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This is another wonderful book from Dr. Sacks. The subtitle, “Tales of Music and the Brain,” is accurate: we have a charming and informative mixture of stories of patients and the neurophysiology that interprets how music is processed and performed. The book is synthetic in combining cases from his practice, other clinical reports, letters from correspondents, references to medical literature, and even Sacks’s own personal experiences with music.

Sacks finds that humans have a “propensity to music,” something “innate” in human nature, perhaps like E. O. Wilson’s biophilia. “Our auditory systems, our nervous systems,” he writes, “are indeed exquisitely tuned for music” (xi). Although humans have been involved with music for millennia, it is only in the last few decades that medical imaging (functional MRI, PET) has shown what areas of the brain are active when music is heard.

While humans routinely enjoy music, the book emphasizes unusual events and neurological patients, in short, departures from the norm. Sacks—himself a lover of music—reports on his own experiences with hallucinatory music and anhedonia (loss of pleasure) in hearing music. He describes going to hear the great baritone Dietrich Fischer-Dieskau but finding that he could not, on that day, perceive the beauty of the music. Another condition “amusia,” or loss of musical ability, can be chronic, acquired, or temporary.

Some patients have had injuries or diseases of the brain that change how music is perceived. A man hit by lightning is suddenly obsessed with piano music. Another man (who survived a brain infection) has amnesia about many things but can still make and conduct music at a professional level. The concert pianist Leon Fleisher visits Sacks to discuss his dystonia, or loss of muscle function in one hand (with implications for the brain). Rolfing and Botox helped him heal and he returned to two-handed performances.

Sacks discusses other phenomena that involve brain structures, for example, perfect pitch; persons with this ability have “exaggerated asymmetry between the volumes of the right and left planum temporale” (128). People who experience synesthesia (perceiving notes as colors) have cross activation of neurons in different areas of the brain. Professional musicians (and patients with Tourette’s) demonstrate cortical plasticity, that is they have expanded areas of the brain for particular uses. Children with Williams syndrome have brains influenced by a microdeletion of genes on one chromosome; they have some cognitive deficits and also a great responsiveness to music. For some conditions, the brain determines all; for others, behavior components are also important.

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In this book Sacks takes the reader into the world of the prelingually deaf, a world in which spoken language is incomprehensible. He describes the visual language, Sign, and considers the development and culture of American Sign Language. Sacks evokes the conflict between those who seek to teach the deaf to communicate via voice and lip-reading and those who affirm Sign, the native culture of the deaf.

In the latter part of the book, Sacks re-creates the student rebellion at Gallaudet University in 1988 when a "hearing" president was chosen from among three finalists, two of whom were deaf. The back cover summarizes this book as "a provocative meditation on communication, biology, and culture."

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This is the journal that Oliver Sacks kept during a "fern foray" in Oaxaca, Mexico. Sacks is a fern lover, even though he admits to an even greater passion for club mosses and horsetails. In 1993 John Mickel of the New York Botanical Gardens introduced Sacks to the New York chapter of the American Fern Society (AFS). Consisting mostly of amateur naturalists, AFS meetings were both congenial and passionate, unlike the cold competitiveness of professional meetings in neurology and neuroscience. The New York AFS folks arrange periodic trips to hot spots in the fern world to indulge their passion. In 1999 Oliver Sacks accompanied them on a trip to Oaxaca, which is a veritable paradise of ferns.

Though the trip is only 10 days long, Sacks packs a month’s worth of sights and sounds and meditations into his journal. We learn a lot about the hundreds of species of ferns that range from southern Mexico’s rain forests to the nooks and crannies of its arid central plateau. But the author’s curiosity roams freely and absorbs his new environment. We learn about the origin of chocolate, the history of tobacco, and the archeology of Monte Alban. We learn about the process of distilling mescal in one’s backyard. Most of all, we are introduced to nearly a dozen vivid characters, united in their enthusiasm for fieldwork and ferns.

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Witty Ticcy Ray tells the story of Dr. Sacks’s treatment of a 24-year-old man with disabling Tourette’s syndrome. The first half of the essay is mainly medical-historical, with some technical language. When Sacks first tries treating Ray with a minute dose of Haldol, Ray finds that even that low dose too effective. It breaks up the rhythms that have determined his life since the age of 4, and he doesn’t like it. Later, a second trial using the same dose succeeds, Sacks believes, because Ray had by that time accommodated mentally to a change in self-image.

Still, over time Ray missed his old wildness and speed, and he and Sacks agree on a compromise: During the week, Ray takes Haldol and is the "sober citizen, the calm deliberator." On weekends, he is again "’witty ticcy Ray,’ frenetic, frivolous, inspired"--and a talented jazz drummer. This, according to Ray, offers Touretters an acceptable artificial version of normals’ balance between freedom and constraint.

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This is a story of injury in the midst of exuberant good health, followed by a progressively darkening journey. The writer experiences a period of isolation from normal life by his hospitalization, isolation from a part of his body by neurosensory damage to the injured leg, isolation from the security of medical colleagues by their insensitivity to his anguish. Sacks reaches a psychological nadir before beginning his return. He chronicles, retrospectively, the stages of this trip. As in the classical journey myths, the traveler returns with new insight and an altered vision of the meaning of disease.

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This is a collection of two dozen case studies, written for non-medical readers, of patients with right-brain disorders. The chapters are divided into four groups: "Losses," dealing with loss of memory, cognition, and proprioceptive sense; "Excesses," with tics and other cases of overabundance; "Transports," with seizures and various "dreamy states," and "The World of the Simple," concerning mental retardation. In every case, Sacks focuses on the interior or existential world of the patient as the foundation of diagnosis and treatment. Sacks argues that this approach is appropriate for the right hemisphere, which compared to the left is less dedicated to specific skills and more dedicated to a "neurology of identity."

Sacks openly proposes these studies as a corrective to the field of neurology, which has tended to focus on the left hemisphere and therefore, he argues, has wound up treating patients solely in terms of specific deficits, often to their detriment. In "the higher reaches of neurology," and in psychology, Sacks argues, disease and identity must be studied together, and thus he recommends that neurologists "restore the human subject at the centre" of the case study. Sacks warmly recommends music, story-telling, and prayer as therapies that work by ignoring physiological defects and speaking to the patient's spirit or soul.

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Jose is a patient who exhibits all the classical symptoms of autism. The caregivers in his institution treat him dismissively, as though he is stupid. Sacks notices, however, that, given a pencil, Jose draws not only with amazing accuracy, but with a quality of liveliness in his representations that betokens close, insightful, and even empathetic observation and awareness. As he encourages Jose to draw, he finds his drawings diagnostically helpful, and powerful evidence of an active interior life to which they provide a valuable link.

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Dr. Sacks was growing up in London during World War II and had a very traumatic experience when he was sent away from his home for protection from the bombing. He and his brother were sent to a boarding school, where they were beaten and underfed. Sack's home had been filled with a wonderful extended family of physicists, mathematicians, teachers, and chemists, in addition to his parents who were both practicing physicians. Being unusually bright and talented, Sacks responded to a wide variety of stimuli when he returned to this environment.

He became fascinated with the chemistry of metals and with the periodic table of elements. An uncle, for whom the book is named, was a manufacturer of light bulbs with tungsten filaments and encouraged him in setting up his own chemistry laboratory in the family laundry room, to do experiments. The family allowed him a great deal of freedom, which encouraged his creativity.

In writing about these experiences Sacks includes the history of the development of chemistry concepts that fascinated him. It was only much later that his interests moved on to the natural sciences and medicine. He says that his parents had been tolerant and even pleased with his early interests in chemistry but by the time he was fourteen they felt that the time for play was over. He kept a journal from the age of fourteen and took advantage of every opportunity to read broadly and experience nature, music and art.

In retrospect, however, Sacks felt that life was shallower after he left behind his passion for chemistry. He says that he dreams of chemistry at night. This description of such intense interest in the world around him and the people he read about or knew explains a great deal about his great success as a neurologist and as a remarkable story teller.

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