BOOK OF THE DAY

On the Move: A Life by Oliver Sacks – review

A revealing autobiography of a shy, withdrawn young man whose neurological work stretched to the very horizons of human potential

Will Self

Fri 8 May 20015

Oliver Sacks, the eminent neurologist and writer, whose many books have done perhaps more than any other body of work to explain the mysteries of the brain to a general readership, is a strong supporter of the “narrativity” theory of the human subject. Suitably enough – given this is an autobiography – Sacks restates the notion here: “Each of us … constructs and lives a ‘narrative’ and is defined by this narrative.” Elsewhere he asserts: “I suspect that a feeling for stories, for narrative, is a universal human disposition, going with our powers of language, consciousness of self, and autobiographical memory.” Setting to one side the truth or otherwise of this contention (personally I think it’s only the social being that is narrated – to ourselves we are always “such stuff as dreams are made of”), for a man who views his life in dramatic terms, On the Move presents the reader with some quite startling narrative leaps. Perhaps the most extreme of these are two seemingly throwaway remarks Sacks makes concerning his sexual life: aged 21, and desperate to lose his virginity, he found himself in the tolerant atmosphere of Amsterdam – yet, trammelled by his Orthodox Jewish upbringing and the social repression of the era, he was unable to act, and instead sat in a bar all evening drinking “Dutch gin for Dutch courage”. He remembered nothing between staggering out of the bar and awaking the next morning in a strange bed, being served coffee by a man who explained: “He had seen me lying dead drunk in the gutter … had taken me home … and buggered me.” A demon even at that age when it came to details, Sacks asked “Was it nice?” to which his ravager replied “Yes … Very nice”, before rounding off the bizarre episode by commiserating: “He was sorry I was too out of it to enjoy it as well.”

The second remark is even stranger: swimming in Hampstead ponds on his 40th birthday, Sacks was approached by a handsome young student from Harvard. A delightful week-long interlude followed: “ … the days full, the nights intimate, a happy, festive, loving week”. It was a great benison – all the greater, because: “It was just as well that I had no foreknowledge of the future, for after that sweet birthday fling I was to have no sex for the next 35 years.”

Accustomed to the contemporary obsession with “identity” (and sex for that matter), we might expect the autobiography of a gay man – especially one from a Jewish immigrant background who ends up emigrating to the US from Britain – to be preoccupied by differences of sexuality and heritage. But Sacks is a man of his generation, and while no prude, nor a jealous guard of his own privacy, nonetheless the personal and existential aspects of this autobiography are definitely secondary to the main business of his life, which has been the practice of neurology and the chronicling of the insights this practice has afforded. In part the light touch on these matters can be explained by a desire not to repeat himself: Sacks’s memoir of his boyhood,Uncle Tungsten, brilliantly realised a portrait of his eccentric family of medics, scientists and technologists, while also recording the traumas of his wartime evacuation and the burgeoning of his own vocation.

Then again, throughout Sacks’s literary oeuvre there has been a determination to put himself in the frame: whether writing, inAwakenings (1973) about the post-encephalitic patients he bestirred from half-century-long swoons, or, in An Anthropologist on Mars (1995) and many other works, about the bizarre psychic, cognitive and perceptual worlds of people with autism, Tourette syndrome, congenital blindness, and a host of other “neuro-atypical” conditions, he has always been at pains to emphasise the interpersonal dimension. For Sacks there can be no conception of the mind in isolation: personhood is a property ever emerging from social and perceptual interaction. Not that this perspective came to him fully realised at the outset; rather the impression On the Move conveys is of a shy and withdrawn young man, who, through a combination of unusual life experience and intensive medical practice, comes to realise in himself an almost preternatural sensitivity to the perspectives of others, no matter how alien these may be.

Oliver Sacks

You don’t need to be a psychologist to see Sacks’s unusual depth of involvement with his patients as some sort of substitute for those 35 romance-free years. The poet Thom Gunn, a friend of the author’s, remarked that he’d worried Sacks was deficient in empathy until he became a clinician. Sacks himself is even more forthright: “I had fallen in love – and out of love – and, in a sense, was in love with my patients.” The criticisms levelled at Sacks – that his books are exploitative, presenting disabled and damaged people as a sort of freak show – are exposed as a nonsense by the books themselves, but if you were in any doubt, the quite unselfconscious accounts given here of Sacks’s extraordinary openness to his patients, should lay them to rest. He writes of intervening during a strike by support workers at Beth Israel, the New York hospital where he worked for many years: “We spent the next four hours turning patients, ranging their joints, and taking care of their toilet needs”. Elsewhere – just as an aside – he mentions that his apartment at the hospital “was always open” to patients. And while he is not known especially as a critic of the psychiatric gulag, many of his experiences in these hospitals move him to anger: “In some of these places, generically referred to as ‘the manors’, I saw the complete subjugation of the human to medical arrogance and technology.”

Sacks met Gunn when he was living in San Francisco and converting his English qualifications to American ones. It was a period in his life defined as much by motorcycling as by medicine – hence the book’s title – and Sacks’s embrace of physicality and risk will be a surprise to any reader who expects a neurologist to be a cold technician. While living in London, Sacks had been a member of the Ton Up Boys bikers’ club that once frequented the Ace cafe on the city’s North Circular bypass. He embarked on an enormous circuit of his new-found home by bike, taking photographs and writing an extensive journal as he went. Then, living in Los Angeles in the late 60s, Sacks became a habitue of Muscle Beach, and even gained a Californian weight-lifting record. At the same time, he was experimenting with a wide range of mood-altering drugs, experiences he wrote about in greater depth in his bookHallucinations (2012). He later moved to New York, where he lived on City Island off the Bronx, and regularly swum around it – swimming remains one of his passions to this day.

It is surely Sacks’s apprehension of his own physicality in these myriad ways that has synergised with his intense clinical experience to produce some of his most fruitful and intellectually exciting work. I began this review hoping to synopsise Sacks’s entire life, but it’s a hopeless task. His truly has been a life lived to the full – and beyond. Friendships with such divergent luminaries as Francis Crick and WH Auden, and with his childhood companions Jonathan Miller and Eric Korn, bring a roseate glow to reminiscence without ever rendering it sickly. The detailed examinations of his own writing life – including the eight traumatic years it took him to writeA Leg to Stand On (1984) – are set beside pen portraits of the many patients who have shared their lives with him. The fruits of success are counterpointed with some quite astonishing professional setbacks, including manuscripts lost and books plagiarised. But while this autobiography foregrounds Sacks’s human relationships, it is the adventure of ideas he has undertaken that has bestowed on his life its remarkable originality.

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 British biophysicist Francis Crick in 1993. Photograph: Daniel Mordzinski/AFP/Getty Images

When Sacks began practising as a neurologist, the theoretical understanding of the relationship of the brain to the conscious mind was still based on gross anatomy: if a portion of the brain was damaged, we might be able to discover by observation of the patient what its function was. The advances in brain-imaging have informed new conceptions of the brain, as a highly plastic environment in which there is constant reorganisation. In the early 1990sSacks became acquainted with Gerald Edelman and his theory of “neural Darwinism”, by which individual consciousness is explained as the function of a process of natural selection between cohorts of competing nerve cells. Sacks describes Edelman’s theory as “the first truly global theory of mind and consciousness, the first biological theory of individuality and autonomy”. Sacks’s enthusiasm for Edelman’s ideas is more than understandable: the sort of conundrums and paradoxes he has investigated in his own patients for decades have all inclined him towards this, the great riddle of human being. Sacks reports that Edelman once said to him, “You’re no theoretician”, to which Sacks replied “I know … but I am a field-worker, and you need the sort of fieldwork I do for the sort of theory making you do.” To which Edelman readily assented.“Field worker” is something of an understatement when it comes to Sacks, unless your idea of a field is incredibly wide – stretching, in fact, to the very horizons of human potential. While not especially forthcoming about his relationship with his father (a doctor who lived and practised into his 90s), Sacks does quote a letter the then chief rabbi, Jonathan Sacks (no relation), sent him after Sacks senior’s death: “He was a true tzaddik – I thought of him as one of the 36 ‘hidden righteous’ whose goodness sustains the world.” In February, Oliver Sacks announced in an interview that the ocular melanoma that had cost him the sight in his right eye seven years ago has returned, and he is now terminally ill. Considering now the vast range of his achievements – which have been moral, and dare I say it, spiritual (despite Sacks describing himself as an “old Jewish atheist”) – I have no hesitation in extending the chief rabbi’s encomium down the generations: Oliver Sacks, like his father, is a true tzaddik, although there’s been nothing particularly covert about his righteousness – any more than his homosexuality. Perhaps it is because he has kept on the move that he has always been able to hide in plain sight.

THE GUARDIAN

Oliver Sacks / The River of Consciousness / Review

A Last Glimpse Into the Mind of Oliver Sacks

By Nicole Krauss

• Dec. 4, 2017
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THE RIVER OF CONSCIOUSNESS
By Oliver Sacks
237 pp. Alfred A. Knopf. $27.

Reading a book published after its author’s death, especially if he is as prodigiously alive on every page as Oliver Sacks, as curious, avid and thrillingly fluent, brings both the joy of hearing from him again, and the regret of knowing it will likely be the last time. In his more than 45 years of writing books — mostly about the workings of the brain, but along the way touching on nearly everything else, too — Sacks taught us much about how we think, remember, and perceive, about how we shape our sense of the world and ourselves. His case studies of those with neurological disorders were works of literature even while they broke scientific ground. But increasingly as he aged, Sacks turned his powers of observation on himself, probing his own experiences, disorders, passions and mental processes with the same wonder and acuity with which he studied his patients. “The River of Consciousness,” a collection of essays he worked on until his death, contains reflections on the evolution of life and the evolution of ideas, on the workings of memory, the process of consciousness, and the nature of creativity, alongside examinations of his own mishearings and misrememberings and his experience of illness.

In an essay about Darwin’s neglected late writings about flowers, Sacks describes a childhood conversation with his own mother in their London garden, “nearly a lifetime ago.” She explained that the reason their magnolia tree was pollinated by beetles was that a hundred million years ago, when the magnolia appeared along with the first flowering plants, bees did not yet exist. The idea of a world without “bees or butterflies, without scent or color” filled the young Sacks with awe: “The notion of such vast eons of time — and the power of tiny, undirected changes which by their accumulation could generate new worlds, worlds of enormous richness and variety — was intoxicating.” The understanding that it could have worked out differently, that humans might never have come to be, “made life seem all the more precious and a wonderful, ongoing adventure … not fixed or predetermined, but always susceptible to change and new experience.” However youthful, that combination of wonder, passion and gratitude never seemed to flag in Sacks’s life; everything he wrote was lit with it. But it was his openness to new ideas and experiences, and his vision of change as the most human of biological processes, that synthesized all of his work.

Following the essay on Darwin’s overlooked late writing is one about Freud’s early work as a neurologist, and how those 20 years of research led him to arrive, by the 1890s, at a vision of the brain as dynamic, its functions not located in isolable centers, but rather achieved through complex systems, open to modification through experience and learning. Freud was prescient in his understanding of memory as a “transforming, reorganizing process” — essentially a creative process, in which memories are perpetually revised and recategorized to shape identity and support a sense of continuity as an individual. Writing to Wilhelm Fleiss in 1896, Freud used the word Nachträglichkeit — “retranscription” — to describe the brain’s action of calling up a memory and revising it in response to fresh circumstances. As this can happen many times in a life, a memory might be described as having a kind of geological history, with different stratifications going back through time, “representing the psychic achievement of successive epochs of life.” Freud wrote that he had come to explain psychoneuroses “by supposing that this translation has not taken place in the case of some of the material.” In other words, that our psychological health depends on our ability to constantly revise and refashion memory to allow for growth and change, and the absence of this process — the stagnation of a memory, the brain’s treatment of it as something fixed — leads to pathology.

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This is an extraordinary insight, one that helped to establish our understanding of the self as flexible rather than static, and our sense of the past as an imaginative reconstruction, ever evolving, both of which make therapy possible. As a neurologist, Sacks deepened our understanding of the dynamic, creative abilities of the brain by uncovering, again and again, the unusual ways the impaired brain may deal with its handicaps, compensating in ingenious ways, or by creating plausible explanations for the nonsensical, thus preserving a form of coherence, however subjective. Taken together, his case studies illustrated how just as homeostasis, the maintenance of constant internal environment, is crucial to all organisms, so is a stable, cogent narrative of reality crucial to the mind and its construction of the self, such that even severely disordered brains will find ways of creating order.

This last point, with its vast implications, affected me powerfully when I read Sacks’s books for the first time while trying to write my first novel 16 years ago. I may have already understood that narrative is a primary human activity, as he points out in an essay in this collection, our way to make sense of the world. But what was revelatory to me as a young writer grappling with the idea of character, with how to describe both humanness and individuality, was the idea that, for the brain, the coherence that narrative forges is paramount to an accurate account of reality.

This idea is treated directly and beautifully in another essay in this collection, “The Fallibility of Memory.” Following the publication of his first autobiography, “Uncle Tungsten,” Sacks came to understand that his memories were not as reliable as he’d thought: After describing in high detail the memory of a thermite bomb that fell behind the family’s house in the winter of 1940-41, he was informed by his brother that he had not in fact been present for it, having been sent away to the relative safety of boarding school. The “memory” had been lifted whole from a letter their older brother wrote to them both, describing the dramatic event in a way that had deeply impressed Sacks at the time. And yet even after accepting the correction, Sacks found that the recollection lost none of its vivid power, having long been embedded as if it were a genuine primary memory. Neither psychoanalysis nor brain imaging can tell the difference between a true and false memory. And more than that, Sacks writes, “There is, it seems, no mechanism in the mind or the brain for ensuring the truth…. We have no direct access to historical truth … no way by which the events of the world can be directly transmitted or recorded in our brains; they are experienced and constructed in a highly subjective way…. Our only truth is narrative truth, the stories we tell each other and ourselves — the stories we continually recategorize and refine.”

Disconcerting as it sounds, Sacks, a genius at identifying the strength that springs from fallibility, locates in this imperfection our human gift for creativity. We may forget the source of what we read or were told, but we can absorb and integrate what others express so vividly that we may come to feel these things originated in ourselves. In an essay called “The Creative Self,” Sacks takes the idea further still, and suggests that a long period of “forgetting,” in which thought and experience become detached from their sources and sift down into the unconscious, is essential to originality. All of us appropriate from others and the culture around us, he writes. “What is at issue is not the fact of ‘borrowing’ or ‘imitating,’ of being ‘derivative,’ being ‘influenced,’ but what one does with what is borrowed or invented or derived; how deeply one assimilates it, takes it into oneself, compounds it with one’s own experiences and thoughts and feelings, places it in relation to oneself, and expresses it in a new way, one’s own.” To fill oneself with the consciousness of others, and then to forget deeply enough, and long enough, that the collective world can be welded to what is unique and original to oneself — this is as precise and moving a definition of creativity as I have come across. On page after page in this collection, drawing on the rich history of ideas he absorbed over a lifetime, Sacks illustrates how it is done.

Nicole Krauss is the author, most recently, of “Forest Dark.”

The 100 best nonfiction books / No 12 / Awekenings by Oliver Sacks (1973)

The 100 best nonfiction books

No 12 

Awakenings by Oliver Sacks 

(1973)

Oliver Sacks’s moving account of how, as a doctor in the late 1960s, he revived patients who had been neurologically ‘frozen’ by sleeping sickness reverberates to this day

Robert McCrum
Monday 18 april 2016

A

mong the great books in this series that address the human condition,Awakenings stands out as a profoundly influential medical classic from the 1970s, whose extraordinary narrative continues to reverberate.

Awakenings has inspired short stories, poems, novels and plays, notably Harold Pinter’s A Kind of Alaska. Its central themes – falling asleep, being turned to stone, being awakened, decades later, to a world no longer one’s own – grip the imagination like the best drama, with this difference: the events described by the late Oliver Sacks actually happened.

The “sleepy sickness” pandemic of 1916-17, which persisted into the 1920s, ravaged the lives of nearly 5 million people before it disappeared, as mysteriously and suddenly as it had appeared, in 1927. A third of those afflicted by encephalitis lethargica died in its acute stages, in advanced states of coma or sleeplessness. Other patients who suffered an extremely severe somnolent/insomnia attack often failed ever to recover their original vitality and lived out their days, cut off from humanity, in a deeply strange, inaccessible, frozen state (“a kind of Alaska”), oblivious to the passage of time or what had befallen them. These survivors were described by the doctor who first identified encephalitis lethargica as “extinct volcanoes”. They would sit motionless and speechless all day in their chairs, totally lacking energy, impetus, initiative, motive, appetite or desire.

Oliver Sacks with a model of a brain, in 2007
 Photograph: Adam Scourfield/

In the majority of cases, these patients had their thoughts and feelings unchangingly fixed at the point at which their long “sleep” had closed in on them. For many survivors, this was the 1920s, a time that would remain more real to them than any subsequent decade. Their minds, however, remained clear and unclouded. And yet, unable to work or see to their needs, frequently abandoned by their friends and families, these patients were put away in hospitals, nursing homes and lunatic asylums and forgotten, like lepers of the 20th century. Yet some lived on, getting older and frailer, inmates of institutions, profoundly isolated, deprived of experience, half-forgetting, half-dreaming of the world they had once lived in.

In 1969, after more than 40 years of lives as insubstantial as ghosts and as passive as zombies, these “extinct volcanoes”, scattered in hospitals for chronic neurological disability in Britain, Europe and the US, erupted into life through the intervention of a remarkable new “awakening” drug, L-Dopa (laevodihydroxyphenylalanine). In one hospital in particular – the Beth Abraham in the Bronx – some 80 patients, long regarded as effectively moribund, returned explosively to life.

Oliver Sacks was the brilliant young neurologist who administered the wonder drug, keeping meticulous notes on his patients’ recovery. Awakenings became his account of a unique experience, the return to humanity of men and women whose personalities had become immured in post-encephalitic torpor. This could be a rollercoaster ride. Some of L-Dopa’s side-effects had a frightening intensity: in one patient’s words: “I can no more control it than I could control a spring tide. I just ride it out and wait for the storm to clear… That L-Dopa, that stuff should be given its proper name – Hell-Dopa!”

While such cerebral storms raged, Sacks took notes. “I cannot think back on this time without profound emotion,” he wrote later. “It was the most significant and extraordinary moment in my life, no less than in the lives of our patients. All of us at Mount Carmel [Beth Abraham] were caught up with the emotion, the excitement, with something akin to enchantment, even awe.”

Young Dr Sacks was not just a gifted neurologist blessed with a brilliant idea for a revolutionary treatment – he was also a passionate writer, committed to reporting an extraordinary story that was unfolding before him from day to day. In the spring of 1969, he writes: “I moved to an apartment a hundred yards from the hospital and would sometimes spend 12 or 15 hours a day with our patients – observing them, talking with them, getting them to keep notebooks, and keeping voluminous notes myself, thousands of words each day. And if I had a pen in one hand, I had a camera in the other: I was seeing such things as had never, perhaps, been seen before – and which, in all probability, would never be seen again.” It was, said Sacks, his duty and his joy “to record and bear witness”. The upshot was Awakenings.

The tales Sacks tells of the lives of Frances D, Rolando P, Lucy K and George W are deeply moving, often shocking and sometimes tragic. Through these case studies, Sacks explores the questions of illness and wellness, suffering, isolation and the psycho-drama of lives renewed by L-Dopa. The strangeness of life in Sacks’s Mount Carmel is captured in the concluding moments of the life of Magda B, who had “a sudden premonition of death”. In Sacks’s account, “her tone was quite sober and factual, wholly unexcited… In the evening Mrs B went round the ward, with a laughter-silencing dignity, shaking hands and saying ‘Goodbye’ to everyone there. She went to bed,” Sacks continues, “and she died in the night.”Awakenings, which pitches the reader into the drama of many such moments, is a voyage into the strange and often disturbing mystery of the human brain.

Sacks’s stories become a kind of memoir, a neurological romance and a profoundly sympathetic essay on the human condition. Readers who watch Duncan Dallas’s TV documentary Awakenings, in conjunction with the book, will have an unforgettable insight into a unique neurological experiment.

A signature sentence

“Almost half of these patients were immersed in states of pathological ‘sleep’, virtually speechless and motionless, and requiring total nursing care; the remainder were less disabled, less dependent, less isolated, and less depressed, could look after many of their own basic needs, and maintain a modicum of personal and social life. Sexuality, of course, was forbidden in Mount Carmel.”

Three to compare

Jean-Martin Charcot: De la paralysie agitant: Leçons sur les maladies du système nerveux (1880)

Harold Pinter: A Kind of Alaska (1982)

Oliver Sacks: The Man Who Mistook His Wife for a Hat (1985)

THE GUARDIAN

THE 100 BEST NONFICTION BOOKS OF ALL TIME

The 100 best nonfiction books of all time

001 The Sixth Extintion by Elizabeth Kolbert (2004)
002 The Year of Magical Thinking by Joan Didion(2005)

003 No Logo by Noami Klein (1999)

004 Birthday Letters by Ted Hughes (1998) 

005 Dreams from My Father by Barack Obama (1995)

006 A brief History of Time by Stephen Hawking (1988)

007 The Right Stuff by Tom Wolfe (1979)

008 Orientalism by Edward Said (1978)
009 Dispatches by Michael Herr (1977)
010  The Selfish Gene by Richard Dawkins

011 North by Seamus Heaney (1975) 

012 Awekenings by Oliver Sacks (1973)

013 The Female Eunuch by Germaine Greer (1970)

014 Awopbopaloobop Alopbamboom by Nick Cohn (1969)

015 The Double Helix by James D Watson (1968)

016 Against Interpretation by Susan Sontag (1966)

017 Ariel by Sylvia Plath (1965) 

018 The Feminine Mystique by Betty Friedan (1963)

019 The Making of the English Working Class by EP Thompson (1963)

020 Silent Spring by Rachel Carson (1962)

021  The Structure of Scientific Revolutions by Thomas S Kuhn (1962)
022  A Grief Observed by CS Lewis (1961)

023 The Elements of Style by William Strunk and EB White (1959)
o24 The Affluent Society by John Kenneth Galbraith (1958)

025 The Uses of Literacy: Aspects of Working-Class Life by Richard Hoggart (1957)

026 Notes of a Native Son by James Baldwin (1955)

027 The Nude: A Study of Ideal Art by Kenneth Clark (1956)

028 The Hedgehog and the Fox by Isaiah Berlin (1953)

029 Waiting for Godot by Samuel Beckett (1952 / 53)

030 A Book of Mediterranean Food by Elizabeth David (1950)

036 Black Boy by Richard Wright (1945)

Illustration by Aidan Koch

Oliver Sacks: Sabbath

THE NEW YORK TIMES

AUG 14, 2015

MY mother and her 17 brothers and sisters had an Orthodox upbringing — all photographs of their father show him wearing a yarmulke, and I was told that he woke up if it fell off during the night. My father, too, came from an Orthodox background. Both my parents were very conscious of the Fourth Commandment (“Remember the Sabbath day, to keep it holy”), and the Sabbath (Shabbos, as we called it in our Litvak way) was entirely different from the rest of the week. No work was allowed, no driving, no use of the telephone; it was forbidden to switch on a light or a stove. Being physicians, my parents made exceptions. They could not take the phone off the hook or completely avoid driving; they had to be available, if necessary, to see patients, or operate, or deliver babies.

We lived in a fairly Orthodox Jewish community in Cricklewood, in Northwest London — the butcher, the baker, the grocer, the greengrocer, the fishmonger, all closed their shops in good time for the Shabbos, and did not open their shutters till Sunday morning. All of them, and all our neighbors, we imagined, were celebrating Shabbos in much the same fashion as we did.

Around midday on Friday, my mother doffed her surgical identity and attire and devoted herself to making gefilte fish and other delicacies for Shabbos. Just before evening fell, she would light the ritual candles, cupping their flames with her hands, and murmuring a prayer. We would all put on clean, fresh Shabbos clothes, and gather for the first meal of the Sabbath, the evening meal. My father would lift his silver wine cup and chant the blessings and the Kiddush, and after the meal, he would lead us all in chanting the grace.

On Saturday mornings, my three brothers and I trailed our parents to Cricklewood Synagogue on Walm Lane, a huge shul built in the 1930s to accommodate part of the exodus of Jews from the East End to Cricklewood at that time. The shul was always full during my boyhood, and we all had our assigned seats, the men downstairs, the women — my mother, various aunts and cousins — upstairs; as a little boy, I sometimes waved to them during the service. Though I could not understand the Hebrew in the prayer book, I loved its sound and especially hearing the old medieval prayers sung, led by our wonderfully musical hazan.

All of us met and mingled outside the synagogue after the service — and we would usually walk to the house of my Auntie Florrie and her three children to say a Kiddush, accompanied by sweet red wine and honey cakes, just enough to stimulate our appetites for lunch. After a cold lunch at home — gefilte fish, poached salmon, beetroot jelly — Saturday afternoons, if not interrupted by emergency medical calls for my parents, would be devoted to family visits. Uncles and aunts and cousins would visit us for tea, or we them; we all lived within walking distance of one another.

The Second World War decimated our Jewish community in Cricklewood, and the Jewish community in England as a whole was to lose thousands of people in the postwar years. Many Jews, including cousins of mine, emigrated to Israel; others went to Australia, Canada or the States; my eldest brother, Marcus, went to Australia in 1950. Many of those who stayed assimilated and adopted diluted, attenuated forms of Judaism. Our synagogue, which would be packed to capacity when I was a child, grew emptier by the year.

I chanted my bar mitzvah portion in 1946 to a relatively full synagogue, including several dozen of my relatives, but this, for me, was the end of formal Jewish practice. I did not embrace the ritual duties of a Jewish adult — praying every day, putting on tefillin before prayer each weekday morning — and I gradually became more indifferent to the beliefs and habits of my parents, though there was no particular point of rupture until I was 18. It was then that my father, inquiring into my sexual feelings, compelled me to admit that I liked boys.

“I haven’t done anything,” I said, “it’s just a feeling — but don’t tell Ma, she won’t be able to take it.”

He did tell her, and the next morning she came down with a look of horror on her face, and shrieked at me: “You are an abomination. I wish you had never been born.” (She was no doubt thinking of the verse in Leviticus that read, “If a man also lie with mankind, as he lieth with a woman, both of them have committed an abomination: They shall surely be put to death; their blood shall be upon them.”)

The matter was never mentioned again, but her harsh words made me hate religion’s capacity for bigotry and cruelty.

After I qualified as a doctor in 1960, I removed myself abruptly from England and what family and community I had there, and went to the New World, where I knew nobody. When I moved to Los Angeles, I found a sort of community among the weight lifters on Muscle Beach, and with my fellow neurology residents at U.C.L.A., but I craved some deeper connection — “meaning” — in my life, and it was the absence of this, I think, that drew me into near-suicidal addiction to amphetamines in the 1960s.

Recovery started, slowly, as I found meaningful work in New York, in a chronic care hospital in the Bronx (the “Mount Carmel” I wrote about in “Awakenings”). I was fascinated by my patients there, cared for them deeply, and felt something of a mission to tell their stories — stories of situations virtually unknown, almost unimaginable, to the general public and, indeed, to many of my colleagues. I had discovered my vocation, and this I pursued doggedly, single-mindedly, with little encouragement from my colleagues. Almost unconsciously, I became a storyteller at a time when medical narrative was almost extinct. This did not dissuade me, for I felt my roots lay in the great neurological case histories of the 19th century (and I was encouraged here by the great Russian neuropsychologist A. R. Luria). It was a lonely but deeply satisfying, almost monkish existence that I was to lead for many years.

During the 1990s, I came to know a cousin and contemporary of mine, Robert John Aumann, a man of remarkable appearance with his robust, athletic build and long white beard that made him, even at 60, look like an ancient sage. He is a man of great intellectual power but also of great human warmth and tenderness, and deep religious commitment — “commitment,” indeed, is one of his favorite words. Although, in his work, he stands for rationality in economics and human affairs, there is no conflict for him between reason and faith.

He insisted I have a mezuza on my door, and brought me one from Israel. “I know you don’t believe,” he said, “but you should have one anyhow.” I didn’t argue.

In a remarkable 2004 interview, Robert John spoke of his lifelong work in mathematics and game theory, but also of his family — how he would go skiing and mountaineering with some of his nearly 30 children and grandchildren (a kosher cook, carrying saucepans, would accompany them), and the importance of the Sabbath to him.

“The observance of the Sabbath is extremely beautiful,” he said, “and is impossible without being religious. It is not even a question of improving society — it is about improving one’s own quality of life.”

In December of 2005, Robert John received a Nobel Prize for his 50 years of fundamental work in economics. He was not entirely an easy guest for the Nobel Committee, for he went to Stockholm with his family, including many of those children and grandchildren, and all had to have special kosher plates, utensils and food, and special formal clothes, with no biblically forbidden admixture of wool and linen.

THAT same month, I was found to have cancer in one eye, and while I was in the hospital for treatment the following month, Robert John visited. He was full of entertaining stories about the Nobel Prize and the ceremony in Stockholm, but made a point of saying that, had he been compelled to travel to Stockholm on a Saturday, he would have refused the prize. His commitment to the Sabbath, its utter peacefulness and remoteness from worldly concerns, would have trumped even a Nobel.

In 1955, as a 22-year-old, I went to Israel for several months to work on a kibbutz, and though I enjoyed it, I decided not to go again. Even though so many of my cousins had moved there, the politics of the Middle East disturbed me, and I suspected I would be out of place in a deeply religious society. But in the spring of 2014, hearing that my cousin Marjorie — a physician who had been a protégée of my mother’s and had worked in the field of medicine till the age of 98 — was nearing death, I phoned her in Jerusalem to say farewell. Her voice was unexpectedly strong and resonant, with an accent very much like my mother’s. “I don’t intend to die now,” she said, “I will be having my 100th birthday on June 18th. Will you come?”

I said, “Yes, of course!” When I hung up, I realized that in a few seconds I had reversed a decision of almost 60 years. It was purely a family visit. I celebrated Marjorie’s 100th with her and extended family. I saw two other cousins dear to me in my London days, innumerable second and removed cousins, and, of course, Robert John. I felt embraced by my family in a way I had not known since childhood.

I had felt a little fearful visiting my Orthodox family with my lover, Billy — my mother’s words still echoed in my mind — but Billy, too, was warmly received. How profoundly attitudes had changed, even among the Orthodox, was made clear by Robert John when he invited Billy and me to join him and his family at their opening Sabbath meal.

The peace of the Sabbath, of a stopped world, a time outside time, was palpable, infused everything, and I found myself drenched with a wistfulness, something akin to nostalgia, wondering what if: What if A and B and C had been different? What sort of person might I have been? What sort of a life might I have lived?

In December 2014, I completed my memoir, “On the Move,” and gave the manuscript to my publisher, not dreaming that days later I would learn I had metastatic cancer, coming from the melanoma I had in my eye nine years earlier. I am glad I was able to complete my memoir without knowing this, and that I had been able, for the first time in my life, to make a full and frank declaration of my sexuality, facing the world openly, with no more guilty secrets locked up inside me.

In February, I felt I had to be equally open about my cancer — and facing death. I was, in fact, in the hospital when my essay on this, “My Own Life,” was published in this newspaper. In July I wrote another piece for the paper, “My Periodic Table,” in which the physical cosmos, and the elements I loved, took on lives of their own.

And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual, but on what is meant by living a good and worthwhile life — achieving a sense of peace within oneself. I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.

Oliver Sacks is a professor of neurology at the New York University School of Medicine and the author, most recently, of the memoir “On the Move.”

THE NEW YORK TIMES

DRAGON

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