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Modern Language Studies

Oliver Sacks: The Ecology of Writing Science Author(s): William Howarth Source: Modern Language Studies, Vol. 20, No. 4, Literature and Science (Autumn, 1990), pp. 103-120 Published by: Modern Language Studies Stable URL: http://www.jstor.org/stable/3195064 Accessed: 07-04-2018 15:45 UTC

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Oliver Sacks: the Ecology of Writing Science

William Howarth

When I was young, I was torn between two passionate, conflicting

interests and ambitions-the pursuit of science and the pursuit of art.

I found no reconciliation until I became a physician. I think all physicians enjoy a singular good fortune, in that we can give full expression to both

sides of our natures, and never have to suppress one in favour of the


Writing Science

-Oliver Sacks, Awakenings'

In 1956, when C.P. Snow wrote that science and letters had split

into two cultures, divided by a "gulf of mutual incomprehension," he felt

that this schism expressed opposite views of time:

The non-scientists have a rooted impression that the scientists are

shallowly optomistic, unaware of man's condition. On the other hand,

the scientists believe that the literary intellectuals are totally lacking in

foresight, peculiarly unconcerned with their brother men, in a deep sense

anti-intellectual, anxious to restrict both art and thought to the existential


The hostility of Snow's dialectic reflects its origin in Cold War strife, when competing ideologies offered rival visions of past and future, theory and

practice, natural law and human need. Since then, science has opened new realms-DNA, computing, space travel-that have led to a "global"

era of broader cultural and disciplinary alliance. Snow might have

glimpsed this trend emerging in the literary work of two scientists, Aldo

Leopold and Loren Eiseley, who wrote with great fluency and dimension

about the ecology of natural relations, the dynamic and cyclical bonds

that have evolved between species and habitats, earth history and human


This development confirms that science and letters have long

enjoyed a necessary union. Science properly began with writing, the first

scratchings on clay being a record of natural data, and the founders of

science-Aristotle, Galileo, Linneaus-all used linguistic structures to

arrange and interpret phenomena. Without the cases and declensions of

Latin we might lack binomial nomenclature, the symmetrical naming of

species; and without the rhetoric of Baconian essays-proposition, proof, conclusion-scientific method would have no convenient form of exposi-

tion. Early writers such as Goethe, Thoreau, and Ruskin wrote scientific

papers; and according to one observer, writing gave Darwin the theory

of natural selection, found while he edited his Beagle notes into the

Journal of Researches (1839).4

? 1990 by William Howarth


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Recently the best science writers have emerged from interdisci-

plinary fields, whether in ecology, anthropology, or microbiology; where

new modes of inquiry have prompted reflective essays on ethical and

cultural problems. As R. Lane Kaufmann has noted, the essay lends itself

to such speculation through its casual yet principled form, an "unme-

thodical method" that departs from the strictly logical mode of con-

ventional science.5 Hence science writing today includes many authors

who effectively use poetic and narrative devices. Witness James Watson's

The Double Helix (1968), which sets his story of modeling DNA against

a mundane background of meals, weather, and smoky British pubs: "I

felt slightly queasy when at lunch Francis winged into the Eagle to tell

everyone within hearing distance that we had found the secret of life."6 Such writers necessarily sense that science is a social and linguistic enterprise, possessing habits of speech and grammar that strongly affect

its content. Stephen Jay Gould often ponders the images and metaphors

of natural history, while Lewis Thomas maintains that words are more

important to science than "getting all the numbers together." Literature, he notes, is a discipline that invites multiple ways of thinking, in concert

with a nature where no facts are "hard," only mutable and moving. The

recognition of quantum physics is that the universe is ever changing, an

insight that corresponds to ecology and its scheme of energy moving

constantly throughout the web of nature.7 Although "ecology" as a term dates from the mid-nineteenth cen-

tury, its origin probably lies in ancient concepts of medicine. In early

Asian and Hellenic times a healthy body was thought to contain elements

poised in careful equilibrium, while illness was a disturbance that

required healing rites to restore harmonic balance. Healers worked

through prayers and magic, then later by compiling systematic records

of diagnosis and therapy, the writings that preserved clinical knowledge

from the age of Hippocrates down to the Renaissance. The great explo-

sion in medical thought after 1600 sprang from Cartesian dualism, which

relegated the soul to a mysterious limbo while examining the body as

a physical, statistical mechanism. Yet even as biomedicine grew more

technical and specialized, it found that the body is an intricate, delicate

network of nerves, organs, and their chemical regulators. To explain these

complex relations, medicine in the late 20th century has drawn on other

disciplines-botany, zoology, and biochemistry-to challenge a host of

problems that are themselves of a broadly environmental nature.

Because of this history a division has gradually emerged in medical

thought between "classical science," a majority that deduces general laws

from individual cases, and "romantic science," a small faction that studies particular cases to write complex, detailed narratives. The two paradigms have quite opposite uses for writing: classical, to analyze and systematize;

romantic, to dramatize and individualize. In either case, writing nec-

essarily qualifies the ancient Hippocratic mandate for a physician's

discretion. "I will keep my silence thereon," the oath declares, "counting

such things to be as shared secrets."

Many recent writers have busily shared their medical secrets,

especially about the afflictions that Susan Sontag calls "the nightside of


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life." Literary journalists frequently write on disease, and several authors

have published "illness narratives," autobiographies of their sufferings. Each infirmity has its laureate: cancer, for Norman Cousins, Anatomy

of an Illness (1979); hypertension, for May Sarton, After the Stroke (1988);

and the dreaded AIDS, recorded by Paul Monette in Borrowed Time

(1989). Various doctors have also written on what medicine grimly terms "pathogenesis," the origin and course of disease, including Lewis Thomas,

The Lives of a Cell (1975); Richard Seltzer, Moral Lessons (1976); and

A. R. Luria, The Man with a Shattered World (1987).8

Luria, a Soviet neuropsychologist and early proponent of

"romantic science," has greatly influenced the development of Dr. Oliver

Sacks, the most gifted and problematic of recent medical writers. Born

and educated in England, where both his parents were doctors, Sacks

has since childhood been a "natural" writer, given to compiling massive

journals of his travel, reading, and daily experience. Since 1960 he has lived and taught mainly in California and New York; currently he is

Professor of Clinical Neurology at the Albert Einstein College of Medi-

cine. Author of many research papers, Sacks is best known to general readers for five books: Migraine (1970), Awakenings (1973), A Leg to Stand On (1984), The Man Who Mistook His Wife for a Hat (1987), and Seeing Voices (1989). These studies all focus on the human dimension

of therapy, expressing Sacks's desire to treat neurological disorder

through healing communities rather than purely empirical medicine.

Neurology deals with medical problems of enormous complexity

and subtlety, the dysfunctions that spread through brain and nerve net-

works to affect a wide range of behavior, from perceptual and muscular

action to emotions or memory. The symptoms are curious and individual,

often quite unpredictable, a situation that forced early neurologists to diagnose through sensitive reading and interpreting of patients' symp-

toms. With the advent of computer-driven CAT-scanning, diagnosis has

shifted radically toward technical, statistical study and away from earlier

holistic views, what Sacks calls "the inseparability of a patient's illness, his self, and his world" (A, 21). In taking this position, he has resisted

the current separation of neurology and psychology and called for greater integration of their interpretive methods. That attitude accounts for his own evolution as a writer, especially

as he moved away from classical medicine. His early publications were

devoted to etiology, explaining the origin and course of disease; but in

time he came to view clinical research in the contexts of philosophy and

art, "some feeling of a whole being" that he might convey through poetic,

meditative tales about mind-body relations. The stylistic change reflects his enthusiasm for the ideas of Luria, a figure well-regarded in psychol-

ogy, if not neurology, but Sacks has avoided alliance with holistic "fringe"

practices. Instead he has sought to become what Brom Anderson calls

"a vernacular philosopher" of medicine, devoted to translating academic

abstraction into ethical and spiritual experience.9

After publication of Migraine and Awakenings Sacks found him-

self regarded as a professional apostate. As he noted in a 1983 issue of the British Medical Journal, peers greeted him with "disapproving or


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uncomprehending silence" because his books abandoned charts and

tables to pursue "considerations beyond the strictly clinical: human, scientific, existential, philosophical." Medical journals shunned him completely, refusing to review Awakenings and rejecting all further articles, even quite conventional ones.'0 Any professional faces this

difficulty in publishing unrefereed research for popular audiences. To

Sacks, the writing represented a synthesis he had sought in medicine, to

reconcile his passion for both science and art by giving "full expression

to both sides of our natures, and never hav[ing] to suppress one in favour of the other" (A, 253-54). Luria's romantic science affirmed that ecological

holism, yet it transgressed the medical profession's strongly Cartesian


Sacks's writings may be regarded as attempts to define a field,

but not without the aid of effective mentors. "If one is blessed (or cursed)

with originality," he wrote in 1983, the problem is "to define how one

stands in relation to tradition." His traditions are both clinical and literary,

for he consciously identifies with post-Renaissance writers of meta-

physical, natural history, and phenomenological prose, from Donne and

Browne down to Humboldt, Darwin, William James, and Vygotsky. Their free-flowing, meditative discourse gave him literary models of

curious power, obedient to disciplinary thought yet impatient with its

conventional forms. Hence Sacks has often sought narrative structures

that relate clinical procedures-which themselves tend to inhibit creative


In medicine the prevailing verb is present; a patient presents

symptoms and the doctor presents a course of diagnosis, prognosis, and

treatment. This process begins with a patients' stories, but doctors often regard that data as incomplete and capricious. Stories may be untruthful,

misleading or biased; in taking a patient's history, the doctor must hear

a text but also see its subtext, the visible and mute signs of malady. A

doctor with "the eye" for diagnosis is constantly deforming narrative into

science. This situation repeats the cultural schism defined by C. P. Snow.

Science is prospective; it recasts past events into logical and predictable sequences of causation. Narrative is more retrospective, faithful to the

eccentric pace of memory and understanding. Wanting to trust his patients' stories, yet also to speak them in his own voice, Sacks has

struggled to reconcile the aims of science and art, despite their opposite

versions of history.

Reference Book

Migraine, which Sacks describes as "a detailed, if somewhat

discursive, reference book," (Mi, xviii) cautiously straddles the domains

of both classical and romantic science. While Sacks provides a compre-

hensive summary of migraine symptoms and therapy, he also expresses

strong sympathy for patients, based on his own childhood experience

of the disease's pain and perceptual distortions. This "constellation of

disorders," as Dr. William Gooddy notes in his preface, creates a rapid

and total physiological crises that arises from the complex interplay of

genetics, personality, and life habits (Mi, xi). Hence the best way to

illuminate the "grand scheme" of migraine is to stress its variables, which


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Sacks provides through classic case histories. Each of these narratives

offers a brief, formulaic statement of an anonymous patient's condition:

"Case 5: A 36-year old woman who suffers from both classical migraines

and cluster headache. Her attacks of migrainous neuralgia are invariably

nocturnal, and are remarkable for the profuse and viscid salivation which

accompanies them" (Mi, 114).

The overall form of Migraine, however, derives from a rhetoric

that approaches broader narrative principles. Arranged in four parts, the

chapters describe what symptoms are, when and why they occur, and

how they may be treated. The first half is descriptive, the second

explanatory and speculative; a pattern that follows classic therapy

(observe, describe, analyze, prescribe) but toward a romantic end, the

"continuous double vision" that sees migraine as both a structure and a

strategy, reflecting "the absolute continuity of mind and body." The

effect is simultaneously inductive and deductive, using a frame of

reference that grows steadily wider to encompass "many, various, and

sometimes very strange facts we are forced to consider" (Mi, xviii).

As a work of science, Migraine rests on an assumption that its

knowledge is accurate yet mutable, because later findings require Sacks to alter his text. Two subsequent editions, published in 1981 and 1985,

both add and subtract material. The reductions mainly eliminate or

condense "lengthy academic discussion" to highlight patients' emotional

problems as a large causative factor. The expansions add new obser-

vations or reflections, identified as "Addenda," which tend to emphasize the utility of self-therapy in milder cases, and to draw conclusions that

Sacks sees as broader, deeper and more personal (Mi, xvi). These include

an epilogue, "The Long Road," a chapter title repeated from his then-

recent memoir, A Leg to Stand On. He did not alter or omit a 1970 dis-

claimer, "I have at all times moved freely, perhaps too freely, between

the statement of facts and the questioning of their meaning" (Mi, xvii).

The words were prophetic, for in each of his subsequent books Sacks

persistently sought ways to develop an appropriate motion between facts

and questions, patients' stories and his own.

Case History Awakenings also evolved through several editions after it first

appeared in 1973, as Sacks added prefaces and epilogues, appended reading lists and glossaries, and throughout stitched an elaborate

embroidery of notes, sometimes annotating themselves. Nearly one-third

of the 1976 version consists of footnotes, an abundance Sacks trimmed back in the 1982 edition, leaving a cleaner but "radically impoverished" text, but in a 1990 edition he has restored or added many notes, along with seven new appendices. In all these versions he presides as a genial

and indefatigable clinician, monitoring the evidence and argument

closely, offering at the end his latest updates on patients' case histories

(A, 256-79). The book thus seems unfinished and continuing, very like a series of medical charts waiting for new entries. In that sense Awak-

enings remains true to its origins in classical science, as Sacks takes pains

to incorporate later findings about his subject.

Two aspects of the book's elaborate apparatus also identify its


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status as romantic science, where methods are even more provisional.

His glossary of "unfamiliar words" acknowledges that the book is for non-

specialists, but also that medical language is imprecise, since the terms

"merge and overlap in meaning, as do the disorders they denote" (A, 324).

His footnotes verify this heterodoxy by offering digressions on poetry

and philosophy, copies of patients' drawings, and lengthy anecdotal

narratives which, like the patient who takes six hours to wipe his nose,

may puzzle or frustrate empiricist readers (A, 288-306). Writing in a voice

that is at once playful and willful, Sacks remains deeply absorbed in his

learning and confident of its appeal. His later books would subdue this

autonomy, but never disavow its habits.

The redactive nature of Awakenings arises not just from science

but also art, for its story line describes a series of shifting, tentative clinical

situations. Over several years Sacks examined patients who had con- tracted viral encephalitis and sustained various effects of Parkinson's

disease: palsy, trance, continuing coma. By administering the drug

levadopa (L-DOPA) Sacks could trace the patients' sudden "awakening"

to more normative states, and then their gradual adjustment to those

profound changes. During the course of treatment he presented his

findings in print and film, and later provided post-mortems. He describes

that early work as providing a "model" or "miniature" for Awakenings

(A, 322-23), the germinating culture that defined the etiology of his own writing methods. As Sacks explained in 1983, his original intent was to write a classic,

prospective account of a medical experiment: "a double-blind trial of

levadopa in a large group of patients who had become institutionalized

after having encephalitis." Soon he found that the patients had complex

symptoms and histories, since many had been in comas some thirty or forty years. Such long-term survivals were unprecedented, and results

with the drug were unpredictable. Patients dosed with L-DOPA came

hurtling back into conscious life, bursting with excessive vitality, and then

modulated into regressive states. "Thus I was impelled," Sacks recalled,

"to a presentation of case histories or biographies, for no 'orthodox'

presentation, in terms of numbers, series, grading of effects, etc., could

have conveyed the historical reality of the experience.""

Since the patients represented a historical paradox, distorting the

usual links of past and future, the doctor's narrative method had to relate

his process of discovery. Their awakenings roused him, led him from

empirical to narrative presentation. His case histories therefore became fully retrospective stories, replete with character, event, and dialogue.

In August of 1969 he wrote nine such accounts but set them aside,

reverting to studies with statistics and tables. He published these in medical journals, chiefly Lancet, in 1969-71. Then he turned to more

popular media. Late in 1972 Sacks wrote an informal account of his work

for The Listener, the BBC cultural weekly. Encouraged by a warm re-

ception from readers, he returned to the early project and in two weeks

wrote eleven more case histories. When published in 1973, his 20

narratives comprised 50,000 words, nearly 170 pages of print written in

just six weeks' time.


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This burst of creativity, remarkably like the experiences of his

awakened patients, seemed to be spontaneous and unmediated. "The

case histories were the easiest to write," Sacks recalled in 1983, "they

wrote themselves, they stemmed straight from experience and I have

always regarded them with especial affection as the true and unassailable

centre of Awakenings." Whether that source was a muse or his journal,

he had gained access to new powers of verbal eloquence. Thus released, his narrative voice soared with incantatory revelations: "They appeared

to be releases or exposures or disclosures or confessions of very deep and

ancient parts of herself

they called to her with Siren voices, they

enticed her, they thrilled her, they terrified her, they filled her with

feelings of guilt and punishment, they possessed her with the consuming,

ravishing power of nightmare" (A, 53).

This passage describes both patient and doctor, and it rises from

his empathic power to imagine or picture her inner life. Often his mythical

allusions carry similar personal undertones: He identifies "Rose R" with

Sleeping Beauty, awakened to wake no more (A, 79); while "Frances D"

identifies Sacks as the "devious and Janus-faced physician," a redeemer-

devil who promises deliverance but only inflicts more torture (A, 53).

By learning to see as his patients see, Sacks affirms his doubled role as healer, the reader/writer who deciphers what patients feel but cannot

speak or explain. Hence his case histories must not be statistical, but

intensely subjective and metaphorical. One patient is "consumed in her

own metabolic furnace"; another speaks a garbled "word salad

Finnegans Wake run backward on tape"; yet another's mind resembles

"a clock shop gone mad" (A, 85, 86, 98). By describing organic disorders

with mechanical analogies, he reinforces just how involuntary the

afflictions feel.

According to Debra Journet, Sacks's narratives have the same

literary motive as Freudian case history, to individuate patients rather

than blur them into data.'2 Standard neurological journals prefer a

mechanical discourse: dry, storyless, governed by abstract nouns, tangled

clauses, and passive verbs-the inert style of so-called "life sciences."

Even direct statements, such as "Parkinson's disease primarily involves degeneration of dopaminergic neurons in the human brain,"'3 describe

disease as chemical actions rather than human events. Sacks instead uses

anecdotal material for its local and eccentric properties, as specifics that


assess the validity of suffering. As he notes in closing, "the whole lesson" of Awakenings lies in understanding Nietzche's dictum that pain will not

make us better, only subtler and more profound (A, 255).

Awakenings is also Janus-faced in its thematics, at once gentle and

loving toward patients but fiercely critical of mechanical, assembly-line

medicine that fails to grasp their plight. This split characterizes not just

Sacks's divided allegiance to art and science, but also his persistent need

for dialectics. Repeatedly he challenges standard etiology by arguing that

Parkinson's disease has "a coherent inner logic and order of its own" (A,

7), a push-pull absence and presence that breaks down distinctions be-

tween voluntary and involuntary behavior. He also decries the author-

itarian nature of medical administration, which organizes hospitals into


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coercive prisons instead of his ecological model, a collaborative com-

munity that is "single, organic, and self-governing" (A, 25).

The driving force in Sacks's romantic science is his sense of

sacramental wonder at the mysteries of health. For him medicine is a

human enterprise that pretends to be rational but has its roots in meta-

physics, myth, and magic. Healing is thus a sacred matter, for although

life does verge toward ever-encroaching death, between them lies an

equitable art, a true medicine that "will restore to us our lost health and

wholeness, and give us a sense of perfect well-being" (A, 28). Within this

transcendental holism lie the harmonic dualities of patient and doctor,

journal and story, text and notes. Health serves human beings not merely

for biological survival, but also for spiritual redemption. Some patients

sense this purpose in their affliction. As "Leonard L." writes in his journal,

"I am a living candle. I am consumed that you may learn. New things

will be seen in the light of my suffering" (A, 240).

In his closing "Perspectives" Sacks summarizes his findings and

defends case-history narrative as the best means of displaying illness and

treatment. Yet his science training also requires a final summary of L-

DOPA and its effects, which he describes as a triadic process of

Awakening, Tribulation, and Accommodation: a change of awareness,

problems and troubles, and returning to the real, the possible. The last

stage he finds most mysterious, for it presents the aspect of nature that

seeks balance, not through adaptive mechanisms but a flow of tran- scendent energy. Viewed in this light, medicine becomes the human

rendering of nature's ecology: "Health is infinite and expansive in mode,

and reaches out to be filled with the fullness of the world; whereas disease

is finite and reductive in mode, and endeavours to reduce the world to

itself" (A, 209). According to Sacks, early reactions to Awakenings either attacked

it as poor medicine or praised it as fine art,'4 but in fact his book never

abandons its roots in classical science. He persistently uses a clinical

vocabulary, and each case history has an orthodox form, beginning with

an account of the patient's disorder and ending with a summary of find-

ings. The book's larger frame repeats this pattern, going from opening

history to closing appendices and notes. Only his patients' narratives are

unconventional, both in their inclusion of broad humanistic issues and

their projection of Sacks's personal discoveries. For in his patients' stories

the doctor clearly found a large measure of himself. "Diseases have a

character of their own," he writes, "but they also partake of our own character" (A, 206).

Neurological Novel

Much of his own character dominates A Leg to Stand On (1984), the most personal work Sacks has published, a "neurological novel" (L,

11) that is less fiction than autobiography. Autobiography is a doubled

form of retrospection in which the author plays both character and

narrator, one to whom events happened and one who now relates that

history. In this case, Sacks is recalling an injury and recovery that

occupied nine weeks of 1974. While hiking in Norway he fell, tore the


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nerves and muscles in his left leg, and after surgery lost for some time all feeling or recognition of the damaged limb. These events he recorded

in a journal and letters but postponed writing for publication until 1982,

when "The Leg" appeared in the London Review of Books. That article prompted his 1984 book, which discards the compendious format of

Awakenings yet sustains many of its principal themes. The story of A

Leg to Stand On projects two selves, patient and physician, who emanate

from the single being of a writer. At the same time, Sacks insists that

the case he describes is not unique but common; a claim verified by the

research of Luria, whom Sacks honors in the book's dedication.

In this text Sacks turns from annotation to situate his ideas entirely in a story. Freed of the Latinate diction of medical diagnosis, he describes his symptoms briefly and in supple, vigorous English, driving forcefully

along the course of a narrative plot. The story's seven chapters recount his medical history: trauma; ensuing illness or loss of wholeness; stages of despair, revival, and reunion; recovery through himself and others; and afterthoughts on a "new medicine." The book actually has a double

plot, original events and subsequent thoughts, which form the twin axes

of its query into the relation of action and ideas. Thus although an accident

opens his story, a book actually launched his writing. As Sacks reports

in his final chapter, reading the early neurologist Henry Head taught him to understand the two modes of thought that govern science and art: "The

abstracting and analyzing mind breaks up movement, sees it as a

sequence, a series of complex procedures. The intuitive, esthetic sen-

sibility perceives it as continuous, indivisible, a stream akin to melody"

(L, 200).

Writing a neurological novel entails balancing these two forces of

order and history, analysis and intuition, the prospective series and the retrospective stream, for they represent the sides of Sacks's sensibility

that generate his work and give it complexity. Repeatedly in the narrative

he represents himself as a divided entity: athlete and intellectual, child and adult, frightened victim and cool professional, who must come to see these parts as entire: "I realized that this 'fascinating case' was me-

me myself, fearfully disabled, and quite likely to die" (L, 23). With this

shock he senses how indifferently death surrounds and shapes life, as unresponsive to his will as the atonic muscles of his atrophied leg. The

collapse of that limb produces a correspondent lesion in his mind,

prompting a series of obsessive dreams, hallucinations, and morbid

visions; yet he reports these moments from a whole and entire per-

spective, the self who made its rite of recovery.

This position is necessary and strategic, for it gives Sacks the

twinned character roles of patient/physician yet retains his options as

narrator. He can thus relate an interval of complete unconsciousness (L,

51), recall a meditative flow of thoughts (L, 67), insert pertinent quo-

tations (L, 73), anticipate ironic surprises (L, 83), and recollect a patient's

history-a ten-minute reverie that fills several pages (L, 79-84). Yet often

these controls appear to vanish as Sacks re-enters his once-broken state,

dreaming again of legs and non-legs, images that tell no story, just remain

fixed and static (L, 94-95); or through migraine attacks, losing half his


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field of vision and seeing mosaic auras (L, 99-102). He is far more directive

when dealing with the story's characters, either casting them as Kafka-

like apparitions (Swan, The Caster, Nurse Sulu, Sister, Surgical House-

man), or inventing delighful "imaginary meetings and dialogues" (L, 87)

with his favorites, such as the maiden aunt who urges him to emulate

his mother's surgical aplomb, "that essential balance of the technical and

the personal" (L, 89).

Surgery and writing both require anatomy, the system of "tension

and connection" (L, 39) that provides structure, and much of the drama

in A Leg to Stand On emerges through Sacks's discovery of narrative

coherence. The accident and recovery he initially saw as "two separate

stories, and it was only gradually that I came to see they were essentially

connected" (L, 40), an insight generated largely by the process of retro-

spection. In writing he converts absolute clinical history into the relative dimensions of story, expanding the flow of time until nearly two-thirds

of his text covers fourteen days of events. His verdict about this period

of crisis and regeneration, "Recovery was an exercise in nothing short

of birth" (L, 161), may seem exaggerated, since his trauma hardly com-

pares with the duress of a difficult pregnancy; but Sacks's moral concerns are in fact generous.

For ultimately he sees that his illness dwells in isolation, that he

recovers by turning outward to others, sensing bonds with them, learning

again to find "essential connection and communion with nature" (L, 163).

Living outside himself is the surest sign of health, just as rising and walking

are his strongest steps toward liberty. The moment Sacks again walks

is the story's turning point, moving him to recognize the power of change

and his need to share it: "'This is the most wonderful thing I have ever

known,' I thought. 'Never must I forget this marvelous moment. Nor can

In that moment I knew I must describe

I possibly keep this to myself.'

my experiences" (L, 141). The patient's pilgrimage is toward a forgotten

unity, linking his ghostly, depressed, and Descartean mind back to the

joyous vitalities of Kant and Leibnitz (L, 149). Even in less complex minds this journey still occurs, for the burden of illness is to reveal depths never

glimpsed in health: "as a patient one's experience forces one to think"

(L, 172).

The end of A Leg to Stand On reflects upon what the experience

taught Sacks, as both physician and writer, and suggests the direction

his future work will take. With the approval of his mentor, A. R. Luria,

who condoned an early account as "surprising, yet ultimately coherent-

with the unity one would expect" (L, 196), Sacks realizes that this interval, full of "wild extremities & epiphanies" (L, 197), compressed into its brief

span a destiny that he should pursue. Luria told him he was building "a

new field" in neuropsychology (L, 197), but Sacks finds precedents in

the writings of Henry Head and Weir Mitchell, an American Civil War

surgeon. Their narratives emphasize "doubleness, as if two modes of

thought, two realms, had conjoined" (L, 200), creating a form that

Mitchell called "clinical fiction" (L, 205) written for the benefit of non-

professional readers.

In writing a neurological novel, Sacks fully sensed that classic


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medicine is bad narration. Each time he was obliged to tell his history

to doctors, they demanded only the "salient facts," which proved not

impartial but hopelessly partial, anything but the whole story (L, 47).

Once, in Norway, an apparition appeared to him, a young doctor with a powerful empathy for patients: "He didn't talk like a textbook. He

scarcely talked at all-he acted. He leapt and danced and showed me

his wounds, showing me at the same time his perfect recovery. His visit

made me feel immeasurably better" (L, 44). This full being, both artist

and scientist, remains Sacks's ideal for neuropsychology, a human,

romantic science that is not confined either to mechanisms or procedures

but studies both, especially their relation and interaction, for in that

ecology lies revealed the dynamism and unity of natural health, "a

magnificent, self-activating, self-regulating automaton" (L, 211-12).

Clinical Tale

Sacks's absorption with these themes quickly produced his 1987

book, The Man Who Mistook His Wife for a Hat, a collection of stories

sub-titled And Other Clinical Tales. This oddly arresting main title,

playing on the notion of taking a wife, reflects his increasing confidence

in reaching general readers. Of these twenty tales, eight previously

appeared in the London Review of Books and the New York Review

of Books. The latter publication has promoted serious but lively

commentary since 1963, when a newspaper strike gave editors an

opportunity to rebuff the New York Times Book Review for its years

of inflicting "tired hacks, lame professors, and breezy illiterates" on the

reading public.1'5 This venue may have encouraged Sacks to write more

spontaneously, in the style of his personal journal, for The Man Who Mistook His Wife for a Hat features strong story qualities of scene, character, and dramatic event; while its technical apparatus (missing

entirely from A Leg to Stand On) consists only of a few amending

footnotes and a brief annotated bibliography.

In the preface, Sacks advises that his narratives are not studies or cases, but stories with an ethical and moral point: "To restore the human

subject at the centre-the suffering, afflicted, fighting, human subject-

we must deepen a case history to a narrative or tale; only then do we have a 'who' as well as a 'what,' a real person, a patient, in relation to

disease in relation to the physical" (M, viii). Since the days of Hippocrates,

he recalls, medicine has been a "tradition by which patients have always

told their stories to doctors," and the physician's task is to make both

temporal and spatial sense of their accounts. His metaphor for such

narration has become cartography, for these stories map the brain and

body relations of otherwise unsurveyed minds, "travellers to

unimaginable lands" (M, viii-ix).

Like the pilgrimage in A Leg to Stand On, travel provides a form

for this collection, for Sacks arranges his clinical tales into a four-part

journey, each segment focused on a "presenting feature" of neurological

disorder. He begins with "Losses" and "Excesses," abnormalities

afflicting healthy persons, then moves to "Transports" and "The World

of the Simple," states of vision and retardation. The passage is from


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normal to impaired, familiar to alien; a reversal of Faulkner's story-telling

progress in The Sound and the Fury (1929), which begins in idiocy and

ends with rational order. Sacks probably acquired this narrative scheme

while writing his eight early tales, since the book builds through a

sustained presentation of its dominant themes.

"Losses" describes not the loss of major faculties such as vision

or hearing, but subtler and more complex "disorders of the hidden senses"

(M, 51) some of which Sacks had personally experienced: the

proprioception that allows for alignment and balance; the perception of

left and right, part and whole, mind and body. In the absence of these

sensory systems only images remain, phantoms so powerful they

challenge conventional ideas of the difference between illusion and reality. In each story, Sacks works toward revealing "the therapeutic

moment" (M, 72) when a patient discovers his loss and, conversely, the

doctor and reader gain a fuller perception of health. Contrary to classical

medicine, Sacks must see, hear, and believe his patients' stories in order

to heal them. In cartographic terms, retrospective narration gives him

three-dimensional relief; it draws contour lines that separate solid land

from the ever-stirring sea.

"Excesses" explores the reverse of loss: hyperactivity in speech, sexual drive, memory, or mimicry; the ever-frisky, shifting pulses of

mental activity that, in more controlled minds, generate creativity and

inspired improvisation. One patient, caught in the seething caldron of

Korsakov's syndrome, must continually invent a world and self to replace those constantly forgotten and lost. In a therapeutic moment of his own,

Sacks sees that this "confabulatory genius" lies at the heart of human

identity; that the mind constantly and unconsciously takes all experience

and constructs it into story: "Biologically, physiologically, we are not so different from each other; historically, as narratives, we are each of us

unique" (M, 110-11). In other words, science elicits unitary law, while art conjures up multiple stories. Sacks's role as doctor/surveyor is to

proportion his narratives, make their individual and universal scale of dimension apparent. "Transports" explores the dream states that produce mysterious visions, states of being that are extra-real: a radio playing in the head,

childhood memories of home and parents, old jokes long forgotten. These

are the states of doubled sense that induce dfid vue, hallucination, and

profoundly mystical rapture, all reported to the conscious mind in

voluminous and uncannily accurate deatil (M, 151). In this section Sacks

begins to map tentative thoughts about how the brain functions through

imagination, something neurology has not understood via purely

empirical study. The ability to think in pictures is a peculiar mental

faculty, common to both science and art. A man who mistakes his wife

for a hat poses ontological questions: while reality contradicts his

"mistake," imagination constantly makes just such leaps-to see what is

not, to observe and create anew, however "abnormal" the vision may

seem to orthodox viewers.

"The World of the Simple" poses a final opposition, the retarded

patients whom Sacks loves for their concreteness and immediacy. Yet


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their lack of abstraction is also profoundly ambiguous, challenging

"romantic science" to explore a neural wilderness, "the almost subhuman

swamplands of the concrete" (M, 174). This cartographer's oxymoron poses a central problem for mind-mappers, who depend on the brain

to discern ambiguity even in vivid, actual particulars. The same gift is

shared by defectives, who lack concepts but can still forcefully

apprehend symbols. All are people with low IQs, unable to conduct a

broad range of mental activity, yet possessing documentary memories

that allow them to intuit grand patterns of design: "Rebecca," who sees

the face of nature, "Martin," the totality of music (he has memorized all

nine volumes of Grove's Dictionary); and the Twins, amazing

mathematical savants who cannot calculate but create their answers

through unconscious algorithms (M, 181-95).

Being a "number brooder" as a boy (M, 202), Sacks identifie

strongly with the Twins, and this connection prompts one of his mos

beautifully told stories, of playing in a mathematical trio:

After a few minutes I decided to join in, and ventured a number, an

eight-figure prime. They both turned towards me, then suddenly

became still, with a look of intense concentration and perhaps wonder

on their faces. There was a long pause-the longest I have ever known them to make, it must have lasted a half minute or more-and then

suddenly, simultaneously, they both broke into smiles (M, 203).

Proceeding through its contrapuntal exchanges, the tale climbs steadil

upward to the heights of 25-figure primes, dramatizing as it goes the ver

qualities of mind that the Twins possess: not intellect but a share

harmonic sensibility, akin to music, and experienced only when the work together, in concert-a pathos doubled by Sacks's report of the

later separation and loss of powers (M, 210).16

In the hands of an "objective" empirical narrator, The Man Who

Mistook his Wife for a Hat might seem only a collection of sideshow freaks. Sacks agrees that these patients are bizarre, for they lack th

ordinary properties of vision, memory, or muscular tone that provid

most human beings with space-and-time locators. Yet the partialness o

his patients also fulfills the physician. His impulse to tell the clinical tales

emerges from sensing "a certain doubleness" in himself, a man "equall

interested in diseases and people" (M, vii). That sense of identity clearl

rises to the surface of his closing tale of Jose, "The Autist Artist," wh

releases himself through the act of drawing, not by copying forms bu by inventing his own (M, 225). In such story-telling, Sacks sees that th

"simple" offers a gifted mind its greatest challenge: to escape the narrow

bounds of ego and explore another's realm: "Of course I do not sugges

that all autists have genius, only that they share with genius the problem

of singularity" (M, 231).

Sign Language

With each of his books Oliver Sacks has grown increasingly self-

referential, until in Seeing Voices (1989) he faces a writer's ultimate con-


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cern, the nature of language. His most speculative work, Seeing Voices

deliberately explores a field of medicine where he lacks clinical authority. Although most of his writing derives from a personal journal, his text is

journalistic, consisting of two pieces for the New York Review of Books

and a central essay on the nature of language. The result is not seamless,

for Sacks has returned to his practice of inserting long, discursive

footnotes throughout the text. The arrangement produces a meandering

stream of thought and afterthought, often less focused than the notes in

Awakenings and lacking the strong portraiture of his clinical tales. In a

review of Seeing Voices, novelist Paul West assailed it as "a ramshackle

job" that still "has its heart in the right place." But Sacks believes in his

method, which he sees as preserving the course of intellectual discovery:

"you must see it as a deliberate strategy, and not a consequence of mere

laziness or carelessness or distraction."'7

The central subject in Seeing Voices is language, viewed partly

from the perspective of neurology, with its tendency to see words as

measuring the "plasticity and symphony" of the nervous system (S, 26).

But Sacks's study is of how the deaf acquire language,unaided by aural-

oral clues, and their "deprived" condition reveals (as did the Simples)

how in medicine absence constitutes a curious presence. A pure abstrac- tion, language creates thought and knowledge through systematic sym-

bols that also form their perceiver's identity. Recognizing a fundamental tautology, that we cannot define thought or language independent of their

forces (S, 73), Sacks sees in the deaf an opportunity to slip that barrier

and explore how words provide the basis for identifying an inner, mental reality: "What is naming for? It has to do, surely, with the primal power

of words, to define, to enumerate, to allow mastery and manipulation;

to move from the realm of objects and images to the world of concepts

and names" (S, 48). His secondary proposition is that language defines "our human

estate and culture" (S, 8), since we receive it from parents and can only

sustain it through constant interchange or transaction with others. In the ecology of mind, language is the energy cycle that flows to, through, and

from an environment. Hence children must acquire words at a critically

early stage of development, between the ages of three and ten (S, 83).

If they remain "dumb" their existence is also a blank, trapped in an "unworld" of silence as "nonpersons" (S, 18, 39). Sacks here expresses

a scientist's positive faith in the ability of language to order existence and

make "sense" of the world, an idea now under vigorous attack by post-

Structural theorists. As a writer he believes in the inherent structure of

language, the grammar and syntax that allow him to describe, re-

organize, and reason about the world's possibilities (S, 67, 74). For him

language is not merely an arbitrary formal device, but "the most exact

expression of our thoughts, our aspirations, our view of the world" (S,

119). His response to Derrida is therefore implicitly genial; indeterminacy

lies not in language but in conflicting discourses (S, 109).

In Seeing Voices Sacks chooses once more to frame this conceptual matter in a sequential narrative, as indicated by his sub-title, A Journey

Into the World of the Deaf. This time neurology and cartography have


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acquired a third discipline, anthropology. By exploring the deaf "world,"

Sacks's journey recounts both his education and introduction to a new

ethnic culture. The deaf lead him toward phenomenology and ethnology,

for in learning to "read" their conditon he moves from a medical to a

cultural diagnosis, seeing "a community with a complete language and culture of its own" (S, 127). In other words, the deaf are themselves a

Sign he must decipher, and this experience provides yet another

awakening to his own identity, the cantor/bard who wanders afar, singing in reasoned eloquence: "They were no longer just individuals,

with an individual's plights or triumphs; they were a people, with their

own culture, like the Jews or the Welsh" (S, 137).

What Sacks learns has been told by others, that after centuries of

enduring fruitless attempts to learn speech or signed phonics, the deaf

have regained Sign as an indigenous language, one that is abstract,

symbolic, and three-dimensional (S, 87). The implication of this history

may be that Sign is humanity's first language, an active, iconic form of

expression that promoted speech, with its emphasis on abstraction and

metaphor (S, 120). By suggesting this path, Sacks also justifies the shape

of his own journey. Beginning as a novice, he gradually reaches a point

of view from within Sign, by acquiring its language in the first two chapters, and then in the third depicting a paradoxical epiphany at

Gaudallet College: isolated in a sea of signing students, he grasps their

isolation from the hearing world: "There is conversing everywhere, and

I can understand none of it; I feel like the deaf, the voiceless one today-

the handicapped one, the minority, in this great signing community" (S, 132). As in his previous works, this process yields a vision of "a unanimous,

the calm strength of union" (S, 133-34), the ecology

communal mind

of health that sustains patient-doctor transactions. But in this story Sacks is not a physician, obedient to the calm logic

of diagnosis; instead he is an outsider with collaborators-a normal role

for journalists, but unsettling to a scientist (S, xii-xiii). By daring to enter

that world and experience it as a novice, Sacks has departed from his

early stance of authority. This shift tends to make Seeing Voices a partial work, which examines the origin of writing's tools, but only occasionally

from a neurological perspective (S, 103). Although thematically consis-

tent with his previous studies of impaired minorities (S, 136), in form this

account is often repetitious in the extreme, achieving in its long part II

the effect of litany and never integrating all three parts. The book seems less a serial journey than a broken set of signs, offered with great enthu-

siasm by a recent learner: "And when Klima and Bellugi themselves

turned to the study of Sign, in 1970, they had the feeling of virgin soil,

of a totally new subject (this was partly a reflection of their own

originality, the originality that makes every subject seem totally new)"

(S, 142).

Yet originality does not fully animate his narrative. Few stories

accompany the expository development, so that the book wavers be-

tween essay and reportage, some of it bent on popularizing intellectual

work (S, 92), and some quite the reverse, intellectualizing an episode of

popular dissent (S, 125). Equally troubling are the frequent notes, many


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of them lucid and passionate, Sacks's own "signs" of comprehension and

involvement, yet vexing because they break the reader's journey into

staccato, tic-like fits and starts. Some might have been omitted, on the

grounds of obscurity or self-evidence (S, 51, 90), while others could well stand in the main text, where they offer fine narrative detail or dramatic history (S, 130). Like one deaf writer's memory of youth, they "thirst for

connection" (S, 117), gropings toward expression instead of fully

rendered thoughts.

Despite their unpopularity with some readers and editors, Sacks

regards his annotations as necessary-hence he has added 20 more

footnotes to the 1990 edition of Seeing Voices. His defense of this practice

leans on both scientific and artistic rationales. In his many editions, he

leaves the text untouched and then adds generations of notes, "because my writing (and thinking) is like a palimpsest." That is also a standard

clinical procedure, as physicians "work up" notes on patients through

multi-layered, serial commentary. Yet a deeper motive is Sacks's desire

to preserve in his writing a sense of colloquy, the play of mind upon the margins of original text:

I have rather strong feelings about holding the integrity and movement

and form of the text, and holding its voice, unimpeded, uninterrupted,

undistracted, and as originally written. And yet I want to give expression

to the profusely (and sometimes chaotically!) flowering afterthoughts

I always have

simplicity of the original text without putting these afterthoughts


I know no way of preserving the tight flow and

The source of this conviction possibly lies in his personal journals, where

the narrative is spontaneous and autonomous, yet also monitored by the frequent addition of later commentary, no doubt penned in all available


Transforming this inchoate matter into print always entails risks.

Faced with describing how he learned about the learning of Sign, Sacks

recognizes that successful tuiton rises from active exchange, as many

mothers know: "Some talk with their youngsters and participate primarily

in dialogue; some primarily talk at their children" (S, 65). Missing

from Seeing Voices are the sessions of talking with patients, the dialogues

that inform his previous narratives, shape them with the lessons that

powerful mentors give to others (S, 68). Certainly, he does bear witness

to his own acquisition of "the world" of the deaf, moving from outer

to inner recognition of their particular speech and sign system. That

account is touching but also alien, for it asks readers to share an advocate's passion for a complex, deeply codified system of notation, yet never fully imparts his pleasure in that passion. Oliver Sacks's journeys as a writer are far from over, for he is now well launched on opening science to readers who need to grasp its energy

and many contingencies. In his literary response to the classical and

romantic paradigms for science, he has looked for ways to express past

and future, logic and emotion, series and flow, within narrative forms.


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His more successful works have recounted the process of discovery that

rises from relations with patients, through intense Socratic dialogues. He

stumbles when caught in isolation, on unfamiliar ground, and without

a set of cases to present. Patients have always represented to him the

opportunity to establish a full ecology of healing, a view that emphasizes dynamic exchange, recurring cycles, the balance and integrated harmony

of health. Anatole Broyard aptly praises Sacks for this genius: "He

reconciles afflicted people to their environment."'9 Writing is clearly his best means to that end, for it unites his native cultures of art and science:

"The essential thing is feeling at home in the world, knowing in the depths

of one's being that one has a real place in the home of the world" (A,


Princeton University


1. Abbreviated references to Oliver Sacks's writings are:

Mi Migraine (Berkeley: University of California Press, 1970, rev


Awakenings (New York: E. P. Dutton, 1974, rev. 1983).


A Leg to Stand On (New York: Summit Books, 1984).

M The Man who Mistook his Wife for a Hat (New York: Harper,

S Seeing Voices (Berkeley: University of California Press, 1989

2. C. P. Snow, Two Cultures and a Second Look (Cambridge: Ca

University Press, 1969), p. 33.

3. See Sherman Paul, "The Husbandry of the Wild" and E. Fred Carlis

Literary Achievement of Loren Eiseley," in Essays on the Essay: Re

the Genre, ed. Alexander J. Butrym (Athens: University of Georgi

1989), pp. 168-91.

4. John Tallmadge, "From Chronicle to Quest: The Shaping of

Voyage of the Beagle," Victorian Studies 23 (1980), 324-45. As Oliv

notes, Darwin's autobiography reports that his early imagina

formed through literature, art, and music; while science later tur

mind into "a machine for grinding general laws out of large collec

fact" (A, 254).

5. R. Lane Kaufmann, "The Skewed Path: Essaying as Unmeth

Method," in Butrym, pp. 221-40. See also Alexander Butrym's pref

1-7), which notes that essays by their indirection encourage readers

formal boundaries.

6. James Watson, The Double Helix (New York: Atheneum, 1968), p. 189.

7. Lewis Thomas, "Humanities and Science," Late Night Thoughts on

Listening to Mahler's Ninth Symphony (New York: Viking, 1983), 255-56;

opinions echoed in Heinz R. Pagels, The Dreams of Reason (New York:

Bantam, 1988); an optimistic account of how "complex sciences" may

humanize culture. Two other examples of recent "literary science" are Tracy Kidder, The Soul of a New Machine (1981), and Richard Preston,

First Light: the Search for the Edge of the Universe (1988). For background

on ecology, see Donald Worster, Nature's Economy: A History of

Ecological Ideas (Cambridge: Cambridge University Press, 1985).


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Susan Sontag, Illness as Metaphor (New York: Farrar, Straus, & Giroux,

1978), p. 8. Literary journalists writing on medicine include Susan Sheehan,

Is There No Place on Earth for Me? (1982), on schizophrenia and sedatives; Mark Kramer, Invasive Procedures (1984), on surgery; and John McPhee,

Heirs of General Practice (1986), on family medicine. For a survey of recent

medical writings, see Anatol Broyard, "Good Books About Being Sick," New York Times Book Review (April 1, 1990), 1, 28-29.


Brom Anderson, "Two Healers," Yale Review 77 (March, 1988), 172.


"The Origin of 'Awakenings,"' British Medical Journal 287 (December,

1983), p. 287. One consequence of fame is the popular press interview. See

Holly Brubach, "Talking to Oliver Sacks," Vogue (November, 1987), 230-


11. For a textual history of Awakenings, see its "Select Bibliography" (A, 320-

23). Oliver Sacks supplied other bibliographical details in letters to W.

Howarth, May 13-15, 1990.

12. Debra Journet, "The Role of Narrative in Neurological Case Histories:

Oliver Sacks and A. R. Luria," paper delivered at Modern Language

Association annual meeting; December, 1987.


Franz Hefti and Eldat Melamed, "L-DOPA's Mechanism of Action in Parkinson's Disease," Trends in Neuro-Sciences (October, 1980), 230a.


Another tribute was imitation: see Harold Pinter's Some Kind of Alaska

(1982), a play directly inspired by Awakenings.


"Shot in the Dark," Newsweek (February 25, 1963), p. 88.


In his film Rain Man (1989), screen writer and director Barry Levinson

adapted several elements of the Twins' story to create Raymond Babbitt,

an autistic savant gifted with mathematical powers.


Paul West, "Say it with Signs," New York Times Book Review (September

17, 1989). Oliver Sacks, letters to W. Howarth, April 13-15, 1990; quoted

by permission.


Sacks, letters to W. Howarth, April 13-15, 1990; quoted by permission.


Broyard, 28.



With the assistance of a grant from the NEH, the Cente

Advanced Studies of the Americas in Seville, Spain, anno

postdoctoral fellowships, each for a minimum of four and m six months, for projects in all fields of colonial Latin Ameri

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Fellows must reside in Seville between April and Octob

Application deadline: January 1, 1991. For information, cont

for the Advanced Study of the Americas, Columbian Quinc

Committee, 322 Dulles Hall, Ohio State University, Colu



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