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Shedding Light Into Abyss of Brain Disorders

March 18, 1986|GARRY ABRAMS | Times Staff Writer

In the world of neurologist Oliver Sacks, there is a retired sailor whose memory lasts no more than a minute. A conversation between identical twins consists solely of prime numbers. A woman "loses" her body. A 93-year-old man walks tilted to one side yet thinks he is as upright as a flag pole. And a talented professor of music believes that a rose is not a rose but a "convoluted red form with a linear green attachment."

These are not descriptions from a horror movie or the results of mind-bending initiation rituals by a bizarre cult. They are thumbnail sketches of the neurologist's patients--victims of congenital, organic or accident-related brain disorders that produce alien forms of seeing and being.

Sacks, a native of London, is professor of clinical neurology at New York's Albert Einstein College of Medicine. He is also a writer who has been praised by critics for bridging the gulf between medicine and literature. In his latest work, "The Man Who Mistook His Wife for a Hat" (Summit Books: $15.95), Sacks has collected 24 case histories of patients who have lost touch with the everyday world of faces and places or their own bodies but have retained what are generally thought of as "higher" mental functions such as abstraction, mathematical skill or capability on intelligence tests.

Troubling Hallucinations

In the book's title case, for instance, Dr. P., "a musician of distinction," gradually lost his ability to recognize faces of friends, students and relatives. More troubling, Sacks writes, "he saw faces where there were no faces to see . . . he might pat the heads of water-hydrants and parking meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture and be astounded when they did not reply." During a visit to Sacks' office, Dr. P. also "reached out his hand and took hold of his wife's head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat!" Nonetheless, Dr. P. retained his musical and intellectual capacities, as illustrated by his ability to play a game of mental chess.

Sacks spins out the tale of this and other mainly incurable cases in prose that has been praised for its sensitivity, clarity and precision. But the neurologist, interviewed recently in Los Angeles, said he knows readers may initially react to these reports with "revulsion, fear, horror at the sight of so much disease and deformity."

"Although it would seem I've written a book about disease and diseases, I would like it to be seen as a sort of book about survival and identity under extraordinary circumstances. . . .

"It just makes me realize how rich human nature is," he said. "Sometimes you only see that in the act of destruction. You don't realize how rich the world of appearances is until you've lost the world of appearances."

Sacks, 53, is a man who seems to be in the sway of a perpetual amusement stimulated by his surroundings--an impression heightened by his huge, gray-streaked beard. Sitting on the roof garden of a West Hollywood hotel, he interrupts his train of thought to laugh at the curious shape of freshly trimmed palm trees and to guffaw at a photographer's "gigantic lens," noting that "lenses are getting stranger and stranger."

But while everyday objects may tickle his sense of the absurd, Sacks is well aware that his patients are people who have gone an almost unreachable distance beyond common understanding.

"I love to encounter other forms of being and other minds," he said, noting that his writing and his work with his patients are attempts "to enter lives and constitutions which are almost unimaginable."

'Philosophical Emergencies'

Sacks regards his patients as more than objects of medical interest.

"I think a lot of neurological emergencies, clinical emergencies, are philosophical emergencies," he said. "If one has had a spinal anesthetic, say, you end here"--he placed his hand against his stomach--"you terminate, and what lies below is not flesh, not real, not anything, it's not even dead . . . and it is a philosophically bewildering thing."

Indeed, Sacks' cases present a variety of quandaries that beg for moral as well as medical assistance.

For example, the patient Sacks calls "The Lost Mariner" is a retired U.S. Navy man whose drinking binges destroyed his capacity to remember anything that happened after about 1945. The sailor must live perpetually in the moment, unable to recognize people--including Sacks--he has seen a few minutes before, and incapable of completing any task that requires more than a minute's worth of memory.

The Navy man's medical problem may be that "two tiny relay stations, and that only, in his brain have gone," Sacks said. But the consequence is that for the man "the whole world has changed, his being has changed, he is a different being. He is not just a man with memory problems, he is a different being in a different world."

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