Oliver Sacks, Neurologist, Author, Migraine Patient
The acclaimed author and neurologist, Oliver Sacks, who has died aged 82, brought stories about unusual neurological cases to a wide audience. His writing managed to explore the complexities of the brain, while maintaining unwavering compassion for his patients. He is, perhaps, best known for books like An Anthropologist on Mars and Awakenings, both of which were adapted for Hollywood. What is less known is that Sacks’ first book, published in 1970, focused on the neuropsychological aspects of migraine.
Like so much of his life, the story of how Sacks came to write about migraine is fascinating. After finishing his medical training in California, Sacks moved to the Bronx to take a position at Montefiore Hospital, which housed the first headache clinic in the nation. There, he cared for hundreds of migraine patients. Sacks, who also had migraine, found their symptoms compelling. He was particularly taken with hallucinatory aspects of migraine—auras that could produce disturbances of speech, hearing, taste, touch and vision just before the onset of an attack. They reminded him of his own experiences with psychedelic drugs in California.
It was in his search for medical descriptions of these phenomena that he stumbled on a book written by a Victorian physician named Edward Liveing, who wrote a detailed treatise about migraine in 1873. And here’s where the story takes a distinctly Sacksian turn: Sacks read the book voraciously but only after he had taken MDMA (now commonly known as ecstasy or “Molly.”) As he described it, the “neurological heavens” opened and, when he asked himself who would be the Liveing of his time, his inner voice screamed “You silly buggar, You’re the man!” He proceeded to draft the entire book in nine days.
Migraine, however, nearly wasn’t published. Sacks’ boss at Montefiore, Arnold Friedman, was furious when he found out about the text. "He told me that migraine was his subject, that it was his clinic, that I was his employee, and that any thoughts I had belonged to him.” Sacks recalled, “He said that if I proceeded with the book, he would see that I was fired, and that I would never have another job in neurology in the United States again." The threat was real. Friedman was an influential and formidable character in neurology, holding leadership positions in the American Neurological Association. But Sacks persevered, conspiring with a janitor to gain access to the clinical records he needed to finish the book. In the end, Friedman fired Sacks. But Sacks was happy and Faber and Faber were delighted to publish the book.
The book itself was a tour de force. The backbone of the text is a thorough and eloquent overview of the various forms of migraine (as they were understood in 1970), peppered throughout with case studies from Sacks’ clinical practice. But what made Migraine different from other texts on the subject were Sacks’ unique observations about the disorder, within which he saw “an entire encyclopedia of neurology.” Foreshadowing his future interests in hallucinations and the nature of consciousness, Sacks devoted a large portion of the text to migraine auras, describing in detail both the variety of visual and sensory disturbances that may be experienced and the affective changes that can accompany aura: déjà vu, existential dread, anxiety, or delirium. That he illustrated these discussions with what might have been the first collection of “migraine art” made the book particularly unusual and innovative. Paintings drawn by people who had experienced migraine aura enabled Sacks to visually describe what aura felt like.
Migraine, however, is a book that ought to be read and understood as a product of its time. In 1970, when it was published, psychosomatic medicine ruled headache medicine. It was a time when some headache specialists thought it was perfectly acceptable to attribute migraine solely to rage or personality flaws of the patient. Sacks, importantly, took the position that migraine was always physiological in nature and he steadfastly rejected the “migraine personality”—an idea popular at the time that held that people with migraine were obsessive, Type-A characters. However, Sacks had not given up the psychological completely. He argued that migraine served important psychological functions, for example providing respite for patients. He also warned that, although the migraine personality may be myth, people with migraine had many other problematic personality types that had to be dealt with at the clinic. So, although Sacks was a progressive physician in many ways, reading Migraine now can sometimes be a jarring experience.
One thing is for sure. Sacks’ trademark empathy and compassion for patients shines throughout his work on migraine. For if he insists that migraine is not just physiological, he does so to encourage physicians to look at the whole patient. “The physician must not dominate or be dogmatic to the patient, must not play the expert, insist “I know best”’ he must listen to the patient, listen beneath words; listen to his special, unspoken needs; address his dispositions, the patterns of his life; listen to what his illness, the migraine, is “saying.” Only then will the path of healing become clear.”
That physicians ought to listen to their patients remains Sacks’s most valuable lesson.
- Oliver Sacks. 1992. Migraine: Revised and Expanded. New York: Vintage Books.
- Interview with Oliver Sacks. March 28, 2011. StarTalk Radio Show with Neil Degrasse Tyson. “Are You Out of Your Mind?” http://www.startalkradio.net/show/are-you-out-of-your-mind/
- Steve Silberman. The Fully Immersive Mind of Oliver Sacks. Wired Magazine. http://archive.wired.com/wired/archive/10.04/sacks_pr.html
Can you tell when a migraine attack is coming?