JOURNAL OF THE HISTORY OF THE NEUROSCIENCES

https://doi.org/10.1080/0964704X.2017.1364956

OBITUARY

Oliver Sacks (1933–2015): A belated obituary

Nicolaas J. M. Arts
Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Wolfheze, The
Netherlands, and the Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van
Gogh Institute for Psychiatry, Venray, The Netherlands

Two years ago, Oliver Sacks left us. With him, neurology and neuropsychology have lost
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not only one of their ablest popularizers, but also an important source of encouragement
and inspiration. His accounts of neurological disorders have thrown new light on the
creative and positive aspects of neuropathology and helped to liberate patients from
feelings of unworthiness and inferiority.
His books brought Sacks acclaim and fame, but we should not forget that for a long
time his popularity remained confined to a lay audience. His writings initially received
little interest from his direct colleagues and often met with suspicion and contempt (Sacks,
1983, 2015). Many thought he romanticized neurological disorders and was heedless to the
crude suffering they caused. In this way, he was felt to wrong these patients (Halliwell,
1999). Only later in his career he was widely appreciated as an original mind by his fellow
neurologists, who finally acknowledged his contributions to neurology and neuroscience.
Apart from the numerous historical chapters, paragraphs, and footnotes in his books,
Sacks wrote several papers on the history of neurology and neuroscience, for instance on
Kurt Goldstein (1878–1965), William Gowers (1845–1915), Edward Liveing (1832–1919),
and Sigmund Freud (1856–1939), which were published in various professional journals
and edited books (Sacks, 1995, 1996, 1997, 1999). When this obituary appears, some of his
previously uncollected papers may have been republished in the first of two planned
volumes of his essays, which is scheduled for October 2017 (Sacks, 2017).
That Sacks got off the beaten tracks of his profession was unexpected and initially not a
matter of free choice or contemplated decision. Writing for a lay audience almost began as
an accident, as the result of the disapproval by his colleagues (Sacks, 1983, 2015). It all had
to do with levodopa, which came on the market in 1968. At that time, Sacks was working
as a consultant for Beth Abraham Hospital in the Bronx, New York, which still housed
dozens of survivors of the devastating encephalitis lethargica (or Von Economo’s ence-
phalitis) epidemic that ravaged the world from 1916 to 1927, claiming millions of victims
(Arts, 2000; Vilensky, 2010). These residents suffered from a severe parkinsonism, known
in the literature as “postencephalitic parkinsonism” (Casals, Elizan & Yahr, 1998; Vilensky,
Gilman, & McCall, 2010a, 2010b). They spent their days in immobility, locked in their
frozen bodies. Sacks decided to treat these living statues with levodopa. The results were
frankly spectacular and aptly characterized by Sacks as “awakenings.” Patients who for
many years had stayed motionless in their wheelchairs or beds suddenly came alive. For
the first time in decades, they were able to speak fluently, to walk, and to dance. However,

CONTACT Nicolaas J. M. Arts k.arts@propersona.nl Neuropsychiatry Center Thalamus, Institution for Integrated
Mental Health Care Pro Persona, Wolfheze 2, 6874BE Wolfheze, The Netherlands
© 2017 Taylor & Francis
 2 N. J. M. ARTS

the side effects of the treatment, which appeared after a honeymoon period of just a few
weeks or months, were as spectacular as the effects. Severe and disabling involuntary
movements, as well as neuropsychiatric disturbances, developed in all but a few of the
treated patients (Sacks, 1973). In Parkinson’s disease, these side effects appear much later,
and are rarely as severe as in postencephalitic patients. At that time, none of the levodopa-
treated patients with Parkinson’s disease had started to develop these side effects (Sacks,
2015). Sacks’ patients thus offered a forewarning of what was to come. What happened to
them demonstrated that levodopa was not without risks. Understandably, Sacks was
convinced he had something important to say. He wrote a series of conventional neuro-
logical papers and sent them to several journals. To his astonishment, all were refused.
Moreover, they evoked plainly dismissive and hostile reactions. Sacks wryly concluded:
“When I had nothing to say I could be published without difficulty; now I had something
to say I was denied publication” (Sacks, 1983, p. 1969). How was he to understand this?
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Little by little, he figured out what had happened. Levodopa was just heralded as the first
effective treatment for Parkinson’s disease—in fact, the first effective treatment for any
neurological disease. Sacks’ papers couldn’t but ruin the party.
After this huge disappointment, it took many years before Sacks again ventured to offer
anything for publication in the medical literature. However, he continued to meticulously
write down his observations on his patients and recorded what they told him. His writer’s
block ended when the editor of the BBC magazine The Listener asked Sacks to write an
article on his experiences with postencephalitic patients. In one stretch, he wrote “The
Great Awakening” (Sacks, 1972). Unlike his colleagues, the readers of The Listener
responded with great enthusiasm. A new perspective opened before him and he made
an important decision: he would tell his patients’ stories, enliven them with quotes, and
add lengthy descriptions and analyses of their symptoms. He did not have to eschew
literary, historical, or philosophical remarks. He allowed himself to follow in the footsteps
of the great clinicians of the nineteenth century (Sacks, 2015).
When the book Awakenings appeared in 1973, it received enthusiastic reviews in the
English press and was a critical success. Famous writers and playwrights praised its literary
qualities. A television documentary of Sacks and his patients was made in the same year.
However, it was received with an icy silence by the neurological community. An impor-
tant exception was the Russian neuropsychologist and physician Alexander Luria (1902–
1977), who had published a similar book in 1968 about the Russian mnemonist Solomon
Shereshevsky (1886–1958) (Luria, 1968). He encouraged Sacks to continue on this new
trail, for science needed to develop a “romantic” side. Its importance was that:

[r]omantics in science want neither to split living reality into its elementary components, nor
to represent the wealth of life’s concrete events in abstract models that lose the properties of
the phenomena themselves. It is of the utmost importance to romantics to preserve the wealth
of living reality, and they aspire to a science that retains this richness. (Luria, 1979, p. 174)

The inspiration and encouragement by Luria was crucial for Sacks. For both of them,
“romantic” science was not a departure from modern science or medicine; it enriched
science. It was not an alternative to modern science or medicine, but a necessary,
additional perspective. Luria and Sacks were firmly embedded in mainstream science.
They simply observed that modern neuroscience and neurology become soulless and
stultifying when patients are seen as nothing but their brains. They remind us that the
 JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 3

experiences of patients are as important as their laboratory or neuroimaging results—not

only when we want to be good doctors, but also when we aspire to be good scientists.
Interestingly, many leading neurologists have adjusted their opinion on Sacks’ work and
now share his convictions.
In a certain sense, Sacks was lost in time. He mostly felt at home among the great
naturalists of the nineteenth century, like Charles Darwin (1809–1882), Alfred Russel
Wallace (1823–1913), and Alexander von Humboldt (1769–1859), whose scientific works
are as readable as novels. The textbooks written by the neurologists Sacks admired, such as
Edward Liveing (1832–1919) and William Gowers (1845–1915), were also lively works,
with detailed patient histories, written in literary prose. This was of vital importance,
because at that time scientific works were produced for the educated lay reader as well.
Without this broader audience, printing numbers would be too small and production
costs too high.
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The emphasis Sacks laid on the positive, creative aspects of neurological disorders had
an enormous emancipatory and liberating effect. According to Silberman, Sacks played a
major role in the emancipation of people with autism spectrum disorders (Silberman,
2015). Likewise, his works had a liberating effect for people with Gilles de la Tourette and

Oliver Sacks sitting in the botanical garden in Amsterdam. The author thanks Mr. Bill Hayes for
providing this picture. © Bill Hayes.
 4 N. J. M. ARTS

other neuro(psycho)logical disorders (Kushner, 2012; Halliwell, 1999). But even when we
acknowledge Sacks’ role as an important popularizer and as a liberator or emancipator, we
still are not doing him full justice. Especially for the busy neurologist or neuropsycholo-
gist, Sacks’ work is a treasure trove. His careful observations and meticulous accounts of
patients’ experiences offer information and instruction that is difficult to obtain in a busy
practice.
A tragic irony in Sacks’ life is that he liberated many from the burden of prejudice and
pseudo-scientific portrayal, but was not able to liberate himself. He showed people with all
kinds of disorders and peculiarities that much creativity and even beauty is hidden in their
difference. He encouraged them to correct their negative self-image and to stop hiding
their problems. But he was hardly able to cope with his own difference. Was he trauma-
tized too much? In the Second World War, when London was continuously exposed to V1
and V2 attacks, his parents (Samuel Sacks [1895–1990], a physician, and Muriel Elsie
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Landau [1895–1972], a surgeon) did what most sensible adults in London did: they sent
him off to the countryside. There, without his parents, the shy, clumsy boy was frequently
bullied and battered. This must have left deep scars on his soul. When he reached
adolescence after the war, there was another problem. The fierce rejection of his homo-
sexuality by his mother burdened him with a lifelong sense of guilt and shame. After a
brief, wild interlude in California, he remained cautious and celibate for almost thirty-five
years and refused to answer questions about his sexual orientation. Finally, at 77, he met
the love of his life in the writer Bill Hayes. The last chapter of On the Move (Sacks, 2015)
offers a beautiful and surprisingly honest account of this romance. Thus, Oliver Sacks’ last
case report is about himself. And unlike most case reports, this one had a favorable
conclusion—indeed, a real American happy ending.

Acknowledgments
This article is based on an earlier obituary written in Dutch (Arts, 2016). The author thanks Kate
Edgar for helpful comments on the text.

References
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