PDF Summary:The Man Who Mistook His Wife for a Hat, by Oliver Sacks

By studying the brain, the science of neurology brings the empiricism of science together with mankind’s deepest philosophical questions. What makes us human? What is the true nature of the self, memory, knowing, or action? The late neurologist Oliver Sacks dedicated his life to studying the mysteries and extraordinary powers of the human brain. In The Man Who Mistook His Wife for a Hat, Sacks presents the case histories of some of his patients. Each story is a profoundly human narrative of struggle, survival, and, in some cases, hope.

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Korsakov’s Syndrome

As humans, we have a basic need to shape a narrative about ourselves and how we came to be who we are. Sacks saw the most profound embodiment of this elemental need in a patient named Mr. Thompson. Thompson suffered from Korsakov’s syndrome, an alcohol-related condition that impairs short-term memory and causes retrograde amnesia—the inability to recall short-term memories.

Thompson’s condition caused him to constantly adopt new personae for himself, refashioning his world in an ever-changing drama with a revolving cast of characters. All the while, Thompson would regale those he encountered with fantastic anecdotes. He gave the outward appearance of a funny, charming, and ebullient man.

But all the while, he was suffering from the devastation of his short-term memory, using his powerful imagination to reinvent the world around him. This provided him with what felt like stability and normalcy, when his true reality had actually gone to pieces.

Visions

Neurological abnormalities can also reshape the human experience through our dreams, revelations, and visions. These sublime moments are central to the human experience and have been the focus of art and spirituality throughout human history.

But they are actually caused by neurological phenomena. Specifically, experiments have shown that stimulation of the temporal lobes can conjure extraordinarily vivid auditory, visual, and even olfactory memories from one’s past.

Musical Seizures

One of Sacks’s patients was an 88-year-old deaf woman named Mrs. O’C, who lived in a retirement home. She had begun hearing old Irish folk songs playing, often quite loudly, sometimes waking her up in the middle of the night. She realized that the songs weren’t coming from a radio or any other external source—the music was playing entirely in her head.

When he ran an EEG test on her, Sacks saw that Mrs. O’C had suffered a stroke and was experiencing temporal lobe seizures during the moments when she indicated that a song was playing. The music brought Mrs. O’C back to her early childhood in Ireland, a period of her life of which she had no concrete memories at all. Her parents had both died before she turned five, after which she’d been sent to America to live with an aunt. The music brought back lost memories of Mrs. O’C’s loving mother. In these memories, it was her mother’s voice that was singing the beloved songs. This confirmed to Mrs. O’C that she had had someone in her life who’d loved and cared for her.

For Mrs. O’C, the seizures were a gift, an opportunity to regain a lost part of herself and open a door that had always been shut.

A Voyage to the Past

Bhagawhandi was a young woman of Indian origin who was suffering from a brain tumor that caused seizures in her temporal lobe. The seizures transported her to the scenes of her girlhood in India, an experience she found enjoyable.

These were rich and detailed journeys to the past—highly organized, presenting consistent and coherent landscapes and characters. She saw her childhood home, village, and the surrounding countryside in vibrant detail. She was not merely seeing these scenes—she was inhabiting and experiencing them.

Bhaghawandi retreated more and more into her dream world, before she came to live there exclusively right before her ultimate death. Her journey to the past was complete.

Reactivating Dark Memories

But the reactivation of lost memories can also be dark and disturbing. One patient named Donald had murdered his girlfriend while under the influence of the drug PCP. Although he had no memory of committing the act, he was sentenced to a hospital for the criminally insane.

Five years later, while out on parole, Donald became involved in a bicycle accident that caused damage to his frontal lobes. Soon after, he began having awful nightmares of the long-suppressed murder. The nightmares turned into waking visions, in which he could suddenly remember and see it in all its horror. The damage to his frontal lobes had reactivated the memory, which now haunted him. Donald was nearly driven to suicide by the suddenly unescapable scene of carnage playing out in his mind.

Thankfully, with therapy and anticonvulsant drugs, Donald’s temporal lobes returned to a normal state and he found peace in gardening and nature, away from people. He managed to get to a place where he could remember the murder but was no longer consumed by it.

Intellectual Disability

Some of Sacks’s most meaningful work was with intellectually disabled patients—those with neurological impairments that left them unable to perform even the most basic functions. He noted that such patients often struggled with abstraction and, instead, inhabited a purely concrete world.

Broadly speaking, abstract thought deals with the world of ideas and concepts that don’t “exist” in the physical world—like humor, freedom, and irony. Concrete thought, meanwhile, concerns those things that do exist in the physical world. Sacks believed that intellectually disabled people, with minds devoid of abstraction, experienced a more intense and vivid world.

We cannot be complete beings without the concrete, and its powers of expression and feeling are just as poignant and powerful as those of abstraction. Sacks saw some of the essential elements of humanity through his work with the intellectually impaired.

Meaning in Narrative

Rebecca was a 19-year-old girl with severe intellectual disabilities. But she had an extraordinary capacity to understand stories and narrative and fully grasped the metaphors, symbols, and imagery contained within them—because symbols, after all, are concrete objects representing abstract ideas. She was liberated from her intellectual constraints when she entered the narrative-based worlds of literature and spirituality.

In working with Rebecca, Sacks found that treatment in traditional clinical settings did little for her. But when she enrolled in a special theatre group for the intellectually disabled, she thrived. Rebecca was able to make meaning and become complete by playing characters.

Rebecca’s limitations concealed the parts of her that were preserved—and indeed, thriving.

After his experience working with her, Sacks saw that neurology focused too much on deficits, with its diagnostic and treatment tools failing to properly account for the full powers of a human being.

Connection Through Art

Jose was a young man in his early 20s who was unable to communicate verbally—symptoms that doctors would later use to diagnose Jose with autism. His parents, fearful that he would suffer a seizure in public and become injured, began keeping him in the cellar of their home when he was a boy. For 15 years, Jose was deprived of nearly all links to the outside world.

After a particularly violent seizure, Jose’s parents finally took him to the hospital, where EEG scans confirmed that Jose was experiencing severe temporal lobe disorders on both his left and right sides.

The hospital staff discovered that Jose had a remarkable talent for drawing. Indeed, Jose’s sketches were his only mode of self-expression, deprived as he was of other means of communication. His excellent performance in visual and spatial tasks seemed to compensate for verbal skills deficits.

The first time Sacks met Jose, he was thoroughly impressed by the young man’s success in drawing a watch in great detail. At their next meeting, Jose was able to reproduce a landscape scene on a magazine cover. In fact, Jose’s copy surpassed the original in many ways—he imbued the scene with mood, feeling, and character that had been lacking in the original. Subsequent drawings from Jose hinted at an interior life rich with creativity, emotion, and a sophisticated appreciation for aesthetics.

Sacks saw that a talented artist like Jose had the potential to lead a rich and fulfilling life, perhaps as an illustrator. But he lamented the short-sightedness of the mental health system of which Jose was a part. Nurturing his prodigious talents would require a patience that the other doctors around him lacked. Sacks lamented that Jose’s talents were likely to be wasted by an outdated mental health framework that saw people like Jose as somehow less than human.

Untapped Potential

Sacks’s work with his patients shows the pitfalls of traditional thinking about neurological disorders. As we’ve seen, people suffering from these conditions can lead rich lives filled with joy and creativity. Studying disorders of the human brain, ironically, can give us insight into just how powerful it is and how it is the source of so much of our humanity.

It is incumbent on the neurological profession to expand its view of neurological disorders and of the people who are afflicted by them. There is enormous untapped potential and capacity for them to lead meaningful and productive lives. But first, we must abandon the idea that such individuals are irreparably damaged or abnormal. But perhaps their “normal” isn’t deviant or wrong, but merely different than our own. Rather than attempting to cure or alter it, we should open ourselves up to the possibilities that the study of their unique brains can reveal to us. In recognizing their humanity, we come to recognize our own.