1 An Anthropologist on Mars SEVEN PARADOXICAL TALES Oliver Sacks Copyright © 1995 ISBN 0679437851 2 To the seven whose stories are related here The universe is not only queerer than we imagine, but queerer than we can imagine. J . B. S. Haldane Ask not what disease the person has, but rather what person the disease has. (attributed to) William Osler 3 Contents Acknowledgments 5 Preface 7 The Case of the Colorblind Painter 10 The Last Hippie 33 A Surgeon's Life 51 To See and Not See 66 The Landscape of His Dreams 88 Prodigies 108 An Anthropologist on Mars 143 Selected Bibliography Contents Acknowledgments 4 Acknowledgments First, I am deeply grateful to my subjects: "Jonathan I.," "Greg F.," "Carl Bennett," "Virgil," Franco Magnani, Stephen Wiltshire, and Temple Grandin. To them, their families, their friends, their physicians and therapists, I owe an infinite debt. Two very special colleagues have been Bob Wasserman (who was my co-author onthe original version of "The Case of the Colorblind Painter") and Ralph Siegel(who has been a collaborator in other books)-we formed a sort of team in thecases of Jonathan I. and Virgil. I owe to many friends and colleagues (more than I can enumerate!) information, help, and stimulating discussion. With some there has been a close, continualcolloquy over the years, as with Jerry Bruner and Gerald Edelman; with othersonly occasional meetings and letters; but all have excited and inspired me indifferent ways. These include: Ursula Bellugi, Peter Brook, Jerome Bruner, Elizabeth Chase, Patricia and Paul Churchland, Joanne Cohen, Pietro Corsi, Francis Crick, Antonio and Hanna Damasio, Merlin Donald, Freeman Dyson, GeraldEdelman, Carol Feldman, Shane Fistell, Allen Fur-beck, Frances Futterman, Elkhonon Goldberg, Stephen Jay Gould, Richard Gregory, Kevin Halligan, LowellHandler, Mickey Hart, Jay Itzkowitz, Helen Jones, Eric Korn, Deborah Lai, Skipand Doris Lane, Sue Levi-Pearl, John MacGregor, John Marshall, Juan Martinez, Jonathan and Rachel Miller, Arnold Modell, Jonathan Mueller, Jock Murray, KnutNordby, Michael Pearce, V. S. Ramachandran, Isabelle Rapin, Chris Raw-lence, BobRodman, Israel Rosenfield, Carmel Ross, Yolanda Rueda, David Sacks, MarcusSacks, Michael Sacks, Dan Schachter, Murray Schane, Herb Schaumburg, SusanSchwartzen-berg, Robert Scott, Richard Shaw, Leonard Shengold, Larry Squire, John Steele, Richard Stern, Deborah Tannen, Esther Thelen, Connie Tomaino, Russell Warren, Ed Weinberger, Ren and Joasia Weschler, Andrew Wilkes, HarveyWolinsky, Jerry Young, Semir Zeki. Many people have shared their knowledge and expertise in the field of autismwith me, including, first and foremost, my good friend and colleague IsabelleRapin, Doris Allen, Howard Bloom, Marlene Breitenbach, Ginger Clarkson, UtaFrith, Denise Fruchter, Beate Hermelin, Patricia Krantz, Lynn McClannahan, Clara and David Park, Jessy Park, Sally Ramsey, Bernard Rim-land, Ed and RivaRitvo, Mira Rothenberg, and Rosalie Winard. In relation to Stephen Wiltshire, I must thank Lorraine Cole, Chris Marris, and above all, Margaret and AndrewHewson. I am grateful to innumerable correspondents (including the now-unknowncorrespondent who sent me a copy of the 1862 Fayetteville Observer), some ofwhom are quoted in these pages. Many of these explorations, indeed, startedwith unexpected letters or phone calls, beginning with Mr. I.'s letter to mein March 1986. There are places, no less than people, that have contributed to this book, byproviding shelter, calm, stimulation. Foremost among them has been the NewYork Botanical Garden (and especially the now- dismantled fern collection), myfavorite place for walking and thinking; the Lake Jefferson Hotel and itslake; Blue Mountain Center (and Harriet Barlow); the New York Institute forthe Humanities, where some of the testing of Mr. I. was done; the library atthe Albert Einstein College of Medicine, which has 5 helped me track down manysources; and lakes, rivers, and swimming pools everywhere- for I do most of mythinking in the water. The Guggenheim Foundation very generously supported my work on "A Surgeon's Life" with a 1989 grant for research on theneuroanthropology of Tourette's syndrome. Earlier versions of "The Case of the Colorblind Painter" and "The Last Hippie" were published in The New York Review of Books, and of the other casehistories in The New Yorker. I have been privileged to have worked with RobertSilvers at the NYRB, and John Bennet at The New Yorker, and the staff of bothpublications. Many others have contributed to the editing and publication ofthis book, including Dan Frank and Claudine O'Hearn at Knopf, Jacqui Graham atPicador, Jim Silberman, Heather Schroder, Susan Jensen, and Suzanne Gluck. Finally, someone who has known all the subjects in this book, and has helpedto give it impetus and shape, has been my assistant, editor, collaborator, andfriend, Kate Edgar. But to return to where I started-for all clinical studies, however widely theyadventure, or deeply they investigate, must return to the concrete subject, the individuals who inspired them, and whom they are about. So to the sevenpeople who have trusted me, shared their lives with me, given so deeply oftheir own experience-and who, over the years, have become my friends-I dedicate this book. 6 Preface I am writing this with my left hand, although I am strongly right-handed. Ihad surgery to my right shoulder a month ago and am not permitted, not capableof, use of the right arm at this time. I write slowly, awkwardly-but moreeasily, more naturally, with each passing day. I am adapting, learning, allthe while-not merely this left-handed writing, but a dozen other left-handedskills as well: I have also become very adept, prehensile, with my toes, tocompensate for having one arm in a sling. I was quite off balance for a fewdays when the arm was first immobilized, but now I walk differently, I havediscovered a new balance. I am developing different patterns, differenthabits& a different identity, one might say, at least in this particularsphere. There must be changes going on with some of the programs and circuitsin my brain-altering synaptic weights and connectivities and signals (thoughour methods of brain imaging are still too crude to show these). Though someof my adaptations are deliberate, planned, and some are learned through trialand error (in the first week I injured every finger of my left hand), mosthave occurred by themselves, unconsciously, by reprogrammings and adaptationsof which I know nothing (any more than I know, or can know, how I normallywalk). Next month, if all goes well, I can start to readapt again, to regain afull (and "natural") use of the right arm, to reincorporate it back into my body image, myself, to become a dexterous, dextral human being once again. But recovery, in such circumstances, is by no means automatic, a simpleprocess like tissue healing-it will involve a whole nexus of muscular andpostural adjustments, a whole sequence of new procedures (and theirsynthesis), learning, finding, a new path to recovery. My surgeon, anunderstanding man who has had the same operation himself, said, "There aregeneral guidelines, restrictions, recommendations. But all the particulars youwill have to find out for yourself." Jay, my physiotherapist, expressedhimself similarly: "Adaptation follows a different path in each person. Thenervous system creates its own paths. You're the neurologist-you must see thisall the time." Nature's imagination, as Freeman Dyson likes to say, is richer than ours, andhe speaks, marvellingly, of this richness in the physical and biologicalworlds, the endless diversity of physical forms and forms of life. For me, asa physician, nature's richness is to be studied in the phenomena of health anddisease, in the endless forms of individual adaptation by which humanorganisms, people, adapt and reconstruct themselves, faced with the challengesand vicissitudes of life. Defects, disorders, diseases, in this sense, can play a paradoxical role, bybringing out latent powers, developments, evolutions, forms of life, thatmight never be seen, or even be imaginable, in their absence. It is theparadox of disease, in this sense, its "creative" potential, that forms thecentral theme of this book. Thus while one may be horrified by the ravages of developmental disorder ordisease, one may sometimes see them as creative too-for if they destroyparticular paths, particular ways of doing things, they may force the nervoussystem into making other paths and ways, force on it an unexpected growth andevolution. This other side of development or disease is something I see, potentially, in almost every patient; and it is this, here, which I amespecially concerned to describe. Similar considerations were brought up by A. R. Luria, who, more than anyother neurologist in his lifetime, studied the long-term survival of patientswho had cerebral tumors or had suffered brain injuries or strokes-and theways, the adaptations, they used to survive. He also studied deaf and blindchildren as a very young man (with his mentor L. S. Vygot-sky). Vygotskystressed the intactness rather than the deficits of such children: A handicapped child represents a qualitatively different, unique type ofdevelopment& If a blind or deaf child achieves the same level of developmentas a normal child, then the child with a defect achieves this in another way, 7 by another course, by other means-, and, for the pedagogue, it is particularlyimportant to know the uniqueness of the course along which he must lead thechild. This uniqueness