At the beginning of his career, Oliver Sacks began working with intellectually disabled patients, and worried that he’d find his work especially depressing. However, his mentor, A. R. Luria, encouraged Sacks to continue working with these patients, adding that his own time working in such a capacity was some of the happiest and most moving of his professional life. Years after, Sacks has come to understand what Luria meant. Mentally challenged people may be “defective” in some capacities, but they may also exhibit a “peculiar clarity” in others.
As he has before, Luria here give Sacks a new attitude about his work as a neurologist. Socially there is a strong tendency for neurotypical people to think of intellectually disabled people as “defective” in some way; however, Sacks comes to realize that an intellectually disabled person may exhibit phenomenal ability in other cognitive areas, and sees that intellectual disability certainly doesn’t mean a lack of humanity or value.
If there’s a single word that can describe the existence of the mentally challenged, Sacks says, it is “concreteness.” The neurologist Kurt Goldstein argued that human beings are unique among living beings insofar as they can reason abstractly and categorically. And yet human beings are also concrete—living, breathing entities. Even if some mentally challenged people lack the ability to reason abstractly, they are perhaps more in touch with the tangible, concrete world.
For the final quarter of his book, Sacks will use the concept of concreteness to structure his discussions of different patients. Like “deficit,” “concreteness” is not itself a scientific phenomenon—it’s an intellectual tool to help scientists make sense of a wide array of people and conditions. The term isn’t perfect, and doesn’t encompass all cases, but it helps Sacks convey the rare insightfulness that he’s noticed in some patients.
Too often, scientists ignore the importance of the “concrete”; in classical science, Sacks argues, the concrete is seen as trivial. But sometimes, patients who have a heightened relationship with the concrete world become attuned to tiny details of the world, or have an uncanny ability to remember physical spaces. And the concrete can be a place of beauty in a way that the world of ideas cannot. Thus, a patient may be mentally disabled and yet have a rare gift for understanding the concrete world.
Sacks isn’t trying to fetishize intellectual impairment, or suggest that it’s preferable to “normal” intelligence; however, he argues that people—both scientists and lay people—are too eager to ignore the unique point of view that mentally disabled people offer; a point of view that Sacks will explore in Part Four.