Oliver Sacks’s book The Man Who Mistook His Wife for a Hat is about neurology: the science that deals with disorders of the nervous system in general and the brain in particular. (Sacks also discusses neuropsychology, a field that, like neurology, deals with the nervous system, but which is more exclusively focused on observing patient behavior. Nevertheless, Sacks is, first and foremost, a neurologist.) Over the course of the book, Sacks discusses twenty-four different case studies, each of which corresponds to a rare neurological disorder. In the process, Sacks not only communicates a lot of information about his various patients; he gives lay readers a sense for how good neurological research should be conducted.
In part, Sacks suggests, good neurological research hinges upon the study and close observation of the brain itself—in a sense, an internal approach to studying the nervous system. Throughout his research into patients’ neurological disorders, Sacks makes use of technologies such as the electroencephalogram, or EEG, which measures brain wave patterns, and the Computerized Topography, or CT scan (which, as of the book’s publishing, was only a decade old). By using technology to analyze the internal structure of the human brain, Sacks can, in some cases, trace a disorder back to a specific area of the brain, and therefore make a better diagnosis for how to treat the disorder.
Nevertheless, Sacks doesn’t exclusively use the internal approach to studying the nervous system; indeed, in the majority of the case studies in the book, he makes no mention of either EEG or CT scans, and focuses instead on descriptions of his patients’ mannerisms and their day-to-day behaviors. One potential reason that Sacks doesn’t dwell on descriptions of elaborate tests or on the precise areas of the brain that might trigger neurological disorders is that he’s writing for a lay audience for which such information wouldn’t necessarily make sense. But at the same time, the relatively little detail about tests and brain waves is indicative of Sacks’s approach to neurology itself, not just his approach to writing about neurology. Sacks argues that neurologists rely too exclusively on scans and other internal measures of the nervous system (see “The Neurological Community” theme). The Man Who Mistook His Wife for a Hat suggests that an internal approach to studying the nervous system is an invaluable tool for neurologists, but one that’s most useful when paired with observation of a patient’s behavior.
In diagnosing and treating his patients, Sacks relies upon an unusually holistic, and even empathetic, approach to observing his patients—in a sense, an external approach to studying the nervous system, emphasizing the ways in which internal neurological problems influence a person’s behavior. Sacks spends long hours interviewing his patients and getting a feeling for how they live their lives. Furthermore—and, according to Sacks, unlike most neurologists—he prefers to study patients in their “natural habitats,” rather than in a clinical, scientific setting. When studying Tourette’s Syndrome, for example, Sacks makes some of his most important insights while observing patients with Tourette’s as they walk through the streets of New York City, rather than while talking to them in a hospital. By relying so extensively on observation of patients’ day-to-day behavior—and, in a way, their lives—Sacks is able to understand their disorders to a degree that wouldn’t be possible had he relied purely on EEGs, or even if he’d relied on in-hospital interviews. Sacks succeeds as a neurologist because he understands how to combine an internal approach to studying the nervous system with an external approach. For example, when working with a man with Tourette’s Syndrome named Ray, Sacks prescribes a drug called Haldol to treat the disorder, based on the brain scans and other internal tests that his colleagues have conducted. However, when he realizes that Haldol makes Ray sluggish and depressed, Sacks spends three months working with Ray to show him how to adjust his behavior to his new neurological state. Put another way, Sacks uses Haldol to remedy Ray’s internal disorder—the precise chemical deficiencies in his brain—but also uses empathetic, one-on-one therapy to help Ray adjust his external actions accordingly. In all, The Man Who Mistook His Wife for a Hat suggests that neurology must blend rigorous study of the nervous system itself with careful observation of how a patient behaves in the world.
Neurology Quotes in The Man Who Mistook his Wife for a Hat
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.
‘Well, Dr. Sacks,’ he said to me. ‘You find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?’
‘l can't tell you what I find wrong,’ I replied, ‘but I'll say what I find right. You are a wonderful musician, and music is your life. What I would prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the center, now make it the whole, of your life.’
What could we do? What should we do? ‘There are no prescriptions,’ Luria wrote, ‘in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being—matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him.’
This unquestionability of the body, its certainty, is, for Wittgenstein, the start and basis of all knowledge and certainty. Thus, in his last book (On Certainty), he opens by saying: ‘lf you do know that here is one hand, we'll grant you all the rest.’ But then, in the same breath, on the same opening page: ‘What we can ask is whether it can make sense to doubt it’; and, a little later, ‘Can I doubt its grounds for doubt are lacking!’
‘Easy!’ I said. ‘Be calm! Take it easy! I wouldn't punch that leg like that.’
‘And why not?’ he asked, irritably, belligerently.
‘Because it's your leg,’ I answered. ‘Don't you know your own leg?’
He gazed at me with a look compounded of stupefaction, incredulity, terror and amusement, not unmixed with a jocular sort of suspicion, ‘Ah Doc!’ he said. ‘You're fooling me! You're in cahoots with that nurse—you shouldn't kid patients like this!’
‘I'm not kidding,’ I said. ‘That's your own leg.’
He saw from my face that I was perfectly serious—and a look of utter terror came over him. ‘You say it's my leg, Doc? Wouldn't you say that a man should know his own leg?’
What wonderful possibilities of late learning, and learning for the handicapped, this opened up. And who could have dreamed that in this blind, palsied woman, hidden away, inactivated, over-protected all her life, there lay the germ of an astonishing artistic sensibility (unsuspected by her, as by others) that would germinate and blossom into a rare and beautiful reality, after remaining dormant, blighted, for sixty years?
Mr. MacGregor’s homely symbol applies not just to the labyrinth but also to the complex integration of the three secret senses: the labyrinthine, the proprioceptive, and the visual. It is this synthesis that is impaired in Parkinsonism.
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.
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.
In all these states—‘funny’ and often ingenious as they appear—the world is taken apart, undermined, reduced to anarchy and chaos. There ceases to be any ‘center’ to the mind, though its formal intellectual powers may be perfectly preserved. The end point of such states is an unfathomable ‘silliness’, an abyss of superficiality, in which all is ungrounded and afloat and comes apart. Luria once spoke of the mind as reduced, in such states, to ‘mere Brownian movement’.
The super-Touretter, then, is compelled to fight, as no one else is, simply to survive—to become an individual, and survive as one, in face of constant impulse. He may be faced, from earliest childhood, with extraordinary barriers to individuation, to becoming a real person. The miracle is that, in most cases, he succeeds—for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are, absolutely, the strongest in our being: stronger than any impulses, stronger than disease. Health, health militant, is usually the victor.
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.
Invested with this sense of ecstasy, burning with profound theophorous and philosophical significance, Hildegard’s visions were instrumental in directing her towards a life of holiness and mysticism. They provide a unique example of the manner in which a physiological event, banal, hateful or meaningless to the vast majority of people, can become, in a privileged consciousness, the substrate of a supreme ecstatic inspiration.
‘I’m like a sort of living carpet. I need a pattern, a design, like you have on that carpet. I come apart, I unravel, unless there's a design.’