counter.theconversation.com/content/46918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Declan Fahy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sacks was able to communicate the fascinating workings of the brain in ways that evoked understanding and compassion.Declan Fahy, Lecturer in Communications, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/422422015-06-01T20:07:48Z2015-06-01T20:07:48ZCelebrating Oliver Sacks’ romantic science and a life now ending<figure><img src="https://images.theconversation.com/files/82622/original/image-20150521-976-18a7wqp.jpg?ixlib=rb-1.1.0&rect=0%2C50%2C1391%2C1049&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sacks’ works have introduced readers to the marvellous complexities of the mind.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mhcseattle/1501582837/in/photolist-jNn5BB-3hG1gg-hLB1Fy-9XySQ1-jAL9P3-ipa6hz-9XyTuf-5kxFWK-pPZZcq-bygmPn-dzvZj2-38qgC4-s5PHF1-kUazL-5MqFJW-r5aTsK-eebK9n-8mfLTG-9ufmWh-3wgYMp-eebJYB-CY3id-82idAF-bbTM1p-5JTjzH-cLcEUU-ch1WAd-7ZUVCn-9NzFKP-aBpQLq-DYJkU-4f8zMF-GcPkC-5Msghj-5MskiY-5Ms9TL-5MmUf2-5MrmmE-5MnBvH-aBpQEu-aBpQSq-aUo976-5Mm5Cp-ct7a4q-5MmtTR-5MmvVv-5MrNhj-5MnzJ6-5MndNR-iza9qj">Mars Hill Church Seattle/Flickr</a></span></figcaption></figure><p>In the preface to <a href="http://www.goodreads.com/book/show/63697.The_Man_Who_Mistook_His_Wife_for_a_Hat_and_Other_Clinical_Tales">The Man Who Mistook His Wife for a Hat</a> (1998), popular neurologist <a href="http://www.oliversacks.com">Oliver Sacks</a> outlines the rationale behind his brand of “romantic science”. Borrowed from friend and mentor AR Luria, <a href="http://luria.ucsd.edu/bio.html">the term </a> describes a literary form operating “at the intersection of fact and fable”.</p>
<p>With this approach Sacks’ works have introduced readers to the marvellous complexities of the mind, proving a great example of how “<a href="http://www.nytimes.com/2009/03/22/books/review/Dizikes-t.html?pagewanted=all%20%22%22&_r=0">the two cultures</a>” of science and literature may be reconciled. </p>
<p>It is telling that Sacks’ admirers come equally from both sides of the divide, with science heavyweights <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1962/crick-bio.html">Francis Crick</a>, <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1972/edelman-bio.html">Gerald Edelman</a>, <a href="http://www.notablebiographies.com/Gi-He/Gould-Stephen-Jay.html">Stephen Jay Gould</a> matched by literary luminaries such as <a href="http://www.poets.org/poetsorg/poet/w-h-auden">W.H. Auden</a>, <a href="http://www.theguardian.com/books/2013/feb/08/my-hero-oliver-sacks-mantel">Hilary Mantel</a>, and <a href="http://www.theguardian.com/books/2015/may/08/on-the-move-a-life-oliver-sacks-review-autobiography-neurologist">Will Self</a> in their effusive praise of Sacks’ oeuvre.</p>
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<p>Sacks revealed in February, in a <a href="http://www.nytimes.com/2015/02/19/opinion/oliver-sacks-on-learning-he-has-terminal-cancer.html">frank but poignant op-ed</a>, that he had only a short time to live. As such it’s hard not to get caught by an undercurrent of sadness when reading his recently-released memoir, <a href="http://www.goodreads.com/book/show/24972194-on-the-move">On the Move: A Life</a> (2015). </p>
<p>The book is an affecting read, revealing aspects of Sacks’ life not previously broached: a closeted life during a time of great hostility towards homosexuality; his otherwise loving mother calling him an “abomination” on account of his sexuality; a drunken quest to lose his virginity; unrequited and lost loves; an addiction to amphetamines; a brother living with schizophrenia during a time of little therapeutic relief; and, of course, for many suffering patients for whom Sacks could offer no respite.</p>
<h2>What we can learn from the life of Sacks</h2>
<p>The majority of Sacks’ adult life is marked by two distinct periods. </p>
<p>The first, as a young man, is characterised by its vigour: motorcycling across America, weightlifting, experimenting with drugs, and youthful lust and love. </p>
<p>His later life, however, is consumed by a sense of vocation. Most of Sacks’ working life comprises a 35-year period of celibacy wherein he adopted an almost monastic existence, working incessantly, eating sardines “out of the tin, standing up, in thirty seconds” and visiting the New York Botanical Garden, a favourite place he “traipsed around, alone, for more than forty years”.</p>
<p>Seeking communion with the world, and how we may labour for others in achieving this state is a theme that runs constantly through Sacks’ life and work. I realise this may seem vague, but suffice to say it’s an elusive phenomenon and the work of a lifetime.</p>
<p>Take the cover of On The Move, which features a young Sacks astride a motorcycle, almost unrecognisable from the figure we have come to know over the last few decades (often looking, in the words of Diane Sawyer, “<a href="https://www.youtube.com/watch?v=QNum0dTYalk">like a stray Santa</a>”). </p>
<p>When riding a motorcycle, Sacks describes feeling “a direct union of oneself”, a life-affirming extension of the self into the world. Sacks’ other great loves of swimming and music similarly point to this desire for communion.</p>
<p>This aspiration is found throughout his case studies, demonstrating a fervent labour to reconcile a narrative gap felt by those persons under his care, and to explain to his readers how many of those with atypical neurology achieve a different but no less rich orientation to the world.</p>
<h2>Seeking the self</h2>
<p>Sacks showed a particular fondness for such cases, for persons who devoted themselves – sometimes ascetically, sometimes ecstatically – to an endeavour in which they both lost and found themselves. </p>
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<figcaption><span class="caption">Oliver Sacks discusses Williams syndrome (2009).</span></figcaption>
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<p>Examples include <a href="http://www.newyorker.com/magazine/1993/12/27/anthropologist-mars">Temple Grandin</a> (an esteemed animal welfare academic), <a href="http://www.newyorker.com/magazine/2015/04/27/the-catastrophe-oliver-sacks">Steven Wiltshire</a> (an artist with extraordinary memory retention), and <a href="http://www.newyorker.com/magazine/1992/03/16/a-surgeons-life">Carl Bennett</a> (the pseudonym of a surgeon with Tourette’s syndrome whose tics are quelled when he is operating). </p>
<p>Or those with <a href="http://www.ted.com/talks/oliver_sacks_what_hallucination_reveals_about_our_minds?language=en">Charles Bonnet syndrome</a> (characterised by persistent hallucinations, usually following the degeneration of sight in old age), who can often live comfortably with their odd visions if they are simply reassured of their sanity. Or indeed those with Williams syndrome, who display such an openness to the pleasures of life:</p>
<p>Many more examples could be given across Sacks’ incredibly wide-ranging work. </p>
<p>We should, however, avoid sentimentalising neurological difference. Many of Sacks’ subjects suffered greatly, finding themselves languishing between worlds in a lonely, purgatorial existence. The 1973 book <a href="http://www.oliversacks.com/books-by-oliver-sacks/awakenings/">Awakenings</a> provides perhaps the most compelling examples here.</p>
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<figcaption><span class="caption">The late Robin Williams on Christopher Reeve and Oliver Sacks (2007).</span></figcaption>
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<p>Still, amid the frustrations of mysterious ailments of the mind there is some solace to be found, if only in the relief of knowing how elusive we are.</p>
<p>Though one may suspect this to be Sacks’ final book, a footnote mentions a forthcoming title, likely to consist of journals of his travels. If there is one piece of advice I would give to new readers of Sacks it would be “Don’t skip the footnotes!”, as Sacks frequently squirrels away pithy insights in these little asides. </p>
<p>Sacks adopts a style of generous, gentle instruction through a focus on narrative – infused with enthusiasm and urgency – to communicate what might seem inexpressible. These case studies are never about a condition somehow neatly cleaved from the subject and held up to view, but rather seek a “thick description” of the context and contingency of how neurological difference manifests itself.</p>
<p>The late Robin Williams – who played a fictionalised version of Sacks in the film adaptation of <a href="http://www.imdb.com/title/tt0099077/">Awakenings</a> (1990) – was a great admirer and friend. It is heartening to see the affection with which Williams speaks of Sacks, and then proceeds to reduce Charlie Rose to a giggling schoolboy.</p>
<p>The typical Sacks reading as a gathering of “the brain’s greatest hits” speaks to the community that Sacks has fostered. Much of his correspondence with those seeking advice or offering their own experiences makes its way into his books, generating a sense of collective labour towards shared goals. </p>
<p>Much will be lost when we can no longer eagerly await the next gift from this dearly loved, stray Santa.</p><img src="https://counter.theconversation.com/content/42242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Wade does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The popular neurologist revealed earlier this year that he only has months to live – a statement which casts his recently-released memoir, On the Move: A Life, in a new light.Matthew Wade, PhD Student in Sociology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.