The Man Who Mistook his Wife for a Hat

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Conceptions of Mental Illness Theme Analysis

Themes and Colors
Neurology Theme Icon
Conceptions of Mental Illness Theme Icon
The Neurological Community Theme Icon
Equalization and Adaptation Theme Icon
Illness as a Gift Theme Icon
LitCharts assigns a color and icon to each theme in The Man Who Mistook his Wife for a Hat, which you can use to track the themes throughout the work.
Conceptions of Mental Illness Theme Icon

In addition to describing the practice of neurology, The Man Who Mistook His Wife for a Hat studies some of the different ways of conceiving of neurological disorders. In a sense, the question of how one should conceptualize mental illness is not itself a neurological question, and, as Sacks shows, scientists’ paradigms (frameworks of agreed-upon assumptions) for mental illnesses are often determined by prejudice, tradition, or convenience, rather than rigorous science. For example, in the first part of the book, Sacks discusses the strong tendency for neurologists to conceive of disorders as kinds of absences, or deficits. For example, aphasia, the inability to speak in words, can be defined as a deficit in Broca’s area, the region of the brain that controls speech. One reason that neurologists prefer to discuss diseases as deficits, Sacks argues, is that deficits in parts of the brain are easier to identify; indeed, neurology arose from scientists’ attempts to trace strange behaviors to deficits in specific areas of the brain.

While the tendency to think of neurological disorders as deficits of some kind can be useful, it creates major weaknesses in the discipline of neurology. For example, as a consequence of the “deficit paradigm,” neurologists are far more comfortable analyzing disorders associated with the left hemisphere of the brain, where it’s easier to trace behaviors to specific areas of the brain, than they are analyzing right-hemisphere disorders. Another consequence of the deficit paradigm is that there is relatively little scholarship on neurological disorders that can be most easily conceived of as abundances. In this way, an arbitrary model for how one should conceive of disorders results in concrete weaknesses in the science of neurology.

If existing ways of talking about mental illness are weak and unnecessarily narrow, Sacks asks, how should doctors conceive of mental illness? In part, the book suggests, scientists should acknowledge the diversity and multiplicity of different conceptions of mental illness, rather than tethering themselves to any single one. The Man Who Mistook His Wife for a Hat conveys the diversity of mental illnesses: the book is divided up into four parts, each one of which is structured around a different conception of mental illness. The first part is structured around the notion that illness is a deficit; the second part is structured around the notion that illness is an abundance of some kind, etc. It’s important to recognize that Sacks isn’t saying that any single paradigm for discussing mental illness is the right one, or even that some paradigms are more correct than others. There are many different ways of defining and classifying mental illness, each of which has its own strengths and weaknesses. Ultimately, the book suggests, neurologists should embrace many different definitions of mental illness, so that their research will explore different kinds of mental illness.

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Conceptions of Mental Illness Quotes in The Man Who Mistook his Wife for a Hat

Below you will find the important quotes in The Man Who Mistook his Wife for a Hat related to the theme of Conceptions of Mental Illness.
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 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 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 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 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

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 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.