SPIEGEL: Dr. Sacks, five years ago, you were diagnosed with a melanoma in your right eye. You thought you would die soon. What has happened since?
Sacks: Well, obviously, I didn’t die. I was told that a melanoma in the eye is more benign than I previously thought, but in those early weeks after the diagnosis, I was still very prone to fear and a sort of black humor. Fortunately, that fear has largely gone away. My feeling now is that time is doubly precious.
SPIEGEL: How is your eye these days?
Sacks: I am actually a little shy about it. I feel it does look bad …
SPIEGEL: … not at all!
Sacks: … well, I bled into the eye and I can’t see through it. So I regard the eye as being out of action. And whether I will recover any sight in it, I don’t know.
SPIEGEL: Did the tumor change your perception?
Sacks: When this presented itself, I noticed that a segment of my vision was missing. I always use the ceiling fan for checking my visual fields. And in the three weeks while I was waiting for surgery, I went from missing one blade to missing three blades. After surgery, my vision was becoming distorted, so that, for example, people looked as if they were elongated and tilted over to one side, almost insect-like. And faces had these strange, sort of puffy protoplasmic extrusions. There was a Francis Bacon exhibit here a while back that reminded me of that.
SPIEGEL: Did you see things that weren’t there?
Sacks: You mean hallucinations? Yes, I did, and I do have them. I tend to see things like little starfish, daisies and raying purple forms … let me bring you something … I kept one or two notes … so that’s my journal (he returns with a huge pile of notebooks).
SPIEGEL: In your new book, you describe the blind spot in your right eye as a “gaping nowhere.”
Sacks: Wait, I’ll show you what it looked like, I made a drawing of it. See, it has more or less the shape of Australia. It causes me a lot of trouble when I bump into people or lamp posts, but it sometimes fills me with wonder, too. One day, for example, I looked at my foot with my right eye and sort of amputated it with my blind spot, a little above the ankle. But when I moved my foot a little, wiggling the toes, the stump seemed to grow a translucent pink extension with a ghostly protoplasmic halo around it. As I continued wiggling my toes, this took on a more definite form until, after a minute or so, I had a complete phantom foot.
SPIEGEL: You specialize in treating patients with neurological disorders. Now you’ve turned into a case study yourself. Do you see this as some sort of dark irony?
Sacks: I do think that it’s a particular irony. Stereo vision for example, which you can only truly have with two eyes, has always been very important for me. From the age of 10 or even earlier, I have loved stereo photography and stereograms. For many people, this loss probably sounds trivial, maybe because they’re not so conscious of having it; and if they lose it, they hardly notice it. But for people like me, it’s really bad.
SPIEGEL: There are other ways for the brain to calculate depth: perspective, movement, shadows. People with vision in only one eye can even drive motorcycles.
Sacks: But they can’t experience depth! And they don’t know what they miss. I once asked a friend, Sue Barry, who was cross-eyed all her life, if she could imagine stereo vision and she said, “Sure I can.” But later, through vision therapy and with the help of special glasses, she gained stereo vision and found herself in a truly spectacular new world. She loved it and came to me and said: “I was wrong.” No one without it can imagine what stereo vision is like, just as a totally colorblind person can’t imagine what color is like.
SPIEGEL: All your case studies seem to have a common theme: the remarkable ability of the brain to compensate and adapt. How do you cope?
Sacks: I don’t think that I have adapted very well. I use a stick now because high curbs are a special danger for me. They look like horizontal lines on the ground. If a room is cluttered, rather than seeing objects in space, I see surfaces which are sometimes on top of each other. I wish I could paint because the world looks to me very much like a canvas with shapes and colors.
SPIEGEL: To what degree can the mind compensate for the loss of input? In other words, how colorful can a blind person’s world possibly be?
Sacks: Oh, very colorful! Zoltan Torey for example, an Australian, who was blinded in an industrial accident when he was 21, visualizes things to the point where he shocked his neighbors by replacing the gutters on the roof of his house at night. If you talk to Zoltan, you don’t feel he’s blind. He seems to be looking at you because he visualizes you in a very vivid, detailed manner. However, of course, if you very quietly turn your back at him, he wouldn’t know.
SPIEGEL: Is it some kind of virtual reality he is creating?
Sacks: No, he does not form a perceptual world. It doesn’t have, for example, all the details; imagery can never be as rich in detail as reality. Zoltan would go on what information he had. Since he was not blind from birth, he has visual memories that he can call on.
SPIEGEL: In theory at least, is anyone who becomes blind later in life capable of compensating with more or less detailed imagery?
Sacks: Not necessarily. John Hull, who corresponds with me by mail, lost his vision when he was in his forties. He describes his state as one of “deep blindness” — a total absence of any imagery. Two years after becoming blind, Hull couldn’t evoke the image of his wife or his children. He said he couldn’t even say which way around the number three went.
SPIEGEL: Does he miss the images?
Sacks: No. He even seems to like his condition. He feels he lives in an authentic, autonomous world, in his words one of “concentrated human condition.”
SPIEGEL: Are you surprised that people’s minds react so differently in comparable circumstances?
Sacks: Originally, I was very surprised. But, these two, I now realize — and I’ve seen dozens of blind people — are extremes. People adapt in different ways, they come up with all sorts of things. Ten to 15 percent of the people who lose their sight hallucinate — and not just little things, but faces and scenes and animals. Others don’t hallucinate at all.
SPIEGEL: Is there something like a psychological resilience that makes some people cope better than others?
Sacks: Well, I mean, Zoltan feels that John Hull was too passive and too acquiescent, to put it bluntly. If you are asking how much of it is a decision to do things and how much is physiology, that’s really a difficult question to answer.
SPIEGEL: Lillian Kallir, a celebrated musician and one of your patients, lost her ability to read music. Later on, she couldn’t read words anymore or identify objects. What’s different when the mind, and not the eye, loses the ability to see?
Sacks: When Lillian wrote to me, she was very puzzled. She asked, “How come I can see tiny little letters, and I can’t make sense of them?” This is perception stripped of meaning. You may occasionally experience this yourself. Proust gives an example of this when he wakes up one morning and he doesn’t know where he is or who he is, and he says, “Memory comes down like a rope from heaven.” For Lillian, however, memory doesn’t come back.
SPIEGEL: How did Lillian describe her experience to you?
Sacks: The whole visual world was confusing for her. Once she took my medical bag instead of her own purse although they looked totally different. But Lillian stayed calm and found ways of living with this. At home, for example, she organized things by color or by position, so that she could identify them, even though they didn’t carry any visual meaning for her. Also, she still had rough categories for things. I remember showing her a picture of a wolf. She wasn’t able to identify it. But she thought that it maybe was a baby elephant. So she could see it was an animal.
SPIEGEL: Some of your patients seem to even gain something from their impairments, for example the painter who lost his color vision but found an even stronger aesthetic identity by working in black and white. Can the tragedies you report on ultimately become opportunities for growth?
Sacks: Well, one wouldn’t wish any of these conditions on anyone, yet there may be a positive side. When the left temporal lobe of the brain gets damaged, people may have a sudden heightened visual facility, and, for example, start painting. People with certain other conditions turn out to be better than normal at reading facial expressions and at hearing expressions of voice. This is not an instantaneous thing. It takes a while to develop. It’s a way to survive and to organize their new world in new ways.
SPIEGEL: You once compared the brain to an “orchestra that conducts itself, with an ever-changing score and repertoire.” Are the off-key performances of this orchestra more widespread than we think?
Sacks: I believe that most of us have small frailties and flaws in how we make sense of the world. In fact, there is an impairment which I myself share with a lot of people: I have trouble recognizing faces. It is quite distressing. If you have this condition, you always fear that people might think that you don’t care or that you are not sufficiently attentive. However, the recognition of faces doesn’t depend on attention. It’s pre-attentive. People who are face blind have to learn to pay unusual attention to the way people are dressed, the way they stand, their voice or the way they move.
SPIEGEL: If you’d meet us five minutes after our conversation in the elevator, would you recognize us?
Sacks: I probably wouldn’t. Although I noticed you were both tall people, but then — there are lots of tall people (laughs).
SPIEGEL: Why is it so difficult for the brain to make sense of the visual world?
Sacks: Because it requires the orchestration of 40 or 50 different areas in the brain. These areas have to do with meaning, with association, emotion and so forth. Fortunately, we are not a blank sheet when we are born. We already have all sorts of potentials, and these have to be developed by experience. I am fascinated, for example, by our ability to read. There is no part of the brain that has been shaped by evolution for reading. Reading has only been around for 5,000 years. The reason why we were able to learn how to read is our inherent potential for shape recognition.
SPIEGEL: Let’s say we could understand the processes of perception, cognition, language and thinking. Would we then be able to enter the inner world of somebody and put ourselves in somebody else’s mind?
Sacks: A very primitive thought reading is possible already, with the medical imaging that is available today. If you ask people to imagine a piece of music, to recite a poem internally or to imagine a color, you will find particular parts of the brain light up. However, the more sophisticated thought reading will never become a reality because there’s novelty and uniqueness in everyone. Everyone’s brain develops in a particular way. Even if you could, theoretically, transmit your brain cells to someone else, they wouldn’t know what to make of it.
SPIEGEL: Why not?
Sacks: Because the language of uniqueness and subjectivity will never be replaced by the language of physiology. For example, if you think of a certain wonderful moment — when there was that marvelous time when your were 22 and in the love and the moon was rising in a starlit sky — how is this moment imprinted in the brain? We don’t know. Our methods are so crude. There are millions and millions of neurons with tens of thousands of connections to others. The degree of it all is unimaginable. Our medical imagery is getting better and better, but I don’t think that we can ever catch up.
SPIEGEL: Dr. Sacks, we thank you for this interview.
Interview conducted by Philip Bethge and Rafaela von Bredow