Oliver Sacks's not quite nonfiction

Oliver Sacks was once crowned “the poet laureate of medicine” — he's known as one of the greatest science writers of our time. But when New Yorker writer Rachel Aviv dug into his archives, she discovered that some details in his intimate portraits of patients mirrored his personal life a little too closely. Guest: Rachel Aviv, staff writer for the New Yorker and author of Strangers to Ourselves. For show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And please email us! ⁠⁠⁠[email protected]⁠⁠⁠ We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices

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• 1:20Speaker 02

  I recently sat down with one of my favorite writers.

• 1:23Speaker 03

  I'm Rachel Aviv and I'm a staff writer at The New Yorker.

• 1:26Speaker 02

  But I called her up to talk about a different writer.

• 1:30Speaker 03

  I think I remember the first story I pitched for The New Yorker. I tried to make it clear, like, don't worry, I'm not trying to do an Oliver Sacks piece because I didn't want them to think that I was daring to compete. I really admired his ability to just delve deeply into the inner life of one person.

• 1:50Speaker 02

  The late neurologist and bestselling author, Oliver Sacks. He's been referred to as the poet laureate of medicine.

• 1:58Speaker 03

  He was sort of like almost the figurehead for medical humanities in a way, like this idea that we have been focusing too much on symptoms and data and that there is a human life behind all of this information.

• 2:13Speaker 02

  Oliver Sacks did something kind of wild for his time. He was a medical doctor who wrote intricate stories about the inner lives of his own patients.

• 2:24Speaker 03

  I do remember being in my early twenties, reading a piece he'd written about a man who was blind and was sort of grappling with the possibility of regaining his sight. I loved how he was focused on one person, sort of one person's journey. He was so focused on the inner life of this person and that it was so textured. Kind of was like, how did he know those details? How did he know that that man was thinking that?

• 2:52Speaker 02

  Maybe the best example of one of these stories is from the book Awakenings, which he published in the early 1970s. He writes about spending 15-hour days at a hospital with a group of patients suffering from a disease called encephalitis lethargica, a sickness that left them catatonic, basically asleep while awake.

• 3:15Speaker 03

  Patients that no other doctors were really paying attention to and kind of developing a wordless rapport with people that were really easy to dismiss as sort of not fully cognizant. And he spent so much time with them that he was able to sort of detect that they were not comatose in the way that other people thought they were.

• 3:39Speaker 02

  That book was adapted for the screen and became an Academy Award nominated film. It starred Robert De Niro as a patient named Leonard and Robin Williams, who played a fictional Oliver Sacks. Towards the end of the movie, he gives a speech about the awakening of the human spirit.

• 3:57Speaker 04

  That the human spirit is more powerful than any drug. And that is what needs to be nourished. With work, play, friendship, family. These are the things that matter. This is what we've forgotten.

• 4:30Speaker 04

  The simplest things.

• 4:33Speaker 02

  Basically, he meant, human connection could somehow awaken the spirit beyond medical care alone.

• 4:44Speaker 02

  Late last year, Rachel wrote a huge magazine story about Oliver Sacks for The New Yorker.

• 4:50Speaker 03

  I became aware that Oliver Sacks had this enormous archive.

• 4:55Speaker 02

  An archive of diaries and letters that Sacks had kept over decades. He documented not just the lives of other patients, but his own experience as a patient in therapy. Rachel got in touch with his foundation and got permission to take a look.

• 5:13Speaker 03

  I was like, how is this possible that this amazing man was in therapy for 50 years? Like, what does a half-century psychoanalytic process look like? I was just like, this man is so articulate about other people's psychic lives, or what is happening in the therapeutic process? And how much can someone change in 50 years of therapy? Like, how far does self-knowledge go?

• 5:37Speaker 02

  Today, we're going to follow Rachel Aviv's journey through the life of one of the most famous science writers of our time, a profile of a man known for his truth-telling in medicine, who Rachel discovered bent the truth.

• 5:51Speaker 03

  In his journals, he would just sort of reflect on what he had done and try to make sense of it. And he would sort of think through, like, art is the lie that tells the truth. Am I doing art, or have I crossed a line?

• 6:04Speaker 02

  I'm Amy Padula. This is Unexplainable.

• 6:23Speaker 02

  So for all of Oliver Sacks's writing about the super intimate details about the lives of patients, he didn't share much about his own life with the public for most of his career. In a 2002 interview, he said that his severe shyness, which he described as a disease, had been a lifelong impediment to his personal relationships. And for most of his life, he lived alone. What were some of the most surprising... Anecdotes or sort of things you learned about what was going on for him in his personal life.

• 6:57Speaker 03

  One of the most amazing sets of correspondence that I read was Sacks's letters to this man who lived in Berlin at the time. And they had met in Europe. They'd had this like whirlwind romance. And then Sacks moved to New York.

• 7:15Speaker 02

  After a couple of weeks, Sacks went back home to New York City and the two start writing to each other.

• 7:20Speaker 03

  And then their entire affair took place in these letters. And they were just like thrilling letters. Each one, it was like Sacks was trying to outdo himself to find new expressions of like the intensity of his love and his sense that he was merging with this man. And that for the first time in his life, he felt at peace with being a gay man. He was seeing the world through new eyes.

• 7:49Speaker 02

  Sacks wrote about these intense feelings. There's a line that describes his happiness. I wonder if you could recall it.

• 7:56Speaker 03

  My blood is like champagne. And then two weeks passed in which he didn't get a letter from this man. And suddenly like all of Sacks's kind of euphoria turned in on him. And he started to think like, I was delusional, like I was part of a two man delusion. Like this was never love. I'm always going to be alone and I always have.

• 8:17Speaker 02

  The man eventually wrote to apologize, but for Sacks, the damage was done.

• 8:24Speaker 03

  And he was like, yeah, this is the truth. I will be in a spiritual cell for my entire life. And he finally just completely cut off the relationship with this man and then began to feel suicidal, which led to him beginning therapy for the next 50 years.

• 8:43Speaker 02

  After that early relationship, Sack suffered. He couldn't make friends. He couldn't connect with people. He became celibate and wrote obsessively.

• 8:54Speaker 03

  Some of his correspondence with other gay men in the 50s and 60s and 70s and even 80s, like the sort of anguished state of being a gay man at that time. I think it's easy to almost forget how excruciating it was then. And so many of the people he was corresponding with, they would be like testing the waters to see if they could reveal to the other one that they were gay. There was so much sort of self-hate and sort of tortured conversation around it. 30, 40 years ago, felt really alive in his letters as well as his journals. Just the sense of like self-punishing, self-hiding experiences.

• 9:39Speaker 03

  I could see how he was sort of expressing a feeling of stuckness in life.

• 9:45Speaker 02

  Was there a moment in the reporting where you started to realize that his personal life was seeping into the work?

• 9:52Speaker 03

  So I had read many of his letters. I went back and I did a lot of rereading because it was like the first time I read everything. I didn't know what I was looking for. And then there would be times, like at one point I was rereading Awakenings. And I remember reading one of the patients describing her blood as being like champagne, which was striking because I, you know, that's the phrase he'd used in his letters to this lover from Berlin. So there were just these kinds of, it was almost like rhymes between his own descriptions of himself and his descriptions of his patients.

• 10:25Speaker 02

  One of the most striking rhymes that she found had to do with a particular poem by Rilke. The poem is about a panther who feels trapped, caged. Where had you seen that poem before?

• 10:38Speaker 03

  It was in his letters to describe how he felt when he was trying to write his first book about migraines. And I just remembered that phrase. And then I searched through my notes and I saw another reference where he had also used that phrase in a letter to his therapist. So it was clearly an important poem for him and his own self-conceptualization in these moments of crisis.

• 11:01Speaker 02

  The poem evoked something similar to the way Sacks was feeling in his journals, about not being able to express his sexuality in his personal life, not being able to connect.

• 11:13Speaker 03

  And then I was reading Awakenings, and I was reading the chapter about Leonard, who's sort of the star of the book.

• 11:20Speaker 02

  Leonard, played by Robert De Niro in the movie adaptation, suffers from a sleeping sickness. He lives in a sort of trance-like state. Sacks gave patients like Leonard a drug called L-dopa, which changes the brain's dopamine levels. In his book Awakenings, Sacks writes that Leonard would spell out answers to questions that Sacks asked him because he couldn't speak.

• 11:44Speaker 03

  I just noticed that he said that Leonard typed out on this, like, typing board, that he felt like the panther in Rilke's poem.

• 11:54Speaker 02

  In the movie adaptation, Robin Williams, as Oliver Sacks, reads that poem.

• 11:59Speaker 05

  His gaze from staring through the bars has grown so weary that it can take in nothing more. For him, it is as though there were a thousand bars, and behind the thousand bars, no world. As he paces in cramped circles, over and over.

• 12:21Speaker 03

  I thought, like, that's a strange coincidence that his patient would happen to sort of cite this poem that had been so meaningful to Sacks. And then I became kind of more attentive to those moments.

• 12:37Speaker 02

  What was going through your mind as you saw these rhymes, as you put it, play out? Was there any betrayal you felt as a reader, seeing this kind of, like, appear in the records?

• 12:50Speaker 03

  Yeah, I mean, I think that made me feel like, OK, well, I can't trust that any particular detail is true.

• 12:59Speaker 02

  Did Oliver Sacks know he was fabricating things?

• 13:02Speaker 03

  Yeah. It was really reading the journals, after I had been reading them for a couple of months, when I just read a passage where he straight out says, you know, I feel like so, I can't remember the exact phrasing, that he's feeling this sense of criminality and that he feels so guilty for making things up.

• 13:22Speaker 03

  I would say that a man who mistook his wife for a hat had a lot of fabrications in it. That book then made him extremely famous. And I think he felt a lot, like much of the guilt that he expresses in his journals is about that particular book. But like, the strange thing is, when that book was about to be published, he wrote his brother and said, like, you might call these confabulations. They're sort of half story, half fable, half made up. He was pretty open about the status. So I don't know what happened in the publishing process. Somehow, these were taken as like, case studies that were supposed to be straight fact. And he seemed pretty clear early on that that's not what they were, at least to himself.

• 14:04Speaker 03

  But suddenly, it became wildly famous and he became this huge figure. Sacks himself says, like, "This was my most flagrant fabrication." And it involved these two twins who had autism, who were institutionalized. And Sacks said that they were like exchanging prime numbers up to, I think, 20 digits. And that finding got a lot of attention because like, no one had known this to be a human capacity. And so psychologists and mathematicians had written about this with some really defending, like, the importance of this finding. And so that felt really like a space where a case study had actually like, had an impact

• 14:47Speaker 03

  on people's understanding of human capacities. So I think I tend to agree with Sacks that that was the most flagrant moment or transgression.

• 14:59Speaker 02

  Rachel's magazine story came out in December of last year, and it got people talking.

• 15:05Speaker 03

  I did see people on the internet, like, putting on, putting their own headlines on the piece and sort of making it all about, you know, "He fabricated." That kind of felt sad to me because that didn't feel like, if I wanted it to be more complicated than just, "Oh, let's dismiss Oliver Sacks, he was making stuff up."

• 15:26Speaker 02

  We'll be back after a short break.

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• 18:45Speaker 06

  Is this Karen Eifler?

• 18:46Speaker 02

  Yes.

• 18:47Speaker 06

  My name is Harold Crick. I believe you're writing a story about me.

• 18:52Speaker 02

  You talked about how some of the comments that you saw in your piece, the sort of TLDR headline, "Sachs fabricated stuff," which is true. But you also said that was frustrating. And I'm wondering why.

• 19:07Speaker 03

  Something interesting happened where I couldn't like tell you quite who or what, but I felt like there was a contingent of like anti-science people on social media. It almost was like, oh, look, this sort of liberal darling of science fabricated things. Like, "Science is a sham." I guess I also just felt like the takeaway of my story, I did not want it to be just, "Oh, my God, let's like throw Sachs out the window. He fabricated things." And so that seemed like there was some of that going on, and I was sad about that. But like, it's within this like much larger context of like one man's sort of struggle, you know, during the time

• 19:52Speaker 03

  when he was fabricating a lot of other sort of literary stars were doing similar things. So it's also within a historical context. But yeah, I think there are moments in which, to me, it was almost the projection that was most striking, like taking phrases that he used to describe his own angst and sort of putting it onto his patients.

• 20:18Speaker 03

  I guess I wanted to think about how those fabrications or those sort of exaggerations feel revealing of dynamics in the way we respond to this kind of writing, in the way that other people respond to it, and the kind of expectations we have for like, what empathy as a writer looks like.

• 20:40Speaker 03

  I think it's more about this genre of writing that he inspired, this sort of telling tales about illness that are kind of supposed to inspire or show you like the secret gift of your illness. I think like, if anything, I would want it to inspire like more kind of thinking about the relationship between like a writer and a subject, and particularly a sort of doctor and the patient subject, and how much of ourselves we bring on to that encounter, sometimes without realizing it, sometimes.

• 21:15Speaker 02

  Do you know how any of his patients felt about his rendering of them?

• 21:20Speaker 03

  Leonard's family loved him. They didn't necessarily think the book was all accurate, but they were just so grateful for the time and the care that he had put into that relationship. Like, the family said that Leonard and his mother just adored him. And the other patients I talked to as well really adored him. They didn't fundamentally care, you know, about like how they were written about in this book. What they cared about was that there was this doctor who was like sitting with them for hours, trying to understand them and making them feel, you know, like that they were someone who had a story to tell.

• 21:58Speaker 02

  A huge part of Sacks's life that Rachel's story eliminates was his ongoing struggle with his sexuality. After that early relationship in Berlin, he lived unhappily closeted and celibate for decades. You unpack some of his battles in therapy and how some of that was getting worked out in the writing. At one point in the piece, you suggest that Sacks spent much of his life searching for love. He once wrote, "We spend our lives searching for what we have lost, and one day, perhaps, we will suddenly find it." I just wonder what you make of that as you were sort of seeing these patterns crop up in the work.

• 22:35Speaker 03

  I mean, that idea that in therapy you're like working through. I like that phrase, working through, because I think like probably most writers choose subjects to some degree because they're working through ideas that are like important or problematic to them. And then they sort of displace it on to these other subjects where they're working through. And it felt like he was like rehearsing this narrative, which was someone who is trapped in this cell, this sort of spiritual cell, this sense of being in a cage, suddenly is kind of released and has this awakening. And many of his stories have that arc.

• 23:19Speaker 03

  And so then it was striking to see.

• 23:23Speaker 03

  I mean, it was, it was almost like the longed for outcome that he keeps sort of playing out in his work.

• 23:33Speaker 02

  Do you think about what you do as a reporter any differently after learning about sort of how Sacks identified with his subjects? Do you think differently about what you do at all?

• 23:46Speaker 03

  I think it was like part of a, like a longer conversation with myself. As I age as a writer, my curiosities change and my identifications change. And so therefore, like when I'm writing a story about a family, for instance, like I'm going to, I might actually change the kinds of questions I'm looking at because of where I am in life. Or I find that I'm often like writing about people with complicated relationships to work. And that's because I'm, there's a question I have about my own relationship to work. Or so, yes, I think like writing is always a kind of working through. And in a way, I think that if it's not a working through, it's less rich.

• 24:30Speaker 03

  Like if you're writing about something about which you have no sort of unsettled questions and curiosities, then, then the writing can be flatter for it. So I think you do want some of that kind of like identification and projection energy. But it can be taken way too far and too far in unethical ways and in really problematic ways. So it feels like a subject.

• 24:54Speaker 03

  That does have stakes in my life and in sort of any kind of writing.

• 24:58Speaker 02

  He was a physician treating them and a writer observing them. And I wonder if if anything came up for you in terms of like that split role.

• 25:09Speaker 03

  Yeah, I mean, I think there were some like problematic like RD Lang type stuff going on where like it's like RD Lang is the psychiatrist who kind of wanted his patients with psychosis to like, it was almost like he was bringing their psychosis to full fruition so that he could gain more insights about the nature of madness. And Sacks actually writes about that too, that kind of guilt that like some of his patients with Tourette's Syndrome, he would like want their tics to reach sort of tic as to become floridly symptomatic essentially, because he felt like in that process, he as a writer and the researcher was sort of gaining more insight into the nature of the disease.

• 25:54Speaker 03

  And I think he like told himself that that could be good for the patient while also sort of realizing it was fundamentally like, you know, helping his project.

• 26:08Speaker 02

  After he had become famous for books like Awakenings and The Man Who Mistook His Wife For A Hat, Sacks did this interview in 1989 with a reporter from PBS.

• 26:19Speaker 07

  A hundred years from now, how would you like to be remembered?

• 26:22Speaker 06

  I would like it to be thought that I had listened carefully to to what patients and others had told me, that I tried to imagine what it was like for them and that I tried to convey this. And to use a biblical term, the feeling he bore witness.

• 26:42Speaker 03

  I think like burying witness in medicine has come to mean like you are sort of present in someone's moment of suffering.

• 26:54Speaker 03

  To allow them to feel that they are seen and they are heard and that they're not alone and that you're kind of like doing this thing where you're not turning away like other people. It's just too hard. This idea of bearing witness is very kind of central in medical humanities. But I don't know that you can also, you can bear witness and also like write a story about someone. Those are two very different acts. And I think Sacks was sort of merging them both and presenting a model of how both can be merged. And there's a lot of like self-interest involved or not self-interest, but sort of you have like a, your mind is doing, calculating things when you're thinking about how someone

• 27:39Speaker 03

  becomes a story. And when you're bearing witness, I think you need to be blank in a way that you probably can't be as sort of an authorial like imagination. Sacks said he wanted to be remembered as someone who bore witness. And I get that, but I also think that it is very hard to do that when you're like telling a sort of magical fable about someone's illness and sort of the gifts that it might have bestowed upon them.

• 28:12Speaker 02

  What I find so fascinating about this story is that there's Oliver Sacks, the doctor, and Oliver Sacks, the writer, and Oliver Sacks, the man. And what happens when all of those versions of Sacks collide into each other?

• 28:30Speaker 03

  I think anyone would kind of say that one of the genius things he did was to see all these patients who were in like comatose states and other doctors had dismissed them and he saw something in them, like he felt a sense of identification. Because he also saw himself as like the living dead and someone who'd been buried alive. These were words that he used. I think he was capable of imagining that there was like a real person, there was like a real consciousness, a real lively intelligence, like sucked away by this illness inside these people. And so he spent enough time with them. To realize that that was true. So I think like, part of that identification and

• 29:12Speaker 03

  projection like allowed him to make the discoveries he made. And then the second half of that was that the projection and the identification sort of obscured the specificity and possibly like, the suffering of what they were going through because he kind of made their lives beautiful.

• 29:32Speaker 03

  I'm curious like, how we turn our own emptiness in our life into art and what the costs of that are? How we manage that?

• 29:42Speaker 02

  Through that process of bearing witness to other people, Sacks was also working through something in himself.

• 29:51Speaker 03

  I was also like, moved by his honesty and the pain of kind of trying to figure that out himself. Everyone like hides things from themselves, but I felt like he really was trying to sort of figure out, like both justify it and flagellate himself for it.

• 30:11Speaker 02

  By 2008, Oliver Sacks had met someone, another writer. His name was Bill Hayes.

• 30:20Speaker 03

  He was a science writer. They had lunch one day and it just sort of proceeded from there. At the end of his life, he falls in love and I just loved that you could find love at age 76. He was so stuck for all of those years. He couldn't come out for all those years. He was doing his best to try and it's just, yeah, that that felt like, sort of, I guess tragic, but beautiful in a way, like just that that sheer effort to sort of understand yourself, even if you really can't.

• 30:57Speaker 02

  This episode was produced by me, Amy Padula. It was edited by Julia Longoria with help from Joanna Solotaroff. Mixing and sound design from Christian Aiella and music from Noam Hassenfeld. Melissa Hirsch checked the facts. Jorge Just is our editorial director. Sally Helm and Meredith Hodnot are two of all The great poet laureates of Unexplainable. And Bird Pinkerton sat on the A train as it barreled towards Washington Heights. She figured someone might think she looked weird or something. She had a broken platypus guitar on her back, an octopus key around her neck, and a boomerang sticking out of her pocket.

• 31:37Speaker 02

  But nope, just a normal day on the subway. As always, thank you to Brian Resnick for co-creating the show with Noam and Bird. If you'd like to support this show and the journalism that Vox does, we would love it if you would become a member. It's really easy to do. Just go to vox.com/members. You'll get access to all of Vox's journalism. For those of you who have emailed us to let us know that you signed up because of Unexplainable, thank you. If you can't join our membership, though, that's okay. If you want to leave a nice review on your podcast platform, five stars, or a written review, we would really appreciate it a lot. Or if you want to tell someone in your life that they might want to listen to the show,

• 32:22Speaker 02

  those things make a real difference. Unexplainable is part of the Vox Media Podcast Network. We'll be back soon with another episode about everything we don't yet know.