The Man Who Mistook his Wife for a Hat

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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.
The Neurological Community Theme Icon

The Man Who Mistook His Wife for a Hat does more than study neurology; it also critiques the state of the contemporary medical community. Throughout the book, Oliver Sacks contrasts his approach to studying patients with neurological disorders with the methods and assumptions of other neurologists. In doing so, he suggests that the neurological community—and, perhaps, the entire medical community—has become overly focused on quantifying its patient research and reducing complex phenomena to simplified, overly mechanical processes.

The Man Who Mistook His Wife for a Hat critiques the neurological community on the grounds that it has in itself become too “left-brained”—in other words, too concerned with understanding patients in abstract, mathematical, or overly mechanical terms. The left-brained-ness of the neurological community can be detected in the way it evaluates patients’ medical conditions. Instead of studying patients in the course of the patients’ ordinary lives, neurologists tend to subject their patients to a series of tests that reduces their lives to quantifiable information. In the case of intellectually disabled patients, for example, neurologists tend to rely too heavily on numerical information, such as IQ, and not enough on other, harder-to-quantify aspects of their patients’ minds.

Another sign of the neurological community’s left-brained tendency is neurologists’ strong desire to schematize neurological disorders as discrete, clearly understood processes. For example, Sacks describes how neurologists focus primarily on disorders that can be traced back to the left hemisphere of the brain, because left-hemisphere disorders can be identified more precisely, and traced back to specific parts of the brain more easily than can right-hemisphere disorders. In short, Sacks claims that the neurological community wants to make neurology as much of a hard science as possible, using rigorous quantitative data whenever possible.

The neurological community’s left-brained emphasis on the quantitative and the mechanistic, Sacks argues, leads to some major problems. One such problem is that neurologists ignore many important neurological disorders, simply because they can’t be reduced to quantitative data or to any clearly delineated cause. In Part One of The Man Who Mistook His Wife for a Hat, Sacks argues that neurologists have mostly neglected disorders that originate in the right hemisphere of the brain, such as face blindness, or Korsakov’s Syndrome. Even when neurologists publish important information about right-hemisphere disorders, he suggests, the results aren’t always widely discussed. In part, this is the case because right-hemisphere disorders are harder to represent quantitatively or trace back to a single isolated part of the brain. Additionally, neurologists neglected important disorders such as Tourette’s Syndrome, because these disorders couldn’t easily be studied in a clinical setting, and their causes weren’t always easy to isolate.

Sacks also argues that the neurological community is largely unable to see or acknowledge the unique virtues of people with neurological disorders (see “Illness as a Gift” theme). In the case of intellectual impairment, for example, neurologists too often conclude that patients have low IQs, but seem not to notice their patients’ creativity, insightfulness, or other right-brained talents. In all, Sacks argues that the neurological community has erred in trying to become as rigorously mathematical as possible, ignoring many of the unquantifiable aspects of the human condition. In order to understand patients fully, he suggests, neurologists need to supplement their quantifiable findings with qualitative observation, using some of the methods more commonly associated with the social sciences.

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The Neurological Community 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 The Neurological Community.
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 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.

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 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 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.