Oliver Sacks Discusses Vision and 'The Mind's Eye'

Normally the eyes and brain work together in a seamless, intricate system. But what happens when the brain can no longer make sense of visual information? Neurologist Oliver Sacks talks about his new book, The Mind's Eye, and what visual disorders reveal about how the brain processes sight.

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IRA FLATOW, host:

Next up, Oliver Sacks, the neurologist and physician who has a new book out called "The Mind's Eye." It's written in a typical Sacks style. It's relating in great detail and passion. You have unusual medical cases of his patients. But this one, you know, is - has all of that, but it has more. It has one thing different than his other books, and that is Oliver Sacks is one of the patients in his own book.

All the case studies in his book have to do with the vision, and in Sacks' case it is his own vision that is in trouble, a cancerous tumor that eventually makes him go blind in one eye. And Sacks treats this vision problem and another of one of a vision problems, which is face blindness - he treats them in such an honest, open and candid way that for the first time we get a real look into what happens when this renowned author and storyteller turns the mirror on himself.

He was gracious enough to allow us to visit his office for a tour of his work area. And what he said about some of the objects on his desk is a reflection of his own philosophy life.

(Soundbite of recording)

Dr. OLIVER SACKS (Columbia University Medical School): My theme is survival. I write about human survival, despite all sorts of problems. And I like to think of the stromatolites, those, you know, modest, unpretentious but tough little fellows which have survived everything for the last three billion years.

FLATOW: And with us today is Dr. Oliver Sacks. He is a Columbia University artist, professor of neurology and psychiatry at Columbia University Medical School. He's been called the poet laureate of medicine. You know him from his books "Awakening," "The Man Who Mistook His Wife for a Hat," "An Anthropologist on Mars," and now "The Mind's Eye." It's out now. Welcome back to SCIENCE FRIDAY, Dr. Sacks.

Dr. SACKS: Very nice to be here again.

FLATOW: Is it all about survival, as your stromatolites, your little fossil on your desk, said?

Dr. SACKS: Yeah. They've held out for a long while. And I think survival is my theme.

FLATOW: And it's true, because all of your books are about how people cope with strange or difficult circumstances, with disabilities. And in your book, half your book, you talk about other people, but you talk - just about half of it, you talk about how you have coped personally with several - several things, including ocular cancer. Is that something different for you to expose to the public, you being the patient?

Dr. SACKS: Yeah. Well, both a patient and the storyteller...

FLATOW: Yeah. Yeah.

Dr. SACKS: ...and the investigator. I'm actually not sure that I have coped as well as some of my other patients.

FLATOW: Talking to Oliver Sacks this hour on SCIENCE FRIDAY from NPR.

He's here with us in New York, author of "The Mind's Eye." And you talk about, as patients do, the horror of the discovery that you had this tumor behind -inside your eye there, and then how you coped with it.

Dr. SACKS: Yes. It was a great shock at first because the particular cancer, which is called a melanoma, was always regarded as uniformly fatal when I was a medical student. But having this in one's eye is much more benign.

FLATOW: And did you react just like one of your patients did? Typical fashion?

Dr. SACKS: I think I did. Outwardly, I was calm. I think inwardly I was sort of screaming: help.

FLATOW: And you kept a diary as it progressed.

Dr. SACKS: Yes.

FLATOW: So that's reflected in the book.

Dr. SACKS: Yeah. It became a huge journal, and also has some strange drawings in it when it tried to depict some of the changes.

FLATOW: Mm-hmm. And were you a good patient?

Dr. SACKS: Well, you would have to ask my doctor.

(Soundbite of laughter)

Dr. SACKS: I think I was reasonable, although I probably had too many questions.

FLATOW: Mm-hmm. And I'll get to a point, I'm sure everybody wants to know, is how is your vision now? How are you doing? How are you feeling?

Dr. SACKS: Generally, I'm feeling fine. But I don't have any use of that eye at the moment.

FLATOW: Mm-hmm. You lost stereoscopic vision, and you say ironically that's interesting because you belong to a club that relied on stereoscopic vision.

Dr. SACKS: Oh yes, the New York Stereoscopic Society. And like all the other members, I had a passion for stereo photography and I would - and we would go on stereo weekends together with our stereo cameras. And I have always been particularly sensitive to stereo, to depth.

FLATOW: Hmm.

Dr. SACKS: And one of the other pieces in the book, called "Stereo Sue," is about someone who achieves this to her amazement and delight as an adult. But I found that losing it has hit me hard.

FLATOW: Yeah. And what about other visual perception problems?

Dr. SACKS: Well, since I don't have any use of the right eye, I can't really see anything to the right of my nose.

FLATOW: Mm-hmm.

Dr. SACKS: But to me, it seems that the visual field is full, so I'm continually startled by things or people appearing on the right. I've learned to accommodate to some extent. But in fact, since the brain isn't getting in any information from this area, it's treated as nonexistent.

FLATOW: One of the most fascinating things you discovered - and I'm sure you were fascinated by it yourself - is when you could not see out of the eye, there were still images in the room there that were sort of latent images still going to your brain.

Dr. SACKS: Yeah, I found that very startling the first time. It was when I was in the hospital. I was watching my hands and then for some reason I closed my good eye, the left eye, but I could still see the wash basin and everything in the room quite clearly. And I thought the dressing must be transparent. But of course the eye was covered, but there was a strange persistence of vision. So it was much more than an aftereffect, so that the image wasn't erased for 15 or 20 seconds.

FLATOW: Does that still happen?

Dr. SACKS: A little bit less.

FLATOW: Hmm. 1-800-989-8255. We're talking with Oliver Sacks, who is a - who's got a very interesting book, author of "The Mind's Eye." And even the cover has distorted vision on it. One of producers who saw this in your office thought it was like somebody had spilled water on it in the office, and then saw the cover of the book and said, no, that's how it's being printed.

Dr. SACKS: Uh-huh.

FLATOW: So we'll get back and talk more with Oliver Sacks. 1-800-989-8255. You can tweet us @scifri, @S-C-I-F-R-I. And Flora Lichtman, our video picks(ph) multimedia editor, is here. She took a tour of Oliver Sacks's office. We'll talk about what his desk looks like and what the objects on his desk tell us. So stay with us. We'll be right back after this break.

I'm Ira Flatow, this is SCIENCE FRIDAY from NPR.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY. I'm Ira Flatow. As our guest this hour is Oliver Sacks, author of the new book, "The Mind's Eye." And in this book, what's unusual about this book - his other books are equally interesting, but what's unusual in this book is that he's one of the patients that he talks about, usually talks about in his book, and talks about his vision problems and dealing with the fact that he had eye cancer, melanoma in his eye, and it caused the loss of vision in his right eye. And then he mentioned that other things happened, other senses - we talked about this perception that you see when your eyes were closed, that you actually still see.

Dr. SACKS: Yeah. Well, I think when the brain isn't getting its usual input, it starts to generate things, and I...

FLATOW: Could that explain other things in life that we have wondered about, about memories and creating memories and things like that, do you think?

Dr. SACKS: Yeah. I think something like this certainly explains some other sorts of hallucinations, so that deaf people tend to get musical hallucinations and blind or partly blind people get visual ones, and people who've lost their sense of smell get smell hallucinations, and people who have had an amputation get phantom limbs.

FLATOW: So you were able to experience this for yourself without having to ask your patients?

Dr. SACKS: Yes, the hallucinations weren't too flamboyant. I mean, they're mostly sort of little geometrical figures and checkerboards and things which half looked like numbers or letters but never quite like them.

FLATOW: Were they more frightening or curious to you as a researcher?

Dr. SACKS: Both. I was frightened for a little while, but then I became intrigued. And now I forget them for most of the time as I forget my kinesis(ph). But I was - I tried to transcribe them and draw them in my journal.

FLATOW: Right. Right. 1-800-989-8255 is our number. With me is Flora Lichtman, our multimedia editor. Hi, Flora.

FLORA LICHTMAN: Hi, Ira.

FLATOW: And as we mentioned at the beginning of the program, Flora took her cameras to your office and you allowed us, Dr. Sacks, to come in and Flora to photograph your desk.

LICHTMAN: That was very generous. We got a full tour of Dr. Sacks's treasures on his desk. And I think we should give people a little taste of what that sounds like. I think starting with one of the things that you showed us most of, which were metals.

(Soundbite of recording)

Dr. SACKS: I want company, even if it's inorganic. A ball of lead. And some of them have to do with my age, so that when I was 72, I got this metal, hafnium, which is element 72. Seventy-three I had tantalum; 74 tungsten; 75, I had rhenium. I also use this to stir my coffee. It's probably the only rhenium stirring rod in the world.

(Soundbite of laughter)

LICHTMAN: Dr. Sacks, what is it about metals that you like?

Dr. SACKS: Well, I think this partly goes back to my Uncle Tungsten, my uncle who made filaments from tungsten and himself loved the density of tungsten and its refractoriness. And like him, my favorite metals are all very dense and have a very high melting point, and they're also very noble, they're not attacked by acids or alkalis. And I dream about them quite a lot. My favorite metals come between 72 and 78, between hafnium and platinum.

LICHTMAN: Which is your age - you're in that bracket right now.

Dr. SACKS: Yes. I'm 77. I am iridium.

LICHTMAN: This year.

Dr. SACKS: A very beautiful metal.

LICHTMAN: One thing you told us is that you like to pick them up. I also fiddle a lot at my desk, but you said that it - maybe that it grounds you. Can you explain that?

Dr. SACKS: Yes. Well, if you drop off some iridium on your foot, you know it. You...

(Soundbite of laughter)

Dr. SACKS: It's - I mean there's - this is reality at its most solid and its most undeniable. But I also - I just like palpating these slabs and cubes, and they're very sweet. It sort of calms me.

FLATOW: Mm-hmm. One of the things you talked about in your book that I hadn't heard about and I didn't know about, or you, having been around you for so many years, you write about a condition called face blindness. Now, I have I have name blindness let me put it(ph) - I can't remember anybody's name. As you listen to SCIENCE FRIDAY, you know that after a while. What is - is that something like face blindness, something to do with people's faces?

Dr. SACKS: Yes. Well, face blindness is quite common, and even something like two or three percent of the population have it in sufficiently severe degree to have difficulty recognizing people they meet daily, and sometimes their own children or spouses, and sometimes themselves.

And it's it becomes something when one(ph) tries to compensate for or cover up. So you may pay unusual attention to the way people are dressed, the way they stand, the way they move or posture, their voice.

FLATOW: Mm-hmm. You say in one part of your book you had even trouble looking in your face. You thought you were looking in a mirror and seeing yourself, when you were actually looking at someone else.

Dr. SACKS: Yes. I was in a restaurant with tables outside. And I started grooming my beard. And after a while, rather quickly, I realized the reflection was not grooming its beard. But on the other side of the window there was a puzzled man with a beard who wondered why I was preening myself in front of him.

FLATOW: Mm-hmm. You seem to be in great spirits. I mean, your illnesses have not seemed to have bogged you down one bit.

Dr. SACKS: Well, they have bothered me plenty in their time. But I'm I feel alive and well and bubbling with books to come, I hope.

LICHTMAN: What's well, what's next?

Dr. SACKS: Next, I think, it will be a book on hallucinations. I only touch on it very, very lightly in the present book.

FLATOW: Mm-hmm. You know, you say you said at the beginning we played that clip about survivorship being the most important thing, or defining you. But I don't think (unintelligible) when we talk to you and we read your books, it's not survivorship, it's the journey in that survivorship. It's what's happening to keep you as a survivor and to keep and how you cope with these things in life that strike you.

Dr. SACKS: Yes, yes, very much so. And this is quite unpredictable. You -people have to find their own strengths and resources, and which they may have no idea of.

FLATOW: 1-800-989-8255 is our number. Talking with Oliver Sacks, author of "The Mind's Eye." Let's see if we can get a phone caller or two here. Let's go to Hoven(ph) in Oregon. Hi, Hoven.

HOVEN (Caller): Hi.

FLATOW: Hi there. Go ahead.

HOVEN: So when he was when you were talking about your - losing your vision and your stereoscopic cameras, there's a thing that when people lose a limb and they still feel pain like they're clenching their fist, they can put a mirror down and see both images. And perhaps you can you could use something like to kind of give you that sense of full depth and you also still take pictures that come out the way you want them to.

Dr. SACKS: Well, perhaps I could. But I see I've tried all sorts of ways and there's nothing which really makes up for the sense of depth. So so far as I'm concerned, everything is on a flat plane in front of me.

FLATOW: Mm-hmm. Let's talk about some of the patients in your book. You write about two different people who lose the ability to read.

Dr. SACKS: Mm-hmm.

FLATOW: And one of them loses the ability to recognize everyday objects. But there's nothing wrong with their vision when you test them.

Dr. SACKS: Yeah.

FLATOW: What wow.

Dr. SACKS: Yes. Well, this lady, Lilian, who was a wonderful peer and just(ph) wrote to me - in a puzzled way she said that she couldn't have started with her becoming unable to read music and then to read anything. And she said, but I can see the smallest letters on the eye chart.

FLATOW: Right.

Dr. SACKS: How come I can see everything clearly but not make sense of it? And but this is typical of what's called an agnosia, where percepts are stripped of meaning. And this then spread from reading matter to everything so that nothing was too well-recognized. And I couldn't imagine how she could function like this. But when I saw her in the office but so I went to make a house call and I found her whole house was beautifully arranged, books and other things were arranged by color, by position, by association. So she had found a way of creating order in what for her was a visual chaos.

FLATOW: Hmm. And you talk about a novelist who can't read but he can still write.

Dr. SACKS: Well, this is common - in fact, almost universal in this condition. (Unintelligible) there's even a Greek name for it in people, called alexia sine agrafia, lost of ability to read but not of ability to write. No, he can write fluently, but he can't read his own writing. And since he was a novelist, he wondered how could he revise the book. And but he has found or his brain has found some ways around this.

FLATOW: Mm-hmm.

Dr. SACKS: He found reading becoming easier. He wondered if he was recovering neurologically. He wasn't. But, in fact, he was unconsciously copying what his eyes were seeing with his hand and then this spread to his tongue. And basically he copies what his eye sees on the back of his teeth and then reads it. So by reading with his tongue, he really I'm sorry. By writing with his tongue, he reads.

FLATOW: It's just amazing how people can adapt to these things, you know, find ways, as you say, to survive if they want to, until they run out of options. Do you foresee people foresee yourself running out of options sometime?

Dr. SACKS: Most of the time. But then one usually find another option in time.

(Soundbite of laughter)

FLATOW: And what fear do you have for yourself that you won't be able to overcome? What's that fear?

Dr. SACKS: Well, I have cataracts in my good eye.

FLATOW: Mm-hmm.

Dr. SACKS: And cataract surgery is very minor. But I don't have an eye to spare. And if I should be one of the one in 10,000 who it goes wrong, I'll be blind. And I'm not quite sure how I would respond to that. I think it's very difficult to imagine myself being blind. But I think I would cope after a fashion, but I will be very dependent on people and things.

FLATOW: Having gone through this now, you mentioned that - I'm trying to remember the year, began - 2005 was it?

Dr. SACKS: Yeah.

FLATOW: Now five years, and reading the histories of these people and your own history - has it changed your views about how the brain works?

Dr. SACKS: Yes. I, from - 30 years ago we used to think of the brain as rigidly programmed. Now I have a great sense of how - of its plasticity. And I think for me this - you know, every patient I see, including myself, sort of increases the sense of plasticity.

LICHTMAN: I have a question about that, because when we were in your office, one thing that amazed me is that you had so many interests, I mean from metals to lemurs to platypi...

FLATOW: Giant squid, don't forget that.

LICHTMAN: The giant squid. And I wondered if this - if you took these up later in life, if this - or if you've always been just a curious person.

Dr. SACKS: Well, I think I've always been curious, and that some of these are sort of boyhood interests which have persisted, but there are new ones as well. And when I want to take a vacation from neurology, then I will take it in botany or chemistry or music or whatever. I've become much more attached to music, I think, since losing some of my vision.

FLATOW: Interesting. We're talking with Oliver Sacks, author of "The Mind's Eye," on SCIENCE FRIDAY from NPR. I'm Ira Flatow, here with Flora Lichtman, talking with Oliver Sacks. Let's see if we can get a phone call or two in. Let's go to Steve in St. Louis. Hi, Steve.

STEVE (Caller): Hi, Ira. How's it going?

FLATOW: Hi there.

STEVE: Hey. Dr. Sacks, I have a question for you regarding stem cell research. I was curious if - hopefully you've kept up with this, I imagine you probably have - if you had any hope that perhaps some of the recent research that's been coming out about the regenerative properties of stem cells might one day restore vision to your sight.

And also, a very quick question regarding your fondness for tungsten earlier. My wedding band that I have on right now is tungsten carbide. I thought you might find that amusing.

(Soundbite of laughter)

Dr. SACKS: I'm delighted to hear you have a wedding band made of tungsten, and I would like to discuss that more. But with regard to stem cells, this carries, I think, tremendous promise for, say, people with Parkinson's disease, where a particular type of cell in connection is knocked out. And - but also for Alzheimer's and many, many degenerative diseases, also for things like spinal cord injuries.

The retina is unbelievably complex, but there have, in fact, been the beginnings of some stem cell research. And it may be possible to give some capacity for vision, but also people are using artificial retinas, which is similar to sort of cochlear implants, although this is very early yet.

FLATOW: Mm-hmm. Are you still involved in research? You're still seeing patients?

Dr. SACKS: Yes, I saw a couple of patients yesterday, and I don't know whether I would call it research or just practicing medicine.

FLATOW: Uh-huh. And you're still - still writing. As you say, you have ideas for a new book coming up.

Dr. SACKS: Yes, yes, the fountain pen never stops.

FLATOW: And as we learned from Flora's video - and you can see Flora's video up on our Website at sciencefriday.com, it's on the Video Pick of the Week - you can see a tour of Oliver Sacks' workspace, right?

LICHTMAN: Yes. Thank you, Dr. Sacks, for having us. It was really a pleasure. And you know, the premise of this video is that our desk, what we choose to surround ourselves with, can reveal something about us. And as a neurologist, I'm curious, do you agree with that?

Dr. SACKS: Oh, absolutely. Freud surrounded himself with antiquities, with little statuettes. But I am - the one thing I regret I didn't have on my desk, which I - was a living being. But I'm - I like sort of plants and fish. If I could have a cuttlefish, I would, but you need seawater and they're rather they're rather tricky.

FLATOW: No Siamese fighting fish for you...

Dr. SACKS: Not yet.

FLATOW: Not yet, okay. Christmas is - Hanukkah is right here.

LICHTMAN: The next desk tour.

FLATOW: Wish we had a latke to offer you, some schmaltz herring or something here today. But I want to thank you for taking the time to be with us today.

Dr. SACKS: Okay. I've loved being here again.

FLATOW: And a happy holiday season to you. And if you want to see a tour of Dr. Sacks's office...

LICHTMAN: Go to our website.

FLATOW: We've started a whole new feature, right?

LICHTMAN: Desktop diaries is what we're calling it.

FLATOW: Desktop diaries, and Dr. Sacks is the first desktop diary we have up there. It's up on our website at sciencefriday.com. And if you missed this conversation or want to listen to it again, you can go to our website and download it at sciencefriday.com, podcast and a video also.

LICHTMAN: And this is some of the music that we heard in Dr. Sacks's office.

FLATOW: Have a great holiday weekend. I'm Ira Flatow for Flora Lichtman, SCIENCE FRIDAY.

(Soundbite of music)

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