Sacks and Ethics

As I did the reading for this week, I found myself feeling very protective of Sacks. I remember, early in the semester, when we were reading Awakenings, my cursory Google search of Sacks revealed that there was great hostility toward him, among book reviewers and medical professionals, and their criticism always had a weird personal quality to it, a whiff of undignified animosity. Alexander Cockburn is an example of this, and so is Tom Shakespeare. Although--to be honest--I find their criticism thoughtless and hard to take seriously, I do want to be sensitive to the real ethical complications and questions of Sacks’s work (notably, these are not the issues that Cockburn and Shakespeare address; they are dismissive rather than critical).

There are basically three ethical concerns that Sacks has raised for me personally. The most significant difficulty I’ve had with Sacks--and this is something I’ve spent a lot of time thinking about--is the fact that he consistently chooses the most extreme and rare cases, rather than trying to elucidate the more common varieties of neurological difference and/or damage with his warmth and erudition and depth of insight, so as to make his work of practical benefit. It’s the deliberate seeking out of impressive and unusual cases that, to me, has a faint suggestion of freak show. Another thing I find problematic about later Sacks is the ambiguity of his role: I felt much more comfortable with the cases in which Sacks was present primarily as a doctor, the best example of this being Awakenings. There, his presence is clearly justified. But with Temple Grandin I was very unclear about what exactly his stated reasons for being with her were. I was curious how he had explained the situation to her, since she didn’t seem to find his presence strange. With Temple Grandin, as with several others, he was in the role of voyeur, primarily. My third concern has to do with his films specifically. I sort of tense up when I notice that Sacks is talking about the patient or subject as if he or she weren’t in the room. That feels like a kind of dehumanization, when you talk about people like museum pieces. But the matter Sack’s ethics is trickier than my criticisms suggest. A lot of what I’ve highlighted is defensible.

As we’ve discussed, there can be some benefit to looking at the extreme cases. They have a way of revealing general principles about the brain. I can see how his writing about Parkinson’s could really alter, for the better, how physicians and lay people understand the condition. Moreover, he is to some degree a creative writer; he is to some degree an entertainer, he is to some degree an educator; he is a public intellectual. A former fiction teacher of mine would ask of a story the Passover Seder question: Why is this night different from all other nights? Or, what is the conflict here? Why is this story of all possible stories worth telling? Why should we care? This is to say, stories are about exceptional happenings. Even stories that claim not to be--like Mrs. Dalloway--can’t help transcending the mundane. If we view Sacks as a short story writer, as I most certainly do, it is perfectly understandable that he would choose the extreme cases.

The ambiguity of his role is problematic, not because I think he ought to take on an especially rigid role for its own sake, but because I think it creates confusion for the person about whom he is writing. I would feel awkward for that reason if he were writing about me. I wouldn’t know how to relate to him or what to expect from him. I wouldn’t be sure whether he was there to help me, or whether he was there to look at me and study me for someone else’s benefit or his own. When he puts on his doctor cap, this problem mostly goes away. A lot of the ethical muddiness dries up. But, on the other hand, stepping out of the doctor role gives him a little more latitude, which can reveal aspects of a condition that are otherwise hard to get at. He can be more flexible in the way he interacts with his subjects. He can see them in a wider variety of contexts. He can elicit different reactions. We can learn some subtle things if he isn’t strictly in the doctor role.

What I don’t find defensible is his habit--albeit occasional--of talking about subjects and patients as though they are not there or cannot hear or cannot understand. Some of his commentary, even if it’s astute, is painful to hear directly and could be better received in final essay form, with necessary qualification. It’s not that the content of his remarks is wrong; it’s that he, in these instances, treats people like objects, and this goes against his project.

Okay, I’m tired.