Human Being versus Human Doing: A Reflection on Oliver Sacks

One must drop all presuppositions and dogmas and rules – for there only lead to stalemate or disaster; one must cease to regard all patients as replicas, and honor each one with individual reactions and propensities; and, in this way, with the patient as one’s equal, one’s co-explorer, not one’s puppet, one may find therapeutic ways which are better than other ways, tactics which can be modified as occasion requires.

– Oliver Sacks, Awakenings

OliversacksOliver Sacks died on August 30, 2015 at the age of 82. He was deservedly anointed the “poet laureate of medicine” by The New York Times. Dr. Sacks described himself in a different way in his book, A Leg to Stand On: “I had always liked to see myself as a naturalist or explorer. I had explored many strange neuropsychological lands—the furthest Arctics and Tropics of neurological disorder.”

His death has been noted in memorial articles in both the lay press and in medical journals, celebrating his gifts as a neurologist and a writer. In my opinion, along with Viktor Frankl, he is one of the true giants of medicine in the last 75 years; not because of a phenomenal discovery or treatment, but because of how he connected with patients as human beings and not just as objectified cases or diseases. I never had the opportunity to meet Dr. Sacks, or even hear him talk. However, for me his thoughts cut to the very heart of the way the United States Army and Medical Corps treats soldiers as automatons; machines to be used up, and if broken, discarded.

Dr. Sacks was a well-known contributor to the New Yorker magazine and in the 14 September 2015 edition, there is a very endearing story by Dr. Sacks; a picture of this man at the very end of his life. In the same edition of the New Yorker is an article by Atul Gawande, a Boston physician and noted writer; his most recent book, Being Mortal is a very serious examination of the way death is managed in our medical culture. Dr. Gawande became a medical and literary confidant of Dr. Sacks and received a letter from him four weeks before his death. The older physician, well aware that he was near the end, expressed his concern for the “deadly effects of social media when they absorb people, to the exclusion of everything else, throughout their waking hours.” In that letter Dr. Sacks, extraordinarily, also recommended a story to Dr. Gawande called “The Machine Stops” by E. M. Forster.

Perhaps the most famous story by Dr. Sacks was The Man Who Mistook His Wife for a Hat. This was a narrative of a man with a complex neurological disorder and the patient subsequently died. In commenting on this story Dr. Gawande did not note drama or heroics as the “disease advanced inexorably…But it was still essential, Sacks wanted us to know, simply to understand. This was a deeper lesson. His most important role, as a doctor and as a writer, was to bear witness to the wide experience of being human. There was a tender passion beneath the dispassion.”

Sacks explained in the preface to that book why he wrote about his patients in this personal manner. “Studies, yes, but why stories of cases?” (I wish those in command of our military would read and understand his reason for telling the stories in this way). “Because, the understanding of disease cannot be separated from the understanding of the person. They are interwoven, and this has been forgotten in our era of scans, tests, genetics and procedure.” Gawande states Dr. Sacks compared the modern clinical practitioner to the man who mistook his wife for a hat—able to register many details yet still miss the person entirely. The task for Dr. Sacks was to restore the human subject at the center—the suffering, afflicted, fighting, human subject— “we must deepen a case history to a narrative or tale.”

Sacks’ eloquent descriptions contrast profoundly with the impersonal and dispassionate manner the Army treats soldiers. There are even more complex issues to consider when telling stories of soldiers. Edward Tick, PhD, in his book War and the Soul describes this particular experience: In war,

“the gigantic will of the collective replaces that of the individual. For the military to function efficiently it must run on a hierarchy of power, tradition and discipline. Basic training curtails our personal will, and then brutal combat damages or destroys it as we are forced to act in ways that oppose our civilized natures and established identities.”

But then, inexorably, after bending to the will of the command structure, the soldier returns home and the very essence of who they are has changed. Tick analyzes this eloquently:

“For these survivors, every vital human characteristic that we attribute to the soul may be fundamentally reshaped. These traits include how we perceive; how our minds are organized and function; how we love and relate; what we believe, expect and value; what we feel and refuse to feel; and what we judge as good or evil, right or wrong.”

But to the command structure in the Army, the human subject, the human being, is not at the center as Sacks demanded; the suffering, afflicted, fighting human subject, is still treated as an automaton. If that machine is broken in a manner the command obviously cannot understand, the goal is to discard the human being because he or she does not do what is expected. What a contrast to the perspective of Oliver Sacks. Gawande stated Dr. Sacks “wanted to see humanity in its many variants, and to do so in his own almost anachronistic way—face to face, over time, away from our burgeoning apparatus of computers and algorithms. And through his writing, he showed us what he saw.”

One of the most common stories soldiers told me, in their own fashion and words, was that they could not do it anymore; could not perform the way command demanded; they were shamed and humiliated. They could not define who they were and what they wanted to happen. I often asked them the question: Do you define yourself as a human being or a human doing? I told them, somehow we must dig down and find those things that bring meaning to their life. To help them I too needed to be a human being and not just a human doing.

Gawande concluded his tribute to Oliver Sacks by returning to the book recommended to him four weeks before Dr. Sacks died: Forster’s “The Machine Stops.” “It’s about a world in which individuals live isolated in cells, fearful of self-reliance and direct experience, dependent on plate screens, instant messages, and the ministrations of an all-competent Machine. Yet there is also a boy who, like Sacks, saw what was missing. The boy tells his mother, ‘The Machine is much, but it is not everything. I see something like you in the plate, but I do not see you. That is why I want you to come. Pay me a visit, so that we can meet face to face, and talk about the hopes that are in my mind.’”