The brain's perception of the body: Sacks breaks his leg, and his brain 'loses' it.
Various strange brain problems
The horrors of unnaturally forcing deaf people to learn speech, depriving them of the rich language and culture of signing
More case studies of people with strange brain problems. I can almost feel parts of my brain looking suspiciously at other parts as I read these. Fascinating, but not at all morbid: Sacks sees these people as people, not as cases.
This is a book in two parts, about strange medical conditions on isolated Pacific Islands. The first is a high incidence of total colour blindness (achromatopsia, locally called maskun) on Pingelap and Pohnpei (which is accompanied by extreme light sensitiveness and poor visual acuity, since the sufferers have only rods, and no cones, in their retinas), the second a high incidence of lytico-bodig, a neurological disorder similar to Creutzfeld-Jacob and Parkinson's disease, on Guam (which may, or may not, be caused by eating cycad flour). Sacks tells the tale of his visits to both places: the first in an attempt to understand what it might be like to live in a colour-free world, the second because the Guam disease has similarities with his own work as described in Awakenings.
The strange diseases aren't described in their usual detail: this is more a travelogue than a medical investigation. But Sacks' deep humanity, his care for the person rather than mere interest in their condition, comes through yet again. As does his dismay at the appalling devastation of island paradises, for such important reasons as American military bases and Japanese golf courses. And the story of how one of the team, a Norwegian achromatope, was sent to a school for the blind, where he was punished for using his sight to read Braille, and was blindfolded, simply beggars belief.
Here Sacks investigates our many and varied responses to music, from absolute (or perfect) pitch, musical hallucinations, via musical synaesthesia, to complete amusia, and then to the varied uses of music therapy for treating other problems. Music seems to occupy its own special part of the brain, not that closely associated with, for example, speech, and to be deeply important to us in surprising ways.
He points out how much our musical environment has changed over the last century: music is now essentially omnipresent. This may account for a seeming increase in so-called "earworms" -- those irritating fragments of songs and jingles that get stuck in your head for simply ages -- since jingles especially are designed to be catchy.
-- Edward Bellamy, Looking Backward, 1887
However, it is difficult to know if these actually are on the increase: what is clear from this book is how many people live with unreported conditions, because they assume (often rightly!) that nothing can be done, or because they think they are "normal", or they are worried that they are not normal.
Sacks starts, in his familiar case study style, with a tour of people suddenly infected with musicophilia, or musical seizures, or musical hallucinations, maybe caused by a problem like a stroke, or simply by ageing and deterioration of hearing. He moves into "natural" musical conditions, from absolute pitch to amusia, and musical savants. (This has one of the best descriptions, for me, of the quality of perception of absolute pitch that I have seen.) Then he describes the interaction of music and other problems, such as amnesia (where, despite almost total amnesia and inability to lay down new memories, musical performance may not be affected), aphasia (speech loss, that may sometimes be alleviated through musical therapy), Tourette's syndrome, Parkinson's disease (where almost completely frozen patients may be able to walk, dance or sing to the right kind of music), depression (which may be alleviated by the right kind of music), and dementia. This part is fascinating: it shows how differently music is handled by our brains from other forms of sound, and how valuable music therapy can be (not just playing any old music, but the right kind of music for each particular condition).
There is also a fascinating chapter on Williams Syndrome: I have encountered this before in readings on language, because these people are severely retarded in certain areas, but are very loquacious with large vocabularies. It turns out that many are also very musically gifted. In fact, one of the things this chapter does is provide yet more evidence that the notion of IQ is severely skewed: many of these people are described as having IQs in the 60s, yet are clearly above average in certain forms of intelligence.
The book does suffer slightly from feeling rushed; there are several places where an anecdote or explanation is repeated, in different words, a few paragraphs on. (I am assuming that this is the result of lacking a final editorial polish, rather than being some subtle musical "theme and variation" stylistic trick.) One stylistic feature that I do approve of the fact the book has footnotes, rather than endnotes (no constant flipping back and forth, just a quick eye-flick downwards).
This is a fascinating book: it shows how subtle and sophisticated is our interaction with music. And, as ever, Sacks' deep humanity and regard for his patients comes shining through.
Here we have seven essays on different forms of blindness, including language loss. We meet people who, whilst being able to see, lose their ability to integrate what they see. This can include losing the ability to read (to integrate letters into words, or even strokes into letters), and some who find it almost impossible to recognise anything. In some people this is congenital (particularly prosopagnosia, or "face-blindness": the inability to recognise faces). In others it is the result of a stroke, or a degenerative brain disease.
Not all is loss: one chapter tells of a woman who gains stereoscopic vision when her vision is corrected as an adult. Sacks himself is eloquent about the wonder of stereo vision, so the chapter about his own loss of vision in one eye, leading to loss of his own highly-prized stereo vision, is particularly poignant.
I find that reading Sacks always leaves me in a sort of paranoid hypochondriac state: have I got that? Well, I must admit that this time, I have actually self-diagnosed (mild) prosopagnosia. Mine is nowhere near as bad as some of the cases described here (including Sacks himself): I do recognise friends and family (most of the time). But it is bad enough that those of my colleagues who know me quite well have been known to say to me, after witnessing me in conversation: "you have no idea who that was, do you?" Conferences, despite being full of people I know well enough to talk to, but not well enough to recognise, are better than many situations: people usually wear name badges. As long as the font size isn't too small, this can be a big help (despite the fact that I'm also very bad at recalling names). Watching films with large casts can sometimes be a bit of a guessing game, however.
So, there's the usual interesting brain stuff in here. We see how amazingly plastic the brain is, how it can reconfigure and rewire when parts are damaged, and how amazingly resilient people are to massive damage. But I felt these essays were maybe a little shallower, a little more rushed, than in others of Sacks' books. Nevertheless, Sacks rushed is still miles better than no Sacks at all.
Hallucinations don’t belong wholly to the insane. People with migraines may see shimmering arcs of light or tiny, Lilliputian figures, the bereaved may receive comforting visits from the departed, and in some conditions, hallucinations can lead to religious epiphanies or the feeling of leaving one’s own body.
Dr Sacks weaves together stories of his patients and of his own mind-altering experiences with hallucinogenics to show hallucinations have influenced every culture’s folklore and art, and why the potential for hallucination is present in us all, a vital part of the human condition.
Sacks’ latest foray into the strange behaviour of the brain is about all the many ways that it can make us perceive things that just aren’t there, can make us hallucinate.
Much of this hallucination seems to be associated with lack of real sensory input. So we have Charles Bonnet syndrome, where visual problems lead to hallucinations of people and places; amputations, leading to phantom limbs; dark quiet rooms as we drift off to sleep leading to hypnagogic phantasms; and more. We have hallucinated vision, smells, speech, music, and other sensations. We have drug induced hallucinations, and drug withdrawal delirium tremens.
Some of the tales are about Sacks’ patients, some about Sacks’ own drug use. Although all the individual anecdotes are fascinating, there is little in the way of analysis. I was interested in why some hallucinations seem merely “syntactic” and unemotional (detailed visions of people, but with no over-arching storyline, and with the subject being a detached observer, aware that this is not real) whereas others are “semantic” and deeply emotional (vivid meaningful scenes that suck in the subject, who feels they are deeply real). I thought this would lead to fascinating insights into what happens in the different parts of the brain, but that is merely hinted at.
What is fascinating is how many of these hallucinations provide a potential explanation for much mythology: some of the visions are of very small people, some of giants, some of loved ones shortly after death, some of frightening suffocation by a presence sitting on one’s chest, some of deeply religious feelings, and so on. I had come across the idea that night-hags (or, more modernly, alien greys) are merely a combination of hallucinations while dropping off to sleep combined with sleep paralysis, but here we get potential sources of “little folk”, giants, ghosts, gods, and all.
While this is all deeply interesting, the account feels somewhat fragmentary: a list of anecdotes, rather than anything much deeper. Interesting, but ultimately unsatisfying.