The Mind Traveller

Oliver Sacks

Migraine at the age of two and the beatings at boarding school helped fashion the life of neurologist and bestselling author Oliver Sacks. Now,in his TV series,he aims to unravel the chaos that can be the human mind.

Andrew Duncan

Andrew Duncan Dr Oliver sacks is the diffident,charming, but undoubtedly odd neurologist who thinks of himself as a reporter from the borders of human experience and who was thrust unwillingly into fame when Robin Williams played him in a film based on his book, Awakenings, about how he administered L Dopa to sleeping-sickness patients and miraculously cured them, albeit temporarily. The book was also the basis of a play by Harold Pinter, A Kind of Alaska, while his subsequent work The Man Who Mistook His Wife For A Hat was turned into a stage play by Peter Brook.

He is instantly recognisable - burly, bearded, dressed in baggy clothes, sandals, grey socks, and clutching a couple of carrier bags. We are in an editing suite in London to discuss his current series, The Mind Traveller but first he catches sight of a banana on a desk and picks it up. "I love them. Would you like half?" He talks in a precise way with a slightly sing-song stammer, reminiscent of the former Archbishop Runcie, searching for the right word amid numerous "ums". His favourite is that clincher of academic equivocation, "but" ,although he is adamant in his dislike of the series title. "I didn't want it to refer to me. I'd prefer Neurological Adventures, or something like that. I loved David Attenborough's The Secret Life of Plants. That wasn't called The Plant Traveller. These days everything comes down to personality and it shouldn't. I want to be the conduit for my subjects. It's them, not me."

He fidgets a lot, sighs and leaves the room to wash, as he is feeling sticky after eating the banana. when he returns he continues, "I don't feel too comfortable in this role as a television narrator. I have to act a bit and don't like being looked at by the camera. It might cause an involuntary exhibitionism. I was in several minds about doing the series, but I'd met Chris Rawlence, the director , ten years ago when he wrote the libretto for a Channel 4 opera of The Hat, and he wanted to make a picture of what interests a neurologist'. Things went in all directions and we inadvertently made nine instead of six films."

His enthusiasm for his subjects people who are deaf blind, colour blind, autistic, or with Williams' or Tourette's syndrome is warm and overwhelming, yet he has been accused of parading a freak show of the mentally disturbed. " Any external criticism is amplified thousand fold internally," he says, slightly anguished. "One must be on one's guard all the time for the propriety of the relationships. I think there is sympathy and curiosity mixed with less noble attitudes like voyeurism for those who are different or disabled people would crowd to see the inhabitants of Bedlam on Sunday - but I do hope I can give a sense of lives that are interestingly "other" and deserve respect and admiration." This week's programme, Rage for Order, is a perfect example: the moving and sympathetically told story of Jessy an autistic artist whose mind holds deep obsessions she can't bear lights being left on and is fascinated by burglar alarms, cashpoint machines, fridges and the weather channel on TV.

Dr Sacks was born in north London in 1933 to parents who were both doctors. His interest in neurology was sparked when he was two and began to have migraines. "I lost vision and colour. Faces became unrecognisable. This gave me an early and frightened sense that the world is constructed by the nervous system and can be misconstrued in all sorts of ways." Already an inward-looking boy, his isolation was further compounded when, at the outbreak of the Second World War, he was sent to boarding school near , Northampton. "Pressure was put on parents to get their children out of danger. It wasn't evident at the time that there might be psychological problems in separation from the family but it soon became clear. For me, it was traumatic. I think it had an effect on the rest of my life. It was a harsh four years and the food was terrible Swedes, turnips and mangelwurzel. I never wanted to see another mangelwurzel and I haven't. I try to recall those days, but meet the resistance of amnesia, or whatever." He stands and runs a hand along his bottom. I still feel sore here at the memory of some of the beatings."

He opens the window he is oversensitive to temperature (he calls it thermal psychosis; he is also claustrophobic and afraid of the dark) before continuing. "The notion of the good and terrible institution has haunted me ever since, and is one of the reasons why much of my - practice is in institutions." He studied at Oxford, qualified as a doctor at the Middlesex Hospital, did some unsuccessful research in Birmingham, before departing for California in 1965 because, he says there was too much competition in the family both his brothers were also doctors and medicine in England was too restricted to contain "an oddity like me. I'm a restless creature" A few years later he took up a post at the Albert Einstein College of Medicine in New York where he is Clinical Professor of Neurology, commuting from the Bronx in his only apparent luxury, a Mercedes.

Every day he visits the botanical gardens, and twice a week he goes to the zoo. "I study the great apes. It's wrong to see ourselves as creatures of culture and forget our biological origins. All sorts of human behaviour is unintelligible unless one considers primate behaviour. We are intelligent apes, with the capacity to be angelic as well as demonic." He explains how multiple sclerosis patients sometimes detect an odd movement in the palate, inner ear and neck. "That's the fishy thing, the vestiges of our gill arches from 100 million years ago. The notion that we have a billion years of evolution behind us is reassuring. Everything has been tested, honed and adapted. But equally it has become clear that even identical twins don't have identical nervous systems. Everyone is unique. That's reassuring, too, although it may also be a lonely thought because it may mean no one can ever fully understand or communicate with anyone else. We may need "normal" as a medical or social word, but life can be led from a lot of different centres. This becomes very clear in the island community of Pingelap [a mile-long atoll in the Pacific, featured in last week's Mind Traveller] where eight per cent of the population has no concept of colour. They think we're distracted by it and don't pay sufficient attention to texture, tone and shape."

As a man trying to make order out of the apparent chaos of our mental condition, he lost his belief in one answer - God - early on. At the age of ten he planted two rows of radishes and suggested that if God wanted to prove His existence He would make one row flourish and the other wilt. Both wilted. So he puts his faith in increased neurological knowledge, which he believes may produce new respect for individuality, in contrast to those who believe we face a future of virtual reality and chemical stimulation. "But," he adds, "who knows which way the future will go?"

Sacks and Williams

He had his own tussles with pharmacologically- induced "happiness" shortly after he became famous. "The change happened with the Hat book. It came out in a small printing, but was a bestseller overnight. Internally I'm probably the same as ever shy, stubborn, curious and I was unlikely to be changed by success or fame, whatever those things mean, but all that publicity was very peculiar. I slept badly, was full of regrets and reproaches, so I was prescribed Prozac. Almost everyone I know was on it. Fortunately or unfortunately it made me sick, and then I started another book, which was better than any Prozac. In fact my footnotes [which in his latest book, The Island of the Colour Blind, take up 71 of the 293 pages] are my Prozac. I love writing them."

When that doesn't work he has twice weekly access to his psychiatrist, sometimes telephoning him on his car phone from out-of-the way places like the Arizona desert. "I've seen him for 30 years, possibly the longest analysis in history I started because I was bored, depressed, destructive, addicted to amphetamine fixes which Jonathan Miller [a lifelong friend with whom he went to St Paul's school] said was a vulgar fourth-rate drug. It made me euphoric, but next day I was in vertical descent with a feeling of folly I told my analyst, "Nothing ever changes. Is this what life is?" Of course, you have to distinguish between neurotic and common unhappiness. I don't want to recommend pain, but it is part of the human predicament and a great deepener. I want to say that one hasn't been fully and responsibly  "human" if one doesn't experience things to the full, but I am beginning to hear a homiletic tone that doesn't belong to neurology."

Anyway , the psychiatry works. "Now I have adventure, novelty, risk and a slight sense of responsibility I'm privileged to have a neutral figure who listens carefully, whom I trust and respect, who knows my darker side. He is still Dr S to me and I am Dr Sacks to him. I know nothing about his personal life and he knows everything about me. Ideally, everyone should have a shrink. It's much more interesting than being plugged into an electrode. Excuse me while I stand for a minute. I hurt my hip and it bothers me to sit." He suffers from success as a weightlifter in his youth he held the Californian record for a lift of over 600lb.

It is difficult to ask such an eminently nice man if the study of the mind can make neurologists as barking mad as some psychiatrists appear to be. Is his empathy with his patients increased because he is himself a dysfunctional human being? He thinks for a long time. "Yes and no. I'm a lonely person, not at ease socially. I'm terrified of crowds and hate being in groups. I have my clinical work I'm fond of botany and I have a passion for swimming. It' s a fairly limited life. I know certain things are difficult for me and on the whole I no longer do them." Perhaps this includes sex.He has never married or lived with anyone and says he's celibate. "Did I use a word like that? It's so sanctimonious, too much like a religious vow, but yeah, OK. On the whole I think it' s partly fear of commitment. I'm not very good at relationships, not even with my plants. I either water them too much or not enough and that's what would have happened if I had had children. They would be neglected or pampered and that would make them unstable. I used to regret not having a family, but I no longer do."

It seems odd that a man who has made it his job to  "bond" with the mentally different says he is no good at relationships. "Ummm, yes. When my mother died, many of her patients and students came to the funeral and I learned so much about the close relationships she had with them which she never had with her family. She was an absentee mother, distant, somewhat shy and formidable, yet she was none of those things with her patients. I liked her. If anything, the relationship was too close. But these things are always so complex and ambivalent. Now she has been dead many years and one learns more. I'm sorry all sorts of misunderstandings and conflicts remained unresolved. I think I am similar to her am emotionally involved with patients, but it's involvement without danger, constrained by the role. It is affection without commitment."

Whether or not you believe in the paranormal may depend entirely on your brain chemistry. People with high levels of dopamine are more likely to find significance in coincidences, and pick out meaning and patterns where there are none. Peter Brugger, a neurologist from the University Hospital in Zurich, Switzerland, has suggested before that people who believe in the paranormal often seem to be more willing to see patterns or relationships between events where sceptics perceive nothing. To find out what could be triggering these thoughts, Brugger persuaded 20 self-confessed believers and 20 sceptics to take part in an experiment. Brugger and his colleagues asked the two groups to distinguish real faces from scrambled faces as the images were flashed up briefly on a screen. The volunteers then did a similar task, this time identifying real words from made-up ones.
Seeing and believing
Believers were much more likely than sceptics to see a word or face when there was not one, Brugger revealed last week at a meeting of the Federation of European Neuroscience Societies in Paris. However, sceptics were more likely to miss real faces and words when they appeared on the screen. The researchers then gave the volunteers a drug called L-dopa, which is usually used to relieve the symptoms of Parkinson's disease by increasing levels of dopamine in the brain. Both groups made more mistakes under the influence of the drug, but the sceptics became more likely to interpret scrambled words or faces as the real thing. That suggests that paranormal thoughts are associated with high levels of dopamine in the brain, and the L-dopa makes sceptics less sceptical. "Dopamine seems to help people see patterns," says Brugger.
Plateau effect
However, the single dose of the drug did not seem to increase the tendency of believers to see coincidences or relationships between the words and images. That could mean that there is a plateau effect for them, with more dopamine having relatively little effect above a certain threshold, says Peter Krummenacher, one of Brugger's colleagues. Dopamine is an important chemical involved in the brain's reward and motivation system, and in addiction. Its role in the reward system may be to help us decide whether information is relevant or irrelevant, says Françoise Schenk from the University of Lausanne in Switzerland. [New Scientist July 2 2002]

Rilke - Panther

John Oxford

Professor John Oxford at the Royal London Hospital: "We have eight brain tissue samples from people who died of encephalitis lethargica. That's not enough - we need a hundred"

Professor John Oxford is determined to solve the riddle of the mysterious brain infection featured in the film Awakenings and in the first of a new series of QED. Nick Griffiths reports.

Secreted away in laboratories around the world are scientists we never see researching diseases we rarely hear of, but which could cause chaos we can hardly contemplate. Back in the early twenties, encephalitis lethargica which imprisons people in a sleeplike state and is the subject of this week's QED : Prisoners of the Forgotten Plague affected up to five million people worldwide; it followed the influenza pandemic at the end of the First World War, which killed up to 40 million people. Professor John Oxford, virologist at the Royal London Hospital in Whitechapel, is dedicated to linking the two outbreaks so a cure for the mystery disease may be found.

The effects of this brain infection can be seen in the film Awakenings, starring Robin Williams and Robert De Niro. It's the true story of British neurologist Oliver Sacks' s work with people who ad survived EL but who had been all but forgotten. QED provides startling original footage of those patients: ageing, wheelchair bound, rigidly statuesque, arms twisted like dead wood, gone to the world but alive inside. "The part of the brain that regulates movement is damaged," explains Prof Oxford," giving the shakiness, the rigidity, the difficulty in moving the facial expression and the tendency to topple over." In the twenties a bride travelling to her wedding fell asleep, never to awake. Move a sufferer's arm into an unnatural position, and it might stay there for ever.

To further knowledge of the disease, Prof Oxford needs brain tissue samples. We have eight, from people who died of EL in the twenties.That's not enough," he says. "We need a hundred."
Not everyone with EL - which is not thought to be transmissible, adding to the mystery - during the twenties died. One third died, quickly; another third recovered. The remainder bore the aftereffects for years or decades and a handful of these survivors live to this day. Philip Leather, now 77 was admitted to hospital aged 13, having been diagnosed with EL by WH Auden's father; 64 years later, he's still there. His sister, Jean Price, tells QED of a bright child, playing the piano at three, who would piece together the back of jigsaws after tiring of the picture side. These days, he can barely write his own name. Jean has pledged her brother's brain, following his death, to Prof Oxford. "Philip's there, living, and in that sense he gives our project a reality. He's a beacon of hope," says the virologist. But I certainly don't want to be thought of as sitting here like a vulture. I might die before Philip. A science project is like a relay race and you hand on to the next person."

This is exactly how he came to have the samples from the twenties: they were in a vault with in his own hospital. In this place of compelling reverence are wooden boxes containing slices of brain, encased in wax, of those who died during the Royal London Hospital's past. According to records, a steward's wife of 37 had suffered a headache  "for four years" and was admitted "delirious, with bubbling respiration". She died within 24 hours. A 17-year old girl was one of 11 from a girls' home to contract EL. Real people, long gone. "Discovering those samples," says Prof Oxford, who was pointed towards them by a colleague, "was mind boggling. I had never conceived that I could walk into a basement and have hundreds of boxes filled with amazing goodies that you could do something with. The scientists working on the outbreak in the twenties must have said,'We can't solve this now but some one in the future will,' and they took samples and stored them away for posterity.That's total science, total philanthropy and totally amazing."

New cases of EL are very rare. QED tracked down Rebecca Howells, now 28, who was admitted to hospital in 1993 suffering from delusions and behaving uncontrollably. She became so ill that her father bade her goodbye .After exhaustive tests, she was diagnosed with EL and given a massive dose of steroids to reduce the brain swelling. Fantastically, she appears to be completely cured. Still no one knows exactly why, nor whether the technique would be as successful on others.

Prof Oxford's personal breakthrough would be to isolate the influenza virus in Philip Leather's brain, to prove the link with EL. He believes a complication in a proportion of those surviving 1918's vast flu outbreak caused the EL that peaked some five years later. If he's right, a future flu pandemic, which would be more easily controlled with today's medicines, could have graver consequences further down the line.

But the eight EL brain samples Prof Oxford and neuropathologist Jenny Ann Geddes have already tested all proved negative: no influenza genetic footprint present. This is a setback, but not an ending. The technology used may not have been sensitive enough, and the sample size too small, he suggests. He has put out a call for more brain tissue to a pathologist he contacted in Prague, who had previously sent over lung samples. "He was a typical central European," explains Prof Oxford, bearded, looking like God. He said,'We had the brain of [composer] Smetana and lost that during the revolution. Do you really think we're going to have EL brain samples?'"

So the search continues. This year an expedition to Spitzbergen, off Greenland, will carefully remove from their permafrost graves the bodies of six miners who died of influenza in 1918.Samples will be taken, a link with EL sought, hope may linger.
"It's difficult to imagine 40 million people dying, but much easier to see one person and multiply that by 40 million," says Prof Oxford. He produces a browning photograph of a couple, arms linked, on their wedding day. On the reverse a legend reads: "Marriage of Thomas Frederick Bithell, 29, to Gladys Rogers, 21, Church of St Ethelwold, Shotton, Flintshire, North Wales, 7 September 1918." "The point of this picture is that Thomas Bithell contracted influenza and died two months later," says Prof Oxford. "In a sense, it's the story of the Titanic couple, Jack and Rose. He dies and she stays on to do all the things he would have wanted her to do. Gladys had this picture by her bedside until she died in 1975.

"I wouldn't want anyone in my group to receive a picture like this and think, 'So what?' This wasn't just about one person: there was the effect on his wife and their families. People are still sending me pictures.Look at Philip Leather. His illness affected so many that the influence is touching us even now."
RT 25 - 31 July 1998

Coming up on QED ... Deadly Secrets explores the tragedy of mothers who kill their babies; in Back from the Dead, we learn how scientists are trying to resurrect the quagga, an animal extinct since 1883; as asthma rates soar Breathless tests a controversial new treatment; and in The Mystery of Spontaneous Human Combustion, QED conducts the largest experiment ever attempted to shed light on this enduring enigma.





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