What would you do if you picked up a newspaper and, all of a sudden, couldn’t read the text in front of you? What if you went into the grocery store and were unable to recognize a tomato as a tomato? Famed neurologist Oliver Sacks shares the tales of patients with these and other unusual ailments, and discusses how our brains shape what we see.

Guests

  • Oliver Sacks Physician and Professor of clinical neurology and psychiatry at Columbia University; and author of "The Mind's Eye" (Knopf)

Transcript

  • 13:06:43

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, our holiday series of live musical performances continues with a look at our local choral scene. But first, the mysterious connection between our brains and how we perceive the world. Imagine picking up the morning newspaper and finding that the words no longer have any meaning to you or walking into your own kitchen and discovering that you no longer know the names of common items you use every day.

  • 13:07:23

    MR. KOJO NNAMDIPhysician Oliver Sacks has worked with patients suffering from these and other unusual ailments. He tells their stories in his latest book, "The Mind's Eye," and explores the complex relationship between our brains and what we see or don't see. Oliver Sacks join us in studio. He's a physician and professor of clinical neurology and psychology and psychiatry at Columbia University. He's author of numerous books including, as we mentioned most recently, "The Mind's Eye." Oliver Sacks, thank you for revisiting us.

  • 13:07:54

    MR. OLIVER SACKSIt's a pleasure to be here.

  • 13:07:56

    NNAMDIYou share the stories of some fascinating patients in this book. But before we talk about them, I'd like to talk about you. You write about the difficulty you have in recognizing faces and places. Can you give us an example of how this affects you?

  • 13:08:10

    SACKSWell, it -- I have sometimes offended people I know well by failing to recognize them. I have sometimes surprised people I don't know at all by hugging them as if they were old friends. And I do better with someone with me who could act as a reliable recognizer.

  • 13:08:33

    NNAMDIThis has been occurring since you were a child.

  • 13:08:36

    SACKSYes, mm-hmm.

  • 13:08:37

    NNAMDIWhen did you become aware of it?

  • 13:08:41

    SACKSIt was sort of forced on me in high school, where there were 500 of us and I was really lost and could hardly recognize anyone. And people would be offended, they would wonder if I was inattentive or idiotic. And I don't think I quite realize myself that it was a specific perceptual problem.

  • 13:09:09

    NNAMDIWhat kind of coping mechanisms have you developed, say, in high school to deal with it?

  • 13:09:14

    SACKSWell, paying attention to visually to the way people dress, their posture, their movement and, of course, to their voice. I mean, often I would be lost until someone spoke and then I'd instantly recognize the voice.

  • 13:09:35

    NNAMDIAt first blush, this sort of face blind, this might seem utmost to be an annoyance. But for many patients, this is more than just annoying, isn't it?

  • 13:09:44

    SACKSOh, it could be crippling when parents don't recognize their children or their spouses or, for that matter, themselves.

  • 13:09:55

    NNAMDIThere's a name for this condition that I am reluctant to pronounce. Can you?

  • 13:09:59

    SACKSYes. Well, it was called prosopagnosia. Prosopo is the Greek for a face or a mask. And it's an oddly -- it seems to be an oddly specific problem and was given its name in the 1940s.

  • 13:10:17

    NNAMDIProsopagnosia. What is it that's happening in the brain of a person who has difficulty recognizing faces or places?

  • 13:10:26

    SACKSWell, the fact that one can have this problem and nothing else suggests that maybe a particular part of the brain or a network of the brain, which is sort of specialized for recognizing faces and now this has been proved by doing brain imagery, functional brain imagery while you present them with pictures or faces or other things. It is this part of the brain, which is in trouble in people who are not good face recognizers, but which are superbly developed in people who are super recognizers. And they call it the fusiform face area.

  • 13:11:08

    NNAMDIWhen did you realize that this for you was not a personal quirk, but something physiological? And it's my understanding that your brother has the same condition. So is it conceivably also genetic?

  • 13:11:20

    SACKSYeah. I have an older brother in Australia and I hadn't seen him for nearly 40 years. My two brothers in England had no difficulty recognizing faces, but my brother in Australia had exactly the same problem as I did. And his wife would have to whisper, whisper who people were to him beforehand. And so then, I thought, we form a pair. This must be a syndrome of something genetic. In fact, families are being described with ten members, one family, both parents, seven of the children and an uncle were all involved. It's not uncommon.

  • 13:12:04

    NNAMDIOur guest is Oliver Sacks. He's a physician and professor of clinical neurology and psychiatry at Columbia University. His latest book is called, "The Mind's Eye." We're inviting your calls, 800-433-8850. Do you know of anyone who has this or a similar condition? 800-433-8850. Or you can send us an e-mail to kojo@wamu.org or tweet at kojoshow. Dr. Sacks, you start your book with a story of a woman named Lillian. She's a musician who essentially sat down at the piano one day for a performance and found that she could no longer read her sheet music. Please share Lillian's story with us, if you would.

  • 13:12:45

    SACKSWell, Lillian was quite a famous pianist and a brilliant sight reader. But there'd been a sudden change in the program from one Mozart piano concerto to another. And as you say, she looked to the sheet and found that unintelligible. She could see it perfectly clearly, but the marks or the notes didn't convey anything to her. This was the beginning of a problem, which later extended to inability to recognize ordinary print and then to recognizing common objects and people around her. But although this was already advanced when I saw her, she was still able to give concerts and to teach because her musical powers were completely unimpaired. And rather than -- though, she now couldn't learn new music from the script. She could only learn it by hearing it.

  • 13:13:43

    NNAMDIIt's my understanding that Lillian found interesting ways of coping with her condition for many years. Tell us about that.

  • 13:13:51

    SACKSWell, when I tested her in the clinic, she could hardly recognize anything and I wondered how she would get around and how she lived. And so I made a house call. I visited her and her husband in their apartment and I saw how she had arranged everything in terms of color, size, meaning, position. But she had her own way of organizing everything in the apartment. And in a way, this made up for the fact that she couldn't recognize the ordinary way. She also knew her own neighborhood well. But later, when I took her into my neighborhood, she was very, very bewildered.

  • 13:14:45

    NNAMDIYou also write about a patient, a novelist, who picks up his newspaper one morning and suddenly was unable to read what was written on the page in front of him. What had happened to this man?

  • 13:14:59

    SACKSWell, he -- his first thought, the letters look strange. This was the Toronto Globe and Mail. But he had looked as if it was printed in Korean or Cyrillic or (unintelligible) some language he didn't know. His first thought was this was a paper put out for an ethnic minority in Toronto. His second thought was that it was some sort of hoax arranged by his friends. But then he guessed the trouble must be in himself. He wondered if he'd had a stroke. And he had indeed had a stroke, confined to a small part of the brain which is involved in reading.

  • 13:15:46

    NNAMDILet's talk about your books for a second because many of our listeners might be familiar with your book "The Man Who Mistook His Wife for a Hat." Describe, if you would, what his condition was and whether it falls into the same category as either the novelist or Lillian's.

  • 13:16:04

    SACKSWell, with Lillian and the novelist, the problems were relatively circumscribed. They were not generally confused. The man who mistook his wife for a hat (unintelligible) degenerative brain process, maybe Alzheimer's, maybe something else, which was advanced. And I first saw him and he made mistakes all the while. He sometimes -- he didn't recognize a glove. He saw it was an object with what he called five outpouchings and it was only when he got his hand into it by mistake that he recognized it. And on one occasion, he -- when he went to get his hat, he clutched his wife's head instead and -- which gave rise to the title of the book. But he was an intelligent and charming man outside the sphere of profound visual confusion and also a good musician and in a way music helped him organize his life.

  • 13:17:18

    NNAMDIIf you have questions about the connection between the brain and what we see, the name of Oliver Sack's latest book is called "The Mind's Eye." If you have questions about that connection, you can call us at 800-433-8850. Here is Steve in Washington. Steve, you're on the air. Go ahead, please.

  • 13:17:36

    STEVEThank you, Kojo. Dr. Sacks, it's a privilege to hear you on the radio. I just have a quick story to tell about the way my dad used to cope with what was probably not a clinically diagnosable problem in recognition, but he was in business and he couldn't remember who people were. And he has this button on his lapel that said, I can't remember your name, either.

  • 13:18:07

    STEVEI still have it after he passed away. It was one of the things that nobody else seemed to recognize. And then, the irony is, I'm the exact opposite. I -- people say to me, gee, Steve, you keep in touch with everybody you've ever met. You remember anybody you've ever met once. It's kind of interesting in the same family the complete opposite qualities.

  • 13:18:33

    SACKSYeah, absolutely.

  • 13:18:34

    STEVEBut it's an interesting coping strength. He kind of used his sense of humor.

  • 13:18:39

    SACKSYeah. Well, I think if he does have difficulty recognizing faces or remembering names or whatever it is, the first thing is to admit it and declare it so then it's clear and out there. People with face blindness are liable to leave a trail of embarrassment and offense and bewilderment behind them and they spend their life apologizing. But if they say outright -- but as a super recognizer, you may have some problems yourself because people may imagine you're tailing them. You know too much.

  • 13:19:21

    STEVEYou know, Dr. Sacks, that's right. People -- you have to be very careful of that because you'd never forget these people that, in fact, they don't think you're being too familiar.

  • 13:19:33

    NNAMDIYes, indeed. You're correct about that, Steve. Thank you for your call. Dr. Sacks, what is it like for you to work with some of these patients? It must require a great deal of sensitivity when you are working with a highly intelligent person who can no longer perform basic tasks.

  • 13:19:49

    SACKSWell, I'd -- I listen as attentively as I can and try to imagine what it's like to be in their shoes or look at the world through their eyes and ears. I often find I can't do this sufficiently in the clinic And I may have to visit them in their own environment, in their home, in their neighborhood.

  • 13:20:14

    NNAMDITalk, if you would, about the title of this book, "The Mind's Eye." You seem to be asking some pretty profound questions about how much our brains are shaped by our experiences And the extent to which we are the authors of our own stories.

  • 13:20:28

    DR. OLIVER SACKSWell, "The Mind's Eye," of course, is a phrase from, "Hamlet," where it has referenced to hallucination. And -- but for me, the meaning of the mind's eye is the ability to imagine anything visually, to form an image to compare this image with reality. Now, for example, people like myself who are bad at recognizing faces are also bad at imagining faces. I don't quite have the proper internal dictionary of faces. In that respect, my own mind's eye is a little defective. But we are obviously born with a good deal of visual equipment and brain equipment, but then its development depends crucially on our environment.

  • 13:21:32

    DR. OLIVER SACKSAnd this, for example, is the case very much with faces. If a Chinese person is brought up in his own country, he may come to think that all European or American faces look similar. This is a common feeling that as one grows up, one's facial recognition tends to get narrowed both more exact, but narrower to a particular group. But with a man -- now, there is no part of the brain which evolution has made to read. Reading has to be learned. It's a cultural invention. Every person has to read from the start. But here, in the act of reading, one develops a special part of one's brain.

  • 13:22:25

    DR. OLIVER SACKSAnd you can immediately sort of -- you can tell without -- from brain imaging whether a person is literate or not.

  • 13:22:37

    NNAMDIYou tell the story of a woman named Pat who had a stroke and lost not just her ability to speak, but language itself. Can you explain?

  • 13:22:48

    SACKSYes. Pat had the condition known as aphasia. In her case, it was from a stroke. And aphasia may involve a loss of ability to express oneself with words and expressive aphasia, but there may also be a so-called receptive aphasia when you hear people perfectly, distinctly, but you don't know what they're saying. It's a game. This is a problem of recognizing the heard word. But it can be a very tragic and isolating condition because we are -- we communicate all the while by voice. Incidentally, if a deaf person who uses sign language, someone at Gallaudet here in Washington would have the condition, they would -- their signing would be impaired. Either their ability to make signs or to read them. So it's not the voice as such, it's language as such.

  • 13:23:59

    NNAMDIPat's story is striking because of her attitude and ability to be in a situation or to, I guess, manage a situation that most of us would find unimaginable. How unusual is she in that way among the patients you've worked with?

  • 13:24:15

    SACKSWell, she was an extravert and socialable person who always reached out to others and longed to communicate so she didn't retreat into silence. She sought for other ways and she learned other ways, partly by herself and partly through speech therapists. But many people with aphasia become particularly good at reading other peoples facial expressions and gestures or the intonations of their voices and also while they're good at communicating their own feelings by gesture and by mime. And she became a sort of virtuosos at both of these, but also she was able to recognize individual words.

  • 13:25:16

    SACKSAnd she was given a book by the speech therapist, which was a sort of dictionary of words for places, for feelings and so she could indicate the subject of a communication and then gesture. And I wouldn’t thought it possible, but she could communicate pretty fully even though she was aphasic. I think this is unusual, but not all that unusual.

  • 13:25:45

    NNAMDIPat seems to be a pretty remarkable woman. We've got to take a short break. A lot of people would like to talk to you on the phone. Our guest is Oliver Sacks. He's a physician and professor of clinical neurology and psychiatry at Columbia University. His latest book is called, "The Mind's Eye," I'm Kojo Nnamdi.

  • 13:27:44

    NNAMDIWe're talking with Dr. Oliver Sacks. He's a physician and professor of clinical neurology and psychiatry at Columbia University. His latest book is called, "The Mind's Eye." He's the author of numerous books, including "The Man Who Mistook his Wife for a Hat." Let's go directly to the telephones to Kristin in Ashburn, Va. Kristin, you're on the air. Go ahead, please.

  • 13:28:05

    KRISTINHi, Kojo, Hi, Doctor.

  • 13:28:07

    SACKSHi.

  • 13:28:08

    KRISTINI have a seven-year-old child who I suspect has face blindness and I was wondering if there's something you can do to test for it and if so, how you would go about it?

  • 13:28:17

    SACKSWell, there are many tests and some of them are online. There is a Professor Nakayama, Ken Nakayama at Harvard, who has more experience here than anyone in the world and if you were to contact him, he, you know, he would send you things and you could be advised both as to the reality or to the extent of face blindness and of ways of dealing with it.

  • 13:28:53

    NNAMDIThank you very much for your call, Kristin. And good luck to you with your son. Here now is Jenel (sp?) in Gaithersburg, Md. Jenel, your turn.

  • 13:29:03

    JENELYes, hi. It's such a pleasure to speak with you Dr. Sacks and you, Kojo. The lady Lillian who couldn't recognize objects in sight, if you had put a blindfold on her, would she be able to recognize them tactilely with her hands by feeling them? Would she recognize things that way?

  • 13:29:21

    SACKSYes, yes, absolutely. And incidentally, the novelist who could not recognize print visually could recognize it if it was written on his hands.

  • 13:29:33

    NNAMDIIf it was written...

  • 13:29:33

    JENELThank you.

  • 13:29:34

    NNAMDI...on his hands?

  • 13:29:34

    SACKSOn his hands.

  • 13:29:36

    NNAMDIThat's absolutely amazing. Jenel, thank you very much for your call. We move on to Christiana in Rockville, Md. Christiana, you're on the air. Go ahead, please.

  • 13:29:46

    CHRISTIANAThank you, Kojo. Your show is always fabulous. I love it. And Dr. Sacks, I always read your articles when they show up in the New Yorker. It's always exciting. Thank you. My experience has been I've been working for many years in senior management incorporations. And I'm struggling with this to this day. Now, you know, I always have to look for clues. Where did colleagues who I've been working with for years, where did they come from? Where is their desk? Where are they moving to? Or can I quickly look on the piece of paper they hold in their hand to see who the memo was out to? It's really a struggle every day, which I have to keep a secret, really.

  • 13:30:24

    CHRISTIANANow, I did go to HR several times suggesting that we would wear name tags. I tried to elude to that problem and say, I think there are quite a number of colleagues who might not easily recognize," especially with senior management, when you go to many different departments, who might not easily recognize another project manager or so on. And I was always being shot down. It was really being trivialized. And I, myself, was afraid to actually come out and say, you know, I can't recognize names. I felt my own position at work was in jeopardy.

  • 13:31:01

    SACKSWell, I think your situation is maybe experienced by tens or hundreds of thousands of other people. The sort of problem needs to be ousted and not secret. And name tags are fine. Whenever I have a birthday party, my guests wear name tags. You know, there was objection at first, but that's better than not being recognized.

  • 13:31:33

    NNAMDIChristiana, I would say keep plugging for the name tags, but you should probably simply admit that it is your problem and not put it on your colleagues.

  • 13:31:42

    CHRISTIANAOkay, yeah, it's -- thank you. I have more courage now.

  • 13:31:47

    NNAMDIThank you very much for your call. Onto Mary Jane in Alexandria, Va. Mary Jane, you're on the air. Go ahead, please.

  • 13:31:53

    MARY JANEThank you, Kojo. Hello Dr. Sacks.

  • 13:31:56

    SACKSHello.

  • 13:31:57

    JANEMy name is Mary Jane Rule and recently we've corresponded about musical notes.

  • 13:32:02

    NNAMDIYes.

  • 13:32:03

    SACKSYes.

  • 13:32:05

    JANEAnd as I was listening, I just wanted to call and say a quick hi to you.

  • 13:32:09

    SACKSOh, that's very nice. Tell the listeners what it is about musical notes.

  • 13:32:15

    JANEOh, you think -- okay. Upon awakening in the morning, I find musical notes sprinkled on the wall and ceiling. They're little shadowy, twinkling music notes. And this often happens when I'm coming up close to a choral concert. And what's interesting now is that this is exactly the time for the notes to appear because our city choir of Washington is having our concert this coming Sunday afternoon. And so far, the notes haven't shown up. Where do you suppose they've gone?

  • 13:32:47

    NNAMDIMary Jane, you've got to stick around for the next segment. We'll be doing Choral, a show about choirs in Washington and then Washington being the nation's choral capital.

  • 13:32:57

    JANEYes, I know, and (unintelligible) as well.

  • 13:33:00

    NNAMDIYes, Dr. Sacks.

  • 13:33:01

    SACKSYeah, no, this is a very benign form of hallucination. And curiously, I've had a lot of letters from others, beside Mary Jane. In fact, I think I will have to write a special piece on hallucinations of musical notation.

  • 13:33:22

    NNAMDIThank you very much for your call, Mary Jane. One of the things Dr. Sacks shares with us also is the experience he has after being diagnosed with ocular melanoma to be running out of time. So I guess you'll just have to read that in the book. But the stories that you share in this new book, Dr. Sacks, suggests that the brain is a very plastic organ. That its ability to adapt even after it's been seriously damaged can be really remarkable.

  • 13:33:47

    SACKSYes. Well, sort of survival in the adaptability of the brain is really my theme. And the novelist who couldn’t read found himself reading, strangely, by using -- by cocking letters on the back of his teeth with his tongue. This was just concocted. But when one part of the brain is knocked out, another part can often take over. But we seem to have just a huge capacity to learn or discover all or devise new ways of doing things. And I think this is much more interesting in a way than the damage done and it's where hope lies.

  • 13:34:35

    NNAMDIAnd on that heartening note, Oliver Sacks, thank you for joining us.

  • 13:34:39

    SACKSThank you very much.

  • 13:34:40

    NNAMDIOliver Sacks is a physician and professor of clinical neurology and psychiatry at Columbia University. Author of numerous books, the latest of which is called, "The Mind's Eye." We're going to take a short break. When we come back, Washington, D.C. Choral Capital of the United States. But of course, in difficult economic times, even choirs are having a hard time. We'll talk about that. I'm Kojo Nnamdi.

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