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
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.
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?
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.
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.
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.
‘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.’
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.
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.
