The chapter revolves around a subject Sacks will refer to as Dr. P. Dr. P. was a singer and a music teacher. During his time as a teacher, Dr. P. developed a strange condition, whereby he was unable to recognize his students’ faces, and instead recognized them purely by their voices. Dr. P. would also mistakenly see faces where there were none.
Dr. P.’s neurological condition has become popularly known as face blindness. This chapter has become more poignant since Sacks originally wrote it, since, later in life, Sacks learned that he had face blindness.
After consulting with a few doctors, Dr. P. came to see Oliver Sacks. Sacks quickly realized that Dr. P. was a man of great charm and sophistication. Yet when he spoke to Sacks, Dr. P. didn’t look at Sacks in an ordinary way—even though he faced Sacks, he seemed to “scan” Sacks, as if breaking Sacks’s face down into its constituent parts. Sacks gave Dr. P. a brief examination, during which Dr. P. took off his shoe, then mistakenly claimed that his shoe was his foot. Dr. P. also failed to identify basic pictures. He could describe the components of the picture, but not the overall scene. At the end of the examination, Dr. P. walked over to his wife, and tried to pick up her head—he’d mistaken his wife’s head for his own hat.
When he first meets with Dr. P., Sacks takes a casual, conversational approach to his patient. His goal isn’t simply to determine what’s wrong with Dr. P., but also to get a sense for Dr. P.’s personality. In this sense, Sacks is different from many neurologists, who would prefer to get to the tests as soon as possible. (And it’s surprising that Sacks places so much emphasis on conversation and getting to know the subject, since he was famously shy.) Dr. P.’s condition enables him to see, but not assemble what he sees into holistic pictures—he can see the trees, but not the forest. He mistakes his wife for a hat because, without a holistic sense of his wife as a person, he confuses his sensory data all too easily.
Perplexed, Oliver Sacks decided to visit Dr. P. at his school. At school, Dr. P. greeted Sacks, but again seemed distant when he shook Sacks’s hand. Sacks tested Dr. P. to see if he could identify face cards—Dr. P. could do so. However, he found it impossible to describe the expressions of actors on television. He couldn’t even recognize a famous photograph of Albert Einstein. Dr. P. could recognize photographs of his friends—however, when asked how he recognized these images, he described individual parts of the faces, such as their teeth. Finally, Dr. P. could recognize objects, but only by feeling them carefully. Sacks then performed another test on Dr. P.—he asked him to list the buildings he walked by in the course of a day. Dr. P. could name only the buildings on his right side. Sacks wondered what, exactly, Dr. P. saw when he stared at the world. When he asked Dr. P. to describe the plots of books, Dr. P. was able to describe the plots in minute detail, but only in terms of plot, rather than visual narrative or the appearance of certain places.
It may be difficult to understand how Dr. P. could be capable of seeing things, and yet not understanding when he sees a face. To understand, we need to remember the difference between sensation (i.e., the ability of collecting sensory data from the external world) and perception (assembling that data into concepts, and things). Dr. P.’s senses seem to be fine (he’s not blind), but his perception is impaired in such a way that he can’t complete the final step and translate sensation into faces, emotions, and objects. The fact that Dr. P. has trouble with the concept of left might suggest that there is a problem in the right hemisphere of his brain (since the right half of the visual cortex processes sensations from the left visual field).
From Dr. P.’s wife, Oliver Sacks learned that Dr. P. was once a talented painter. His early paintings were finely detailed, but over time his work became less realistic until, in the end, his canvases were “blotches of paint.” Sacks realized that Dr. P.’s paintings marked the development of his visual agnosia (inability to interpret visual sensations) over time: his sense of the concrete visual world slowly disappeared. When Dr. P. asked Sacks what he recommended, Sacks said that although he couldn’t entirely explain what’s wrong with Dr. P., he encouraged Dr. P. to continue teaching music, since that was what brought him joy. Although Sacks never saw Dr. P. again, he knows that Dr. P. taught music until the very end of his life.
Sacks doesn’t recommend a surgery or even a specific treatment for Dr. P.; indeed, his only advice is that Dr. P. immerse himself in music. Sacks’s advice is emblematic of his approach to patients throughout the book: because, for the most part, there is no outright “cure” for the neurological disorders described in the book, Sacks seems most concerned with helping patients adapt to their conditions, especially with the help of the arts, and go on to live fulfilling lives.
In a postscript, Oliver Sacks tries to interpret Dr. P.’s inability to identify objects. He offers two hypotheses: 1) Dr. P.’s brain couldn’t receive the visual information necessary for making visual judgments (e.g., “This is a glove.”); 2) Dr. P.’s brain received the proper visual information, but couldn’t translate this raw information into a holistic judgment about the object. To understand these hypotheses fully, Sacks says, we need to understand what is meant by “judgment.” Judgment is one of the quintessential human behaviors, and yet neurology mostly ignores it. Sacks argues that the brain doesn’t just process information in an abstract, mechanical way, but also in a personal way; in other words, it imbues raw sensory data with personal significance. In a way, the current state of neurology is like Dr. P.’s mind: it’s too focused on the “left”—the abstract, mechanical side of neurology.
Sacks’s interpretation of Dr. P.’s condition isn’t overly technical or characterized by jargon. He’s writing for a lay audience, so he tries to keep his scientific writing simple and accessible. Again, Sacks’s theories about Dr. P. hinge upon the distinction between sensation and perception. Humans perceive the world not simply by “translating” visual data into vision; they imbue the visual data with highly personal, idiosyncratic associations that may originate in the right hemisphere of the brain. Sacks critiques the neurological community for conceiving of perception as an overly mechanistic, left-brained process—a critique that Sacks will reiterate throughout the book.
Sacks was never able to investigate Dr. P. further and determine his disease pathology. However, he found a case from 1956 in which a young man was unable to recognize faces—even his own. However, he’d become adept at studying objects by touching them. The young man couldn’t even picture objects in his dreams—his visual imagination had ceased to exist. Sacks wonders if this patient and Dr. P. had similar disorders. However, he acknowledges that they didn’t have the same problem: where Dr. P. mistook his wife for a hat, the 1956 patient needed his wife to identify herself by wearing a large hat.
Sacks omits a lot of medical jargon and terminology—not just because he’s writing for a lay audience but because he doesn’t always have the time and resources to conduct thorough tests and scans of his patients. Thus, in the case of Dr. P., he doesn’t know exactly what P.’s condition was; he can only compare Dr. P.’s condition with that of other similar patients. Chapter One sets the tone for the rest of the book, in which Sacks will often be more concerned with showing how patients adapt to their conditions than with offering a precise diagnosis.