Everything in Its Place: First Loves and Last Tales (Picador Collection)

by Oliver Sacks

It was full of special treasures, secret pleasures, for the knowing, patient eye.

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.

He had been “away,” “absent,” for an unconscionable time. Not in a sleep, not in a trance, but deeply submerged. And now that he had emerged, those years were a blank. It was not amnesia, not “disorientation”; his higher cerebral functions, his mind, had been “out” for seven years. How would he react to the knowledge that he had lost seven years, and that much of what was exciting, important, dear to him had passed irretrievably away? That he himself was no longer contemporary but a piece of the past, an anachronism, a fossil strangely preserved?

As Beckett writes, “Nothing is more real than nothing.”

All of these are experiences of nothingness (or, more precisely, privations of the experience of somethingness).

a lightning autobiography.

Tourette’s cannot be studied or understood in isolation, as a “syndrome” confined to the person who has it; it invariably has social consequences and comes to include or incorporate these as well. What one sees, therefore, is a complex negotiation between the affected individual and his world, a form of adaptation sometimes humorous and benign, at other times charged with conflict, pain, anxiety, and rage.

He was a gifted inventor of the truth, of whatever seemed true to him at the moment.

There is normally a beautiful balance, a delicate mutuality, between the frontal lobes and the subcortical parts of the brain that mediate perception and feeling, and this allows a consciousness that is free-ranging, playful, and creative. The loss of this balance through frontal-lobe damage can “release” impulsive behaviors, obsessive ideas, and overwhelming feelings and compulsions.

One sees a kaleidoscopic array of symptoms and dysfunctions, never exactly the same in any two people. The neurological dysfunctions interact with all that is particular and unique in an individual—their preexisting strengths and weaknesses, their intellectual powers, their skills, their life experience, their character, their habitual styles, as well as their particular life situations.

temporarily restore a focus, an island of identity.

Cerebral function is not like cardiac or renal function, which proceeds autonomously, almost mechanically, in a fairly uniform way throughout life. 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.

“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.”

All of these diseases—kuru, CJD, scrapie, and various rarer ones like fatal familial insomnia and Gerstmann-Sträussler-Scheinker syndrome—are relentlessly progressive and rapidly fatal. All produce devastating spongy changes and cavitations in the brain—hence they are referred to collectively as the transmissible spongiform encephalopathies, or TSEs.

The disease agents in each of these are very difficult to isolate, smaller than viruses, and, ominously, capable of surviving the most drastic conditions, including extreme heat and pressure as well as chemicals like formaldehyde and all the usual sterilization procedures.

Bacteria are autonomous and multiply by themselves; viruses use their genetic material to subvert the host’s cells to replicate—but the TSE disease agents show no ...

Gajdusek named these agents “infectious amyloids.” (They are now known as “prions,” the name given to them by Stanley Prusiner, who was awarded a Nobel Prize for his work in identifying this new class of pathogen.) But if prions could not replicate like viruses, how did they multiply and spread? One had to envisage a wholly new form of disease process—one akin not to biological replication but to chemical crystallization, whereby the tiny prions, which are actually deviant, pleated forms of a normally present brain protein, act as “pattern-setting nucleants,” or centers of recrystallization, causing rapidly spreading transformations of the surrounding crystalline proteins. Such nucleation is seen in the patterning of ice or snowflakes, and...

“super-positive” states: they betoken disorder, imbalance in the nervous system, but their energy, their euphoria, makes them feel like supreme health.

Mania is a biological condition that feels like a psychological one—a state of mind.

I wanted to believe this too . . . to believe in her breakthrough, her victory, the delayed efflorescence of her mind. But how does one tell the difference between Plato’s “divine madness” and gibberish? between [enthusiasm] and lunacy? between the prophet and the “medically mad”?

He speaks of Sally’s “pitiless ball of fire,” her “terrified grandiosity,” of how anxious and fragile she is inside the “hollow exuberance” of her mania. When one ascends to the exorbitant heights of mania, one becomes very isolated from ordinary human relationships, human scale—even though this isolation may be covered over by a defensive imperiousness or grandiosity.

what a narrow ridge of normality we all inhabit, with the abysses of mania and depression yawning to either side.

In some botanical gardens, there are massive ferns more than a hundred years old. Death is not built in to these plants as it is for us more specialized life-forms, with the ticking clocks of our telomeres, our liability to mutations, our running-down metabolisms. But youth is apparent, even in ferns. The young Woodsia are charming: a bright spring green; tiny, like babies’ toes; and very soft and vulnerable.

The term ‘‘magic’’ was continually used—Seaborg and others spoke of a magic ridge, a magic mountain, a magic island of elements. This vision came to haunt the imagination of physicists the world over. Whether or not it was scientifically important, it became psychologically imperative to reach, or at least to sight, this magic territory. There were undertones of other allegories as well—the island of stability could be seen as a topsy-turvy, Alice-in-Wonderland realm where bizarre and gigantic atoms lived their strange lives. Or, more wistfully, the island of stability could be imagined as a sort of Ithaca, where the atomic wanderer, after decades of struggle in the sea of instability, might reach a final haven.

Writing should be accessible in as many formats as possible—George Bernard Shaw called books the memory of the race. No one sort of book should be allowed to disappear, for we are all individuals, with highly individualized needs and preferences—preferences embedded in our brains at every level, our individual neural patterns and networks creating a deeply personal engagement between author and reader.

“capturing the invisible rather than reconstituting the visible.”

“Deus sive Natura”

I have a number of patients with very advanced dementia or Alzheimer’s disease, who may have very little sense of orientation to their surroundings. They have forgotten, or cannot access, how to tie their shoes or handle cooking implements. But put them in front of a flower bed with some seedlings, and they will know exactly what to do—I have never seen such a patient plant something upside down.

Everything is public now, potentially: one’s thoughts, one’s photos, one’s movements, one’s purchases. There is no privacy and apparently little desire for it in a world devoted to nonstop use of social media. Every minute, every second, has to be spent with one’s device clutched in one’s hand. 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.

As a neurologist, I have seen many patients rendered amnesic by destruction of the memory systems in their brains, and I cannot help feeling that these people, having lost any sense of a past or future and caught in a flutter of ephemeral, ever-changing sensations, have in some sense been reduced from human beings to Humean ones.