67 pages • 2 hours read
The Man Who Mistook His Wife for a Hat
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Themes
Human Resilience
From the onset, Sacks makes it clear that his view of neuroscience is different from earlier practitioners. He explains the favorite word of neuroscience is “deficit,” yet throughout the book, he shows that some deficits can lead to heightened use of other parts of the brain. He explores how “deficits” can also empower patients to find alternative ways to be in the world. Many of the symptoms that neurologists observe in patients are not only symptoms of deficit, but also the brain’s attempt to right itself after losing one or more of its faculties.
One of the neuroscientists that Sacks quotes, Kurt Goldstein, coined the term “self-actualization,” which became one of the founding theories of the humanistic psychology movement of the 1970s and beyond. The term suggests that human beings have an innate tendency to grow and show their full potential. Even when their brains are injured, human beings continue to try to enact this self-actualization principle, as Sacks demonstrates.
In some cases, patients find alternative ways to function, even if they’ve lost their primary way of relating to the world. In the case of Chapter 1’s Dr. P.—the titular case—the patient unconsciously relies on music, both his ability to recognize music and the “music of the body” to compensate for his visual agnosia. In some cases, as with Christina of Chapter 3, the patient can consciously relearn to use visual ability to compensate for the loss of proprioception. Even the patients who Sacks calls “simple” find ways to express themselves, soothe themselves, and look for purpose in ways that are meaningful for them. José draws, Martin sings and studies Bach, Rebecca performs, and the Twins relate to one another through numbers. All demonstrate their tendency to grow and develop.
Sacks witnesses firsthand the power of the human will to survive, and he documents his case studies with admiration and awe. Despite the use of now arcane language, Sacks conveys a deep respect of and appreciation for his varied patients:
The miracle is that, in most cases, he succeeds—for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are absolutely, the strongest in our being: stronger than any impulses, stronger than disease (64).
Through his documentation, Sacks shows a dynamic scope of human resilience. In some cases, he cures his patients and ushers them into the next era of their lives. In others, he facilitates treatments that help the patients find a sense of wholeness and purpose, predominantly through artistic outlets. Although Sacks cannot always cure or treat his patients’ conditions, each case study provides him with a piece of the neurological puzzle. In his writing, Sacks orders these pieces to show readers that patients are neither defined nor totally confined by their illnesses.
Romantic Science Versus Classical Science
Sacks refers often to Luria’s “romantic science.” Romanticism as a philosophy and literary movement held as its core value a respect for the human individual. Romantic writers and thinkers valued emotion as much as reason, if not more so. They studied individuals and paid close attention to deviations from the norm, believing that man has a soul, each person is unique, and individuality should be celebrated. Romantics also valued connection with nature, spiritual aspirations, and an openness to experience.
In the Preface, Sacks writes the following:
Hippocrates thus introduced the case history, a description, or depiction, of the natural history of disease—precisely expressed by the old word “pathology.” Such histories are a form of natural history—but they tell us nothing about the individual and his history; they convey nothing of the person, and the experience of the person, as he faces, and struggles to survive, his disease. There is no “subject” in a narrow case history; modern case histories allude to the subject in a cursory phrase (“a trisomic albino female of 21”), which could as well apply to a rat as a human being. To restore the human subject at the centre—the suffering, afflicted, fighting, human subject—we must deepen a case history to a narrative or tale; only then do we have a “who” as well as a “what,” a real person, a patient, in relation to disease—in relation to the physical (iii).
Sacks’s choice to share case studies of individual patients is itself a Romantic approach to neuroscience. Rather than lumping individuals into impersonal groups or studying their brains as scientific data, he focuses on the entire human experience. He makes room in his philosophy for understanding that individuals have different paths, different needs, and different abilities. Rather than trying to homogenize each patient, restoring them to objective “health” by curing each problem, Sacks notes that some diseases actually benefit patients. Some of the “strange” behaviors that manifest may also bestow patients with extraordinary abilities.
For example, in Chapter 9, Sacks notes that those with aphasia can often spot lies where “normal” people are fooled. In Chapter 20, Sacks points out that Hildegard’s visions were likely caused by migraines, and the transcendent experiences of Fyodor Dostoyevsky were brought on by epilepsy. He does not dismiss the spiritual beliefs surrounding their neurological episodes as delusional; he allows that the interpretations and emotions brought on by the fits could still be valid for them.
The Romantic view is most apparent in the latter half of the book, when Sacks discusses “Transports” and “The World of The Simple.” In using the language of poetry and painting to understand patients with unusual presentations of memories, Sacks see not only their objective neurological conditions and experiences, but their subjective interpretations of those experiences. He observes that which may apply to their physical sensations, their sensory perceptions, and their emotional interpretations and corresponding feelings.
Sacks knows that he has much to learn from observing patients with intellectual disabilities. Sacks asserts that human beings are not their minds alone; people, regardless of their disabilities, are also their emotions, their relationships with others, and their sense of communion with the divine. These patients strive for a sense of harmony with themselves and their world. Although patients present atypical behaviors, Sacks notes that their “abnormal” behaviors are, in actuality, deeply human.
A Holistic Approach to Neurology: Body, Mind, and Soul
Sacks concerns himself with the conditions of his patients’ bodies, minds, and souls. In doing so, he adopts a holistic approach to neurology that dismantles the field’s turn-of-the-century divergence into “a soulless neurology and a bodiless psychology” (48). Although he does not give a technical definition of what he means by “soul,” he makes careful observations about patients’ abilities to interact with other people, find meaningful work, have a sense of purpose, and to feel peace. For many of his patients, the damage to or irregularity in their brains not only affects the way they think and move, but also their ability to feel and satisfy their souls. For Sacks, this is an important part of what is missing in neurology—the understanding of a person as a whole organism. Sacks notes how important it is to see patients both inside and outside a clinical setting, observing how they interact with a less predictable world. This is especially true of observing those with Tourette’s, for their nervous energy is exacerbated in less predictable settings. He also investigates patients’ relationships with family members when possible, gaining greater insight into their mental states.
In cases where Sacks has no solution to the neurological problems his patients face, he helps them find ways to compensate for their lost mental and physical abilities. Sacks uses the exploration of healing arts to nurture his patients’ passions. Communion, art, music, and gardening are alternative venues through which people with disabilities can awaken their feelings and rejuvenate their souls.
In Chapter 2, Sacks asks what a person is if not his memories, and he wonders if a person can have a sense of identity if they cannot remember one moment to the next. In the case of Jimmie G., Sacks sees a bright man who can perform many mathematical tasks. Jimmie can even make connections with other people when playing games. However, Jimmie lacks a sense of purpose, a connection with something higher, and the ability to feel deeply about it. Because Jimmie G. cannot remember or form new memories, he cannot form the social and personal narratives that develop relationships. For him, every moment is new and somewhat confusing. Sacks does not give up on Jimmie G. He seeks guidance from the sisters who note that Jimmie connects while taking communion.
In Chapter 10, Sacks sees that Ray’s happiness is not dependent upon neurological regularity or control of his Tourette’s alone, but also on his ability to express himself through music. He approves of Ray’s plan to go off his meds during the weekend so that he can actualize his natural musical ability, enhanced by his Tourette’s. In Part 3, Sacks notes that the unbidden music that Mrs. O’C. hears and the memories of India that Bhagawhandi P. experiences are not mere hallucinations. The musical triggers are part of their identity and place in the world. Sacks points out their beneficial qualities of restoring forgotten memories to a person who wants them. In all these instances, Sacks demonstrates to the reader how a neurological malfunction can lead to a loss of some aspect of their soul and how even the neurologically impaired can recover those aspects, especially with help.
In Chapter 12, Sacks is less successful in helping William Thompson free himself from mythomania, or the compulsion to lie. Interacting with people stimulates Mr. Thompson’s need to invent stories, so it is only alone in the garden that he can experience a sense of peace. Through Mr. Thompson and others, Sacks underscores the healing power of nature and its ability to ground patients in their present lives.
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