Oliver Sacks And The Science Narrative


“[Narrative] is present at all times, in all places, in all societies; indeed narrative starts with the very history of mankind; there is not, there has never been anywhere, any people without narrative; all classes, all human groups, have their stories.” — Roland Barthes, “An Introduction to the Structural Analysis of Narrative”

Though writer and neurologist Oliver Sacks passed away only recently, on August 30, his legacy has been many decades in the making. Fortunately, we’re left with his large and valuable body of work to revisit as often as we like: through his examination of his patients and the transformations they underwent during the course of their diseases (and occasionally their recoveries), Sacks mused to inspiring effect on philosophical matters of consciousness, identity, and what it means to be human. (For those unfamiliar with Sacks’ work, I couldn’t begin to do a summary justice; I recommend going straight to the source. Start with The Man Who Mistook His Wife for a Hat, a collection of vignettes about patients with strange ailments treated by Sacks in the 1970s and 1980s.) He also ushered in a new era for the medical narrative, a form not new to the scientific community but one that had fallen out of fashion. Sacks used the personal story rather than a third-person statement of facts in many of his cases as a way of understanding and explaining how people respond to each other and to their own health, mental states, and emotional experiences. He also related over and over the resilience of his patients and their ability to cope with mental and physical challenges, even very debilitating medical conditions.

In his essay “Sabbath,” one of his last pieces for The New York Times, Sacks describes his impulse to record the experiences of his patients as stories:

“…I found meaningful work in New York, in a chronic care hospital in the Bronx (the “Mount Carmel” I wrote about in “Awakenings”). I was fascinated by my patients there, cared for them deeply, and felt something of a mission to tell their stories — stories of situations virtually unknown, almost unimaginable, to the general public and, indeed, to many of my colleagues. I had discovered my vocation, and this I pursued doggedly, single-mindedly, with little encouragement from my colleagues. Almost unconsciously, I became a storyteller at a time when medical narrative was almost extinct. This did not dissuade me, for I felt my roots lay in the great neurological case histories of the 19th century (and I was encouraged here by the great Russian neuropsychologist A. R. Luria). It was a lonely but deeply satisfying, almost monkish existence that I was to lead for many years.”

It’s ironic that Sacks should feel so alone as a storyteller. Storytelling evolved as a means for people to share information in a memorable and engaging way so that individuals could bond with each other: the primary purpose of telling a story is to create an emotional and cultural shared experience.* Though Sacks helped create these experiences, he evidently found that his highly subjective and theoretical approach in a field that reveres objectivity and action were alienating to his peers. The recording of data and reporting of results are meant to be unambiguous activities so that they remain reproducible. Eliminating the subjective, human impulse from scientific projects creates more stable, reliable information upon which rational decisions can be made. This is especially important in medicine, where doctors must remain emotionally detached from their patients so their personal whims, biases, and preconceived notions don’t affect the care they provide. By reporting his own feelings of surprise and frustration, as well as freely admitting that his interpretations of patients’ conditions were often subjective (while trying to see things from their point of view, and acknowledging his struggles in doing so), Sacks consciously shunned the objectivism that is the cornerstone of science and took a different, less-traveled path in his treatments.

It seems likely that humans have assimilated storytelling as a fundamental neurological process because of our advanced ability to analyze cause and effect, to investigate the reasons behind events, to find out what came before so we can predict what will happen next. In this way science and storytelling are fundamentally intertwined. Of course, the content, inflection, and meaning of a story can change drastically depending on the teller, the listener, and the context in which the story is told. Science and medicine are concerned primarily with facts, undisputed events through which a clear cause and effect can be traced. But why should medicine be concerned with just the ailment and the cure, and not the individual subjected to them? Indeed, in his stories Sacks himself is often less focused on curing diseases (one assumes he has considered whether a cure exists, and where it does not, he focuses more on the immediate experience of the patient). His tales are not episodes of the diagnostic TV show House, with a dramatic moment followed by rising action and a moment of epiphany about the cause of an illness and how it might be reversed. In Sacks’s world, definitive diagnoses are only sometimes made; he reminds us that often we must face the anxiety of the unsatisfying mystery, the emptiness of the unresolved. Why does a particular brain injury cause a woman to hear deafening Irish folk music? Sacks can tell her generally what part of her brain is affected, but as to why Irish music specifically and with such regularity, he can only speculate.

But Sacks doesn’t limit a person’s story to her ailment. He instead suggests that all personal narratives are ongoing and simply include a medical condition as part of them. The resolution of his stories lies in his assimilation of the whole, from the history and personality of the patient to the current moment of the patient’s life, and in his ability to express what an individual is experiencing, the medical reason why, and what we can learn from the incident. His stories fascinate partly because they are medical oddities that make us appreciate our own relative health and soundness of mind but also because they force us to think about our own identities in a new way. What if you lost the ability to conceptually distinguish your foot from your shoe? What if you lost all sense of empathy for others? What if amnesia caused you to forget the last 30 years of your life, but you didn’t know you had forgotten them? How much of who you think you are would remain?

By assigning real people to nebulous medical issues, Sacks intimately connects readers with his subjects. Research has shown, for example, that stories have the power to make people more open-minded and social. Stories that create tension and emotional resonance cause a spike in cortisol (to keep our attention) and oxytocin (to form or strengthen interpersonal bonds). Further, a happy ending is likely to produce dopamine (to make us feel triumphant or optimistic). The work of neuroeconomist Paul Zak has demonstrated that even simple storytelling can have dramatic effects on a person’s measured empathy and charitability, effects much more pronounced than those produced by exposure to a mere string of facts. Stories manipulate listeners, but that isn’t always a bad thing. Sacks seeks only his readers’ attention and understanding.

Perhaps most importantly, Sacks tells us that our personal narrative is as vital as the one we tell others.

“If we wish to know about a man, we ask ‘what is his story—his real, inmost story?’—for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us—through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives—we are each of us unique. To be ourselves we must have ourselves—possess, if need be re-possess, our life-stories. We must ‘recollect’ ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.” — Oliver Sacks, “A Matter of Identity”

Psychologists and therapists have been discovering more about how much one’s inner narrative affects his sense of self and in turn his whole life: our personal life stories guide our behavior and how we see ourselves, which in turn affect how others treat us. Our memories of ourselves shape who we are and who we want to become. “We now know that memories are not fixed or frozen, like Proust’s jars of preserves in a larder, but are transformed, disassembled, reassembled, and recategorized with every act of recollection,” Sacks says in his book Hallucinations. It stands to reason, then, that our personal narratives are constantly reshaped by our feelings each and every moment, and there really is no objective sense of self. This is the real value of writing down our narratives: to make something illusory a little more concrete and tangible, to contribute, however idiosyncratically, to the larger story of the role we play in the universe. Without written stories, we are scattered, lost to the cosmos.

Sacks’s gift to his patients was helping them find their own narrative and their sense of place, even if they didn’t quite realize he was doing it. “I have no literary aspirations whatever, only the desire to report clinical reality in all its richness,” Sacks once wrote. Yet he had an extraordinary literary gift, the ability to translate his observations into scientifically and emotionally salient lessons for both the medical community and the general population. Inevitably we as his readers are left to continue Sacks’s own narrative for him, but as long as it continues to inspire, it won’t have to have an ending.

*For a well-researched examination of the literature of narratives and the brain, see Pedro Monteiro’s post at Digital Distributions.

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