What Book to Read?

As I said in an earlier post , my book club has decided to spend one session talking about writing on mental illness. I initially read Salley Vickers’s The Other Side of You, but came to the conclusion that though it is about a psychiatrist and his patient, it’s not really about mental illness. So I decided to read some of Oliver Sacks’s case studies. But I find that these 1994 ones aren’t really about illness either. Sacks argues that ‘Defects, disorders, diseases … can play a paradoxical role, by bringing out latent powers, developments, evolutions, forms of life, that might never be seen, or even be imaginable in their absence.’  The case studies are for the most part about latent powers; our group will need to talk about the very idea of ‘illness’.

There are seven case studies covering a range of conditions. Sacks writes about a painter who became colour blind in late middle age; a young man who became blind and lost much of his memory because of a brain tumour; a surgeon with Tourette’s syndrome; a man who, having been blind for most of his life was returned to partial sight; a painter who obsessively painted from memory the village he had lived in as a child; a boy with autism and a remarkable ability to draw; and an animal behaviour scientist with autism. It is from the last of these, Temple Grandin, that Sacks takes the title of his book. Grandin says that the difficulty she has in trying to work out the unspoken social codes by which non-autistic people live – ‘trying to figure out the natives’ – makes her feel like ‘an anthropologist on Mars’. Sacks admits that he too could be seen as an anthropologist of autism.

This is not a medical text. Dr Sacks wears his expertise lightly, though there are some phrases I had to look up, such as eidetic memory and the names of the various parts of the brain. Sacks generalises the case studies to a degree by including some medical history of each condition, some comparison with other people in similar circumstances and comments by other neuroscientists which illuminate current medical thinking and practice. There’s also a detailed bibliography with suggestions for further reading (now probably in need of updating). Sacks attempts to explain what has happened to the brain of each of these people, noting the plasticity of the brain, and the way that it can compensate for damage in one area by development in another. He suggests that there is some ‘higher level’ of consciousness, though this has not yet been mapped, that integrates other functions, like sight or memory. In these cases it does not work, or works differently from normal. I found this discussion fascinating because it is an area I know nothing about, so it was a revelation to me that colours, for example, are not ‘out there’ in the world, but, in Sacks’s words, ‘are constructed by the brain’.

But the main emphasis is on the response of each individual to their circumstances. Sacks, like many novelists, is writing about the triumph of the human spirit. He has spent time with all of the people he writes about, and considers them friends; this is the key to his writing about them. They ‘exemplify these conditions’, but ‘they are unique individuals, each of whom inhabits (and in a sense has created) a world of his own.’ Not all of the seven have been equally able to live fully with a damaged or differently functioning brain; the ‘gift of sight’, for example, proved a burden because of the near impossibility of learning to see again in middle age. Temple Grandin, on the other hand, says she would now not choose, even if she could, to be non-autistic. She has a clear understanding that she is missing out on things other people take for granted, like personal intimacy. But ‘Autism is part of who I am’. And five out of the seven have indeed achieved amazing things. The two whose lives appear – at least from the outside – unfulfilled have insurmountable problems, whereas the other five have by some combination of chance, application and endurance, managed to find ways to live productively with their condition.

All this unsurprisingly leads Sacks to question whether it may not be necessary ‘to redefine the very concepts of ‘health’ and ‘disease’, to see these in terms of the ability of the organism to create a new organisation and order, one that fits its special, altered disposition and needs, rather than in terms of a rigidly defined ‘norm’.’ This comment appears in the preface, and I wondered on reading it whether Sacks was being a bit romantic in seeing such profound disabilities as opportunities.  At the end, I could not but agree that this altered sense of reality he describes is ‘no less human for being so different.’ So you can see why I don’t think this book is really about ‘mental illness’, and why we might need a different way of talking about it. But has he picked his case studies to suit his argument?

There is a lot about Oliver Sacks on the internet – his home page is a good place to start. There is also further information about three of the people named in the case studies – Temple Grandin, Stephen Wiltshire, and Franco Magnani.