Thursday, 31 January 2013

Hallucinations - Oliver Sacks

Anne Fadiman wrote in Ex Libris that every bibliophile has a shelf (or shelves) of books that is somewhat off-kilter from the rest of their taste.  Mine might be my theology shelf, or my theatrical history shelf, but I think the books (few as they are) most likely to surprise the casual observer would be those on neurology.

When I told my Dad I'd bought and read Hallucinations by Oliver Sacks (after he'd spotted a review and told me about it), he asked "But will you be writing about it on your blog?"  "Of course," thought I - it hadn't crossed my mind that I wouldn't.  But I pondered on it, and thought - would blog-readers used to my love for 1930s novels about spinsters drinking tea also want to read about phantom limbs and Delirium Tremens?

Believe me, you will.  I have almost zero interest in science in all its many and varied forms.  I stopped studying it when I was 16 (except for maths) and found it all very dull before that point.  (Apologies, science-lovers.)  Biology was far and away my least favourite subject.  And yet Hallucinations is absolutely brilliant, as fascinating and readable as his popular work The Man Who Mistook His Wife For A Hat.  A predilection for scientific books is definitely not a prerequisite.  Sacks is just as much a storyteller as a scientist.

Before starting Hallucinations, I thought they were mostly terrifying, felt real, and came chiefly with a fever or drug abuse.  While hallucinations can be all these things, I was surprised to learn how often they are benign (even amusing or comforting) and easily recognised as fake.  Strangest still, I hadn't realised that (under Sacks' definitions) I had experienced hallucinations myself.

That's not quite true - I knew I'd had them when I had an extremely high temperature during flu, but I hadn't known that what I'd had repeatedly as a child were hypnagogic hallucinations - those that people get just before going to sleep.  Aged about 5, I often used to see chains of bright lights and shapes (and, Mum remembered but I did not, faces) in front of me - whether my eyes were open or closed - at bedtime.  It turns out hypnagogic hallucinations are very common, and (Sacks writes) rarely unnerving for the hallucinator.  Well, Dr. Sacks, aged five I found them incredibly frightening, and usually ran to mother!

There are so many types of hallucinations that Sacks has witnessed in decades of being a neurologist, encountering hundreds of people and hearing about thousands from his colleagues.  This book just includes the ones who gave him permission.  It would necessitate typing out the whole book to tell you all the illustrations he gives, but they range from fascinating accounts of Charles Bonnet Syndrome (basically seeing hallucinations, often highly detailed, for long or short periods) to hallucinated smells, sounds, and even a chapter on hallucinating doppelgangers.

Almost all of these hallucinations act alongside lives which are lived otherwise normally, and do not suggest any terrible neurological condition.  It is somewhat chilling that Sacks recounts a study which revealed that 12 volunteers, with otherwise 'normal' mental health histories, were asked to tell doctors they were hearing voices - and 11 were diagnosed with schizophrenia.  Sacks is keen to point out how many patients with hallucinations, even when voices, are not suffering from schizophrenia or any other sort of mental illness.  He is deeply interested in how people manage their lives when seeing hallucinations at any hour of the day, and offers up humble praise to those who take it in their stride.

This is what makes Sacks so special.  A few of the blurb reviews describe him as 'humane', which I suppose he is - but the word feels a little dispassionate.  Sacks, on the other hand, is fundamentally compassionate.  He never treats or describes people as case studies.  The accounts he gives are not scientific outlines, interested only in neurological details, but mini-biographies filled with human detail, humour, and respect.  Here's an example of all three factors combining:
Gertie C. had a half-controlled hallucinosis for decades before she started on L-dopa - bucolic hallucinations of lying in a sunlit meadow or floating in a creek near her childhood home.  This changed when she was given L-dopa and her hallucinations assumed a social and sometimes sexual character.  When she told me about this, she added, anxiously, "You surely wouldn't forbid a friendly hallucination to a frustrated old lady like me!"  I replied that if her hallucinations had a pleasant and controllable character, they seemed rather a good idea under the circumstances.  After this, the paranoid quality dropped away, and her hallucinatory encounters became purely amicable and amorous.  She developed a humour and tact and control, never allowing herself a hallucination before eight in the evening and keeping its duration to thirty or forty minutes at most.  If her relatives stayed too late, she would explain firmly but pleasantly that she was expecting "a gentleman visitor from out of town" in a few minutes' time, and she felt he might take it amiss if he was kept waiting outside.  She now receives love, attention, and invisible presents from a hallucinatory gentleman who visits faithfully each evening.
And with this respect and kindness definitely comes a sense of humour - the sort of humour exemplified by many of the people he met.  This detail, in a footnote, was wonderful:
Robert Teunisse told me how one of his patients, seeing a man hovering outside his nineteenth-floor apartment, assumed this was another one of his hallucinations.  When the man waved at him, he did not wave back.  The "hallucination" turned out to be his window washer, considerably miffed at not having his friendly wave returned.
Although Sacks does not compromise his scientific standing, Hallucinations is definitely (as demonstrated by me) a book which is accessible to the layman.  In the whole book, there was only one sentence which completely baffled me...
When his patient died, a year later, an autopsy revealed a large midbrain infarction involving (among other structures) the cerebral peduncles (hence his coinage of the term "penduncular hallucinations").
I'll take your word for it, Oliver.

But, that excerpt aside, Hallucinations was more of a page-turner than most detective novels, paid closer attention to the human details of everyday life than much domestic fiction, and certainly left me with more to think about than many books I read.  I hope I've done enough to convince you that, even if you think you won't be interested, you probably would be.

I have wondered whether my interest in neurology might, in fact, just be an appreciation of Oliver Sacks.  I've started other books in the field and not finished them, though I will go back to one on synaesthesia that I recently began.  Perhaps no other author combines Sacks' talents as scientist and storyteller... but I'm happy to be proven wrong, if anyone has any suggestions?

For now, though, I'm going to have to hunt out my copy of Sacks' Awakenings...

35 comments:

  1. If you're interested in neuroscience, let me recommend you The Tell-Tale Brain; it covers all the new advances in the science and posits some new ideas about the way the brain works; it has a great chapter on brain and art, and also the link between synesthesia and creativity.

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    1. Thanks Miguel! I shall put it on my list - it sounds like it would be right up my street, so long as I can understand it!

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  2. This sounds great, which only backs up all the other glowing reviews I have read of it. Despite interest in other branches of science, neurology has never intrigued me. Still, if anyone could get me interested in the topic it sounds like it would be Sacks!

    I have spent literally years trying to figure out what my odd shelf is (a la Fadiman) and I still have no idea. Clearly, my library is not yet large enough for real patterns (or oddities) to have emerged. As good a reason as any to continue to expand it...

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    1. Sacks could get ANYONE interested in ANYTHING, I reckon. Do give it a whirl - or try The Man Who Mistook His Wife For A Hat, which is much easier to find and even better.

      Good luck finding your shelf - if you HAVE to buy lots more books then you HAVE to, just make your peace with it ;)

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  3. Great review! There is plenty of room in my heart for both tea-drinking-spinster novels and neurology anecdotes. I thought that Oliver Sacks' Island of the Colorblind was fascinating, and I will definitely look for this one.

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    1. Thanks Elizabeth! I'm glad you enjoy both sides of my blog :) I like to add a touch of variety occasionally!

      I think Hallucinations is rather better than Island of the Colorblind, simply because it covers more ground, with way more accounts and testimonies. So you'll love it!

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  4. Love this review! I'm going to have to check out Sacks. I love "accessible science." I may have to start out with the one Elizabeth mentioned - colorblindness has always intrigued me. I'm not sure what my odd shelf would be. There is definitely a broad spectrum in the non-fiction department, but down to one subject/genre? Have to ponder what that might be...

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    1. Ooo, he has one on music and the brain -- and it's actually IN my library (small miracle!). :)

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    2. Thanks Susan!
      Ah, yes, Musicophliia - he covers quite a lot about hallucinations there too, as he kept referring to it in this book (I haven't read Musicophilia - or whatever the title is.)

      Maybe you're too widely-read to have a strange shelf, Susan!

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  5. Thank you Simon for reviewing this book and being so specific. For the first time ever I now know what I had all those years ago as a 5 or 6 year old were hypnogagic hallucinations. I had this repetitively and have questioned several medical people over the years out of curiosity but now having read more about it online I know this is what it was. Mystery solved. Oliver Sacks is brilliant and I think most people who say they hate science would enjoy more of it if it was taught in a different way than how we all were taught in school.

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    1. There we go, Pam! I've got to say, it did feel nice for it to be recognised as a common experience. I'd forgotten quite what a traumatic experience I found it at the time, but reading the book brought it back.

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  6. "I have almost zero interest in science in all its many and varied forms." How can that be??!! What on earth happened to you that resulted in that outcome?

    Weeping Cat

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    1. It's not my fault Dark Puss - I did my best!

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    2. I was worried this would pain you, Peter! But I wanted people to know that they'd still enjoy this even with a modicum of interest in science (or without it), so I left the sentence in...

      I'm afraid I don't think my default was an interest in science! I can't blame bad teaching or poor parenting, because both were great - but my heart was always with literature first and foremost.

      There must be SOME subject which bores you, Peter? Is there?

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    3. I'm pretty much interested in most things apart from reality TV and mad baking competitions (I like baking itself however!). To OVW - I'm sure you tried very hard indeed to give this man a proper rounded education!

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  7. Ooh, I too had the bedtime scary lights thing - I remember calling for my parents repeatedly and them clearly stifling exasperation about it, but I was *definitely* seeing red lines coming towards me, which is scary when you're 6. Interesting to know what it was and that it's fairly common.

    Actually, I don't know that I'd expect someone who reads a lot and/or has a lot of books to mainly have books from one genre or of one type only. In my experience, most of such people will have at least a few different areas of interest, and will definitely be open to reading and indeed own some books which don't fit any of them. But I can't say I've closely inspected many people's bookshelves intentionally so perhaps these people are atypical & postmodern!

    I look forward to any future recommended reading on synaesthesia. I first heard about it when I was around 10 on a Radio 4 programme and thought, 'what, doesn't everyone associate colours with letters/numbers/days of the week?!' and proceeded to argue with my friend in the playground about what the correct shade and font for Wednesday was. So in summary, you're right: neurology can be very interesting!
    - Rachel

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    1. We are hypnagogic together, Rachel! You should totally guilt trip your parents with this book... ;)

      I'm intrigued about your comment on wide-read people not having unexpected categories. I suppose it's true. My reading is rather more specialised than most - I know a lot of people who'll just pick up something that looks interesting at the library or bookshop, whereas I rarely read a book without knowing *something* about it beforehand, through recommendation or something, and so it's unusual that I go outside my recognised areas of fondness.

      I find synaesthesia fascinating, but I have no claim to experiencing it (well... I think of songs as shapes, and I have quite a strong reaction to numbers as shapes [not corresponding with their actual shapes] but I don't think I'm quite there...)

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  8. Simon, Simon, Simon. How could you doubt for a moment that your Bloggies would be interested in all manner of varied supjects, not just tea and gardens and cats.

    I understand about the colours of the weekdays, Rachel. Wednesday was chalky white, of course. As opposed to Friday, which was pure white. Right?

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    1. I should never have doubted my readers, should I Susan?!

      It's intriguing that synaesthesiacs (?!) don't agree on the colours they see for letters, etc.

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    2. I second your first point, Susan! If you follow...

      I would have to disagree with you there, however. Wednesday is definitely a yellow curly word on orange, in a sort of Comic Sans font. Friday is forest green, just like 4. I think it should be expected that people don't agree on these things, though - would it really be synaesthesia if everyone's was the same? (That made more sense in my head)

      Simon, I think the shapes thing does count - I hear there are various types of the condition. Colours with numbers/letters are reasonably common, I heard, whereas people who associate, say, words with flavours or smells (I heard of a man for whom the word 'village' tasted of sausages, and he had strong negative reactions to words that tasted unpleasant, though I forget the example) are very few. As I understand it, the term covers the overlapping/interfering of any of the senses really. http://www.guardian.co.uk/lifeandstyle/2011/dec/05/synaesthesia-hearing-colours-mixing-senses is a good article on this which I came across through my work.

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    3. I agree that it would be odder if people had the same synaesthesia manifestations - I meant it's intriguing that something which seems objective fact, observed by the senses, is in fact subjective...

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  9. Interesting! I love the idea of a peek of what-you-wouldn't-expect on everyone's bookshelves. :)

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    1. Fun idea, isn't it! What's on yours, Tiffany?

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  10. The TED presentation by Oliver Sacks on this is fascinating.

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  11. I have only read An Anthropologist on Mars, but agree with you that Sacks makes science interesting and understandable for the layman. I don’t read enough non-fiction and should really pick up this book or another one by Sacks soon.

    I can’t think of any other author who “combines Sacks' talents as scientist and storyteller” as you say, but I for history, I can recommend Alison Weir; I have only read The Life of Elizabeth I and The Six Wives of Henry VIII and can say that both books were as readable and as exciting as a novel, not dry or dusty at all.

    I will have to re-read that essay in Ex-Libris, I don’t remember the bit about the “off-kilter” shelf. I am trying to think if I have one or if all my books are off kilter. It is fun to think about!

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    1. I think you'd definitely enjoy this, Ruthiella. And if *all* your shelves are off-kilter, what does that mean about you as a reader! How interesting...

      I haven't read any history non-fiction (or historical fiction, come to that) for years, so perhaps I should dabble. I really like history at school, and considered doing it joint-honours at university, but I'm less interested now...

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  12. Terrific review Simon. I have not read any of Sacks' work although he does get glowing recommendations. I will have to think about what hallucinations I have...I think smells and sounds more than sights. Fascinating.

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    1. Thanks so much Belle!
      The book is definitely even more interesting when you can identify with various phenomena...

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  13. Brilliant review, Simon. I’ve learnt about Sacks from my English tutor few years ago. I remember, each lesson he had different book that I had to read out laud to him in order to polish my accent (it didn’t work, but at least we had fun). One week he brought “The man who mistook his wife for a hat” and I loved it (after I’ve read it on my own quietly;)). I will definitely add Hallucinations to my tbr list.

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    1. Thanks Agnieszka! What a fun book to choose to develop an accent - although it must have included lots of long neurological terms which won't have come in handy much!

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  14. I'm in the middle (well 3/4 of the way through) The Man Who Mistook. I am enjoying it, but some of the more clinical aspects of the book are a little tougher for me.

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    1. Tougher because they're sad, or because they're overly-scientific? I did feel quite emotional about some of them.

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  15. could you check out my literature blog please?! http://literaturespy.blogspot.co.uk/

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  16. I have toughened sensory system hallucinations throughout and since a heavy bout of depression wherever i feel I smell of bleach or nail polish remover. I feel this book ought to be a motivating scan.

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