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OntheMove,byOliverSacksTheNewYorkTimes

http://nyti.ms/1HcAnnf
SUNDAYBOOKREVIEW

OntheMove,byOliverSacks
ByANDREWSOLOMON

MAY11,2015

Medicineisdominatedbythequants.Welearnabouthumanhealthfrom
facts,andfactsaremeasurable.Adiseaseispresentornotpresenta
reckonableproportionofpeoplerespondtoaparticulardrugtheinability
topredictgene
environmentinteractionsreflectsonlyafailuretomapfacts
wewilleventuallybeabletodetermineandiftheobservablephenotype
variesforanestablishedgenotype,thedifferencesmustbecausedby
calculableissues.Inthisversionofthings,thecasehistoriesthat
constitutedmostofmedicalliteratureuptotheearly20thcenturyreflecta
lackofempiricalsophistication.Onlyifwecantcomputesomethingarewe
reducedtostorytelling,whichisinherentlysubjectiveandofteninaccurate.
Sciencetradesinfacts,notanecdotes.
NoonehasdonemoretoshiftthisarithmeticalnavetthanOliver
Sacks,whosecareerasaclinicianandwriterhasbeendevotedtocharting
theunfathomablecomplexityofhumanlives.Allsortsofgeneralizations
aremadepossiblebydealingwithpopulations,hewritesinhisnew
memoirOntheMove,butoneneedstheconcrete,theparticular,the
personaltoo.Theemergentfieldofnarrativemedicine,inwhicha
patientslifestoryiselicitedinorderthathisimmediatehealthcrisismay
beaddressed,inmanywaysreflectsSacksbeliefthatapatientmayknow
moreabouthisconditionthanthosetreatinghimdo,andthatdoctors
abilitytolistencanthereforeoutranktechnicalerudition.Common
standardsofphysicianneutralityareinSacksviewcoldandunforgiving
atrespassnotmerelyagainstapatientswishforlovingcare,butalso

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againstefficacy.Sackshasinsistedfordecadesthatsymptomsareoftennot
whattheyseem,andthatwhilespecializationallowstherefinementof
expertise,itshouldneverreplacethegeneralismthatconnectsthedots,nor
thwartthetendernessthatgooddoctoringrequires.Areasonablecorollary
totheDelphicinjunctiontoknowthyselfistoknowthypatient,andfew
physicianshavedevotedthemselvesmoreunstintinglytosuchinclusive
knowledgethanSacks.Patientswantcoherence,whichcanbeachieved
onlywhenthecontradictoryessentialsofexperienceareassembledintoa
fluidaccount.Thedoctormustnotonlylisten,butalsoprocesswhathehas
heard.
Sacksinterest,however,isnotmerelyinhelpinghispatientsconstruct
theirstories,butalsoinrecountingthemtotherestofus.Theethicsofthat
undertakinghaveoftenbeenquestionedmostnotably,perhaps,bythe
disabilityactivistTomShakespeare,whodescribedSacksasthemanwho
mistookhispatientsforaliterarycareer.JanetMalcolmsassertionthat
everyjournalistwhoisnottoostupidortoofullofhimselftonoticewhatis
goingonknowsthatwhathedoesismorallyindefensiblehasaparticular
relevancetoSacks:Whenthejournalistisadoctor,theexploitationoftrust
isparticularlycomplicated.Sacksdecisiontowriteabouthisownpatients
asuncannyspecimens(inthisbook,hereproducesanotethatdescribesa
dancingpatientasanidiotNijinsky)canfeelatoddswiththecareful
sensitivitywithwhichhehasclearlylistenedtoandobservedthem.
Sackshaslonggrappledwiththisdichotomy,anditsurfacesrepeatedly
inhismemoir.Hedoesnotplaydowntheangerofsomepatientswhohave
feltbetrayedbyhisportrayalsofthem,nordoeshedenyhisfrustration
withwaryoneswhoresistedbeingdepicted.Healsoreportspatientswho
feltdeeplysatisfiedtoreadtheirtalesinprintwhobelievedthatSacks
hadtransformedtheirlonelystrugglesintoheroicexemplarsofdignity.
Sacksneitherdodgesnorpursuesthesemoralquandariesattherootofhis
workthismemoirismoreahistoryofhiscareerthanananalysisofit.
Fordecades,hisoeuvrehaspointedtoveryhighboundarieswithmost
people,startlinglylowoneswithhispatients,andrathermuddledoneswith

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hisreaders.Hisdelvingaccountsoftheinvalidshetreatshaveuntilnow
stoodinstarkcontrasttohisrestraintaboutrevealinghimselfdeeply,even
thoughautobiographicalthreadsrunthroughsuchbooksasALegtoStand
On,UncleTungstenandHallucinations.Adoctorconcerned,
engaging,humane,eccentricandunforthcominghasoccupiedthe
foregroundinhisselfdescription.WithOntheMove,hehasfinally
presentedhimselfashehaspresentedothers:asbothfullyvulnerableand
anobjectofcuriosity.
Themostattractiveandmostproblematicqualitiesofhiswritingturn
outtobewhatarebestandworstinhim.Hisimmersioninhispatients
brokennessismirroredhereinhisacknowledgmentofhisownbrokenness,
hisbelatedempathyforhisyoungerself.HewasevacuatedfromLondon
duringWorldWarIItoaboardingschoolwherehewasoftenbeatenbya
sadisticheadmasterhehadabrotherwhodevelopedschizophreniahe
realizedhewashomosexualasateenagerinthe1940s,inthoseAlanTuring
yearswhenprejudicewasatitsapex.Medicaltrainingpressedhimtoward
aloofness.Therehastobe,alongwithfellowfeelingandsympathyand
compassion,asortofdetachmentsothatoneisnotdrawnintoatooclose
identificationwithpatients,heexplains.Hislifebattlehasbeenbothto
sustainsuchdetachmentandtoovercomeit.
Aftermanyyearsofsidesteppingthequestionofhissexualorientation,
Sackshasfinallywrittenaboutbeinggay,recallinghismothershorrorat
thenews(hewas18shesaid,Iwishyouhadneverbeenborn),hisearly
loveaffairs,theprolongedsexlessnessofhismidlife,andhisrecent,happy
coupledomwiththewriterBillHayes.Sackswritingaboutsexualityisboth
laboredandmovingthisisstillroughtopographyforhim.Inhisyounger
days,hewasastonishedthatsomeonehehadbeenseeingmightbeinlove
withhim,andalarmedbythebelateddiscoverythathehadbrokenhis
heart.Histransitionintocelibacyispresentedwithoutexplication.After
thatsweetbirthdayfling,Iwastohavenosexforthenext35years,he
writes.Butwhynot?Heexplainsonlythathehadtroublewithbonding,
belongingandbelieving.Sackshascaredformanypeopleespeciallyhis
patientsbutthekindofloveonwhichmarriagesarebasedseemstohave

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beennotmerelyelusive,butbewilderingtohim(thoughhehasbeenseeing
thesamepsychoanalystfornearly50years).Sacksdidnotsomuchavoid
conventionasfailtonoticeitheunderstandsdifficultfacetsofthehuman
experiencewithsingularclarity,butemotionalrulesthatarelegibletomost
peopleseemtobewilderhim.
Theprimarymarkofagoodmemoiristhatitmakesyounostalgicfor
experiencesyouneverhad,andSackscapturestheelectrifyingdiscoveries
hemade,especiallythoseinhisearlycareer,withvivid,hardedgeprose.
Heiscompellingdescribinghisromancewithmotorbikes,whichherode
acrossvastdistancesinhisyouth,crisscrossingmuchofNorthAmericaand
Britain,andhisobsessionwithanextremekindofweightliftinginhislate
20s,hecouldreadilysquatlift600pounds.Heconveystheconsuming
intensityofhiswritingpracticethesuddeninsightsandensnaringperilsof
thedrugaddictionthatnearlykilledhimandtheexpatriatespermanent
yearningforthecountryheisntin,missingtheUnitedStateswhilein
Englandandviceversa.Heexpressestheendemicsadnessofremembrance
towardtheendoflife,whenthebadrecollectionsremainsad,andthegood
onesareinfusedwiththemelancholyoftheirtransience.Hedoesnot
disguisethepersistenceofhisguiltaboutthosewhomheintroducedto
drugs,orwhomhedidnotloveenoughorseeenoughorhelpenough.
Neitherdoesherenouncehisvendettasagainstthosewhowillfullyhurt
him,includingasupervisorwhocriticizedhismanuscript,firedhimand
thenplagiarizedfromit,andtheauthoritieswhosackedhimandexpressed
disapprobationforhischoosingtoplaywithautisticpatientsratherthan
applyarewardandpunishmentmodel,anapparentwhimsynowborneout
assoundpractice.
OntheMovesometimesstumblesinawaytypicalofcelebrity
autobiographieswhichistosaythatbeingalreadyinterestedinSacks
willgiveyoupatiencewithdetailsofhowhishousekeepercookedfishorhis
longswimsaroundCityIslandthatotherreadersmayfindunexciting.Parts
ofthebookarebracinglyinnocentpartsaresnobbish,withextended
descriptionsofhisgoodreviews,banaldisquisitionsonfamousfriends(his
cousinAbbaEban,thepoetThomGunn,W.H.Auden,FrancisCrick,

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RobertDeNiro,StephenJayGould,etc.)andaslightlypompoussequence
aboutmeetingthequeenwhenshemadehimaCommanderoftheOrderof
theBritishEmpire.Sacksassumessometimesthatweknowmoreofhis
pastthanwedo,andsometimesthatweknowless.Partsofthis
undertakingreaddismayinglylikethebookonemightwriteforones
grandchildren.
Thoughheisnotateaseintheworld,Sackswantsitsnoticehisface
hasappearedonthecoverofseveralofhisbooks,asitdoes,rather
fetchingly,onthisone.Thepoignancyofthisshyexhibitionismpermeates
thisbook.Hedescribesoneofhispatientsashavingacompulsiontobe
seenandshown,toexhibithimself,butalsotohidefromsighthecouldbe
describinghimself.Themosttouchingpartofthebookistheexpositionof
hisrelationshiptohisAuntLennie,whoseemstohavegivenhima
confidencethathisquietlyaccomplishedparentsfailedtoinstill.Lens
beliefinmehadbeenimportantsincemyearliestyears,hewrites,since
myparents,Ithought,didnotbelieveinme,andIhadonlyafragilebelief
inmyself.Later,hemuses:Itwasnoteasytobelievethatanyonecared
formeIsometimesfailedtorealize,Ithink,howmuchmyparentscared
forme.Itisonlynow,readingtheletterstheywrotetomewhenIcameto
America50yearsago,thatIseehowdeeplytheydidcare.Thewritingof
thisbookmusthavehelpedinthathealing,whichgivesitconsiderable
pathos.
Asayoungman,Sackswrotetohisparentsthathecouldrepaytheir
benevolencebyleadingafairlyhappyandusefullife,andheappearsto
havekeptthatpromise.Heisenamoredofhumanitydespiteoftenfinding
individualpeopledifficult,
splendidlyinclinedtowhathecharacterizesas
childish,ingenuousenthusiasm.Inwritingaboutfellowscientists
especiallytheNobellaureateneuroscientistGeraldEdelmanhe
demonstratesundimmedintellectualvigor,anddrivestowardanagnostic
theoryoflifeasawashinbothconsciousandunconsciouschoices,andthus
permanentlysuffusedwithpossibility.Thispositionentailstherejection
notofparticularfacts,butofthetyrannyoffactsaltogether.Heangered
membersofthemedicalestablishmentearlyinhiscareerbecause,he

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writes:Ihadcastdoubtonpredictabilityitself.Ihadcastcontingencyas
anessential,unavoidablephenomenon.Hehasalwaysbeen,hewrites,
hauntedbythedensityofreality.
Toclinicians,Sacksgenerallyseemsaverygoodwriter,andtolay
readers,heoftenseemsaremarkabledoctor,buttheextentofhis
distinctionineitherareahasbeensubjecttoquestion.Hiswriting
sometimeshasatingeofexpos,andthereisnoevidencethathisclinical
skillsoutrankthoseofotherneurologists.Todismisshimoneitherofthese
fronts,however,missesthecentralfactthattranslatingbetweenthosetwo
arenashasgreatvalueofitsown.Sacksabilitytoenactandcelebrate
intuitioninmedicineandprecisioninartissingular.Incomparinghimself
tothepoetThomGunn,hewrites,Thom,eventhen,waslapidaryand
incisiveIwascentrifugalandeffusive.Edelmansvisionofanessentially
individual,personalworldgaveSacksthefeelingofhavingbeen
liberated...fromaworldofshallow,irrelevantcomputeranalogiesinto
onefullofrichbiologicalmeaning.Thisfreedominturnledhimto
conclude,Individualityisdeeplyimbuedinusfromtheverystart,atthe
neuronallevel....Wearedestined,whetherwewishitornot,toalifeof
particularityandselfdevelopment,tomakeourownindividualpaths
throughlife.
Sacksfirstmajorbook,in1973,wasAwakenings,whichinspireda
documentary,aplaybyHaroldPinterandafeaturefilm.Thetitleistelling.
Thoughheexplicitlyaddressestherevivingofpatientslongcaughtin
Parkinsoniancatatoniacausedbyencephalitis,therealaccomplishmentof
thisandhissubsequentbookshasbeenthelargerawakeningtotheidea
thatmedicineitselfsitsrightlyattheintersectionbetweenliteratureand
science.
ONTHEMOVE
ALife
ByOliverSacks
Illustrated.397pp.AlfredA.Knopf.$27.95.

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Correction:October18,2015
AreviewonMay17aboutOntheMove,amemoirbythelate
neurologistOliverSacks,referredincorrectlytoasportatwhich
Sacksexcelledinhisyouth.Thesport,powerlifting,isnotaform
ofbodybuilding.(Thoughthetwopursuitssharesometraining
techniques,particularlyliftingweights,theirprimarygoalsare
different.Thatofpowerliftingistoliftasmuchweightas
possiblethatofbodybuildingistobuildandshapeones
musculature,particularlyforcompetitiveexhibition.)
AndrewSolomon,aprofessorofclinicalpsychologyatColumbiaUniversity
MedicalCenter,istheauthor,mostrecently,ofFarFromtheTree:Parents,
ChildrenandtheSearchforIdentity.
AversionofthisreviewappearsinprintonMay17,2015,onpageBR10oftheSundayBook
Reviewwiththeheadline:HisOwnCaseHistory.

2016TheNewYorkTimesCompany

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