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The Science of Storytelling: Self and World as Narrative

jlustick's picture
As someone with a passion for creative writing and a future career in medicine, I have always been interested in how others manage to intertwine these two disciplines. Oliver Sacks, author of several books including The Man Who Mistook His Wife for a Hat and Other Clinical Tales, is one of the most prominent physician-writers. Sacks’s writing validates my belief that these two fields are not mutually exclusive but actually complement each other quite effectively. Sacks makes storytelling science and science storytelling. His book is divided into four sections—losses, excesses, transports, and the world of the simple—each of which contains a series of clinical tales focusing on an individual’s experience with a neurological disorder. Sacks expands upon Hippocrates’s notion of a case history, a story of a disease’s emergence and evolution, and writes clinical tales in which the central subject is not the disorder but the individual, the human. This literary choice suits his scientific purpose: to examine the way people with neurological disorders come to understand their selves and world. Sacks’s text does not read like a dry lab report or journal article; he uses his skills as a novelist to craft narratives that are entertaining, educational, and intriguing with complex, multi-dimensional, human characters at their core. In many ways, these clinical tales are literature at its best: gripping, real, and intellectually stimulating. Yet they are also science at its best: Sacks uses literary techniques to expose and understand the internal narratives of his patients and the consequences of disrupting such narratives.

The book opens with two epigraphs which together capture Sacks’s multifaceted approach. The first, from William Osler, a physician and prolific writer, speaks to Sacks’s belief that science can be entertaining; watching a neurological disorder unfold is at least as fascinating, mystifying, and thought-provoking as a good whodunit. The second quotation, from physician Ivy McKenzie, addresses the difference between a physician and a naturalist, the former being one who is concerned with the human subject and its preservation of an identity and sense of self in adverse circumstances. Whether studying or treating, a physician must investigate the narrative world of his patients, an aspect that may not be of interest to the more “naturalist” scientists. In the book’s preface, Sacks identifies himself as both a naturalist, fascinated by disease, and a physician, fascinated by people. Sacks looks at disease, specifically neurological disorders, through the lens of the individual. Unlike many naturalists, Sacks is more concerned with the unique than with average adaptations, experiences, and environments.

Sacks’ tales are nonfiction in that they are attempts to accurately expose the medical fascinations and enigmas that he encounters in his daily practice as a clinical neurologist. Nonetheless, he is storytelling and so the question naturally arises as to whether his desire for and construction of narrative impedes the work’s scientific value. After all, empirical data and dry qualitative studies are the form of research with which we are most accustomed and often consider most “true.” Stories are frequently perceived as less direct, less informative, more “fluff.” In addition, there is the fact that stories are overtly subjective and scientists typically strive for the objective, an illusive concept that supposedly allows for an absence of personal bias. However, I would argue that this kind of “objectivity” is impossible as long as the researchers are human.

The human brain operates in such a manner that we are left to constantly see, reason, and explain selectively and subjectively. Storytelling or confabulating as it is often called is an inherent practice of the human nervous system; it is a way for our brain to reduce complex and uncertain input into a coherent narrative that enables a logical sense of self. In fact, there is a part of the brain associated with the neocortex, which has the crucial task of filling in gaps and piecing together the narrative of the self. I will refer to this facet of the human brain as “the storyteller.” Thus, storytelling is embedded in our brains and therefore inescapable. Perhaps Sacks is simply more honest or open about his confabulation. He makes no attempt to disguise the fact that these tales are based on personal experience rather than a set of controlled trials that can be generalized to a larger population. He actively and consciously pieces together personal experiences, interactions, and insights so as to create a possible narrative. As a result, each tale is as much about his own brain and storytelling process as that of his patient. He does not claim that the narrative he comes up with is the narrative; it is simply a possibility. Being right seems less important than seriously observing and thinking. With each case, Sacks aims to enter the seemingly foreign and impossible world of the neurologically disturbed.

Throughout the book, Sacks highlights the ways in which empirical research provides an inadequate level of understanding of neurology. Given that much of Sacks’s work focuses on the oddities and exceptions, the tendency of the lab or clinic to focus on mainstream behavior and trends would prove counterproductive. Sacks remarks that within such formal settings, scientists have a habit of overlooking outliers, those people or things that are not supposed to exist—a kind of subjectivity, in fact. A prime example of this occurs in the fourth section, in which Sacks discovers that many of his mentally retarded patients are extraordinarily talented, idiots savants of sorts, yet “the tests had given no inkling of anything by the deficits” (172). Sacks suggests that the testing or research done on his subjects is cursory, confined to “the obvious and testable ‘surface,’” and does not show “that there are depths below” (186). Sacks argues that such depth can only be uncovered if a researcher strips himself of presupposition and purpose and interacts with patients as people, even attempting to establish a relationship with them. Part of the reason Sacks’s methodology works is that he does not pressure himself to draw conclusions or come up with a diagnosis or treatment solution. Relieved of this task, Sacks, unlike more directed researchers, is able to patiently and openly observe. Sacks prioritizes the quality and thoroughness of his observations, not the consistency or comprehensibility. As a result, he sees and discovers the unimaginable.

What Sacks is doing in this text is science, for science is a far more flexible discipline than many individuals assume. While empirical, laboratory-based studies may prove optimal for some fields, others, like neurology, must become acquainted with a person’s essential being, a concept which cannot be captured in precise facts and figures.

According to Sacks, the self is in fact a story: “each of us is a biography, a story. Each of is a singular narrative, which is constructed continually, unconsciously, by, through, and in us” (105). To expose and try to understand a person’s essential being, we must examine their story. Optimally, the story Sacks tells is the subject’s personal narrative. He attempts to enter each of his patients’ storytellers and show how that individual creates a sound narrative and identity out of seemingly disconnected, incoherent experiences. Each of the clinical tales supports the notion that a current self depends on both a present story and a set of memories that can be woven together in a rational manner. Sacks searches within each of his neurologically disturbed patients for a lucid narrative and sense of self; he never dismisses the possibility that such sense exists, no matter how severe the disease.

Sacks does not assume that the world of his patients matches his own but rather looks for alternative worlds and seeks to understand their creation. Open to other possibilities, he finds that many of his patients do in fact live in worlds full of meaning, pleasure, and complexity. He tells of individuals who derive order and coherence in distinct ways, organizing their world and selves around a musical or numeric schema, for example. For these people, musical notes or numbers are not simply topics of study or intellectual intrigue but the lens through which they understand themselves and the world around them. Sacks describes the way in which numbers, for example, possess a multidimensional, tangible quality, seen and even felt by his patients. While these individuals seem acutely isolated, alone in their strange worlds, Sacks postulates that such is not the case. They simply find companionship in other ways; numbers and music, for example, can play the role of friends. A key quality of Sacks’s writing is that he exposes his patients not as illogical but simply illogical in the context of the prevailing system of logic.

The question arises as to whether it is problematic for individuals to only exist as meaningful and sane beings within their private worlds. Must every individual have a place within the dominant world or should we accept the existence of exclusive, isolated worlds? Is the goal of medicine to help everyone fit into the dominant world or help them find happiness and meaning? It often seems as though we’ve decided, as a society, that there are certain essentials to achieving a state of happiness and meaning—friends, family, a career, etc.—and without these, someone is lost. But I now wonder if such is the case or if these aspects of life are only necessary for those living in the dominant world in which things like music and numbers are not sufficiently meaningful. Unfortunately, Sacks’ tales suggest that many of his patients must relinquish their current narrative of self and world if they are to assimilate and achieve acceptance in the dominant world.

When it comes to morals and a physician’s creed to “do no harm,” treatment of neurological disorders is a contentious issue. Sacks provides the example of identical twin brothers, a pair of idiots savants who communicate by numbers; tossing primes back and forth is their version of an intimate conversation. After being separated and pushed to assimilate into society, the twins lose their “chief joy and sense of their lives. But this is considered a small price to pay, no doubt, for their having become quasi-independent and ‘socially acceptable’” (199).  But I am not sure it is such a small price. While it is easier for society if these twins conform, such normalization strips the boys of their selves and centers and severely affects their psychological state. In another case, a talented artist undergoes intensive therapy for muteness. The treatment proves successful in that she begins to talk but unsuccessful in that it strips her of her artistry, her prior mode of communication: “we are left with a genius who has had her genius removed, leaving nothing behind but a general defectiveness” (200). Sacks does not provide a solution to the treatment dilemma. In fact, his personal stance on the issue is left ambiguous, and it seems possible that he himself is uncertain as to what is most moral or ethical. Seemingly, his intention is more to expose neurological treatment as contentious and to encourage others to look beyond the surface and accept the possibility of a different kind of world.

Sacks writes about a world of paradoxes, one in which things are not black or white and people are not necessarily healthy or sick. In many of the cases he examines, the patient’s adaptation to his neurological “disease” leaves him feeling physically healthy and psychologically fulfilled. In other cases, the disease itself offers a person a unique state of health, the most noteworthy example being a tale of a ninety year-old woman “sick” with neurosyphilis which leaves her uncharacteristically energetic, lively, and affable (97). Later in the book, Sacks quotes an epileptic who writes, “‘healthy people can’t imagine the happiness we epileptics feel during the second before our fit…I would not exchange it for all the joys that life may bring’” (T. Alajouanine 1963 in Sacks 137). Patients may avoid treatment so as to preserve their psychological state. Their storyteller has constructed a narrative in which their neurology is not disturbed but perfectly in sync with their world and selves.

Despite his clear expertise and intelligence, Sacks takes a humble approach to both treatment and storytelling, allowing himself to be amazed and confused by the mental capacities of others, even those deemed simpletons or retardants. He is willing to see the ingenuity of each individual’s brain, regardless of his or her intelligence quotient. In this way, he is more objective than the most empirical scientist, for he has not deemed some things or people more or less meaningful, real, or right than others. Sacks’s approach suggests a recognition on his part of the limitations of his own brain and the impossibility of ever fully understanding the neurology of another. After all, the brain remains, as Emily Dickinson writes, “wider than the sky,” and the one entity of which our mind cannot fully conceive.

Sacks O. The Man Who Mistook His Wife for a Hat and Other Clinical Tales. New York: Summit Books, 1998.


Paul Grobstein's picture

Sacks and objectivity

"he is more objective than the most empirical scientist, for he has not deemed some things or people more or less meaningful, real, or right than others"

Very interesting, important, compelling argument.  "Objectivity" involves acknowleding one's own contribution to a story, the centrality of story in what one is exploring (at least if that is human), AND finding ways to make it accessible to others?