In the twelfth chapter, titled “A Matter of Identity,” Dr. Sacks recounts the case of a patient with a memory disorder that rendered him unable to recognize not only others but himself — unable, that is, to retain the autobiographical facts which a person constellates into a selfhood. To compensate for this amnesiac anomaly, the man unconsciously invented countless phantasmagorical narratives about who he was and what he had done in his life, crowding the void of his identity with imagined selves and experiences he fully believed were real, were his own, far surpassing what any one person could compress into a single lifetime. It was as though he had taken Emily Dickinson’s famous verse“I’m Nobody! Who are you?” and turned it on himself to answer with a resounding “I’m Everybody!”
But just as depression can be seen as melancholy in the complex clinical extreme and bipolar disorder as moodiness in the complex clinical extreme, every pathological malady of the mind is a complex clinical extreme of a core human tendency that inheres in each of our minds in tamer degrees. By magnifying basic tendencies to such extraordinary extremes, clinical cases offer a singular lens on how the ordinary mind works — and that, of course, is the great gift of Oliver Sacks, who wrests from his particular patient case studies uncommon insight into the universals of human nature.
“Such a patient,” Sacks writes of the inventive amnesiac man, “must literally make himself (and his world) up every moment.” And yet that is precisely what we are all doing in a certain sense, to a certain degree, as we continually make ourselves and our world up through the stories we tell ourselves and others.
We have, each of us, a life-story, an inner narrative — whose continuity, whose sense, is our lives. It might be said that each of us constructs and lives, a “narrative,” and that this narrative is us, our identities.
If we wish to know about a man, we ask “what is his story — his real, inmost story?” — for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us — through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives — we are each of us unique.
Sacks considers the basic existential responsibility that stems from our narrative uniqueness:
To be ourselves we must have ourselves — possess, if need be re-possess, our life-stories. We must “recollect” ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.
“It takes a special energy, over and above one’s creative potential, a special audacity or subversiveness, to strike out in a new direction once one is settled.”
By Maria Popova
“And don’t ever imitate anybody,” Hemingway cautioned in his advice to aspiring writers. But in this particular sentiment, the otherwise insightful Nobel laureate seems to have been blind to his own admonition against the dangers of ego, for only the ego can blind an artist to the recognition that all creative work begins with imitation before fermenting into originality under the dual forces of time and consecrating effort.
In his impressive handwritten notes on creativity and the brain, which became the basis of the essay, Sacks had enthused about — in two colors, underlined — the “buzzing, blooming chaos” of the mind engaged in creative work. But, contrary to the archetypal myth of the lone genius struck with a sudden Eureka! moment, this chaos doesn’t occur in a vacuum. Rather, it coalesces from a particulate cloud of influences and inspirations without which creativity — that is, birthing of something meaningful that hadn’t exist before — cannot come about.
With the illustrative example of Susan Sontag — herself a writer of abiding wisdom on the art of storytelling — Sacks traces the inevitable trajectory of creative development from imitation to originality:
Susan Sontag, at a conference in 2002, spoke about how reading opened up the entire world to her when she was quite young, enlarging her imagination and memory far beyond the bounds of her actual, immediate personal experience. She recalled,
When I was five or six, I read Eve Curie’s biography of her mother. I read comic books, dictionaries, and encyclopedias indiscriminately, and with great pleasure…. It felt like the more I took in, the stronger I was, the bigger the world got…. I think I was, from the very beginning, an incredibly gifted student, an incredibly gifted learner, a champion child autodidact…. Is that creative? No, it wasn’t creative…[but] it didn’t preclude becoming creative later on…. I was engorging rather than making. I was a mental traveler, a mental glutton…. My childhood, apart from my wretched actual life, was just a career in ecstasy.
I started writing when I was about seven. I started a newspaper when I was eight, which I filled with stories and poems and plays and articles, and which I used to sell to the neighbors for five cents. I’m sure it was quite banal and conventional, and simply made up of things, influenced by things, I was reading…. Of course there were models, there was a pantheon of these people…. If I was reading the stories of Poe, then I would write a Poe-like story…. When I was ten, a long-forgotten play by Karel Čapek, R.U.R., about robots, fell into my hands, so I wrote a play about robots. But it was absolutely derivative. Whatever I saw I loved, and whatever I loved I wanted to imitate — that’s not necessarily the royal road to real innovation or creativity; neither, as I saw it, does it preclude it…. I started to be a real writer at thirteen.
Sontag’s experience, Sacks argues, reflects the common pattern in the natural cycle of creative evolution — we learn our own minds by finding out what we love; these models integrate into a sensibility; out of that sensibility arises the initial impulse for imitation, which, aided by the gradual acquisition of technical mastery, eventually ripens into original creation. He writes:
If imitation plays a central role in the performing arts, where incessant practice, repetition, and rehearsal are essential, it is equally important in painting or composing or writing, for example. All young artists seek models in their apprentice years, models whose style, technical mastery, and innovations can teach them. Young painters may haunt the galleries of the Met or the Louvre; young composers may go to concerts or study scores. All art, in this sense, starts out as “derivative,” highly influenced by, if not a direct imitation or paraphrase of, the admired and emulated models.
When Alexander Pope was thirteen years old, he asked William Walsh, an older poet whom he admired, for advice. Walsh’s advice was that Pope should be “correct.” Pope took this to mean that he should first gain a mastery of poetic forms and techniques. To this end, in his “Imitations of English Poets,” Pope began by imitating Walsh, then Cowley, the Earl of Rochester, and more major figures like Chaucer and Spenser, as well as writing “Paraphrases,” as he called them, of Latin poets. By seventeen, he had mastered the heroic couplet and began to write his “Pastorals” and other poems, where he developed and honed his own style but contented himself with the most insipid or clichéd themes. It was only once he had established full mastery of his style and form that he started to charge it with the exquisite and sometimes terrifying products of his own imagination. For most artists, perhaps, these stages or processes overlap a good deal, but imitation and mastery of form or skills must come before major creativity.
Curiously, Sacks points out, many creators don’t make the leap from mastery to such “major creativity” — something Schopenhauer considered in his incisive distinction between talent and genius. Often, creators — be they artists or scientists — content themselves with reaching a level of mastery, then remaining at that plateau for the rest of their careers, comfortably creating more of what they already know well how to create. Sacks examines what set those who soar apart from those who plateau:
Why is it that of every hundred gifted young musicians who study at Juilliard or every hundred brilliant young scientists who go to work in major labs under illustrious mentors, only a handful will write memorable musical compositions or make scientific discoveries of major importance? Are the majority, despite their gifts, lacking in some further creative spark? Are they missing characteristics other than creativity that may be essential for creative achievement — such as boldness, confidence, independence of mind?
It takes a special energy, over and above one’s creative potential, a special audacity or subversiveness, to strike out in a new direction once one is settled. It is a gamble as all creative projects must be, for the new direction may not turn out to be productive at all.
Much of the gamble, Sacks argues, is a kind of patient gestation at the unconscious level — something Einstein touched upon in explaining how his mind worked. Echoing T.S. Eliot’s insistence on the necessity of “a long incubation” in creative work, Sacks adds:
Creativity involves not only years of conscious preparation and training but unconscious preparation as well. This incubation period is essential to allow the subconscious assimilation and incorporation of one’s influences and sources, to reorganize and synthesize them into something of one’s own…. The essential element in these realms of retaining and appropriating versus assimilating and incorporating is one of depth, of meaning, of active and personal involvement.
He illustrates the detrimental absence of such a gestational period with an example from his own experience:
Early in 1982, I received an unexpected packet from London containing a letter from Harold Pinter and the manuscript of a new play, A Kind of Alaska, which, he said, had been inspired by a case history of mine in Awakenings. In his letter, Pinter said that he had read my book when it originally came out in 1973 and had immediately wondered about the problems presented by a dramatic adaptation of this. But, seeing no ready solution to these problems, he had then forgotten about it. One morning eight years later, Pinter wrote, he had awoken with the first image and first words (“Something is happening”) clear and pressing in his mind. The play had then “written itself” in the days and weeks that followed.
I could not help contrasting this with a play (inspired by the same case history) which I had been sent four years earlier, where the author, in an accompanying letter, said that he had read Awakenings two months before and been so “influenced,” so possessed, by it that he felt impelled to write a play straightaway. Whereas I loved Pinter’s play — not least because it effected so profound a transformation, a “Pinterization” of my own themes — I felt the 1978 play to be grossly derivative, for it lifted, sometimes, whole sentences from my own book without transforming them in the least. It seemed to me less an original play than a plagiarism or a parody (yet there was no doubting the author’s “obsession” or good faith).
In a testament to his uncommon empathic might and his endearing generosity of interpretation in regarding others, Sacks reflects on the deeper phenomena at play:
I was not sure what to make of this. Was the author too lazy, or too lacking in talent or originality, to make the needed transformation of my work? Or was the problem essentially one of incubation, that he had not allowed himself enough time for the experience of reading Awakenings to sink in? Nor had he allowed himself, as Pinter did, time to forget it, to let it fall into his unconscious, where it might link with other experiences and thoughts.
The unfortunate playwright seems to have embodied the lamentation which poet Mary Oliver so beautifully articulated in her meditation on the creative life: “The most regretful people on earth are those who felt the call to creative work, who felt their own creative power restive and uprising, and gave to it neither power nor time.”
All of us, to some extent, borrow from others, from the culture around us. Ideas are in the air, and we may appropriate, often without realizing, the phrases and language of the times. We borrow language itself; we did not invent it. We found it, we grew up into it, though we may use it, interpret it, in very individual ways. What is at issue is not the fact of “borrowing” or “imitating,” of being “derivative,” being “influenced,” but what one does with what is borrowed or imitated or derived; how deeply one assimilates it, takes it into oneself, compounds it with one’s own experiences and thoughts and feelings, places it in relation to oneself, and expresses it in a new way, one’s own.
On the redemptive acceptance of the terminally ill as “a living part of the community.”
By Maria Popova
“There is something in personal love, caresses, and the magnetic flood of sympathy and friendship, that does, in its way, more good than all the medicine in the world,” Walt Whitman wrote in his insightful meditation on healthcare and the human spirit, from which contemporary medicine has much to learn, after he volunteered as a nurse during the Civil War.
I thought of Whitman during a beautiful, bittersweet weekend of poetry with a dear, terminally ill friend who is living longer and more fully than her grim diagnosis had originally prophesied, largely thanks to her deliberate decision to immerse herself in such a “magnetic flood of sympathy and friendship,” to spend weekends reading poetry with people who love her.
In one particularly moving portion, Dr. Sacks recounts his encounter with a sixty-year-old woman named Tomasa, born the same year as he, who for the past quarter of her life had been living with lytico — a progressively paralytic disease endemic to the island of Guam, in some cases resembling ALS and in others Parkinson’s.
He describes Tomasa’s state at the time of their meeting:
She had already had lytico for fifteen years when he met her; it has advanced steadily since, paralyzing not only her limbs but the muscles of breathing, speech, and swallowing. She is now near the end, but has continued to bear it with fortitude, to tolerate a nasogastric tube, frequent choking and aspiration, total dependence, with a calm, unfrightened fatalism. Indeed a fatality hangs over her entire family—her father suffered from lytico, as did two of her sisters, while two of her brothers have parkinsonism and dementia. Out of eight children in her generation, five have been afflicted by the lytico-bodig.
And yet what made Tomasa’s condition extraordinary against the backdrop of Western medicine is how it was met by the community and her loved ones. Dr. Sacks writes:
Family, friends, neighbors, come in at all hours, read the papers to her, tell her the news, give her all the local gossip. At Christmas, the Christmas tree is put by her couch; if there are local fiestas or picnics, people gather in her room. She may scarcely be able to move or speak, but she is still, in their eyes, a total person, still part of the family and community. She will remain at home, in the bosom of her family and community, in total consciousness and dignity and personhood, up to the day of her death, a death which cannot, now, be too far off.
This acceptance of the sick person as a person, a living part of the community, extends to those with chronic and incurable illness, who may, like Tomasa, have years of invalidism. I thought of my own patients with advanced ALS in New York, all in hospitals or nursing homes, with nasogastric tubes, suction apparatus, sometimes respirators, every sort of technical support — but very much alone, deliberately or unconsciously avoided by their relatives, who cannot bear to see them in this state, and almost prefer to think of them (as the hospital does) not as human beings, but as terminal medical cases on full “life support,” getting the best of modern medical care. Such patients are often avoided by doctors too, written, even by them, out of the book of life.
Inside the “buzzing, blooming chaos” of a brilliant mind at work.
By Maria Popova
“The act of writing is an integral part of my mental life; ideas emerge, are shaped, in the act of writing… a special, indispensable form of talking to myself,” Oliver Sacks wrote as he reflected on storytelling and the curious psychology of writing. Indeed, what makes his writing so singular and splendid is that it makes the reader feel like she is listening to the inner song of the writer’s very consciousness, where concepts are syncopated, ideas harmonized, and divergent associations strummed into a smooth melody of meaning.
What a privilege, then, to witness the raw rhythm of that consciousness in Dr. Sacks’s notes to himself — the creative sandbox in which he worked out his ideas and sketched the skeletons of what he would later flesh out into essays and entire books.
“The need to think on paper is not confined to notebooks,” he professes in his indispensable memoir. “It spreads onto the backs of envelopes, menus, whatever scraps of paper are at hand.” That miscellany of canvases for informal thought is what I have the grateful chance to share here — a rare glimpse of an extraordinary mind at work, courtesy of Bill Hayes, Dr. Sacks’s partner (who has written beautifully about their love and life together in his memoir Insomniac City), with special thanks to Dr. Sacks’s editor, Dan Frank, and his longtime assistant and collaborator, Kate Edgar, currently heading the Oliver Sacks Foundation and putting together the Oliver Sacks archive of which these papers will one day be a part.
Using whatever paper and writing instrument he had on hand, Dr. Sacks jotted down ideas as they occurred to him — unedited, un-self-censored flights of fancy, captured before they flew away and later domesticated into the thoughtful, exquisitely structured, immensely insightful formal writings for which he is so beloved.
On a plain piece of legal paper, he ponders the mysteries of consciousness. In a lengthy diary entry snaking around the cartoon airplanes on an airline menu, he records with childlike wonder the thrill of being allowed to go inside the cockpit and marvels at the “hundreds! thousands of dials” inside the “tiny cabin.” On the inside of a folder, he contemplates what it means to be alive. On hotel stationery, he contrasts fancy and imagination. On two loose leaves stapled, he distinguishes between the two modes of creativity.
After countless hours of deciphering his archetypal doctorly handwriting, and with greatly appreciated help from Bill Hayes, I’ve transcribed the most notable of Dr. Sacks’s notes.
In one set of notes — part of what would become “The Creative Self,” one of ten essays in the forthcoming posthumous anthology The River of Consciousness — he appears to be offering a wonderful taxonomy of the two types of creative work: making and birthing, reminiscent of Lewis Hyde’s dichotomy of work vs. labor.
Dr. Sacks characterizes making as “elementary,” “primitive,” “juvenile,” and “pathological,” and birthing as “deep,” “motivated,” “personal,” “not immediate,” and “not conscious,” underlining “theoretical/structural.” Where making is driven by association and memory, birthing “needs ‘incubation'” and is marked by intuition. But before we hasten to assume that he valued the latter type of creative work more highly than the former, he lists Darwin as an example of a writer who makes and Rilke as one who births, which strongly suggests that he saw the two not as a hierarchy but as distinct, complementary forms of creative work — Darwin was, after all, one of Dr. Sacks’s great heroes.
He continues on a second page, contrasting the “quick” and “funny” thought process of making with the “pondering,” “weighing,” “judgment,” and “reflecting” of birthing. Where the former is aimed at “learning,” the latter is “concept-driven” or “self-driven.”
put in perspective
speak for others
“fix” in words
find verbal equivalent
Next to “fun” and “wit,” he jots down a parenthetical example: “I sighed as a lover, I obeyed as a son” — a line from the memoirs of the great historian Edward Gibbon, which must have impressed itself upon Dr. Sacks’s literary imagination in the course of his lifetime of voracious reading.
In red ink, he adds another set of motives which differs from the first in seeming to be aimed more at the effect of writing than at its cause:
On another piece of paper, he lists the categories of writing under the bold heading “The Writing Life”:
PORTRAITS ~ bios
MEMOIR — AUTOBIO.
School or college “essays”
On the inside of a folder, Dr. Sacks considers what it means to be alive:
Alive — hence universals of activity, organizing, adapting, but equally of individuality, identity, diversity.
He circles in red an insight he perhaps deemed most worthy of preservation and further development:
Organisms are not machines, computers, automata, replicas, factories, “standard models,” or identities (like atoms!).
Opposite it, he contrasts inner concerns (“passion, curiosity, concern, tenacity, audacity”) with the outer ones, among them “community” and two other illegible words. He then lists the encouraged qualities — in all organisms? in humans? in himself? — “adventure, novelty, risk, error, stimulation, support, adventure, freedom.”
On the back of the folder, he further crystallizes these wonderings and ponderings under the heading “Creativity and the Brain”:
The brain is alive, incessantly active, seething — physiologically — from the moment of birth to the moment of death. All brains — of idiots or geniuses, human beings or dogs. This is most evident in unusual/abnormal conditions.
He proceeds to consider the chief function of the brain:
ORDER OUT OF CHAOS. The brain is in an organism which has to negotiate a complex world, from adequate representation of the world. To understand the world — to seek or make meanings — categorize.
On can almost see the characteristic enthusiasm animating his beaming face as he adds, in two different colors for special emphasis:
BUZZING, BLOOMING CHAOS — literally chaos.
On a piece of stationery from the Ritz Carlton in Chicago, Dr. Sacks ponders memory and creativity, contrasts fancy and imagination, and lists as “The Neural Basis”:
They called me Inky as a boy, and I still seem to get as ink stained as I did seventy years ago.
I started keeping journals when I was fourteen and at last count had nearly a thousand. They come in all shapes and sizes, from little pocket ones which I carry around with me to enormous tomes. I always keep a notebook by my bedside, for dreams as well as nighttime thoughts, and I try to have one by the swimming pool or the lakeside or the seashore; swimming too is very productive of thoughts which I must write, especially if they present themselves, as they sometimes do, in the form of whole sentences or paragraphs.
On another legal pad page, he jots down a short autobiographical sketch under the title “The Joy of Writing,” reminiscent of Antoine de Saint Exupéry’s The Little Prince in its warmhearted contrast between the penchant for writing and the comical incapacity for drawing:
Words came to me early and easily, and I was reading and writing by the age of four or earlier.
On the other hand, I could not (and cannot) draw anything recognizably — my dogs look like insects, my elephants like amoebae. I seem to have almost no voluntary visual imagery. I cannot conjure up scenes of people or animals in my mind. I cannot “see” my parents or the house where I was born. And yet, I am told, my writing is often very “visual” — may call up vivid images in other people’s minds.