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Tales of Oliver Sacks and the Brain

A man struck by lightning develops a sudden obsession for piano music. A woman suffers seizures upon hearing Neapolitan songs (and only Neapolitan songs). Clive Wearing is amnesic; he entirely forgets experiences mere seconds after they occur — and yet he remains a brilliant singer and conductor. Oliver Sacks

"Music, unique among the arts, is both completely abstract and profoundly emotional," Oliver Sacks writes in Musicophilia: Tales of Music and the Brain. In this latest mingling of biography and science, the author of Awakenings, The Man Who Mistook His Wife for a Hat, and Uncle Tungsten: Memories of Chemical Boyhood explores the mysterious relationships between sound and movement; music and medical treatment; and memory and imagination.

"Music is central in every culture," he reminds us. "So much of the brain is recruited in its service."

Lest music's profound power over human beings be mistaken, one only need witness its impact on the brain's physiology. Sacks notes, "Anatomists today would be hard put to identify the brain of a visual artist, a writer, or a mathematician — but they could recognize the brain of a professional musician without a moment's hesitation."

Sacks took time out from his book tour for a conversation about tandem bicycles, auditory cheesecake, soggy manuscripts, lost specimens, and more.

Dave: Is there a song stuck in your head today?

Oliver Sacks: It's half-stuck. Of all things, it's the same one that's stuck in Hal's brain in 2001. I keep thinking of "A Bicycle Built for Two."

[sings] Daisy, Daisy
Give me your answer do
I'm half-crazy
All for the love of you.

For some reason, that's been going through my mind. I'm not sure why. I think it was probably the first song I learned. My mother used to sing it, and she herself had learned it when she was a little girl in the 1890s, when I guess tandems were new.

You know, come to think of it, I did see a tandem yesterday. Maybe that provoked it.

Dave: Some positive associations. A friendly earworm, maybe.

Sacks: Yes, and it's not intrusive. It's been in and out of my mind today. Whether really to call it an earworm or just one of the in-and-out things... I do tend to hear the entire verse, whereas an earworm is often condensed or fragmented.

Dave: "Music," you write in Musicophilia, "unique among the arts, is both completely abstract and profoundly emotional."

You also state that music gives listeners "an ability to organize, to follow intricate sequences, or to hold great volumes of information in mind."

Are the two facts related? Do rhythm and melody serve as unobtrusive frameworks for ideas and information?

Sacks: That's an interesting notion. When I wrote that, I was especially thinking of the element song or the alphabet song or work songs. But in a sort of quasi-musical way, vast volumes of poetry were sung or recited. Probably most of Homer was sung. That's partly what I had in mind, as well.

Whether in an unconscious way whole parts of life are epiphanized in music, that might be something different — I'm thinking of Proust there. I do mention, but this is a very special thing, Ernst Toch, the composer; his grandson told me he could be given a string of a hundred figures and repeat it immediately. He would convert it to a melody as he heard it.

Dave: You've said in interviews that you often take notes about work while you're at a musical performance. Is that because you find the conditions more enjoyable than, say, sitting at a desk, or does music in some way assist your thought process?

Sacks: I think both. Even sitting at my desk, I will often have the radio on. I quite like background music, and it can facilitate.

I think I quoted Nietzsche. He was very fond of Georges Bizet, and he would go along to Bizet concerts with a notebook. He said, "Bizet makes me a better philosopher."

I was just speaking with a close friend of mine. The first time we met, he saw me at Carnegie Hall at a Mozart mass, scribbling in a notebook.

Dave: At the New Yorker Festival, you said, "Moving to rhythm spontaneously appears in every human child. It doesn't appear in any other animal. The human nervous system is uniquely equipped to deal with complex strings of sound and to make sense of them."

Why did that faculty develop uniquely among humans?

Sacks: There is a need to communicate, and to communicate increasingly both concrete and abstract ideas and emotions. The range of communication is relatively small before one comes to our genus.

There's been some thought that maybe language started on the hands and related to sign language, but we need our hands for many other things. It's the development of the vocal tract as well as the auditory parts of the brain that seem to be unique to us.

Whether music piggybacks on speech or visa versa, or whether they were separate evolutions, people will argue every way. And of course Steven Pinker, after people like William James, see music as trivial and incidental, "auditory cheesecake," which I don't go along with. Music is central in every culture. So much of the brain is recruited in its service, for perception or imagination. Musical instruments go back fifty thousand years.

I think of what Mendelssohn said: "In some ways, music is more precise than language." It's the other form of communication.

Perhaps poetry is somewhere between propositional language and music. I imagine that early communications were half-sung or incanted. And to go back to your earlier point, probably most of Homer was sung; and people who know the Talmud by heart know it as a sort of incantation.

Dave: It's not hard to imagine a direct relation between music and the first religious gatherings.

Sacks: One can only guess, but in every religion music plays a part. Music seems to lend itself to ritual, to liturgy, to prayer, to uniting a congregation and forming as it were an elevated form of communication, somewhat different from ordinary, prosaic speech.

Dave: And to ecstatic behavior, to states that transcend any kind of rational dialogue.

Sacks: Absolutely.

Dave: I've been working on a project about David Halberstam and his new book about the Korean War, The Coldest Winter. The book opens a year or so into the war, as the Chinese are rumored to be entering the battle. One passage in particular struck me as incredibly evocative. Halberstam was writing about the Americans:

[T]hey heard musical instruments, like weird Asian bagpipes. Some of the officers thought for a moment that a British brigade was arriving to help them out. But it was not bagpipes; instead it was an eerie, very foreign sound, perhaps bugles and flutes, a sound many of them would remember for the rest of their lives. It was the sound they would come to recognize as the Chinese about to enter battle, signaling to one another by musical instrument what they were doing, and deliberately striking fear into their enemy as well.

Sacks: That's amazing. I wish I'd known that passage. It would have been published. I will use it in the next edition.

Dave: What I found fascinating was the multiple uses to which the music was put. The Chinese were using it functionally to communicate, but you can imagine how frightening it would have been to the enemy.

Sacks: Martial music of another kind. I imagine a lot of martial music is partly to invigorate and unite one's own people, but also to strike terror into others.

Dave: You've often written about patients, as you do in Musicophilia. You tell stories about people. Was it ultimately your fascination with those kinds of stories that led to a career as a physician?

Sacks: I think that's part of it. The other half was that I came up through science, through physics and chemistry and biology and physiology; all of these remain prime interests, but then they can be embedded in the story of a human predicament or challenge. I think it's the coming together of biography with biology which so fascinates me.

I like people stories, but not as it were in a purely novelistic way. It's perhaps a bit more like a detective story: I also want to know what's going on in the body and the brain.

Dave: In The Man Who Mistook His Wife for a Hat, you write about Wiccy Ticcy Ray. "He could have scarcely survived," you say, "had he not been a weekend jazz drummer."

When you met Ray, you had to go back to studies from the late 1800s to read about Tourette's syndrome. It had become a kind of lost condition.

Sacks: It was supposed to be very rare and perhaps mythical. I think I mention, the day after seeing Ray, I thought I saw three people on the streets of New York with Tourette's. I thought I must have been seeing this, but not seeing it, all my life. I wondered if it were a thousand times commoner, and it is.

There are a lot of forgotten conditions that may have to be rediscovered again and again.

Dave: How did you wind up at Beth Abraham Hospital in 1966? Was that a conscious move on your part toward chronic care?

Sacks: Oh, no. I went to New York with one of my recurrent delusions: I wanted to be a bench scientist, a hands-on chemist or pathologist.

I had a fellowship in neurochemistry and neuropathology, but I was awfully and catastrophically clumsy. I was always breaking apparatus, I was losing specimens. I caused trouble. Finally they said, "Sacks, get out. Go see patients. You'll do less harm."

I was really sort of relegated to what was regarded as a chronic disease dump. That's where they sent their semi-functioning fellows, where supposedly one couldn't do much harm.

That dump for me was and still is an enchanted place. It's where I saw my Awakenings patients and innumerable others. It wasn't what I solicited, but in fact turned out to be almost providential.

Dave: You've written clinical tales in An Anthropologist on Mars and The Man Who Mistook His Wife and now Musicophilia. Oaxaca Journal and Uncle Tungsten reflect your own life and experiences. Island of the Colorblind is something of a cross between the two.

How do you come to these subjects? How did you come to publish the journal about Oaxaca?

Sacks: I'm an inveterate keeper of journals. I've done them all my life. Last year I was in Costa Rica and I kept a Costa Rican journal, but I felt one was enough. Most of my journals I never look at again and no one else ever looks at.

I suppose that after Oaxaca Journal and Uncle Tungsten and Island of the Colorblind, I sort of felt I ought to go back to patients and clinical tales, but I also write other things. I had another little piece about ferns in the New Yorker about six weeks ago, like a tiny miniature of Oaxaca Journal. It occupied one Saturday morning in New York.

Dave: Where does the fascination with storytelling come from? Who did you read when you were younger?

Sacks: I grew up on Dickens and Victorian storytellers, although lots of others.

I saw a DHL truck this morning, and it immediately made me think of D.H. Lawrence. I love D.H. Lawrence short stories. I often go back to them. I don't read much in the way of novels or short stories now, but I love biographies of every sort. And autobiographies and letters.

Dave: As I read Uncle Tungsten, I marveled at your mother, who had no objection to giving lessons far beyond your years. She would explain to you such things as the deformation of crystal structures — when you were five years old.

Sacks: I didn't know what she was talking about. I think she often forgot my age — she forgot it then, and I think she forgot it later with some of the anatomy stuff. But there really was a passion for explanation, which very much matched my own curiosity.

Dave: In Musicophilia, you write about the striking effects of musical training, how the brain will change physiologically after just a short period of training. What is it about music that makes the brain so immediately and formidably react?

Sacks: It's partly because so much of the brain is recruited for the perception of music, the analysis of music, pitch and rhythm and melodic contour and timbre — they all have their own networks.

Of course the brain reacts to all experience. There have been some interesting cases. For example, an investigation of people who take up juggling; various motor parts of the brain increase with juggling. But music is as motor as juggling — and so much else. You find that the cognitive, the emotional, the motor, the autonomic... every part of the brain is involved.

Also, listening to music is anticipatory. It's not passive — you're picking up what goes on, you're getting the rules of the music, so that changes the frontal lobes as well. It's extraordinary.

Go to this man Gottfried Schlaug, who has written about it. You can recognize the brain of a musician, whereas you can't recognize the brain of a mathematician or a writer or a visual artist.

Dave: I know that you swim and cycle. Is that purely for you aerobic exercise, or...

Sacks: No. For a start, I'm bored by cycle machines. I'm also somewhat bored by lap swimming; I prefer open water, though one doesn't have access to it all the time. I'm at a hotel [in California], and I had a swim at six this morning. I'm going to have one this afternoon.

I really associate California with Lake Tahoe. I was out in Tahoe in August, and I adore that. There the swims have no limit. I'm very fond of swimming on my back, which is a little dangerous in a swimming pool. I would get into almost trance-like states on long swims in Tahoe. It was partly a relaxation, but also things happen. Sometimes sentences and paragraphs and ideas start to flow through my mind.

This is actually how I first met Kate [Editor's note: Kate Edgar, associate to Oliver Sacks], many, many years ago. I was writing part of A Leg to Stand On by a lake. I would go for a swim, and half a chapter would come to me in the swim. I would write it down, dripping all over the manuscript. The publisher wondered if I'd dropped this soggy manuscript in the bath. They said they only knew one person, a former editor of theirs, now in San Francisco, who could make any sense of it. Kate did, and that's how we met.

But there's something about swimming and cycling, as with music, which facilitates flow — emotional flow, intellectual flow — and so I find them lovely states. One can do the same with walking, except now I'm getting rather arthritic in the knees, which limits walking, but it doesn't limit cycling or swimming.

Dave: You mentioned A Leg to Stand On. In Musicophilia you describe a woman with a paralyzed leg; music helped her reclaim that leg.

Sacks: This came out earlier: There's an intimate functional and anatomical connection in human beings between music, whether it's heard or imagined, and movement. You can't hear or imagine music without a motor activation. Even if you don't move externally, the motor cortex is moving.

Whether it's children moving spontaneously or the parkinsonian patients, or myself after I'd forgotten how to use the leg as I was coming down the mountain, or whether it's just people dancing, I think it's the same thing.

Dave: Have you recently dreamed of the periodic table?

Sacks: No, but I do have one in my pocket.

Dave: Why do you have one in your pocket?

Sacks: I think because it's iconic. Obviously, I know it backwards and forwards, but it gives me a special sort of comfort. I feel like I have a miniature of the universe in my pocket. It's been a love object for so long. As other people have photos of children in their wallet, so I have a periodic table.

Dave: Can I ask what else you have in your wallet?

Sacks: Actually, not much else. A driving license, a credit card, and some money. A spare key. A health insurance card. It's a rather meager wallet.

Dave: Your next book is about the eyes, is that correct?

Sacks: I think so. About a third of my book on migraine [Migraine] is about visual disturbances. I've always been interested in visual imagery and perception, illusions and hallucinations. I want to put various visual pieces together. This will include a large piece on visual hallucinations of blindness or visual impairment, which of course is so much akin to the musical hallucinations of the deaf. I will also, I think, include a bit of case history on a subject called OS.

Dave: What is OS?

Sacks: Oliver Sacks.

Dave: Ah.

Sacks: It's also Osmium.

Dave: Your own element. What is the case history of Oliver Sacks?

Sacks: I've been having a little visual problem myself in one eye. Although I'm sorry to have it, I've kept a careful journal with some kinship to A Leg To Stand On. I want description and explanation.

Dave: Is there a case study or a patient that comes to mind? For instance, in this book, Tony Cicoria, who "was inspired, even possessed" by piano music after being struck by lightning.

Sacks: There's a patient I have in mind that I've been writing about a bit, whom I was asked to see relatively recently, although there have been many such patients. She was in a nursing home, and they said, "She's an old woman. She's crazy. She's seeing things." She was indeed an old woman, but she was robustly sane.

She was blind, and she was having strange, complex hallucinations, which are often associated with blindness. She was immensely reassured when I said, "No, you're not mad. These symptoms go with blindness. They're sometimes called Charles Bonnet hallucinations."

She said, "Who was Charles Bonnet?" And I then told her about how this Swiss naturalist in the middle of the 18th century had been given a description of such hallucinations by his ninety-year-old blind grandfather. She was delighted that the hallucinations were neurological, and especially that they had a name.

And I'm forgetting the first piece. I don't know if you saw a piece of mine called "Stereo Sue." It was in the New Yorker last year.

Dave: I didn't.

Sacks: A woman I happened to meet, she was the wife of an astronaut, and at one time I was going to write about the experiences of astronauts. This woman had been born with a squint, a strabismus cross-eyed. Although she had good function in both eyes, her two eyes never synchronized, so she only saw with one eye at a time. I asked her if she could imagine what it was like to have stereoscopic vision, for which you need the two eyes together. She said, yes, she guessed so. She said she was a professor of neurobiology and she knew all about it.

I left it there. But nine years later I got a letter from her, recalling this conversation, saying, no, she couldn't imagine but now she had it. She gave me a wonderful description of the miracle of seeing in stereo after she had been stereo-blind for fifty years.

For me that was a different kind of history because it was a description of someone gaining a perceptual power and not losing it.

Dave: Did she gain stereo vision through surgery?

Sacks: No. Partly through optical means and partly through exercises. She'd had several surgeries in the past that had roughly aligned the eyes, so she was no longer grossly cross-eyed, but it hadn't yet led to any functional coordination. When that was finally achieved, she described very dramatically how she got into the car. She said the steering wheel was popping out of the dashboard. First, she thought this was some strange mirage. Then she looked with one eye and then the other, and then both, and she realized that this was it. This was what they were all talking about.

That will be the opening piece, somewhat elaborated.

Dave: Have you begun teaching at Columbia yet?

Sacks: No, not really. I've given a few lectures there, but I will dive in fully, I think, probably in December.

Dave: Do you know what specifically you'll be teaching?

Sacks: I don't exactly. Some of it will be in neurology and psychiatry, but some of it will have to do with writing and music. I will fluctuate between the two campuses. And I will also follow an almost lifelong interest of mine, which I've never written about, but I'm excited to explore it more deeply: schizophrenia.

Oliver Sacks spoke at the Arlene Schnitzer Concert Hall in Portland, Oregon, on October 18, 2007. This conversation took place the following day by telephone.

÷ ÷ ÷

Dave interviews authors for Powell's. He created our Out of the Book film series. He likes cats and dogs.

Books mentioned in this post

  1. A Leg to Stand on Used Trade Paper $8.95
  2. The Island of the Colorblind
    Used Trade Paper $8.95
  3. Oaxaca Journal (National Geographic... Used Trade Paper $7.50
  4. An Anthropologist on Mars: Seven...
    Used Trade Paper $5.95
  5. Musicophilia: Tales of Music and the...
    Used Hardcover $7.95
  6. Uncle Tungsten: Memories of a...
    Used Trade Paper $6.95
  7. The Man Who Mistook His Wife for a...
    Used Trade Paper $6.50
  8. Awakenings Used Trade Paper $9.50

Dave is the author of Out of the Book, Volume 3: State by State

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