Mind & Brain / Memory, Emotions, & Decisions

Tucked away in the cabinets of Oliver Sacks’s Greenwich Village office are hundreds of small black notebooks, each filled with jottings and sketches, newspaper clippings, and photos. These are the accumulated reflections from a lifetime spent observing the extraordinary ways the human brain can misfire and misbehave: a man who believes his own leg does not belong to him, an autistic woman with a gift for understanding animals, and the man who mistook his wife for a hat—the case that inspired one of Sacks’s most famous books.

What people may not know about Sacks, however, is that the 74-year-old neurologist has spent much of his career regularly treating patients in mental-health facilities around New York City. Those patients have more commonplace problems such as dementia, sciatica, gait disorders, and seizures. He does love the challenge of an unusual case, of course, and those kinds of cases keep finding him. After his book Awakenings was adapted into an Oscar-nominated movie starring Robin Williams, the letters started pouring in, and they continue to today. Many are from people who are experiencing an interesting neurological phenomenon, or know someone who is. “My assistant Kate removes about nine-tenths of them,” Sacks says. “That leaves me about a thousand per year to read.”

In his latest book, Musicophilia: Tales of Music and the Brain, Sacks focuses on unusual cases having to do with music’s effects on the mind, such as a man who found relief from Tourette’s syndrome by playing the drums, and another who was driven to the edge by an unwelcome and unending tune that cycled uncontrollably through his head.

Seated at an aging wooden desk in front of a wall of tacked-up photos that include snapshots of past patients, Sacks spoke to DISCOVER about his recent musical investigations, his experiments with unlocking his own secret wells of creativity, and why he accentuates the positive with his patients whenever he can.

You are so famous for your books that most people don’t realize you have a day job. What is your regular work like?
Well, I see a few patients. Some of them are in nursing homes or in chronic disease institutions, like Beth Abraham Hospital, where the events in the book Awakenings happened 40 years ago, or the Little Sisters of the Poor, whom I’ve also been with for almost 40 years. I also go to a clinic, and I do a few house calls, which I’m fond of. For example, I personally called on a lady with amusia [the inability to perceive musical tones and rhythms] in the Bronx.

A world without music: What is her life like?
This is a delightful, intelligent lady, a former schoolteacher, who from her earliest years has been unable to recognize any piece of music, or indeed to hear it as music. She herself said to me, “You want to know what I experience when you play music? Go into the kitchen and throw the pots and pans around. That’s what I hear.” So although there are people who are considerably tone deaf, this is nothing compared to the absolute inability to perceive or conceive of music, which this otherwise gifted and articulate woman has. She was extremely relieved to find out that this so-called congenital amusia has a clear neurological basis. It’s not just in her mind; other people have it, although it’s pretty uncommon. She used to go to concerts with her husband. She says she wished she had been diagnosed 70 years earlier. She might have been spared a lifetime of being polite but bored, bewildered, and sometimes excruciated while listening to music.

In Musicophilia, you describe an intense personal experience with music 33 years ago, after you badly injured your leg while mountain climbing. How did music help you?
I found myself with this useless, floppy leg, and I was up at five or six thousand feet on a mountain. No one knew where I was—this was before the era of cell phones—and I had to try and save my life. I happened to have an umbrella with me, and I snapped off the top and splinted my leg. I tried to move myself down the side of the mountain, pushing myself along with my elbows, which was quite a cumbersome movement. Then I found the Volga Boatmen song going through my mind. I would make a big heave and a ho on each beat in the song. In this way, it seemed to me that I was being “music-ed” down the mountain. It became fun and easy and efficient. Everything was sort of coordinated and synchronized by the beat.

And music helped with your recovery, too?
Yes, after I was safe and my leg had been put together, I was still out of action neurally. In an injury like this, the body image changes. There have been functional MRIs that show this sort of thing. If a limb has been inactive for a while, it starts to lose its representation as part of the body image that is mapped in the cerebral cortex, and becomes difficult to use. Sheer will alone may not be enough to get it back; you almost have to be tricked back into action. Something spontaneous has to happen. For me, one form of this was when music suddenly came to me—this tape I’d been listening to again and again [Mendelssohn’s violin concerto]. It sort of came to me like a hallucination and got me going, triggering the ability to walk again. I once saw an older woman who had had a broken hip; no one knew why her leg didn’t move. She told me that it had moved once, when she was listening to an Irish jig.

You’ve also found that people with aphasia—the inability to speak because of neurological damage—can sometimes sing.
A good proportion can. So automatically when I see aphasia patients, I engage them in “Happy Birthday.” Beyond propositional speech and making sentences, there seems to be language embedded in song and in automatism of various sorts. I don’t like the word “automatism,” but when you recite a poem, it’s there, and it’s used as a different form of memory [than the memory of regular speech]. It’s used as procedural memory. But this doesn’t mean that it’s just mechanical.