The Unreal World

Hallucinations BY Oliver Sacks. Knopf. Hardcover, 352 pages. $26.

The cover of Hallucinations

In the best chapter in Hallucinations, Oliver Sacks describes his own history of experimentation with drugs during his thirties, when he was a neurology resident in Southern California on a quest to satisfy an obsessive curiosity about the neurochemical background of dreams and hallucinations. A day on Artane, a synthetic drug allied to belladonna that in large doses can induce delirium, featured a visit from his friends Jim and Kathy. Sacks cooked ham and eggs, chatting with them as he stood in the kitchen and they sat in the living room, then put breakfast on a tray and carried it to them, only to find that they had never been there. Their presence, and indeed the entire conversation, had been “completely invented” in Sacks’s brain. Other hallucinations experienced that day included the sound of a helicopter whirring above—Sacks believed it contained his parents on a surprise visit from London—and a conversation with a spider that asked Sacks whether he believed that Bertrand Russell truly exploded Frege’s paradox. (In a fascinating footnote, Sacks observes that on the basis of this anecdote, and more particularly on the account of the spider’s “philosophical tendencies and Russellian voice,” his friend Thomas Eisner, the great entomologist, claimed to have been able to identify the particular species Sacks saw.)

Sacks’s weekend drug experimentation escalated: a cocktail of amphetamine, LSD, and cannabis let him see true indigo, a color unknown in nature, while morning-glory seeds gave him the conviction that a visitor, in actuality a psychoanalyst colleague of Sacks’s physician parents, was in fact only a replica of the woman he knew. In London, after extracting morphine from the drug cabinet in his parents’ home office and injecting it, he enjoyed a spectacular hallucination of the Battle of Agincourt on the sleeve of his dressing gown, remaining immersed in the vision for more than twelve hours; the span of time lost sufficiently alarmed Sacks that he gave up opiates altogether. In New York, he suffered acute delirium tremens after the sudden cessation of a serious chloral hydrate habit, experiencing intense hallucinations and fending off panic only by writing a clear, almost clinical account of what he saw. It was during this period that Sacks’s vocation as a writer would emerge, and the theme of writing as refuge and remedy will return in Hallucinations as a refrain.

One of the most amazing passages in the book describes Sacks’s experimentation with amphetamines. On one striking occasion, as the drug took effect, he began reading an 1873 book on migraines by the physician Edward Liveing, his absorption taking on a sublime beauty and intensity; he moved steadily through its five hundred pages, unsure at times whether he was reading or writing the volume. The book seemed to have all the richness and humanity lacking in the academic articles that constituted modern medical literature. Asking himself who might be the Liveing of the 1960s, Sacks heard a “disingenuous clutter of names”: “I thought of Dr. A. and Dr. B. and Dr. C. and Dr. D., all of them good men but none of them with that mix of science and humanism that was so powerful in Liveing. And then a very loud internal voice said, ‘You silly bugger! You’re the man!’”

That sense of vocation has since scarcely dimmed. As Sacks approaches eighty, indeed, a feeling of urgency clings to his writing, an acknowledgment of the possibility that sufficient time may not remain for him to explore the tranches of the human brain not yet mapped in his lucid prose. This pressure creates the drama of Hallucinations, such as it is. The book builds a natural history out of first-person accounts about a range of visual and aural hallucinations: the phantasms people have encountered while on drugs, on the verge of sleep, in sensory-deprivation tanks, or walking down the street. Sacks always places the highest value on the testimony of patients, but for hallucinations this tendency is especially strong, because words and testimony provide the only means of access. Unlike, say, memory loss, which usually can’t be described by the sufferer and is best documented by an observer, hallucinations are invisible and inaudible to outsiders and for the most part have to be conveyed by the person who experienced them.

Hallucinations doesn’t represent a classic example of “late style” of the kind Adorno discerned in Beethoven—alienated, defiant—or as Edward Said developed the notion, an artistic lateness conceived not in terms of resolution or closure but rather as a matter of “intransigence, difficulty and contradiction.” There is no diminishment of Sacks’s warmth, nothing sere or withered, no turn against the earlier vision of the human brain as near-endlessly able to compensate for all but the most devastating losses. But a certain textual thinning out can be discerned, at least in contrast to the copiously rich case-study approach for which Sacks is best known. Sacks’s 2010 collection The Mind’s Eye included a journal of his own experience with eye cancer, but otherwise was, like many of his previous books, organized as a gallery of portraits: a pianist who lost the ability to read music, a cross-eyed neurobiologist who gained stereoscopic vision in middle age. Hallucinations is more meandering, not as tightly focused, with chapters divided on the basis of types of hallucination (delirium, say, or night hags) rather than by individual patient. This leads to a slight damping down of Sacks’s characteristic courteous demand that the reader feel a profound empathy for each compelling individual whose story of loss and compensation he narrates.

It’s not that there aren’t gripping accounts from patients brought to life on the page in Sacks’s evocative study. One of the characters Hallucinations offers for our extended contemplation is Rosalie—blind, in her nineties, and suffering from the condition called Charles Bonnet syndrome, named after the eighteenth-century naturalist who wrote up a study of his grandfather’s hallucinations and later came to experience very similar ones himself. Rosalie sees parades of figures in what she calls “Eastern dress,” the fantastical, elaborate arabesques of her visions representing a disposition to the exotic that is characteristic of the syndrome. Another sufferer, Marjorie J., has what she calls “musical eyes,” seeing phantom musical staves—complete with clefs and notes—and also, sometimes, crossword squares. Lifelong immersion in musical scores seems to lead Charles Bonnet sufferers who are losing vision due to cataracts or macular degeneration to experience this sort of hallucination, in which the scores are “pseudo-music”—unreadable and unplayable. Elsewhere Sacks revisits some memorable moments chronicled in earlier books, including the disturbing incident described in “The Man Who Fell Out of Bed,” from the 1985 book The Man Who Mistook His Wife for a Hat, in which a patient with a parietal-lobe tumor tries to kick his own left leg out of bed under the mistaken impression that someone has placed a cold cadaver limb beside him as a practical joke. Sacks also remines the episode in which he lost the body image of his own left leg following a bad accident (the matter of his autoethnographic 1984 memoir A Leg to Stand On).

The first-person experiences of doctor as patient are part of what has always given Sacks’s writing its peculiar humanity, but over the past decade he has turned an even more sustained and persistent attention to his own experiences. Those partial revelations give this book considerable poignancy. Partial, because although Sacks’s personal experiences are strongly present in his writing, the term “personal” may be something of a misnomer. His 2001 memoir Uncle Tungsten: Memories of a Chemical Boyhood only glances at many of the things that commonly form a point of autobiographical obsession, and in general Sacks has written strikingly little about the sexual aspects of the mind’s development, his own and that of others. Uncle Tungsten offered a tantalizing glimpse of weirdness in its depiction of the author as a scientifically inclined and acutely shy fourteen-year-old, being given access (by a friend of his surgeon mother’s, and at her instigation) to a teenage female cadaver for dissection. One of the most intimate moments in that memoir underlines the intensely solitary nature of the course Sacks has mapped out for himself. It is a description of experiencing his first orgasm while floating on a corkboard in a Zurich swimming pool as a young teenager (water is Sacks’s preferred medium, and he is a passionate lifelong swimmer): “It did not occur to me to connect this with ‘sex,’ or other people; I did not feel anxious or guilty—but I kept it to myself, feeling it as magic, private, a benison or grace that had come upon me spontaneously, unsought. I felt as if I had discovered a great secret.”

As in Uncle Tungsten, the play of revelation and reticence in Hallucinations is hugely attractive. It is perhaps precisely the impersonal quality of Sacks’s temperament, his deep privacies and resolute withholdings, that facilitates that extraordinary humanity, that loving curiosity about the experiences of other people, that near-magical ability to see how even the most seemingly devastating losses may be remedied by the mind’s remarkable powers of compensation. In this sense, Hallucinations is no more or less mystical than any of Sacks’s previous volumes. His case studies have always been haunted by the numinous. On the book’s final page, when Sacks considers how the “sensed presence” that may have evolved as a way of detecting threats can become the basis of a profound religious belief, he makes the empiricist point that biology may produce a feeling of religious passion. Like many of the observations in Sacks’s book, this one is couched so modestly and so gently that it seems not reductive but transcendent, the dependence of belief on biology representing one more example of the remarkable grace to be found in the operations of the human mind.

Jenny Davidson teaches in the department of English and comparative literature at Columbia University. Her novel The Magic Circle will be published in 2013.