10 Questions: For Oliver Sacks

Nancy Ramsey is a contributor to CBSNews.com

(CBS)

Born in London in 1933, Dr. Sacks is a neurologist who trained at Oxford University and has lived and worked in New York since 1965. He's taught at Albert Einstein College of Medicine and New York University. Just this past summer, he was appointed a professor of clinical neurology and psychiatry at Columbia University.

One of Dr. Sacks's early books was "Awakenings," based on his experiences with a group of patients in the Bronx who contracted sleeping sickness after World War I and were frozen in sleep for decades. He treated them with L-DOPA, then a new drug, which, remarkably, "awakened" them. (The book was turned into an acclaimed film starring Robin Williams and Robert DeNiro.)

Other books include "Seeing Voices," about the world of the deaf, and the bestselling "The Man Who Mistook His Wife for a Hat," a collection of case histories of patients with bizarre neurological conditions, told with Dr. Sack's characteristic warmth and humanity. Eager to talk with Dr. Sacks, we posed our 10 Questions to him, and he asked us, in his charming British accent, if that was "rather like the 10 Commandments."

Bach's "Solfegietto." I remember my brother Marcus, who was ten years my senior, learning it with our music teacher. No! No! No! the teacher, who was Italian, would say, pounding his fist. That piece of music was banged into my memory.

It's a piano piece with a very Bach fugal structure. It's formally intricate, but it also arouses an intense emotion that I can't really describe. I think it was a rather jolly piece. But my brother died a couple years ago, and now it comes to me as if it were his signature tune, with an elegiac quality.

2. You open Musicophila with an anecdote from Arthur C. Clarke's novel Childhood's End. "Curiosity brings them down to the Earth's surface to attend a concert," you write, "they listen politely, and at the end, congratulate the composer on his 'great ingenuity'—while still finding the entire business unintelligible." How would you describe the concept of music to one of those aliens?

I think one would have to say music is a form of expression and communication with no external reference like language or drawing but which can express and communicate emotions, moods, what human beings call the heart, as nothing else can. Music communicates being alive. The kinetic, quick aspect of music is very important.

I saw a little boy of three or four, who was dancing to whatever was going through his head. He wasn't wearing an I-Pod. My immediate thought when I saw him was, No chimpanzee does this. Music and language is all rather human.

3. You're a neurologist. How did you choose that profession?

Both my parents had training in neurology, though neither stayed in it. My mother was a surgeon, my father a general practitioner. Both felt neurology was too academic, and perhaps too sad. Back then you couldn't do much, you could just diagnose patients.

So medical stories were part of the dinner table conversation. It both fascinated and frightened me, and no doubt fascinated and frightened guests. My mother would synchronize stories of puss with the soup.

Secondly, I had several visual migraines, which are both fascinating and frightening. In a migraine all sorts of things can happen. One first has an aura. I lost my sense of tonality—that's called amusia—at the same time I was seeing something that was like a Chopin ballad being played on the radio, which had a rhythmic, metrical structure.

So from a very early age, I got some idea of how things depended on the brain.

4. What's been your biggest challenge as a physician?

The "Awakenings" patients. That was the deepest and strangest and most moving, the one I explored the most intimately. I lived next door to them, I was there day and night, I got to know their families. They had this strange disease, this sleeping sickness, which was a worldwide pandemic, probably a virus, but the virus has never been identified. In London there was one hospital with 20,000 such patients.

It was like Rip Van Winkle, or Sleeping Beauty. When one woman awoke, she said, "I know it's 1969, but I still feel it's 1926." She had the postures and mannerisms and interests of a young woman. These were people for whom hope had long since been abandoned, and then they became almost the definition of hope, when they were given an exit by L-DOPA. But tragically, as the movie showed, that was limited.

5. Music is being used as therapy, for a variety of patients. Tell us a little about that.

The therapeutic power of music has been hyped on the one hand, dismissed on the other.

In 1966, at Beth Abraham Hospital in the Bronx, where I saw the Awakenings patients, I heard these stories told by nurses who'd been there for years. They had patients with Parkinson's who couldn't move. But on Sundays or Saturdays, they'd go to religious services and they could sing. They could be brought out of themselves with music. And it wasn't mechanical. The patients were regaining their own sense of inner rhythm and time and temporal order.

I haven't had much experience with autism, although in 1973, I was in a ward at Bronx State. I couldn't have a conversation with the autistic patients, but I could play pool and music with them. I think with the pool table, it was the pure delight of movement and power. It was not threatening, and some of them were very good at it. With music, I had an old upright piano and donated it to the hospital; people would listen or dance or take my hands and play.

It was very exciting for them, to make some real, unconditional contact. The ward had this horrible behavior modification, what those in charge were pleased to call "therapeutic punishment." I was happy to just play pool and share music with the patients, and they saw me as someone who was nonthreatening.

6. Your chapter "A Bolt from the Blue: Sudden Musicophilia" centers around a surgeon who was struck by lighting, recovered, resumed working with no impairment, and suddenly had "this insatiable desire to listen to piano music." This reminds me of the joke about the patient who wakes up after surgery and says, Doc, will I still be able to play the violin? Because I couldn't before...

I suspect we all have potentials that may not be realized, and indeed if they were all realized, we wouldn't know which direction to go in, would we?

One might think of the brain as a complex administrative or political organization in which certain people are constrained to keep their mouth shut but in some circumstances release may be given.

I can't say exactly what's going on, but there seem to be certain musical networks that are previously undeveloped and perhaps inhibited. It's these temporal lobes that come up again and again in my work, they're either stimulated or released and as such play a part in the production of music, and they're close to the parts of the brain associated with emotion. Everything, I've often said, can be experienced in the temporal lobes; they're a sort of shorthand for a whole variety of orchestrated networks.

I think if there is such a thing as divine intervention, I guess it would operate through the nervous system. God acts through the temporal lobes! [On a number of occasions, Dr. Sacks has identified himself as a "Jewish atheist."] How's that?

Something I haven't touched on here, but I touched on in An Anthropologist on Mars is that temporal lobe seizures or epilepsy is often associated with religious or mystical feeling.

7. Tell us about that.

I'm seeing two patients on this: One of them has been drawn into religious belief from the sort of epiphanies or experiences of a seizure. The other is in a skeptical frame of mind and regards this sternly as a seduction by the part of the brain, and sees it as her duty to consider the feelings critically and perhaps resist. Religious feeling and religious belief are separate.

I see a religious feeling as a unity, a harmony, possibly a purpose, possibly a presence. But I'm not sure purpose or presence are as universal as this feeling of harmony.

8. You have a chapter titled "Brainworms, Sticky Music, and Catchy Tunes," exploring when music "crosses a line and becomes, so to speak, pathological" and "subverts a part of the brain, forcing it to fire repetitively and autonomously (as may happen with a tic or a seizure.)"

Earworms, or brainworms, may start as very meaningful, but they become mechanically repetitive. One is then seeing helpless loop activity in the brain, which resembles seizure activity.

Advertisers are wicked specialists in the production or earworms. So much music is designed to be manipulative—film scores, advertisements, theme songs. I think it's a perverse use of music.

9. Speaking of potentially perverse uses of music, what do you think of all these people walking around with I-Pods in their ears?

Well, it is a cellphone culture we live in, and the two may go together. I contrast this with what I saw in Costa Rico recently, where I went to a biology station. I was living for a few days in a village where women were breastfeeding babies, men were playing cards, there was a lovely street life. It was before all these f******* new technologies seduced people. What a jabbering species we are.

As far as the music goes, it's lovely to have music, it's a form of musicophilia. But it can be too much, one shouldn't walk the streets which are full of dangers and other people in a totally private world of one's own. That's what mad people do. The uses of cellphones are just like hallucinations. And then there's the additional twist: Truly crazy people pretend to be using cellphones!

10. Do you have a favorite piece of music?

It changes. On my CD player at home, I'm listening to a medley of Schubert songs. But just yesterday I was sent a CD, Bach Goldberg Variations. Whatever I play at any particular time is my favorite. Basically I like all classical music, staring with Bach and ending more or less with Brahms. I am fond of Stravinsky.

My musical education and tastes end around 1950. I'm afraid I've never really entered jazz or blues, but when I hear them on the radio, they sometimes break me up, or tear me up. One of my brothers who was very musical brought jazz into the house. I didn't go with that, but it is amazing stuff.