Sunday, November 25, 2012
Oliver Sacks
We shall never know, for the business of adaptation—and, indeed, of life as he knew it—was suddenly cut across by a gratuitous blow of fate: an illness that, at a single stroke, deprived him of job, house, health, and independence, leaving him a gravely sick man, unable to fend for himself. For Amy, who incited the surgery in the first place, and who was so passionately invested in Virgil’s seeing, it was a “miracle” that misfired, a calamity. Virgil, for his part, maintains philosophically, “These things happen.” But he has been shattered by this blow, has given vent to outbursts of rage: rage at his helplessness and sickness; rage at the smashing of a promise and a dream; and, beneath this, most fundamental of all, a rage that had been smoldering in him almost from the beginning—rage at being thrust into a battle he could neither renounce nor win. At the beginning, there was certainly amazement, wonder, and sometimes joy. There was also, of course, great courage. It was an adventure, an excursion into a new world, the like of which is given to few. But then came the problems, the conflicts, of seeing but not seeing, not being able to make a visual world, and at the same time being forced to give up his native competence—a torment from which no escape seemed possible. But then, paradoxically, a release was given, in the form of a second and now final blindness—a blindness he received as a gift. Now, at last, Virgil is allowed to not see, allowed to escape from the glaring, confusing world of sight and space, and to return to his own true being, the touch world that has been his home for almost fifty years.
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A Neurologist’s Notebook
ReplyDeleteTo See and Not See
by Oliver Sacks
The New Yorker
Issue of 1993-05-10
http://www.newyorker.com/archive/content/articles/060619fr_archive01
Internet Archive – Way Back Machine
http://web.archive.org/web/20060831124229/http://www.newyorker.com/archive/content/articles/060619fr_archive01
“To See and Not See” is the tale of a man who was blind from early childhood, but was able to recover some of his sight after surgery. This is one of an extremely small number of cases where an individual regained sight lost at such a young age, and as with many of the other cases, the patient found the experience to be deeply disturbing.
ReplyDeleteThis essay inspired the Brian Friel play Molly Sweeney.
The 1999 film “At First Sight” is based on this essay.
An Anthropologist on Mars: Seven Paradoxical Tales is a 1995 book by neurologist Oliver Sacks consisting of seven medical case histories of individuals with neurological conditions such as autism and Tourette syndrome.
ReplyDelete1. “The Case of the Colorblind Painter” discusses an accomplished artist who is suddenly struck by cerebral achromatopsia or the inability to perceive color due to brain damage.
2. “The Last Hippie” describes the case of a man suffering from the effects of a massive brain tumor, including anterograde amnesia, which prevents him from remembering anything that has happened since the late 1960s.
3. “A Surgeon’s Life” describes Sacks’ interactions with Dr. Carl Bennett, a surgeon and amateur pilot with Tourette syndrome. The surgeon is often beset by tics, but these tics vanish when he is operating.
4. “To See and Not See” is the tale of a man who was blind from early childhood, but was able to recover some of his sight after surgery. This is one of an extremely small number of cases where an individual regained sight lost at such a young age, and as with many of the other cases, the patient found the experience to be deeply disturbing.
5. “The Landscape of His Dreams” discusses Sacks’ interactions with Franco Magnani, an artist obsessed with his home village of Pontito in Tuscany. Although Magnani has not seen his village in many years, he has constructed a detailed, highly accurate, three-dimensional model of Pontito in his head.
6. “Prodigies” describes Sacks’ relationship with Stephen Wiltshire, a young autistic savant described by Hugh Casson as “possibly the best child artist in Britain.”
7. “An Anthropologist on Mars” describes Sacks’ meeting with Temple Grandin, a woman with autism who is a world-renowned designer of humane livestock facilities and a professor at Colorado State University. The title of this essay comes from a phrase Grandin uses to describe how she often feels in social interactions.
As soon as I met Virgil, at the arrival gate at LaGuardia Airport, I could see for myself that everything had gone quite terribly wrong. He was now almost fifty pounds heavier than when I had met him in Oklahoma. He was carrying a cylinder of oxygen strung over one shoulder. He groped, his eyes wandered, he looked totally blind. Amy guided him, her hand under his elbow, everywhere they went. And yet sometimes as we drove over the Fifty-ninth Street Bridge into the city he would pick up something—a light on the bridge—not guessing but seeing it quite accurately. But he could never hold it or retrieve it, and so remained visually lost.
ReplyDeleteWhen we came to test him in my office—first using large colored targets, then large movements and flashlights—he missed everything. He seemed totally blind—blinder than he had been before his operations, because then, at least, even through his cataracts he could detect light, its direction, and the shadow of a hand moving before him. Now he could detect nothing whatever, no longer seemed to have any light-sensitive receptors: it was as if his retinas had gone. Yet not totally gone—that was the odd thing. For once in a while he would see something accurately: once, he saw, described, grasped a banana; on two occasions, he was able to follow a randomly moving light bar with his hands on a computer screen; and sometimes he would reach for objects, or “guess” them correctly, even though he said he saw “nothing” at such times—the blindsight that had first been observed in the hospital.
We were dismayed at his near-uniform failure, and he was sinking into a demoralized, defeated state—it was time to stop testing and take a break for lunch. As we passed him a bowl of fruit, and he felt the fruit with swift, sensitive, skillful fingers, his face lighted up, and he regained his animation. He gave us, as he handled the fruit, remarkable tactile descriptions, speaking of the waxy, slick quality of the plum skin, the soft fuzz of peaches and smoothness of nectarines (“like a baby’s cheeks”), and the rough, dimpled skin of oranges. He weighed the fruits in his hand, spoke of their weight and consistency, their pips and stones; and then, lifting them to his nose, their different smells. We included an exceedingly clever wax pear among the real fruit; with its realistic shape and coloring, it had deceived sighted people completely. Virgil was not taken in fora moment: he burst out laughing as soon as he touched it. “It’s a candle,” he said immediately, somewhat puzzled. “Shaped like a bell or a pear.” While he may indeed have been, in von Senden’s words, “an exile from spatial reality,” he was deeply at home in the world of touch, in time.
But if his sense of touch was perfectly preserved, there were now, it was evident, just sparks from his retinas—rare, momentary sparks, from retinas that now seemed to be ninety-nine per cent dead. Bob Wasserman, too, who had not seen Virgil since our visit to Oklahoma, was appalled at the degradation of vision, and wanted to reëxamine the retinas. When he did so, they looked exactly as before—piebald, with areas of increased and decreased pigmentation. There was no evidence of any new disease. Yet the functioning of even the preserved areas of retina had fallen to almost zero. Electroretinograms, designed to record the retina’s electrical activity when stimulated by light, were negative, and visual evoked potentials, designed to show activity in the visual parts of the brain, were absent—there was nothing, electrically, going on in either the retinas or the brain that could be recorded. This could not be attributed to the original disease, retinitis, which had long been inactive. Something else had emerged in the past year and had, in effect, extinguished his remaining retinal function.
We remembered how Virgil had constantly complained of glare, even on relatively dull, overcast days—how glare seemed to blind him sometimes, so that he needed the darkest glasses. Was it possible (as my colleagues Kevin Halligan and Gerald Edelman suggested) that with the removal of his cataracts—cataracts that had perhaps shielded his fragile retinas for decades—the ordinary light of day had proved lethal, burned his retinas? It is said that patients with other retinal problems, like maculardegeneration, may be exceedingly intolerant of light—not merely ultraviolet but light of all wavelengths—and that light may hasten the degeneration of their retinas. Was this what had happened with Virgil? It was one possibility—the Halligan-Edelman hypothesis. Should we have foreseen it, and rationed Virgil’s sight, or the ambient light, in some way?
ReplyDeleteAnother possibility—a likelier one—related to Virgil’s continuing hypoxia, the fact that he had not had properly oxygenated blood for a year. We had clear accounts of his vision waxing and waning in the hospital as his blood gases went up and down. Could the repeated, or continuing, oxygen-starving of his retinas (and perhaps also of the visual areas of his cortex) have been the factor that did them in? The extinction, in either case, seems to be irreversible.
This, then, is Virgil’s story, the story of a “miraculous” restoration of sight to a blind man, a story basically similar to that of Cheselden’s young patient in 1728, and of a handful of others over the past three centuries—but with a bizarre and ironic twist at the end. Gregory’s patient, so well adapted to blindness before his operation, was first delighted with seeing, but soon encountered intolerable stresses and difficulties, found the “gift” transformed to a curse, became deeply depressed, and soon after died. Almost all the earlier patients, indeed, after their initial euphoria, were overwhelmed by the enormous difficulties of adapting to a new sense; though a very few, as Valvo stresses, have adapted and done well. Could Virgil have surmounted these difficulties and adapted to seeing where so many others had foundered on the way?
We shall never know, for the business of adaptation—and, indeed, of life as he knew it—was suddenly cut across by a gratuitous blow of fate: an illness that, at a single stroke, deprived him of job, house, health, and independence, leaving him a gravely sick man, unable to fend for himself. For Amy, who incited the surgery in the first place, and who was so passionately invested in Virgil’s seeing, it was a “miracle” that misfired, a calamity. Virgil, for his part, maintains philosophically, “These things happen.” But he has been shattered by this blow, has given vent to outbursts of rage: rage at his helplessness and sickness; rage at the smashing of a promise and a dream; and, beneath this, most fundamental of all, a rage that had been smoldering in him almost from the beginning—rage at being thrust into a battle he could neither renounce nor win. At the beginning, there was certainly amazement, wonder, and sometimes joy. There was also, of course, great courage. It was an adventure, an excursion into a new world, the like of which is given to few. But then came the problems, the conflicts, of seeing but not seeing, not being able to make a visual world, and at the same time being forced to give up his native competence—a torment from which no escape seemed possible. But then, paradoxically, a release was given, in the form of a second and now final blindness—a blindness he received as a gift. Now, at last, Virgil is allowed to not see, allowed to escape from the glaring, confusing world of sight and space, and to return to his own true being, the touch world that has been his home for almost fifty years.