The Man Who Mistook His Wife for a Hat by Oliver Sacks

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The Man Who Mistook His Wife for a Hat

(Literary Masterpieces, Volume 9)

The Man Who Mistook His Wife for a Hat: And Other Clinical Tales could be, in the hands of a lesser writer, a mere compendium of neurological grotesqueries. As Dr. Oliver Sacks himself points out, in one of two important epigraphs (this one by William Osler): “To talk of diseases is a sort of Arabian Nights entertainment.” What saves this book from charges of medical voyeurism is that Sacks has several significant underlying concerns, not the least of which is reconsidering the very fundamental issue of what constitutes a neurological disease.

The Man Who Mistook His Wife for a Hat is divided into four sections: “Losses,” “Excesses,” “Transports,” and “The World of the Simple.” In each section, Sacks tells a number of clinical tales, which particularize the behavioral consequences of various right hemisphere brain disorders and also pose questions of philosophical and ethical importance. Sacks is working in a rich tradition of narrative case histories, begun by Hippocrates in Greece and perfected in the nineteenth century, lost with “the advent of an impersonal neurological science,” and revived in the twentieth century by the Soviet psychologist A. R. Luria. This tradition encourages physicians to listen, with professional interest, to their patients’ accounts of their illnesses, and to focus not only on obvious “deficits” but also on patients as complete human beings. This attitude of affectionate attention is characteristic of The Man Who Mistook His Wife for a Hat.

In “Losses,” the reader is introduced to Dr. P., or “The Man Who Mistook His Wife for a Hat.” Dr. P. is a patient whose case negates one of the fundamental axioms of classical neurology: that any brain damage will reduce or remove the ability of an individual to think in abstract or categorical ways. Dr. P., contrary to the received wisdom, has lost instead all ability to recognize the individual and the concrete. Looking at a picture, he attends to color or shape but not to the picture as a whole. Given a red rose, he comments, “About six inches in length. A convoluted red form with a linear green attachment. . . I think this could be an inflorescence or flower.” Dr. P. cannot be entirely sure until he smells it. He is unaware of anything unusual in his method of perception. As the title of this piece suggests, because of a similarity in size and shape, he is even capable of mistaking his wife’s head for a hat.

In this opening essay, Sacks suggests that Dr. P.’s case holds a metaphorical warning for the science of neurology, which has moved inexorably toward abstraction, at the same time eschewing the particular and the personal. Sacks sees this branch of science developing an agnosia, or perceptual difficulty, not unlike Dr. P.’s—a difficulty of which it is unaware. It has pursued the abstract idea of disembodied diseases, has paid exclusive attention to the measurable, and has become sadly mechanistic and dehumanized. Such cases as Dr. P.’s not only call into question established ideas about brain damage but may also point the way toward a neurology which can reintegrate brain and mind, science and art, patient and disease.

“Excesses” allows the reader to contemplate some symptoms of brain damage in other than the traditional context of “deficits.” Witty Ticcy Ray is a patient with Tourette’s syndrome; he has an excess of energy which exhibits itself in involuntary and extravagant motions. On the one hand, his tics are a severe handicap, stigmatizing him since the age of four and making a normal life nearly impossible. On the other hand, his abnormally quick reflexes and abrupt movements add a manic energy to his career as a weekend jazz drummer, where he has made a name for himself with his wild improvisations. His story raises intriguing therapeutic questions. When he is treated with Haldol, his tics are controlled, but so are the rest of his reactions. He is less quick, less playful, less impulsive. He...

(The entire section is 1,330 words.)