The Big Idea: Oliver Sacks


A little over a year ago, I had surgery to repair a bad fracture of my right shoulder. Though the injury was anything but psychosomatic, I was surprised by the intensity of its psychological impact on me. I wrote about that here on The Rumpus and also here, but I omitted from these accounts an unusual experience I had about two weeks after my operation.

I was still in a lot of pain, still taking narcotics on and off, and still sleeping poorly. I was also claustrophobic and bored, unable to work, drive, or even turn the pages of a book or magazine. My friend Brenda called and correctly sized up my condition: “You sound terrible.” She offered to pick me up, drive me across town to her house, make me tea, and drive me back. “A change of scenery will do you good,” Brenda said.

She was right. By the time we returned to my house on that clear summer afternoon, I’d cheered up considerably. I was delighted to see my college-aged son arriving home at the same time, standing on the steps wearing shiny, dark blue basketball shorts, a black t-shirt, and a dark blue baseball cap. I was eager to introduce him to Brenda and also to get some assistance from him in moving from the car to the house—no small feat with my arm still bound to my chest. My son has always been a sweet and polite boy and, at twenty, well past the age where “meeting a friend of Mom’s” is an activity to be ducked, so I was surprised, and a bit miffed, when he didn’t even acknowledge us before disappearing into the house. I said goodbye to Brenda, and made my way awkwardly to the door, which I discovered my son had locked behind him. Now I was really annoyed. I struggled, left-handed, to pull my key from my purse and let myself in.

I called my son’s name. No one answered. I walked from room to room, looking for him. The house was empty. I had seen my son, clear as day. But he wasn’t there.

Several months later, I had the opportunity to review Oliver Sacks’s new book, Hallucinations, and learned that my experience was not so unusual as I believed. Though we most often think of hallucinations as part of the psychosis people with schizophrenia or mood disorders may develop, many other conditions can also cause hallucinations: migraine, drugs and alcohol (and withdrawal), seizures, PTSD, and sleep or sensory deprivation—to name a few. My cooped-up, drugged-up, sleepless self was, apparently, ripe for a visit from an apparition.

Hallucinations is Sacks’s twelfth book. As in nearly all of his books, including The Man Who Mistook His Wife for a Hat, An Anthropologist on Mars, and Musicophilia, in Hallucinations Sacks blends clinical anecdotes from his neurology practice, neuroscience, historical and literary references—and memoir. Hallucinations features a chapter, “Altered States,” which first appeared in The New Yorker, in which Sacks details his youthful and extensive experimentation with LSD, amphetamines, and other drugs.

Sacks, who turns eighty today, has been keeping journals since his teens. As a young neurologist in the 1960s, he felt unsatisfied by dry case reports and scientific articles, and longed to write about his patients in a more nuanced and literary way. His second book, Awakenings (made into a movie with Robin Williams and Robert DeNiro and nominated for three Academy Awards), is a collection of the life stories of people who’d been suspended in a near-catatonic state for decades after contracting encephalitis lethargica, possibly related to the influenza pandemic of 1918. These people were reanimated in the 1960s by a then-new drug, L-dopa. In Awakenings, as in Hallucinations and other works, Sacks uses neurological phenomena and impairments as windows into his patients’ humanity—as well as his readers’ and his own.

I spoke with Sacks recently in his New York office about Hallucinations. I was curious about his thoughts regarding the relationship between hallucinations and the imagination and creativity—especially writing. I also asked him about his own experiences of hallucination, and his drug use.

But first, I couldn’t resist seeking his opinion of the vision I had that summer afternoon last year.


The Rumpus: What happened to me that day? According to your book, there are many reasons why I might have hallucinated—sleep deprivation and drugs and pain and so forth. But was it random and meaningless that I hallucinated my son, specifically?

Oliver Sacks: Nothing is meaningless. That’s certainly what my analyst says. On the other hand, I think of my patient who saw Kermit the Frog and said, “Why Kermit? He means nothing to me.” But obviously your son must mean a lot to you. I think a good analyst will always be alert for the biological and the medical. I mention this in Hallucinations. I speak of how when I was in South America, I started getting some very strange, tenacious dreams.

Rumpus: And it was the anti-malarial drug you’d been taking.

Sacks: Yes. My analyst said, “You’ve brought me more dreams in the last two weeks than in the last ten years. Are you on something?”

Rumpus: Were the dreams good fodder for the psychoanalysis?

Sacks: No. They weren’t, actually. They were peculiar. Sort of Jane Austen-like.

Rumpus: And you mentioned that you’re really more of a Dickens fan.

Sacks: Yes.

I’m fascinated by the “reality” of your hallucination. That you were surprised he didn’t open the car door, that he locked the door in your face—which isn’t ordinarily in keeping with what a hallucination is about. Was it purely visual? Did you hear the ground crunching under him? Or hear him speak?

Rumpus: No. It was all visual and lasted five seconds, perhaps. I ask about meaning because I’m curious about a distinction you make, throughout Hallucinations, between a hallucination that’s experienced by someone on drugs, or with migraine, etc., as opposed to one experienced by someone who’s mentally ill. The difference between the sensation of simply “watching a movie” in the former, and feeling that things are directed at you, that they have emotional content and meaning, in the latter—and why you decided to mostly eliminate psychotic hallucinations from the book.

Sacks: Psychotic hallucinations are an enormous subject and I didn’t feel I could do justice to them, and I think one can’t without describing the entire world of the psychotic. I’ve occasionally wondered if I might write a chapter or a book on schizophrenia. I have a schizophrenic brother. But I felt it was just too much for me. Also, I thought I wanted to lean—perhaps excessively—towards a reassuring stance: that most hallucinations, or many hallucinations, are not psychotic and not something to be silent or afraid about.

Rumpus: I was certainly reassured.

Sacks: How did you feel when you realized the door was closed? You realized it was a hallucination at that point.

Rumpus: I was frightened. I told no one about it, not even my husband, until after I had read your book. When you’re able to reassure people their hallucinations are neurologic in origin, do you find that they still have an emotional relationship to the hallucinations? That it’s hard to objectify them?

Sacks: The woman who saw Kermit the Frog also saw hideous, dismembered faces and was very frightened and wondered if she was getting psychotic. She wondered from what depths these things had been conjured up. I may have given an excessively neurologic reply when I said there are areas in the superior temporal sulcus, or whatever, which have to do with eyes and mouth and where characteristically one gets such deformed faces and it’s all neurological. Well, she was reassured that she wasn’t psychotic, but I think she still wondered how something so horrible could be related to the nervous system.

Rumpus: I’m fascinated by the relationship between hallucinations and the brain. At one point you say that when you hallucinate a color, there’s demonstrable visual cortex activity. But when you imagine a color, there isn’t.

Sacks: Yes. I mean, it may be a matter of degree. There may be much less. But there is activity of perceptual or “super-perceptual” force in various areas when one hallucinates. There may be a sort of fainter, echo-like color, with imagination. I have very poor voluntary visual imagery, although I’m assailed by colorful, sometimes violent, involuntary visual imagery.

Rumpus: Like PTSD? Or nightmares?

Sacks: Usually lying in bed. I think especially since losing my sight in one eye and having poor vision in the other, the moment I close my eyes there is a teeming world for which I’m not responsible.

Rumpus: You describe the hallucinations Henry James had on his death bed—vivid scenes of the Napoleonic Wars—and novelist Amy Tan’s hallucinations when she had Lyme disease. Do you think that creative people have more interesting hallucinations? Or do you think they simply describe their hallucinations in a more interesting way?

Sacks: Well that’s a very nice, contrasting pair. Amy called them “a detritus of a dream,” or something like that and had not much interest, whereas Henry James thought it was some subjacent fantasy which he’d had all his life and finally sort of took over. At one time I did read a book called The Voices of Poetry, where the thesis was very much that a “voice” is not just a metaphoric reference to the muse.

Rumpus: Have you had that experience in writing? Of hearing a voice?

Sacks: No. Yes. Although I wouldn’t call it…I’m not sure what to call it. I have it less now, but with my first book, with Migraine, there were many, many problems, including a sort of mad, internal threat in which I said to myself, in September of ’68, You have ten days to write it and if you’re not finished by ten days, you’ll commit suicide. This sounds even madder than it was. You have to know some of the background. Anyhow, under my own threat or joke, I first started writing and within hours the feeling of terror was replaced by a feeling of joy in the writing and, in particular, a feeling that I was taking the book down to dictation. It came to me absolutely fluidly by a sort of inner voice. I was excited. I didn’t want to go to bed. I slept for two or three hours a night and no more. Perhaps I was hypomanic. I’m not sure what word to use.

So that was very much like hearing a voice. I can’t say it was anyone’s voice in particular. But my verbal auditory imagery is as vivid as my visual imagery is poor. My musical imagery is somewhere in between.

Rumpus: In the chapter “Altered States,” you were said that while withdrawing from chloral hydrate “I wrote for my life.” You were frightened by the hallucinations you were having.

Sacks: Yes.

Rumpus: And as you were writing, the writing became more and more interesting to you, and then ultimately you abandoned drugs. Did writing feel sort of like getting high? Were you intoxicated by writing?


Sacks: Occasionally. I had a bunch of surgeries about three years ago, when I had to have my knee done and a laminectomy, and then after that I broke a hip. I was in intense pain. Most of The Mind’s Eye was written at that time and I felt that writing was more effective than morphine.

Rumpus: Really? Literally? In the moment: I’m in pain. I will write. My pain will be relieved while I’m writing? Not just, sort of, in general?

Sacks: No. Only with the act of writing.

Rumpus: With the act?

Sacks: Yes. Writing and thinking. It didn’t go away completely but I didn’t need to take, and also didn’t want to take morphine when I was writing.

Rumpus: About that chapter, “Altered States”—about your youthful drug use: I recently read your memoir, Uncle Tungsten. And I was struck that you were a pretty timid, cautious boy. And yet, when you were a young man, you started indulging in what we would probably now call “risk-taking behavior,” including injecting intravenous morphine you took from your parents’ medical office.

Sacks: Yes.

Rumpus: When you look back on it, are you surprised by your behavior? Or did it seem like a natural part of your intellectual curiosity?

Sacks: Well, there was risk-taking before that. I got my first motorbike at seventeen and I semi-raced motorbikes in England, and I think I am very lucky to have had twenty-five years of hard and often provocative riding and lived to tell the tale. I never got seriously injured on the bike. Although the bike and drugs didn’t mix and I didn’t try to mix them.

Something I don’t tell in the book: I was very heavily on amphetamines in my first three months in New York. But I looked into the mirror in the middle of being stoned and was promptly sobered by seeing that I’d lost about a hundred pounds. Seeing, as it were, the skull under my skin. And I said to myself: Oliver, you will not see another new year unless there’s intervention. So then I certainly realized how frightening it was. With the morphine, especially, I was really asking for trouble.

Rumpus: When you look back on all that do you think that was just about being young and foolish, or do you feel, for example, that on LSD your own personal experiences of hallucination have fed your creativity in any way?

Sacks: Well, it’s not an either/or. My analyst, whom I saw this morning—the same one I still see after forty-seven years or whatever—he once had a phrase which stays in my mind: “masochistic temptation and punitive injunction.” There’s a deadly precision about that. Anyhow, these are strong in my character and have given rise to much trouble. I’m now old and still considerably foolish—and one way and another I’ve been grateful to many, many people and events and just luck to find myself now about to have an eightieth birthday, when most of my friends thought I would sort of not see thirty, with motorcycling.

The other half of this is that I think I did get an incomparable experience of various sorts of visual hallucination. And later when my patients [those described in Awakenings] were on L-dopa, they had all sorts of hallucinations. And I think I could sort of understand them better.

Rumpus: You write about the possibility of art inducing hallucinations. Listening to Monteverdi allowed you to see the elusive color “true indigo.” What do you think was going on there? Can art be hallucinogenic? Or does it just heighten perception?

Sacks: It can certainly transport one. I’m not sure how far the transport may go. Without being quite a philistine, I’m afraid my own sensitivity to visual art is not great. When I see what joy and insight and wonder people can get from visual art I feel there’s something defective in me. On the other hand, I’m readily transported by music. I think there are ways of getting as high as with any drug. I suspect that this happens in some religious ceremonies. I think that, in a sense, this is what happens when one falls in love.

Rumpus: Even to the point of hallucination? Did you hallucinate the indigo? Or did you simply interpret the color you saw as indigo?

Sacks: It was a very sensory experience, as people describe synesthesia. It’s said you can’t hallucinate what you’ve never experienced—but, then, I think you can.

Rumpus: What would that look like?

Sacks: Indigo!

Rumpus: But you had imagined it. You had thought about it. You knew what you were looking for.

Sacks: I knew it was going to be on the blue end of the spectrum. But in fact, the indigo—whatever I saw—was beyond any spectral experience.

Rumpus: So now were getting into the realm of creativity.


Sacks: Well, maybe. This comes up, this sort of thing, strongly in people with olfactory hallucinations. They often say: “Not only can I not describe this, I never experienced it. I don’t know what associations to make.”

A chemist colleague of mine runs a seminar in which art and science are brought together. And one such session was devoted to olfaction. And there was an olfactory physiologist from Columbia and a friend of his, a parfumier. Forgive my French accent. And the parfumier had made something unlike anything ever encountered on earth. And it had a very strong smell which aroused no associations and could not be compared to anything. One realized this was absolute novelty. And I quote Poe on this: absolute novelty can enter some hallucinations and maybe some psychosis. I don’t know if imagination is enough. I think hallucinations in various ways go beyond imagination. These are not necessarily creative ways, though maybe they could be put down to creativity.

Rumpus: Almost like a visitation? Or would you say hallucinations sometimes come from a part of the brain that isn’t part of the “self?”

Sacks: Yes, well that’s what the muse is. Or the devil!


“The Big Idea” features interviews with writers, artists, scientists, activists, and others who take a long and broad view of an issue, problem, or concept, and pursue it over many years. Visit the archives here.


Featured image of Oliver Sacks © by Elena Seibert.
Second image of Oliver Sacks © by Adam Scourfield.

Suzanne Koven MD, MFA is a primary care physician and writer-in-residence at Massachusetts General Hospital in Boston. Her writing has appeared in the New England Journal of Medicine, the Boston Globe, VQR, and elsewhere. Her interview column “The Big Idea” appeared at The Rumpus. Her memoir-in-essays, Letter to a Young Female Physician, will be published by W. W. Norton & Co. on May 4, 2021. More from this author →