Oliver Sacks: A Neurologist Who Could Be "Mistook" For a Psychiatrist

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That Oliver Sacks, MD, the renowned neurologist and writer, died on Sunday, August 30, should not surprise us-for during his dying, he prepared us so well for his impending death at age 82. By writing a series of profound pieces for TheNew York Times after he found out that he had a terminal illness, he taught us much about how to live and die.

On February 19th, 2015, he wrote an opinion piece entitled My Own Life, upon learning that his melanoma was now terminal. He describes being able to now see his life from a broad perspective, "with a deepening sense of the connection in all its parts." He wants to straighten out his "accounts with the world."

Is it ever too early to straighten out our accounts?

In a follow-up piece published in the Sunday Review on July 24th, Oliver Sacks: My Periodic Table, he describes how comforted he felt by viewing a night sky "powdered with stars," as he said that Milton once wrote. He felt connected to these stars, to lemurs, to the periodic table and, in other more cliched words, to all of life and the universe.

Most recently, on August 14th, 2015, Dr Sacks wrote an Opinion Piece in the Sunday Review entitled Oliver Sacks: Sabbath. In it he described how the Jewish Sabbath day of rest turns out unexpectedly to have such important meaning for him, not in a supernatural or spiritual sense, but as a self-professed "atheist Jew," as a day of rest, a day of thinking about the most serious things in his life, "a time outside time." He seems to be suggesting that we all take some days of a Sabbath to similarly review the meaning of our lives.

Death Anxiety

From these writings, it appears that Dr Sacks has dealt successfully with the death anxiety we all have-the death anxiety that the cultural anthropologist Ernest Becker pointed out over 40 years ago in his Pulitzer Prize winning book The Denial of Death. Serendipitously, I had a related episode in which my own death anxiety became more conscious for a time. This occurred right after the public broadcast when President Jimmy Carter also announced that he had metastatic melanoma.

I just so happened to be scheduled for my annual dermatology exam. Part of this exam is to see whether any of my numerous skin moles (given the extensive exposure my fair skin had to the sun during my sports-oriented youth) had turned into a melanoma.

Changed into a gown, I sat on the exam table, reading, as I awaited my well-known dermatologist, who was behind schedule as usual. “What are you reading about, Steve?”, she asked upon entry. I never know if she remembers from year to year that I am a psychiatrist.

“Death anxiety,” I sort of sputtered out. After a brief silence, as if we both were surprised by my response, I added: “You've heard about Oliver Sacks and President Carter talking about their terminal illnesses, both from melanoma”? Yes, she nodded. “Well, I'm thinking of writing a blog about their public comments and, of course, I have my own personal concerns.”

“Well, you know, we don’t know the origin of President Carter’s melanoma (as I tensed up further). I finally relaxed when she finished scanning my skin and said “It looks like you have nothing to worry about now.” I responded, “Well, I hope, at least until next year! Just in case, though, I’ve already done a first draft of my own eulogy.”

What I was actually reading were excerpts from a book by another renowned physician writer. With his book Staring at the Sun: Overcoming the Terror of Death, the existential psychiatrist, Irvin Yalom, MD, has contributed substantially to addressing Dr Becker’s concerns by treating disguised death anxiety in patients, educating the public, and exploring his own fears of death. Too much, or too little, attention to dying can be problematic, he concludes. At best, having an “awakening experience,” such as a dream, loss, retirement, or trauma, can stimulate the recognition of death anxiety and inspire one to rearrange priorities if necessary. Ignoring death altogether can lead to high-risk behavior or an unsatisfactory lifestyle, perhaps as Dr Sacks portrays of his earlier life.

Dr Sacks’ terminal illness seemed to be such an awakening for me. If I should end up in a state of dying like Dr Sacks, will I also be able to react with the same grace? Maybe even more importantly, will I live with that grace day by day?

We, and I, may very well die suddenly, unexpectedly, and tragically, as we have seen all too clearly in the recent tragic killings in (among other places) Roanoke, Virginia. And, we cannot even know we are dying if we develop something like Alzheimer's disease.

Neurology and psychiatry

That tension I felt in my dermatologist’s office was a personal reaction to Dr Sacks' dying. My professional reactions as a psychiatrist are numerous and easier to process.

Probably, psychiatrists had been paying special attention to the career of Dr Sacks. As a neurologist, he was a specialist in a field that overlaps psychiatry. Freud was a neurologist first.

As a clinician, Dr Sacks was renowned for his careful and humane evaluations of unusual patients. He makes an obvious case for psychiatric clinicians to have enough time for the evaluations of complex patients--time that for-profit managed care companies often try to limit. I bet that if Dr Sacks had been a psychiatrist, he would have wanted to know what made the perpetrator of the Roanoke killings tick like a time bomb. Was it an unusual combination of pathological narcissism, paranoia, and post-traumatic reactions? He leaves it up to us to figure that out as best we can with whatever information emerges without a personal evaluation.

As a popular writer, Dr Sacks made his unusual case studies come alive in compassionate ways that enhance what it means to be human in such best-selling books as The Man Who Mistook His Wife For A Hat. Among many others, some might be of particular interest to psychiatrists, such as The Mind's Eye, Seeing Voices, and Musicophilia. He is an inspirational model for me, a more occasional writer.

As an introspective person, Dr Sacks wrote revealing books about himself, Hallucinations and On the Move: A Life. Like Freud, he conveyed a self-analysis of his history of struggling earlier in his life with his homosexuality, substance abuse, loneliness, and long motorcycle journeys, only to become a model, fortunately, for recovery with a later life of professional and personal love.

Dr Sacks was even a family member of someone with severe mental illness. He had a brother with schizophrenia and, like so many such siblings, struggled with whether he did enough to help.

Psychiatrists are used to criticism-often intense public criticism. Despite all that he accomplished, Dr Sacks was not immune to a bit of that. Did he exploit some of his patients for his writing? Did he pay too much attention to their literary presentation rather than a drier scientific analysis? Were the titles of his books too cute?

A psychiatric life

In some of my blogs for Psychiatric Times, I have written brief eulogies on psychiatrists who have inspired me. Dr Sacks has, too.

There seems to be so much of a psychiatrist in Dr Sacks that I, for one, would nominate him to be an honorary psychiatrist. Wouldn’t you?