Oliver Sachs is Dying

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Oliver Wolf Sacks, CBE (born 9 July 1933) is an American-British neurologist, writer, and amateur chemist who is Professor of Neurology at New York University School of Medicine. Between 2007 and 2012, he was professor of neurology and psychiatry at Columbia University, where he also held the position of “Columbia Artist”. Before that, he spent many years on the clinical faculty of Yeshiva University‘s Albert Einstein College of Medicine. He also holds the position of visiting professor at the United Kingdom’s University of Warwick.[1] 

Sacks is the author of numerous best-selling books,[2] including several collections of case studies of people with neurological disorders. His 1973 book Awakenings, an autobiographical account of his efforts to help victims of encephalitis lethargica regain proper neurological function, was adapted into the Academy Award-nominated film of the same name in 1990 starring Robin Williams and Robert De Niro. He and his book Musicophilia: Tales of Music and the Brain were the subject of “Musical Minds“, an episode of the PBS series Nova. [ from Wikipedia]

In a recent essay in the New York Times, “My Own Life,” Sachs announced that he has terminal cancer.

A month ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver … now I am face to face with dying. The cancer occupies a third of my liver, and though its advance may be slowed, this particular sort of cancer cannot be halted.

It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can. In this I am encouraged by the words of one of my favorite philosophers, David Hume, who, upon learning that he was mortally ill at age 65, wrote a short autobiography in a single day in April of 1776.

I have devoted a previous post to Hume’s courage in the face of death, and this line from Hume particularly resonates with Sachs: “It is difficult to be more detached from life than I am at present.”  Here is the rest of the brief essay in full.

Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.

This will involve audacity, clarity and plain speaking; trying to straighten my accounts with the world. But there will be time, too, for some fun (and even some silliness, as well).

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming.

This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future. I rejoice when I meet gifted young people — even the one who biopsied and diagnosed my metastases. I feel the future is in good hands.

I have been increasingly conscious, for the last 10 years or so, of deaths among my contemporaries. My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

My Thoughts

When I think of all the athletes and soldier and financiers and tycoons and actors and all the others who garner so much adulation from our culture, and compare them with the scientists who work in obscurity to shed a little light on our ignorance, I am ashamed that so many care more for the former than the latter.

I thank Professor Sachs for a lifetime of beneficial work in the service of humanity, and for his beautiful New York Times essay which exemplifies his intellectual and moral virtue. Goodbye Professor.

The nations wax, the nations wane away;
In a brief space the generations pass,
And like runners hand the lamp of life
One unto another. ~ Lucretius

Hume on Suicide

Of Suicide” by David Hume

David Hume (1711-1776) was a Scottish philosopher, economist, historian and one of the most famous figures in the history of Western philosophy and the Scottish Enlightenment. Hume is often grouped with John Locke, George Berkeley, and a handful of others as a British Empiricist. Hume begins his essay like this:

One considerable advantage that arises from Philosophy, consists in the sovereign antidote which it affords to superstition and false religion…when sound Philosophy has once gained possession of the mind, superstition is effectually excluded; and one may fairly affirm, that her triumph over this enemy is more complete than over most of the vices and imperfections incident to human nature.

Philosophy is an antidote to the superstition and irrationalism that make our lives miserable. The superstitious cannot even take refuge from their misery in sleep because they are haunted by their dreams; nor can they take refuge in their death, even if they are quite miserable or in pain, since they fear offending the gods. Therefore superstition forces them to stay alive, even when dying would be preferable. When fear of death is joined by superstition the result “deprives men of all power over their lives…” We fear bringing about death even though it would often be better to do so.

Hume now turns to the examination of suicide “to restore men to their native liberty … ” He has in mind the superstition that prevents people from committing suicide when in pain. Hume distinguishes the laws by which the gods govern nature, and the laws by which humans govern themselves. Just as nature carries on without considering the interests of humans, so humans may use the power the gods have given them regarding their own happiness. Thus people don’t incur the wrath of a god by exercising their will since the gods have given them this power. If it would be against the gods’ province to choose to commit suicide, then it would be against the province of the gods to preserve life by saving someone from an oncoming boulder.

Similarly, since according to the laws of nature an insect can destroy human life, it would be strange if humans weren’t granted such powers regarding their own lives. Hume believes that the gods must have given us the power to escape a bad life. Consider that if our enemies hurt us, most will allow us to fight back. Why then demand that I resign myself to inaction if threatened by pain and suffering? So Hume argues that people’s lives are their own, to dispose of as they choose because the gods have given us this power. That is why we dam rivers and create vaccines, or act as heroes and risk our lives; we use the power the gods have given us to change the world.

Hume argues that committing suicide does no harm to society. He also says that when we are dead, we no longer receive benefits from society, and hence we no longer have obligations. But even if we did have obligations, surely they are limited. If we are not obligated to do a small good for society at great expense to ourselves, then we are not obligated to suffer greatly for some small benefit to society. If I am old and infirmed I may quit my job, thereby ceasing contributing to society. So why may I not quit life? And if the continuation of my life is a burden to society, then I should be praised for ending it. Or if you are about to be tortured for crimes against society, wouldn’t putting yourself to death be in the public’s interest? That wouldn’t invade the realm of providence anymore than those who ordered the torture did.

I agree with Hume. We should generally respect individual autonomy, including the choice to not live longer.

Alan Watts: On Insecurity and Anxiety

A few days ago I wrote a post about the thought of Alan Watts, a popularizer of philosophy who I discovered long ago.  And yesterday I wrote about depression and anxiety. The combination of these two posts reminded me of a book by Watts that I had forgotten about: The Wisdom of Insecurity: A Message for an Age of Anxiety (1951).

In the book Watts wrote about mindfulness a half century before it became popular. He argued that our inability to be mindful is the root of much of our anxiety. We claim to only enjoy the present if we are assured of a happy future, but there are no such assurances. In fact we can’t really experience the future. So to be happy we must live in the present, we must be mindful.

Watts also believed that Western culture was neurotic. In it people spend their days doing jobs they hate for money, but which bring little happiness. As he said elsewhere about money: “If you say that money is the most important thing, you’ll spend your life completely wasting your time: You’ll be doing things you don’t like doing in order to go on living, that is, in order to go on doing things you don’t like doing — which is stupid!” Instead we should use our minds, if possible, to be creative, which is to be in the present.

Still most of us anxiety and insecurity confronted with life’s constant change. Most of all we want to hang on to ourselves, but this is an illusion. For, as we pointed out in a previous post, there is no enduring self or ego or I. Here is Watts explaining this lack of self:

While you are watching this present experience, are you aware of someone watching it? Can you find, in addition to the experience itself, an experiencer? Can you, at the same time, read this sentence and think about yourself reading it? You will find that, to think about yourself reading it, you must for a brief second stop reading. The first experience is reading. The second experience is the thought, “I am reading.” Can you find any thinker, who is thinking the thought, I am reading?” In other words, when present experience is the thought, “I am reading,” can you think about yourself thinking this thought?

Once again, you must stop thinking just, “I am reading.” You pass to a third experience, which is the thought, “I am thinking that I am reading.” Do not let the rapidity with which these thoughts can change deceive you into the feeling that you think them all at once …

In each present experience you were only aware of that experience. You were never aware of being aware. You were never able to separate the thinker from the thought, the knower from the known. All you ever found was a new thought, a new experience.

This is the doctrine of no-self in Buddhism, and the same point that David Hume made when he said:

For my part, when I enter most intimately into what I call myself, I always stumble on some particular perception or other, of heat or cold, light or shade, love or hatred, pain or pleasure. I never can catch myself at any time without a perception, and never can observe any thing but the perception…. If any one, upon serious and unprejudic’d reflection thinks he has a different notion of himself, I must confess I can reason no longer with him.

But why then is the idea of the ego so entrenched? Watts thinks that psychological continuity is to blame.

If you imagine that memory is a direct knowledge of the past rather than a present experience, you get the illusion of knowing the past and the present at the same time. This suggests that there is something in you distinct from both the past and the present experiences …

But, as a matter of fact, you cannot compare this present experience with a past experience. You can only compare it with a memory of the past, which is a part of the present experience. When you see clearly that memory is a form of present experience, it will be obvious that trying to separate yourself from this experience is as impossible as trying to make your teeth bite themselves.

To understand this is to realize that life is entirely momentary, that there is neither permanence nor security, and that there is no “I” which can be protected.

I am more philosophically sophisticated than when I first read Watts. But reading him never ceases to surprise me. He seems to have a unique talent to express the nearly inexpressible. It seems there is a wisdom to insecurity.

Depression & Anxiety: Freedom Without Responsibility

Consider these two questions: 1) Are you responsible for being depressed or anxious? And 2) Should you feel guilty or ashamed of being depressed or anxious? Let’s consider the first question.

Here are four possibilities:

1) You’re not free, and thus you are not responsible for being depressed;
2) You’re free, and thus you are responsible for being depressed;
3) You’re not free, but you are still responsible for being depressed;
4) You’re free, but you are not responsible for being depressed.

Consider the benefits and costs to each option:

  • The benefit of adopting #1 is that you don’t feel responsible for your situation; the cost is that you don’t feel free to change your situation.
  • The benefit of #2 is that you do feel free to change your situation; the cost is that you feel responsible for your situation.
  • This view only has costs; you don’t feel free to change your situation, and you do hold yourself responsible for your situation.
  • This view only has benefits; you feel free to change your situation, and you don’t feel responsible for your situation.

From a cost/benefit analysis you should choose #4. Why don’t people do this? Probably because they don’t think #4 makes sense. Most people think that either #1 or #2 is true. But #3 and #4 are possibilities too. We might live in a determined world where people should be held responsible (#3). Our mental states might be determined, but we are responsible for taking drugs or going to counseling to change those states. Or we might live in a free world where people shouldn’t be held responsible (#4). We might be free to choose our actions and mental states, but not be responsible for them because determinism is very strong.

I’m not saying which if any of these options best represents the state of the world, I’m just saying we don’t know which one is best. We can’t definitely answer the question, “Am I responsible for being depressed or anxious?” What we can say is that you might as well believe #4. To do this just accept that the past is determined, it is closed—you can’t affect it. But the future is not determined, it is open—you can affect it. (These claims could be wrong if backward causation is possible, or if fatalism is true. But almost no professional philosophers hold such views.) So it is easy to believe that we are free but not responsible.

Now consider the second question: Should you feel guilty for being depressed or anxious? Here an insight from Stoicism is invaluable—we can’t change the way some things are, but we can change our view of those things. Guilt and shame are attitudes toward reality that we can reject. So just say, “I will not feel guilt or shame.” Of course we can choose shame and guilt, and if we do we shouldn’t feel guilty about that either. But we can choose not to do this too. We can say, to hell with guilt! So go ahead and say it. To hell with guilt! Remember, guilt is something that other people or organizations use so that they can control you. Don’t let them manipulate you. Control your view of things.

Now suppose you try to change your attitude, but a week or a month or a year later you still feel guilty about being depressed. I say keep trying, but don’t feel guilty about feeling guilty. Remember, you’re only free, if at all, regarding your actions in the present! And the present recedes into the past instantaneously. So just keep telling yourself: “right now I’m free to try to reject guilt, and if I’m not successful I won’t feel guilty.”

But don’t try to hard either. Things take time, patience is a virtue. Relax, accept yourself, and let the guilt slowly recede. Remember that everything changes, and you will too. Go with the flow, change with the universe, and don’t fight too hard. Flow as peacefully as possible down the river of life.

In other words, don’t forget the Taoist concept of wu wei. Wu wei literally means “without action”, “without effort”, or “without control.” It also means “action without action” or “effortless doing” or “action that does not involve struggle or excessive effort.” This doesn’t mean that we shouldn’t act or that the will is bad, but that we should place our will and actions in harmony with nature. And sometimes nature will take time to cure our ailments. Sometimes we just have to wait for things to pass. And all things will pass.

The Big Questions – The Circle

Think about some of the most important questions human beings can ask: 1) What should we believe? 2) What should we do? 3) What type of people should we become?

Regarding the first question I am a Humean. We should proportion our assent to propositions based on reason and evidence. Fortunately we have a large body of scientific knowledge which does just this. Following the lead of science gives us the best chance of having our beliefs correspond to reality, thereby increasing our chances of living well.

The second question takes us into the realm of ethics, politics, career choice and other practical concerns. Unfortunately, it is almost impossible to give a general answer to the question, how should we live. But we are probably best advised to look to the Buddhism, Stoicism and other profound philosophies of life for such answers.

The third question doesn’t demand an answer so much as a transformation. It is relatively easy to say, for example, that we should be rational, peaceful and loving, that we should study, meditate, exercise and do productive work. But transforming ourselves is difficult. If our first question was about theoretical knowledge, our second about practical knowledge, this third question is about putting knowledge into practice.

So there you have it. We should think scientifically, act so that we and others do well, and achieve psychic harmony. Still we can’t do any of this by ourselves. We also need a planet with air and water to sustain us, and a society that provides the chance to learn and the freedom to act and transform.  But we can’t have a good planet or environment or society without good people to care for those things. And we can’t have good people without a good society that produces good people.

So we are caught in a circle, hoping that it is a positive feedback loop. Hoping that our efforts will slowly transform both ourselves and our environment to increase the chances that we flourish. It’s a lot to wish for.