Stereo Sue, or the Quale of Sobriety

The June 19 New Yorker has an essay titled “Stereo Sue” by the neurologist Oliver Sacks, author of The Man Who Mistook His Wife for a Hat and other books. Sacks shines at the classical art of extracting large general insights from the detailed clinical study of individual cases, much in the vein of Freud and Jung, but with the benefit of a huge library of other studies as reference points. The titular Sue is a real person, Sue Barry, a professor of neurobiology and a mother, who was born cross-eyed. Because her eyes could not simultaneously focus on the same object, she lacked true depth perception, commonly known as binocular vision, stereoscopic vision, or stereopsis. When the two eyes are able to focus on the same object, the distance between the eyes feeds the brain with two slightly different images, and the brain uses these differences to generate the remarkable three-dimensional composite image that most of us take for granted as a representation of reality. Even after a series of cosmetic operations in childhood which brought her eyes into apparent alignment from an observer’s viewpoint, Sue remained stereo-blind. She could function quite adequately in the three-dimensional world by deducing depth and distances from other clues such as size and motion. But she had no concept of what the world looked like to persons with binocular vision. Friends tried to explain the experience of stereo vision to her, but she could grasp it hardly better than a color-blind person could understand the spectrum. What Sacks called “the subjective quality, the quale of stereopsis” completely escaped her.

Sacks’ use of the word ‘quale’ sent me to Google, where I learned that it is pronounced KWAH-lay, and means the “raw feel”, the basic “what it is like-ness” of a particular sensation or state of mind. According to an academic author in the Wikipedia, ‘quale’ refers to the properties of sensory experiences which are, by definition, unknowable in the absence of direct experience of them. As a result, says this writer, they are incommunicable.

After almost half a century of monocular vision, Sue experienced mounting practical problems with her vision as she passed middle age. Sue found an eye therapist who fitted her with special glasses and taught her a series of eye exercises designed to train her eyes to focus simultaneously on the same object. After the first session, Sue went back to her car and happened to glance at the steering wheel. It had “popped out” of the dashboard. As she continued her exercises, she was delighted. “Ordinary things looked extraordinary. Light fixtures floated and water faucets stuck way out into space.” She also experienced feelings of confusion, as if she were in a fun house or high on drugs. “The world really does look different.” A grape poised at the edge of her fork fascinated her. The skull of the skeleton of a horse in the building where she works suddenly seemed to stick out so much that she actually jumped back and cried out. When she walked in the park, every leaf stood out in its own space. Every surface had more texture. “She was startled and disoriented at first, but for the most part she felt entirely, and increasingly, at home with stereoscopy. Though she continues to be conscious of the novelty of stereo vision, and indeed rejoices in it, she also feels now that it is ‘natural’ — that she is seeing the world as it really is, as it should be. Flowers, she says, seem ‘intensely real, inflated,’ wher they were ‘flat’ before.” The acquisition of stereoscopy, Sacks writes, has been a constant source of delight for her, and a great practical benefit. Sacks sums up that Sue “had discovered for herself that there is no substitute for experience, that there is an unbridgeable gulf between what Bertrand Russell called ‘knowledge by description’ and ‘knowledge by acquaintance’.”

The case for recovery from addiction to alcohol and drugs is often grounded in the avoidance of dramatic harms such as car crashes, crimes, suicides, and debilitating illness, to name just a few. Dr. Sacks’ essay about Stereo Sue suggests a far more important and more difficult challenge, namely that of conveying to those who are still actively drinking and/or using the “raw feel” or “what-it-is-likeness” of sobriety. It is a more important challenge, because the great majority of addicted persons do not personally experience the catastrophic harms that make headlines, nor the lurid agonies that make bestselling memoirs. The sociologist C. Wright Mills famously wrote in the 1950s that “most men lead lives of quiet desperation.” Most persons who are addicted to alcohol and/or drugs lead functional lives. If there is drama, it is tightly controlled and kept private. To the outsider, most addicted persons seem normal and their addiction is invisible. Addicted persons range up and down the social scale and occupy all points on the bell curve of achievements. In your local high school, both the dropout candidate and the valedictorian may be addicted. In your workplace, the lowest go-fer and the chairman of the board may have something unsuspected in common. Basing the case for recovery on a parade of horrors does not resonate with the personal experience of most addicts; it falls as flat as the scare tactics in the movie Reefer Madness.

However, trying to talk about sobriety to people who suffer from addiction, without resorting to scare tactics, can be as challenging as explaining stereoscopic vision to Dr. Sack’s friend Sue before she found her eye therapist. The problem is not merely “denial,” in the sense of actively rejecting a proposed diagnosis. If so, it would be a relatively simple matter of adopting a more skillful clinical approach — “rolling with resistance,” in the words of Motivational Interviewing, instead of the confrontational approach that seeks the patient’s surrender. The more difficult problem is perceptual. The mind under the chronic influence of intoxicating substances may have as much difficulty grasping the quale of sobriety as a color-blind person has in appreciating a rainbow. Frequently there is a crust of stereotypical beliefs to the effect that sobriety is gray, joyless, and somber, and this may be sustained by the anecdotal evidence of persons whose venture into sobriety unmasks a lingering clinical depression. But even when this is stripped away, and when the addicted person knows deep inside that there is nothing more desperately boring and anhedonic than addiction, there is still no insight into the “raw feel,” the “what-it-is-likeness” of sobriety. There is no way to know sobriety without going there. If you wish to know the taste of a pear, you must eat it yourself (Mao). Everything short of that is hypothesis, speculation, fantasy, illusion, self-deception — ignorance.

And so we seem to have come to a logical dead end. Using scare tactics to motivate actively addicted persons does not work. But trying to sell in words the positive experience of sobriety, its quale, does not work either. By definition, the inner experience of sobriety is unknowable in the absence of direct experience, and cannot be conveyed in words. We who stand in the three-dimensional world must communicate the positive feel of our sobriety by supplementing verbal description with our attitude and behavior. We can begin by correcting our perception of persons who are addicted. When we see such a person with both eyes open, we perceive both the manifestations of the addicted self, and also the positive inner pole within the person that clings to life and seeks freedom from the drug. To see only the addicted side, or only the healthy side, is to look at the addicted person with one eye shut. Binocular vision means to see these two different and mutually exclusive images and to combine them mentally into a three-dimensional composite that is realistic and lifelike precisely because it harbors opposites within it. When we demonstrate the advantages of our sober vision by treating the addicted person — despite perhaps their numerous and horrible negative qualities — with the respect and dignity that we would wish for ourselves, then we stand a chance of communicating that which cannot be communicated. Words are, after all, only one narrow channel on the broad spectrum of human communication. When we demonstrate in our own lives, but above all in our contacts with persons suffering from addiction, that the state of sobriety is worth inhabiting, then we have a chance of motivating the addicted to take the leap into our territory. Once here, they too will come to experience sobriety, like Sue experienced stereo vision, as a constant source of delight, a great practical benefit, and the ‘natural’ way of being in the world, of seeing the world as it really is.