A podacst interview with Dr Oliver Sacks, visiting professor

Published March 2013

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Oliver Sacks first entered the public consciousness with his 1973 memoir Awakenings: an extraordinary account of 80 patients, who had fallen into a catatonic state as a result of the sleepy-sickness pandemic (encephalitis lethargica) that swept the globe just after the First World War. The story of how he awoke them with the new drug, L-DOPA, gave rise to the film (a partly fictionalised version of the book), starring Robin Williams and Robert De Niro, in 1990.

Dr Sacks went on to study the connections between music and the brain and various neurological disorders such as Tourette's syndrome and Parkinson's disease. His keen perception and his gift for storytelling have illuminated many of these little-understood conditions.

“We see with the eyes, but we see with the brain as well,” he has observed. His new book explores the subject of hallucinations and what they can tell us about the workings of the brain.

“I’ve been interested in hallucinations for a long time – had a few myself – I have written a little about them in other books, but I wanted to bring everything together in one book,” he explains in this podcast. “In the last ten years it’s been possible to monitor the activity of the brain as one is having particular sorts of hallucinations, so if people are hallucinating faces you can pick up activity in a part of the brain normally used for recognising faces.”

Hallucinations opens with the story of Rosalie, a blind lady in a nursing home who is startled by figures who seem to parade before her eyes. “Rosalie was a very alert woman of 90 who had suddenly started behaving strangely and looking around her at invisible things, and the staff wondered if she was going mad or senile or had had a stroke or was toxic from some medications,” says Dr Sacks. “They asked me in to see her and she said that she’s been blind and hadn’t seen anything for five years, but now she was seeing things. I said ‘What sort of things?’ and she described people, usually numbers of people, often uniformly dressed in Exotic Middle-Eastern dress marching in rows; she saw animals, she saw snowfall, she saw children, she saw little elf-like people a few inches high and she said she’d never experienced anything like this in her whole life before.”

Dr Sacks asked if it was like a dream, and she said no, it was more like watching a series of film clips. “I couldn’t find anything medically amiss with her, but I took a guess at what was going on, I said that people who lose their vision are apt to get hallucinations – that this had been described in the middle of the 18th century by a man called Charles Bonnet, and that it was sometimes called Charles Bonnet Syndrome and that it was benign; it didn’t mean that anything awful was coming.” She was hugely relieved to hear that it was OK to have these hallucinations, adds Dr Sacks, and she said: “Tell the nurses I have Charles Bonnet Syndrome!”

Rosalie was particularly disturbed by images of deformed faces – something (explains Dr Sacks) that is common with all types of hallucinations, including the hallucinations that many people can have sometimes when they are lying in bed with their eyes closed, awaiting sleep. “There seem [to be] particular parts of the brain which are concerned with the mouth and the eyes and if those are also being stimulated automatically, then one tends to get [hallucinations of] deformities.”

One of his reasons for writing the book has been to reassure people who are experiencing hallucinations that there are many causes, aside from psychotic disorders, than can trigger the brain to generate lifelike images, smells and sounds.

“I’ve deliberately omitted anything more than a brief reference to the hallucinations of schizophrenic people because I think they tend to be different,” he says, “they tend to be more auditory, they often seem to be strongly addressed to the person, whereas the sorts of hallucinations that Rosalie had were nothing to do with her mood and her thinking. She couldn’t influence them, she couldn’t interact with them and so, in my book, on the whole I’ve dealt with other sorts of hallucinations which usually go with brain conditions or eye conditions or sometimes very traumatic or sad events which have happened, of which perhaps the commonest are bereavement hallucinations.”

In the book Dr Sacks also touches on the effect of drugs on the brain, frankly detailing his own experiences with hallucinogenic drugs, which he took over a brief period during the 1960s. “I’d read Aldous Huxley’s book, The Doors of Perception: Heaven and Hell, and I wanted an experience or two myself,” he explains, “although one of the strangest ones was with a drug not usually used for hallucinating, but known to produce delirium, in which I had only auditory hallucinations. I imagined that friends had arrived, and I was talking to them through a swing door, asking them what they wanted for breakfast, and when I came out with their breakfast there was no-one there. I was very shocked at that.”

On another occasion, Dr Sacks hallucinated a talking spider who “had a voice very similar to that of Bertrand Russell”, and with whom he discussed analytical philosophy. “My drug-taking was all between the ages of 30 and 33. The final experience inspired me to write my first book [Migraine, 1970] and got me into writing, and after that I never took drugs again.”

To hear the full interview - including why Dr Sacks believes Joan of Arc suffered from temporal lobe hallucinations - click on the audio podcast icon at the top of the page.

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Oliver Sacks , M.D. is a physician and a best-selling author. He is both professor of neurology at NYU School of Medicine and a visiting professor at the University of Warwick. He is best known for his collections of neurological case histories, including The Man who Mistook his Wife for a Hat (1985), Musicophilia: Tales of Music and the Brain (2007) and The Mind’s Eye (2010). He is a frequent contributor to the New Yorker and the New York Review of Books, and a fellow of the American Academy of Arts and Letters as well as the American Academy of Arts and Sciences. His most recent book, Hallucinations (2012), is published by Knopf.