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Mental Disorders

by Oliver Sacks
Vintage Books, 1996
Review by Christian Perring, Ph.D. on Jun 30th 1998

An Anthropologist on Mars When I was in graduate school, a fellow student commented about Oliver Sack's book The Man Who Mistook His Wife for a Hat that it was full of counterexamples to philosophical theories that had yet to be thought of. I remember reading that book with a sense of amazement at the bizarre cases of neurological disorders, and a realization that the standard assumptions about the mind could be wrong. These cases seemed philosophically important, even though it wasn't clear how to connect them with the existing philosophical debates.

 By now the initial surprise at the many ways in which the mind can disintegrate or malfunction has worn off. Sacks has continued to write case histories and longer studies, and a collection of seven of these were recently published in An Anthropologist on Mars. It is interesting to compare this to the earlier collection The Man Who..., which contained 24 cases in 243 pages, written between 1980 and 1985. The tales in the newer book are much longer and Sacks puts a little more of himself into them. He is a gifted writer, with a philosophical frame of mind, so they make for compelling reading. "The Last Hippie," for instance, is about a man with massive prefrontal brain damage and almost no ability to remember current events, who is brought alive and kept together by his music. The title story is about Sacks' encounter with Temple Grandin, an autistic woman who has written about her condition and has worked hard for the improvement of animal farming conditions. "The Case of the Colorblind Painter" tells the story of a artist who loses his color vision and manages to adapt to his non-colored world. Sacks combines his usual scientific expertise with thoughtful asides, which makes the cases both interesting and thought-provoking.

 One of the main themes of the book is strongest in his account of his visit with Dr. Carl Bennett, in "A Surgeon's Life." Bennett has Tourette's, the condition the causes severe tics and the calling out of socially inappropriate phrases. These symptoms are stronger or weaker depending on context, and the amazing fact is that Bennett is an accomplished surgeon and pilot. The condition is bizarre and important especially because of this mixture of the neurological and intentional, and raises what might be called the new "mind/body" problem, or more accurately, the "person/brain" person. The old mind/body problem is a metaphysical one, about whether a non-physical soul exists, or whether we are no more than our brains and bodies. This old problem has not been solved so much as surpassed. The pressing philosophical issue facing us now as our knowledge of the brain increases is how to combine this new knowledge with our old understanding of what people are.

 Modern biopsychiatry tends to take a crude reductionist approach to this problem: people are no more than their brains and mental disorders are no more than malfunctions of the brain. This view is alarmingly popular today, both among scientists at prestigious institutions such as the National Institute for Mental Health, patient advocacy groups such as the National Alliance for the Mentally Ill, and on the national media. Part of the controversy is about whether mental illness is caused by genetic factors or by childhood experience, and often it is reduced to that issue. But what is so valuable about Sacks' work is how he shows that there is more to the issue than nature vs. nurture. All the cases that Sacks discusses are neurological disorders, and the causes of often well understood as brain damage. But knowledge of the causes of neurological conditions does not by itself tell us how to understand the people with those conditions. Sacks is determined to find the humanity and creativity of the people he encounters, and this is not just a rich philosophical attitude, but it also seems to pay dividends in clinical consequences.

 So when Sacks spends several days with the surgeon Carl Bennett, he is fascinated by how Tourette's enters into Bennett's identity. When Bennett is operating on a patient, the Tourettic identity disappears. It might then seem that Tourette's is simply a condition that Bennett has to fight and eliminate as far as possible. But things are not so simple, because Bennett also partially identifies with is condition which is also related to playfulness and meticulousness. Sacks writes about his experience of flying in Bennett's plane.

    And Bennett, though superbly skilled, a natural aviator, is like a child at play. Part of Tourette's, at least, is no more than this-the release of a playful impulse normally inhibited or lost in the rest of us. The freedom, the spaciousness, obviously delight Bennett; he has a carefree, boyish look I rarely saw on the ground.

 Not only does Sacks find something positive about Tourette's, but he also relates it to our understanding of humanity. Instead of crude reductionism, Sacks takes us in the opposite direction, enabling us to see the value of difference and the dangers of having too narrow a conception of what is normal.

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