To think today of the late Oliver Sacks, physician and author, is to bring to mind the extraordinary fellow human beings whose defects and gifts, depicted in Sacks’s books and essays, made the world a bit larger and much more interesting: the twin autistic boys who could instantly recall hundred-digit figures; the man who could not identify the person at whom he was staring in the mirror; the sailor for whom the distant past was detailed and vividly clear but for whom the immediate past had no existence; the woman without an awareness that she had been enclosed for sixty years in a body, her own; and, of course, the scores of victims of the 1920s encephalitis epidemic who had been treated with the new L-DOPA drug, and had recovered for a brief period the awareness of living. All these human exceptions peopled the world of medicine that Sacks created for his readers.

When describing these exceptions, Sacks appears forever sympathetic in manner, not “kindly” as a physician but reassuring, at first surprised but never shocked, in command but not intrusive. He wants his patients, as well as his readers, to know that they are in the hands of an experienced professional who would understand, calmly, what was utterly and uniquely stunning about them.

That physician is one thing. The writer of these letters is another. He is a being of doubt, fear, regret, ambition, resignation, shyness, and grandiosity. Not only is the collection of letters itself massive (brilliantly selected by Kate Edgar, his long-term aide), so also is the scale of the author’s psychological complexity. The length of many of the letters, some of which go on for thousands of words, captures a man besieged by painful ambivalence (“I should never have become a doctor”) and self-disgust (thirty years old, he sees himself as “huge and oedematous…fat, balding, elderly”), and yet boyishly proud to have won first-place honors for lifting, in competition, 575 pounds from a squat position.

Having received psychiatric help for depression during most of his adult life, Sacks wrote hundreds of affectionate letters to his parents while referring to them elsewhere as “darling, damnable” and adding, “I can’t stand my parents—my mother brooding, paranoiac and depressed…my father, clownish, scholarly, doing his best to avoid the house.”

Everywhere in these letters one comes upon a tension between Sacks’s self-searching doubt and his raging ambition, a tension so severe that the reader wonders how, out of such great negativity, a career so crowned with success could have arisen:

I am, by turn, credulous and distrustful; I fear proximity and intimacy, seeing it as a dangerous invasion, a potential annihilation of my own identity; and then again, in the tally of contradictory feelings, I expect constantly to be abandoned or deprived of what I have…

And what he had, most plentifully, is “a great compensation: I can think, I can sublimate, I can channel my thwarted ardours into work. And it is in terms of work that most of my hopes lie.”

And work he did: books, scores of essays and articles, many interviews after he had become famous, and many lectures to audiences both clinical and public. As his reputation grew, so did what he identified as his “obstructive-explosive” drive, his desire to experience greater and greater sensations of power, no matter the source, even if illicit, even were they to come by way of “nicotine, amphetamine, mescaline, cocaine.” His close friend, the Anglo-American poet Thom Gunn, said that Sacks’s use of such drugs was “outrageously extreme, far more than anyone else I knew.” And yet, amid such emotional turbulence, the rich vein of Sacks’s productivity never ceased to flow—an average of five thousand letters a year, including “sudden 10,000 word infusions,” and ever more books and essays. Creation exploded from tumult. 

Early in his career, he acknowledged three truths: the first is that he “always take[s] things to excess”; the second is that he was not meant to be a neurologist in a conventional way. Never feeling happy in any departmental “home,” Sacks learned how to “inure [himself] to the predictable pig-headedness and bewilderment of [his] colleagues” and to satisfy himself with the conviction that he had “transcended their powers of understanding or acceptance.” The third revelation was that he would find his true company not with colleagues but with patients. Thus the source of the original, and happily lonely, path that he was to follow for most of his life. In another of those lengthy and forthcoming letters to his parents, he spelled out a kind of testament:

I am a good (and, very rarely, at magic moments, a great) teacher; not because I communicate facts, but because I somehow convey a sort of passion for the patient and the subject, the way their symptoms dovetail into their total being, and how this, in turn, dovetails into their total environment: in short, a sort of wonder and delight at the way everything fits.

He probed the ways patients’ diseases became their identities—they became “The Lost Mariner,” “Witty Ticcy Ray,” or “The Autist Artist.” Since each such celebrated patient and all the others were truths in and of themselves, the full array of patients he treated and the afflictions they suffered, while enormous, was consonant with the full range of conflicts and turbulence that Sacks had come to recognize in himself. Everything did indeed fit. He would let his own excesses and turmoil respond sympathetically to the disturbances of his patients; what might appear as remote or foreign to other neurologists would find companionship in the unsettled irregularities of his own identity.

This process, which he called a “romantic neurology,” sought to locate the real person, the subjective “I,” as distinct from the “it” (the clinical condition). Working with this separation in mind—which meant working as few other neurologists work—he could report that “I find every patient I see, everywhere, vividly alive, interesting and rewarding; I have never seen a patient who didn’t teach me something new, or stir in me new feelings and new trains-of-thought.” But those feelings and thoughts could not have been “new.” Rather, they must have been latent within Sacks himself, ready for reaction, and thus enormously gratifying to him as a man and not only as a physician.

Oddly enough, these letters rarely mention therapeutic success or reduction of symptoms. Those may or may not have occurred, but the letters center on the doctor’s satisfaction, not the patients’. In their rich variety, liveliness, and intelligent curiosity, such letters prompt a question that can arise in any discussion of Oliver Sacks: What explains his good fortune in having so many patients with such fascinating, odd, and memorable afflictions? The man who mistook his wife for his hat is only one of myriad patients whose range of excessiveness or deprivation is apparently nowhere to be found in the practice of other neurologists. 

Readers are left to speculate about such good fortune. They can, and should, respect Sacks’s fully sympathetic approach to his patients, an approach that brought like to like, injured mortal to injured mortal, a process akin to pheromones connecting. The bonds Sacks forged with his patients often gave them hope and encouragement. The letters let us know that while Sacks could not always promise healing, he did offer understanding and fellow-feeling of the most inward and authentic sort. That was perhaps the greatest gift of this greatly gifted and remarkable man. 

Oliver Sacks
Edited by Kate Edgar
Knopf
$40 | 752 pp.