How should physicians write medical case reports? To start with something singular perhaps. Not always to tell about a particular instance of a syndrome, but sometimes to talk about how doctors see their patient’s idiosyncrasies within a bigger picture. For case reports submitted to medical journals, that bigger picture invariably implies some type of statistical norm, because without these norms, descriptions of the individual would be hopelessly mired in what the 19th-century physicist John Tyndall referred to as a labyrinth “of mere fabulation or co-existences and sequences.” Yet the “thicker” part of the story, the subtleties of how doctors and their patients experience complex problems, can be lost in the necessary abstractions of scientific reporting. Oliver Sacks, the New York-based neurologist whose international literary career has spanned more than four decades, has made an art form of case reports, using them as conduits to transmit a world view in which science plays a major but not a determining role in the way we think about ourselves, our pasts and our futures. With a characteristic optimism, Sacks keeps his patients in the foreground, drawing on clinical relationships that have sometimes extended for years.
In his latest book, The Mind’s Eye, Sacks describes six patients who came to him with unusual problems ranging from the concert pianist who had lost her ability to read music to the neurobiologist who was losing her sense of depth perception. While the book might be taken as a collection of stand-alone cases, it also succeeds as a case series exploring the idea of seeing. The lens of neuroscience offers a fresh perspective on the old question: “To what extent are we the authors, the creators, of our own experiences? How much are these predetermined by the senses we are born with, and to what extent do we shape our brains through experience?” People who lose their sight at an early age will “reallocate” parts of their cortex to different senses, leading to a compensatory hyperacuity. “Born-blind people with normal hearing don’t just hear sounds: they can hear objects … when they are fairly close at hand.” According to one woman who had lost her sight at the age of 15, “Even though I am totally blind … I consider myself a very visual person. I still ‘see’ objects in front of me. As I am typing now I can see my hands on the keyboard … I don’t feel comfortable in a new environment until I have a mental picture of its appearance. I need a mental map for my independent movement too.”
People who lose their sight later in life are forced to find a new way of living, and it is encouraging to learn that our brains are far more capable of adapting as adults than was once thought. But since we are each thrown into life challenges with slightly different physiological equipment and through different life trajectories, can we really talk about a “typical” blind experience? How differently will someone with artistic tendencies reinvent his or her world compared to someone with the temperament of an engineer who has to be accurate to the last detail?
In a bizarre twist of fate, while putting together this book, Sacks developed retinal melanoma and lost his peripheral vision. It comes as no surprise that he includes his personal experiences as a seventh case, though it jars us from the more comfortable perspective that has, until now, been limited to reflections on a select group of remarkably well-adapted individuals. Still, including his situation works here. Somehow, he manages to express enough of his curiosity about what his body is going through to keep consistent with his other stories, while allowing us to feel his very personal uncertainties, fears and desperation when he considers that things might not work out the way he hopes.
The Mind’s Eye is a book about individual discovery, not simply of unique problems, but of an intensely curious attitude toward singularities that can enrich the way we interact with our patients and even the way we live our own lives. Through his expression of medicine as bringing together science and human experience, Oliver Sacks does more than show us how to write fulsome case reports. He shows us why we love to read them.