In matters of taste one should announce a prejudice. I have a visceral antipathy towards psychiatric romantics and the stories they generate. They have done much harm to patients and to my profession usually by inflating some half baked idea into a practice that made fools of us all.
The psychiatric romantics have given us the homeless mentally ill, the sex change operation, multiple personalities that incorporate animal alternative personalities expected to bark, meow, or moo in therapy, and abduction victims of aliens from other galaxies.
All of these were launched and then sustained by the narrative power of stories told by psychiatrists who were overwhelmed by their feelings for patients and abandoned their judgment.
These general observations bring us to the work of Dr. Oliver Sacks - author of " Awakenings," and " The Man who Mistook his Wife for a Hat." He has brought forth another collection of the essays he regularly publishes in the New Yorker. These articles, like his others, recount his experiences with patients suffering from such neuro-psychiatric conditions as autism, epilepsy, Tourette's Syndrome, and frontal lobe injury.
He calls the works "tales" because they are novelistic portrayals of the plight and responses of individuals who carry the burden of these impairments. And they are to be read as personal adventures of Doctor Sacks -- each one part encounter, part travelogue, and part reflection on the meaning of life as revealed to him by these patients.
If you prefer your medical stories tight, tidy and illuminated by the clean light of science - like the jewels Berton Roueche wrote for the New Yorker twenty-five years ago or the contemporary compelling essays of Lewis Thomas and Gerald Weissman - these compositions are not for you. Dr. Sacks is not neat. He is a big grizzly bear of a man with the brain of a neurologist and the heart of a romantic poet - a Wordsworth wannabe in the district of the sick. He cares too much and feels too much to be careful about what he says.
Dr. Sacks brings a sympathetic pen to the patients he describes. His descriptions of their symptoms - what their diseases take from them and impose upon them - are thorough, indeed masterful. But Dr. Sacks intends to go beyond the clinical delineation of symptoms. He knows these can be found in any textbook of neuro-psychiatry.
He writes stories about these individuals so as to illustrate their .. strengths as well as their weaknesses, their compensatory responses to their illnesses and the gifts that emerge despite, and sometimes because of, their injuries. He knows these patients as friends - indeed often as travelling companions - and although his training as a physician helps him to identify their symptoms his extensive experiences as their friend allows him to depict their strengths and demonstrate their achievements.
A warm heart and an expressive, expansive style are employed to capture a unique aspect of humanity - life persisting, even flowering under the altered conditions of specific mental disorders.
I believe many readers will enjoy these tales. They are narratives portraying remarkable individuals from within the contexts of their lives. Some of these patients are restricted to chronic mental hospitals from whence Dr. Sacks occasionally takes them out on whirlwind outings. Others are living independently such as the successful surgeon with the twitches of Tourette's Syndrome or the biologist with an autistic defect to her emotional life for which she partially compensates with a mechanical hugging device which runs on compressed air. All of these -- friends of Oliver -- are given a vitality through the narrative form and his presence in their lives.
And is he ever present. He is in their kitchens, their bedrooms, their basements. He is in their offices, their classrooms, their studios. He is eating with them, drinking with them, driving with them. He's at rock concerts with them, he's flying airplanes with them, he's operating on surgical patients with them. He's everywhere with them. And it is from these experiences with them as friends in his life that Dr. Sacks demonstrates how, despite their handicaps and grotesqueries, they are intriguing characters.
In these tales Oliver Sacks is explaining his friends to us and, as one does in describing a friend to others, he shows their foibles - for these individuals, the particular symptoms of their neuro-psychiatric afflictions. But he evokes their foibles from within their strengths, their compensating aptitudes, their pluck
and persistence, their valor. He thus gives these patients a human face and sometimes a touch of glory.
Dr. Sacks is an Englishman but hardly the stereotype. He is not careful with his emotional investments. He is not slow in committing himself to friendship nor selective of a few friends - tried and true, bound with hoops of steel, and all that. Sacks seems drawn to everyone by his feelings for them. He adds his feelings to every situation where the patients do not supply their own - thereby tainting his descriptions of them.
One telling example of his intrusions occurred during a visit with Clara and David Park -- university teachers who have an autistic (affectively blunted) daughter, Jessy. Sacks was impressed by the great warmth they showed her (further documented in Clara Claiborne Park's moving book on her life with Jessy, " The Siege") " I see how you love her" , said Sacks to David Park. " Does she love you, too?" " She loves us as much as she can," he replied -- a spare comment more telling about the nature of autism than Dr. Sacks' numerous attempts to force an interpretation onto the emotional experiences of these patients that begin with such statements as " I had the feeling that" , " One must suspect he felt" , etc.
These constant recountings of his feelings render a liking for Oliver Sacks' tales very much a matter of taste. In tales intended not only to depict a condition but to illuminate aspects of its nature as an experience lived by the patient, Dr. Sacks' emotive style clouds his message. He is attempting to be medically discerning at the same time as he is responsive to the sentiments of the moment. Open and non-judgmental beyond the point where judgment is needed. Linguistically facile to the point of excess and incontinence. Passionate not cool and thus a writer who fits the style of Tina Brown's New Yorker in ways Berton Roueche never would.
Sacks is so eager to narrate compellingly about certain human situations that - unlike a writer such as Tom Wolfe - he can not retain enough distance from the subject for precision and perspective to emerge from his tales.
One of many telling examples of how over involvement mars his message is when Dr. Sacks can not bring himself to reject the claims, and thus the embedded hopes, of believers in "facilitated communications." With this technique mentally retarded and autistic children have been "helped to communicate" by "facilitators" who direct the hands of these impaired patients over a keyboard and type out "messages" from their frozen psyches.
Experimental proof that the messages come from the mind of the facilitators is now irrefutable. An acceptance of unpalatable experimental results is not Dr. Sacks' strong suit. Rather openness to contemporary beliefs and non-judgmentalism are absolutes in his style of reasoning. Therefore he closes a footnote on this psychiatric misdirection by saying "There remains a nucleus of apparently bona fide phenomena that deserve a careful and openminded scrutiny." To which the only answer is "My foot, there is!"
Dr. Sacks' tendency to follow his feelings wherever they lead is partially kept in check by the arena where he plies his skills, neuro-psychiatry and by the distinguished neuroscientists he consults for explanations of the patients' symptoms.
He must hold to some of the empirical facts of the brain when he is bringing forth his narratives, his reflections on these patients and his descriptions of their mental conditions. However, his passionate nature (with its inclination towards long-winded melodrama as exemplified by statements such as "There seemed to me pain, renunciation, resolution, and acceptance all mixed together in her voice" ), his blindness to empirical results (as when he equates pharmacological treatments of schizophrenia with psychosurgery) and his silly attitudes that emerge from his thralldom to contemporary fashion with its vestiges of the 60s, as when he says, "All of us need to take little holidays from our frontal lobes" , tug at these moorings and make him a poor guide to these patients for all that he may be their great friend.
Director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and Johns Hopkins Hospital since 1975, Paul R. McHugh has founded, chaired or directed an almost infinite number of professional institutes, faculties and boards concerned with psychiatry and behavior. His curriculum vitae covers 28 pages. His book, "The Perspectives of Psychiatry," (with P.R. Slavney) is a widely used text in five languages.
"An Anthropologist on Mars: Seven Paradoxical Tales," by Oliver Sacks. 328 pages. New York: Alfred A. Knopf. $24