HOUSE CALLS AT THE EDGE OF THE MIND

By R.Z. Sheppard

The doctor is in. it took more than 20 years, but after six successful books and numerous articles by and about him, neurologist Oliver Sacks, 61, has arrived (all 210 burly pounds of him) as the latest two-cultures hero, a man of science as well as a man of letters. W.H. Auden detected the budding synthesis in Sacks' work in the early 1970s, when he declared Sacks' book Awakenings a masterpiece of medical literature. Hollywood grasped this high concept two decades later. Awakenings, the movie, starred Robin Williams as the dedicated doctor and Robert DeNiro as a patient temporarily freed from years of catatonia by Sacks' experimental use of the drug L-dopa.

Sacks has since had to cope with the symptoms of contact celebrity. He receives 15,000 letters a year; invitations and requests arrive daily. An assistant who handles this traffic is currently turning down lecture bookings for the rest of 1995. A good chunk of Sacks' time goes to the BBC, which is preparing a series about him.

There are also Sacksian spin-offs: Harold Pinter's 1982 play A Kind of Alaska was inspired by Awakenings. Both a Michael Nyman opera and Peter Brook's The Man Who are theatrical versions of Sacks' 1985 best seller The Man Who Mistook His Wife for a Hat; the Brook play opens at the Brooklyn Academy of Music this week.

Sacks' latest book should not be lost in the commotion. An Anthropologist on Mars is still another collection of wide-ranging essays that he calls "neurohistories," an anecdotal form that combines science, sympathy and old-fashioned storytelling. Where most clinicians study at arm's length a case of amnesia, say, or autism or agnosia (inability to recognize a word or a shape), the British-born physician tries to see through the eyes of the patient. "The study of disease," says Sacks, "demands the study of identity, the inner worlds that patients, under the spur of illness, create."

This is a bold statement in an age that seeks to reduce imagination to a set of neurological functions. Creativity is not a word that comes easily to many physicians, but Sacks strongly believes that invention is a measure, if not a definition, of health. His own robust literary output flows from different sources. "It's the mixture of physiology with poetic and often tragic accounts of the subjective aspects of being ill, of neurological syndromes which fascinates the two halves of me," he says. "I might go to an Ibsen play one night and a physiology meeting the next." Now those two halves have come together. "It's the relation between these two centers that is sometimes complementary."

In the most illustrative essay in Anthropologist, Sacks introduces Temple Grandin, who in her childhood was found to have Asperger's syndrome, a high-function form of autism. Grandin now holds a Ph.D. in animal science and a teaching post at Colorado State University. She is well known not only on the medical-conference circuit for her insights into Asperger's but also in the meat-packing business for her advice on the humane treatment and disposal of livestock. Among her contributions is a design for a curved slaughterhouse ramp that is said to reduce animal anxiety by keeping hidden the high-tech poleax that dispatches the critters.

"I know what the cow is feeling," Grandin, a realist, tells Sacks over a dinner of spare ribs. But while she has animal rapport, her neurological wiring bypasses most human emotions; the upheavals of Hamlet and Romeo and Juliet leave her unmoved. The characters closest to her heart are Star Trek's android Data and his poignant predecessor, the supercognitive Mr. Spock.

With Grandin and other subjects, Sacks has refined the case history into an art form. As his friend and colleague New York City neuropsychologist Elkhonon Goldberg puts it, "Oliver has salvaged the uniqueness of patients from statistical averaging." Indeed, each essay seems like an extended house call from an old-fashioned family doctor. There is also Sacks' open, encompassing style that welcomes the reader into his esoteric world. "A neurologist's life is not systematic," he writes, "but it provides him with novel and unexpected situations, which can be windows, peepholes, into the intricacy of nature-an intricacy that one might not anticipate from the ordinary course of life."

Sacks' course has been anything but ordinary. He was born in 1933 into a London household of high achievement. Both parents practiced medicine and instilled in their four sons a reverence for the family vocation. Three grew up to be physicians. The child Oliver was stimulated by good food, emotional warmth and high-minded conversation.

This was significantly interrupted at the beginning of World War II when, at six, he was shipped to a country boarding school for safety. He escaped the Blitz but suffered bad cooking and unpredictable canings. Visits from his overworked parents were sporadic. Basic science proved more dependable: the behavior of hydrogen, boron and manganese was more consistent than that of his headmaster.

For a man who studies the brain, the most complex mechanism in the universe, fundamentals are still reassuring. "Generally I tend to like more primitive things," Sacks explains; "ferns more than flowering plants, invertebrates more than vertebrates, inorganic chemistry more than organic chemistry."

Not to mention elemental species like the Hell's Angels. After receiving degrees in physiology, biology and medicine from Oxford, Sacks headed to California in 1960 to study neurology and sample the wild life. He rode with the notorious bikers' club and lifted weights competitively. A 600-lb. hoist won him a state championship. Today he keeps in shape by swimming two hours a day. "It's like watching a porpoise," says his friend, New Yorker writer Lawrence Weschler. "He's incredibly powerful, incredibly graceful and incessant."

Sacks is a less impressive terrestrial. Whoever defined walking as a series of movements to keep from falling down could have had him in mind. His 1984 book A Leg to Stand On is a neurological account of his recovery from severe muscle and nerve damage suffered in a tumble during a 1976 hiking trip in Norway. After writing the book, he slipped and injured his other leg. It was awkwardness, however, that led to his becoming a clinician. In California, Sacks worked in a lab with disastrous results. He absentmindedly misplaced data and once accidentally dropped his lunch into a centrifuge. It was clear he wasn't suited for research.

The hospitals that later employed Sacks would never do as sets for a TV-doc opera. He has worked for years under drab and underfunded conditions, treating cases that most physicians rarely see: Tourette's syndrome, which can cause uncontrollable tics and twitches and outbursts of profanity; or brain injuries that preserve old memories but prevent the forming of new ones.

Sacks frequently befriends the people in his care. He brings them souvenirs from his travels and calls long distance to see how they are doing. "He is probably the most caring, sensitive doctor that we have ever met," says Sister Theresa Robertson of New York City's Little Sisters of the Poor, a home for the aged. It's an unglamorous practice that Sacks maintains despite his considerable financial success. He has little regard for status. There are no diplomas on the walls of his Greenwich Village office. He has lost track of where his credentials are. Politics and organizations are to be avoided also. "The only memberships I enjoy," he says, "are in the British Pteridological Society and the American Fern Society."

Both as man and model, Oliver Sacks has obvious appeal. He is descended from a line of literary physicians-from Chekhov to Jonathan Miller, the late Lewis Thomas and, perhaps most significantly, the Russian neurologist A.R. Luria, whose neurohistorical writings helped introduce the public to the mysteries of the brain.

But Sacks is especially engaging at a time of highly specialized, technical and increasingly impersonal medicine. Who, these days, wouldn't want a warm, erudite physician, one who might prescribe a cat as well as a CAT scan? Who could resist bragging about My Doctor the Writer? Certainly not those whose lives he honors in his books.

--Reported by Sharon E. Epperson/New York

With reporting by SHARON E. EPPERSON/NEW YORK