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Oliver Sacks, Exploring How Hallucinations Happen

The famed neurologist talks to Fresh Air about how grief, trauma, brain injury, medications and neurological disorders can trigger hallucinations -- and about his personal experimentation with hallucinogenic drugs in the 1960s.

35:50

Other segments from the episode on June 21, 2013

Fresh Air with Terry Gross, June 21, 2013: Interview with Oliver Sacks; Commentary on the word "metadata"; Review of Kanye West's album "Yeezus."

Transcript

June 21, 2013

Guest: Oliver Sacks

DAVID BIANCULLI, HOST: This is FRESH AIR. I'm David Bianculli, editor of the website TV Worth Watching, sitting in for Terry Gross. Our guest, neurologist Oliver Sacks, has explored perception, memory and consciousness through such bestselling books as "Awakenings," "The Man Who Mistook His Wife for a Hat" and "Musicophilia." His latest book, "Hallucinations," will be released in paperback next month.

It draws on history, literature and the patients he's treated, patients who have experienced hallucinations brought on by neurological disorders, brain injuries, medications, fevers, blindness and more, hallucinations that range from the terrifying to the transcendent.

One chapter, called "Altered States," is about his own experiments with mind-altering drugs in the '60s, when he was a neurology resident. These drugs connected with the reason he wanted to be a neurologist, which was to study how the brain embodies consciousness and the self and to understand its amazing powers of perception and distortion. Terry spoke with Oliver Sacks last November, when his book "Hallucinations" was published.

TERRY GROSS, HOST: Dr. Oliver Sacks, welcome back to FRESH AIR.

OLIVER SACKS: It's good to be with you again.

GROSS: In our previous interview two years ago, for your book "The Mind's Eye" about visual disturbances, you had a chapter about losing vision in one eye because of cancer, and you wrote in a footnote: In the '60s, during a period of experimenting with large doses of amphetamines, I experienced a different sort of vivid mental imagery.

And we talked about that a little bit because I was so surprised that such a big revelation that you'd taken large doses of amphetamines was confined to a little footnote. But now, your whole book is about hallucinations, and there's a whole chapter about the hallucinatory drugs you took when you were young. Did you know that that footnote was going to become a book when you wrote it?

SACKS: No, by no means. I knew I would have a book on hallucinations, but the personal chapter was not in the manuscript until relatively late, and then it was evoked for me. I was actually in hospital with a broken hip and feeling rather bored and testy, and a friend said you sometimes talked about the '60s, can you tell me more?

So I told him stories, and he transcribed them and brought them back to me. And that's the way, the way they got into the book.

GROSS: And you're comfortable with that?

SACKS: Fairly comfortable, at least I'm talking about something which is long past. But I sort of regard myself as a subject for case history, as I regard anyone else. And fortunately, I survived it, and I'm here to tell the tale 45 years later.

GROSS: And an interesting tale it is, as we'll hear in a moment. But first, why did you want to write about hallucinations, hallucinations caused by medical problems, by drugs, by neurological disturbances, intentional hallucinations, unintentional hallucinations?

SACKS: Well, I think I've been interested in hallucinations almost all my life. And, you know, and I was fascinated by, say, "Great Expectations," reading about the hallucinations of Miss Havisham, which Pip has. A lot of Dickens books are about being haunted by hallucinations. But then as a medical student and a doctor, I saw hallucinations of every sort.

And with a brother who was schizophrenic, he would talk with his hallucinations, and that was a very different sort of experience. I've written bits about hallucinations, I think, in most of my earlier books, but I thought it was time to try and bring the whole lot together, the more so as we now have methods of looking at the brain and seeing exactly what goes on while people are hallucinating.

GROSS: You're talking about functional MRIs.

SACKS: Yeah.

GROSS: So at the beginning of your chapter about your own experimentation with altered states, you write: Every culture has found chemical means of transcendence. At some point, the use of such intoxicants becomes institutionalized at a magical or sacramental level. What are you thinking of there?

SACKS: Well, I was thinking of peyote ceremonies with Native Americans, but similar ceremonies in Mexico with morning glory seeds - ololiuqui, similar ceremonies in Central America with magic mushrooms, similar ones in South American with both - I can't pronounce it, ayahuasca. And so there's - this seems to happen in every culture at some point.

GROSS: And you write that some drugs like hallucinogenic drugs promise transcendence on demand. Is that why you wanted to experiment with them?

SACKS: Well, I think it's one of the reasons. It's probably a little too high-sounding for all of my reasons. I mean, I think I sometimes just wanted pleasure. I wanted to see a visually and perhaps musically enhanced world. I wanted to know what it was like, and I think those are ways an observer part, as well as the participant. I would often keep notes when I got stoned.

GROSS: Did it seem absurd to you to keep notes on the experience because the experience was so heightened and can be so absorbing to take notes on, it brings you outside of it while you're in it, which can seem absurd in that moment?

SACKS: Yes, well, I didn't always take notes on it. I especially tended to take notes, I think, if a trip turned frightening, and then the taking notes would help me stand outside this, in a way.

GROSS: So you started taking LSD in 1964, and you write that you took mind-altering drugs every weekend for a while. Give us a sense of one of the better experiences that you had that made you want to keep using it.

SACKS: Well, a particular experience was with a color. I had been reading about the color indigo, how it had been introduced into the spectrum by Newton rather late, and it seemed no two people quite agreed as to what indigo was, and I thought I would like to have an experience of indigo.

And I built up a sort of pharmacological launch pad with amphetamines and LSD and a little cannabis on top of that, and when I was really stoned I said: I want to see indigo now. And as if thrown by a paintbrush, a huge pear-shaped blob of the purest indigo appeared on the wall.

It again had this luminous, numinous quality. I leant toward it in a sort of ecstasy. I thought: This is the color of heaven, or this is the color which Giotto tried to get all his life but never could. I thought maybe this is not a color which actually exists on the Earth, or maybe it used to exist or no longer exists.

And all this went through my mind in four or five seconds, and then the blob disappeared, giving me a strong sense of loss and heartbrokenness, and I was haunted a little bit when I came down, wondering whether indigo did exist in the real world.

And I would turn over little stones. I once went to a museum to look at azurite, a copper mineral which is maybe the nearest to indigo, but that was disappointing. I did in fact have that experience again, but when I had it the second time, it was not with a drug, it was with music, and I think music can take one to the heights in a way comparable with drugs. But I think the indigo was my favorite hallucination.

GROSS: Were you already a neurology student?

SACKS: Yes, I was a neurology resident at that time, and the air was buzzing with discoveries and talk about neurotransmitters and drug actions and what one could do for people with psychosis or people with Parkinson's. And so the chemistry of the nervous system was a very hot topic and inviting one to try for oneself.

GROSS: My guest is neurologist Oliver Sacks. His new book is called "Hallucinations." We'll take more - talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: So if you're just joining us, my guest is Dr. Oliver Sacks, who's best known for his case studies in neurology. He's a neurologist, and he often writes about what people experience perceptually when they have neurological disorders. His books include "The Man Who Mistook His Wife For a Hat," "Musicophilia" and "Awakenings." His new book is called "Hallucinations."

So give us an example of a really bad time that you had on a hallucinogenic drug.

SACKS: Well, I think the worst time was also a rather puzzling time. It was in '65. I was new to New York. I was sleeping very badly. I was taking ever-increasing doses of a sleeping medication called chloral hydrate. And then one day I ran out of it. But I didn't think much of this, though when I went to work, I noticed I was rather tremulous, and at that time I was doing neuropathology, and it was my turn to slice a brain and describe all the structures, which I usually enjoyed doing and did easily.

But this time it was difficult, and I hesitated, and I felt my tremor was becoming more obvious. When the session was over, I went to have a coffee across the road, and suddenly my coffee turned green and then purple. And I looked up, there was a man paying at the register, and he seemed to have some huge proboscidean head like a sea elephant.

I was panicked. I didn't know what was happening. I ran across the street to a bus, got on it, but the people on the bus terrified me. They all seemed to have huge egg-shaped heads with eyes like the eyes of insects, compound eyes, which moved suddenly.

I wrote all this in my journal. I felt that I would get dangerously out of control one way or another, either with panic or catatonia or whatever, unless I made a note. And I somehow managed to get off the bus and onto a train and get off at the right stop that when I got off - I lived in the Village then, as I do again now - the houses, the buildings were flapping like flags in a high wind.

When I got back to my apartment, I phoned up a friend of mine, we'd interned together, her name was Carol Burnett, and I said: Carol, I want to say goodbye. I've gone mad. And she said: Oliver, what have you just taken? And I said: I haven't just taken anything. And she thought for a moment and said: What have you just stopped taking?

And I said: That's it, the chlor. And so this was the beginning of an attack of the DTs, the delirium tremens, not induced by alcohol withdrawal but by chloral withdrawal. It's a dangerous state. I should really have checked myself into hospital, but I didn't. I thought I wanted to go through it with some kindly medical supervision, and I did. But there were many, many terrifying things there.

GROSS: Was it helpful while you were having these nightmarish hallucinations, because of withdrawal from the medicine that you were taking, was it helpful to know that they were medically induced hallucinations, that you weren't losing your mind and that this was going to end?

SACKS: Yeah, yeah, yeah, absolutely. When I realized it was medication and not madness, that was a relief so huge that I felt I could sit through the rest of it.

GROSS: As a neurologist, what did you learn from that experience?

SACKS: Well, I think I learned that one shouldn't be silly. But in particular, from that experience, there were all sorts of particular, odd visual perceptions. Sometimes I could not see continuous motion, I would only see a series of stills. And that fascinated me very much, and it made me in fact wonder whether the sense of visual motion is an illusion, whether in fact we see a series of stills.

I don't think I'd had that thought until I was seeing stills. I felt that almost every possible sensory combination was offered to me, every fantasy, every dreamlike distortion. And with hallucinations one remembers them, unlike dreams, and on the whole they're not like dreams because dreaming, you're asleep, you're only a dreaming consciousness, whereas here you're awake and observing yourself.

GROSS: So I want to quote something you wrote about how you stopped doing amphetamines. You wrote: After taking amphetamines, I would feel I had made a crazy ascent into the stratosphere but had come back empty-handed and had nothing to show for it, that the experience had been as empty and vacuous as it was intense.

Then you write about how one time when you came down, you'd retained a sense of illumination and insight, and you had a revelation about migraine, and the next day you started writing about this, and you realized writing was where your real joy was, it was about writing for you, and you never took amphetamines again.

SACKS: Yeah. Well, I think one of the reasons I took drugs was somehow to regain the feeling of intellectual energy and enjoyment and maybe creativity, which I'd known years before as a boy in my days when I loved chemistry but which then seemed to have abandoned me.

And with that particular amphetamine trip, which went along with the fact that I was seeing patients with migraine, who I found fascinating and felt deeply for, and as well as a wonderful old book written in the 1860s on migraine, and the overwhelming feeling was that now it was the 1960s, and we should have such a book again, and who would write it?

And a very loud inner voice said, you silly bugger, you're the man. And after that, something seemed to be switched on in my head, and basically I never took drugs again.

GROSS: So, you know how some people say the human brain is wired for God, you know, wired to, to have religion. What's your take on that?

SACKS: I'm very intrigued by the relationship between drugs and religion and hallucination and religion. There's a long chapter on epilepsy, which at one time was called the sacred disease - although Hippocrates said there was nothing sacred about it.

Although, he allowed sometimes the symptoms of epilepsy may be visionary and, in particular, there is a sort of seizure which some people get called an ecstatic seizure, when there will be a feeling of bliss or rapture, a feeling of being transported to heaven, sometimes of hearing angelic voices or seeing angels or communing with God.

Experiences like this can happen with seemingly quite irreligious people who have - who don't seem to have an iota of religious disposition, but the experience may be rather overwhelming and may lead to conversion.

GROSS: But it's interesting how often those visions - if we want to call it that - come from something that nowadays would be diagnosed as a disorder and in fact are disorders like epilepsy or schizophrenia.

SACKS: Yes. Well, certainly. I think there's probably always been visions and voices, and these were variously ascribed to the divine or demonic or the muses. I think many poets still feel they depend on an inner voice, or a voice which tells them what to do.

The medicalization of hallucinations really only occurred in the 19th century, and following that, people became, I think, very much more anxious about hallucinations and secretive and ashamed, and the subject was much less discussed. I think hallucinations need to be discussed.

There are all sorts of hallucinations, and there are many sorts which are OK, like the ones I think which most of us have when we're in bed at night before we fall asleep when we can see all sorts of patterns or faces or scenes.

BIANCULLI: Author and neurologist Oliver Sacks, speaking to Terry Gross last year. We'll continue their conversation in the second half of the show. I'm David Bianculli, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

BIANCULLI: This is FRESH AIR. I'm David Bianculli, in for Terry Gross, back with more of Terry's 2012 conversation with neurologist Oliver Sacks. He's the author of the bestselling books, "Awakenings," "The Man Who Mistook His Wife for a Hat" and "Musicophilia." His books are based on the patients he's treated, as well as medical history, literature and his own experiences. His latest book, "Hallucinations," comes out in paperback next month. It's about hallucinations brought on by neurological disorders, brain injuries, medications, fevers, blindness and more, hallucinations that range from the terrifying to the transcendent.

GROSS: You write in your book "Hallucinations" about an auditory hallucination you had that really might've saved your life. You were mountain climbing and you'd injured your foot or your leg and part of you just wanted to just, like, slow down, sleep. But then you heard a voice which said what?

SACKS: Yeah. Well, the impulse to sleep - I'd torn off most of the thigh muscles and the knee was dislocating backwards. And at one point I got quite shocked and must have a little sleep. And the voice said, no, that would be death. Go on. You've got to keep going. Find a pace you can keep up and keep it up. And this was a very clear commanding voice. It was a sort of life voice and it was not to be disobeyed.

GROSS: And so you kept going in spite of the horrible shape that your leg and knee was in.

SACKS: Yeah. I was sort of lowering myself down with my arms. I had splinted the leg as best I could with an umbrella stick and my anorak, which I tore in two. Incidentally, I thought that was going to be the last day of my life and it had every prospect of being, but I was found at twilight by two hunters. This was in north Norway. But that voice was crucial for me.

GROSS: Whose voice did you hear? Was it your voice, a stranger's voice?

SACKS: Not my voice. I often hear my voice. I am always sort of cursing or muttering to myself. But this was a very clear, assured voice. Not a voice I recognized but a voice I trusted. And which I suppose I realized came from some part of me, because there's no other place it could've come from.

GROSS: What do you speculate goes on neurologically when, in a state of extreme danger like you were in, a voice tells you to do the thing that you need to do to save your life?

SACKS: It seems to me almost like an ultimate safeguard. Some power, propensity, which is sort of built into the structure of the mind and the emotions. Probably I would think most people would go through a life and never hear it. It only announces itself in extremity.

GROSS: If you're just joining us, my guest is neurologist Oliver Sacks, best known for his books "The Man Who Mistook His Wife for a Hat," "Musicophilia" and "Awakenings." His new book is called "Hallucinations" and it's about the medically induced hallucinations, naturally occurring hallucinations - like between waking and sleeping and hallucinations that are side effects of drugs, hallucinations that are caused by various medical conditions. Yeah.

SACKS: Can I add to your list? Hallucinations which are caused by real-life experiences, such as bereavement.

GROSS: Yes. I'm glad you mentioned bereavement. And that is such a common form of hallucination, where, you know, you've lost somebody who you love and you think you've seen them or heard them say something. And when that happens, I think it's fair to say it feels like a visitation. How would you describe that?

SACKS: Yeah. Well, someone dies, there's a hole in your life and that hole can be briefly filled, I think, by a hallucination. Typically, the bereavement hallucinations - which are common; something like 40 or 50 percent of bereaved people get them occasionally - are often felt as very comfortable, comforting, and they may help them through the mourning process, and then when one has mourned fully, they disappear.

GROSS: How, as a neurologist, would you interpret those hallucinations?

SACKS: Well, with any hallucinations, if you can say do functional brain imagery while they're going on, you will find that the parts of the brain usually involved in seeing or hearing - in perception - are, in fact, being active, have become super-active by themselves. And this is an autonomous activity. This does not happen with imagination. But hallucination, in a way, simulates perception, and the perceptual parts of the brain become active. But, you know, what else is going on, there's obviously a very, very strong, passionate feeling of love and loss with bereavement hallucinations, and I think intense emotion of any sort can produce a hallucination.

GROSS: Say you had actually seen - say it really was like a visitation from the person who you're mourning, what would be happening in your brain, compared to the activation that you're describing in a hallucination? In other words, like, does the FMRI, the functional brain imagery, prove that it really wasn't a visitation, that it was just something induced by your brain?

SACKS: Well, you would see a precise coincidence between the visitation and quite major changes in the brain, and you cannot reduce the visitation to those changes, but you also cannot just discuss those changes without saying it was experienced as a visitation. I mean, the whole hard question of neurology or of science or philosophy is how to connect brain activity with experience and mind. And all we could say, on the whole, is that things go parallel.

GROSS: I'm just curious. Like how - how do you do functional brain imagery of somebody who has had a hallucination? I mean, they're probably not hooked up to the FMRI...

SACKS: Yeah.

GROSS: ...when they're feeling like they had this visitation from a lost loved one.

SACKS: Well, there, it will be difficult, because hallucinations like this are rare and sporadic and unpredictable. But there are other people - and I am especially interested in this, because I've worked in old age homes for the last 40 years or so, and I've seen many, many elderly people who are intellectually intact, but have impaired vision or hearing, have visual or auditory hallucinations on this basis.

The visual one they call Charles Bonnet Syndrome, and people may see faces. They may see landscapes, patterns, musical notation, for hours a day. And in this situation, you can have someone inside a functional MRI, and they can, say, raise a finger when they are hallucinating. You may then say to them: You are hallucinating faces. They may say, how the hell do you know? And you will say, because the face recognizing part of your brain suddenly became very active.

GROSS: Wow. Uh-huh...

SACKS: And it is this sort of thing, especially with patients with Charles Bonnet Syndrome, that you can plot and you can map the brain by the sort of hallucinations people get.

GROSS: What has been the most dramatic change you've seen in your field since you started as a neurology resident in the '60s?

SACKS: I think probably the ability to visualize the brain in life with functional imaging or PET scanning, and if the brain is exposed to record from individual cells. But there's been a whole change of orientation. We now, for example, think of vision - what one sees - as being constructed. We know that the image on the back of the retina then has to be analyzed by 40 or 50 different systems in the brain.

And then all of these work together to produce the final image. The sense of the brain's complexity and wonder, I think, has been increased. We are now very much looking at consciousness as a central problem, whereas that was regarded as either not a problem or an insoluble problem or a mystery 30 years ago. We have found forms of treatment which could not have been imagined a few years ago.

In particular I think of the use of stem cells and other things for neurodegenerative disease. I think neurology has both expanded and become much more hopeful than it was when I entered it. So neurology is fun now.

GROSS: Well, Dr. Sacks, it's just such a pleasure to talk with you. You're always so interesting. I thank you so much for coming back to our show.

SACKS: Well, thank you so much. And I always love talking with you and I love the way you keep me focused, or you try to keep me focused.

(LAUGHTER)

SACKS: Although I'm incorrigible.

GROSS: You're great. I really appreciate you talking with us. Be well and thank you again so much.

SACKS: Thank you.

BIANCULLI: Neurologist and author Oliver Sacks, speaking with Terry Gross last year. His latest book "Hallucinations" comes out in paperback next month.

Coming up, our linguist Geoff Nunberg looks at the advent and meaning of metadata and said he never met data he didn't like. This is FRESH AIR.

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DAVID BIANCULLI, HOST: This is FRESH AIR. What effect of the revelations about NSA surveillance has been to bring the unfamiliar word metadata into the spotlight. Our linguist, Geoff Nunberg, explains what metadata is, how it's related to the big data revolution and whether it makes any difference - or, as he puts it: does meta matter?

GEOFF NUNBERG, BYLINE: This is just metadata. There is no content involved. That was how Senator Dianne Feinstein the NSA's blanket surveillance of Americans' phone records and Internet activity. Before those revelations, not many people had heard of metadata, the term librarians and programmers use for the data that describes a particular document or record it's linked to. It's the data you find on a card in a library catalog, or the creation date and size of a file in a folder window. It's the penciled note on the back of a snapshot: Kathleen and Ashley, Lake Charles, 1963. Or it could be the times, numbers and GPS locations attached to the calls in a phone log.

Metadata was bound to break out sooner or later, riding the wave of data in all its forms and combinations. Big data and data mining are the reigning tech buzzwords these days, and university faculties are scrambling to meet the surge in demand for courses in the hot new field of data science. It's as if data is usurping information as a byword. Up to now, data has played a supporting role in the information age. There's a popular definition of data as the raw material that becomes information when it's processed and made meaningful. That puts information at the center of the modern tech world, but it isn't how anybody actually uses the two words. I have this image of somebody working on a spreadsheet as a manager leans over and says, is it information yet?

But the shift in focus from information to data reflects a genuine difference between the two. Information brings to mind the knowledge that's gathered in libraries, encyclopedias and journals - stuff that has an independent existence in the world. Data is always connected to particular things and events. It comes from experiments and sensors and official records, or from the scuff marks we leave behind as we click on websites, make calls, go through the E-Z Pass toll booths, visit an ATM. It's all out there, accumulating in ginormabytes, overflowing the server farms.

When you're focused on information in that stand-alone sense, metadata plays a subordinate role. In the old days, it was just a tool for getting to the stuff you were really interested in. Think how much metadata you had to wade through to find a passage about drunkenness in Tocqueville's "Democracy in America."

Looking up the book in the library card catalogue, writing down its call number, finding it on the shelves, searching for drunkenness in the index, then finally turning it to the page.

Now that that kind of information is online, metadata can seem almost irrelevant. No need for catalogues or indexes - you just enter a query and when the book comes up, you barrel in sideways. That's probably why Google was so careless about metadata when they digitized major library collections for Google Books. Literally millions of books are mis-dated or misclassified. It's not odd to run into a web browser manual dated 1939 that lists Sigmund Freud as its author.

Or a copy of "Madame Bovary" attributed to Henry James and filed under antiques and collectibles. The faulty metadata prompted some grumbles from academics, and Google's been working on fixing it. But it doesn't bother most of the people who use Google Books. They get at its information in other ways.

But metadata gets a lot more respect in other corners of the Google Campus, not to mention from its competitors up and down U.S. 101. Their focus is not information in the abstract, but on collecting specific data about their users. And for that, they need to get the metadata right. Who's visited this page? How long did they stay? Where did they go next? Who did they email, call, or text?

All so that advertisers can ensure that the seersucker jacket I clicked on yesterday will stalk me to the end of my days. That's the same kind of metadata the NSA has been trawling. Its defenders maintain that we have to be willing to trade some privacy for some security, and right now we're all arguing about where to put the boundaries.

But some advocates of the surveillance have also tried to soft pedal its intrusiveness. You hear people pronouncing metadata as a soothing incantation, as if your right to privacy ends as soon as you lick and seal the envelope. Sifting through the metadata, the president said, involves just modest encroachments on privacy.

James Clapper, the director of National Intelligence, compared the programs to combing through a library with millions of volumes and sorting them by their Dewey decimal numbers, without actually opening and reading them. But if you're going to compare this to rummaging around in an old-fashioned library, it's more like opening the back covers of all the books to see whose names are on the borrowers' cards.

Whether or not you think the government should be sweeping this stuff up, calling it metadata doesn't make the process any less intrusive. Tell me where you've been and who you've been talking to, and I'll tell you about your politics, your health, your sexual orientation, your finances. So maybe we should let the word sink back into the nerdy cubicles it came from. When it comes to privacy, the meta doesn't matter. In the post-information age, it's just data all the way down.

BIANCULLI: Jeff Nunberg is a linguist who teaches at the University of California Berkeley School of Information. Coming up, Ken Tucker reviews "Yeezus," the new album from Kanye West. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVID BIANCULLI, HOST: This is FRESH AIR. Kanye West has been busy in both the music and the gossip worlds. He's just released a new album called "Yeezus" and last weekend he became a father when his girlfriend, Kim Kardashian, gave birth do a girl. Rock critic Ken Tucker says West's constant blending of his public life and his music makes his new album all the more striking - and sometimes more problematic.

(SOUNDBITE OF SONG)

KANYE WEST: (rapping) What you doing in the club on a Thursday? She said she only here for a girl birthday. They order champagne but still look thirsty. Rock forever 21 but just turned 30. I know I got a bad reputation. Walk around always mad reputation.

(rapping) Leave a pretty girl sad reputation. Start a fight club bad reputation. I turn the nightclub...

KEN TUCKER, BYLINE: Kanye West is having some serious fun with us on his new album, "Yeezus," starting with the title. It's a play on his nickname, Yeezy, and his penchant for placing himself in cultural importance just this side of the Son of God. And that's just the first clue as to how assiduously aggressive and transgressive West wants to be on this album.

Over the course of this collection, he cuts across boundaries of musical genres, historical references and good taste, with slashing rhythms and precise wordplay that will strike some as lacking in hip-hop beauty. My reaction upon first hearing the whole album all the way through has remained firm throughout subsequent listenings. This is a strikingly unified, eloquently ugly record that demands, boldly but also desperately, beseechingly, to be heard.

(SOUNDBITE OF SONG, "BLACK SKINHEAD")

WEST: (rapping) Got my theme song, my leather black jeans on, my by any means on. Pardon, I'm getting my scream on. Enter the kingdom but watch who you bring home. They see a black man with a white woman at the top floor they gonna come to kill King Kong. Middle America packed in, came to see me in my black skin. Number one question they asking (bleep) every question you asking.

(rapping) If I don't get ran out by Catholics, here come some conservative Baptists. Claiming I'm overreacting like the black kids in Chiraq, bitch.

TUCKER: That's "Black Skinhead" samples Gary Glitter's "Rock and Roll Part 2" to bolster its rebellious lyric. It's too easy to hear a lot of the sentiments on this album as merely arrogant, a quality West has done little to downplay in a recent interview with The New York Times, comparing himself most favorably to innovators such as Walt Disney and Steve Jobs, or in a song title such as "I Am a God."

But that song has already yielded the funniest phrase that's been repeated all over the Internet, with the highly self-aware Kanye posing as a pampered star, snapping in a French restaurant to hurry up with his order of croissants.

(SOUNDBITE OF SONG, "I AM A GOD")

WEST: (rapping) I am a god so hurry up with my damn massage and a French-ass restaurant. Hurry up with my damn croissants. I am a god. I am a god. I am a god. I just talked to Jesus. He said what up, Yeezus? I said (beep) I'm chilling, trying to stack these millions. I know he the most high but I am a close high. Me casa su casa.

(rapping) That's our costa nostra. I am a god.

TUCKER: Kanye West remains a good collaborator. The numerous producers include the French duo Daft Punk, and Rick Rubin, who's worked with everyone from Black Sabbath to Johnny Cash, says he was brought in by West near the completion of the album to help strip down the sound.

One result is that this album's diverse, cacophonous music fills even his most hostile lyrics with dread. This dread, I think you have to hear it in many moments as the cry of a man who wants the world to know how vulnerable and self-conscious and shrewd he is, every time he presents a resentful, tough-guy, I'm-a-genius image to the world. I should also say that this next song, as do many here, contains a disparaging term for women.

(SOUNDBITE OF SONG, "BLOOD ON THE LEAVES")

NINA SIMONE: (singing) Strange fruit hanging from the poplar trees. Blood on the leaves.

WEST: (rapping) I just need to clear my mind, now. It's been racing since the summertime.

SIMONE: (singing) Leaves.

WEST: (rapping) Now I'm holding down the summer now.

SIMONE: (singing) Leaves.

WEST: (rapping) And all I want is what I can't buy now.

SIMONE: (singing) Blood on the leaves.

WEST: (rapping) 'Cause I ain't got the money on me right now. And I told you to wait.

SIMONE: (singing) Leaves.

WEST: (rapping) Yeah, I told you to wait.

SIMONE: (singing) Leaves.

WEST: (rapping) So I'm a need a little more time now.

SIMONE: (singing) Blood on the leaves.

WEST: (rapping) 'Cause I ain't got the money on me right now. And I thought you could wait. Yeah, I thought you could wait.

SIMONE: (singing) Leaves.

WEST: (rapping) These bitches surrounding me.

SIMONE: (singing) Black bodies swinging in the southern breeze.

WEST: (rapping) All want something of me. Then they talk about me.

SIMONE: (singing) Breeze.

WEST: (rapping) Would be lost without me. We could've been somebody.

SIMONE: (singing) Strange fruit hanging...

WEST: (rapping) Thought you'd be different about it.

SIMONE: (singing) ...on the poplar trees.

WEST: (rapping) Now I know you not it.

SIMONE: (singing) On the poplar trees.

WEST: (rapping) So let's get on with it. We could've been somebody...

TUCKER: Some people have been scandalized by the song "Blood on the Leaves" - scandalized that a black artist as erudite as Kayne West could take Nina Simone's version of "Strange Fruit" and turn its devastating metaphor for lynched slaves into a whine about difficulties he's having with the women in his life. The album is shot through with sex - talk about how much the singer likes it, but also how much he uses it as yet another power strategy.

But scandal is what West uses as a come-on, before diving deeper. His tabloid romance with Kim Kardashian is, whatever their private relationship may be, practically designed to drive serious people nuts. How could, the feeling goes, one of the most gifted contemporary performers find satisfaction with a reality-TV star?

Yet this is the way West likes his art: superficially messy, only to reveal itself as rigorous, something joyous or tortured, and which invariably proves more complex than it appears. Give the man some croissants, will ya?

BIANCULLI: Ken Tucker reviewed the new Kanye West album "Yeezus." You can download podcasts of our show at freshair.npr.org and follow us on Twitter at nprfreshair and on Tumblr at nprfreshair.tumblr.com.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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