At the age of nineteen, a “mentally retarded” patient named Rebecca entered Oliver Sacks’s clinic. Her grandmother described her as being “like a child.” Rebecca couldn’t always tell left from right, and sometimes spent hours trying to fit her left foot into a right-sided shoe. She also had a cleft palate, which made it difficult for her to talk. She loved nature and worshipped her grandmother, who told her stories. Rebecca excelled at understanding complex metaphors—in spite of her low IQ, she had a rare gift for “poetic power.”
Rebecca exemplifies the unique, “concrete” point of view that Sacks began to explain in the Introduction to Part Four. However, it may seem counterintuitive to describe Rebecca as having a rare gift for metaphor, since one could argue that metaphor is the exact opposite of “concreteness.” In Part Four, Sacks uses several terms such as “moron,” “retarded,” and “idiot” which were once common in the medical community, but which have become heavily stigmatized and are no longer so commonly used. For the purposes of this summary, we’ll use terms such as “intellectually disabled” to describe Rebecca.
Rebecca had an incredible ability to see the world—especially the natural world—as one poetic whole. She would stand outside, saying, “Look at the world, how beautiful it is.” As Sacks spent more time with her, he came to realize how inadequate traditional methods of evaluating intelligence are. Such tests are primarily designed to measure mental deficits; they can’t show neurologists the mind’s unique powers.
Rebecca’s lack of cognitive ability in some areas doesn’t do justice to her cognitive abilities in others. Sacks implicitly criticizes the neurological community in this passage—as before, the crux of his criticism is that neurologists are too reliant on narrow, perhaps overly quantitative measures of cognitive ability.
When Rebecca’s grandmother died, Rebecca was devastated, but she conducted herself with impressive dignity. She told Sacks, “I’m so cold, it’s winter inside … she was a part of me. Part of me died with her.” She later told Sacks, “It is winter. I feel dead. But I know the spring will come again.” In her grief, Rebecca turned to the synagogue (she’d been raised Jewish) and delivered the Kaddish (a Jewish funeral prayer) for her grandmother’s funeral.
Sacks writes movingly about Rebecca’s religious passion and the way she turns to art, as well as religion, in her time of emotional need. Rebecca may be mentally impaired in some ways, but there’s nothing juvenile or unsophisticated about the way she copes with grief.
Rebecca’s life proves that doctors pay far too much attention to patients’ defects and not enough to “what is intact or preserved.” One consequence of this bias is that doctors lack the terminology to talk about a patient’s link with the concrete world. Rebecca was always interested in words. She could understand the concept of a symbol, and often spoke in a symbolic language, which helped her make sense of “concrete reality” in a way that abstract thought couldn’t. She once told Sacks, “I’m like a sort of living carpet. I need a pattern, a design … I unravel unless there’s a design.” Later in her life, Rebecca became very interested in the clinic’s theater group. Sacks concludes, “If one sees Rebecca on stage … one would never even guess that she was mentally defective.”
Though Sacks argues that mentally disabled people often display a special connection with the “concrete” world, he also praises Rebecca for her ability to speak poetically and metaphorically (which, one could argue, is the opposite of speaking concretely). But Rebecca finds ways of expressing abstract, ineffable emotions with the help of concrete language. Sacks’s point isn’t that Rebecca is incapable of abstract thought of any kind; rather, Rebecca uses her familiarity with the concrete realm to express complex emotions and abstract thoughts in ways that most human beings couldn’t.
In the Postscript, Sacks notes that music, stories, and theater can have an especially powerful effect on the mentally challenged. There have been cases of patients with severe damage to their frontal lobes, leaving them almost unable to walk, who learn to walk with the help of music. In a way, music helps people organize their minds, and much the same is true of drama. Love and talent for the arts seems to be one of the quintessential human qualities, one which has very little to do with traditional ideas of intelligence.
One of the uniting themes of Sacks’s book is the way that people, especially those with neurological conditions, use art to make sense of their existence. If Sacks has a definition of human nature in mind, his definition would surely include the ability to make and respond to art. Ultimately, then, his subjects’ love for art and poetry is a powerful reminder of their resilient humanity.