To these seven narratives of neurological disorder Dr. Sacks brings the same humanity, poetic observation, and infectious sense of wonder that are apparent in his bestsellers Awakenings and The Man Who Mistook His Wife for a Hat. These men, women, and one extraordinary child emerge as brilliantly adaptive personalities, whose conditions have not so much debilitated them as ushered them into another reality.

I am writing this with my left hand, although I am strongly right-handed. I had surgery to my right shoulder a month ago and am not permitted, not capable of, use of the right arm at this time. I write slowly, awkwardly - but more easily, more naturally, with each passing day. I am adapting, learning, all the while - not merely this left-handed writing, but a dozen other left-handed skills as well: I have also become very adept, prehensile, with my toes, to compensate for having one arm in a sling. I was quite off balance for a few days when the arm was first immobilized, but now I walk differently, I have discovered a new balance. I am developing different patterns, different habits ... a different identity, one might say, at least in this particular sphere. There must be changes going on with some of the programs and circuits in my brain - altering synaptic weights and connectivities and signals (though our methods of brain imaging are still too crude to show these).

Though some of my adaptations are deliberate, planned, and some are learned through trial and error (in the first week I injured every finger of my left hand), most have occurred by themselves, unconsciously, by reprogrammings and adaptations of which I know nothing (any more than 1 know, or can know, how I normally walk). Next month, if all goes well, I can start to readapt again, to regain a full (and "natural") use of the right arm, to reincorporate it back into my body image, myself, to become a dexterous, dextral human being once again.

But recovery, in such circumstances, is by no means automatic, a simple process like tissue healing - it will involve a whole nexus of muscular and postural adjustments, a whole sequence of new procedures (and their synthesis), learning, finding, a new path to recovery. My surgeon, an understanding man who has had the same operation himself, said, "There are general guidelines, restrictions, recommendations. But all the particulars you will have to find out for yourself." Jay, my physiotherapist, expressed himself similarly: "Adaptation follows a different path in each person. The nervous system creates its own paths. You're the neurologist - you must see this all the time."

Nature's imagination, as Freeman Dyson likes to say, is richer than ours, and he speaks, marvellingly, of this richness in the physical and biological worlds, the endless diversity of physical forms and forms of life. For me, as a physician, nature's richness is to be studied in the phenomena of health and disease, in the endless forms of individual adaptation by which human organisms, people, adapt and reconstruct themselves, faced with the challenges and vicissitudes of life.

Defects, disorders, diseases, in this sense, can play a paradoxical role, by bringing out latent powers, developments, evolutions, forms of life, that might never be seen, or even be imaginable, in their absence. It is the paradox of disease, in this sense, its "creative" potential, that forms the central theme of this book.

Thus while one may be horrified by the ravages of developmental disorder or disease, one may sometimes see them as creative too - for if they destroy particular paths, particular ways of doing things, they may force the nervous system into making other paths and ways, force on it an unexpected growth and evolution. This other side of development or disease is something I see, potentially, in almost every patient; and it is this, here, which I am especially concerned to describe.

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© 1996 by Oliver Sacks.

Tags: Psychology & Psychiatry

About the Author

Oliver Sacks is the author of Awakenings, The Man Who Mistook His Wife for a Hat, and many other books, for which he has received numerous awards, including the Hawthornden Prize, a Polk Award, and a Guggenheim Fellowship. He is a member of the American Academy of Arts and Letters and lives in New York City, where he is a practicing neurologist. He recently accepted a new position at Columbia University. More