RUTH COHEN: Good evening,
ladies and gentlemen. My name is Ruth Cohen. And I am the director of the
Center for Lifelong Learning here at the American
Museum of Natural History. On behalf of my colleagues,
it is my pleasure to welcome you here
tonight for what promises to be a stimulating,
engaging, conversation with one of the greatest physicians
and storytellers of our time, Dr. Oliver Sacks. First, a couple of
housekeeping details. Turn off your cell phones. They interfere with
Lifelong Learning. No flash photography, please,
in deference to our guest. Please take a moment at
the end of the program to give us your feedback through
the evaluation forms that have been handed out. For your trouble,
we will enter you into a raffle to win tickets to
the Margaret Mead Film Festival coming up here November
10th through 13th, opening night or closing
night, and you get a party. Tonight's lecture is part
of a number of programs throughout the year
that the museum produces to welcome audiences of all
ages and all levels of curiosity to learn and experience
science and culture. Our monthly science cafe
series, a new adult course in a series on the science
of attachment and other brain sciences. The parent child bond
coming up, you've seen some of these
things on the screen. Our beloved documentary
film festival, the Margaret Mead
Film Festival, which is a feast of independent
visions of world culture. And also opening November
19th, Beyond Planet Earth, the Future of Space
Exploration, which will be our latest exhibit. Hope to see you back
here in November. Now, it is my great
privilege and pleasure to introduce Oliver Sacks and
welcome him back to the museum. Dr. Sacks' influence
is wide and profound and reaches medicine,
science, culture, the arts. He is a doctor who has changed
the practice of neurology. He is a philosopher
who has changed how we perceive
ourselves as humans, and, indeed, the very
definition of perception. He is a storyteller,
an artist who can draw portraits that reach
our hearts as well as our minds and expand our compassion and
understanding of one another. In the preface to his new
book, The Mind's Eye, Dr. Sacks states that it is the
patient's description of their experiences that
stimulates exploration that is the starting point of
any treatment or diagnosis. Tonight he will take us all
on these amazing explorations. Ladies and gentlemen,
let's welcome Oliver Sacks. OLIVER SACKS: Thank you very
much for that introduction. It's a great pleasure being
here in the museum again, in my favorite museum,
which I've come to almost every weekend since '65. I am delighted to see some
members of the deaf community here and an interpreter. And I hope-- and
you should watch him when you lose interest
in what I'm saying. I will also say
since someone has been flashing a red light at me
that I prefer no photography. My retinas are sensitive, and
I don't want to be distracted. I think I should
say a little bit about how this book started. Am I audible to all of you? AUDIENCE: Yes. OLIVER SACKS: OK, I know
I'm distressingly visible. And I wish I weren't. I took my degree in
medicine in 1958. I've been seeing
patients ever since. But in the 90s, I didn't write
any extended case histories. I, although I continued
to see patients, I diverted myself with writing
a memoir, Uncle Tungsten and a travel journal,
My Oaxaca Journal. But then in '99, a
patient came to see me. I think she had read The Man
Who Mistook His Wife for a Hat. And she wondered, no
photography, please. And, she wondered if something
similar was going on with her. She gave me a story of how,
nine years earlier, her name was Lilian Kallir She was a
very eminent concert pianist. There'd be a change
in her program and a sudden switch to
a different Mozart piano concerto. And she flipped open
the score to look at it and found it unintelligible. She saw everything clearly,
the notes, the clefts, but it made no sense to her. And then some years later,
she became unable to read, although she could still write. And she wrote me a letter. When I saw her, I found
she could recognize almost nothing in the office. And I was bewildered
as to how she had made her way to the
clinic and how she managed. Shortly after she left, I
couldn't find my medical bag. And then she came back saying
that she'd been in a taxi and discovered that
she had my medical bag. She said, I am the woman
who mistook the doctor's bag for her handbag. She said but she had seen the
scarlet tip of my reflex hammer there and that
gave her the clue. The one thing that stood
out when I examined her was that she was extremely
sensitive to colors. I couldn't understand how she
made sense of a visual world until I visited her apartment
and found that everything was classified in terms of
color, position, association so she could recognize
nothing in the ordinary way, but everything in
an artificial way. She became very dear to
me as did her family. And when my father, who was a
general practitioner in London visited patients, he always
looked in the refrigerator. I was not quite that bold. But Lilian would
always provide me with Schmaltz Herring when I
came on a neurological visit. And I think it's
no good becoming a doctor to one's friends. But it's OK becoming
friends with one's patients or one's doctors. And as the first
extended case history I'd written in 10 years then
was my history Lilian Kallir. This started me off. I then found myself thinking of
a patient in the hospital where I worked, Beth Abraham
Hospital in the Bronx. This was someone I'd
known since 1991, a woman with a devastating
aphasia and quite unable to express
herself in language and not very good at
understanding language, although preternaturally
acute in reading people's facial expression and their
gestures, tone of voice and so forth. And in a remarkable way, she had
become an amazing communicator. And I wrote about her as well. I hope the sipping is not
monstrously amplified. Or can you hear my heartbeat? The last time I was
here, I got very upset by the microphone, which
was in my field of vision. And I felt it was like
a fly around my face. But now, as I will mention, I
can see nothing to the right. I can't see this. If it was on my
left, I could see it. In fact, I only
realized it was there when I looked in a mirror. I'm sorry I looked in
the mirror, otherwise I would be blissfully ignorant. I think I'm-- as a-- so for me, writing and
stories and thoughts start from individual patients. There's no intention early on
about writing about a patient. And with Pat, the
woman with aphasia, I had seen her for 12
years before it occurred to me to write about her. And then, of course, I
spoke to her daughters and she, herself,
indicated with gestures that I should go ahead. I think I will tell you a little
bit about another patient, although I shouldn't really. She was really as much a
collaborator as a patient, in fact, she wasn't a patient. I had met her in 1996. At that time, I was very
interested in space flight, and her husband, Dan
Barry, was an astronaut. And I went to one of
his launch parties. And there was his
wife Sue Barry. And I noticed something
slightly odd about her gaze. And she came up to
me and she said, you've noticed something
slightly odd about my gaze. She said with your
neurological eye. And I said, oh. I tried to apologize. And she said no, that was OK. There was something
slightly odd about her gaze. She indicated that she had been
born with her eyes crossed, that there had been
various operations to straighten the eyes,
and although no one but a neurologist would notice
anything amiss, in fact, each eye acted independently. And the right side will scan for
the right eye and the left side for the left eye. So the eyes were
not in alignment. She was not seeing with
both eyes simultaneously. I said, can you imagine
what seeing with both eyes would be like? Can you know what stereo
vision would be like. Because you need both eyes
to see in three dimensions. And she thought a bit and
said, yeah, I think so. She said she was a
professor of neurobiology, that she had read all of the
basic papers on stereo vision. And, yes, she could imagine it. But then she sent me a letter
nearly nine years later recalling this conversation. And she said I was wrong. And she said she could say
she was wrong, because now she had developed stereo vision. And she felt it as a great
wonder and a great blessing. And she said that no one who
didn't have stereo vision could imagine it. And she'd been wrong. And she sent me a chunk of
her visual journal, which was very lyrical and very accurate. She took great delight in this. She described how
it had happened. She'd gone to see a
behavioral optometrist and had been put
through various tests. And after one of these sessions,
she went out to her car and she said she saw the
steering wheel thrusting out, popping out from the dashboard. And at first she thought this
was some strange illusion. But then she closed one
eye and then the other, and she could only see
this with both eyes. And this, for her,
was her first, the first time in her
life, she had seen in 3D. She said she was very puzzled. Because it was her impression
and her doctors impression that if one didn't have stereo
vision by the age of two, one would never get it. And she was 50. Well, I get lots of
letters from people. A lot of the letters make
sad and painful reading where people describe some loss,
something which has gone wrong. This was a different letter,
because it was jubilant. And it described how something
wonderful had happened. And I was very puzzled
and slightly suspicious. Because it seemed
impossible to me. But I made one of my
remote house calls. She lived up in Massachusetts. I love going on neurological
housecalls, the further the better. And I went along with two
colleagues, an ophthalmologist and a visual physiologist. And when I tested her,
things were clearly genuine. I showed her some
slides, which could not be made sense of unless
one had stereo vision. And so she clearly had it. So one of the seven
pieces in the mind's eye is called Stereo Sue. She started signing
her letters Stereo Sue. And she's called
Stereo Sue in the book. If I can find it, I'm just
going to read a paragraph from the end of her journal. She said, after
almost three years, my new vision continues to
surprise and delight me. One winter day, I was
racing from the classroom to the deli for a quick lunch. After taking only a few steps
from the classroom building, I stopped short. The snow was falling lazily
around me in large, wet flakes. I could see the space
between each flake. And all the fakes
together produced a beautiful
three-dimensional dance. In the past, the snow
would have appeared to fall in a flat sheet in one
plane slightly in front of me. I would have felt like I was
looking in on the snowfall. But now I felt myself within the
snowfall among the snowflakes. Lunch forgotten, I watched the
snow fall for several minutes. And as I watched, I was overcome
with a deep sense of joy. A snowfall can be quite
beautiful, especially when you see it for the first time. Sue has now-- The New Yorker published
my piece on Sue-- and Sue has gone on to write
a very good book of her own. One reason I wrote
about her was that I started to realize, as she did,
that there must be thousands, or tens of thousands of people,
in her position who have never seen in 3D but who can
learn to see in 3D. And so I think it's
worth making that public. I, myself, had a passion for
stereo photography and 3D. And when I was a
boy, I used to make what are called
hyperstereoscopes, which basically put your
eyes a yard apart and may enable you to
see distant mountains or buildings in 3D. And I used to come to
the museum regularly every month to the monthly
meetings of the New York Stereoscopic Society. And this obviously had prompted
my question to Sue back in '96. Can you imagine stereoscopy? But just about a year, a
little less than a year after seeing Sue,
something happened to me and to my vision. And when this happened,
I started keeping a journal, many journals. I am going to read you a little
bit about how things started. It was in December of
'05, Saturday morning. I'd gone for a swim. And then I went to a movie. But before the movie
started and the previews, something suddenly started up,
a glittering, flashing light to my left. And I was puzzled. I thought first it might
be a visual migraine. One can get zigzags and bright
lights with visual migraines. But this was clearly different. And it was clearly
just affecting one eye. And I got panicked. I thought, am I going
blind in that eye? Am I bleeding? Have I detached a retina? Or was it nothing? Will it just be better
in five minutes? I stayed for part of the
film, although I really didn't see any of the film. Because I spent all the while
testing my visual fields. I found that I had lost a
wedge-shaped slice of vision in the sort of between
9:00 and 11:00. I phoned up my
ophthalmologist friend, the one who had come with
me to see Stereo Sue. He lived far away, but he
said go see an ophthalmologist immediately. And so usually I'm
at the doctor end. But now I was at
the patient end. A couple of hours later, I
was in the ophthalmologist consulting room. I told my story again, indicator
the quadrant of blindness my right eye. He listened carefully,
looked noncommittal, and after checking my visual
fields, took his ophthalmoscope and peered into the eye. Then he put down the instrument,
leaned back and gazed at me, I thought, with different eyes. There'd been a sudden likeness
or casualness in him before. We were not exactly friends,
but we were colleagues. Now suddenly, I was in a
quite different category. I see pigmentation, he said,
something behind the retina. It could be a hematoma
or it could be a tumor. If it's a tumor, it could
be benign or malignant. He seemed to take a deep breath. Let's look at the worst
case scenario, he continued. I cannot be sure what he said
for a voice had started up in my head shouting
cancer, cancer, cancer. And I could no longer hear him. Well, two days later,
I saw a specialist and he confirmed that this
was a cancer, a melanoma, behind the retina. He indicated this actually
not verbally but with a model. He had a model of an eye. And then he took
something, which looked like a small,
shriveled, black cabbage. And he put this in the eye. And that said to me, melanoma. When I was a medical student,
melanoma was a death sentence. And in England when judges
pronounce the death sentence, they put on a black cap. And seeing this black melanoma
had that feeling for me. But the surgeon, to
whom incidentally I dedicate the book,
immediately reassured me and said that melanomas in
the eye are much more benign. And he said in the old days,
they would take the eye out. But now, one could
irradiate it, laser it, and preserve vision and probably
never hear from it again. Well, this was done. And I enjoyed some
vision with that eye. There was a part missing. When I looked at my five-bladed
fan, I only saw four blades. And then later I only
saw three blades. And things started happening. Finally, vision in that
eye became so distorted that I would close it
voluntarily, in particular, people became attenuated,
insect-like creatures slightly tilted to one side. My journal and my
book has pictures. I'm not very good at drawing. They're rather
Furber-like pictures. And, anyhow, you'll
see my picture of what happened to human beings. You'll say, but this was
only with the right eye. But it somehow infected
vision altogether. Then in June of '07, I lost
all central vision in that eye. And it was something
of a relief to me, although rather terrifying. The evening of the lasering,
I took off the dressing. And I looked in the mirror. And I couldn't see my head. I could only see from here down. Now, losing central
vision in that eye, I lost my special pleasure and
pride, which was stereo vision. I don't know how
visible this will be. Let me see if I can
find what I want. Yeah. Well, there's a picture here. I say, here I'm pouring a
glass of wine for a friend. But as you see, I missed the
glass and pour it in his lap. In those early days
when I lost stereo, I would go to shake
hands with someone. And I would miss their
hand by six inches or so. Losing stereo, I think
affected me, especially seriously because I'd
been passionately, so passionately stereo before. And I think I'd probably come to
rely on binocular cues and less on things like
perspective and occlusion, which you have with one eye. Four years later, I've
made some accommodations to this, but only some. I carry a stick basically
because I can't judge sometimes how far things are away
or the depths of curves, the depths of curves. But the-- if all of you
were to close one eye, or hold your hand
over one eye, I wonder what your responses would be? I think responses
are very varied. When I was a little
10-year-old at school, the teacher found me closing
one eye and then the other. And she said, what
are you doing? And I said, I'm experimenting. I said, when I close one eye,
the world gets completely flat. And when I open it, it opens
like a piano accordion. But nine people out of 10,
don't have this so abruptly. But everyone of the New York
Stereoscopic Society had this. We were all super stereo people. And I had gone in a flash from
super stereo to non-stereo. I sometimes, if one can be-- if dreams can afford
reliable testimony, I sometimes have stereo dreams. And when I wake up to the
appallingly flat world I'm in where there's
a sort of visual chaos that looks as if the fan is
about to hit my reading lamp, I know that they
are six feet apart. But I can't see that
six feet of apartness. There is no distance
between everything. it's all flat and on one plane. Although I will say, there
are occasional advantages. One advantage, I
think, is that I've become more sensitive to
paintings and photographs, which of course these depict a
three-dimensional world on one plane. Before this happened, I
used a stereo camera myself. And my sense was very
much of objects in space at different distances. And now for me, there
are just outlines all on the same surface. This can produce many
strange illusions. I'm going to just find
another page in the journal. Yeah. Another one of my
peculiar pictures there. An appalling site this
morning in the parking area at Chelsea Piers, an enormous
truck on top of my car. My immediate
feeling was, my God, they allow things like this. My first feeling was
of a hideous accident that the truck, in its folly,
I have difficulty reading my own writing, became
impaled on my car and would be crushing
it by its weight. And then I realized
that the truck was the other side of the garage. But I couldn't see that it
was 30 yards behind my car. It was just sitting on my car. This sort of illusion is, well,
perhaps some of you have this, but I still had a little
peripheral vision. And that was very important. Then two years ago,
I bled into the eye, which took away vision. I think I-- I didn't think it would
make much difference. I thought, well, there was
only a little peripheral vision there anyhow. But it made a lot of difference. Because then I found I
couldn't see to the right. I'm going to read a little bit. Yeah, again, when things happen
you kid yourself, it's nothing. One of those things I thought,
although it was unlike anything I'd ever experienced before. It will clear in a few minutes. But it didn't clear. It grew denser and denser. On Monday morning,
Kate, who works with me, came over and suggested
we go for a walk together. As soon as we emerged into the
morning bustle of Greenwich Avenue crowded with people
balancing coffee cups and cellphones,
people walking dogs, parents with children
going to school, I realized that
I was in trouble. I was startled, even terrified. Because people and
objects suddenly seemed to materialize to
look at me on the right side without any warning. Had Kate not been
walking on my right, protecting my
blind side, I would have been colliding with
everything, tripping over dogs, crashing into strollers
without the least awareness that they were there. Normally, once peripheral vision
alerts one to what's happening. It may not be conscious. But you keep your distance. You know what's going on. And if something
important is going on, then you turn your eyes so you
focus in with central vision. But I wasn't getting
any sort of clue. I am not getting
any sort of clue, which is why I am not disturbed
by this thing on my face. Because not only
can I not see it, but there's a sort of
neglect of the right. One doesn't-- I don't entirely
believe that there is anything on my right. So let me, if I can, wait I've-- yeah, so when Kate and I
came back from the walk-- oops, I've got two
pages stuck together. I can't find I want. I got into the elevator. And for some reason, Kate
didn't get in with me. I assume she was checking the
mail or talking to the doorman. And then her voice
said, when do we start? And with difficulty,
amazement and difficulty, I turned round and saw that she
was already in the elevator. Now it wasn't simply that
I had failed to see her. But it didn't occur to me
that she would have come in. And this business of
neglect is quite striking. And I have, and anyone
who is missing an eye or missing in central
vision of one eye, has this peculiar bisectional,
well, this peculiar half of the world. I shouldn't call it a bisection. Because when you
are this way, you think your visual
fields are full. But what's out there
is nothing or nowhere. And you have to be sort of
super conscious and vigilant and consciously make
yourself turn to check. And, of course, if you
don't have any visual field beyond there, you can't
just move your eyes. You have to turn your body. And that makes people nervous. They say, why is he turning
around and staring at us? Well, so anyhow, my
memoir illustrated with Furber-like drawings
is also in the book. So there are the three ladies
I mentioned originally. And I loved all of them. And originally I
was going to write a little book called Three Women
with Sue, and Pat, and Lilian. But then I started having
the trouble with my own eye. And I also then got a
very interesting letter from a novelist, a very
good crime novelist, in Canada called Howard Engel. And he described to me
how, the previous summer, he'd gone down to breakfast. He felt fine. He went to get the newspaper,
the Toronto Globe and Star, which looked fine as it
was lying on his doorstep. But when he brought it closer,
he found it unintelligible. He said it seemed to be written
in Serbo-Croat or something. His first thought was
that it was, indeed, an esoteric edition of the
paper put out for a minority community in Toronto. His second thought was that this
was an elaborate gag, which had been arranged by his friends. But when he opened
the paper and saw the entire thing was in this
unintelligible script, which he calls Serbo-Croat, he
didn't read Serbo-Croat. Indeed, I don't know whether
there is a written Serbo-Croat. But this was his way of
saying it wasn't intelligible. He began to fear that something
had happened to his brain. He went into his library. As a writer he had thousands of
books and in several languages. Now, they were all in
unintelligible Serbo-Croat. If this happened to
any of you, and we live in a world full of
signs and letters, notices of every sort, but if you're
a writer and you can't read and you can't read your
own books, he went along. He woke his son who
was 12 years old. They went along to a hospital. And there the
diagnosis was confirmed that he had had a
small stroke affecting a restricted visual
area in his brain and really knocking out reading,
but essentially nothing else. He didn't realize until a
nurse suggested it to him, she said, why don't
you write something. He said I can't write. Because I can't read. And she said, try. She put a pen in his hand. And he signed his name and had
no difficulty and then wrote. And people who
have this condition can write perfectly well. It has like a lot of medical
conditions, a Latin name they call it, Alexia
sine agraphia, inability to read without
inability to write. So he then realized that
perhaps he could write a book. But what was the use of writing
a book if he couldn't read it and couldn't check it. Well, he-- something
rather strange happened, which took
him by surprise. I think if I can find it,
I will go back to reading. I organized all
this so carefully. And now I can't find anything. Wait. Here it is. Yeah. I think here we are. Oh, I can't find it. I will tell you the story. He-- I am a storyteller. Most of them are maybe
3/4 true, sometimes, sometimes almost
completely true. Howard Engel, Howard
found that he was starting to read a little bit. And he got very excited
and asked the neurologist to check him over. And the neurologist
found not a trace of normal reading ability. So what was happening? We put this together,
which wasn't entirely easy. Because this was
largely unconscious. Howard had taken to copying
the shapes of letters, easier if it was handwriting than
print, with his finger. He would just sort of go
along like this, basically in a way writing or
copying with his finger. And then this spread
to his tongue. And he would copy
what his eyes were scanning on the roof of his
mouth or the back of his teeth. I've said that people who lose
reading still have writing. So for him, essentially,
he was reading by writing with his tongue
on the back of his teeth. It's still sort of slow. But he can get through
a Dickens book. It may take him a
month, whereas it would have taken him two days before. But I found this very amazing. And it brought home to me
that there are always ways and there are nearly always
ways round a problem. You may not think
of them yourself. But your brain somehow does so. By accident you will stumble
on something like this as Lillian the pianist
really had stumbled on the preservation of
color and using color to organize her world. A particular part of the brain
is damaged, has to be damaged, if one is going to lose
the ability to read. And it is damaged in everyone
who has this problem. So it almost seems
as if there is a reading center, a part of
the brain dedicated to reading. But one feels how can this be? Because writing was only
invented 5,000 years ago. There isn't time for
evolution to work. One can understand how
there might be special areas for facial recognition. Books that will go right
back and monkeys and apes have to recognize one another. But reading is a
cultural achievement. In the 1860s, Wallace,
who was the co-discoverer of natural selection
was very puzzled by this very thing
and, in general, by what human beings could do. For Wallace, natural
selection, as he said, would only produce a
brain a little better than that of an ape. And for Wallace, adaptation,
anything develops, evolution would be
immediately useful. But how could you
explain the ability to read or make music,
which might only appear, shall we say, half a
million years later when people became cultured. Well, in fact, a
part of the brain which is specialized for
recognizing shape and scenery and which does this through
a vocabulary of shapes is trained by learning to read. The brain of a
literate person is different from the brain
of an illiterate person. And for me, learning about
this was the first example of how learning and how
culture has altered our brains. I am going to talk a little
bit about something else, which is recognizing faces. Again, I'm going to read
something from the book. It is with our faces
that we face the world. From the moment of birth
to the moment of death, our age and our sex are printed
on our faces, our emotions, the open and instinctive
emotions which Darwin wrote about as well as the hidden
or repressed ones which Freud wrote about are displayed on our
faces along with our thoughts and intentions. Though we may admire arms and
legs, breasts and buttocks, it is the face,
first and last, which is judged beautiful
in an aesthetic sense, fine or distinguished in a
moral or intellectual sense. And crucially it is by
our faces that we can be recognized as individuals. I have had difficulty
recognizing faces for as long as I can remember. I didn't think too much
about this as a child. But by the time I was a
teenager in a new school, it was often a cause
of embarrassment. My frequent inability
to recognize schoolmates would cause them bewilderment
and sometimes offense. It did not occur to
them, why should it, that I had a perceptual problem. Then at the age of
78, it says 76 here, but that was when I
originally wrote this. Despite a lifetime of
trying to compensate, I have no less
trouble with faces. I'm thrown particularly when
I see people out of context, even if I've been with
them five minutes before. This happened one morning
just after my appointment with my psychiatrist. I'd been seeing him twice weekly
for many years at this point. A few minutes after
I left his office, a soberly dressed man greeted
me in the lobby of the building. I was puzzled as to why
this stranger seemed to know me until the doorman
addressed him by name. It was, of course,
my own analyst. This failure to
recognize him came up as a topic in our next session. I think he did not
entirely believe me when I maintained that it had
a neurological basis, rather than a psychiatric one. Well, I often apologize to
a large, clumsy, bearded man walking towards me. And I'm afraid we will collide. And then I realized
that it's a mirror. And sometimes these things can
happen the other way around. There's a cafe, or there
was a cafe in Chelsea Market I was rather fond of. It had tables outside. And once I was having lunch
there and turned to the window. Like many people with a beard,
I started grooming myself. And then I realized that
my reflection was not grooming itself. And, indeed, it was not grooming
itself but looking at me oddly. There was, in fact,
a gray-bearded man on the other side
of the window who must have been wondering
why I was preening myself in front of him. Kate often cautions
people in advance about my little problem. She tells visitors, don't
ask if he remembers you. Because he will say no. Introduce yourself by name
and tell him who you are. And to me she says,
don't just say no. That's rude and
will upset people. Say, I'm sorry. I'm awful about
recognizing people. I wouldn't recognize
my own mother. I did recognize my own
mother usually, usually. Well, I have an older brother,
I had an older brother, who had gone to Australia
when I was a teenager. And I met him again
for the first time in more than 30 years in 1985. And I found that he had exactly
the same problem with faces and also with places. He was a doctor in Sydney. And his wife would always
bring in the chart on a patient before the patient came in. Because she knew
that he would fail to recognize the
patient, even if he'd seen the patient the day
before or the week before. And I was a little
puzzled by this and started to wonder whether
this could be a family thing or a genetic thing. Prior to that, I just thought
of it as a sort of idiosyncrasy. And, in fact, I
thought it might have been due to absent mindedness
or not paying attention. I didn't quite know what it was. In '85, '86 when
my book, The Man Who Mistook His Wife
for a Hat came out, I started to receive
a lot of letters from people who
said that they also had problems of recognition,
not as bad as Dr. P. But their problems
were lifelong. For example, there
was one letter in '91. A woman wrote me
saying, I believe that three people in
my immediate family have visual agnosia, my
father, a sister, and myself. We each have traits in
common with your Dr. P but hopefully not
to the same degree. My father was unable
to recognize his wife in a recent photograph. At a wedding reception,
he asked a stranger to identify the man sitting
next to his daughter, my husband of five years at the time. I have walked by my
husband while staring directly at his face
on several occasions without recognizing him. Unlike Dr. P I feel I
can read people well on an emotional level. Well, this was one of dozens
of letters I started to get. And I began to wonder,
neurologist's had written about sudden
loss of ability to recognize faces as a result
of a stroke or a head injury. But here were people saying
they were born this way and that it had been lifelong. And I wondered whether
there was a condition, a lifelong condition, of being
unable to recognize faces, which was being
disregarded which had never attracted either
medical or public attention. And then in 2005, or
something like that, I found that a
colleague at Harvard had sent out electronic
questionnaires to more than 50,000 people and
examined a good many of them. And he had come
to the conclusion that somewhere between 2%
and 3% of the population were fairly severely face blind,
enough to get into trouble and to need help, even
though some of them might not realize it. Because they had become so
good at recognizing people by their clothing,
their movements, the way they walked, their voice,
their context, or whatever. And 2% to 3% means 5,
6, 7 million people, including, no doubt,
2% to 3% of all of you. And so here, again, I partly
wrote about face blindness, my own and other
people's, because I thought this was a topic which
needed to be talked about. There are a number of topics
which have been secret. No one talked about
dyslexia a few years ago. Now it's known that a
substantial minority of children have dyslexia
and sometimes heightened visual or musical abilities
going along with the dyslexia. And there are forms
of teaching which make life much easier for them. There needs to be something
for the face blind. I am usually helped
by Kate or someone. I really have to have
a recognizer with me. But that's a problem
and quite a common one. And, again, there
is a particular part of the right
hemisphere, which is concerned with
the identification and the representation of faces. If people have
hallucinations of faces, which is something I
will be writing about one of these days,
you'll find activity in this face area heightened. And you can show it's face
area by giving people-- putting people in a
functional brain imaging and showing them photos. And the area will immediately
spike when they see a face. So seeing faces seems to be
built in evolution really. But it also depends
on early life. Now, I haven't been
watching the time and I-- well, there are-- oh,
yeah, I should say, because I shouldn't leave
things in a negative way. The other side of face
blindness are super recognizers. And let me read
you another letter. As I get older, I maybe
see fewer patients. I often take two hours
to see a patient. And there's a limit to how
many patients I can see. But I get hundreds, indeed,
thousands of letters. Here's a letter from
someone, Alexandra Lynch. She said it happened
again yesterday. I was on my way down
into the subway in Soho when I identified someone 15
feet ahead of me, back turned, talking intimately
with a friend as a man I knew or had seen before. I had last seen him
briefly two years earlier at an opening in Midtown. And she goes on to say, this
is an integral part of my life. I catch a passing
glimpse of someone, and with no real effort,
flash, place the face. Yes, that's the girl who served
us wine in the East Village Bar last year. And, anyhow, people like
this have indelible memories of faces and may have tens
of thousands of faces. And they need to be
employed by the CIA. Their gift can cause
trouble as well. Because they recognize strangers
who become suspicious and say, oh, you've never seen-- we've never met before. And she said, yes, we did 32
years ago in that little alley in Florence. And then they think they
may have been tailed or she has something
against them. So, in fact, there's
a whole spectrum. Most people are in the middle. But down at one end of
people like me or worse. And they come much
worse than me. And at the other end are
the super recognizers. I think at this point, it's
a little after 8 o'clock. I should stop and be
open to your questions. But thank you very much
for your attention. I hope my deaf friends will
feel free to answer questions as well, which would be
interpreted to me and my answer back to them. And Hailey, who works
with me, will help me with your questions. Because I'm rather
deaf as well as rather blind and rather lame. I hope the central nervous
system is roughly intact. Hi Hailey. HAILEY WOJCIK: So we have
some microphones up here in the front of the auditorium. If you'd like to ask
a question, please come up and speak clearly and
closely into the microphone. AUDIENCE: Dr. Sacks, in your
discussion of Stereo Sue, you made the point
that you thought it was important to write
about because you suggested that somehow or other things
could be improved in people. It would suggest that there's
some mechanism that you're suggesting that could
do this in someone who didn't have stereo vision. OLIVER SACKS: What
was the last question? HAILEY WOJCIK: You're
suggesting that there's a mechanism that could
be improved if you don't have stereo vision. OLIVER SACKS: Yeah, right. It seems probable that Stereo
Sue, like many people born with a severe convergent squint
might have had a little stereo vision when she was young. When I brought this
up, she said, yes, sometimes as a child
a blade of grass would seem to stick forward. But then she'd lost that and
more or less forgotten about it until I brought this up. You have to have two good eyes. Some people who
have a strabismus may lose the sight in one eye. The brain may suppress
the sight in one eye. But the alternative is that you
have good sight in both eyes. And then it really may require
quite elaborate training. And Sue, herself, has
written about this. But there are-- the
brain essentially has to have two pictures,
images, corresponding to what the two eyes see. And the differences
between these two pictures are interpreted as depth. And when stereoscopes were
invented in the 1830s, originally they would
have geometrical drawings, a cube slightly tilted
in one drawing, a scene. And if you look
into a stereoscope, you see two flat pictures, a
flat picture with each eye. But the brain will
compare them and you'll have a single picture in depth. If that mechanism is
intact, and perhaps it would survive
in everybody, even if they didn't have
any stereo vision when they were very young. If that mechanism is
intact, seemingly it will work if you
can align the eyes. But it's-- I mean, no
promises can be made. And this is not easy. But life is much more
fun in 3D than 2D, even though there are
2D athletes and aviators and surgeons. It's amazing what one
can do with one eye, if that's all you ever had. But still two eyes are better. RUTH COHEN: AUDIENCE: I'd like to
ask you, what happens, or have you seen any 3D films? And if so, how does your
problem with your right eye, how is that affected, or is it? HAILEY WOJCIK: Can
you watch 3D films? OLIVER SACKS: No, I can't. I haven't seen Avatar. I used to adore 3D films. And in my piece Stereo
Sue I talk about some of the 3D films, which appeared
in the 1950s which thrilled me. But now if I wore
the stereo glasses, I would get two images,
which would confuse me and wouldn't fuse. I have to see-- I have to see a 2D
version of a 3D film. AUDIENCE: I have a question
from a pure medical standpoint in terms of treatment
modalities for people that have certain
conditions where they can't recognize faces. I think there are new
drugs that are coming out, which target like histone
bodies and other such things in the brain that can affect
how our genes are coded for how our brain functions. They're also doing this
for psychiatric disorders. I'm wondering what your
thoughts are on this and where medicine might
be going with that? OLIVER SACKS: I haven't
caught a word of this. HAILEY WOJCIK: Yeah. OLIVER SACKS: Can
you tell me, give me the gist of what was said? HAILEY WOJCIK: It's
so the treatments for a person affected-- OLIVER SACKS: By the
way, this is not you. It is that for me the
amplification system booms. And I, yeah. HAILEY WOJCIK: Are there
any drug treatments for a person with agnosia, gene
therapy or things like that. AUDIENCE: Like histone therapy. OLIVER SACKS: Yeah. As far as I know, no drugs. The genetics of face blindness
are being investigated. But as yet, there is nothing
helpful on the horizon. I mean, what is needed is
recognition and training and other forms of things and
being able to say, I'm sorry, I don't recognize you. I have a problem. If you don't say that,
you will be seen as rude. But so at the moment,
there are only sort of behavioral approaches. AUDIENCE: Sir, I have a neighbor
who was a perfectly healthy man and suddenly
started to go blind. And gradually the rest of his
body deteriorated to the stage where he is now a quadriplegic. I'm told by a colleague
that this man has Alzheimer's first presenting
as occipital problem with his vision. Do you-- OLIVER SACKS: He's
asking about Alzheimer's? HAILEY WOJCIK: Yes. Well, someone who
has Alzheimer's who went blind who
is quadriplegic. OLIVER SACKS: Well, when
you have Alzheimer's, you may have difficulty
recognizing people and objects like the man I wrote about who
mistook his wife for a hat. You don't go blind to such. But you develop an agnosia,
which means you see clearly. But you can't interpret
what you're seeing. AUDIENCE: This man was a
professor at university-- OLIVER SACKS: No, I think there
are six people behind you. And I think we should
give them a chance. AUDIENCE: I was
wondering how, there have been a lot of
studies where when people have different aphasias and
agnosia such as in the Broca's or Wernicke's area. The brain can, other
parts of the brain will kind of pick up where
those areas leave off. But in a lot of the cases
with the agnosias for the face blindness that you're
talking about that such a thing doesn't
really exist. It's all like conscious
efforts to try to get over with this issue. So what are your thought-- I was wondering why, for some
different aphasias and agnosias other parts of the brain can
pick up on that while others can't. OLIVER SACKS: I think
that was English. But I'm afraid I
didn't catch a word. Incidentally, I'm sorry you're
getting a demonstration of what deafness sounds is like. And it's not just amplitude. So what did the young lady say? HAILEY WOJCIK: OK, so if
I'm paraphrasing this right, that there are ways that
the brain will compensate for different, for
like Broca's aphasia, but why doesn't it do
that for prosopagnosia? Why do they have to
be sort of conscious? OLIVER SACKS: All right. There's-- the brain can only
compensate to some extent. There's a fairly
small area, which has become specialized
for face recognition. And if that's knocked,
it's knocked out. And again, I wrote about
this in an earlier book. There are particular areas of
the brain in the visual cortex, which are specialized for
the perception of color and also with the
imagination of color. And if those are
knocked out, there's no way around this, unless
there's some healing. But at the moment
that doesn't seem to be that much adaptation
of the brain there. AUDIENCE: Early in
your presentation, you mentioned I think
it was Stereo Sue who went to a therapist who asked
her a bunch of questions. And then after
that, she walked out and her steering wheel
popped up into her face. As a result, the way
you presented it, it was after these
questions were asked, she suddenly saw in stereo. I'm very curious as
to the relationship between the questions
and her sudden ability to be able to see in stereo. HAILEY WOJCIK: OK, why did the
steering wheel sort of suddenly pop out at Sue and-- OLIVER SACKS: Well,
the steering wheel. I mean, before,
until that point, the steering wheel had been
flush with the dashboard. And as she remarked of the
snow, and as I have now, everything used to
be in a flat plane. But with stereo vision things
are not on a flat plane. They protrude or they retreat
in the third dimension. And she was experiencing for the
first time, the steering wheel looking as it should look. AUDIENCE: I'm sorry. But I don't think
that my question was properly interpreted. I want to know what
the therapist that she saw that afternoon before
she went to drive her car-- OLIVER SACKS: Oh I see. Yeah I'm sorry. AUDIENCE: Asked her that
enabled her to suddenly be able to see in stereo. OLIVER SACKS: All right. OK, she was being
given exercises to get the two eyes to move
together and in alignment and congruously. These were quite
complex exercises, which she had been doing for a time. And at that point, she had
achieved alignment of the eyes, although it was rather
brief and unstable. But when she got into
the car, her then aligned eyes allowed
her to see it in stereo. AUDIENCE: Also she-- OLIVER SACKS: But you
would have to find the details in her book. AUDIENCE: OK. Thank you. AUDIENCE: Hi. Thank you. I work with Asperger kids. And I'm curious about, when
you say superconscious, is it the same thing is that
I see over and over again? For example, I'm taking--
this kid curses all the time. And I'm taking him
to a pizza place. I say, hey look, if you curse,
I'm going to be kicked out. We're going to be kicked
out of this pizza place. And he says, no, I'm
not going to curse. I am not. I said how do you know
you're not going to curse? Well, I know. And what happens is
that he puts his mind up to this higher level,
this super level that we may look at as normal. But these kids will just
have their mi--they'll kick their minds up to another level. And they will act just fine. And I'm just
wondering, does that relate to your superconscious? HAILEY WOJCIK: He's
talking about Asperger kids and I'm not 100%
sure that I actually understand your question. AUDIENCE: Like he uses
the word superconscious. And it seems like these
kids will raise up the intensity of their mindset. So they could, a better
example, a hyperactive student, a client of mine, he's
going out with a girl. And he says, I said,
well, how's your-- he calls himself hyperactive. He said, oh, I'm not going
to be hyper with the girl. I don't want the girl
to know I'm hyper. And he could control
his hyperactivity. HAILEY WOJCIK: So how
do they control it? OLIVER SACKS: Great. AUDIENCE: Because he kicks
his mind up to that level because it's so
important to him. OLIVER SACKS: Well,
if I understand you, you could be speaking about
Tourette syndrome when there are sudden, explosive
movements and words and often curses. Now, I saw a
colleague, a surgeon in Canada, who had
very severe Tourette's but had been completely
accepted by the community. One of the things
he tended to say was hideous, hideous, hideous. And I was with him
in an outpatient when a man came in
with a condition, which was, indeed, hideous. And I feared that
he might say this. What happened was he was
just say hid, hid, hid, hid. Somehow, consciousness
allowed him to abbreviate the word so it
didn't have its usual sound. And if this is what
you're asking about. HAILEY WOJCIK: Yeah. OLIVER SACKS: Yeah, OK. AUDIENCE: Hi. Do people with
that kind of alexia have difficulty perceiving
numerals, logo, icons, et cetera? HAILEY WOJCIK: Does the
alexia affect logos, numerals? OLIVER SACKS: Yes,
well, in fact, there are slightly different
parts of the brain. One can have an alexia
for music without having an alexia for print, although
Lilian ultimately got both. It can be the other way round. You can also have
a specific alexia for numerals and for
any particular sort of symbolic notation. You can also have an alexia for
English but not for Chinese. But you may say then, Chinese
is an ideographic language. And it's quite different. But you can have an alexia
in English and not in French. And sort of there's not only-- so there is exquisite
specialization within the specialization. RUTH COHEN: We're going
to take these last three people for questions. AUDIENCE: Dr. Sacks, one of
your quotes in one of your books was, if a man has
lost a leg or an eye, he knows he has lost
a leg or an eye. But if he has lost himself,
his own sense of self, he cannot notice. Because he is no
longer there to notice. And you were talking about
a brain injured patient. I happened, 10
years ago, happened to have my temporal lobe
and hippocampus removed. I had brain surgery. You were talking
before about something called Capgras syndrome. That's a disease
that I have as well where familiar people you see
everyday appear unfamiliar. And unfamiliar people
that you've never met, or mere acquaintances,
appear familiar. And that's because
the right side of the brain kind
of overcompensates for the left side of the brain. And that's my case. When one side outweighs
another, the unfamiliar may look familiar. But the familiar
look unfamiliar. HAILEY WOJCIK: She
has Capgras syndrome. AUDIENCE: And you
taught me about, that's called Capgras syndrome. And I learned that through
you and Dr. Orrin Devinsky. And you were talking
about facial recognition? OLIVER SACKS: Yeah. AUDIENCE: And the
off-balance in the brain. OLIVER SACKS: So it's
all about Capgras? HAILEY WOJCIK: Right. OLIVER SACKS: Yeah. HAILEY WOJCIK: She's
a patient of Orrin's. OLIVER SACKS: Oh, I see, yeah. Well, there are a number of
paradoxical seeming conditions. One of them, which was
described about a century ago, has the effect of making those
nearest and dearest to one, in some sense, unfamiliar. You recognize them, but there
is not the appropriate feeling of warmth. And because of this-- There's something there? HAILEY WOJCIK: It's there. OLIVER SACKS: OK. And because I can hear
a whistling sound. But they can't. AUDIENCE: No. OLIVER SACKS: No, it's OK then. Now, if someone looks just like
your husband or wife or child, but you don't have the
feeling you used to have or the feeling you should
have, then you might say, perhaps, they are impostors. Perhaps they are duplicates. You do not get this
with strangers or people you don't know terribly well. Because there's no
special emotional bond. But it's really
that it seems to be the dissonance between
a visual recognition, a perceptual recognition,
but an emotional breakage as if there's something
broken or not connected between the visual and
the emotional centers. And I think it must be quite
difficult to live with. And I think you must be brave
and resourceful to be doing so. AUDIENCE: The other side
is the hyperfamiliarity where people you
don't know appear to be extremely familiar. OLIVER SACKS: Yeah. AUDIENCE: As if
they're your friends. OLIVER SACKS:
Hyperfamiliarity, yeah. Incidentally, people
with face blindness, myself included, on the one
hand we cut our closest friends. We may also embrace strangers. I was at a party recently. And when the door was
opened, I said to my hostess, lovely to see you
again and kissed her. And she says, ah, she says
your hostess is over there. But there is a syndrome in
which everyone seems familiar, although you know this
can't possibly be so. Your intellect will tell you
that you can't get on the bus and have met everyone there. Yet, you may feel that. And so the sense of familiarity
and memory are different. But that too is very intriguing. And you're in very good
hands with Dr. D, the best. AUDIENCE: Hi. Thank you. I'd just like to ask if it's
physically possible to have a modicum of stereo vision with
one eye or whether the fact that, when I cover an eye,
I see very little difference between one eye and double. Does that mean I very
low stereo vision? Or is it just my
brain compensating knowing what I should see? HAILEY WOJCIK: Can you have
any stereo vision with one eye. You're asking if you can have
stereo vision if only these-- AUDIENCE: Yes. Is it possible? Because I have
essentially the same depth perception with one or two. How do you explain that? HAILEY WOJCIK: So
she feels like she has depth perception with one
eye, the same as with two. And she's asking if
that's just compensation or some other mechanism or if
that's actually stereo vision. OLIVER SACKS: Well, I've had
a lot of letters from people who have lost one eye but
maintained that they somehow regained stereo vision. I think that I suspect that
this is an illusion, and a very nice illusion, made possible
by the fact that monocular cues of perspective and occlusion and
so forth have been heightened. I don't know what else to say. I wish I were one of them. But for myself, things remain
as flat as a playing card, except in dreams. And except, I will confess,
on a couple of occasions when I smoked some pot when
some flowers I was looking at seemed to thrust out towards me. AUDIENCE: Thank you. I'll try that. OLIVER SACKS: But
it didn't last. AUDIENCE: What are you pla-- RUTH COHEN: Oops. Try again. AUDIENCE: What are you
planning to write next? HAILEY WOJCIK: Oh, what
are you writing next? OLIVER SACKS: Oh, I've
just finished writing a book on hallucinations. I finished on Thursday. And I got word from my editor
today that he liked it. And I-- and I hope it
will come out next year. AUDIENCE: Thank you. OLIVER SACKS: Thanks
for your question. RUTH COHEN: Thank you
very much, Dr. Sacks.
