The Man Who Mistook His Wife for a Hat does more than study neurology; it also critiques the state of the contemporary medical community. Throughout the book, Oliver Sacks contrasts his approach to studying patients with neurological disorders with the methods and assumptions of other neurologists. In doing so, he suggests that the neurological community—and, perhaps, the entire medical community—has become overly focused on quantifying its patient research and reducing complex phenomena to simplified, overly mechanical processes.
The Man Who Mistook His Wife for a Hat critiques the neurological community on the grounds that it has in itself become too “left-brained”—in other words, too concerned with understanding patients in abstract, mathematical, or overly mechanical terms. The left-brained-ness of the neurological community can be detected in the way it evaluates patients’ medical conditions. Instead of studying patients in the course of the patients’ ordinary lives, neurologists tend to subject their patients to a series of tests that reduces their lives to quantifiable information. In the case of intellectually disabled patients, for example, neurologists tend to rely too heavily on numerical information, such as IQ, and not enough on other, harder-to-quantify aspects of their patients’ minds.
Another sign of the neurological community’s left-brained tendency is neurologists’ strong desire to schematize neurological disorders as discrete, clearly understood processes. For example, Sacks describes how neurologists focus primarily on disorders that can be traced back to the left hemisphere of the brain, because left-hemisphere disorders can be identified more precisely, and traced back to specific parts of the brain more easily than can right-hemisphere disorders. In short, Sacks claims that the neurological community wants to make neurology as much of a hard science as possible, using rigorous quantitative data whenever possible.
The neurological community’s left-brained emphasis on the quantitative and the mechanistic, Sacks argues, leads to some major problems. One such problem is that neurologists ignore many important neurological disorders, simply because they can’t be reduced to quantitative data or to any clearly delineated cause. In Part One of The Man Who Mistook His Wife for a Hat, Sacks argues that neurologists have mostly neglected disorders that originate in the right hemisphere of the brain, such as face blindness, or Korsakov’s Syndrome. Even when neurologists publish important information about right-hemisphere disorders, he suggests, the results aren’t always widely discussed. In part, this is the case because right-hemisphere disorders are harder to represent quantitatively or trace back to a single isolated part of the brain. Additionally, neurologists neglected important disorders such as Tourette’s Syndrome, because these disorders couldn’t easily be studied in a clinical setting, and their causes weren’t always easy to isolate.
Sacks also argues that the neurological community is largely unable to see or acknowledge the unique virtues of people with neurological disorders (see “Illness as a Gift” theme). In the case of intellectual impairment, for example, neurologists too often conclude that patients have low IQs, but seem not to notice their patients’ creativity, insightfulness, or other right-brained talents. In all, Sacks argues that the neurological community has erred in trying to become as rigorously mathematical as possible, ignoring many of the unquantifiable aspects of the human condition. In order to understand patients fully, he suggests, neurologists need to supplement their quantifiable findings with qualitative observation, using some of the methods more commonly associated with the social sciences.
The Neurological Community ThemeTracker
The Neurological Community 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.
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.
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.
One speaks of ‘idiot savants’ as if they had an odd ‘knack’ or talent of a mechanical sort, with no real intelligence or understanding. This, indeed, was what I first thought with Martin—and continued to think until I brought in the Magnificat. Only then did it finally become clear to me that Martin could grasp the full complexity of such a work, and that it was not just a knack, or a remarkable rote memory at work, but a genuine and powerful musical intelligence.
This is the positive side—but there is a negative side too (not mentioned in their charts, because it was never recognized in the first place). Deprived of their numerical ‘communion’ with each other, and of time and opportunity for any ‘contemplation’ or ‘communion’ at all—they are always being hurried and jostled from one job to another—they seem to have lost their strange numerical power, and with this the chief joy and sense of their lives. But this is considered a small price to pay, no doubt, for their having become quasi-independent and ‘socially acceptable’.
Could he, with his fine eye, and great love of plants, make illustrations for botanical works or herbals? Be an illustrator for zoology or anatomy texts? (See the drawing overleaf he made for me when I showed him a textbook illustration of the layered tissue called ‘ciliated epithelium’.) Could he accompany scientific expeditions, and make drawings (he paints and makes models with equal facility) of rare species? […] He could do all of these—but, alas, he will do none, unless someone very understanding, and with opportunities and means, can guide and employ him. For, as the stars stand, he will probably do nothing, and spend a useless, fruitless life, as so many other autistic people do, overlooked, unconsidered, in the back ward of a state hospital.