An Anthropologist on Mars: Seven Paradoxical Tales

“[…] I am sometimes moved to wonder whether it may not be necessary to redefine the very concepts of ‘health’ and ‘disease,’ to see these in terms of the ability of the organism to create a new organization and order, one that fits its special, altered disposition and needs, rather than in the terms of a rigidly defined ‘norm.’” 

Here, Sacks challenges what he and his fellow physicians view as “health” and “disease” and asks whether it is possible for someone with a neurological condition to still be viewed as healthy, whole, and valid. Each patient Sacks will work with throughout the book further tests his idea of what makes for a “normal” person or brain. By gaining a better understanding about how those with neurological conditions adapt to and thrive in the world, he opens up more opportunities to understand the many ways we can exist in our bodies. Here, for example, Sacks proposes that it isn’t so much any neurological state itself but rather the individual’s response to it that is “healthy” or “disordered.“ By this metric, Virgil is at his least “healthy” when struggling to cope with the restoration of his sight, while Jonathan’s adaptation to the loss of his color vision demonstrates his continued “health” in the wake of major injuries. 

“[…] I have taken off my white coat, deserted, by and large, the hospitals where I have spent the last twenty-five years, to explore my subjects’ lives as they live in the real world, feeling in part like a naturalist, examining rare forms of life; in part like an anthropologist, a neuroanthropologist, in the field—but most of all like a physician, called here and there to make house calls, house calls at the far borders of human experience.” 

This passage prepares the reader for Sacks’s project: to observe patients as both a physician and an anthropologist as they live their daily lives in order to see how they have adapted to their conditions. Sacks views medicine not merely as a science, but as a discipline that overlaps with social sciences and human experience broadly. He says he has “taken off [his] white coat” to indicate that rather than solely visiting and getting to know these people in a hospital setting, he is invested in interacting with these patients out in the world at large. He views this as more natural and compares himself to a “naturalist” observing an animal in their habitat versus the more cold and sterile environment of a hospital or doctor’s office.

“As Jonathan pointed out, we accept black-and-white photographs or films because they are representations of the world—images we can look at, or away from, when we want. But black and white for him was a reality, all around him, 360 degrees, solid and three-dimensional, twenty-four hours a day.”

Jonathan suffers from achromatopsia after an accident leaves him color-blind. This is particularly devastating for him since he is an artist in his sixties who views this as a loss of identity. Sacks compares his situation to a black-and-white photograph to give the reader a better sense of the stakes for Jonathan. While a typical person can choose whether or not to look at a black-and-white photograph, Jonathan cannot turn off this black-and-white way of viewing the world, which only heightens his frustration and fear that he has lost a part of himself permanently.

“Visual illusion is neurological truth.” 

Sacks uses this quote to give context to achromatopsia. Even when we know that something is an illusion, our brains still take what we see as a fact. In Jonathan’s case, his world looks gray and dirty, and despite the fact that this is not an objective truth, it has become his reality in the wake of his accident.

“He seemed bland, placid, emptied of all feeling—it was this unnatural serenity that his Krishna brethren had perceived, apparently, as ‘bliss,’ and indeed, at one point, Greg used the term himself. […] many of his Hare Krishna friends would come to visit him; I often saw their saffron robes in the corridors. They would come to visit poor, blind, blank Greg and flock around him; they saw him as having achieved ‘detachment,’ as an Enlightened One.” 

Here, the lines between the effects of a brain tumor and signs of enlightenment blur for Greg’s Hare Krishna peers. Although Sacks views “detachment” as a negative effect of his patient’s neurological condition, this is something that other Hare Krishnas feel they can learn from as an ideal. This gives the reader a sense of how and why Greg’s brethren did not get him help sooner. It also reflects Sacks’s interest in redefining what health and disorder actually look like and raises the question of whether all adaptations are necessarily negative.

“Some sense of on-going, of ‘next,’ is always with us. But this sense of movement, of happening, Greg lacked; he seemed immured, without knowing it, in a motionless, timeless moment.” 

Sacks here points out part of what sets Greg apart from other patients and what is likely one of the reasons the Hare Krishnas mistook his illness for detachment. Unlike most of us, he has no sense of the future, living always in the present or a past time, meaning he no longer has a sense of anticipation or anxiety about what will happen to him. This docility is the exact opposite of how he was before his tumor, which unnerves and unsettles his family while also perplexing Sacks, who tries to find ways to reach and connect to him.

“Though as a neurologist I had to speak of Greg’s ‘syndrome,’ his ‘deficits,’ I did not feel this was adequate to describe him. I felt, one felt, that he had become another ‘kind’ of person; that though his frontal lobe damage had taken away his identity in a way, it had also given him a sort of identity or personality, albeit of an odd and perhaps a primitive sort.” 

This passage directly ties into Sacks’s project—to re-examine what we consider “deficits” and to redefine health, norms, and adaptations in regard to neurological conditions. Sacks sees Greg F. as a different “kind” of person because while his old identity was stripped away, he morphed into someone with a different personality. He can still interact with the world, albeit in a limited way, and to categorize him as suffering from “deficits” characterizes his existence as wholly negative rather than as a nuanced and complicated transformation that he and others could learn from.

“Any disease introduces a doubleness into life—an ‘it,’ with its own needs, demands, limitations. With Tourette’s, the ‘it’ takes the form of explicit impulsions and compulsions: one is driven to do this, to do that, against one’s own will or in deference to the alien will of the ‘it.’” 

Despite Sacks’s holistic view of neurological adaptation, he posits that a condition can create a different part of that patient that shares time, energy, and resources with their “true” self. Disorder and diagnosis create another layer of identity and selfhood that can have its own drive contrary to the patient’s will. Sacks introduces this idea when discussing Dr. Carl Bennett because Tourette syndrome is a clear-cut example of a person’s life doubled; while Bennett is an acclaimed surgeon, he must also reckon with his tics and outbursts. The “alien will” here refers to his Tourette syndrome compulsions, which Bennett struggles to separate from his own thoughts and intentions. This tension between the self and the “alien will” is part of Sacks’s interest in writing this book.

“There are so many people with Tourette’s who become agonized and self-conscious, withdraw from the world, and lock themselves in a closet. Not so Bennett: he had come through and braved life, braved people, braved the most improbable of professions. All his patients, I think, perceive this, and it is one of the reasons they trust him so.” 

This passage is an example of what Sacks wants to witness and observe in these seven stories: how patients adapt to their conditions and find a way to develop a relationship with their “alien will” or illness. If Bennett were Sacks’s patient in a hospital or clinical setting, he would not have the chance to see how Bennett is able to defy expectations and live a full, confident life. Sacks repeats the word “brave” to emphasize and underscore just how extraordinary Bennett is to observe. It is also worth noting that Sacks partially credits Bennett’s Tourette’s with his ability to connect with patients, further complicating the division between health and disorder.

“‘Tourette’s is like an epilepsy in the subcortex; when it takes over, there’s just a thin line of control, a thin line of cortex, between you and it, between you and that raging storm, the blind force of the subcortex. One can see the charming things, the funny things, the creative side of Tourette’s, but there’s also that dark side. You have to fight it all your life.’”

Here, the reader encounters the “it” or the “alien will” of a disorder once again. Bennett’s life is divided between an outwardly charming and composed self that is always at odds with the “dark side”—his tics and compulsions. Bennett expresses that much of this doubleness is for him about control, which he describes as though he were at odds with nature itself, calling his dark side “that raging storm.” This image gives Sacks a glimpse into just how much Bennett has to suppress and control in order to build a life for himself that is not completely defined by Tourette’s.

“A neurologist’s life is not systematic, like a scientist’s, but it provides him with novel and unexpected situations, which, can become windows, peepholes, into the intricacy of nature—an intricacy that one might not anticipate from the ordinary course of life.” 

Sacks here explains his motivations and what satisfies him about being a neurologist in particular. He has the privilege of looking into another person’s reality—one that might be quite different from his own. Sacks says this during his experience with Virgil, who exemplifies Sacks’s fascination with understanding another person’s perspective. His description of empathy is somewhat ironic as well; Sacks can see “windows, peepholes,” yet Virgil struggles with the difficulty of literally learning to see and with the desire to return to a state that others might not have seen as ideal, but that worked for him for many decades. In this sense, Virgil’s story illustrates what happens when medicine fails to adequately consider a patient’s worldview.

“When we open our eyes each morning, it is upon a world we have spent a lifetime learning to see. We are not given the world: we make our world through incessant experience, categorization, memory, reconnection.”

Virgil struggles with the immense learning curve of learning to see after decades of near-total blindness. His struggle to catch up on this “lifetime [of] learning” will eventually take a physical toll on his body as well as his eyesight. Sacks frames how challenging Virgil’s circumstances are by reminding the reader that most of us have learned how to see the world from a very young age while bombarded with constant visual stimuli. The idea that a person may have no inner visual guide to the world seems impossible, yet Sacks is able to give the reader a peek at just how massive an undertaking Virgil has taken on by having both of his cataracts removed.

“As Virgil explored the rooms of his house, investigating, so to speak, the virtual construction of the world, I was reminded of an infant moving his hand to and fro before his eyes, waggling his head, turning it this way and that, in his primal construction of the world.” 

Despite the supposed “miracle” of Virgil’s newly recovered eyesight, Sacks observes that his need to learn the “virtual construction” of his house has infantilized him. Sacks repeats the word “construction” twice here to underscore Virgil’s inability to see how shapes, colors, and parts of objects connect to one another. This infantile state undermines the decades of adaptation, adjustment, and identity Virgil has made in order to live as a blind man, and this struggle causes him great existential and psychological distress.

“[…] Virgil was treated by his family as a blind man, his seeing identity denied or undermined, and he responded, compliantly, by acting, or even becoming, blind—a massive withdrawal or regression of part of his ego to a crushing, annihilating denial of identity.” 

Virgil’s new ability to see, which initially appears to be a good thing, actually becomes an existentially difficult change for him to accept. His family also struggles to understand this change in him, and they revert to a dynamic in which Virgil acts blind even though he no longer is. Although Sacks characterizes this as a “crushing, annihilating denial of identity,” Virgil in fact misses the familiarity of his former identity. This passage disrupts the reader’s preconceived notion that to regain sight is to necessarily be happier or healthier.

“In the newly sighted, learning to see demands a radical change in neurological functioning and, with it, a radical change in psychological functioning, in self, in identity.” 

Sacks here articulates how a change in neurological function must always come with a change in psychological functioning, meaning that the patient’s understanding of themselves must evolve to meet their new reality. This idea harkens back to the Preface, in which Sacks wonders whether we need broader understandings of health and norms. Virgil is a prime example of supposed improvement not necessarily equating to physical and psychological health.

“What is clear is that at the height of his illness, his brain perhaps stimulated by excitement and fever, Franco started to have, nightly and all night, vivid dreams. Every night, he dreamed of Pontito, not of his family, not of activities or events, but of the streets, the houses, the masonry, the stones—dreams with the most microscopic, veridical detail, a detail beyond anything he could consciously remember.” 

This passage describes the mysterious illness which seems to have triggered Magnani’s vivid dreams and obsession with Pontito. Sacks points out that Magnani does not dream of family or people or events as one might expect, but solely of the streets and buildings. This anticipates Stephen Wiltshire’s desire to draw buildings, although the origins of their obsessions have very different causes. In Magnani’s case, the obsession, though neurological, is also inseparable from the changes that have taken place in Pontito over the years, especially as a result of WWII.

“Such apparitions are not only visual. Franco can hear the church bells (‘like I was there’); he can feel the churchyard wall; and, above all, he can smell what he sees—the ivy on the church wall, the mingled smells of incense, must, and damp, admitted with these, the faint smell of the nut and olive groves that grew around the Pontito of his youth. Sight, sound, touch, smell, at times are almost inseparable for Franco”

Magnani’s memory is not merely vibrant and detailed but seemingly infused into all of his senses. This has sparked his obsession with painting his home village in all of its particularity. Sacks shows this in the text by highlighting details like “the faint smell of the nut and olive groves,” which call to mind a very specific scent strong enough to transport Magnani into the past.

“The cost of Franco’s nostalgia and art, then, has been his reduction to a sort of half existence in the present.”

As Sacks notes earlier on in the book, neurological conditions often come with a “doubleness” in which the illness or disorder takes something away from the patient. In Magnani’s case, this doubling means that he is often consumed by images and sensations of a place that no longer exists in the way that it once did. This robs him of the opportunity to stay fully in the present and take in his current-day life, alienating him from friends and family. Magnani’s loved ones are unable to connect with him about anything that isn’t Pontito or his artwork.

“One may be born with the potential for a prodigious memory, but one is not born with a disposition to recollect; this comes only with changes and separations in life—separations from people, from places, from events and situations, especially if they have been of great significance, have been deeply hated or loved. It is, thus, discontinuities, the great discontinuities in life, that we seek to bridge, or reconcile, or integrate, by recollection and, beyond this, by myth and art.” 

Magnani’s memories of Pontito appear to be heightened precisely because his childhood was “discontinued” by the interruption of World War II. Rather than having a photographic memory from birth, Magnani’s illness heightened his sensory attachment to these moments, and his desire “to bridge, or reconcile, or integrate” these into his artwork gives him a way to return to these moments. Sacks makes clear that our ability to recollect and remember our lives is defined in part by feelings, both good and bad, as well as by significant changes that mark the passing of time—something that Magnani seems particularly invested in.

“I wanted to be liked by Stephen, or at least seen as a distinct person—but there was something, not unfriendly, but de-differentiating in his attitude, even in his indifferent, automatic good manners and good humor. I had wanted some interaction; instead, I got a slight sense, perhaps, of how parents of autistic children must feel when they find themselves faced with a virtually unresponsive child.”

Sacks uses first-person narration in the essay “Prodigies” in part due to his inability to connect to Stephen. As he mentions here, he wants to interact with Stephen in a meaningful way, but Stephen’s classical autism makes it difficult, throwing Sacks back into his own limited perspective. Stephen frustrates sacks not because he has done anything wrong, but because the window or peephole he’s found with other patients does not seem to exist in this relationship. This shrouds Stephen in mystery, since Sacks can’t fully know what he thinks, feels, or sees.

“I sometimes wondered whether ‘emotion’ or ‘emotional response’ might be radically different in Stephen: no less intense, but somehow more localized than in the rest of us—object-bound, scene-bound, event-bound, without ever coalescing or extending into anything more general, without becoming a part of him.” 

Stephen is not as easy to interact with as other patients, yet Sacks can see some emotional response in him. Sacks seeks to understand the intricacy of a patient’s lived reality, and here he believes he has found some of what Stephen’s inner life might look like: emotions felt in relation to a specific occurrence that he does not go on to internalize. Autism thus presents a particular challenge to Sacks’s “neuroanthropological” methods; while Sacks is viewing Stephen as a holistic, nuanced person, Stephen seems to view and categorize the world around him in a way that is incredibly compartmentalized.

“While autism was described almost simultaneously by Leo Kanner and Hans Asperger in the 1940s, Kanner seemed to see it as an unmitigated disaster, where Asperger felt that it might have certain positive or compensating features—a ‘particular originality of thought and experience, which may well lead to exceptional achievements in later life.’” 

This passage highlights a tension that has existed for decades among neurologists—determining whether autism is always a catastrophic diagnosis, or if this specific and unique way of understanding the world can be nurtured to encourage success. Rather than viewing Grandin in these either-or terms, Sacks tries to understand her as a more complex human being. By bringing this historical context in at the beginning of the essay, Sacks helps the reader understand the wide range of associations and outcomes autism carries, and how much these might affect a person like Grandin.

“It is not just pleasure or relaxation that Temple gets from the machine but, she maintains, a feeling for others. As she lies in her machine, she says, her thoughts often turn to her mother, her favorite aunt, her teachers. She feels their love for her, and hers for them. She feels that the machine opens a door into an otherwise closed, emotional world and allows her, almost teaches her, to feel empathy for others.” 

Sacks gets a glimpse at an intimate moment in which Grandin can encounter physical contact in a way that is safe and comfortable for her. Unlike many individuals with autism, Grandin is able to show Sacks just how much this truly helps her to access that “closed, emotional world” in which he is so interested. This proves to him that she truly does feel emotions, but that they are perhaps compartmentalized to such a degree that she is unable to access them without the help of her squeeze machine.