Eric Kandel: Oliver Sacks shows disease brings out courage, beauty

Eric Kandel, a Nobel Prize-winning neuroscientist at Columbia University, reflects on Oliver Sacks' contributions to the field of neurology and recent op-ed in The New York Times about his liver cancer diagnosis.

Oliver Sacks is an extraordinary storyteller. That, per se, is not unique. Edith Pearlman, whose name immediately springs to mind, and whose recent book of short stories is on my night table also is extraordinary. What is unique about Oliver is that he is unique as the best storyteller about disorders of the brain. As a result, he has created among his readers a large following of people interested in the biology of mental processes.

It strikes me, as I sit down to write about Oliver, that he is following a great descriptive tradition in neurology whereby studies of the neurological defects in single patients gave us some of our initial insights into how brain gives rise to mind.

In 1861, the French neurologist Paul Broca described the first of several patients who, after a stroke, could still understand language perfectly well but could not express themselves in language. When these patients died and came to autopsy, all had a lesion in the same area in the front of the brain and all these lesions were on the left side. This caused Broca to pronounce: we talk with our left hemisphere.

Fifteen years later, in 1871, Carl Wernicke encountered a patient who, after a stroke, could express himself perfectly well but could not comprehend language. This patient's lesion proved to also be on the left side, but now near the back of the brain. Moreover Wernicke realized that the region at the back, concerned with comprehension, communicated with the lesion in the front, concerned with expression, and these insight allowed Wernicke to develop the first biological scheme for language. (If you want figures or more discussion, see Principles of Neural Science, Fifth Edition, chapter 1, pages 10 - 12.)

Broca and Wernicke wrote clearly and well but they did not write for the general reader and, in fact, did not know how to do so.

The remarkable contribution that Oliver has been able to make in his dozen best-selling books is his ability to combine the deep insights into brain function with that of a fine storyteller.

In one of his early books, "Awakenings," published in 1973, Oliver describes a population of patients he encountered in Beth Abraham, a nursing home for the elderly in the Bronx. Here, he found a significant number of people who were survivors of the worldwide epidemic of sleeping sickness, which broke out about 1918 to 1922. Many of these people had not been out of bed for decades. Realizing that some patients developed this illness as a late form of Parkinson's disease, Oliver and others on the staff started these patients on a new drug that had just emerged to treat Parkinson's disease: L-Dopa.

To everyone's amazement, the drug transformed their lives. It truly awakened them after more than a decade of incapacitation and non-action.

Nothing on this scale and with this drama had ever occurred in medical history. Oliver followed these patients with generosity, neurological insightfulness and affection and tells their story in an absolutely captivating way.

He applied these skills to many other disorders: prosopagnosia, face blindness (of which Oliver suffers), is brilliantly discussed in "The Man Who Mistook His Wife for a Hat." The fascination of visual hallucinations and their distinction from psychotic hallucinations are wonderfully discussed in his recent book "Hallucinations."

Musical hallucinations and dementia are wonderfully treated in "Musicophilia," a book further enriched by Oliver's love and talent for music.

One of the special things to emerge from Oliver's writing is his belief that disease often brings out a particular courage and beauty in the afflicted person and a determination to overcome their handicap.

This of course comes full circle because Oliver's attitude toward his patients describes Oliver's -- and my -- reaction to Oliver and his illnesses and his recent realization, and announcement, that he may die soon. It is of further interest that the metastatic liver disease that seems most responsible for his decline is secondary to another disease, melanoma of the eye. This co-occurrence has reminded me of how bravely Oliver has handled the physical ups and downs of his life, which have by no means been rare.

I personally hope that one of the miracles that Oliver has described for others works here for him. But as Oliver points out, we need to remember that 81 years is a good life span, a span during which Oliver Sacks has transformed their view of the mind for millions of people in a way that is both insightful and entertaining. It is because of this combination that the message is so powerful.