DEE WILSON CONSULTING

The December 15, 2025 issue of The New Yorker contains an article by Rachel Aviv, "Mind Over Matter: Did the celebrated neurologist Oliver Sacks write his patients into case studies of his own psyche?"  A better title for the article would be "Fact and Fiction, Truth and Projection in Oliver Sacks' Case Studies." 

 

Sacks was the author of Migraine, Awakenings, A Leg to Stand On and The Man Who Mistook His Wife for a Hat, and other books. Aviv states that Sacks "rejected what he called "pallid, abstract knowing," and pushed medicine to engage more deeply with patients; interiority and how it interacted with their diseases." Physicians were encouraged to help their patients develop narratives which "could help them reconstruct a new story of their lives." However, as Daniel Kahneman and other cognitive psychologists have pointed out, storytelling is influenced by a number of heuristic biases and shaped by audience response. Why tell a dull story when with a few revisions, it's possible to tell an exciting one, a story people will pay to read?

 

Aviv asserts: "… in his journal, Sacks wrote that "a sense of hideous criminality remains (attached) to his work: he had given his patients "powers (starting with powers of speech) which they do not have." "Some details, he recognized, were "pure fabrications."  Sacks, Aviv states, "tried to reassure himself that the exaggerations did not come from a shallow place, such as a desire for fame or attention. ... (he wrote), "It is not merely or wholly a projection - nor ... a mere 'sensitization' of what I know so well in myself. But (if you will) a sort of autobiography. He called it "symbolic 'exo-graphy.' " Aviv continues:  "Sacks had "mis-stepped in this regard, many many times in Awakenings, he wrote in another journal entry, describing it as a "source of   severe long-lasting self- recrimination."  In Awakenings, Sacks told the story of eighty patients at Beth Abraham Hospital in the Bronx "who had survived an epidemic of encephalitis lethargica, a mysterious, often fatal virus that appeared around the time of W.W. I. The patients had been institutionalized for decades, in nearly catatonic states. Sacks wrote that his patients were "mummified," like "living statutes." For these patients, Sacks used a medicine called L-dopa, "which elevates the brain's dopamine level, and was typically used to treat Parkinson's disease. Sacks' book is about the awakenings of these patients within days of beginning to take L-dopa, "their old personalities intact." The book was widely viewed as a masterpiece of medical witnessing, Aviv states.  "The Guardian would name it as the twelfth best non-fiction book of all time." 

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Patients in Awakenings were first overjoyed by their freedom, then their new vitality becomes unbearable.  As they continue taking L-dopa, many are consumed by insatiable desires.  "L--DOPA is wanton egotistical power, "one patient says in the book. "Another patient is so aroused and euphoric that she tells Sacks, "My blood is champagne"-- the phrase Sacks used to describe himself when he was in love with Vincze." And: "The book becomes a kind of drama about dosage: an examination of how much aliveness is tolerable, and at what cost."  Aviv speculates that Sacks, a closeted homosexual, "is reassuring himself that free rein of the libido cannot be sustained without grim consequence."

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Aviv writes that "Sacks early case studies also tended to revolve around secrets, but wonderful ones. Through his care, his patients realized they had hidden gifts - for music, painting, writing - that could restore to them a sense of wholeness." Aviv opines: " It speaks to the power of the fantasy of the magical healer that readers and publishers accepted Sacks' stories as literal truth." In a letter to his brother, Marcus, "Sacks enclosed a copy of The Man Who Mistook His Wife for a Hat ... calling it a book of "fairy tales." He explained that "these odd Narratives - half- report, half-imagined, half-science, half-fable, but with a fidelity of their own -- are what I do, basically to keep MY demons of boredom and loneliness and despair away." He added that Marcus would likely call them "confabulations ... " 

Sacks was surprised by the success of the book. He wrote in his journal, "Guilt has become much greater since 'Hat' because of (among other things) My lies, falsification" ... It is killing me, soul-killing me. 

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Aviv writes that Sacks aspired to "bear witness" -- "a term often used within medicine to describe the act of accompanying patients in their most vulnerable moments, rather than turning away. ... But perhaps bearing witness is incompatible with writing a story about it." 

 

Apart from being a cautionary reminder that memoirs and first person accounts of events and other people should not be taken at face value, and about Sacks' lack of intellectual integrity,  Aviv's article suggests that the imaginative features of storytelling are in conflict with an intent to tell the literal truth, in part because to imagine is to project one's own preoccupations onto events, and in doing so, impose one's mental framework on whatever is being described.   

      

Aviv states that as Sacks became older, he used fewer "exaggerations" and confabulations in his books. He also "appeared to have had remarkable relationships with his patients, corresponding with them for years." Sacks' empathy for patients was real.  Aviv asserts that "After living in the forgotten wards of hospitals, in a kind of narrative void, perhaps his patients felt that some inaccuracies were part of the exchange. Or maybe they thought, ‘That's just what writers do’. Sacks established empathy as a quality every good doctor should possess, enshrining the ideal through his stories."