4 Dec 2010 
The Gazette ROBERT BURTON

SAN FRANCISCO CHRONICLE A close look at visual perception As physician and
storyteller, Oliver Sacks offers up fascinating case histories - including
his own
Want to get Oliver Sacks's view on perception? Look no farther than his
latest book, The Mind's Eye. Here the physician and neurologist offers up
his usual elegant mixture of case history and street-level observations of
the struggles of those afflicted with visual disorders. 

COLUMBIA UNIVERSITY VIA MCCLATCHY-TRIBUNE Oliver Sacks writes about the
diagnosis of his own ocular melanoma.
 
We see a concert pianist with the inability to recognize objects try to
navigate the aisles of her once-familiar grocery store, a neurobiologist
describe the return of stereoscopic vision, a novelist who can write but
can't read what he has just written. As always, Sacks's Sherlock Holmes-like
attention to clinical detail gives the reader the feeling of making
leisurely rounds with a preeminent behavioural neurologist. 

However, for me, the case histories are a backdrop. The underlying and more
gripping subtext is Oliver Sacks observing Oliver Sacks. 

To put this narrative into historical context, keep in mind that the field
of modern neurology, from its inception in the mid-19th century, was built
on the individual case report. For example, a psychiatrist and
neuropathologist observes a middle-aged woman with behavioural changes, loss
of memory and intellectual deterioration. The doctor keeps detailed notes,
charts her decline and, when she dies, performs an autopsy. The physician,
Alois Alzheimer, publishes a single case report (1907), and our
understanding of brain disease is forever changed. 
Given today's sophisticated technology, it's hard to imagine a time when the
bedside was the lab and an entire field was constructed out of the most
primitive of clinical tools - a tuning fork, a safety pin, a wisp of cotton
and a reflex hammer. Yet that was the general state of neurology when Sacks
entered the field. For many of us, the relative lack of diagnostic
laboratory tools was part of neurology's attraction; there was a palpable
sense of intellectual excitement and purpose (as well as an often
unwarranted degree of self-congratulation) in knowing that another's health
depended upon the keenness of your observations and deductions. 

But times change. Science has made the study of neurology a team effort.
Rugged individualism is a historical mote in progress's eye. 

Seeing Sacks in this light helps understand the arc of this book. Sacks
introduces himself as "both a physician and storyteller" and lets us know
that he "is not an academic neurologist" and has mostly worked in old-age
homes. He allies himself with general practitioners who, "apart from their
broad medical education, have little in-depth knowledge of rare conditions,
and must research problem cases, and especially, go back to original
descriptions." In short, he wants us to see him as a storyteller, not a
scientist; if so, we should be looking for metaphors rather than mere
clinical instruction. 

Perhaps the most revealing is his description of his own lifelong face
blindness. "I have had difficulty recognizing faces for as long as I can
remember." He continues to be thrown when he sees people out of context,
even if he's seen them only a few minutes earlier. Having a similar problem,
I can attest to the frustration and awkwardness this can sometimes create. 

But Sacks goes on to wonder if this inability to recognize faces might be
why he has been accused of shyness, reclusiveness, social ineptitude,
eccentricity, even Asperger's syndrome. A particularly telling detail: He
once mistook a face in a restaurant window as being his own reflection, only
to find out it was a bearded man on the other side of the window. It's hard
not to interpret this passage as pointing toward flawed self-reflection as
the result of an inherent defect in perception, a condition that he shares
with and which allies him with his patients. 

Depending on your age and degree of denial of sickness and mortality, you
may find, as I did, that the cumulative effect of the case histories is a
lurking apprehension that, without warning or apparent reason, the
healthiest of us can be stripped of our sense of self. Yet despite the
foreshadowing, I was unprepared for the penultimate chapter. 

While at a movie, Sacks notices a spot in front of his right eye. The
symptom persists; he is diagnosed with an ocular melanoma. He can't sleep,
can't imagine his future clearly. As with his patients, he pays detailed
attention to the phenomenology affecting his eye. In short, he remains the
doctor observing the patient - though now he is both. And yes, his
ophthalmologist is a kind, gentle man of the old school, but it is through
the wonders of modern technology (radiation and laser therapy) that his eye
is spared, though his vision in the eye remains diminished - an irony not
lost on Sacks. As though picking himself up after a fall, he concludes this
chapter with an extraordinary passage: 

"I have a large 'nowhere' in my right visual field and my brain, a nowhere
of which I am not and can never be directly conscious. For me, people and
objects continue to 'disappear into thin air' or 'come out of the blue' -
these are no longer just metaphors for me, but as close as I can come to
describing the experience of nothingness and nowhere." 

The narrative arc is complete. Sacks musters up the same degree of courage
and resilience that he admires in his patients, and we leave him hoping for
the best. 

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