The Man Who Mistook his Wife for a Hat

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The Man Who Mistook his Wife for a Hat Quotes

Note: all page and citation info for the quotes below refers to the Simon & Schuster edition of The Man Who Mistook his Wife for a Hat published in 1998.
Part 1, Introduction Quotes

It is, then, less deficits, in the traditional sense, which have engaged my interest than neurological disorders affecting the self. Such disorders may be of many kinds—and may arise from excesses, no less than impairments, of function—and it seems reasonable to consider these two categories separately. But it must be said from the outset that a disease is never a mere loss or excess—that there is always a reaction, on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be: and to study or influence these means, no less than the primary insult to the nervous system, is an essential part of our role as physicians.

Related Characters: Oliver Sacks (speaker)
Page Number: 6
Explanation and Analysis:

In the Introduction to Part One of his book, Oliver Sacks describes a paradigm (conceptual framework) that many neurologists have used to understand mental disorders: deficit. Sacks acknowledges that the “deficit” paradigm can be useful at times—it’s convenient, for instance, to define certain disorders, especially disorders of the left hemisphere of the brain, in terms of the absence of a specific brain function. However, Sacks also acknowledges that the overuse of the deficit paradigm can be harmful to neurology, because it pushes neurologists into conceptual corners. For example, when neurologists grow too accustomed to conceiving of every disorder as an absence, they ignore the complicated processes by which patients with mental disorders compensate for their deficits, whether consciously or unconsciously.

Put another way, the neurological community, as a consequence of its tendency to think of disorders as absences of some kind, neglects the process of adaptation by which patients respond to their conditions. It is this process that Sacks intends to study throughout his book. Sacks will not throw out the deficit paradigm altogether—indeed, he admits that such a paradigm can be very useful. However, he tries to modify and revise this paradigm, and use other paradigms, so that he keeps an open mind when discussing different neurological conditions.


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Part 1, Chapter 1 Quotes

‘Well, Dr. Sacks,’ he said to me. ‘You find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?’

‘l can't tell you what I find wrong,’ I replied, ‘but I'll say what I find right. You are a wonderful musician, and music is your life. What I would prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the center, now make it the whole, of your life.’

Related Characters: Oliver Sacks (speaker), Dr. P. (speaker)
Page Number: 18
Explanation and Analysis:

In this chapter, Sacks investigates a patient named Dr. P., who seems to suffer from a kind of “face blindness.” Dr. P. is a talented musician, and a charming, intelligent man; however, he lacks the ability to recognize people’s faces, and also cannot describe different expressions, except in the most reductionist, fragmentary ways. Sacks studies Dr. P. for several weeks, but offers no neurological treatments for Dr. P.’s condition—no drugs or therapy. His only advice for the doctor is to immerse himself in music, as he’s been doing for most of his life already.

It’s worth asking why Sacks chooses to begin his book with a case study in which he doesn’t “cure” the patient, Dr. P., of his ailment. Perhaps the answer is that, in this book, Sacks is more interested in studying the ways that neurological patients live with their disorders and find ways to adapt and work around their disabilities. The duty of a good neurologist, Sacks further suggests, is to train patients to survive with their conditions and find emotional and spiritual meaning in their lives—thus, Sacks fulfills his duties by advising Dr. P. to continue embracing music. (And indeed, art, seen as a form of therapy and even religious worship, will be one of the key themes of the book.)

Part 1, Chapter 2 Quotes

What could we do? What should we do? ‘There are no prescriptions,’ Luria wrote, ‘in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being—matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him.’

Related Characters: Oliver Sacks (speaker), A. R. Luria (speaker), Jimmie G.
Page Number: 34
Explanation and Analysis:

In this chapter, Sacks examines a patient named Jimmie G. who suffers from a rare disorder called Korsakov’s Syndrome, which renders him incapable of remembering anything for longer than a few minutes. Sacks recognizes that, in spite of his training, there is very little he can do for Jimmie: Jimmie’s brain has already been so damaged by alcohol that he’ll never regain his memory. Sacks turns to his friend and mentor, A. R. Luria, for advice about how to proceed with Jimmie, and Luria tells Sacks that he should try to show Jimmie how to preserve his dignity, will, and morality—in other words, how to live with his condition, rather than curing his condition.

Luria’s advice for Sacks could be taken as a kind of thesis statement for the book itself. Sacks is interested in how patients with rare neurological disorders preserve their dignity and their humanity, even after their conditions alienate them from the rest of their species. In a way, Sacks’s book is less a neurological treatise than it is a profound, philosophical examination of what it means to be human, and how we struggle to preserve our humanity in the face of adversity.

If Jimmie was briefly ‘held’ by a task or puzzle or game or calculation, held in the purely mental challenge of these, he would fall apart as soon as they were done, into the abyss of his nothingness, his amnesia. But if he was held in emotional and spiritual attention—in the contemplation of nature or art, in listening to music, in taking part in the Mass in chapel—the attention, its ‘mood’, its quietude, would persist for a while, and there would be in him a pensiveness and peace we rarely, if ever, saw during the rest of his life at the Home.

Related Characters: Oliver Sacks (speaker), Jimmie G.
Page Number: 38-39
Explanation and Analysis:

At the conclusion of Chapter Two, we learn what becomes of Jimmie G., a patient afflicted with a rare case of Korsakov’s Syndrome, which leaves him incapable of forming new memories. Sacks argues that Jimmie learns how to preserve his dignity and sense of self, using the institutions of the Catholic Church to do so. In loving detail, Sacks describes how Jimmie immerses himself in Mass, praying, taking communion, etc. His lack of memory prevents him from forming close friendships with other people, but not from forming a close worshipful bond with Catholicism itself. Sacks further concludes that Jimmie achieves a state of lingering inner peace, thanks to his religion.

One of Sacks’s most provocative theses in the book is that human beings need to form connections with the external world, or with other people, in order to feel fully human—if not, they become lost in a constant state of flux. Patients like Jimmie, whose conditions prevent them from forming close bonds with other people, must learn how to connect with the world in some other way, or risk losing their sense of self and their humanity.

Part 1, Chapter 3 Quotes

This unquestionability of the body, its certainty, is, for Wittgenstein, the start and basis of all knowledge and certainty. Thus, in his last book (On Certainty), he opens by saying: ‘lf you do know that here is one hand, we'll grant you all the rest.’ But then, in the same breath, on the same opening page: ‘What we can ask is whether it can make sense to doubt it’; and, a little later, ‘Can I doubt its grounds for doubt are lacking!’

Related Characters: Oliver Sacks (speaker), Ludwig Wittgenstein (speaker)
Page Number: 44
Explanation and Analysis:

At the beginning of this chapter, Sacks brings up the work of the great 20th-century philosopher Ludwig Wittgenstein. Toward the end of his life, Wittgenstein wrote an unpublished treatise on certainty and doubt, usually known by the title “On Certainty.” The book has been influential among philosophers—but Sacks believes that he’s found an interesting connection between Wittgenstein’s abstract, theoretical ideas, and the real world of neurology. Wittgenstein begins his book by studying the possibility that a human being could examine his own hand and conclude that the hand doesn't belong to him; while Wittgenstein was speaking theoretically, Sacks argues that patients who lose their innate sense of proprioception (i.e., their ability to feel a sense of ownership and control over their own bodies) would be thrust into a situation not unlike the one Wittgenstein described—they’d always have to doubt and question their own bodies’ orientations and positions.

The passage is a great example of how Sacks enlivens his neurological discussions with vivid examples taken from art, history, literature, and philosophy. Sacks’s book is much broader and far-reaching than a work strictly concerned with neurology. Although it’s full of rigorous science and insightful medical research, the book is often more interested in using neurology (and philosophy, among other intellectual disciplines) to understand concepts like human nature, the self, and existence.

Part 1, Chapter 4 Quotes

‘Easy!’ I said. ‘Be calm! Take it easy! I wouldn't punch that leg like that.’

‘And why not?’ he asked, irritably, belligerently.

‘Because it's your leg,’ I answered. ‘Don't you know your own leg?’

He gazed at me with a look compounded of stupefaction, incredulity, terror and amusement, not unmixed with a jocular sort of suspicion, ‘Ah Doc!’ he said. ‘You're fooling me! You're in cahoots with that nurse—you shouldn't kid patients like this!’

‘I'm not kidding,’ I said. ‘That's your own leg.’

He saw from my face that I was perfectly serious—and a look of utter terror came over him. ‘You say it's my leg, Doc? Wouldn't you say that a man should know his own leg?’

Related Characters: Oliver Sacks (speaker)
Page Number: 56
Explanation and Analysis:

In this chapter, Oliver Sacks meets with a patient who claims that doctors have removed his real leg and attached a rotting leg to his body. Sacks chooses to deal with the patient by reasoning with him: he asks the patient why he thinks that the leg attached to his body isn’t “his” leg.

The passage is an interesting example of the conversational, one-on-one approach that Sacks often adopts when dealing with patients. While many neurologists take a clinical, quantitative approach to their patients, and prefer running impersonal tests, Sacks believes that part of the job of the neurologist is to interview the patient directly and get a good sense for the patient’s personality. The passage is also interesting because it’s an example of one case in which Sacks disrupts the patients “illusions.” As a scholar of rare neurological conditions, Sacks is often put in a situation in which he must choose whether or not to break the truth to his patients (for example, when he meets with Jimmie G., he has the opportunity to tell Jimmie that, contrary to what he may think, it’s not 1945). In this case, Sacks chooses to communicate the truth to his patient, perhaps recognizing that, sooner or later, his patient needs to accept that his leg is, in fact, his leg.

Part 1, Chapter 5 Quotes

What wonderful possibilities of late learning, and learning for the handicapped, this opened up. And who could have dreamed that in this blind, palsied woman, hidden away, inactivated, over-protected all her life, there lay the germ of an astonishing artistic sensibility (unsuspected by her, as by others) that would germinate and blossom into a rare and beautiful reality, after remaining dormant, blighted, for sixty years?

Related Characters: Oliver Sacks (speaker), Madeline J.
Page Number: 63
Explanation and Analysis:

In this chapter, Sacks works with an elderly blind patient named Madeline J., who suffers from cerebral palsy and lacks the ability to use her hands normally. However, somewhat surprisingly, Madeline’s inability to use her hands is, in effect, unrelated to her palsy—and with Sacks’s coaching, she gradually discovers how to use her hands normally, a skill that’s been lying dormant within her for six decades.

The passage is an especially moving example of how patients can adapt to their situations, and how the job of a good neurologist is to help patients adapt in the healthiest, most manageable way possible. Sacks can’t always train his patients to live fruitful, happy lives, but at times—with Madeline J., certainly—he succeeds by using a compassionate yet scientifically rigorous approach.

Part 1, Chapter 7 Quotes

Mr. MacGregor’s homely symbol applies not just to the labyrinth but also to the complex integration of the three secret senses: the labyrinthine, the proprioceptive, and the visual. It is this synthesis that is impaired in Parkinsonism.

Related Characters: Oliver Sacks (speaker), Mr. MacGregor
Page Number: 73
Explanation and Analysis:

In Chapter Seven, Oliver Sacks work one-on-one with a man named Mr. MacGregor, who, as a result of his Parkinson’s disease, is unable to synthesize information from his vestibular, visual, and proprioceptive systems—meaning that, in short, he walks with a significant lean. During the course of his interview with Mr. MacGregor, MacGregor compares the vestibular system (located in the inner ear) with a carpenter’s level, whose purpose is to determine what is and isn’t straight. As Sacks explains, the problem with Mr. MacGregor’s mind isn’t that his “carpenter’s level” isn’t working; rather, it’s that his brain doesn’t know how to translate signals from his vestibular system. In the passage, Sacks makes an important distinction between sensation and perception. MacGregor’s sensations are perfectly ordinary—his senses work just find—but his mind can no longer translate sense into perception, thanks to the effects of Parkinson’s.

Part 1, Chapter 9 Quotes

Here then was the paradox of the President's speech. We normals—aided, doubtless, by our wish to be fooled, were indeed well and truly fooled (‘Populus vult decipi, ergo decipiatur’). And so cunningly was deceptive word-use combined with deceptive tone, that only the brain-damaged remained intact, undeceived.

Related Characters: Oliver Sacks (speaker)
Page Number: 84
Explanation and Analysis:

In this chapter, Sacks makes a rare political statement: he’s in the hospital, observing his patients, many of whom lack the ability to interpret words, mannerisms, or speech inflections, as they watch a televised speech by “the president” (presumably, President Ronald Reagan). As the patients watch the president’s speech, they laugh and grimace with confusion and distaste—from their perspective, Reagan is a fake, utterly unconvincing speaker. Some of them find Reagan’s vocabulary childish (since they can’t respond to his vocal inflections) while others find his delivery and inflection stodgy and insincere.

Sacks, we can deduce, was no fan of Reagan, and so, in a way, he admires his patients for “seeing through” the political pageantry and recognizing the truth: Reagan is an actor, whose job is to seduce people into believing him. (The Latin phrase in this passage roughly translates to, “The people want to be deceived, so let them be deceived.”) Unlike the bulk of the American population, the patients in Sacks’s hospital see through Reagan’s act. Thus, the passage is the first of many examples of how a neurological “disorder” can actually be an advantage in some parts of life.

Part 2, Introduction Quotes

We might imagine, from a case of amnesia or agnosia, that there is merely a function or competence impaired—but we see from patients with hypermnesias and hypergnosias that mnesis and gnosis are inherently active, and generative, at all times; inherently, and—potentially—monstrously as well. Thus we are forced to move from a neurology of function to a neurology of action, of life. This crucial step is forced upon us by the diseases of excess—and without it we cannot begin to explore the ‘life of the mind’. Traditional neurology, by its mechanicalness, its emphasis on deficits, conceals from us the actual life which is instinct in all cerebral functions—at least higher functions such as those of imagination, memory and perception. It conceals from us the very life of the mind.

Related Characters: Oliver Sacks (speaker)
Page Number: 89
Explanation and Analysis:

In Part Two of the book, Sacks shifts from discussions of neurological disorders that can be most conveniently conceived of as “deficits” in some way to disorders that can more easily be thought of as abundances of a particular neurological function. One consequence of Sacks’s emphasis on the paradigm of overabundance is that Sacks is necessarily forced to write about the effects of overabundance on his patients’ lives (whereas, when writing about a deficit of some kind, it was less necessary for him to talk about real-world effects).

The passage provides another important argument for why neurological paradigms (such as deficit) inhibit the practice of neurology as much as they help it. When neurologists become too accustomed to speaking of disorder as a kind of deficit, they neglect real-life examples of how the deficit impacts patients’ lives, and concentrate their efforts on the problem with a literal part of the human brain. Sacks’s solution to such a problem isn’t to throw out the idea of deficit, or of neurological paradigms altogether, but rather to balance out such a paradigm with others, including but not limited to the paradigm of superabundance.

Part 2, Chapter 10 Quotes

There followed three months of deep and patient exploration, in which (often against much resistance and spite and lack of faith in self and life) all sorts of healthy and human potentials came to light: potentials which had somehow survived twenty years of severe Tourette’s and ‘Touretty’ life, hidden in the deepest and strongest core of the personality. This deep exploration was exciting and encouraging in itself and gave us, at least, a limited hope. What in fact happened exceeded all our expectations and showed itself to be no mere flash in the pan, but an enduring and permanent transformation of reactivity. For when I again tried Ray on Haldol, in the same minute dose as before, he now found himself tic-free, but without significant ill-effects—and he has remained this way for the past nine years.

Related Characters: Oliver Sacks (speaker), Ray
Page Number: 99
Explanation and Analysis:

In this chapter, Sacks works with a patient named Ray who has a bad case of Tourette’s Syndrome, a neurological disorder that gives him constant tics, limited motor control, and an inability to concentrate on anything for very long. At first, Sacks tries to “cure” Ray’s Tourette’s by prescribing him a drug called Haldol, which limited Ray’s symptoms but also leaves Ray weak, tired, and depressed. Only later, when Sacks works with Ray to adjust to his new drug treatment and calibrate his behavior accordingly, does Ray begin to warm to his new life.

The passage provides an especially clear example of what distinguishes Sacks’s methods from those of many of his fellow neurologists. Sacks sees it as his duty to diagnose his patients and provide the appropriate treatment, but also to help his patients adjust to their new ways of life. Sacks’s approach is consistent with his philosophy that neurological disorders should be conceptualized not simply as impairments of the brain, but as external, real-world manifestations of those impairments. Put another way, Tourette’s Syndrome isn’t considered a disorder simply because it’s an abnormality of the nervous system; it’s a disorder because it effects the way people behave from day to day. Therefore, it’s Sacks’s duty to help Ray adjust his behavior after ingesting Haldol.

As this pattern became clear to him, and after discussing it with me, Ray made a momentous decision: he would take Haldol ‘dutifully’ throughout the working week, but would take himself off it, and ‘let fly’, at weekends. This he has done for the past three years. So now there are two Rays—on and off Haldol. There is the sober citizen, the calm deliberator, from Monday to Friday; and there is ‘witty ticcy Ray’, frivolous, frenetic, inspired, at week- ends.

Related Characters: Oliver Sacks (speaker), Ray
Page Number: 101
Explanation and Analysis:

At the end of the chapter, Oliver Sacks adds a surprising coda: his patient, Ray, who suffers from Tourette’s Syndrome, has accepted the drug Haldol, which he takes regularly. As a result of ingesting Haldol, Ray has made a new, functional life for himself—he has a good job and a loving wife (where previously he struggled to form friendships or relationships with others). However, Ray isn’t entirely happy with his new life—although he didn’t always like having Tourette’s, he’s nostalgic for the heightened awareness and quick thinking that Tourette’s provided him. Therefore, on weekends Ray refuses to take his Haldol, and savors the liveliness and energy of Tourette’s Syndrome.

Throughout the book Sacks suggests that, in spite of the connotations of the word “dis-order,” not all neurological disorders are purely malicious; indeed, some disorders could be construed as rare gifts. Tourette’s impairs Ray’s life in many ways, but it also makes him feel happy and alive at times. In the end, Ray chooses to split the difference and move back and forth between his sedated, “normal” existence and his Tourette’s existence.

Part 2, Chapter 12 Quotes

Such a frenzy may call forth quite brilliant powers of invention and fancy—a veritable confabulatory genius—for such a patient must literally make himself (and his world) up every moment. We have, each of us, a life-story, an inner narrative—whose continuity, whose sense, is our lives. It might be said that each of us constructs and lives, a ‘narrative’, and that this narrative is us, our identities.

Related Characters: Oliver Sacks (speaker), William Thompson
Page Number: 110
Explanation and Analysis:

In this chapter, we’re introduced to a man named William Thompson, who, like Jimmie G., lacks the ability to remember anything for longer than a few seconds. Unlike Jimmie, however, Thompson compensates for his condition by constantly improvising new identities. In the course of a conversation, Thompson might pretend to be as many as a dozen different people, and then identify other people in a variety of contradictory ways.

As Sacks sees it, Thompson’s condition is emblematic of the struggle for identity that's integral to human nature. Human beings feel a natural desire to have a stable identity, and most humans take such an identity for granted. William Thompson, however, has no significant powers of memory, and therefore, no sense of who he is. In the absence of a memory—and, therefore, identity—he simply improvises identities for himself, creating elaborate narratives about his life, and the lives of others.

Part 2, Chapter 13 Quotes

In all these states—‘funny’ and often ingenious as they appear—the world is taken apart, undermined, reduced to anarchy and chaos. There ceases to be any ‘center’ to the mind, though its formal intellectual powers may be perfectly preserved. The end point of such states is an unfathomable ‘silliness’, an abyss of superficiality, in which all is ungrounded and afloat and comes apart. Luria once spoke of the mind as reduced, in such states, to ‘mere Brownian movement’.

Related Characters: Oliver Sacks (speaker), A. R. Luria
Page Number: 118
Explanation and Analysis:

In Chapter 13, Sacks devotes some time to discussing the principle of equalization. Equalization, a concept found in the writings of A. R. Luria, describes a set of behaviors often found in people with serious neurological conditions. Often people who lack powers of memory will adopt a certain attitude of nonchalance, as if to compensate for their confusion about who they are and about what's going on in the rest of the world. As Sacks puts it, patients of this variety live in a constant state of “Brownian motion” (a reference to the rapid molecular motion one can observe under a microscope). In a constant flux state, people with neurological disorders try to gain a measure of control over their own situations by affecting an indifferent attitude. Equalization is only one of the many ways that, according to Sacks, patients adapt to their disorders.

Part 2, Chapter 14 Quotes

The super-Touretter, then, is compelled to fight, as no one else is, simply to survive—to become an individual, and survive as one, in face of constant impulse. He may be faced, from earliest childhood, with extraordinary barriers to individuation, to becoming a real person. 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. Health, health militant, is usually the victor.

Related Characters: Oliver Sacks (speaker)
Page Number: 124-125
Explanation and Analysis:

In Chapter 14, Sacks returns to discussing Tourette’s Syndrome, a disorder that, during the course of his career (and largely because of his research) became much more commonly discussed, both in the medical community and in the general public. There are certain patients with Tourette’s whose symptoms are so severe that they can barely control their own bodies. Sacks describes one such patient—an elderly woman who stands in the street, seemingly mocking other people. Sacks is amazed by the woman, because he realizes that, although she can barely control her body, she’s caricaturing the people who walk by her throughout the day. As Sacks interprets it, the woman is trying to maintain a semblance of control over her self and her body, using humor and satire to distance herself from her neurological condition. In this sense, Sacks believes, the woman’s behavior is representative of the struggle to maintain a sense of order and meaning. The woman’s behavior is heroic, because she’s actively fighting for her individuality—and, at least according to Sacks, winning.

Part 3, Introduction Quotes

All the transports described in this section do have more or less clear organic determinants (though it was not evident to begin with, but required careful investigation to bring out). This does not detract in the least from their psychological or spiritual significance.

Related Characters: Oliver Sacks (speaker)
Page Number: 130
Explanation and Analysis:

In Part Three of the book, Oliver Sacks turns to discussing neurological “disorders” that, in spite of their misleading name, aren’t necessarily negative at all. Sacks is interested in neurological abnormalities that alter the patient’s perception of the external world. Furthermore, he argues that throughout history people who’ve claimed to experience religious visions or achieve divine inspiration may have had a rare neurological condition, such as a seizure of the temporal lobes, that altered their perception of reality. Sacks isn’t trying to suggest that there is anything disingenuous about mystics’ claims of divine inspiration; as he says here, finding a concrete, neurological explanation for a vision does nothing to interfere with the legitimacy or significance of that vision.

Part Three of the book is especially interesting insofar as it challenges the dogma that neurological disorders exemplify “something wrong” with the brain. Sacks instead argues that, at times, neurological disorders give the patient a rare form of inspiration.

Part 3, Chapter 17 Quotes

Another week passed, and now Bhagawhandi no longer responded to external stimuli, but seemed wholly enveloped in a world of her own, and, though her eyes were closed, her face still bore its faint, happy smile. ‘She's on the return journey,’ the staff said. ‘She'll soon be there.’ Three days later she died—or should we say she ‘arrived’, having completed her passage to India?

Related Characters: Oliver Sacks (speaker), Bhagawhandi P.
Page Number: 155
Explanation and Analysis:

In Chapter 17, one of the most moving in the book, Sacks describes a likeable young woman named Bhagawhandi, who had a terminal tumor and had only a few months left to life. As her tumor grew, however, Bhagawhandi began to experience strange visions, during which she felt that she was traveling back to her old village in India. While Sacks speculated that these visions originated as seizures in her temporal lobes, he was unable to account for the vividness and complexity of the visions.

Sacks describes Bhagawhandi’s eventual death as a return—the completing of her “passage to India” (an allusion to the famous E. M. Foster novel A Passage To India). In doing so, he reminds us that not all neurological abnormalities are necessarily bad—in Bhagawhandi’s case, for example, her hallucinations put her in a calm, peaceful state of mind and relaxed her as she approached death. Furthermore, Sacks reminds his readers that he’s not writing a strictly scientific book—here, as in other parts of the book, Sacks raises philosophical, religious, and even mystical themes that other neurologists might dismiss as “unscientific.”

Part 3, Chapter 19 Quotes

Donald has not forgotten, or re-repressed, anything of the murder—if, indeed, repression was operative in the first place—but he is no longer obsessed by it: a physiological and moral balance has been struck.

But what of the status of the first lost, then recovered, memory? Why the amnesia—and the explosive return? Why the total black-out and then the lurid flashbacks? What actually happened in this strange, half-neurological drama? All these questions remain a mystery to this day.

Related Characters: Oliver Sacks (speaker), Donald
Page Number: 164-165
Explanation and Analysis:

In Chapter 19, Sacks discusses a man named Donald who committed a murder while he was high on PCP, claimed to have no memory of the murder, pled insane, and ended up in a mental institution. Later, after a bicycle accident, Donald sustained an injury that caused him to re-experience the act of killing in vivid, almost photographic detail, again and again. Like many of the patients in Sacks’s book, Donald eventually learns to live with his condition by adapting—he goes to therapy and receives training on how to cope with the constant barrage of painful memories.

However, in this passage at the end of the chapter, Sacks acknowledges how little neurologists know about Donald’s condition: they don’t understand how (or why) he blacked out the initial memory of the murder, or how those memories returned in such a vivid way. In a way, Sacks’s observations remind us why it’s so important for neurological patients to learn to adapt and live with their conditions: quite frequently, neurologists have no convenient cure for their disorders.

Part 3, Chapter 20 Quotes

Invested with this sense of ecstasy, burning with profound theophorous and philosophical significance, Hildegard’s visions were instrumental in directing her towards a life of holiness and mysticism. They provide a unique example of the manner in which a physiological event, banal, hateful or meaningless to the vast majority of people, can become, in a privileged consciousness, the substrate of a supreme ecstatic inspiration.

Related Characters: Oliver Sacks (speaker), Hildegard of Bingen
Page Number: 169
Explanation and Analysis:

In Chapter 20, Sacks discusses the life of Hildegard of Bingen, a famous Christian mystic who claimed to have experienced divine visions. Hildegard, Sacks speculates, had a neurological condition that allowed her to experience frequent seizures and vivid hallucinations. One could argue that a medical explanation of Hildegard’s visions interferes with her claims of divine inspiration. But, as Sacks argues here, the “banality” of a neurological explanation says nothing about the true source of the visions—one could conceivably argue that Hildegard really was receiving divine inspiration, and that God chose to communicate with her by giving her a seizure of the temporal lobes. And, of course, even if one disputes the divine nature of Hildegard’s visions, one can respect the sophistication of her writing, the sincerity of her piety, etc. In all, Sacks uses the life of Hildegard to emphasize his point that studying the physiological sources of inspiration do nothing to trivialize inspiration itself.

Part 4, Introduction Quotes

But of much greater interest, much more human, much more moving, much more ‘real’—yet scarcely even recognized in scientific studies of the simple (though immediately seen by sympathetic parents and teachers)—is the proper use and development of the concrete.

The concrete, equally, may become a vehicle of mystery, beauty and depth, a path into the emotions, the imagination, the spirit.

Related Characters: Oliver Sacks (speaker)
Page Number: 176
Explanation and Analysis:

The final quarter of Sacks’s book begins with an extended discussion of the concept of the “concrete.” Like the concepts of deficit or abundance, concreteness is not in itself a scientific phenomenon—rather, it’s a conceptual tool, with its own unique strengths and weaknesses, that helps neurologists get a better sense for their patients’ conditions. When applied to cases of mental disability, however, Sacks has found that the concept of concreteness is a good way to understand his patients’ worldview. Sacks argues that many patients with mental disabilities have a special connection with the concrete world, almost as if, in the absence of the ability to conceive of abstract concepts, their minds focus on the physical, tangible realm.

It’s important to keep two things in mind, however: first, Sacks isn’t necessarily saying that all mentally disabled people compensate for their conditions by focusing on the concrete realm; second, Sack’s isn’t trying to fetishize or condescend to intellectual disabilities. Rather, he’s trying to complicate traditional understandings of mental illness by showing how, in some cases, a deficit in some cognitive faculties may be accompanied with an overabundance of others.

Part 4, Chapter 21 Quotes

‘I’m like a sort of living carpet. I need a pattern, a design, like you have on that carpet. I come apart, I unravel, unless there's a design.’

Related Characters: Rebecca (speaker)
Page Number: 184-185
Explanation and Analysis:

In Chapter 21, we meet Rebecca, a mentally disabled woman who possesses a phenomenal ability to speak in poetic, metaphorical phrases. After the death of her beloved grandmother, for example, Rebecca describes her emotions as wintry, and confesses to Sacks that she thinks of her life as a carpet, requiring intricate patterns and designs to give it order and meaning.

Sacks’s characterization of Rebecca as a great poet and metaphorical thinker might seem counterintuitive, given his emphasis on the concrete in the Introduction to Part Four—one could reasonably argue that poetry is the exact opposite of the concrete (literal versus non-literal). However, as Sacks sees it, Rebecca’s talent lies in her ability to represent challenging, abstract concepts such as grief, change, and nostalgia in immediately accessible, concrete terms. The passage is notable, furthermore, in conveying the sophistication and dignity with which Rebecca conducts herself after her grandmother’s death. Contrary to what many in both the medical community and the public might think, there is nothing immature or “deficient” about Rebecca’s emotional response to her experience with grief and depression.

Part 4, Chapter 22 Quotes

His innate, hereditary musical gift had clearly survived the ravages of meningitis and brain-damage—or had it? Would he have been a Caruso if undamaged? Or was his musical development, to some extent, a ‘compensation’ for brain-damage and intellectual limitations?

Related Characters: Oliver Sacks (speaker), Martin A.
Page Number: 187
Explanation and Analysis:

In this chapter, the subject is a patient named Martin A., who, in spite of—or perhaps because of—his mental disabilities, possesses a phenomenal memory and appreciation for music. Martin A. has little to no knowledge of the world, but he knows almost everything there is to know about classical music, especially Bach. Too often, people think of Martin A.’s talents as a mere “echo” of his father’s (Martin’s father was a great opera singer). However, Sacks wonders if, in a sense, Martin’s mind has compensated for its mental impairments with a greater focus on music—in other words, certain deficits in Martin’s mind brought about his great abilities in other cognitive departments.

Martin, then, is exemplary of Sacks’s concept of adaptation. In this case, Martin doesn’t consciously adapt to his mental condition; however, Sacks hypothesizes that his mind has been unconsciously compensating for his mental condition, leaving him with a world-class knowledge and appreciation of Bach.

One speaks of ‘idiot savants’ as if they had an odd ‘knack’ or talent of a mechanical sort, with no real intelligence or understanding. This, indeed, was what I first thought with Martin—and continued to think until I brought in the Magnificat. Only then did it finally become clear to me that Martin could grasp the full complexity of such a work, and that it was not just a knack, or a remarkable rote memory at work, but a genuine and powerful musical intelligence.

Related Characters: Oliver Sacks (speaker), Martin A., Johann Sebastian Bach
Page Number: 193
Explanation and Analysis:

In this passage, Sacks describes some of the stereotypes about the mentally disabled. One common stereotype is that mentally disabled people who exhibit profound talent in some other cognitive area—“idiot savants” as they’re often known—aren't truly gifted at all. In other words, many people—including both doctors and lay people—think of “idiot savants’” mental abilities as mere party tricks or mechanical processes, demonstrating no profound ability or sophistication. Sacks shows that, in fact, people with both significant mental talents and mental impairments can make sophisticated, mature judgments—they’re more than just parrots. In the case of Martin A., for example, Martin’s judgments about the music of J. S. Bach show deep understanding of Bach’s music. His opinions about music are no less valid than those of any other music expert—his mental impairment is, in this case, a non sequitur.

Part 4, Chapter 23 Quotes

This is the positive side—but there is a negative side too (not mentioned in their charts, because it was never recognized in the first place). Deprived of their numerical ‘communion’ with each other, and of time and opportunity for any ‘contemplation’ or ‘communion’ at all—they are always being hurried and jostled from one job to another—they seem to have lost their strange numerical power, and with this the chief joy and sense of their lives. But this is considered a small price to pay, no doubt, for their having become quasi-independent and ‘socially acceptable’.

Related Characters: Oliver Sacks (speaker), John, Michael
Page Number: 209-210
Explanation and Analysis:

In this moving chapter, Sacks describes the lives of “the twins,” John and Michael, who had phenomenal mathematical talents. John and Michael could remember long numbers and calculate the day of the week for any date in history. However, later in their lives, John and Michael were split apart and forced to work in menial jobs. As a result, they lost their ability to do complex math—which, previously, had been a source of tremendous joy and comfort for them both.

The passage is particularly noteworthy because one can sense Sacks’s bitterness and disillusionment with society. He’s shown that John and Michael are talented, if idiosyncratic mathematicians—and instead of nurturing their gifts and encouraging them to put their talents to use, society has first treated John and Michael’s genius like a mere party trick, and then rejected it altogether in favor of making them “socially acceptable.” In this chapter, and particularly the next one, Sacks suggests that society needs to rethink the way it conceives of neurological disorders and find better ways of encouraging neurodivergent people to develop their unique gifts, rather than marginalizing them and forcing them to conform to lifestyles that aren’t meant for them.

Part 4, Chapter 24 Quotes

Could he, with his fine eye, and great love of plants, make illustrations for botanical works or herbals? Be an illustrator for zoology or anatomy texts? (See the drawing overleaf he made for me when I showed him a textbook illustration of the layered tissue called ‘ciliated epithelium’.) Could he accompany scientific expeditions, and make drawings (he paints and makes models with equal facility) of rare species? […] He could do all of these—but, alas, he will do none, unless someone very understanding, and with opportunities and means, can guide and employ him. For, as the stars stand, he will probably do nothing, and spend a useless, fruitless life, as so many other autistic people do, overlooked, unconsidered, in the back ward of a state hospital.

Related Characters: Oliver Sacks (speaker), José
Related Symbols: José’s Drawings
Page Number: 231-232
Explanation and Analysis:

In the final chapter of the book, Sacks discusses an autistic patient named José. For most of his life, José has been treated like a waste of space—he’s regularly called “hopelessly retarded.” And yet, Sacks discovers, he’s a very gifted artist. In short, because of society’s ignorance of neurological disorders, José, a great artist with a lot of talent to offer the world, has been placed in a hospital and forced to live a “useless, fruitless life.” As with the previous passage, you can almost feel Sacks’s quiet fury.

In the thirty years since Sacks’s book was published, Western society has indeed become more understanding of autism. Autistic people have achieved success in many walks of life, rather than living out their lives in hospitals. However, people continue to have many misconceptions about autism and mental illness in general. In the end, Sacks seems to be making a plea for understanding: if people would only take the time to recognize the talent and ingenuity of people like José, he seems to be saying, people with neurological disorders could live more fulfilling, productive lives, and the world would be a happier place for everyone.

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