The River of Consciousness

by Oliver Sacks

  The huge role of contingency, of sheer luck (good or bad), it seems to me, is even more evident in medicine than in science, for medicine often depends crucially on rare and unusual, perhaps unique, cases being encountered by the right person at the right time.

  Cases of prodigious memory are naturally rare, and the Russian Shereshevsky was among the most remarkable of these. But he would be remembered now (if at all) as merely “another case of prodigious memory” had it not been for the chance of meeting A. R. Luria, himself a prodigy of clinical observation and insight. It required the genius of a Luria, and his thirty-year-long exploration of Shereshevsky’s mental processes, to produce the unique insights of Luria’s great book The Mind of a Mnemonist.

  Hysteria, by contrast, is not uncommon, and has been well described since the eighteenth century. But it was not plumbed psychodynamically until a brilliant, articulate hysteric encountered the original genius of the young Freud and his friend Breuer. Would psychoanalysis, one wonders, ever have got going without Anna O. meeting up with the specially receptive, prepared minds of Freud and Breuer? (I am sure that it would have, but later, and in a different way.)

  Could the history of science—like life—be rerun quite differently? Does the evolution of ideas resemble the evolution of life? Assuredly we see sudden explosions of activity, when enormous advances are made in a very short time. This was so for molecular biology in the 1950s and 1960s and for quantum physics in the 1920s, and a similar burst of fundamental work has occurred in neuroscience over the past few decades. Sudden bursts of discovery change the face of science, and these are often followed by long periods of consolidation and relative stasis. I am reminded of the picture of “punctuated equilibrium” given us by Niles Eldredge and Stephen Jay Gould and wonder if there is at least an analogy here to a natural evolutionary process.

  Ideas, like living creatures, may arise and flourish, going in all directions, or abort and become extinct, in completely unpredictable ways. Gould was fond of saying that if the evolution of life on earth could be replayed, it would be wholly different the second time around. Suppose that John Mayow had indeed discovered oxygen in the 1670s or that Babbage’s theoretical Difference Engine—a computer—had been built when he proposed it in 1822; might the course of science have been quite different? This is the stuff of fantasy, of course, but fantasy that brings home a sense that science is not an ineluctable process but contingent in the extreme.

  * * *

  *1 Armitage, a former master at my own school, published his book in 1906 to stimulate the enthusiasm of Edwardian schoolboys, and it seems to me now, with different eyes, that it has a somewhat romantic and jingoistic ring, an insistence that it was the English, not the French, who discovered oxygen.

  William Brock, in his History of Chemistry, provides a different perspective. “Early historians of chemistry liked to find a close resemblance between Mayow’s explanation and the later oxygen theory of calcination,” he writes. But such resemblances, Brock stresses, “are superficial, for Mayow’s theory was a mechanical, not a chemical, theory of combustion….It marked a return to a dualistic world of principles and occult powers.”

  All the greatest innovators of the seventeenth century, not excluding Newton, still had one foot in the medieval world of alchemy, the hermetic, and the occult—indeed Newton’s intense interest in alchemy and the esoteric continued to the end of his life. (This fact was largely forgotten until John Maynard Keynes brought it out, startlingly, in his 1946 essay “Newton, the Man,” but the overlap of “modern” and “occult” in the climate of seventeenth-century science is now well accepted.)

  *2 Duchenne’s most famous student, Jean-Martin Charcot, remarked,

  How is it that a disease so common, so widespread, and so recognizable at a glance…is recognized only now? Why did we need M. Duchenne to open our eyes?

  *3 When I described the phenomena of migraine aura in the original 1970 edition of my book Migraine, I could only say that they were “inexplicable” by existing concepts. But by 1992, in a revised edition and with the help of my colleague Ralph M. Siegel, I was able to add a chapter discussing these phenomena in the new light of chaos theory.

  *4 A somewhat similar sequence has occurred in “medical” psychiatry. If one looks at the charts of patients institutionalized in asylums and state hospitals in the 1920s and 1930s, one finds extremely detailed clinical and phenomenological observations, often embedded in narratives of an almost novelistic richness and density (as in the classical descriptions of Kraepelin and others at the turn of the century). With the institution of rigid diagnostic criteria and manuals (the Diagnostic and Statistical Manuals, or DSMs) this richness and detail and phenomenological openness have disappeared, and one finds instead meager notes that give no real picture of the patient or his world but reduce him and his disease to a list of “major” and “minor” diagnostic criteria. Present-day psychiatric charts in hospitals are almost completely devoid of the depth and density of information one finds in the older charts and will be of little use in helping us to bring about the synthesis of neuroscience with psychiatric knowledge that we so need. The “old” case histories and charts, however, will remain invaluable.

  *5 The study and understanding of phantom limbs has been given fresh impetus over the last few decades by the very large number of wartime amputees, fueling more research and the burgeoning technology of modern prostheses. I describe phantom limb syndrome in greater detail in my book Hallucinations.

  *6 Mr. I., a painter, had normal color vision until he had a car accident and suddenly lost all sense of color—thus he had “acquired” achromatopsia, as I describe in An Anthropologist on Mars. But there are also people who are congenitally achromatopic, as I explore in The Island of the Colorblind.

  *7 For Damasio’s appraisal, see his 1980 paper in Neurology, “Central Achromatopsia: Behavioral, Anatomic, and Physiologic Aspects.” Zeki’s history of Verrey and others appears in a 1990 review paper in Brain, “A Century of Cerebral Achromatopsia.”

  *8 Zihl’s case is described in greater detail in the previous chapter, “The River of Consciousness.”

  *9 Darwin remarked on the importance of “negative instances” or “exceptions” and how crucial it is to make immediate note of them, for otherwise they are “sure to be forgotten.”

  *10 Stent’s article, “Prematurity and Uniqueness in Scientific Discovery,” appeared in Scientific American in December 1972. When I visited W. H. Auden in Oxford two months later, he was greatly excited by Stent’s article, and we spent much time discussing it. Auden wrote a lengthy reply to Stent, contrasting the intellectual histories of art and science; this was published in the March 1973 Scientific American.

  *11 Darwin was at pains to say that he had no forerunners, that the idea of evolution was not in the air. Newton, despite his famous comment about “standing on the shoulders of giants,” also denied any forerunners. This “anxiety of influence” (which Harold Bloom has discussed powerfully in regard to the history of poetry) is a potent force in the history of science as well. In order to successfully develop and unfold one’s own ideas, one may have to believe that others are wrong; one may have to, as Bloom insists, misunderstand others and (perhaps unconsciously) react against them. (“Every talent,” Nietzsche writes, “must unfold itself in fighting.”)

  *12 Darwin himself was often appalled by the very mechanism of nature whose workings he saw so clearly. He expressed this in a letter which he wrote to his friend Joseph Hooker in 1856: “What a book a Devil’s Chaplain might write on the clumsy, wasteful, blundering low and horribly cruel works of nature!”

  *13 Humphry Davy, like Agassiz, was a genius of concreteness and analogical thinking. He lacked the power of abstract generalization that was so strong in his contemporary John Dalton (it is to Dalton that we owe the foundations of atomic theory) and the massive systematic powers of his contemporary Berzelius. Davy hence descended from his idolized position as “the Newton of chem
istry” in 1810 to being almost marginal fifteen years later. The rise of organic chemistry, with Wöhler’s synthesis of urea in 1828—a new realm in which Davy had no interest or understanding—immediately started to displace the “old” inorganic chemistry and added to Davy’s sense of being outmoded in his last years.

  Jean Améry, in his powerful book On Aging, speaks of how tormenting the sense of irrelevance or obsolescence may be, in particular the sense of being intellectually outmoded through the rise of new methods, theories, or systems. Such outmoding in science can occur almost instantly when there is a major shift of thought.

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