Years ago, in the preface to his first book, the neurologist Oliver Sacks announced his interest in founding a “romantic medicine.” He’s been refining the art and the science together ever since. After recent pauses for a memoir and a book about a trip to observe exotic ferns, Sacks returns in the just-published Musicophilia: Tales of Music and the Brain (Alfred A. Knopf, 2007) to the “clinical tales” that made him famous: weird case studies that locate the uncanny in everyday life. The goal is rarely to cure the patient in traditional terms. Most of Sacks’s new cases — such as a woman with “amusia,” the inability to hear music as anything but random sound — can’t be cured at all, and many of the conditions that the author describes don’t even qualify as disease. Instead he marvels at the “richness” of human possibility.
Sacks allows himself to be guided by a theme for the first time in Musicophilia. As a universal that can’t exist outside the human context, music is a perfect subject for him: It’s a powerful yet inarticulate element of who we are. And in keeping with Sacks’s increasingly personal approach to his medical observation, it’s also a central part of his own history, as he’s an enthusiastic amateur pianist who grew up in a musical household.
Musicophilia focuses on the ineffable, intertwined nature of music with humanity; but more than that, it’s about the people whom music affects in so many different ways. The book’s subjects are filled with music, like the man whose advanced Alzheimer’s disease keeps him from conversing but not from singing with feeling, or the community of people with Williams Syndrome, a genetic condition that leaves them unable to add single-digit numbers, but with a near-universal appreciation for music and the skill to make it.
Musicophilia acts as a summa of sorts for Sacks, with quotations from his other books. He brings back famous subjects for encores, like the man who gave the title to one of his most famous books of case studies, The Man Who Mistook His Wife for a Hat and Other Clinical Tales (Summit Books, 1985). (Disabled by a brain tumor that kept him from recognizing faces and everyday objects, that man used the rhythm of song to carry him through tasks he could no longer visualize.) Sacks also draws on his own anomalousness — his migraines, his depression, his solitariness — to explain, for example, how a chance hearing of Schubert cuts through his depression and briefly makes him “alive once again.” Such accounts extend Sacks’s anthropological journey through the world of weird neurological disability — and ability.
Reveling in the oddness of the odd has put Sacks at odds with disability studies, where he has been criticized as “the man who mistook his patients for a literary career.” But if he has fashioned himself as a new kind of freak-show impresario, it’s a freak show that actually redeems the freaks. Like his earlier books, Musicophilia displays a gallery of people with strange brains, but with appreciation for the ways their anomalies inform their individual selves. Moreover, this latest book brings Sacks closer to disability studies than he’s yet been. Although he doesn’t explicitly engage debates on eugenics and euthanasia that energize much of the field, he nevertheless offers a valuable response to one of the most vexing issues in disability studies today: the problem of how to find humanity (and thus value) in the severely mentally disabled.
Disability studies understandably privileges problems of social integration. I say “understandably” because disabled people face high unemployment, lack of opportunity, and general invisibility in the able-bodied world. The field accordingly frames disability as a problem, first of all, of representation, a constructed outcome that results from the interaction of body and environment. It follows from that equation that altering the environment can efface the disability. For example, curb cuts and accessible buildings allow a wheelchair user to get around like the able-bodied majority. If all of our public spaces were wheelchair accessible, the argument goes, wheelchair users would not be disadvantaged. That constructionist paradigm dominates disability studies for good reason. Not only does it highlight the extent to which disability is a constructed idea rather than an absolute value, it also places practical emphasis on making disabled people visible in public spaces.
The model fits physical disability best, however. Disability-studies theorists have long recognized that the American idea of ability centers on being useful — and usefulness centers, in turn, on the ability to perform productive work. In the United States, “abled” means “able to work.” In some cases, that means that mental impairments can be treated as physical injuries. When a brain-injured composer who can no longer keep in mind what she has just played receives a special music-processing computer that stores her work automatically, for example, it allows her to compose again. For purposes of employment, she’s no longer disabled. Integrating the physically disabled into the workplace in this way thus brings them closer to another socially constructed ideal, that of the “normal.”
But what about people who will never work for a living? Many mentally disabled people simply can’t work — and that raises the problem of how to value them. We can all come together in our shared horror at the Nazi extermination of the disabled on the basis that they led “useless lives.” But on what basis can we then agree to value such lives?
Rosemarie Garland-Thomson, an Emory University professor and a major disability-studies theorist, recently proposed what she calls “human biodiversity,” an ethic that welcomes “the wide range of human variations of form, function, and behavior.” But the biodiversity argument — whether applied to human beings or rain-forest species — conventionally has a distinct utilitarian underpinning. We conserve because doing so is in our best interest; today’s weed may be tomorrow’s useful miracle drug. Similarly, Garland-Thomson writes that disabled people offer “useful perspectives and skills” to the common store.
But she also suggests that human biodiversity promotes a “model of intrinsic rather than instrumental valuing of human beings.” That escapes the onus of use value, but its rationale borders on the religious notion that all people are valuable because God loves them all. Disability studies, like most academic inquiry, steers clear, however, of such religiously based arguments. How then can the field find secular value in human beings who have no hope of contributing to our collective pursuits?
Enter the “old Jewish atheist” Oliver Sacks. (That’s what he calls himself in Musicophilia.) Throughout, he draws on examples of mentally disabled people who cannot live unaided, people whose neurological problems keep them out of sight, usually in nursing homes. Indeed care facilities are often where Sacks — a doctor who still makes house calls — visits them. Not in search of cures, but of humanity.
He presents a moving case study of a former musicologist, Clive Wearing, whose bout with encephalitis has left him with total amnesia. His short-term memory loss is so severe that — as his wife describes it — he cannot “retain any impression of anything for more than a blink.” Stranded in the present with neither the memory of the past nor the fixity to envision the future, Wearing feels constantly disoriented, like he’s suddenly waking up after being unconscious. But he feels that way perpetually, from instant to instant.
Remarkably, though, Wearing can still play music, for the skills and procedural memory required to do so lie outside the damaged parts of his brain. And even more remarkably, he can still love his wife in a way that allows her to love him as her husband, not as someone who occupies his body but no longer his role. Wearing’s passion for his wife, Sacks writes, “has engraved itself in him.” In the grandest romantic tradition then, this profoundly disabled man claims his humanity through not only his ability to create, but also his capacity to love.
Sacks offers the capability of emotion as the answer to the problem of human value. That value shines through Wearing’s deficits, and Sacks wonders at it: not the wonder of a doctor so much as of a fellow human being.
Disability studies has no truck with doctors for the most part, for the human difference of disability represents for most doctors the unsolvable case, a marker of medical failure. Sacks is a doctor by training and trade, but he rejects the “find and solve” model that turns disability into disease. Musicophilia shows more clearly than ever the common ground that Sacks shares with thinkers in disability studies, their concern with the same problems, and their shared value of human difference.
The case of Wearing — like so many others in Musicophilia — showcases Sacks’s contention that the source of humanity lies not in economic capacity, but in emotion. Music may efface disability, but more important, it provides an outlet to illuminate passion, and thus makes the case for the humanity of the mentally disabled. Wearing can’t retain a thought long enough to reason, but he can still feel. People suffering from dementia, argues Sacks, “can experience the entire range of feelings the rest of us can,” and just as deeply. Music (or music therapy) may or may not open a window through which others can view those feelings. Either way, though, the feelings are there — and they form the basis of a personal self that exists before intellect, and endures even after intellect (and with it the ability to work) may have passed on.
Leonard Cassuto is a professor of English at Fordham University.
http://chronicle.com Section: The Chronicle Review Volume 54, Issue 10, Page B13
