The Man Who Mistook His Wife for a Hat and Other Clinical Tales

Series of twenty-four essays about people with neurological conditions, focusing on the patient’s experiences. Sacks did not agree with the categorization of mental dysfunctions as “types,” which are treated in the same manner regardless of individual nuances. His goal was to use these case studies to improve physicians’ treatment methods, to go beyond the “one size fits all” approach to treating neurological issues. He specifically desired to find unique ways to help each individual discover a sense of personal identity, leading to a more meaningful life.

“To restore the human subject at the center—the suffering, afflicted, fighting human subject—we must deepen a case history to a narrative or tale; only then do we show more have a “who” as well as a “what,” a real person, a patient, in relation to disease—in relation to the physical. The patient’s essential being is very relevant in the higher reaches of neurology, and in psychology; for here the patient’s personhood is essentially involved, and the study of disease and of identity cannot be disjoined.”

These true stories contain a variety of subjects, such as loss of memory, people whose limbs feel foreign, those who cannot recognize faces, some whose deficits are more than offset by amazing artistic or mathematical skills. They are told in an empathetic way, and they are truly absorbing. First published in 1985, there is a small amount of “dated” language, as the author acknowledges in his introduction to the new edition. There is also a bit of terminology that may not be familiar to the layperson.

I have had this book on my “to read” list for a very long while and am glad to have finally read it. I appreciated the follow-ups to each story, which tells the reader what happened to each individual (where the information was available). I found it fascinating. If you are even slightly interested in neuroscience it will be well worth the time invested.

“I wish to acknowledge the selfless help and generosity of the patients (and, in some cases, the relatives of the patients) whose tales I tell here—who, knowing (as they often did) that they themselves might not be able to be helped directly, yet permitted, even encouraged, me to write of their lives, in the hope that others might learn and understand, and, one day, perhaps be able to cure.” – Oliver Sacks show less

I’m on the fence about whether to recommend this.

On the one hand, those who are looking for an introduction to the extraordinary things that can happen when brains go bad (damaged by diseases or accidents, genetically miswired …) are likely to be fascinated by these tales of folks coping with extreme memory loss, sensory hallucinations, epileptic seizures preceded by bizarre hallucinations, savantism and, yes – an inability to recognize familiar objects, as in the case study alluded to in the title of the book.

On the other hand, this book is full of problems, many of them having to do with the dated nature of the essays - Sacks penned this back 1970, when neuroscience was in its infancy – but some having to do with Sacks's show more offputting approach to science and storytelling.

The main issue: the science part of this is tremendously dated. As this book captures what one might call the “dawning of neuroscience,” Sacks is writing about hypotheses (logical guesses) rather than scientific certainties. And while he is rightly credited for correctly hypothesizing that encephalitic patients might be roused by the administration of L-Dopa (the plotline of the movie Awakenings, starring Robin Williams), many (many) of the hypotheses he advances in these essays have since been thoroughly discredited. (Moreover, the frequency with which he equates correlation with causation makes me question what they were even calling “scientific method” back in the 1970s!)

Another flaw: the extent to which the patients in this book are treated as the sum of their symptoms rather than as human beings who happen to be suffering from dysfunctions. Sacks pays lip service to the importance of valuing the “personhood” of the folks in these tales … but then goes on question whether this patient’s life has ceased to have meaning, or whether that patient has lost his soul. Wow! As a person who has worked extensively with folks with neurological dysfunctions, I was appalled by his callousness and not in any way assuaged by the philosophical pretentions he uses to justify his often appalling speculations.

Yet another reason I hesitate to recommend this: Sacks’ storytelling, which I found to be unnecessarily dense and presumptuous. His abundant employment of obscure medical terminology is entirely unnecessary (I say this as a scientist myself – the way we talk to each other isn’t the way we should be talking to laypeople, as he should certainly be aware), his digressions are often specious, and his incessant references to obscure philosophical ideas hit as pretentious rather than learned – like a college professor trying way too hard to convince his students of his erudition.

When I first read these case studies back in the late 1970s, they inspired in me a curiosity so profound that they likely influenced my decision to become a biologist. It’s ironic that these same essays now inspire so much frustration. But also, to be fair, they provoke a renewed appreciation for the enormous strides we’ve made in neuroscience since these were penned, and serve as a reminder of the fascinating complexities that we are still struggling to fathom. show less

In his introduction to this selection of intriguing neurological cases he has encountered, Dr Sacks emphasizes the need " to restore the human subject at the centre - the suffering, afflicted, fighting human subject ...only then do we have a "who" as well as a "what" '.
And in these accounts of the strange tricks the brain can play on the person, those individuals are vividly portrayed with their coping strategies - the woman who, unable to see left would turn a full circle right; people who lose sense of their bodies and need to look in mirrors to adjust their posture.
He considers the occasional 'plus' side of mental disturbance - the heightened sensations of drug use; the re-living of past happy times, as when an elderly woman suddenly show more started 'hearing' songs from her early childhood, a time that had been sealed off to her in a subsequent hard life. "She felt illness as health, as healing."
He looks too at the mysteries of the 'idiot savant' - twins with learning difficulties such that they could not do simple maths, and yet were inexplicably able to perform mindboggling feats of calculation.
Fascinating book. show less

“Hiya, Doc! Nice morning!”

Once we step past the title on our way through the stories in this book, we can get past the impression that we’ve just seen a poster for a circus curiosity. I call them stories; they can’t be other than composites of case histories used for the purposes of illustration. It just wouldn’t be ethical, would it. And besides, we shouldn’t let truth get in the way of a story. There’s far too much dependence on truth and memoir in the book market at the moment. Fiction is far more interesting. Ethics don’t apply so easily there. And besides, ‘truth tellers’ are a scary bunch, as are highly moralistic writers and thinkers. Perhaps fiction is the last totally free area of human thought. Sacks guides show more us early through this by quoting Luis Bunuel – the Spanish film maker at the beginning:

‘Life without memory is no life at all ... our memory is our coherence”

Now, why would a medical man quote a film-maker!

I’m always a sucker for a story about a misfit or outsider. They are the heart of literature. I love a fictional outsider, hence I adore the writing of Dostoyevsky, Kafka, Salinger, and so on through a long list. The plight of the outsider humanises us. We like to join the herd if we can, then no one can see us. No one wants to be watched and dissected. The herd does all the watching. They also do all the defining as they look out at who isn’t in the herd. “Look at the way he … “, “What is she wearing!” etc. Medical cases are like this too, once you are unwell you are a category of being you may not like the sound of, poked and prodded, your previous rights to anonymity suspended. Once you have a medical condition, you are outside the norm. The language of categories takes over.

Language takes me straight to the case of Jimmy G, who cannot form new memories. When Sacks encounters him, he appears to behave as though he recognises his doctor, he’s chatty, affable, engaging. We discover this ‘performance’ of sorts as a remnant of the little language still available to Jimmy G. The extent of his brain damage has not affected his procedural memories, including the stylistic elements of social interactions formed in words, all those throw away “hello, how are you” type of phrases. Once this performance ends and there's nothing else there, we share in the grief for the lost identity hiding behind the shadow of the person that is there. Sacks describes a tension in Jimmy, a recognition of his condition when he runs out of procedural phrases. He ceases to be other than a series of scripted performances. The moment feels tragic, and it is. We want to believe Jimmy is still there. He seems such a nice guy.

Jimmy G’s story becomes a story of the human condition. No one wants to disappear. If we had a grim choice what would we offer to lose: hand, foot, sight, hearing, touch? Think about it… the sense of who we are; memory forms the person who we think we are. It’s like death while living. Who wants purgatory? Sacks offers us this existential illustration, through this character of Jimmy G. Was he real or actual? It matters little, he could be a variant on a theme that we all believe we have a concrete idea of our own integrity as a person, our likes, dislikes, behaviours. Jimmy has none of these after a certain point. And yet, he is like us in every way – he performs the ritual greetings – what else can he do – he goes on - as Samuel Beckett reminds us of what we all do.

I wasn’t looking at the outlier in Jimmy G, I was looking at myself, my alternate self, perhaps, there but for the grace of god self, fellow traveller. We are all an accumulation of atoms, formed in a slight variance to the other. Individual, but not free of our shared human elements. Odd, instead of unique I like to think, we need to be in the herd, but don’t like being there. Jimmy doesn’t have that dilemma any more.

Bunuel again: “I can only wait for the final amnesia, the one that can erase an entire life…”

Except, Jimmy G might just escape the final amnesia. He lives. Or the many Jimmy G’s that went into making up this one Jimmy G story. Oliver Sacks, I take off my hat to you. You’ve given Jimmy G a memory. show less

I picked this up at a railway station, shortly after it was published, not quite knowing what to expect. Frankly, I think it was the extraordinary title (and my lack of time) that made me grab it.

All these years later, I remember it well. It was my first introduction to all sorts of bizarre psychological, psychiatric, and neurological conditions that are now more widely known to the general public, and left me amazed at the power and quirks of the human brain. And it was my first introduction to Sacks himself.

Sacks could have presented a Victorian freak show in book form, and I did occasionally feel a twinge of guilt at my interest in such devastating personal medical problems (this was before Miserly Lit was big).

But that's not what show more he wrote.

This is sensitive, educational, affectionate, and, yes, amusing. Tragic, but never sentimental, Sacks writes with engaging charm. I think this is a force for good. show less

This best-selling book by the neurologist / writer Sacks was simply fascinating. This is neurology for the layman, split up into easily absorbed bite-sized case studies from Sack's patient files.

The first section centres on losses - some patients suffer from disorders which affect the memory, others have lost the ability to undertake normal motor functions, and some have phantom limbs where amputations have occurred. All of the cases are tragic and yet fascinating in equal measure.

The second part focuses on excesses, looking at specific cases of patients with Tourettes, a patient with sudden lack of inhibition brought on by syphilis contracted 70 years previously, and a man considered a riot to all around him, who confabulates in a show more hilarious manner yet sadly has no true understanding of self remaining.

In 'Transports', Sacks talks about fascinating cases such as the woman who suddenly starts hearing Irish music continuously for months on end, and has previously inaccessible childhood memories awakened by the music. Perhaps my favourite was the case of the man who, after taking mind-bending drugs, had a super heightened sense of smell for a year, to the point where he could sniff out people like a dog.

The final section, 'The World of the Simple', exemplifies just how amazingly complex the human brain is. In many of the cases cited, despite the patients being scientifically considered retarded with very low IQs, they had amazing cognitive abilities, such as the ability to learn 2,000 operas in their entirety, or to instantaneously perform complex mathematical computations. These heightened abilities of siloed intelligence are juxtaposed with their general neurological limitations, and Sacks explains how many such patients can be 'reached' by vehicles such as music, drama, nature and numbers.

With all of the cases Sacks addresses in this book, the brain injuries or conditions are never cut and dry tales of limitations; the immense power and mystery of the human brain (and strength of character) consistently prevails, totally absorbing you as a reader.

Captivating, bizarre and thought-provoking, this is a fabulous insight into the enigma of the human brain. Our health is our wealth - we have much to be thankful for. show less

Oliver Sacks explores some of the things that can go wrong because of brain injuries through a series of case studies.

Through bizarre and moving accounts of some of his patients, the author pleads by example for patients to be seen not just as neurological puzzles and symptoms but as human beings with emotional needs and responses. Even those with low IQs can respond to symbols and stories, ways of thinking which the modern West has devalued in favour of logic and proveable fact. We need both and the author shows why and how it can be done. A marvellous book.