January 1, 2026 : Wondercab Mini (103A)

WELCOME

In the wake of Rachel Aviv’s recent piece in the NYer, revisiting the question of Oliver Sacks’s narrative reliability.

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Revisiting the Question of Oliver Sacks’s Narrative Reliability

In the comments section of our last issue, T. McD cited a batch of somewhat startling revelations in Rachel Aviv’s recent New Yorker piece on Oliver Sacks touching on the ongoing question of the latter’s narrative reliability, and gazing a bit further back at this Cabinet’s entry featuring my dialog with Salman Rushdie regarding similar sorts of concerns with regard to Ryszard Kapuściński, McD wondered about my own reaction to Aviv’s piece, especially in light of the intimate 35-year-long friendship I’d shared with the good (if at times confoundingly complicated) doctor, chronicled in my 2019 book And How Are You, Dr. Sacks?

And indeed, fair enough as questions go. I suppose I should begin by stating that I consider Ms. Aviv to be one of the finest writers currently working at the New Yorker, a real throwback to the Old School tradition of the likes of Janet Malcolm (see also, for example, her extraordinarily vivid, nuanced and devastating 2024 piece on Alice Munro), and I consider the current Sacks piece well in line with that estimation. As it happens, she and I had several hours-long conversations about Oliver in the lead-up to her piece, she cites my work in several places, and her conclusions dovetail with several of the themes I too was exploring in my book, though she was able to probe things considerably further than I was able to on the basis of new material made available to her in the archives of the Oliver Sacks Foundation.

Before going any further though, it might make sense to revisit the entirety of a late chapter from my book in which I too had been grappling with some of those issues. Note that my chronicle before that had focused in particular on the seven or so years at the outset of our relationship, in the late seventies and early eighties, when, newly arrived at the New Yorker myself, I had been following Oliver on his medical rounds and some of his far-flung travels and interviewing a whole slew of his friends and colleagues in the lead-up to what I hoped would be one of those old-style multi-part profiles in the magazine. These were years across which he was still pretty much of a recluse and largely unknown despite the fact that he had already published his seminal magnum opus Awakenings a few years earlier. Indeed, still devastated by the at-best mixed response to that book, roundly dismissed and attacked by a conventional medical establishment that condemned a narrative and anecdotal case-study approach utterly at odds with their then-more-orthodox quantitative, mass-latitudinal data-driven peer-reviewed expectations (and even outright refusing to credit some of his descriptions of what had been going on with his patients), Oliver at the time was in the midst of an eight-year blockage on his next book, about a neurological crisis of his own, precisely around this question of whether he would be believed. It was only toward the end of that period when he finally managed to break through the blockage with the imminent publication of that next book A Leg to Stand On, that I set to work on my own profile, but by that point he asked that I forgo publication (a request with which I of course complied), for reasons that would be discussed in detail in my eventual book (thirty years later), after Oliver, on the verge of his own death, himself insisted that I take up the tale once again after all.

At any rate, before turning to further comments on Aviv’s treatment of the theme, here is the penultimate chapter of my own 2019 book:

Chapter 19 of And How Are You, Dr. Sacks?
A DIGRESSION ON THE QUESTION OF RELIABILITY AND THE NATURE OF ROMANTIC SCIENCE

But—­and ­here I want to shift keys, maybe even modulate from the major down to a minor register for a while before returning to the main chronological pro­cession (which now, alas, is beginning to rush ­toward its conclusion)—­the ­thing is that Oliver’s blithe confession of his own prosopagnosia shaded into a wider concern on the part of many regarding the extent to which this albeit thoroughly engaging chronicler (who couldn’t even keep ­faces straight, for God’s sake) could be relied upon more generally: The ongoing suspicion, that is, that he was sometimes making ­things up, exaggerating, fantasticating, seeing more than was ­there, or even things that­ weren’t ­there (1).

FN (1):
See as well, for example, this passage from Alan Bennett’s diaries, Keeping On Keeping On, pp. 235–36:

“Chatwin—­like Sebald, Kapuściński and Oliver Sacks—­operates on the borders of truth and imagination, dodging over the border into fantasy as and when it suits and making them difficult to pin down. Defenders of Chatwin like Francis Wyndham dismiss criticism of this as ‘En­glish, literalist or puritanical’—in my case all three. One tells the truth or one makes it up, not both at the same time. One tells the truth. It ­isn’t just a whim. Or so I tell myself. Such characters trouble me.”

All the variations on Michael Neve’s critique (2).

FN (2):
Curiously, such a cata­log of aspersions might have been thought to include an instance to which Oliver himself continually used to allude, one he never seemed able to shake: the slashing ­wholesale rejection of his 1970 letter to The Journal of the American Medical Association, the one in which he’d tried to alert his colleagues to the wild side effects he and his colleagues ­were beginning to encounter with the L-­DOPA ­they’d been administering to their patients. The fact is (and this sort of confirms the wider point), if you go back and actually look at the letters that JAMA published in response to Sacks et al.’s, they ­weren’t nearly as dismissive and cutting and thoroughly rejectionist as Sacks himself kept remembering; rather, they ­were relatively mea­sured, pointing out that the patients Sacks and his colleagues­ were dealing with ­were much more extremely impacted by their Parkinsonism than the average sorts of patients most doctors would be encountering, such that the Sacks side effects might not be expected to show up everywhere ­else. (The fact that ­later on such side effects did begin showing up everywhere ­else, albeit to a lesser degree, is beside the point ­here; what’s germane is how wildly Oliver himself continually exaggerated the purdah-­shaming tone of the letters in question in his own recollection of them, as if he had been utterly cast out of the profession.)

As for the original misgiving ­here, the question of ­whether Oliver’s admitted prosopagnosia might be seen to undercut his reliability on other scores, it seems to me that the very opposite was the case. For one ­thing, he lavished a far more focused level of attention on his patients than on­ others in his social world. (He once recalled for me how the remarkable photographic memory that had helped him sail through college and medical school completely disappeared soon thereafter. At first he fretted that he might be entering an early-­onset Alzheimer’s. But in fact, he came to understand that his wide-­ranging memory was just becoming more selective, and focusing in par­ticular on his patients.) Beyond that, it may well have been in compensation for the prosopagnosia that he started taking such thorough case notes on ­every single patient interview he undertook, taking the notes in the first place and then retaining them long ­after he was legally required to. (I myself can relate to the latter: I have a terrible innate memory for specific incidents and conversations, even just a few hours ­after the fact, which is one of the reasons I am such a ferocious note-taker; as a reporter, I’m not unlike the severe asthmatic who overcompensates himself into becoming a professional soccer player. And something similar may have been going on with Oliver as well.)

As for the wider misgiving, however—­the nagging suspicion that Oliver at least occasionally exaggerated or confabulated or the like, or that the ­things he was seeing ­ were at best anecdotal and of no wider medical use—­misgivings that Oliver confessed to sometimes having himself (as he said of his Leg book, every charge that was being waged against him, he had at one point or another hurled against himself, only more severely), the question, that is, of his general trustworthiness, relevance, and reliability, ­there it seems to me that a wider-­ranging consideration may be in order.

­After all, as sympathetic a friend and colleague as Jonathan Miller had at one point in our conversation conceded how “you begin to wonder. When you visit the cases he talks about, none of them ­really exhibit any of the features that he claims they have. A lot of medical ­people I think are very, very suspicious of what he says about the cases he talks about in Awakenings. And I know friends of mine who’ve actually seen them say they are not quite what he says.” And indeed, ­these sorts of reservations ­were often expressed to me, especially in the early days when I was just getting started on my profile, by doctors and medical writers with whom I would broach the subject.

However, such misgivings ­were directly countered by the countless testimonials I collected during the years of my research, from colleagues and patients and reporters and friends and documentarians alike, to the effect that as unlikely and almost unbelievable as many of Oliver’s reports might have seemed, ­they’d all seen it, too, and could corroborate his descriptions and vouch for his clinical trustworthiness.

ISABELLE RAPIN

Well, ­there’s no doubt that many ­people ­don’t see his work as serious science. But for example, remember how he described that very rapid change in some of his patients, how they would go from being totally Parkinsonian to completely not, just like that, in an instant. When he described that in Awakenings, ­people thought he was making it up, but ­today this phenomenon is called the “on-­off effect” and is well known and well recognized. So you see, I think he’s an excellent observer.

DUNCAN DALLAS

As I say, when you first saw the patients who’d survived the time of Tribulation, you ­didn’t ­really believe all the ­things Oliver was ascribing to them, but the more time you spent with them, the more you began to realize how their inner lives­ were in fact still quite dense with experience, and then, when coupled with the films Oliver himself had been taking earlier on, both before and ­after L-­DOPA, you could see that it was all true.

MARGIE KOHL

What­ever other license Oliver may take at times, what he says about the patients is true. He trained me. I am a fantastic observer ­today, and it is all thanks to him. “Go in ­there,” he would say, “and tell me what you see.” Most neurologists are so stuck in their checklists and their Medicare-­mill fifteen-­minute drills that they miss everything; Oliver missed nothing.

And when I asked her directly about the charge that Oliver made­ things up, Kohl responded emphatically:

I know the charge is not true, and I was there. Sure, he would­ occasionally attribute a higher vocabulary to some of the patients—Maria, for instance, was uneducated and he made her language flow, but this was as much as anything out of re­spect for her, an honoring and cherishing of her—­and in a wider sense he embellished nothing. And many of the patients did talk fluently and with ­great subtlety.

But you had to be willing to sit at the bedside and listen. They­ didn’t just up and tell you ­these things. You had to establish rapport and a context.

With Leonard, for instance, most ­people had never gotten to him ­because (and I am speaking ­here of the years before L-­DOPA) they ­wouldn’t spend the time with him: He was very slow, each letter might take a minute for him to spell out on his board, and everyone else would limit themselves to yes or no questions. But Oliver sat it out.

And even, elsewhere in our conversation, Jonathan Miller himself:

Well, he is unreliable only in the sense that it would be very difficult to accommodate some of his work within the body of neurology as it stands ­today. On the other hand, he also appeals to and represents some aspects of classical neurology which the modern reductionist neurology ­hasn’t accommodated itself to. This curious sort of infinity that does exist within each individual self, which simply ­doesn’t get treated in ordinary neurology.

Beyond such testimonials, in further adjudicating the question of Oliver’s overall reliability, one needs to consider the sorts of distinctions Oliver himself has made: How, for example, he may at times not see things directly but “imagines” his way to the truth, which is to say that he gives articulation to the otherwise inarticulate through an act of active imaginative projection, one that he subsequently confirms through further observations (and corroborates in the prior literature). Such a method may indeed run ­counter to the strictures of conventional positivist science, with its insistence on valuing only that which can be mea­sured and quantified (ideally by way of double-­blind and peer-­reviewed experiments), but Oliver’s entire point is that certain ­things cannot be quantified (such as, precisely, the depth of experience—­ “Sometimes,” he once told me, “I feel like I am not so much interested in phenomena as in the resonance of phenomena, what it is like to live with the phenomena”), and that such quantifying studies by definition have to carve out a scrupulously circumscribed portion of clinical reality, when what he is often trying to gauge, access, evoke, and address is the wider reality, in its entirety, of the patient’s experience.

­Here, as well, we are broaching into the terrain of his entire critique regarding the necessary limitations of computers and artificial intelligence (“Although ­people regularly talk about ‘personal’ computers, interface is the one ­thing you ­can’t do with them”), which is almost always a stand-in for his critique of positivism in general. Not that positivist research is without its uses (far from it!), but that positivism can only take one so far, and it ­doesn’t get to dictate the lack of validity of anything beyond its ken. Just ­because something ­can’t be quantified ­doesn’t mean it is not ­there (­here we verge back on the terrain of Jane Goodall and the qualitative change in her capacity for observation that occurred when she started giving her chimpanzees names rather than assigning them numbers). “The other day,” Oliver told me at one point, regarding his colleague and former Luria student, “I called Nick Goldberg ‘my bête noire and favorite adversary’ and he was honored. Anyway, Nick says neurology is hardware and neuropsychology is software. But isn’t ­there anything else? Granted, sickness is stripping ­people down to their robotics—­and damaged robotics at that—­and I know robotics. Indeed, I know it better than most. But I also know that ­there’s more than robotics to ­human experience. Admittedly, as there is a robot in me, ­there is also a roboticist. But­ there’s also an eideticist. And you have to get from the Robot to the Creature, which is what Kant is all about.”

This, too, is where Leibniz comes in for Oliver. What he particularly trea­sured in Leibniz was his monadology, the notion that reality was made up of a vast latticework of ­wholes, ­every one of which reflected back the entire infinity of the universe (the ­ whole business of the macro in the micro, the infinite one could find reflected in even the most infinitesimal, an essentially kabbalistic notion, and indeed, Leibniz was consulting with kabbalists when he was developing it), and that therefore, as a result, the true doctor (and Oliver considered Leibniz “the ultimate physician”) has to deal with the ­whole person (one infinite monad to another, an “I” to a “Thou”), not just the fragmented facets delivered forth by all the ever more narrowly siloed specialists and their ever more narrowly slicing and dicing quantitative diagnostic tools.

Granted, Oliver sometimes pushed this critique too far. But here I’m reminded of a seminal clarification the ­great religious historian Donald Nicholl offered us back in my days at Santa Cruz: He spoke of the value of heresies, and more specifically of the way that in the de­cades of the early church fathers, heresies ­were defined as long-­ suppressed aspects of the truth that then got idolatrized as the whole truth. Their problem was hence not so much one of verity as one of proportion. And in ­those terms, it seems to me that when it came to his critiques of positivism, more often than not Oliver stayed on the proper side of right relation. (Even though he once quipped to me how “At my symbolic best, I aspire to Donne, at my conceptual best, to Wittgenstein, but sometimes, I grant, I get overDonne.”)

But there was a still-­wider issue ­here, that of the very nature and facticity of narrative itself (­ whether any story, any tale, can ever be strictly true (3) ),

FN(3):
*The sort of ­thing that E. L. Doctorow was getting at in his novel The Waterworks when he has his narrator explaining, regarding one of the book’s principal characters, how “I withhold­ here the circumstances of our first sight of Satorius. I want to keep to the chronology of­ things but at the same time to make their pattern sensible, which means disrupting the chronology. After all there is a difference between living in some kind of day-­to-­day crawl through chaos, where there is no hierarchy to your thoughts, but a raucous equality of them, and knowing in advance the whole conclusive order . . . which makes narration . . . suspect.” (p. 123)

a question to which Oliver alluded in another typewritten letter he sent me some months ­after the first round of attacks on his Leg book:

January 11, 1985

Dear Ren

The reviews which bothered me most of ALTSO (in the LRB, and a very similar one in the TLS, I don’t think you saw it) [­were ­those that contained] the imputation that I had lied . . .­ here, and therefore everywhere as well. And of course, this readily ties in with self-­doubt and accusation, and conceivably, too, an impulse to lie (or at least to “enhance”: the TLS reviewer spoke of “dramatic enhancement,” and you yourself said yesterday, “Ollie, come on!”). I could not, I think, lie “phenomenologically” (I mean, about phenomena)—­because I love them too much, and they do not admit of any lies.

Or, as he’d put it that other time: “It ­wouldn’t be home [. . .] ­unless potassium carbonate ­were exactly like potassium carbonate. That’s why truthfulness is so important.”

Continuing on:

I may indeed (this is difficult for me to judge, ­because I am so intuitive, and ­there is a borderland somewhere between “glimpsing” and “guessing”) say more than I am absolutely sure of—­this was the case with “Dr. P,” [the original man who mistook his wife] and therefore of the extreme plea­sure when I came across Macrae’s description of an almost identical case.

What is very important to think clearly on, though, and to discuss—­and I think I ­ will follow your advice and do this at the next Narrative seminar—is the business of “telling a tale,” finding or imposing dramatic organization over and above, but never violating a phenomenological description. And the business as to ­whether there “is” any such organization in reality, e.g., in the case of being ill, or sustaining some damage . . . Michael Neve, in the LRB, felt “the story” took over, had to proceed with its own inexorable momentum. ­There may be something in this, but not in the pejorative way he means. The 1974 experience was organized “dramatically,” the 1984 one [when Oliver broke his other leg on the eve of the Leg book’s ­publication] was not (was hardly an “experience,” just a boring, meaningless consecution of events . . .)

The extent, generalizing, to which “Life” is just a boring, meaningless consecution of events . . . and the extent to which it constitutes, is constituted on, organized as, experienced as . . . a story . . . (this would have been your challenge too, perhaps not unlike Shengold’s, in trying to make a “narrative” of my “life.”)

[. . .]

Anyhow, love, Oliver

A.R. Luria reserved the term “romantic science” for the sorts of extended storytelling he chose to engage in across the latter half of his life in The Man with a Shattered World, The Mind of a Mnemonist, and the like (in contradistinction to the other kind of more conventional scientific investigation at which he also excelled) and for the sorts of truths he felt could only be arrived at by such storytelling. And Oliver followed his hero in that characterization.

The passage from my conversation with Jonathan Miller, quoted earlier in this chapter (about how one ­couldn’t help but begin to wonder about Oliver’s veracity), was itself sandwiched between two countervailing senses of the situation. I’d begun by asking about the various imputations of exaggeration and the like, and he’d shot back: “But ­ they’re all true! And at the same time, yes, completely mad.”(4)

FN (4):
One is momentarily reminded of Adorno’s remark to the effect that nothing is true in psychoanalysis except the exaggerations. In addition to their all being true, all the truths are fictions, so that it gets so you ­can’t separate them out. It ­isn’t that ­they’re invented. But you begin to wonder . . .

And onward through Jonathan’s point about his friends who’ve seen some of the instances in person and claim that ­things are not precisely as Oliver says they are: “But the fiction is so luminous and so beautiful,” Jonathan had gone on, “that, in a way, it’s beside the point, because the fictions become more important. And the facts seem almost like impudent irrelevancies. ­There’s a tremendous overlap between him and Borges in some ways.”

During the twenty years that I used to teach my annual Fiction of Nonfiction classes (surveying all the fictive elements of narrative nonfiction, from form and structure through voice and tone and irony and freedom and so forth), ­toward the end of the course, when we arrived at Oliver’s prose, I deployed a slightly different coinage: Rhapsodic Nonfiction. ­Here, I hooped Oliver and Ryszard Kapuściński (both of whom had often found their strict veracity called into question) as each being instances of the sort of practitioner who first approaches his subject across one sort of daily and immediate writing (daily dispatches as the premier foreign correspondent for the Polish Press Agency, in Kapuściński’s case; ­those 500-­word clinical notes for ­every patient he saw across his entire ­career, in Oliver’s), and then years ­later might return to the same material in a conspicuously different register. Thus, for example, Kapuściński begins his legendary account of the final days of Ethiopia’s Haile Selassie, The Emperor, “In the eve­nings I listened to ­those who had known the Emperor’s court.”

“In the eve­nings,” which is to say when he had finished with his day job (filing ­those news reports). And “listened,” past tense, which is to say back then and over ­there. You can almost hear him swirling the whiskey in his snifter as he launches into his reverie-­like tale before an intimate and rapt audience now that he is back home ­after his years of wandering. And as I argued in that “Allegories of Eastern Eu­rope” piece (from the Threepenny Review, reprinted in my book Everything That Rises, (pp 141-158), Kapuściński’s text, when it was published in 1978 in Warsaw, seemed to operate at four levels simultaneously: as more or less straightforward reportage; as a prophetic allegory of the situation in Poland at that very moment, deep into the corrupt regime of the Communist Party chieftain Edward Gierek and just two years from the coming upsurge of Solidarity (let ­those with ears to hear, hear); as a more general allegory of the precarious dynamics of any and ­every sort of imperial court; and finally, as literature of the highest order, where it took its rightful place on the shelf alongside Calvino, García Márquez, Kafka, and, yes, Borges. (Jonathan Miller, incidentally, once mounted a remarkably evocative adaptation of Kapuściński’s Emperor on the London stage. {See the kinescope of same back in our Issue #101A.})

Ryszard Kapuściński and Oliver at our home in Pelham, my wife Joanna in the background.

Oliver’s rhapsodic writings arise in a similar context, for not only can he do the other—he has, repeatedly, ­every day through his entire ­career, and to remarkable documentary effect—­but ­these tales are pitched slightly differently, and they shimmer to similar effect (hence all the references to Arabian Nights entertainments and so forth, both on his own part and on that of ­others). He is writing for a different audience (though one that he dearly hoped would come to include his medical colleagues, responding in a slightly different way from their usual reaction) and not asking to be judged by the same actuarial quantitative peer-­reviewed standards as more conventional medical researchers (though even he himself occasionally grew confused on this last point).

And yet, in another sense, he was asking to be so judged. Or rather, he was trying to advocate for and model a different sort of medicine on behalf of chronic, often institutionally ware­housed and largely abandoned patients, especially ­those with massively enveloping syndromes that set them off at a nearly infinite remove, the sort of patients often referred to as “hopeless” or “mere vegetables.” And ­here—­and this is something Oliver’s blithe critics often failed to notice—­narrative of this sort was part of the therapy itself. Helping to turn an It back into an I, in ­Sister Lorraine’s evaluation. Or maybe a patient (an object) back into an agent (a subject). The therapy in question had to be intensely collaborative—­patients who had been treated as mere thrown-­away objects might well have long since lost any sense of their own capacity for agency and subjectivity. Trying to puzzle out their story, Oliver would often spend hours at a time with any single one of them (out of both compassion and fascination on his own part). Such ­people ­were privileged witnesses to and actors along the very remotest stretches of ­human possibility, and as such had marvelous stories to offer about such extreme vantages and experiences. The way a Parkinsonian can be jump-­started, as it ­were, into fluid action by the mere extension of a friend’s helping hand, so Oliver would offer his collaboration, sharing the self-­organizing capacity for narrative. Doctor and patients would work out (literally, “make up”) their stories together, and in so ­doing the doctor would help his patients to re-­compose themselves. As such, narrative was not unlike Oliver’s beloved ­music, in that it allowed patients to be moved by what moved them. And the animating surround to the entire exercise was nothing less than love, understood, granted, in an impersonal Eliotian sense. (But just try to quantify that!) (5)

FN (5):
It occurs to me in this context that this model of the doctor, by way of painstaking attention and concourse, helping the patient to make up, compose, and narrate into being a therapeutic way of thinking about the extremity of his or her specific existential situation, might in turn account for the singularly knotty problems Sacks himself got into with his Leg book—­all the convolutions and blockages involved in its writing, and, once finally written, the text’s exceptional susceptibility to all the Nevian sorts of critique—­precisely ­ because, in the particular instance in question, doctor and patient ­were one and the same person. Sacks had been all by himself, chasing his own tail, the necessary (self-)love all bollixed up with equally strong doses of self-­doubt and self-­loathing. He never achieved any Eliotian distance whatsoever.

And the marvel of the ­whole ­thing was that, as the years passed, Oliver, by way of his stories (and in particular the tenor of ­those stories, the quality of their attentiveness), along with the example set by a few other similar visionaries, actually began to turn the tide on how conventional neurology was being taught and practiced. Not at all bad for a series of “mere anecdotes.”

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.The New Yorker’s Rachel Aviv.

Rachel Aviv’s reportage complicates (or at very least thoroughly expands upon) many of the themes broached in that chapter, and several of her archival discoveries are indeed quite disturbing (again, as here).

For example, where Oliver in Awakenings had portrayed the central Leonard L character (the one portrayed by Robert De Niro in the eventual movie version) as having in his pre-stricken days been an exceptionally bookish and solitary young man who reverting to type, following his awakening forty years later, embarked upon the composition of a luminous 50,000 word autobiography, Aviv questions the characterization of Leonard’s youth as all that bookish or solitary (he never described himself as being any sort of a loner, on the contrary, and had certainly never likened himself to Rilke’s Panther, one of the most powerfully memorable grace notes in the entire Awakenings book—that was a characterization Oliver had often applied to himself, and clearly projected onto his Leonard portrayal). Meanwhile she relates truly disconcerting passages from Leonard L’s autobiography (where for example already on page 3 he boasts of his adventures during his teenage years with two close buddies rampaging about and raping a host of young girls, including his own cousin, along with some girls he babysat for). Aviv herself notes how those particular “memories” may have been part of a more general chemically induced priapic upsurge which Oliver had documented among Leonard and several of the other patients in the later “Tribulation” phases of the Awakening drama (and now that I think about it, I vaguely recall Oliver’s and my both considering them in that light)—but still, the general tenor of mischaracterization is rampant and startling. Likewise, for further example, with Aviv’s close-reading of Oliver’s account in his Man Who Mistook His Wife for a Hat book of his own interactions with a pair of actually quite famous and well-studied mathematical twin “idiot savants,” centering around their prodigious capacity for summoning up prime numbers, one higher than the next, as part of ongoing conversations in which Oliver himself claimed to have taken part: it turns out that whereas others of the Twins’ mathematical capacities (such as their ability to instantaneously state the day of the week of any calendrical date offered to them) are thoroughly documented in other people’s accounts, no one but Oliver seems to have noticed that fascination with primes (one which, incidentally, Oliver himself had evinced as a child). And there are several other such instances, many of them quite disconcerting.

Perhaps even more so, though, are the copious journal entries Aviv has found where Oliver lacerates himself over his tendencies toward exaggeration and downright confabulation. (“In his journal,” Aviv reports, “Sacks wrote that ‘a sense of hideous criminality remains (psychologically) attached’ to his work: he had given his patients ‘powers (starting with powers of speech) that they do not have.’ Some details, he recognized, were ‘pure fabrications.’” And so forth.) She acknowledges, however, how across the same journals Oliver would go on “to reassure himself that the exaggerations did not come from a shallow place, such as a desire for fame and attention. ‘The impulse is both “purer” and deeper,’ he wrote. ‘It is not merely or wholly a projection—nor (as I have sometimes, ingenuously-disingenuously, maintained) a mere ‘sensitization’ of what I know so well in myself. But if you will a sort of autobiography.’ He called it ‘symbolic exo-graphy.’”

Again these are themes which to some degree I as well had explored with Oliver across my years of conversations with him, though I think Aviv has added considerable fine-grained reporting and taken the discourse considerably forward. My own gloss upon her work would consist in a slight change of emphasis (in no sense by way of refutation or rebuttal), beginning, as it happens, with the one place in her piece where she got things slightly wrong as they pertained to me (or more likely, I suspect, had a more accurately nuanced account shaved away across the successive compressions of the editing process). “In the early eighties,” Aviv writes at one point, “Lawrence Weschler, then a writer for The New Yorker, began working on a biography of Sacks. Weschler came to feel that Sacks’s homosexuality was integral to his work, but Sacks did not want his sexuality mentioned at all, and eventually asked him to stop the project.” That is not precisely correct. As things began coming to a head in this regard toward the end of 1984 (beginning around p. 295 in my book),

The elephant in the room, of course, was the question of Oliver’s homosexuality—or not the homosexuality itself (who cared about that, except obviously Oliver himself, exquisitely, lashingly, continuously) so much as Oliver’s attitude towards its possible revelation (which at the best of times had been tortuously attenuated). Indeed, a good part of our relationship in those early years, as he slowly, tentatively, achingly revealed the dimensions of the calamitous blight, had consisted in my assuring him that (as I saw things anyway), really, Oliver, hardly anybody cares, certainly no one that matters. Alas, to no avail.

Wasn’t there some way, Oliver would implore, that I could compose the profile without mentioning his homosexuality? Surely it had nothing to do with his scientific work, he had gone to great lengths to make sure that his medical career was in no way shadowed by his in-any-case largely superseded homosexuality (he had been celibate at that point for decades). To which I’d agree that of course his homosexuality itself didn’t matter in the slightest, but his attitude toward that homosexuality was of the essence of who he was and how he had evolved both as a person and as a doctor.

In that context, I would highlight two particular tentpoles in his life story as I had come to understand it (there were of course several others but let’s confine ourselves here to these two). The first occurred when Oliver was about twenty, home from Oxford during a break and going around on house calls with his father (who like his mother was both a doctor and an Orthodox Jew). After a certain amount of hemming and hawing, his father prodded Oliver, “You never bring home any girlfriends.” Now it was Oliver who took to harumphing. “Is it that you don’t like girls?” his father hazarded. Whereupon Oliver, taking a deep breath, declared flatly, “Father, I am a homosexual,” (this despite the fact that he had yet to have consummated any actual physical relationship), “please don’t tell Mother, it would devastate her.” The next morning, however, Oliver’s surgeon mother (whom up to that point in their lives had doted on this youngest and clearly most prodigiously gifted of her four sons, probably too much so—she had even taken him along, when he was twelve years old, to the autopsy of another twelve year old boy, thinking he would likely find the experience interesting)—anyway, now she came tearing down the stairs and launched into several relentless hours’ worth of “hysterically Deuteronimical cursings and denunciations” (“wretched perversion,” “filth of the bowel,” etc.) culminating in the devastating insistence that she wished he “had never been born.” Whereupon she fell silent and the two, while still residing in the same house, didn’t so much as talk to each other for several weeks, after which, when they resumed doing so, the subject was never once broached again for the rest of her life.

That searing malediction of course colored everything that was to follow, from Oliver’s flight (as soon as he’d completed his medical studies) clean out of England to distant and far more accepting California, across his relatively brief but in itself quite harrowing period of over-the-top sexual and pharmacological (and leather-clad motorcycling) liberation there, an ever-mounting phantasmagoric delirium that came close to killing him, on the far side of which, after moving to New York, he proceeded to quit it all (with the exception of the motorcycling) pretty much cold turkey and enter psychoanalysis. Of which more presently.

Which bring us, though, to the second of the tentpoles I wanted to discuss here, which has to do with Oliver’s tenure at Beth Abraham, the old Home for the Incurable in the Bronx, around 1966, and the Awakenings drama upon which he embarked there a couple years later. Most accounts of that saga focus on his eventual administration of the new wonder-drug L-DOPA to the post-encephalitics he encountered there and the marvels and calamities that thereupon cascaded forth. But to my mind, the truly amazing (and defining) moment in the story came much earlier, at the very outset, when Oliver first entered the dismal wards of that sorry place, filled to the gills with catatonics, brain-damage victims, and warehoused “vegetables” of all sorts, and gradually came to the horrifying conviction that at least some of those wretches—the frozen, drooling, palsied “human-statues” before him—might yet be completely alive there inside and had been so for years (and from there his burrowing through decades-old case files to determine that many of them had originally, decades earlier, been felled by the now long-forgotten sleeping sickness pandemic on behalf of whose longterm victims Beth Abraham had originally been founded; his sequestration of such veteran patients in a ward of their own; on through his slow painstaking initial attempts at making contact with them, one by one. And the question there is, why was he and he alone able to see through to the possibility of there being a vivid interior life persisting deep within those apparently extinct volcanoes when dozens of other doctors over the prior years had not?

And here we arrive at a whole knot of issues at the heart of both Aviv’s and my own earlier characterizations of Oliver’s story. Because Oliver could relate to the situation of those wretched patients both out of the residue of his mother’s malediction itself and the sheer extent of the drug induced extravagances and catatonias he’d thenceforth experienced as its direct result during his ensuing wild California days (when his slogan had been “Every dose an overdose”), and beyond that, the wider identification he’d come to feel more generally with what his California-era friend, the psychoanalyst Bob Rodman, termed “communities of the refused” (an identification which would subsequently extend to Parkinsonians, Touretters, amnesiacs, the Deaf, the catatonic, the colorblind, the faceblind, and other such marginalized communities, and for that matter ferns and cuttlefish and even certain inert chemical elements as well). That sense of identification came to ground a profound empathy which, on the one hand helped him to give voice to the otherwise voiceless by helping them to reclaim their own stories, their own narratives, in so doing allowing them to reemerge as the active agents of their own lives—a practice which, granted, occasionally overstepped its bounds into outright projection and, in the subsequent recounting, downright confabulation. (It may be worth noting here that he had only been able to complete work on his Awakenings book in the immediate aftermath of his mother’s death.) And then, coming full circle, the ferocity with which his mother’s maledictions could return as self-doubt, self-laceration, and even self-loathing on that very score.

During the early years I spent in his near-continuous company, Oliver would sometimes refer to himself as a “clinical ontologist,” by which I came to understand he meant a doctor whose entire practice in relation to his patients, revolved around the question, How are you? Which is to say, how do you be? Hence the title of the book I eventually ended up writing about those and the subsequent years of our friendship, And How Are You, Doctor Sacks? What was, what had been his story?

But my own efforts at such narrative-forming were as nothing compared to the efforts of Leonard Shengold, the eminent New York psychoanalyst who took Oliver on at the nadir of his early midlife crisis, in the mid-sixties, and would go on seeing him, two or three times a week, for almost the entirety of the next half century. (Talk about a deep engagement with knots upon knots!) And it is part of the genius of Rachel Aviv’s reportage that she recenters her version of his tale, to the extent that she can, around the mystery of their work together, Sacks and Shengold, and their own inter-relationship. (No easy task since the late Dr. Shengold forebade his children from ever divulging his notes on those sessions, on the entirely appropriate grounds of doctor-patient privilege (even though, on the other hand, for what had he himself been preserving them?)

Who knows the extent that work had helped Oliver, seven years before his own eventual passing, to finally allow himself to fall in love with Billy Hayes, the lovely and loving young writer out of San Francisco who in turn helped Oliver to reach the point where he was able and willing to craft a memoir of his own in which he would finally publicly divulge his homosexuality for the first time.

Alas, no sooner had Oliver completed that manuscript than he suffered a recurrence of a cancer which he had seemed to have surmounted seven years earlier (just before meeting Billy, which also may have played its own role in his subsequent openness to such a late-life flowering) but, as soon became clear, he would not be able to surmount it this time. Several months on, Aviv reports, “in the summer of 2015, before Shengold went on his annual summer break, Sacks said to [his assistant Kate] Edgar, ‘If I’m alive when Shengold returns, I’m not sure I will need to go back to my sessions.’ They had been seeing each other for forty-nine years. Sacks was eighty-two. Shengold was eighty-nine.”

A few paragraphs later, Aviv goes on to relate how

In August, two weeks before Sacks died, he and Shengold spoke on the phone. Shengold was with his family at a cottage in the Finger Lakes region of central New York, where he spent every summer. [His daughter] Nina told me, “We all gathered in the living room of that little cottage and put my father on the speaker phone. Oliver Sacks was clearly on his deathbed—he was not able to articulate very well. Sometimes his diction was just gone. Dad kept shaking his head. He said, “I can’t understand you. I’m so sorry, I can’t hear you.” At the end of the call, Shengold told Sacks, “It’s been the honor of my life to work with you,” and said, “Goodbye, Oliver.” Sacks responded, “Goodbye, Leonard.” It was the first time they had ever used each other’s first names. When they hung up, Shengold was crying.

Dr. Leonard Shengold (1925-2020).

“Philosophy unties knots in our thinking,” Ludwig Wittgenstein, another of Oliver’s heroes, wrote in one of his Zettel entries almost a century ago. “Hence its results will be simple. But philosophizing has to be as complicated as the knots it unties.”

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HAPPY NEW YEAR! And see you next week…