Unexplainable - Oliver Sacks's not quite nonfiction

Episode Date: March 23, 2026

Oliver Sacks was once crowned “the poet laureate of medicine” — he's known as one of the greatest science writers of our time. But when New Yorker writer Rachel Aviv dug into his archives, she discovered that some details in his intimate portraits of patients mirrored his personal life a little too closely. Guest: Rachel Aviv, staff writer for the New Yorker and author of Strangers to Ourselves. For show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And please email us! ⁠⁠⁠[e-mail]⁠⁠⁠ We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Visit BetMGM Casino and check out the newest exclusive. The Price is Right Fortune Pick. BetMGM and GameSense remind you to play responsibly. 19 plus to wager. Ontario only. Please play responsibly. If you have questions or concerns about your gambling or someone close to you, please contact connects Ontario at 1-866-531-2,600 to speak to an advisor,

free of charge. BetMGM operates pursuant to an operating agreement with Eye Gaming Ontario. Square note that in hospitality, officiacy is. everything. That's why their system lets you take payments. Track sales, handle inventory, manage staff, send invoices, and keep up with finances all in one place. Apply through orders with zero mistakes. Get the data you need and keep everything working together. So you're ready for whatever's next. Learn more about their customizable plans at squareup.com. I recently sat down with one of my favorite writers. I'm Rachel Levive and I'm a staff writer at The New Yorker. But I called her up to talk

about a different writer. I think I remember the first story I pitched for The New Yorker. I, like, tried to make it clear, like, don't worry. I'm not trying to do an Oliver Sacks piece because I didn't want them to think that I was daring to compete. I really admired his ability to just, like, delve deeply into the inner life of one person. The late neurologist and best-selling author, Oliver Sacks,

he's been referred to as the poet laureate of medicine. It was sort of like almost the figurehead for medical humanities in a way, like this idea that we have been focusing too much on symptoms and data and that there is a human life behind all of this information. Oliver Sacks did something kind of wild for his time. He was a medical doctor who wrote intricate stories about the inner lives of his own patients. I do remember being in my early 20s reading,

a piece he'd written about a man who was blind and was sort of grappling with the possibility of regaining his sight. I loved how he was focused on one person, sort of one person's journey. He was so focused on the inner life of this person and that it was so textured. Kind of was like, how did he know those details? How did he know that that man was thinking that? Maybe the best example of one of these stories is from the book Awakening's, which he published, in the early 1970s. He writes about spending 15-hour days at a hospital with a group of patients suffering from a disease called

Encephalitis Lethargica, a sickness that left them catatonic, basically asleep while awake. Patients that know other doctors were really paying attention to and kind of developing a wordless rapport with people that were really easy to dismiss as sort of not fully cognizant. And he spent so much time with him

that he was able to sort of detect that they were not comatose in the way that other people thought they were. That book was adapted for the screen and became an Academy Award-nominated film. It starred Robert De Niro as a patient named Leonard and Robin Williams, who played a fictional Oliver Sacks.

Towards the end of the movie, he gives a speech about the awakening of the human spirit. that the human spirit is more powerful than any drug, and that is what needs to be nourished with work, play, friendship, family. These are the things that matter. This is what we've forgotten, the simplest things. Basically, he meant human connection could somehow awaken the spirit,

beyond medical care, alone. Late last year, Rachel wrote a huge magazine story about Oliver Sacks for The New Yorker. I became aware that Oliver Sacks had this enormous archive. An archive of diaries and letters that Sacks had kept over decades. He documented not just the lives of other patients, but his own experience as a patient in therapy. Rachel got in touch with his foundation and got permission to take a look.

I was like, how is this possible that this amazing man was in therapy for 50 years. Like, what does a half-century psychoanalytic process look like? I was just like, this man is so articulate about other people's psychic lives, what is happening in the therapeutic process, and how much can someone change in 50 years of therapy? Like, how far does self-knowledge go? Today, we're going to follow Rachel Levieve's journey

through the life of one of the most famous science writers of our time, a profile of a man known for his truth-telling in medicine, who Rachel discovered bent the truth. In his journals, he would just sort of reflect on what he had done and try to make sense of it, and he would sort of think through, like, art is the lie that tells the truth. Am I doing art, or have I crossed a line? I'm Amy Padula. This is unexplainable.

So for all of Oliver Sacks's writing about the super intimate details about the lives of patience, He didn't share much about his own life with the public for most of his career. In a 2002 interview, he said that his severe shyness, which he described as a disease, had been a lifelong impediment to his personal relationships. And for most of his life, he lived alone. What were some of the most surprising anecdotes or sort of things you learned about what was going on for him in his personal life? One of the most amazing sets of correspondence that I read was Sax's letters to this man who lived in Berlin at the time. And they had met in Europe, they'd had this whirlwind romance.

And then Sachs moved to New York. After a couple weeks, Sachs went back home to New York City. And the two start writing to each other. And then their entire affair took place in these letters. and they were just like thrilling letters. Each one, it was like Sacks was trying to outdo himself to find new expressions of, like, the intensity of his love and his sense that he was merging with this man

and that for the first time in his life, he felt at peace with being a gay man. He was seeing the world through new eyes. Sachs wrote about these intense feelings. There's a line that describes his happiness. I wonder if you could recall it. My blood is like champagne, and then two weeks passed in which he didn't get a letter from this man. And suddenly, like, all of Sax's kind of euphoria turned in on him.

And he started to think, like, I was delusional, like, I was part of a two-man delusion. Like, this was never love. I'm always going to be alone, and I always have. The man eventually wrote to apologize. But for Sachs, the damage was done. And he was like, yeah, this is the truth. I will be in a spiritual cell for my entire life. And he finally just completely cut off the relationship with this man

and then began to feel suicidal, which led to him beginning therapy for the next 50 years. After that early relationship, Sack suffered. He couldn't make friends. He couldn't connect with people. He became celibate and wrote obsessively. Some of his correspondence with other gay men in the 50s and 60s,

and 70s and even 80s, like the sort of anguished state of being a gay man at that time. I think it's easy to almost forget how excruciating it was then. And so many of the people he was corresponding with, they would be like testing the waters to see if they could reveal to the other one that they were gay. There was so much sort of self-hate and sort of tortured conversation around it. 30, 40 years ago felt really alive in his letter. as well as his journals, just the sense of, like, self-punishing, self-hiding experiences. I could see how he was sort of expressing a feeling of stuckness in life.

Was there a moment in the reporting where you started to realize that his personal life was seeping into the work? So I had read many of his letters. I went back and I did a lot of rereading because it was like the first time I read everything, I didn't know what I was looking for. And then there would be times, like, at one point, I was rereading Awakenings. And I remember reading one of the patients describing her blood as being like champagne, which was striking because, you know, that's the phrase he'd used in his letters to this lover from Berlin.

So there were just these kinds of, it was almost like rhymes between his own descriptions of himself and his descriptions of his patients. One of the most striking rhymes that she found had to do, with a particular poem by Rilke. The poem is about a panther who feels trapped, caged. Where had you seen that poem before? It was in his letters to describe how he felt when he was trying to write his first book about migraines.

And I just remembered that phrase, and then I searched through my notes, and I saw another reference where he had also used that phrase in a letter to his therapist. So it was clearly an important poem for him and his own self-conceptualization. in these moments of crisis. The poem evoked something similar

to the way Sacks was feeling in his journals about not being able to express his sexuality and his personal life, not being able to connect. And then I was reading awakenings, and I was reading the chapter about Leonard, who's sort of the star of the book. Leonard, played by Robert De Niro in the movie adaptation,

suffers from a sleeping sickness. He lives in a sort of trans-like state. Sacks gave patients like Leonard a drug called L. Dopa, which changes the brain's dopamine levels. In his book Awakenings, Sacks writes that Leonard would spell out answers to questions that Sacks asked him because he couldn't speak. I just noticed that he said that Leonard typed out on this, like, typing board, that he felt like the Panther and Rilk's poem. In the movie adaptation, Robin Williams, as Oliver Sacks, reads that poem. His gaze from staring through the bars has grown so weary that it can take in nothing more. For him, it is as though there were a thousand bars, and behind the thousand bars, no world.

As he paces in cramped circles over and over. I thought, like, that's a strange coincidence that his patient would happen to sort of cite this poem, had been so meaningful to Sacks. And then I became kind of more attentive to those moments. What was going through your mind as you saw these rhymes, as you put it, play out? Was there any betrayal you felt as a reader seeing this kind of like appear in the records? Yeah, I mean, I think that made me feel like, okay, well, I can't trust that any particular detail is true. Did Oliver Sacks know he was fabricating things?

Yeah. It was really reading the journals. After I had been reading them for a couple months, when I just read a passage where he straight out says, you know, I feel like so, I can't remember the exact phrasing, that he's feeling this sense of criminality and that he feels so guilty for making things up. I would say that a man who mistook his wife or a hat

had a lot of fabrications in it. that book then made him extremely famous. And I think he felt a lot, like much of the guilt that he expresses in his journals is about that particular book. But like the strange thing is when that book was about to be published, he wrote his brother and said, like, you might call these confabulations. They're sort of half story, half fable, half made up. He was pretty open about the status. So I don't know what happened in the publishing process. Somehow these were taken as like cases.

studies that were supposed to be straight fact. And he seemed pretty clear early on that that's not what they were, at least to himself. But suddenly it became wildly famous and he became this huge figure. Sacks himself says like this was my most flagrant fabrication. And it involved these two twins who had autism, who were institutionalized. And Sacks said that they were like exchanging prime numbers up to, I think, 20 digits. And, and that they were, like, exchanging prime numbers up to, I think, 20 digits. And that finding got a lot of attention because no one had known this to be a human capacity. And so psychologists and mathematicians had written about this with some really defending the importance of this finding. And so that felt really like a space where a case study

had actually like had an impact on people's understanding of human capacities. So I think I tend to agree with Sacks that that was the most flagrant moment or transgression. Rachel's magazine story came out in December of last year, and it got people talking. I did see people on the internet, like putting on, putting their own headlines on the piece and sort of making it all about, you know, he fabricated. That kind of felt sad to me because that didn't feel like if I wanted it to be more complicated than just, oh, let's dismiss Oliver Sacks. he was making stuff up. We'll be back after a short break.

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You talked about how some of the comments that you saw in your piece, the sort of TLDR headline, Sacks fabricated stuff, which is true, but you also said that was frustrating. And I'm wondering why. Something interesting happened where I couldn't, like, tell you quite who or what. But I felt like there was a contingent of, like, anti-science people on social media. It almost was like, oh, look, this sort of liberal darling of science fabricated things. Like, science is a sham.

I guess I also just felt like the takeaway of my story I did not want to do. to be just, oh my God, let's like throw sacks out the window. He fabricated things. And so that seemed like there was some of that going on and I was sad about that. But like it's within this like much larger context of like one man's sort of struggle, you know, during the time when he was fabricating a lot of other sort of literary stars were doing similar things. So it's also within a historical context. But yeah, I think there are moments in which, to me, it was almost the projection that was most striking, like taking phrases that he used to describe his own angst and sort of putting it on to his patience. I guess I wanted to think about how those

fabrications or those sort of exaggerations feel revealing of dynamics in the way we respond to this kind of writing and the way that other people respond to it and the kind of expectations we have for, like, what empathy as a writer looks like. I think it's more about this genre of writing that he inspired, this sort of telling, tells about illness that are kind of supposed to inspire or show you, like, the secret gift of your illness. I think, like, if anything, I would want it to inspire, like, more kind of thinking about the relationship between, like, a writer and a subject, and particularly a sort of doctor and the patient subject, and how much of ourselves we bring onto that encounter sometimes

without realizing sometimes. Do you know how any of his patients felt about his rendering of them? Leonard's family loved him. They didn't necessarily think the book was all accurate, but they were just so grateful for the time and the care that he had put into that relationship. Like, the families said that Leonard and his mother just adored him. And the other patients I talked to as well really adored him. They didn't fundamentally care, you know, about, like, how they were written about in this book.

What they cared about was that there was this doctor who was, like, sitting with them for hours, trying to understand them and making them feel, you know, like that they were someone who had a story to tell. A huge part of Sacks's life that Rachel's story eliminates was his ongoing struggle with his sexuality. After that early relationship in Berlin, he lived unhappily closeted and celibate for decades. You unpack some of his battles in therapy and how some of that was getting worked out in the writing. At one point in the piece, you suggest that Sacks spent much of his life searching for love. He once wrote, we spend our lives searching for what we have lost, and one day perhaps, we will suddenly find it.

I just wonder what you make of that as you were sort of seeing these patterns crop up in the work. I mean, that idea that in therapy you're like working through, I like that phrase working through because I think like probably most writers choose subjects to some degree

because they're working through ideas that are like important or problematic to them. And then they sort of displace it onto these other subjects where they're working through. And it felt like he was like rehearsing this narrative, which was someone who is trapped in this cell, this sort of spiritual cell, this sense of being in a cage,

suddenly is kind of released and has this awakening. And many of his stories have that arc. And so then it was striking to see, I mean, it was almost like the longed for, outcome that he keeps sort of playing out in his work. Do you think about what you do as a reporter any differently after learning about how Sacks identified with his subjects? Do you think differently about what you do at all?

I think it was like part of a longer conversation with myself. As I age as a writer, my curiosities change and my identifications change. And so therefore, like, when I'm writing a story about a family, for instance, like, I'm going to, I might actually change the kinds of questions I'm looking at because of where I am in life. Or I find that I'm often, like, writing about people with complicated relationships to work. And that's because I'm, there's a question I have about my own relationship to work. So, yes, I think, like, writing is always a kind of working through. And in a way, I think that if it's not a working through, it's less rich. Like if you're writing about something about which you have no sort of unsettled questions

and curiosities, then the writing can be flatter for it. So I think you do want some of that kind of like identification and projection energy, but it can be taken way too far and too far in unethical ways and in really problematic ways. So it feels like a subject that does have stakes. in my life and in sort of any kind of writing. He was a physician treating them and a writer observing them. And I wonder if anything came up for you in terms of like that split role. Yeah, I mean, I think there was some like problematic like R.D. Lang type stuff going on where like,

like R.D. Lang is the psychiatrist who kind of wanted his patients with psychosis to like, it was almost like he was bringing their psychosis to full fruition so that he could, gain more insights about the nature of madness. And Sachs actually writes about that, too, that kind of guilt that, like, some of his patients with Tourette syndrome, he would, like, want their ticks to reach, sort of tick as, to become floridly symptomatic, essentially, because he felt like in that process, he as the writer and the researcher was sort of gaining more insight into the nature of the disease. And I think he, like, told himself that that could be good for the patient,

while also sort of realizing it was fundamentally, like, you know, helping his project. After he had become famous for books like Awakening's and the man who mistook his wife for a hat, Sacks did this interview in 1989 with a reporter from PBS. A hundred years from now, how would you like to be remembered? I would like it to be thought that I had listened carefully to what patients and others had told me that I'd try to imagine what it was like for them and that I'd try to convey this and to use a biblical term, the feeling he bore witness. I think like bearing witness in medicine has come to mean,

like you are sort of present in someone's moment of a suffering to allow them to feel that they are seeing and they are heard and that they're not alone and that you're kind of like doing this thing where you're not turning away. Like other people, it's just too hard. This idea of bearing witness is very kind of central in medical humanities. But I don't know that you can also,

you can bear witness and also like write a story about, someone. Those are two very different acts. And I think Sacks was sort of merging them both and presenting a model of how both can be merged. And there's a lot of like self-interest involved, or not self-interest, but sort of you have like a, your mind is doing calculating things when you're thinking about how someone becomes a story. And when you're bearing witness, I think you need to be blank in a way that you probably can't be as sort of an authorial, like, imagination. Sack said he wanted to be remembered as someone who bore witness. And I get that, but I also think that it is very hard to do that

when you're, like, telling a sort of magical fable about someone's illness and sort of the gifts that it might have bestowed upon them. What I find so fascinating about this story, is that there's Oliver Sacks the doctor and Oliver Sacks the writer and Oliver Sacks the man. And what happens when all of those versions of Sacks collide into each other? I think anyone would kind of say that one of the genius things he did was to see all these patients who were in, like, comatose states, and other doctors had dismissed them, and he saw something in them.

Like, he felt a sense of identification. Because he also saw himself as, like, the living dead and someone who'd been buried alive, these were words that he used. I think he was capable of imagining that there was, like, a real person. There was, like, a real consciousness, a real lively intelligence, like, sucked away by this illness inside these people. And so he spent enough time with them to realize that that was true. So I think, like, part of that identification and projection, like, allowed him, to make the discoveries he made.

And then the second half of that was that the projection and the identification sort of obscured the specificity and possibly like the suffering of what they were going through because he kind of made their lives beautiful. I'm curious, like, how we turn our own emptiness in our life into art

and what the costs of that are, how we manage that. Through that process of bearing witness to other people. Sacks was also working through something in himself. I was also, like, moved by his honesty and the pain of kind of trying to figure that out himself. Everyone, like, hides things from themselves, but I felt like he really was trying to sort

of figure out, like, both justify it and flagellate himself for it. By 2008, Oliver Sacks. had met someone, another writer. His name was Bill Hayes. He was a science writer. They had lunch one day, and it just sort of proceeded from there. At the end of his life, he falls in love, and I just loved that you could find love at age 76. He was so stuck for all those years.

He couldn't come out for all those years. He was doing his best to try, and it's just, yeah, that felt like sort of, I guess tragic but beautiful in a way, like just that sheer effort to sort of understand yourself, even if you really can't. This episode was produced by me, Amy Padula. It was edited by Julia Longoria with help from Joanna Solitaref, mixing and sound design from Christian Ayella and music from Noam Hassanfeld. Melissa Hirsch checked the facts.

Jorge Just is our editorial director. Sally Helm and Meredith Hodnott are two of all the great poet laureates of Unexplanable. And Bird Pinkerton sat on the A-Train as it barreled towards Washington Heights. She figured someone might think she looked weird or something. She had a broken platypus guitar on her back, an octopus key around her neck, and a boomerang sticking out of her pocket. But nope, just a normal day on the subway. As always, thank you to Brian Resnick for co-creating the show with Noam and Bird.

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