Oliver Sacks Knows What It Means to Teach

If you want to see the qualities that make Dr. Oliver Sacks my favorite writer, simply watch what he does when asked to provide grades for the medical students working with him:

I submitted the requisite form, giving all of them A’s. My chairman was indignant. “How can they all be A’s?” he asked. “Is this some kind of joke?”

I said, no, it wasn’t a joke, but that the more I got to know each student, the more he seemed to me distinctive. My A was not some attempt to affirm a spurious equality but rather an acknowledgment of the uniqueness of each student. I felt that a student could not be reduced to a number or a test, any more than a patient could. How could I judge students without seeing them in a variety of situations, how they stood on the ungradable qualities of empathy, concern, responsibility, judgment?

Eventually, I was no longer asked to grade my students.

Dr. Sacks is a neurologist. His expertise ranges so far and wide (he has written on autism, Tourette’s, migraines, colorblindness, sign language, musical hallucinations) that the word “specialization” no longer fits.

Now, I’m a teacher, not a doctor. But reading Sacks’ autobiography, I’m struck by how teachers and doctors both feel a crucial tension, confronting the same fundamental choice in how to define our professional selves. Am I a narrow specialist, applying my expertise to address a specific need of the pupil or patient?

Or am I generalist, embracing the full complexity and interconnectedness of the human before me?

Sacks embeds his answer in practically every paragraph. His purpose, always, is the health and flourishing of the human being. This doesn’t mean jettisoning professionalism. Insofar as this is a debate, Sacks refuses to take a “side.” Instead, through his work and writing, he marries the clinical and the human, the scientific and the spiritual, the pragmatic and the poetic. His prose bubbles and eddies with insight and compassion, rich currents of thought cascading in long sentences that layer adjectives like river sediments, each deposit deepening and shifting the fluid organic whole.

Sacks does not choose between being scientist and humanist. Instead, he weds the roles together, merging them into one.

How does this process begin? For Sacks, it starts with listening to his patients. He lends not only an analytic eye but a sympathetic ear. Sacks grew up with three brothers; two became doctors, but the third, Michael, was troubled by schizophrenia. Over time, Michael found he could confide only in his younger brother Oliver:

[Michael] had begun to think of… the entire medical profession as determined to devalue or “medicalize” everything he thought and did, especially if it had any hint of mysticism, for they would see it as an intimation of psychosis. But I was still his little brother, just twelve years old, not yet a medicalizer, and able to listen sensitively and sympathetically to anything he said, even if I could not fully understand it.

Much of neuroscience aims to reduce our minds to mechanisms. We seek the brain region responsible for X, the neurotransmitter that underlies Y, the biological mechanism for Z. (Never mind if X, Y, and Z happen to be our most precious expressions of self.) Shining in this way, the light of neurology is bright and deadly. It explains and sterilizes us, turns us into labeled anatomical diagrams.

But Sacks resists this “medicalization.” People are people: gloriously unique, irreducibly complex. They are not bundles of symptoms. He gazes into the deepest, most mystical parts of the human psyche, and—far from extinguishing the living mystery of experience, of selfhood—Sacks’ science embraces and nourishes it.

So it must be with teachers. Recent decades have given us a wealth (you might say a clutter) of tools and checklists. Our shelves overflow with tables of state standards, banks of test items, standardized assessments. Like doctors, we’ve got a plethora of diagnostics at our fingertips.

But we must not “medicalize” our students. These tools begin a conversation; they do not end it. To learn any subject—math, history, Spanish, even neurology—is to undertake a fabulous and singular journey, to exercise your humanity at its highest level.

That’s not on the checklists; rather, it’s what the checklists are there for.

To be sure, specialization has its benefits. As a math teacher, my job is quite specifically to help my students learn mathematics, not to cook their breakfast or to counsel them on romance. (Neither my cooking nor my counsel would do them any favors.) For Sacks, this goes double: a neurologist is nothing if not an exquisitely trained specialist.

But when Sacks began working at a headache clinic, he found that his patients’ needs forced him outside of this mindset:

[Seeing patients] gave me a feeling of what seemed wrong with American medicine, that it consisted more and more of specialists. There were fewer and fewer primary care physicians, the base of the pyramid…. I found myself feeling not like a super-specialist in migraine but like the general practitioner these patients should have seen to begin with. I felt it my business, my responsibility, to enquire about every aspect of their lives.

Later, of his patients at Beth Abraham hospital, he writes:

I lived next door to the hospital and sometimes spent twelve or fifteen hours a day with them. They were welcome to visit me; some of the more active ones would come over to my place for a cup of cocoa on Sunday mornings.

This might seem to threaten the idea of clinical distance. In patient/doctor and pupil/teacher relationships, we are rightly afraid of impropriety. So we grow to fear attachment, enmeshment—any sort of excess sympathy—as a sign that lines are being crossed, balances disturbed. Instead, we stay cool. Removed.

“Professional.”

But to Sacks, propriety is not at odds with intimacy. In fact, the whole purpose of professionalism is to create space for a clear and purposeful connectedness. He writes of his own psychoanalyst:

I still see Dr. Shengold twice a week, as I have been doing for almost fifty years. We maintain the proprieties—he is always “Dr. Shengold” and I am always “Dr. Sacks”—but it is because the proprieties are there that there can be such freedom of communication. And this is something I also feel with my own patients. They can tell me things, and I can ask things, which would be impermissible in ordinary social intercourse.

Reading Sacks, I’m always moved by the extraordinary empathy he lends to every patient. In those crippled by illness or disorder, he finds hidden strengths, adaptive resilience. In those dismissed by others—as psychologically diminished, intellectually null, or beyond treatment—he finds untold complexity and richness. He writes:

I find every patient I see, everywhere, vividly alive, interesting and rewarding; I have never seen a patient who didn’t teach me something new, or stir in me new feelings and new trains of thought.

I wish, desperately, that I could say the same of every student I’ve taught. But the day is only so long; owing sympathy and attention to all of my students, I inevitably shortchange most of them. They each face unique puzzles and struggles, carry with them distinctive strengths and personal motives—but hell if I manage to discover half of these stories before they graduate and move on.

I’ll never understand my students as deeply as Sacks understands his patients. Still, it’s an ideal I can strive towards.

As it is, my “knowledge” of my students is often statistical. I know how they’ve performed on homework, quizzes, and tests. I can predict how they’ll fare on the high-stakes exams that will circumscribe their opportunities for the future. Our educational system is increasingly a statistical one.

In medicine, statistics are also ascendant, and in a footnote (it’s always a footnote, with Sacks—the notes for Awakenings originally ran to twice the length of the text itself) Sacks relays one memorable anecdote on the topic:

“How many patients do you have on L-dopa?” he asked me.

“Three, sir,” I replied eagerly.

“Gee, Oliver,” Labe said, “I have three hundred patients on L-dopa.”

“Yes, but I learn a hundred times as much about each patient as you do,” I replied, stung by his sarcasm.

Sacks doesn’t deny the value of statistics. (“All sorts of generalizations are made possible by dealing with populations,” he remarks.) But he insists that they are not enough. Alongside the cold and towering arsenal of data, he supplies an utterly necessary complement: a renewed humanism, a depth of caring and compassion, a creative receptiveness to the variety of human strengths and experiences. He doesn’t rebel against the statistical regime; he simply denies that it can substitute for older and more personal forms of wisdom.

That’s the balance I seek in my teaching. The word essential springs to mind, in its two distinct senses: the newer one of “very important,” and the older one of “capturing the essence.” Test scores, statistics, student data—these things are very important, but they are not the essence.

Tests are only stethoscopes. They are not the heartbeat itself.

Sacks is dying of cancer. In a February essay, he wrote, “It is up to me now to choose how to live out the months that remain to me.” When he passes, the world will lose an extraordinary being, a form of life every bit as distinctive and wonderful as the patients to whom he lent his sympathy, his Sunday afternoons, and—perhaps most lasting of all—his words.