Oliver Sacks makes discovery an intimate pursuit in ‘Hallucinations’

NEW YORK — Oliver Sacks never meant to be part of the story. Indeed, much of his new book, “Hallucinations,” (Alfred A. Knopf: 326 pp., $26.95), which mixes case studies, analysis and personal observation, had already been written when, in March 2011, the 79-year-old author and neurologist tripped over a box of books in his lower Manhattan apartment and broke his hip.

While in the hospital, he was visited by a friend who got him talking about the 1960s — especially his experiences, as a UCLA graduate student, with drugs.

“I started with cannabis,” Sacks writes. “A friend in Topanga Canyon, where I lived at the time, offered me a joint; I took two puffs and was transfixed by what happened then.” From there, it was a short step to LSD and morning glory seeds, and eventually amphetamine — although for the most part, his experiences never got particularly out of hand.

Still, looking back, Sacks seems somewhat abashed by the memories. “But I told him the story,” he says of his friend, and he scribbled it down and brought back a typed-up version the next day. He encouraged me: Don’t hide this away.”

A year and a half later, Sacks sits at the desk in his home office, wearing khakis and sneakers, looking none the worse for wear. It’s a warm fall morning, and outside, construction trucks rumble through the West Village streets. Sacks is speaking softly, pausing often, discussing the elusive balance between his responsibilities as a clinician and as an author, a process that has occupied his writing since the publication of his second book, “Awakenings,” in 1973.

“Hallucinations,” as it turns out, puts the issue front and center — and not only because its sixth chapter, excerpted in the New Yorker this past August, grew out of those transcribed hospital room memories. Moving between present and past (he uses Dostoevsky, for instance, to discuss epileptic seizures), Sacks frames hallucination as the most human of phenomena, an experience many people share.

He opens the book with a discussion of Charles Bonnet syndrome, a common condition among patients with failing eyesight who see things — faces, letters, geometric shapes — in their visual fields. He writes about Parkinson’s patients who “see” music (“a collage of music scores,” one notes, “superimposed upon the surface, especially with my peripheral vision”) and narcoleptics prone to sleep paralysis. Phantom limbs, delirium, migraine auras; this is not the stuff of psychosis or schizophrenia but of the rational human mind.

Even Sacks’ drug experiences come off as innocent, remembered with a sense of play.

“Hedonism wasn’t absent,” he admits with a low laugh, “especially with amphetamines.” But more to the point was a sense of discovery — not the least of which were the boundaries of his mind.

For Sacks, the key is revelation: How the stories he tells — his own and other people’s — allow him to make what might seem an abstract subject concrete. And yet, there’s a discomfort that comes along with this: the discomfort of exposure, of writing about real people in the world.

“I always misread ‘portray’ and ‘portrayal’ as ‘betray’ and ‘betrayal,’” he explains. “With the 100-odd stories I’ve gathered here, I corresponded with every patient. I sent them what I’d written, and have to be confident that they will be comfortable. But” — and here he laughs a little, softly, and looks away as if a bit abashed — “a different sort of discomfort comes into play in regard to the naughty ‘60s.”

“Hallucinations” seeks to work against our preconceptions, whether they have to do with clinical distance or the larger question of what hallucination means.

“Hallucinations are not like imagination,” Sacks says flatly. “There are many sorts of hallucinations,” he continues, “and one shouldn’t be afraid of mentioning that one has them.”

As an example, he cites the story of a religious novice who had hallucinations of Satan. “She saw him,” he recalls, “she heard him, and she smelled him, a little bit of sulfur. This was probably a schizophrenic psychosis, but I wasn’t sure. Some of the nuns in the religious center where I worked said they would agree that in a non-religious person this would be like a psychosis, but a novice may have to wrestle with deep questions of good and evil before feeling the call or dedication, and visions like this are not so uncommon. This is a dramatization of thought they may have to go through.”

That’s a fascinating distinction because it suggests the importance of taking each situation on its own terms, which has been Sacks’ intention all along. How else to see from the inside the oddities he writes about, the syndromes and dysfunctions?

In “Awakenings,” he describes a group of patients who contracted encephalitic lethargica, or sleeping sickness, in the 1920s, only to be “awakened,” 40 years later, by an experimental drug. In his 1985 breakthrough “The Man Who Mistook His Wife for a Hat,” he introduces a wide array of brain disorders; the title piece involves a man who cannot recognize what he sees.

As with most of Sacks’ writing — including “Hallucinations” — these books are built around case studies, that 19th century diagnostic device.

“I am a describer,” Sacks admits, “a storyteller, for better or worse. Without descriptions, one can’t get the whole picture, nor identify with all the dynamics of a case.”

This style of descriptive narrative fell into disfavor in the 1950s, with the advent of the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Sacks, though, still considers it an essential tool.

“When I did more clinical teaching,” he remembers, “I had a small group of students every Friday afternoon and I would take them round to patients. There was one patient who had a rather rare condition, a cavity in the spinal cord, and she would show herself. ‘Look at the painless burn,’ she would say, ‘I leaned against a radiator and didn’t feel it.’ And she would tell the students: ‘Don’t memorize Page 900 of the textbooks, visualize me. Use my image, it’ll be with you.’ I used to love going to clinical rounds, and in some sense, I’m taking my readers on clinical rounds.”

At heart here is a respect for both the patient and the literary enterprise. Still, it’s complicated, this matter of a doctor writing about those he treats. Over the years, Sacks has been criticized; disability activist Tom Shakespeare once called him “the man who mistook his patients for a literary career.”

But if he now seems to have made his peace with it (“I used to feel fairly conflicted,” he admits), Sacks acknowledges that the balance is delicate — even when it comes to himself.

“To some extent,” he says, “I regard myself as potential clinical material. Whether this pushes too far into self-revelation or self-exhibition, I don’t know. I enjoy doing it, but I feel uncomfortable at times … and never more than in regard to the scandalous Chapter 6. When the book proofs were delivered to the New Yorker, I hoped they might do anything but Chapter 6. But they chose Chapter 6.”

Oliver Sacks will be in conversation with David Milch at the Aero Theatre in Santa Monica, 8 pm, Wednesday, November 14, 2012. For more information: https://livetalksla.org/

david.ulin@latimes.com