Everything in Its Place: First Loves and Last Tales

by Oliver Sacks

have never found swimming monotonous or boring. Swimming gives me a sort of joy, a sense of well-being so extreme that it becomes at times a sort of ecstasy. There is a total engagement in the act of swimming, in each stroke, and at the same time the mind can float free, become spellbound, in a state like a trance. I have never known anything so powerfully, so healthily euphoriant—and I am addicted to it, fretful when I cannot swim. Duns

The actual presence of the elements reinforced the feeling that these were indeed the elemental building blocks of the universe, that the whole universe was here, in microcosm, in South Kensington. I had an overwhelming sense of Truth and Beauty when I saw the periodic table, a sense that this was not a mere human construct, arbitrary, but an actual vision of the eternal cosmic order, and that any future discoveries and advances, whatever they might add, would only reinforce, reaffirm, the truth of its order.

This feeling of grandeur, the immutability of nature’s laws, and of how they might prove graspable by us if we sufficiently sought them—this came to me overwhelmingly when I was a boy of ten, standing before the periodic table in the Science Museum in South Kensington. It has never left me, and fifty years later it is undimmed. My faith and life were set at that moment; my Pisgah, my Sinai, came in a museum.

I do not think my experience is unique. Many scientists, no less than poets or artists, have a living relation to the past, not just an abstract sense of history and tradition but a feeling of companions and predecessors, ancestors with whom they enjoy a sort of implicit dialogue. Science sometimes sees itself as impersonal, as “pure thought,” independent of its historical and human origins. It is often taught as if this were the case. But science is a human enterprise through and through, an organic, evolving, human growth, with sudden spurts and arrests, and strange deviations, too. It grows out of its past but never outgrows it, any more than we outgrow our childhoods.

There is, among Orthodox Jews, a blessing to be said on witnessing the strange: one blesses God for the diversity of his creation, and one gives thanks for the wonder of the strange.

The brain/mind, in contrast, is anything but automatic, for it is always seeking, at every level from the perceptual to the philosophical, to categorize and recategorize the world, to comprehend and give meaning to its own experience. It

If the brain is to stay healthy, it must remain active, wondering, playing, exploring, and experimenting right to the end. Such

“We cannot be taught wisdom,” as Proust remarks, “we have to discover it for ourselves by a journey which no one can undertake for us, an effort which no one can spare us.” Are such stages purely existential or cultural—the behaviors, the perspectives appropriate to various ages and stages—or do they also have some specific neural basis? We know that learning is possible throughout life, even in the presence of cerebral aging or disease, and we can be sure that other processes, at a much deeper level, are continuing, too—a culmination of the ever wider and deeper generalizations and integrations that have been occurring in the brain/mind throughout life. In

Perhaps, too, it will remind us of what a narrow ridge of normality we all inhabit, with the abysses of mania and depression yawning to either side.

Sadly and ironically, soon after I arrived in the 1960s, work opportunities for patients virtually disappeared, under the guise of protecting their rights. It was considered that having patients work in the kitchen or laundry or garden, or in sheltered workshops, constituted “exploitation.” This outlawing of work—based on legalistic notions of patients’ rights and not on their real needs—deprived many patients of an important form of therapy, something that could give them incentives and identities of an economic and social sort. Work could “normalize” and create community, could take patients out of their solipsistic inner worlds, and the effects of stopping it were demoralizing in the extreme. For many patients who had previously enjoyed work and activity, there was now little left but sitting, zombielike, in front of the now-never-turned-off TV.

Indeed (at least in the manner they were originally used), the antipsychotic drugs tended to lower energy and vitality and produce an apathy of their own.

By 1990 it was very clear that the system had overreacted, that the wholesale closings of state hospitals had proceeded far too rapidly, without any adequate alternatives in place. It was not wholesale closure that the state hospitals needed but fixing: dealing with the overcrowding, the understaffing, the negligences and brutalities. For the chemical approach, while necessary, was not enough. We forgot the benign aspects of asylums, or perhaps we felt we could no longer afford to pay for them: the spaciousness and sense of community, the place for work and play, and for the gradual learning of social and vocational skills—a safe haven that state hospitals were well equipped to provide.

In forty years of medical practice, I have found only two types of non-pharmaceutical “therapy” to be vitally important for patients with chronic neurological diseases: music and gardens.

I cannot say exactly how nature exerts its calming and organizing effects on our brains, but I have seen in my patients the restorative and healing powers of nature and gardens, even for those who are deeply disabled neurologically. In many cases, gardens and nature are more powerful than any medication.

Those trapped in this virtual world are never alone, never able to concentrate and appreciate in their own way, silently. They have given up, to a great extent, the amenities and achievements of civilization: solitude and leisure, the sanction to be oneself, truly absorbed, whether in contemplating a work of art, a scientific theory, a sunset, or the face of one’s beloved. A

I worry more about the subtle, pervasive draining out of meaning, of intimate contact, from our society and culture.