The books of Oliver Sacks have lit up many hidden corners of the brain, but human musicality is still mysterious, he tells Shane Hegarty.
'I'm sorry you catch me like this. I'm usually very sweet and calm." Dr Oliver Sacks relaxes, finally, in a meeting room in a London hotel, aware that the previous 15 minutes have been somewhat farcical.
He was late arriving, thanks to a television interview that required a cameraman to film him from several angles. "Tiresome," he says, with forceful impatience. There then followed an extended search for a quiet corner, during which a journalist, a publicity person, an internationally renowned neuroscientist and bestselling author and his personal assistant shuffled around the hotel lobby to the soundtrack of frustrated huffing.
The small talk was clipped and uncomfortable. Having heard him on Today with Pat Kenny the previous day, I had mentioned to Sacks: "You were on Irish radio yesterday." "Was I?" he'd replied.
Nowhere was acceptable, either because of the distracting drone of a television set, a crying baby or the threatened onslaught of 150 conference delegates emerging for their lunch. So it is a relief when we eventually take refuge in a quiet room, where Sacks offers apologies as he sucks on a complimentary sweet, realises it's not to his taste and spits it back into the wrapper.
He had picked this hotel as a base for his few days of publicity for his new book, he says, because it's close to a decent swimming pool. "I was there at 6.30 this morning." He swims about an hour a day, as he has done for many years. It explains why, despite a small stoop, he has a physical presence which belies the fact that he's 74.
He has been a doctor for half a century, based largely in New York since leaving Britain in the 1960s. He has been an author since his first book, Migraines, was published in 1970, but it was his next, Awakenings- detailing his revival of long-term victims of a sleeping sickness - that established his reputation as both a far-thinking physician and a fluid writer as interested in his patient's stories as he was in their conditions (the book was later adapted into a successful film).
His subsequent masterpiece of popular science, The Man who Mistook his Wife for a Hat, confirmed his place as a medical explorer with a gift for revealing how much we can learn about the brain and identity through the myriad and curious ways it can go wrong.
"I think I felt that myself, even when I was a child, when I would get visual migraines," he says. "And this would sometimes blind you to some part of the visual field, or remove colour or depth or movement, or give you strange distortions as if it were a fish-eye lens. And I think this taught me very early that we were given the world through the grace of a fully functioning brain, and what can go wrong.
"And again, one might think that seeing things is seamless, but you only have to lose one aspect of that to realise that there is a huge complexity of orchestration. So, in this way, these accidents of nature are crucial."
His latest book, Musicophilia: Tales of Music and the Brain, takes various "musical" conditions and asks what we can learn from people who can "see" or "taste" music; those who cannot process it; others who become obsessed with it; and severe amnesiacs who can still remember intricate pieces. It also lauds the therapeutic value of music for Parkinson's or Alzheimer's patients. Because Sacks is himself a "modest musician" (he plays piano), the book also reveals a fascination with why humanity is so obsessed with music in the first place.
"There is no culture in which music is not central, in which it doesn't have a dozen roles from martial music to lullabies," he observes. "There were bone flutes and things going back. And I think it does enter into the lives of most people. Not necessarily overwhelmingly."
Even when an infant has yet to gain control of its limbs, it will attempt a rudimentary jig. "This is so impressive and so spontaneous and universal and exclusively human. I mean this reacting to music. No chimpanzee does it."
No species at all? "I've got to watch myself here," Sacks says, smiling. "I have to say there are no other mammals, because people have been sending me videos of birds that keep time to music.
"One used to speak of a bird brain, but in fact they are rather remarkable. Birds have immense powers of memory and learning and birds may be able to do things that mammals can't. But putting aside birds, I think this is an exclusively human thing, this putting together of anatomical connections between auditory motor parts of the brain. And even if someone is not visibly moving, all the motor parts of their brain are working."
DOES HE BELIEVEthat there is an evolutionary reason for our ability to both appreciate and write music? "I don't even know if I'm competent to speculate," Sacks admits. "I mean, what is unique is this enormous apparatus for auditory analysis, for dealing with very rapid and complex streams of sound and for making such streams. Intuition makes it difficult to see that one is branching off from the other. I can't help wondering how much the sometimes inaudible or unnoticed musical background that many, or possibly all, of us have running in our minds, plays some essential part in one's emotional and intellectual life. I'm guessing. I don't know."
Through these cases, he says, he has "learned how many parts of the brain are involved, so that music is in a way much more demanding than speech, much more demanding than seeing. And, in general, how robust the whole thing is once it's set up. So there is this business of people with advanced dementia being able to respond to music. It is stunning. And you see this again and again."
Sacks has shone a light on so many previously hidden corners of the brain, and has seen science gradually light it up with scanners, but he does not feel that it is shedding its mysteries, only that it may yet reveal "gulfs we cannot bridge". And while he has seen massive progress during his career, neurology is still in its relative infancy. "I think there has been a huge leap and that we may now have arrived at the beginning," he says.
Has his experience left him fearful of how much the brain can affect identity when it malfunctions? "Life is very, very clever. It is very resilient. It has so much in reserve, and so much plasticity. I mean, plasticity is one of the underlying themes of this book. So the man who suddenly loses one ear and everything is wrong, and then he adapts . . ." Sacks pauses. "I'm sorry, I'm afraid I keep thinking personally. I have more or less just lost one eye. But I think I perceive the various adaptations are starting, some conscious and some unconscious. And I depend on them. I know the wily brain will find ways of using monocular clues more efficiently."
The problem was caused by a benign tumour behind his right eye, and while it leaves no outward scar it has left permanent damage. "It had to be radiated and then lasered," Sacks says. "I hope I have an understanding with the tumour that I say: 'Okay, you can have the eye if you leave me alone.' In fact, this is the sort of tumour that doesn't normally metastasise. But I have more or less lost central vision. I was very passionate about binocular vision, in fact I've written a whole article about stereo, so it's ironical that I, the stereophile, should lose it. However, there will be adaptation. I'm not saying I will adapt. Some of it is conscious, some of it is not."
The scientist in him can't help but be fascinated by accidental revelations that have come from his treatment. For instance, a brain scan revealed that the area responsible for language was lit up brightly even while he was lying quiet and alone in the scanner. "I was rather intrigued," he says.
SACKS CONTINUES TOpractise as a doctor two days a week, at various clinics and hospitals in New York. He and his assistant also sift through the letters currently arriving at a rate of 100 a day, many of them currently related to music. He corresponds, and sometimes uses the material he receives as case studies.
"It is a huge privilege when people share their experiences of their lives, their thoughts, their bewilderments, their uncertainties," he says.
He tells me that he will be coming to Ireland within days to meet a family of eight children he has heard about, four of whom are musical and four of whom have "amusia", which renders them unable to process notes.
His assistant, Kate Edgar, arriving in the room, raises an eyebrow and suggests that there may yet be logistical difficulties in that. But he does, he says, like making "house calls".
"I couldn't imagine giving up," he says. "I mean, everything starts with patients, with subjects, or with descriptions of phenomena. And there's endless variety and diversity, fortunately or unfortunately. I sometimes think in terms of fauna and flora and landscapes of the brain and of myself as a sort of naturalist. Although, I'm also a physician with responsibility towards the individual. And these two visions have to be complementary to each other."
• Musicophilia: Tales of Music and the Brain , by Oliver Sacks, is published by Picador, £17.99.
Into the zone: Sacks on listening and writing
"WHEN I'M WITHpatients I don't use a tape recorder. Maybe I should. I do write. I sometimes wish I had shorthand, because it would be very nice to get their words. But I do try and get their words when I can. I need the act of writing to remember, to engrave it in my mind."
"[I WRITE] EITHERlonghand or I'm a bizarrely rapid but also inaccurate two-fingered typist. I have an old IBM Selectric . In fact, I have several of them, because now they are 40 years old one has to cannibalise them for parts when they break down. I mean, Kate [Sacks's assistant] turns them into beautiful computer prints. But I am rather afraid of computers, especially their power of erasure. I need to have a palimpsest and to have the original."
"I USUALLY HAVEpens of four or five different colours. There's a sort of 'stratigraphy'. I find it difficult to revise. I tend to redraft entirely, which can lead to problems, because they might give rise to six drafts, because they are all, as it were, different. And they may all be good, but you can't collate them because they're all from different perspectives."
"I SOMETIMES WARMup with the footnotes. And sometimes the footnote precedes the text. There is a sort of warming-up thing. As with swimming, it takes me 20 minutes to get into the zone."
