The case study has a long history within medicine. It is an efficient way for doctors to present complicated or unique cases found in the clinic, and share them with other doctors and scientists. However, since the lurch towards evidence-based medicine, the case study had fallen somewhat out of favour. When Oliver Sacks published his first work Migraine, he received a lot of criticism from his peers, as case studies were seen as vulgar and perhaps even exploitative. It is hard to believe now, but there was a time when science communication was not as accepted and encouraged in the academy. The popular scientific medical case study is now a common format for physicians and physician-scientists to share their work and lives through, from Atul Gawande to Henry Marsh and many more. Today’s scientists and science communicators stand on the shoulders of giants: from Carl Sagan to, indeed, Oliver Sacks.
I have always been a great fan of Oliver Sacks. My love for his work, his mind and his sensitivity was first ignited after reading The Man Who Mistook His Wife for a Hat. My passion for neuroscience, neurology and neuropsychology was without doubt fuelled partly by Dr Sacks. But, perhaps, no book of his has been so materially influential on my own life as his 1995 work An Anthropologist on Mars. While some of the terminology, many of its theories and speculation, and most certainly the statistics mentioned in the book, have changed, the fundamental truth of the book remains.
In An Anthropologist on Mars, the reader is introduced to a myriad of characters. From the painter who, after an accident, could only see in greyscale, to the surgeon with Tourette’s. But it is the last chapter – the one the book gets its name from – that stayed with me the most. The eponymous chapter follows an animal scientist named Temple Grandin. A scientist with autism. As I read on, I found myself relating to some of the descriptions of Dr Grandin and some of her experiences of existing in the world. I, too, was a sensory seeking child in many ways. I peeled the textured wallpaper that paved the way up the stairs, I delighted in walking and playing barefoot on the textured tiles of the garden of my childhood home, I plucked at and smelled the plants in our garden, I enjoyed spinning or laying upside down until I would get slightly dizzy, and, like Temple, I could spend hours in my own little world. Temple’s world of directness, missing social cues and manually applying, rather than intuitively sensing, social rules, norms and emotions is identical to my own. As Temple said: “Much of the time, I feel like an anthropologist on Mars.””
“Much of the time,” she said, “I feel like an anthropologist on Mars.””
As I read her story, one with many similarities and some differences to my own story, a thought that had occurred to me approximately 6 years earlier resurfaced. Was I also autistic?
On June 12 2023, both everything and nothing at all changed. I was formally diagnosed with an Autism Spectrum Disorder which did not quite come as a surprise. I finally had an explanation for why I could barely (most recently, not at all) tolerate crowds, why I could never seem to really connect to people beyond the surface, why everything was so much harder for me than it was for others, why I had been an insular child with intense interests and why I grew into an insular adult with intense interests. And why I mostly preferred it that way. The neuropsychologist brought the news with the gentle directness and sensitivity that would make Oliver Sacks proud, and left room for it to sink in in silence. I was not surprised. I had known all my life. Consciously and unconsciously. I, too, was an anthropologist on Mars.
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Getting an official diagnosis brought with it an intense sense of relief – feeling like an outsider (autsider if you will), my constant observing and analysing, had a cause – and a deep sense of grief. The grief was not for a neurotypical or non-disabled life. I had never lived one. It was mostly for the parts of my childhood where being misunderstood, oblivious and alone made me wonder if there was something wrong with me. And for the moments where I would relentlessly cross my own boundaries and overexert myself in an attempt to get by like everybody else. For the times where I would have no energy left to do anything but eat and sleep after a long day at school or at the lab. For the misunderstandings, the lost friendships, the feelings I had unwittingly hurt and my feelings that were hurt by others by the mislabelling of my intentions. A simple diagnosis caused a whirlwind of feelings that left debris that will take longer than three months to sift through.
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Dr Grandin isn’t the only person with autism mentioned in An Anthropologist on Mars. An autistic couple, Mr and Mrs B, who have two autistic children, described their autism as follows:
Indeed, in some autistic people this sense of radical and ineradicable differentness is so profound as to lead them to regard themselves, half-jokingly, almost as members of another species (“They beamed us down on the transporter together,” as the B.s liked to say), and to feel that autism, while it may be seen as a medical condition, and pathologized as a syndrome, must also be seen as a whole mode of being, a deeply different mode or identity, one that needs to be conscious (and proud) of itself.
For me, autism is also a deeply different mode or identity that needs to be conscious (and proud) of itself. Whilst sensory overload and panic attacks in crowded, bright, loud and smelly places are debilitating, and while migraines and exhaustion as a simple consequence of socialising, or panic rising in your chest because a plan was suddenly changed, can also be debilitating, my autism has brought me so much as well. If I am interested in something, I can easily become an expert. I have moments of intense focus where the world seems to disappear. I recognise patterns. My hypersensitive smell has more than once saved me and those around me from consuming spoiled food. I am a rational and analytical person. My directness is not always a curse but is often appreciated by the right people (note: I am never deliberately rude, not even when being direct). And my sensory sensitivities can cause intense pleasure when wandering around nature as much as it can overwhelm. There is no use, and I have no interest, in changing who I am. Perhaps I am a member of a different species, beamed down on the transporter with Mr and Mrs B, or maybe I am like an anthropologist on Mars. But I wouldn’t change it for the world.
Perhaps I am a member of a different species, beamed down on the transporter with Mr and Mrs B, or maybe I am like an anthropologist on Mars. But I wouldn’t change it for the world.
Dr Oliver Sacks, his interest in human stories and the narratives that make medicine what it is at its best, has without a doubt changed people’s lives and society’s attitudes. A man who helped introduce a wider public to autism and a man who reminded us how adaptable the human mind is, is the reason I have found my true self and true identity at the age of 26. The medical case study, human stories, underpin evidence-based medical science. Facts and scientific theories and rigorous use of the scientific method are what separates (in the best of circumstances) our current science from its past iterations. However, without an understanding of the humanity beneath the science, our science would be insufficient. We wouldn’t be people but mere automatons. Luckily, as Dr Sacks demonstrated, we are so much more than that.
The Dot. 