by Oliver Sacks
Knopf, 274 pp., $26.95
Readers of The New York Review, to which he was a regular contributor over many years, need no introduction to Oliver Sacks. A number of the pieces in Everything in Its Place, his second posthumous volume, which collects published and unpublished work, first appeared in these pages, as did a number of those in the first posthumous Sacks volume, The River of Consciousness (2017), which is dedicated to Robert Silvers, his editor at the Review. Everything in Its Place is, in some senses, a slighter book than that one, which Sacks himself put together before his death. The pieces in it are generally shorter, some barely more than fragments, but this is not a mere Sacks smorgasbord: it has a distinct identity of its own and covers a remarkably wide range of topics, none of them unknown to his regular readers, but unified by a particular tone. To describe it as valedictory would be to oversimplify, and many of the pieces were written long before Sacks’s death in 2015, but consciously or unconsciously the editors have fashioned the book in such a way that we are left with an image of the author that is extraordinarily touching—not lacking in his habitual energy and driven curiosity, but somehow vulnerable, even fragile.
There are echoes here across the whole of Sacks’s voluminous oeuvre—tales differently told, glancing allusions to people encountered elsewhere, fragments of autobiography. The book is divided into three sections: First Loves, Clinical Tales, and Life Continues. The opening piece, “Water Babies,” a celebration of swimming in the author’s life, is exquisitely composed, a prose poem in all but name, and a reverie so euphonious that it might well lend itself to musical setting in the manner of Knoxville: Summer of 1915, Samuel Barber’s superb rendition of the opening of James Agee’s A Death in the Family:
We were all water babies, my brothers and I. Our father, who was a swimming champ (he won the fifteen-mile race off the Isle of Wight three years in succession) and loved swimming more than anything else, introduced each of us to the water when we were scarcely a week old…. We never “learned” to swim.
We see the infant Sacks already at one with the natural world. Water is his natural habitat: he sees that his father, “huge and cumbersome on land,” becomes transformed, “graceful, like a porpoise,” and he himself—self-conscious, nervous, and also rather clumsy—is likewise transformed:
Swimming gives me a sort of joy, a sense of well-being so extreme that it becomes at times a sort of ecstasy…. The mind can float free, become spellbound, in a state like a trance. I have never known anything so powerfully, so healthily euphoriant—and I am addicted to it, fretful when I cannot swim.
Sacks mentions, almost casually, something I have never read before: during his adolescence he succumbed to a skin condition that specialists could neither define nor cure. “I was covered in weeping sores. Looking, or at least feeling, like a leper, I dared not strip at a beach or pool, and could only occasionally, if I was lucky, find a remote lake or tarn.” (Very Sacks, that last word.) The condition passed when he went to Oxford, and then for the rest of his life he was a water baby again. But that period of hideous self-consciousness can only have contributed to the sense of otherness of which he speaks elsewhere, and which is no doubt the source of his uncommon capacity to engage with those who feel somehow excluded from what seems to be everyone else’s birthright.
“My father called swimming ‘the elixir of life,’ and certainly it seemed to be so for him: he swam daily, slowing down only slightly with time, until the grand age of ninety-four. I hope I can follow him, and swim till I die.” And so he did, until a few days before the end.
“Water Babies” was published in The New Yorker in 1997, when Sacks was in rude health, so any valedictory tone is deceptive, but it sounds a note that will be heard tolling gently throughout the book. The pieces collected in Everything in Its Place introduce us to the remarkable, odd boy that he was, as with his friends and fellow pupils Jonathan Miller and Eric Korn—young Jewish polymaths all—he ate up the scientific world. Sacks seems to have been the most single-minded of them, contriving out of sheer curiosity to get himself locked into the Fossil Invertebrate Gallery of the Natural History Museum in South Kensington overnight: “Familiar animals became fearful, uncanny, as I prowled that night, their faces suddenly looming out of the darkness or hovering ghostlike at the periphery of the flashlight. The museum, lightless, was a place of delirium, and I was not wholly sorry when morning came.”
This is an unusual boy, one who had, as he puts it, an “overwhelming sense of Truth and Beauty” when at the age of ten he saw a periodic table in the Science Museum and became convinced that “these were indeed the elemental building blocks of the universe, that the whole universe was here, in microcosm, in South Kensington.” That boy makes many appearances in these pages, and it becomes increasingly clear that Sacks was that boy to the very end of his days, engaging, eagerly and with a never-ending sense of wonder, not only with science but with its history and the people who made it: “Science is a human enterprise through and through, an organic, evolving, human growth, with sudden spurts and arrests, and strange deviations, too. It grows out of its past but never outgrows it, any more than we outgrow our childhoods.” His encounter, at the age of twelve, with the great nineteenth-century chemist Humphry Davy confirmed him, he says, on the path of science. For him, it must always be personal: he had to engage with people, whether dead or alive.
After graduating from Oxford, he applied himself to research, and it was a disaster. He found it impossible to work in the abstract; only when he went to work in a hospital as a neurologist, interacting with patients, did he begin to fulfill his potential. His natural shyness disappeared in the face of the problem to be solved—the human problem, the difficulty or the damage inflicted on the individual by his or her condition.
But he was equally fascinated by the brain itself. By involving the patient as much as possible in his own insatiable inquisitiveness about its extraordinary ways, he took some of the doom, the curse, out of the condition. “Hallucinations, whether revelatory or banal,” he writes in “Seeing God in the Third Millennium,” “are not of supernatural origin; they are part of the normal range of human consciousness and experience…. They provide evidence only of the brain’s power to create them.” While open to a vast range of human experience, he firmly discounts the extraterrestrial and the metahuman, marveling less at the brain’s failures than at its attempts to adjust to loss of function, the “organized chaos” described by the early-twentieth-century neurologist Ivy Mackenzie. “The brain,” says Sacks, “comes to terms with itself, re-establishes itself, at other levels.”
In the essay “Telling,” he describes the upsetting case of the director of a hospital who, struck down by Alzheimer’s, is admitted to his own hospital. He behaves as if he were still running it, until one day by chance he picks up his own chart. “That’s me,” he says, recognizing his name on the cover. Inside, he reads “Alzheimer’s disease” and weeps. In the same hospital a former janitor is admitted; he too is convinced that he is still working there. He is given harmless tasks to perform; one day he dies of a sudden heart attack “without perhaps ever realising that he had been anything but a janitor with a lifetime of loyal work behind him.” “Should we,” asks Sacks, “have taken away his accustomed and well-rehearsed identity and replaced it with a ‘reality’ that, though real to us, would have been meaningless to him?”
It was through stories like these that Sacks became a best-selling author: they made science—particularly neurology—human. His writing is direct, transparent, accessible—too accessible for the British publisher Faber and Faber, which rejected the original manuscript of Awakenings (1973), telling him to “professionalize” it. But from the beginning, quite apart from his keen grasp of the clinical aspects of his work, he was a remarkable wordsmith. Here, too, we see the child in the man: the bibliophagous boy greedily devouring, he tells us in “Libraries,” his favorite reading: “the many volumes of Mellor’s Comprehensive Treatise on Inorganic and Theoretical Chemistry”; there are sixteen. He was, perhaps surprisingly, not a good pupil at school, “but I was a good learner…. I had to be active, learn for myself.” He accordingly spent hours in libraries, sacred places to him. Their rapid death, as he sees it, both in America and England, shocks him: visiting a campus library whose entire stock had been digitized, he “felt that a murder, a crime had been committed: the destruction of centuries of knowledge.” He longs for a physical book, “its look, its smell, its heft.” This tone of lament is often heard through the essays—a sharp sense of loss, of a world irrecoverably changing.
In a happier age, the young book-hungry Sacks sought out the library whenever he was free; there he read poetry, novels, plays, history. As a young teenager, he came across A Journey Round My Skull by the Hungarian poet and playwright Frigyes Karinthy, which describes the author’s operation for a brain tumor in the 1930s; Sacks’s masterly introduction to the NYRB Classics edition is reprinted in Everything in Its Place. The autobiographical resonance is unmistakable as he describes Herbert Olivecrona, the Swedish neurologist who performed the operation: “At intervals, the cool, kindly voice of Olivecrona broke in, explaining, reassuring, and Karinthy’s apprehension was replaced by calm and curiosity. Olivecrona, here, seems almost like Virgil, guiding his poet-patient through the circles and landscapes of his brain.”
Later, at Oxford, Sacks came across Edward Liveing’s Megrim (1873), which inspired him to write his first book, Migraine (1967). At Oxford he was thrilled to be able to handle the incunabula, the earliest books ever printed. His obsession with words vies with his passion for science—reading them, but also writing them. His childhood nickname was “Inky”; he started writing in journals from his teens and never stopped. He wrote in cafés, in bars, on his bike, even at concerts. He almost never read the journals; they were sketchpads he used to work out his themes, to find his form, to articulate his story.
For Sacks, language and science were inextricably intertwined. In the particularly vivid essay about his hero Humphry Davy (about whom he writes a great deal more in Uncle Tungsten, 2001), he celebrates the “union of literary and scientific cultures” represented in Davy’s friendship with Coleridge: “Coleridge and Davy seemed to see themselves as twins: Coleridge the chemist of language, Davy the poet of chemistry.” Davy was a great communicator, too: “He had always been eloquent and a natural storyteller, and now he was to become the most famous and influential lecturer in England…. His lectures moved from the most intimate details of his experiments…to speculation about the universe and life, delivered in a style and with a richness of language that nobody else could match.” It is not hard to see why he might have been Sacks’s hero, though there is an even earlier model to hand, as described in his memoir On the Move: his father, who chose to be a general practitioner because it would be more real, more fun, than specializing: “He knew the human, the inward side of his patients no less than their bodies and felt he could not treat the one without the other…. This intense interest in the entire lives of his patients made him…a marvellous storyteller.”
“I am a storyteller, for better or for worse,” writes Sacks in On the Move. “The act of writing seems as fresh, and as much fun, as when I started it nearly seventy years ago.” For some people, this is a problem. There is, and always has been, a question about the degree to which Sacks fed off his patients’ ailments and the extent to which he betrayed their confidences. In “A Summer of Madness,” a review in these pages of Hurry Down Sunshine, Michael Greenberg’s devastating book about his daughter’s manic depression, Sacks acknowledges this problem: “The question of ‘telling,’ of publishing detailed accounts of patients’ lives, their vulnerabilities, their illness, is a matter of great moral delicacy, fraught with pitfalls and perils of every sort.”
Telling, of course, is what Sacks does: he tells patients what ails them and tells the world about them. Indeed, his whole enterprise might reasonably be described as telling some startling, not always comfortable truths about our lives. He concludes his essay on Hurry Down Sunshine with words that might just as well apply to his own work: “Perhaps…it will remind us of what a narrow ridge of normality we all inhabit, with the abysses of mania and depression yawning to either side.”
There is a sense, throughout Everything in Its Place and throughout all his written work, that Sacks has been on that narrow ridge himself and sometimes slipped off—notably during the alarming years of his addiction to amphetamines. But even when he is sober, there is an underlying compulsiveness teetering on the brink of mania in almost any activity he pursues. When he enters a long-distance swimming competition, the judges have to plead with him to stop after he has swum five hundred lengths—six miles. He engages in equally excessive cross-continental motorcycling marathons; as a body-builder, he makes his already large frame monumental. When he goes into the kitchen, he eats his way through a whole refrigerator of food, and when he asks his sister-in-law if he can use her typewriter to make a few notes, he is still there three days later, having written most of a book. The sheer exorbitancy of it all is hair-raising; if his thirty-five-year abstinence from sex had not encompassed the worst of the AIDS years, we might have lost him much earlier.
Perhaps it was his driven nature that led him to write with such tenderness about mental asylums, as they were originally conceived: institutions where disturbed people could find sanctuary, protected against the menaces of their fellow citizens and relieved of the burden of having to pretend to be normal. Originally, says Sacks, these were calm and beautiful places, clean and light, with gardens and agricultural lands, and the inmates were given useful and productive work to do, which grounded them and enhanced their self-respect. Eventually these institutions became overcrowded and descended into brutality and relentless discipline.
Sacks traces with fine sympathy the terrible spiraling failure of care over the twentieth century: the overreliance on antipsychotic drugs led to the building of short-stay facilities and the premature release of patients entirely unable to support themselves; then, in the 1960s, a new move to promote patients’ rights meant that they were no longer permitted to work in the laundries or kitchens or gardens: “There was now little left but sitting, zombie-like, in front of the now-never-turned-off TV.” The drugs have improved, but “the too-exclusive emphasis on chemical models of schizophrenia, and on purely pharmacological approaches to treatment, may leave the central human and social experience of being mentally ill untouched.”
Sacks finds an alternative, though it is hard to know who in the English-speaking world would try to replicate the extraordinary community he describes in the Belgian town of Geel, where mental patients are lodged on a regular basis as boarders in the townspeople’s homes. “What makes Geel remarkable,” reports the team of anthropologists who have made a study of the town, “is not the blurring of the boundary between normal and abnormal, but the recognition of each patient’s human dignity, to the extent that, for them, family and community life is given an honest chance every single day.”
This is a rare sunbeam in a book that, while rejoicing in a life lived with quite extraordinary richness, is filled with foreboding for the future. Sacks returns to Colorado Springs, forty years after his first visit when, newly arrived in America, he hoped to join the Air Force: “I was still in love with an America I had dreamed about…young, innocent, ingenuous, strong, open, as Europe had long ago ceased to be.” He was twenty-seven “and full of vigor and hope and optimism myself—that day, that vision of Colorado Springs and the Air Force Academy, made my heart exalt, beat strongly with joy and pride.”
Now he stays in a great sprawling hotel called the Broadmoor, self-described as “a legendary destination resort”; he is too kind to say this, but in England, Broadmoor, a high-security psychiatric hospital in Berkshire, is a byword for the criminally insane. The resort is, he says, like Hearst Castle, “with a lake, three golf courses, fake four-posters in the bedrooms, and flunkies, charming men and women trained to anticipate your every wish and action, pulling out chairs, opening doors, offering suggestions for dinner.”
Munching on a chicken sandwich “the size of my head,” his memory of the past comes back to him with a sense of the ludicrous “as I sit here in this plush, false Eden, forty-three years later.” The piece ends, “I stir slightly in my seat, and the waiter, telepathic, brings me another beer.” This essay, with its exquisitely judged last line, is a masterly encapsulation of what it is to age and to feel the present mocking one’s past, and it prompts the thought—not for the first time—that had Sacks chosen to write fiction rather than fact, he might have followed in the footsteps of those other great doctor-writers, Anton Chekhov, Mikhail Bulgakov, W. Somerset Maugham, William Carlos Williams.
In “Life Continues,” near the end of the book, his despair takes hold in a big way when he contemplates the takeover of the world by technology, especially computers and smartphones:
Those trapped in this virtual world are never alone, never able to concentrate and appreciate in their own way, silently. They have given up, to a great extent, the amenities and achievements of civilization: solitude and leisure, the sanction to be oneself, truly absorbed, whether in contemplating a work of art, a scientific theory, a sunset, or the face of one’s beloved.
As a neurologist he has seen many patients “rendered amnesic by destruction of the memory systems in their brains…. What we are seeing—and bringing on ourselves—resembles a neurological catastrophe on a gigantic scale.” He quotes E.M. Forster’s famous premonitory story “The Machine Stops”: “Cannot you see…that it is we that are dying, and that down here the only thing that really lives is the machine?”
What hope is there? “Only science,” he says, “aided by human decency, common sense, farsightedness, and concern for the unfortunate and the poor, offers the world any hope in its present morass.” But to a large extent it was science that got us into this morass, and Sacks’s trusting expectations of human decency only show that, as he often asserts in his writing, he is fundamentally unpolitical. “Between us,” he cries, “we can surely pull the world through its present crises and lead the way to a happier time ahead. As I face my own impending departure from the world, I have to believe in this—that mankind and our planet will survive, that life will continue, and that this will not be our final hour.” In a similar vein, he hopes, in “The Aging Brain,” that “if we are lucky enough to reach a healthy old age, this sense of wonder can keep us passionate and productive to the end of our lives.” Our best chance for the future, we may feel, is that there may be others among us like this uncommon, passionate, and enlightened man whose essential quality, repeatedly demonstrated not only in the present volume but across his oeuvre, is a kind of innocence—an unquenchable eagerness, a ravening curiosity, and a radiant delight in the world.
In a sense, Sacks’s entire extensive output constitutes a giant self-portrait of the scientist as artist. As he wrote in “My Own Life,” his public farewell in The New York Times, “Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.” Everything in Its Place is a pendant to the bigger portrait, but in one of the pieces, “Botanists on Park,” chronicling the Sunday morning activities of the American Fern Society, some of whose members wore T-shirts “which bore slogans such as ‘Ferns Are Ferntastic,’” we come close to the quintessential Sacks, swarming over the park, scratching and sniffing, in quest of “chink-finding, xerophytic ferns.” Maybe he felt like Kipling’s Mowgli, his childhood favorite, exploring the world through his senses, half wild, half human. But for this reader it was the image of Samuel Pickwick that came irresistibly to mind. Dickens seems to have anticipated Oliver Sacks by a century:
A casual observer might possibly have remarked nothing extraordinary in the bald head, and circular spectacles…to those who knew that the gigantic brain of Pickwick was working beneath that forehead, and that the beaming eyes of Pickwick were twinkling behind those glasses, the sight was indeed an interesting one. There sat the man who had traced to their source the mighty ponds of Hampstead, and agitated the scientific world with his Theory of Tittlebats, as calm and unmoved as the deep waters of the one on a frosty day, or as a solitary specimen of the other in the inmost recesses of an earthen jar.
And perhaps Dickens’s farewell to Pickwick is how we should part from Sacks, too:
Let us leave our old friend in one of those moments of unmixed happiness, of which, if we seek them, there are ever some, to cheer our transitory existence here. There are dark shadows on the earth but its lights are stronger in the contrast. Some men, like bats or owls, have better eyes for the darkness than for the light; we, who have no such optical powers, are better pleased to take our last parting look at the visionary companions of many solitary hours, when the brief sunshine of the world is blazing full upon them.
In his exquisite memoir, Insomniac City, Sacks’s partner, Bill Hayes, writes of him, “Before long I found myself not just falling in love with O; it was something more, something I had never experienced before. I adored him.” We may feel the same.
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