Case Study

Reading between the lines.
Jan. 29 1997 3:30 AM

Case Study

The curiosity of Oliver Sacks.

The Island of the Colorblind
By Oliver Sacks
Knopf; 298 pages; $24

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I was terrible at math when I was young (if anything, I'm worse now), but that didn't stop me from reading everything nontechnical I could get my hands on concerning topology, which my dictionary defines as "a branch of mathematics that deals with the properties of a geometric figure which do not vary when the figure is transformed in certain ways." However arcane, it was the most anecdotally fascinating area of math: Moebius strips; Klein bottles; the four-color map problem; the protean qualities of the torus, or doughnut. That I couldn't have begun to understand the theory didn't trouble me, although I did feel that I was misappropriating something haughtily above my station. I would focus on a single mind-bending element--for example, that the Klein bottle's neck (roughly speaking) folds back into its body, making inner and outer a single surface and the whole a two-dimensional object however much airspace it might occupy--and send myself on a little psychedelic journey contemplating the paradox.

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Much the same applies to neurology, Oliver Sacks' area of specialization. Scientifically challenged readers can be entranced by the dérèglement de tous les sens charge obtainable from his descriptions of anomalies of memory and perception; lack of knowledge of the exact workings of the cerebral cortex is hardly a deterrent. Sacks' accounts of aphasia or amnesia or autism or Tourette's syndrome provide a certain believe-it-or-not quotient for the lay reader; they also have the force of parables. His best-known book, The Man Who Mistook His Wife for a Hat (1985), is less a freak show than a gallery in which we can see ourselves reflected variously, with one element out of whack, fun-house-mirror style. The views are frequently precipitous, causing the reader to reflect upon those delicate and unaccountable features of the brain, ordinarily taken for granted, with appropriate wonder.

The lure of the case study as a literary genre has been insufficiently examined. It can take a number of forms: the prurient (as in much of Freud's), the haunting (ditto), the sordid-poetic (Kraft-Ebbing, for example), the pregnant-random (as in much of criminology). The closer--and most eminent--predecessor to Sacks' own approach was the Russian psychologist A.R. Luria, whose The Mind of a Mnemonist (1968) and The Man With a Shattered World (1972) are book-length case studies of novelistic richness. The mnemonist, S., is a touching character whose "disorder" is the most poetic imaginable even as it brings him torment. He cannot forget anything, and if he needs to put something out of mind, he has to take a mental walk down his mental road and dig a mental hole in which to bury it; he is also afflicted (if "afflicted" is the word) with synesthesia, as well as with an uncertain grasp of self. Luria's observations are clinical, but they exude a tangible warmth. He--and consequently, his reader--cannot consider S. without entering his consciousness, identifying with him.

The same can be said of Sacks, who clearly loves his subjects. In An Anthropologist on Mars (1995), Sacks deepens his focus (The Man Who Mistook comprised more than 24 cases, An Anthropologist only seven), entering the world of his subjects, seeing their daily lives, traveling with them (most of his earlier cases were observed in hospital settings), and consequently his accounts become the more affecting even as they involve more hard science. But the lay reader can bypass the technical data embedded in the story of the painter who became totally colorblind following an accident (and a possible stroke), and ponder instead the near-mystical shift that occurred in someone formerly dependent on color who came to forget what color was, and to value his achromatopic perception without regret or sense of handicap. The surgeon with Tourette's, the blind man who regained his sight to his dismay, the subjects variously marooned in the hippie subculture of 1969 or in a Tuscan village of the 1930s, the remarkably gifted autists--all are admirable, all are moving, all are acutely recognizable in human terms. The reader might be forgiven for wondering if he or she might not possess a touch of autism or Tourette's. This is not the same thing as leafing through the Merck Manual and imagining that one possesses every symptom; rather, it is a measure of Sacks' imaginative capacity for feeling empathy, and for transmitting the same. We come to see that the varieties of human behavior are not fenced off into plots. My tics and mnemonic quirks--or yours--may not constitute a syndrome, but we are not so vastly removed from Sacks' subjects, either.

The Island of the Colorblind is a quite different kind of book, even if it could be superficially described as consisting of two case studies. The cases in question both occur in Micronesia: a concentration of congenital achromatopsia on Pingelap, one of the Caroline Islands; and the occurrence among a stratum of the population of Guam of a disease called lytico-bodig, which can take forms resembling Parkinson's disease, amyotrophic lateral sclerosis ("Lou Gehrig's disease"), or Alzheimer's disease--or two or all three in combination. While these ailments and those affected by them are described by Sacks with his habitual sympathy and imagination, the real subject of the book is Micronesia itself, and in particular its flora.

Sacks' writing has many charms, among them an avuncular presence, an unaffected storyteller's voice not often found in popularized science writing these days. In this book Sacks makes it clear how much this owes to the works he read as a child, how the passion, clarity, and warmth of Victorian botanists and zoologists--Darwin above all--formed his imagination. For him, botany was the road not taken, and here he indulges his continuing interest. But it is not his ostensible subject, so he relegates much of what he has to say about plants--among other things--to frequent, lengthy, and digressive notes. These appear in the back of the volume, making it necessary to read the thing with two bookmarks. While this might sound unwieldy, it soon establishes its own rhythm.

In any case, the diseases in question and the flora in the margins are intrinsically connected, the tissue being the nature of the islands themselves. The congenital colorblindness of Pingelap is a direct result of the place's isolation and its vulnerability to natural cataclysm--it was a storm that decimated the island's population and enforced inbreeding, causing a recessive gene to flourish. The origins of lytico-bodig on Guam are still mysterious (as is the fact that, apparently, no one born after 1950 or so has been afflicted); there are many theories afloat, one of them involving the culinary use of the fruit of the cycad, a genus of fernlike shrub that is among the oldest forms of life on the planet.

Sacks' informed curiosity about the causes of the disease (which might hold a clue to the unsolved mysteries surrounding its Western relatives) is hardly separable from his affection for the plant. At one point, he is so taken by a large cycad cone that, "intrigued by the almost-animal warmth of the cone, I hugged it, impulsively, and almost vanished in a large cloud of pollen." This is comical, and he knows it, but it is also characteristic of the love and wonder he feels for the myriad adaptations of life, especially its most wayward forms.

The Island of the Colorblind is an odd book, part case study, part travelogue, part weave of digressions, but this oddness is a measure of the personality that unifies it. It also reflects the fact that the islands are the subject here, in both the literary and the clinical sense of the word, and that disease, flora, and topography are all essential and inseparable constituents of their dossier. Sacks allows the reader to browse at will among the curio-filled cabinets of his mind. This openness is what makes him such a sympathetic observer of others, and also what can best persuade the apprehensive lay reader that science expresses the very highest imagination.

Luc Sante is the author of Low Life, Evidence, and The Factory of Facts (to be published this fall).