Oliver Sacks met with a lively patient named Mrs. B., whom he determined to be suffering from a cerebral tumor. When Sacks spoke to Mrs. B., she addressed him as “Father,” “sister,” and “Doctor.” She explained that she couldn’t look at “all” of Sacks—she had to construct his identity by putting together small details of his appearance, such as his coat and his beard. She also insisted that she could no longer tell the difference between left and right, and that the whole world had been reduced to “a facetious insignificance” since she developed her condition—she greeted everything with the same nonchalance.
Mrs. B.’s condition is difficult to understand; it appears that she lacks the ability to discern the differences between basic concepts and categories. In the absence of such an ability—which most human beings take for granted—Mrs. B. compensates by affecting a tone of total, humorous indifference to reality.
Mrs. B. was, much like William Thompson, “de-souled” as a person. Yet her condition was emblematic of the concept of equalization developed by A. R. Luria, which Sacks described in the case of William Thompson and which we’ll see again in later chapters.
Mrs. B., much like other patients in this section, is alienated from other people, and “equalizes” by affecting a tone designed to compensate for her condition. Here Sacks also raises the interesting question of how one connects the idea of a “soul” to the brain and the sense of “self.”
In the Postscript, Sacks notes that the indifferent affect of Mrs. B. is a common manifestation of equalization. There are cases of patients telling two contradictory stories within minutes of each other, all the while maintaining the same nonchalant pose. For people like Mrs. B., “there ceases to be any ‘center’ in the mind,” and yet their minds work perfectly well.
Many patients with neurological disorders “equalize” and compensate for their conditions in different ways, sometimes by unconsciously changing their personality, sometimes consciously by changing their behavior.