The Lies and Falsifications of Oliver Sacks
In a recent bombshell piece for the New Yorker (archive), Rachel Aviv explored the personal journals of the celebrated neurologist and writer Oliver Sacks. What she found was shocking: he had fabricated and embellished some of his most well-known work — like Awakenings and The Man Who Mistook His Wife for a Hat. Sacks himself referred to his “lies” and “falsification” in journal entries.
But, in his journal, Sacks wrote that “a sense of hideous criminality remains (psychologically) attached” to his work: he had given his patients “powers (starting with powers of speech) which they do not have.” Some details, he recognized, were “pure fabrications.” He tried to reassure himself that the exaggerations did not come from a shallow place, such as a desire for fame or attention. “The impulse is both ‘purer’ — and deeper,” he wrote. “It is not merely or wholly a projection — nor (as I have sometimes, ingeniously-disingenuously, maintained) a mere ‘sensitization’ of what I know so well in myself. But (if you will) a sort of autobiography.” He called it “symbolic ‘exo-graphy.’”
Sacks had “misstepped in this regard, many many times, in ‘Awakenings,’” he wrote in another journal entry, describing it as a “source of severe, long-lasting, self-recrimination.”
The author Maria Konnikova discovered Sacks’ work in high school — “it blew my mind”, she writes. After the Aviv piece was published, Konnikova wrote a post about Sacks: The man who mistook his imagination for the truth.
When Joseph Mitchell invents a fishmonger, nobody gets hurt. It’s not journalism. It’s not nonfiction. But it’s not life or death. When Jonah Lehrer invents a quote from Bob Dylan, you can call him a narcissistic idiot for thinking he can get away with fabulizing a living legend whose every word has been studied. It’s not journalism. It’s not nonfiction. But, again, it’s not the end of the world. When Oliver Sacks invents an ability that does not exist or crafts a portrait of his own creation, he is hampering medical progress and tampering with the ethics of his profession. Not all journalistic malfeasance is created equal. There are plenty of shades of grey. But making up medical details is not in the gray zone. It’s malpractice.
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Wow. I am going to need some time to process this. I was fascinated by his books—partly because I believed it all to be accurate.
I read this over the weekend and thought of you immediately. This was a shocking read!
I'm a doctor. It's my second career; I was a book editor before. Naturally, when I decided to go back to school to pursue medicine, I read all sorts of books by doctors about taking care of their patients. Obviously, I read everything he wrote (for a general audience, anyway).
This is such a betrayal.
One of the difficult truths about medicine is that the pathological basis of disease is often hard to correctly understand without lots of background knowledge. Most people don't have the education to understand it. And so one of our biggest jobs as physicians is coming up with approximations of physiological phenomena, of the complex ways medications work, of the delivery of vaccines, etc., that our patients can understand.
It's not this, but it's like this.
We are constantly translating medicine into human experience.
But we're also constantly doing that work for our colleagues. It may take a different format (starting with something like "So, you know how mRNA works?" rather than "So you know that your body helps you fight off disease?"). And to me, that's why this is such a disappointment and such a shame.
As physicians, we can't all be experts in every field. We have to rely on our colleagues' narratives of their areas of expertise in order that we can develop a shared mental model of what the body does, how it does it--in sickness and in health--and most importantly, what we as physicians can do to make our patients better. Fabrication erodes our ability to build that model. It erodes our trust in our colleagues. It makes us worse at medicine.
This is absolutely spot on.
I feel that the translation side of medicine has become even more important as we’ve moved away from a more paternalistic model towards shared decision making.
I constantly find myself studying the communication styles of people who excel at conveying complex subject matter for a lay audience. Explaining *is* the job. Love it, or hate it, unless you can be as clear and helpful as a chat bot, you will lose patients.
I had a brain tumour removed a decade ago and read this article and the substack post with interest. When I was under treatment, I remember the doctors in my teaching hospital answering a question I asked with “Well you know the work of Oliver Sacks…” The question I asked was something like “If this is a slow growing tumour, then how has it affected who I am?”
I did know the work of Oliver Sacks but I don’t remember ever reading him looking for truth. I believe I enjoyed his work for illuminating human experience. Some years after my surgery, I re-read The Man Who Mistook His Wife for a Hat and felt disappointed. Not because I felt let down about truth, but because the book didn’t have an account that described something like my experience. Of course! He couldn’t have written about my experience in the time while the tumour was growing, during the harrowing months of my diagnosis, or the many years that have since passed. I felt let down, but I was/am still glad to know that someone was writing about the lives of remarkable people that otherwise would have gone unremarked.
This post by Atul Gawande is interesting:
https://books.substack.com/p/diary-atul-gawande-on-oliver-sacks
It was published in 2023, and includes some parts of the postscript he wrote in the New Yorker just after Sacks’s death. In this, unlike the New Yorker piece, Gawande is measured, never claiming that Sacks was writing the truth, but also noting that he wrote about people with empathy and respect.
We're talking about Patch Adams, right?
???
I haven't read the piece yet, but it occurs to be that Dr. Sacks is not around to defend or explain himself so we don't know the whole story and never will.
The article is sourced from Sacks own journals where he freely discusses his own feelings of guilt and shame over the fabrications. I don’t think there’s really a basis for doubting the verdict here. The article is still very well worth the read though, it’s a fascinating look at a man who clearly struggled with his place in the world.
It is unfortunate, but I always read Oliver Sacks' books as fiction anyway. As a non-medical, random consumer of literature I don't really care if they are real or not. I'm not trying to take away from others' disappointment and understand it's a betrayal of "truth," but I read most non-fiction as "based on a true story" anyway.
I went into medicine because of his Hat book. I was planning on applying to grad school for neuroscience, and switched that plan to medical school. I didn't end up being a neurologist, but his books inspired me to treat each patient as their own unique entity, inspired me to have curiosity and empathy when interacting with people.
So sad to have your heroes fall. But perhaps this approach to patients is what he meant by his stories having their own kind of fidelity? Like he was glamorizing what is still a fundamental truth, which is that each human being contains multitudes and should be treated with respect and reverence.
We can be better, more humanist clinicians whether Dr. Sacks was exactly who he appeared to be or not.
Easier said than done sometimes.
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