Neurology, Music and Time: A Bakhtinian Study of Reminiscence by Oliver Sacks
Oliver Sacks and Narrative Medicine
This paper aims at exploring the narratological notions in Oliver Sacks’s Reminiscence problematized by Bakhtin’s theory of narratology. Olivers Sacks is one of the pioneers of medical humanities. He has narrativized many of the interesting cases that came across him during his career as a neurologist. Rita Charon titling her article on Oliver Sacks, that she had written for healthaffairs.com, “Remembering Oliver Sacks, A Pioneer of Narrative Medicine” (Charon), discusses Sacks’s epistemology: Dr. Sacks developed an epistemology, not of knowledge alone but of an artist’s means of seeing. In Sacks, seeing became knowing, and knowing encompassed caring. The knowledge base was prodigious, not only of neurology but of musicology, literature, marine biology, and chemistry (Charon). Charon’s exploration of Sacks’s epistemology brilliantly points towards the necessity of narrative medicine, on the one hand, and on the other, all inclusivity of Sacks’s approach towards knowledge and life. Dr Sacks wanted his readers to enter the world of his patients through his narrations of their ailment. His accounts, as we shall see later, are vivid in details, stylistic in structure, literary in semantics and scientific in appropriation. He amalgamates his knowledge of science with the personal experience of his patients. Bakhtin, in his critique of Dostoevsky’s writings, introduced the term dialogism. He believes that a novel is, and has to be, comprised of multiple voices. During the process of novelization of other genres, he writes, voices “become more free and flexible, their language renews itself by incorporating extraliterary heteroglossia and the "novelistic" layers of literary language, they become dialogized, … the novel inserts into these other genres an indeterminacy, a certain semantic openendedness” (Bakhtin 20). Bakhtin comments that for novel to become the dominant genre, it has initiated a renovation of other genres. They are infected by novel’s “spirit of process and inconclusiveness” (Bakhtin 20). He lays down the three basic characteristics of novel. First, he call “stylistic three-dimensionality”, by which he means the “multi-languaged consciousness.” This is what he sums up by the term “heteroglossia.” The second characteristic, for Bakhtin, is that the novel effects “radical changes” in the “temporal coordinates of the literary image.” Meaning thereby that the process of novelization disconnects the event or the image from its immediate temporality and contextualizes it another time, which has universal notion. Third, and most important, characteristic of novel is that it opens a “zone of maximal contact with the present” in all its openendedness.” (Bakhtin 21). Oliver Sacks was a true polymath and he tended very carefully to his narratives. He himself theorizes his reasons and process of writing: To restore the human subject at the center—the suffering, afflicted, fighting human subject – we must deepen a case history to a narrative or tale; only then do we have a “who” as well as a “what,” a real person, a patient, in relation to disease in relation to the physical. (Sacks 15) He wants his reader to know “who” really the person is suffering from that illness. He often quotes from Hippocrates: “it is far more important to know what person the disease has than what disease the person has” (Hippocrates). Oliver Sacks’s approach towards his patients is not only suggestive of his kindness and passionate love for them but also of the wholistic nature of his method of dealing with the disease itself. The framework for this paper will be formed by juxtaposition of Olivers Sacks’s method of narrativizing medicine and case histories, and Bakhtinian elements of novelization. This will help in recognizing Oliver Sacks’s pattern of narrativizing case histories. Oliver Sacks’s Reminiscence will be looked at from this perspective. It will be a multi-layered analysis of characters (patients), narrator and narrative by looking at the elements of heteroglossia in language. The layer of the analysis will deal with the structural three dimensionality of Sacks’s narrative. The characters, and the events that happen to them, will be deconstructed in the same light. The language use of Oliver Sacks will be the point of focus for it will tell us about the multiplicity in Sacks’s voices as a narrator. The layer of the analysis will explore the temporality in Reminiscence. As the title of this case history suggests, the notion of time and temporality is dominant in the story. The characters’ association with their past and their engagement with the present, at backdrop of neurological illnesses, will be interesting to look at from Bakhtinian notion of temporal coordinates. The last part will aim at looking for the presentness of the past for the characters. The multi-layered analysis will be done simultaneously of each character and event. After exploring the above in the narrative, there will be an in detail analysis, in view of the above framework, of the whole structure of the narrative. Before delving into the case history, it is of importance to explore what medical humanities is and how does Sacks’s oeuvre relates to it. As to the question of medical humanities: “this approach will allow us to inspect our thoughts and preconceptions about illness and patients. It also shows us how one’s identity can be redefined positively while fighting against an illness, disease, or disorder” (Lenus and Rao 1756). Sacks’s oeuvre, in general, is an attempt at this. Sacks has written many books. In his famous book Awakenings, Sacks expresses his confusion: When I was young, I was torn between two passionate, conflicting interests and ambitions – the pursuit of science and the pursuit of art. I found no reconciliation until I became a physician. I think all physicians enjoy a singular good fortune, in that we can give full expression to both sides of our natures, and never have to suppress one in favor of the other. (Sacks 345) Oliver Sacks, a neurologist, was born in a household where a lot of people were doctors. His major engagement with medicine began when his mother used to come and tell stories of medical cases. He begins his talk “Narrative and Medicine: The Importance of the Case History” at University of Warwick (Distinguished Lecture Series): “I went to Middlesex hospital … I retain very little memory of medical lecture there; on the other hand, I remember all the patients I saw” (“Dr Oliver Sacks- Narrative and Medicine: The Importance of the Case History”). His recollection of patients in his case histories is of quite an emotional magnitude. He really remembers, with all the nitty-gritty details of his patients. Michael Stein, in Accidental Kindness notes: “My training in unkindness began the first day of medical school” (Stein 15). He believes that doctors are trained to be unkind. It is argued, he feels, that kindness weakens the doctor’s ability to cure a patient because he can get carried away with the emotions: “Kindness” is not a term used in the medical literature; it is not included in the mission statement of health care organizations” (Stein 13). Stein thought of it as the ability of doctors that not only allows them to cure their patients but also offers them an insight into the complexities of the ailment. Similarly, Oliver Sacks considers doctor’s ability to associate with his patients, his strength. Migraine was his first book. It was a descriptive (and cautious) engagement with the subject at the backdrop of classical science. He summarized symptoms of migraine and gave some ideas as to its therapy, but, most importantly, he personalized the experience of patients, for he had suffered migraine since childhood, and sympathized with them.
Nostalgia: Healing or hurting?
To create a contrast, Sacks has intertwined a similar story of Mrs. O`M, who also heard music in her mind. He merely touches upon Mrs. O`M’s condition and does not discuss her in detail but the contrast sheds light on Mrs. O`Cs condition too. He narrates: When I came to examine Mrs. O’M. I found nothing abnormal except in her hearing, and here what I found was of singular interest. She had some inner-ear deafness, of a commonplace sort, but over and above this she had a peculiar difficulty in the perception and discrimination of tones of a kind which neurologists call amusia, and which is especially correlated with impaired function in the auditory (or temporal) lobes of the brain. She herself complained that recently the hymns in the chapel seemed more and more alike so that she could scarcely distinguish them by tone or tune but had to rely on the words, or the rhythm. (Sacks 150-151). Her case brings forth another interesting symptom. This lady is unable to distinguish between different tones. Thus, she was neurologically tone-deaf. In her case too, the music she heard was from her past, but she did not like it at all. It can be observed that that Sacks uses technical terms to be precise in his narrative. He has already touched upon these terms in Mrs. O`C’s case, which means that he has empowered his readers to be equipped with enough vocabulary to familiarize themselves with such an unfamiliar discipline. The gap that Sacks is bridging is beneficial for the readers as become medicine literate. Mrs. O`M’s experience are of biological (neurological) nature. She does not have psychological effects, other than the irritation that she feels. She does not drown in her past. While commenting on Mrs. O`C’s and Mrs. O`M’s ailment, Sacks gives an intertextual reference, which portrays how interdisciplinary Sacks is. He calls “what was going on with Mrs. O’C and Mrs. O’M? “Musical epilepsy”” (Sacks 151). Then he quotes a phrase from Thomas Mann: “the world behind the music,” and explains how musical epilepsy, that seems a contradiction in terms is, in fact, a real medical phenomenon. The hallucinatory nature of these episodes urge Sacks to draw onto the Jacksonian notion of “double consciousness.” He quotes: “There is (1) the quasi-parasitical state of consciousness (dreamy state), and (2) there are remains of normal consciousness and thus, there is double consciousness...a mental diplopia” (Sacks 152). This notion is of interest because it can be used in most hallucinatory cases. The concept of time (past and present) is sufficiently explained in this quote. Although both patients respond differently to their condition but the common element in their experiences is based on temporality. Mrs. O`C’s dialogue is very profound: “I know you’re there, Dr. Sacks. I know I’m an old woman with a stroke in an old people’s home, but I feel I’m a child in Ireland again—I feel my mother’s arms, I see her, I hear her voice singing” (Sacks 152). Sacks’s engagement with the illness, and the way he feels connected with the patients, is notable. Mrs. O`C’s account is one good example of how doctors should engage with their patients. Sacks’s difficulty is twofold: he must get to the bottom of the illness by what the patient expresses, which is very difficult because of the physicality of the illness (such as fits and seizures); and he inevitably sympathizes with the patient. The way an author connects with his characters, Sacks connects with his patients. The difference is that an author creates his characters and all the details of their lives, but Sacks’s real life characters come to him with their lives. He must narrativize their already present lives. There is no climax (or anti-climax) with their stories that Sacks can design. Moreover, Sacks’s own role in the character’s development is of a very realistic nature. They are in the truest sense round characters, and, almost always, their point of change is when they meet Sacks. So, in a sense, Sacks is an active character in his own stories. Once Mrs. O`C was cured, she came to Dr. Sacks and told her that: “I’m glad it happened,” she said when it was over. “It was the healthiest, happiest experience of my life. There’s no longer a great chunk of childhood missing. I can’t remember the details now, but I know it’s all there. There’s a sort of completeness I never had before.” (Sacks 161). Mrs. O`C is happy because she has got back a “great chunk of childhood.” The interplay between past and present is evident here. The fact that she feel complete is because her present has found its context, the past. Sacks’s narrative ends here, with giving proper closure to his character, avoiding “epic’s openendedness,” he has not only participated in the giving a sense of completeness to his patient, in real life, but also has done that in his narrative.
In the last part of the narrative Sacks contextualizes this story by referring to other such cases and providing with the medical background. He draws on the example of a famous composer Shostakovich, who had a metal in his musical lobe. The doctors who diagnosed his problem and cured him documented that he was not very happy with the treatment because with that metal fragment inside “each time he leaned his head to one side he could hear music. His head was filled with melodies—different each time—which he then made use of when composing” (Sacks 157-158). Music (and swimming) was Oliver Sacks’s passion. He has an entire book on Music. Another intertextual reference that Sacks provides is Dostoevsky’s. He notes that: Dostoevsky had “psychical seizures” or “elaborate mental states” at the onset of seizures, and once said of these: You all, healthy people, can’t imagine the happiness which we epileptics feel during the second before our fit... I don’t know if this felicity lasts for seconds, hours or months, but believe me, I would not exchange it for all the joys that life may bring. (Sacks 160). Interestingly, Bakhtin’s inspiration for dialogic thinking was from Dostoevsky’s works. He compares Dostoevsky’s novels with Dante’s works, calling them such “verticality” (Bakhtin 66) as was Dante’s. A wholistic impression of Sacks’s works, without attempting to generalize, would be that his works stand at the meeting point of science and fiction, without becoming science-fiction. He has maintained the creativity of an author and profundity of a scientist. Bakhtin claims that “The novel comes into contact with the spontaneity of the inconclusive present; this is what keeps the genre from congealing. The novelist is drawn toward everything that is not yet completed” (Bakhtin 25). Sacks’s keen interest in medicine and curiosity about the intricate delicacies of illnesses drew him “toward everything that is not yet completed.” He was not a teacher or a master, he was a keen learner. His intertwining of these two disciplines conveys his urge for learning, for whatever he could not find through scientific reasons, he would find in creative imagination. To consider Sacks as one of the finest medical humanists and medicine narrators would not be an exaggeration. He resides at the heart of interdisciplinarity.
A Doctor Writes: Oliver Sacks's Literary Odyssey Through the Brain
Awakenings is the first of his series of novelized case histories. Patients of sleeping sickness early 20th century started waking up. There were some 20 different patients who woke up from comma. Oliver Sacks narrativizes the accounts of those 20 in a very descriptive manner. To remain true to his narrations, he does not forgo the medical terminology, but to retain common reader, he gives an elaborate glossary of the key medical terminology used. This was not appreciated, and he had to face criticism, but, nonetheless, it prevailed, and to this day, is considered a pioneer work in the field of narrative medicine. There are some phenomenal books, majorly discussing details of certain ailments, but Sacks always personalizes all his narratives make things easier for the common reader. Another collection of medical stories, that came right after A Leg to Stand On, which is Sacks’s personal experience of broken leg, is The Man Who Mistook His Wife for a Hat. This book is one among the most famous medical narratives and is almost taken for literature. Sacks’s effort to bridge the gap between science and creativity were met in this book. A lot of editions were published, and a lot of copies were sold. The story in discussion is one among those brilliantly crafted narrations. Reminiscence is one of those words that exist at the intersection of neurology (biological memory), psychology (nostalgic memory), and literature (symbolic memory). Bakhtinian, while laying foundation of his theory of novelization, heteroglossia, and dialogism, notions at the historical nature epic. He argues that the past is of absolute nature in epic. Novel, on the other hand, deals with an open-ended temporality. Oliver Sacks’s engagement with the temporality of his patients is of a similar nature.
Reminiscence: Music, Memory, and Science
The story begins with a very descriptive detail of Mrs. O`C’s first encounter with the musical problem. The beginning is quite literary, and one is captivated right from the beginning: Mrs. O’C. was somewhat deaf, but otherwise in good health. She lived in an old people’s home. One night, in January 1979, she dreamt vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang. When she woke up, the music was still going, very loud and clear. “I must still be dreaming,” she thought, but this was not so. She got up, roused and puzzled. It was the middle of the night. Someone, she assumed, must have left a radio playing. But why was she the only person to be disturbed by it? She checked every radio she could find—they were all turned off. Then she had another idea: she had heard that dental fillings could sometimes act like a crystal radio, picking up stray broadcasts with unusual intensity. “That’s it,” she thought. “One of my fillings is playing up. It won’t last long. I’ll get it fixed in the morning.” She complained to the night nurse, who said her fillings looked fine. At this point another notion occurred to Mrs. O’C.: “What sort of radio station,” she reasoned to herself, “would play Irish songs, deafeningly, in the middle of the night? Songs, just songs, without introduction or comment? And only songs that I know. What radio station would play my songs, and nothing else?” At this point she asked herself, “Is the radio in my head?” (Sacks 147) Right from the beginning, we see that Sacks has introduced the heteroglossia of voices. Freud maintained that “the interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind” (Freud). The “vividity” of Mrs. O`C’s dreams signifies the neurological nature of the unconscious mind. Sacks began by inculcating the three voices: Mrs. O`C’s dreams (the present), of Mrs. O`C’s childhood and of music. The Mrs. O`C wakes up but the sound of music continues. The comment she makes is suggestive of the duality of consciousness that she is battling with: “I must still be dreaming.” The vivid nature of the dream points to how Sacks perceives, and expresses, ideas, and events in the neurological sense. Bakhtin maintains that “the novel, however, is associated with the eternally living element of unofficial language and unofficial thought (holiday forms, familiar speech, profanation)” (Bakhtin 24). For Bakhtin, the unofficial language is the “eternally living element Mufti 7 of a novel.” Sacks actualizes it in the above description of the medical phenomenon. There is no medical jargon. The story begins in the middle of the action. Sacks masterfully describes the character’s confusion by juxtaposing past and present. As discussed above, the notion of time is very important in Bakhtin’s universe of discourse. He believes that novel has challenged with “absolute past” of epic that was the source of creativity. He noted that it is memory that lies at the heart of epic writing. A past that was known to the community. The function of the epic was not to create a new story but to present the old story with a newer expression. That is why there are multiple renditions of the same plot. Novel, on the other hand, Bakhtin insists, “is determined by experience, knowledge and practice (the future)” (Bakhtin 22). Considering the above, Sacks’s narration is but an amalgamation of “experience, knowledge and practice” in the truest sense. His knowledge of medicine allow him a glance into the inner world of his character (patient). His prose comprises of creative and scientific elements simultaneously. Mrs. O`C’s use of the process of elimination in triangulating the problem that was happening to her is very scientific. She begins by suspecting that I is the radio. The claim is “falsified” by an observation that the radios are turned off. Then she observes that no one else is being disturbed by it. Her mind goes to her dental fillings. She somehow knows that dental fillings can sometimes pick up frequency and act like crystal radios. She gets the nurse to falsify that claim. Ultimately, she ends up finding that the music was in her head. The “soliloquy”, at this point, is brilliant. Naturally, Sacks was not present there, so the self-talk in Mrs. O`C’s head is but a creation of Sacks. This self-talk builds up to the realization that the radio was in Mrs. O`Cs head. To focus on the notion of time and temporality, there is a clear indication of past and present. The word ‘reminiscence’ naturally indicates memory and, to put it vividly, Mrs. O`C, at Mufti 8 this moment, is undergoing a neurological fit of memory. She is in the present and in past at the same time, listening to music from her childhood. Mrs. O`C was taken to a psychiatrist who told her that her mind was functioning fine and that she must visit a neurologist. She was brought to Sacks. He notes down the first interaction: “Conversation was far from easy, partly because of Mrs. O’C.’s deafness, but more because I was repeatedly drowned out by songs—she could only hear me through the softer ones” (Sacks 148). The present moment is “drowned out” by past. The music not only occupies Mrs. O`C nostalgically but also as an aesthetic experience. She is at the intersection of present and past. She sees Sacks but listens to her past. The optics of that moment drag her out, into the now of her life, when she is in her eighties, but the auditory part of the same moment pulls her back inside the past. Bakhtin comments on the nature of time in novel: “The novel, from the very beginning, developed as a genre that had at its core a new way of conceptualizing time” (Bakhtin 29). The novel nature of Sacks’s narrative, playing at the crossroads of medicine and humanities could only be housed in a dialogic narrative. Thus, Sacks novelizes his experience. Sacks quotes another neurologist who believed that the totality of our experiences is save in the neurological cells of our brain. Different triggers bring them on the front. The triggers can range from psychological to physiological. The interplay of psychological and somatic changes in our body can result in different kinds of psychological and physiological events. Mrs. O`C is going through one of such experiences. Her present moment is overwhelmed with the past. Here, the presentness of the past is physiological in notion. Moreover, we see that at this moment, Sacks, who is the narrator of the story, has also become a character. As a narrator, he seems omniscient but as a character, he expresses his difficulties of guessing what is happening within his patient’s mind. Sacks uses his “knowledge” of neurology and psychology to question things Mufti 9 that might lead him to the details of the ailment. The Bakhtinian notion of novelization, where creativity is owed to knowledge rather than memory, relates naturally with Sacks’s condition here. Four voices have entered the narrative so far. Mrs. O`C in her eighties, Mrs. O`C in her childhood, Dr. Sacks as the narrator (author or storyteller), and Dr. Sacks as a neurologist. This woven tapestry of multi-layered narratives brims with meanings and it becomes difficult to move on. As has been mentioned recurringly that Dr Sacks’s multidisciplinary approach is key to his success as a medical narrator. Moving on, Sacks steers the plot towards a scientific turn. He says (in scientific jargon): “I wanted to do an electroencephalogram straightaway, paying special attention to the temporal lobes, the “musical” lobes of the brain, but circumstances conspired to prevent this for a while” (Sacks 148). Bakhtin held that the narrative of a novel is in simple language, and commenting on the first part of this story, it was argued that Sacks uses simple language. This part, however, seems to contradict the above claim, but that is not the case. Sacks uses technical jargon sometimes. It is not to distance the non-technical (or rather non-medical) reader from the intricacies of his patient’s conditions, but to bring them closer to the scientific side of those realities. He initiates a process in the reader that leads to an enlightenment, on one hand, and inspires quest, on the other. Also, he almost always translates, or explains, the phenomenon behind the technical term. For example, here he elaborates right away the meaning of “temporal lobes” that is “musical” lobes of the brain. Bakhtin refers to the Socratic dialogues as the one of the oldest forms of novel. He believes that this is “document that reflects the simultaneous birth of scientific thinking and of a new artistic-prose model for the novel” (Bakhtin 25). He call this genre apomnemoneumata “that is, as a genre of the memoir type, as transcripts based on personal memories of real conversations among contemporaries” (Bakhtin 25). Sacks’s narrative is quite in relation to that. His conversations with the patient are written down, giving voice to the common man, who becomes the hero of this novel. Sacks’s treatment of the ailment was successful, and the music was gone. When Sacks conversed with Mrs. O`C and asked whether se missed the songs, she replied: “It’s funny you should ask that,” she said with a smile. “Mostly, I would say, it is a great relief. But, yes, I do miss the old songs a little. Now, with lots of them, I can’t even recall them. It was like being given back a forgotten bit of my childhood again. And some of the songs were really lovely.” (Sacks 149) We see here how Mrs. O`C’s nostalgia was neurologically brought to the front. She considers it a “forgotten bit of … childhood.” Sacks’s success in recreating the narrative has not only brought to the front the delicate and somewhat interesting details of the ailment but has also given voice to an unknown person.
“Dr Oliver Sacks- Narrative and Medicine: The Importance of the Case Historywww.youtube.com/watch? v=7PYAnB5Jx-k. Accessed 2 Feb. 2024.
Bakhtin, Mikhail. The Dialogic Imagination: Four Essays. University Of Texas Press, 2008.
Barfield, Ray. “Doctors Who Tell Stories: Oliver Sacks and Narrative Medicine.” Literary Hub, 16 Dec. 2015, Accessed 2 Feb. 2024.
Charon, Rita. “Remembering Oliver Sacks, a Pioneer of Narrative Medicine.” Accessed 1 Feb. 2024.
Class, Monika. “Introduction: Medical Case Histories as Genre: New Approaches.” Literature and Medicine, vol. 32, no. 1, 2014, pp. vii–xvi, Accessed 22 Jan. 2020.
Freud, Sigmund. “A Quote from the Interpretation of Dreams.” Accessed 2 Feb. 2024.
Hippocrates. “Hippocrates Quotes (Author of Hippocratic Writings).” Www.goodreads.com, Accessed 2 Feb. 2024.
Lenus, Leenu, and H Kalpana Rao. Medicalization of Arts and Humanization of Medicine: The Interdisciplinarity in Oliver Sacks’ The Case of the Colour-Blind Painter. 11, no. 5 (2022).