Review: The Man Who Mistook His Wife for a Hat

The Man Who Mistook His Wife for a Hat, Oliver Sacks. New York: Touchstone, 2006 (originally published in 1985).

Summary: Brief case histories of twenty-four patients with unusual neurological conditions.

Oliver Sacks is one of those authors I discovered in recent years, beginning to read him only shortly before his death in 2015. Only now have I gotten around to what is probably his most famous work. It is organized in four sections: Losses, Excesses, Transports, and The World of the Simple. Each section is introduced by a clinical discussion followed by four to nine illustrative case histories.

The title essay is found in the first section on losses, or cognitive deficits due to disease or damage to a particular brain structure. In the case of Dr. P, a musician and teacher, while the cause remained undetermined, he could not identify the objects he was seeing. He could describe them in detail, but he did not know what he was seeing. Hence at one point, when getting dressed to go out, he grabbed the top of his wife’s head, thinking it a hat. His visual agnosia left his musical abilities untouched, and with accommodations was able to continue in this work. One of the other cases described in this section was of a woman who lost all sense of her body, a loss of what is called proprioception. She could not tell where her arms or legs were apart from seeing them and had to learn to function by sight rather than by this sense of ourselves we take for granted. Sacks also describes cases of phantom limbs, pain, of someone who could see only the right half of their world, and a man who could not remember his life after 1945.

The section on excesses covered cognitive functions that might be describe as being in hyper mode. He covers things like Tourette’s syndrome, and a fascinating instance of “Cupid’s Disease,” a case of late onset in a patient nearly 90 of symptoms from syphilis contracted when she worked in a brothel as a young woman. It made her “frisky,” symptoms which for her were actually somewhat welcome! Although treated for syphilis, the symptoms remained.

“Transports” covers instances of sensations, memories, or visions that come due to epilepsy, or sometimes drugs, as was the case of a student who suddenly had a heightened sense of smell for a three week period before reverting to normal. Perhaps the most famous case is that of Hildegard of Bingen, whose migraines were accompanied by visions rendered in drawings.

The final section, discussing subjects with profound mental deficits were some of the most touching as Sacks recognizes what they possessed rather than what they lacked, such as Rebecca, who blossomed in a theatre program despite an IQ of 60, or twins who spoke to each other in prime numbers and could almost instantaneously calculate the day on which any calendar date would fall for 80,000 years. The last case of an autistic patient, Jose, shows how much things have advanced since Sacks wrote. He was considered mentally deficient but Sacks discovered an artistic ability that brought him to life. When he was moved to a quieter setting and allowed to develop his artistic expression, he flourished. Perhaps Sacks anticipated (and maybe helped) the advances in the treatment of those on the autism spectrum.

Sacks account is fascinating for its account of unusual neurological conditions, revealing the influences of neurophysiology on our personalities. What is also impressive is the delightful respect Sacks has for his patients. He listens to them and recommends treatments and accommodations that respect their individuality. At the same time, this book strikes me as a “snapshot in time” that reflects the state of knowledge in the 1980’s, which has advanced tremendously since then. What hasn’t changed is the care for the person Sacks shows. They are not just cases to him but people, and hopefully we will never advance beyond respecting the dignity of each person in the way Sacks does.

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