17 September 2009

Q&A with Oliver Sacks: Hallucinations, neurological curiosities and a passion for understanding

Famed neurologist Oliver Sacks was nice enough to let the TEDBlog into his office for an interview before his talk went up today. He hosted us for over an hour, discussing his new book about vision and the mind and giving details on the visual hallucinations that he's been experiencing since he lost vision in his right eye. Dr. Sacks proved as interesting as all rumors indicate, with an office full of his hobbies and interests -- from his expanding geological collection to an antique crystal radio (made in 1915) and a Wimshurst machine, it was a little oasis for the curious mind.

Well, first of all, it’s lovely to meet you. I think you’re probably very accustomed to people being impressed by your work.

And disappointed when they meet me in the flesh.

(Laughter)

What was TED like for you?

It was a wonderful sort of gathering. You never quite knew what was going to happen next. And there were so many creative people of every sort there. I think it was really rather astounding.

You’re currently writing a new book on hallucinations …

Well, it’s not just hallucinations, but they’ll be about half the book. The current title is The Mind’s Eye and it’s about vision and visions and visual memory, as inspired in the first place by people coming to see me as patients or writing letters. I get something like 200 letters a day, of which I answer about 30. I can't answer them all. But, I really feel very privileged because people write to me from all over and tell me interesting things that are going on with them. And, in a strange way, as a neurologist, I think I sometimes get my ideas in this way. You know, in health things are seamless. You would have no idea that color and motion and texture and depth are separately processed in the brain, because what we perceive, finally, is a whole visual world. But I often communicate with people who’ve lost just color perception or lost just stereo vision, which shows how things can go wrong. So yes, the hallucinations fascinate me, but mostly because they show how the brain works in everyday life.

But also, as a physician, I need to be in a position to reassure people with a particular sort of hallucination that they’re not going mad. They’re not losing their mind. And the word hallucination has bad vibes. It immediately suggests something ominous. It’s sort of a pity we don’t have another word. Although, curiously, I was just reading an 1824 book called The Philosophy of Apparitions and in those days “apparitions” was used, or “phantoms.” They’re both nice words. You talk about phantom limb, you don’t talk about a hallucinatory leg. Somehow, a phantom limb sounds better.

You wrote this book A Leg to Stand On and it was about your experience of having the leg, but having the feeling of leglessness, the opposite of phantom limb. And now you’re writing many years later about hallucinations and I’ve been told that you’re having some hallucinations yourself, in fact.

Well, I don’t have much vision in the right eye. I had a tumor in the right eye, which has been irradiated and lasered, and I hope laid to rest. But that has taken most of the retina with it on that side and so I’ve only got a little sliver of peripheral vision and the rest is a great black area of scotoma, which changes its appearance as soon as I look up at the ceiling -- then it camouflages and turns white, or turns blue if I look at the sky. And it tends to be full of tiny things, of tiny letters and numbers, which look rather like incised hieroglyphics to me, along with a few other simple things like chessboards and spirals and spiders’ webs. So I’m just having fairly simple geometrical hallucinations. I’m not having faces or anything like this, and don’t expect to have them.

But they’re very easy to separate from reality?

Um, yes. Mostly. Although occasionally, I confess, certainly in the early days, when I would perhaps go in to someone’s apartment, I might think, “What an interesting … what a curious stippled wallpaper.” And I’d mention this. And the person would say, “What do you mean stippled? It’s not stippled.” So, now I realize the stippling comes from me, from the visual areas of my brain which area trying to fill in this rather large blind spot.

But with hallucinations that are complex and more plausible and in context, then it can be different. that are complex and more plausible and in context, then it can be different. There’s a historical description, from the Charles Lullin in the 1750s where he first saw a gigantic wheel in mid-air and he thought, “Oh, so that’s a hallucination. We don’t have gigantic wheels in mid-air.” But then his granddaughters came to visit and he said, “Who are these handsome young men with you?” and they looked downcast, because there weren’t any handsome young men. But, there could have been. They were sufficiently plausible.

And it can go the other way around. I got a story about someone who’d become very used to his hallucinations and very cool about it. He lived on the 19th floor of an apartment building, and one day he saw someone hovering outside his window. You don’t have someone hundreds of feet off the ground, so he thought it was a hallucination. And the hallucination apparently waved at him. He paid no attention. And then of course, the window cleaner talked to the person next door and said, “What’s wrong with him? I waved at him and he didn’t respond.” So there, reality was mistaken for a hallucination.

Things like this conjure up, for example, images of that movie A Beautiful Mind, based on the life of John Nash, where the lead character has to learn to recognize what is reality and what is hallucination.

Well, first, that film is quite a long way from the book. There’s a certain distinction from reality -- although I know John Nash a little, and, he was quite approving of the book and the film. On the whole, visual hallucinations are not nearly as common in schizophrenia as voice hallucinations. But, the sort of hallucinations I’m dealing with here are very different from psychotic hallucinations. Psychotic hallucinations seem to be often intimately connected with what one is thinking or feeling and they may address one and command one, or accuse one or seduce one. his is unlike the sort of hallucinations that blind people can get, when the brain is not getting its normal input but the visual parts of the brain still stay active and may develop their own output. The people who have these sorts of hallucinations think they see them on a screen or possibly their room, but they don’t interact with the hallucination. When I talked at TED I think I described one patient with this sort of hallucination. I said to her, “Is it like a dream?” And she said, “No, it’s not. It’s like a movie. A rather boring movie.”

So, one of the things I was saying at the beginning and I have to illustrate this, is that I’m writing about something that is a rather different thing than psychotic hallucinations such as John Nash’s. The next book will be about that. Maybe.

People often use say that I study mental illness. But I am not a psychiatrist; I study people with neurological problems and not primarily mental illness as such.

READ MORE: Dr. Sacks discusses his motivation for writing, the photos above his desk, his upcoming operation and his friendship with Francis Crick.

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17 September 2009

What hallucination reveals about our minds: Oliver Sacks on TED.com

Neurologist and author Oliver Sacks brings our attention to Charles Bonnett syndrome -- when visually impaired people experience lucid hallucinations. He describes the experiences of his patients in heartwarming detail and walks us through the biology of this under-reported phenomenon. (Recorded at TED2009, in Long Beach, California. Duration: 18:48)

Twitter URL: http://on.ted.com/39

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05 February 2009

TED2009 minutes from Erik Hersman: Oliver Sacks on hallucinations

The ever busy Ethan Zuckerman has had to give the reins over to fellow blogger, Erik Hersman today as he accepts an award in Denver. As implausible as it may seem, Erik is as timely and productive as Ethan. Not convinced? Here's an excerpt from his first blog of the day on Oliver Sacks:

"We start this morning with Oliver Sacks, who since Awakenings first stormed the bestseller lists (and the silver screen), has become an unlikely household name, and single-handedly invented the genre of neurological anthropology.

We see with our eyes, but we also see with our minds. Hallucinations is what he will be talking to us about today."

To get the full story, you can go to either Ethan's or Erik's blog.

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01 June 2008

WSF report: Oliver Sacks, Abyssinian choir on music

Photo of Dr. Calvin O. Butts III, acknowledging Jim Gates and Stephon Alexander at the Abyssinian Baptist Church, as part of the World Science Festival, NYC. From entropybound's flickr set (and check out his blog).

TED's Marla Mitchnick reports from the Saturday night blockbuster "Music and the Brain," held at the Abyssinian Baptist Church and hosted by the Rev. Calvin Butts III:

Many hundreds of people came out, on a rainy Saturday evening in Harlem, to hear the great Dr. Oliver Sacks speak on "Music and the Brain." We waited in a line that snaked all the way down 138th Street from the church, around the corner, and way down Adam Clayton Powell Jr. Blvd.

Though the event listing mentioned the location as The First Abyssinian Baptist Church, a historic Harlem landmark built in 1808, which is well known for its choir and its pastor, Calvin O. Butts III, and we all knew that gospel music was to be paired with Dr. Sacks' talk, no one was quite prepared for the multilayered experience that lay ahead.

A ferociously energetic church lady in a polka-dot dress was hawking CDs along the line, in a voice that demanded one's attention, and with an intensity that made me quake in my boots. To refuse her wares would take some courage! Thank god the line began to move.

Leaving the stairwell to enter the balcony, the space of the enormous church opened up in all its glory. Silvery pipe-organ pipes rose up everywhere -- in the balcony, at the back, the sides, up behind the altar area. I've never seen so many. But the church organ had some company: a concert grand piano, a full drum kit, a three-drum African skin-drum kit, and a freestanding jazz organ.

Sitting in the front row of the balcony, we were amongst a happy crowd of folks -- who seemed well enough behaved to my eye, but apparently not in the judgment of the large, bald, Abyssinian Baptist employee, wearing an OFFC T-shirt, who was overseeing our section, and who apparently felt we all fell quite short of the mark. Upon closer inspection, the large red letters OFFC on the front of his shirt were accompanied by some smaller yellow letters below, explaining the acronym: "On Fire For Christ!" The fire must have been pretty hot, to judge by the way this fellow made sure that no one put their feet upon the balcony rail, and generally acted like a cross between a stern master at a boys' school, and a security specialist on a far-off planet -- one where no one's even heard of laughter -- who took his job in deadly earnest.

Having recently edited the video for his 2005 TEDTalk on string theory, I recognized Brian Greene and trotted over to say hi to him before the show. When I asked him how the World Science Festival was going, his face lit up, and he said: "It could not be going any better, the events are sold out, they've been fantastic, and best of all: people are talking about science!"

There were running jokes throughout the evening, from Brian Greene and Oliver Sacks, both Jewish by birth, about being converted -- and all of us non-Baptists in the audience understood why. The Abyssinian Baptist Church is one that understands the powers of spectacle and ritual, and engages in these with dignity and stateliness, but without formality. The professional rigor of the choir is accompanied by natural talent, a general sense of vocal ease, and a straightforward joy in the act of singing for god.

There were ten items on the program before Oliver Sacks' talk -- starting with a gorgeous organ prelude, played by a young woman named Dina Marie Foster Osborne. Another notable experience was the solo African drumming which ushered in the entrance of the choir. Sadly his name was not on the program, but the big, happy, relaxed man who played the African drum set took three skin-drums and two sticks, and made a universe out of them -- he went from drumming with joyous intensity, all the way down to the softest beats imaginable, ones that you could hardly hear, and that your ears strained to catch because they were exquisite. Then the entrance of the 51-person choir, all traditionally bedecked, in dark red draping robes that were accessorized with stripey yellow and black African cloth about the neck and sleeves -- was awesome. They appeared out of nowhere, snaking their way like a rushing red river through all the aisles at once, and seen from the balcony above, it was glorious.

A number of musical numbers followed -- with soloists, all instruments, and a taste of the whole choir's sound -- all instruments were involved, and there were too many talented folks to list them all. When the music got going I looked down, and smiled when I saw that the fearsome lady in the polka-dot dress, the one who'd been hawking CDs outside, was gettin' down -- standing up in her pew and just dancing with abandon.

There was a very adorable moment when four first-graders from the Thurgood Marshall Academy lower school led a tribute to undercredited scientific ancestors, followed by an African libation ceremony for all those Americans who made a way out of no way...

Dr. Calvin O. Butts, III, invited Brian Greene up to say a few words, and gave a generous intro to Dr. Sacks.

When Brian Greene began to speak, he quoted a great story from Sir Ken Robinson about a 7-year-old who followed her own drum in the quest for truth, and then said:

"I may be a Jewish physicist, but I'd be tickled silly if someday I was reincarnated as a Baptist minister!" And I believed it -- in speaking about his passion for science, for science education, and for the spreading of the explorational scientific spirit throughout popular culture -- his voice had all the cadences of a believing man aflame. He was wearing a very nice suit - but really he should have worn a T-shirt that said "OFFS:" On Fire For Science. He burned up the house with his passion.

Then Dr. Butts gave a warm and generous introduction to Oliver Sacks, and Dr. Sacks stepped up to speak. He spoke of the power of music to exalt us as individuals, and to bond us as a community. He spoke of the neurological differences in practicing musicians' brains vs. all others -- saying that if you looked at Einstein's brain scans, or at Brian Greene's, you'd have no notion that they were men of science -- but if you looked any any of the brain scans of the people in this choir you'd immediately think -- ah yes, I bet these are musicians!

But then he got into the nitty-gritty of the evening -- not just the power of music for all of us, but the power of music for people who are in serious trouble.

He went back to stories about the patients from Beth Abraham Hospital, original home of the case studies that made up his stories about how music could jump-start speech, general motor-movement, singing, and even dancing, in patients who'd been frozen in inert states, sometimes for years. He spoke of how the auditory-memory part of the brain is very close to the part of the brain that processes emotion, and that with patients suffering from Alzheimer's or acute dementia, even when all event-memory, and all personal identity memory is lost, that the ability to recognize familiar music never goes away. He spoke of how rhythm is, in some cases, far more essential than melody or words, and said that rhythm is at the very center of being a human being.

He spoke of aphasia, loss of speech, and how recent discoveries involving music therapy have shown -- in cases of severe damage to the left lobe/language center of the brain -- that patients can experience -- with much work -- the right side of the brain taking over the job, and becoming the vehicle for speech: an amazing transformation known as "cerebral plasticity."

Dr. Sacks spoke with compassion, humor, ease, and an obvious appreciation for the context of this extraordinary event. He ended with the words: "... We can not say that music is an art and not a science, no more than we can say that chemistry is a science and not an art. Science and art come together."

The Abyssinian Baptist choir followed Dr. Sacks' talk with many gospel tunes, each more rigorous, more passionate, and more beautiful than the last, proving his point completely.

I looked up and noticed that stern fellow, the one with the OFFC tee-shirt, guarding the balcony door. The choir was singing the rollicking number "Didn't my Lord Deliver Daniel!" Everyone was dancing in their seats, the harmonies were so surprising and the rhythm was potent. The guard held his body rigid, even in the midst of the swaying multitude, but wait -- was that a very subtle bob to his head? Yes -- it was almost imperceptible, but I definitely detected a subtle movement about the neck. Even he was not immune to "the impact of music..."

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