Book SummaryThe Man Who Mistook His Wife for a Hat, by Oliver Sacks

1-Page Summary1-Page Book Summary of The Man Who Mistook His Wife for a Hat

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 stories of his patients, all of whom were suffering from some form of neurological impairment. In sharing these stories, Sacks weaves a narrative that demonstrates the remarkable complexity of the human brain and its extraordinary capacity to adapt. As we’ll see, the brain is the source of our very humanity, giving us our identity and deepest sense of self.

As we study the lives of these patients, some key themes emerge:

• The brain has a remarkable ability to compensate for neurological shortcomings in one area with neurological strengths in another. Thus, a patient with impaired powers of speech might excel at the visual arts, or a patient suffering from an inability to understand words might be better at discerning the non-verbal parts of language.
• The neurological profession has often misunderstood neurological disorders, thinking of them solely as illnesses that must be “cured.” But sometimes, the disorder gives meaning, hope, and identity to the patients experiencing them—and the patients have no wish to be “cured.”
• What manifests outwardly as the symptoms of a disorder are often attempts by the brain to provide order, regularity, and a consistent self-narrative for the patient. Thus, a man with retrograde amnesia that prevents him from forming short-term memories might constantly weave fantastical stories about who he is to strangers, so that he always maintains a consistent notion of the self.

Deficits

Neurologists often speak of brain disorders in terms of deficits. A deficit is an impairment of some element of neurological functioning, usually linked to brain damage to a particular area.

But the brain is adept at turning deficits in one area into surpluses in another—enabling patients to navigate their world, make sense of what they see, and retain some sense of identity and self.

Agnosia

We can see a clear example of a neurological deficit in the case of Dr. P, who experienced strange problems with visual recognition. He was unable to recognize the faces of his students and was known to pat inanimate objects like parking meters and fire hydrants, thinking they were children. He even struggled to identify his own wife—whose head he often grabbed at, believing it was a hat. Dr. P was suffering from agnosia—an inability to recognize and interpret visual data.

Sacks found that Dr. P could only recognize pictures of family and friends in which the subjects had distinct features—he identified a photo of his brother Paul, for example, by noting Paul’s square jaw and big teeth. He could identify only the features and use them as a clue to guess the identity of the person, but he was not truly recognizing them.

Despite this, Dr. P’s mind seemed to compensate for this deficit by crediting his neurological “account” in other ways. He had exceptional powers of abstract description and excelled at schematic mental models involving abstract shapes—for example, he was a skillful player of blind chess, able to perfectly visualize the board and pieces in his mind. His intact abstract sensibility gave him some means of interpreting what he saw with his eyes, providing him with a tool to order, recognize, and make sense of his world.

Aphasia

Some people who’ve suffered brain damage are unable to understand language. They suffer from aphasia—the inability to process and understand spoken words.

In the 1980s, Sacks was at an aphasiac ward of a psychiatric hospital, where the patients were watching a televised speech by US President Ronald Reagan. Their aphasia inhibited them from processing and understanding the words the president was speaking. But they could still understand the non-verbal aspects of language, indeed, far better than most other people.

They only heard Reagan’s tone and inflection, and thus, saw the polished actor-turned-president as a dissembling phony, keenly picking up on the falseness of his tone and body language. And their reaction to his speech was not reverential respect—it was uproarious, hysterical laughter!

Superabundance

Throughout most of the history of neurology, practitioners have focused on these deficits and the problems that result from the loss of function. But what about the opposite phenomenon, of excesses and superabundances? What happens when neurological functions work on overdrive?

When neurological disorders manifest as excesses and superabundances, they heighten some of the most crucial aspects of our humanity—impulse, will, action, and passion—and remove our inhibitions. Patients who experience the rush of these highs often report feeling more alive and human than ever as a result of their disorder. The patient does not wish to be “cured,” because they do not believe themselves to be ill.

Tourette’s Syndrome

One of the most famous disorders of superabundance is Tourette’s syndrome. Associated with an excess of the hormone and neurotransmitter [restricted term], Tourette’s is characterized by an excess of nervous energy, commonly finding expression in repetitive motor movements called tics, as well as verbal outbursts.

One man, who called himself “Witty Ticcy Ray,” had experienced severe tics since the age of four. And yet, Ray forged a meaningful life for himself despite his affliction—indeed, he claimed it gave him an entire identity. He was an accomplished jazz drummer and a masterful ping pong player, both fields in which the speedy reflexes and reactions caused by his syndrome appeared to give him an advantage.

When Sacks began treating him with [restricted term], an antipsychotic medication that blocks [restricted term] receptors in the brain, Ray felt he’d lost some essential part of himself. Although his tics decreased, he became slow and...

The Man Who Mistook His Wife for a Hat Summary Introduction

Neurology is often seen as a purely cold and clinical science, dealing with the concrete wiring of the brain. Indeed, we often think of brain science as a field of study too esoteric and advanced for it to have anything deeper to say about the human condition.

But this view is false. The human brain is not a computer or purely rational processor of data. The brain is precisely what makes us human, giving us our identity and deepest sense of self. Neurology is that rare field that can bring the rational empiricism of science together with the deepest philosophical questions that mankind has always sought to answer. What makes us human? What is the true nature of the self, of memory, knowing, or action?

By studying the work of neurologists—specifically their work with people who have suffered brain damage—we...

The Man Who Mistook His Wife for a Hat Summary Chapter 1: Deficits

Neurologists often speak of brain disorders in terms of deficits. A deficit is some impairment of neurological function, usually linked to brain damage to some particular area. Damage to Broca’s area, for example, is known to cause aphasia—the inability to process and understand written or spoken language.

We now know that the right hemisphere of the brain is primarily responsible for recognizing and ordering our reality. Indeed the right hemisphere is the neurological base of our identity and sense of self. It is how we root ourselves in time, space, and relation to other people.

But when the right hemisphere is damaged and the individual begins to lose this grounding and sense of identity, the brain has a remarkable ability. It replaces or compensates for this loss, creating a new reality that keeps our identity and self intact. In other words, the brain is adept at turning deficits in one area into surpluses in another.

In this chapter, we’ll explore the stories of patients who suffered brain damage that compromised core functions like visual recognition, memory, body awareness, and language. All of these patients lost some crucial element of their humanity, but...

The Man Who Mistook His Wife for a Hat Summary Chapter 2: Superabundance

In the last chapter, we focused on the impact of neurological deficits—disorders that produce some impairment or inhibition of crucial functions like speech and memory. Throughout most of the history of neurology, practitioners have focused on these deficits and the problems that result from the loss of function.

But what about the opposite phenomenon, of excesses and superabundances? What happens when neurological functions work on overdrive? That is what we’ll explore in this chapter.

Illness as Wellness

Disorders of superabundance make it difficult to control crucial aspects of our humanity—impulse, will, action, and passion. Patients who experience these uninhibited rushes often don’t feel ill or lost at all, as did some of the patients like Jimmie G. and Christina whom we met in the previous chapter. Indeed, this other class of patients often reports feeling more alive and human than ever as a result of their disorder. The rich interior life of a person, once dormant and dull, can become truly activated by neurological illnesses.

But there is a dark side to this frenzy and mania. The excesses can subsume the individual. Illness can masquerade as...

Shortform Exercise: Understand the Self

Explore why maintaining a self-narrative is so crucial to our existence.

Briefly explain how your memories of past experiences and events shape your identity and sense of self.

The Man Who Mistook His Wife for a Hat Summary Chapter 3: Visions

In the first two chapters, we looked at how neurological disorders can manifest as either deficits or superabundances—the brain either underperforming or overperforming. In this chapter, we’ll explore another dimension of how neurological abnormalities reshape the human experience: through our dreams, revelations, and visions.

Many of us have entered such mystical and otherworldly states before—an old memory suddenly unearthed, seemingly from nowhere; déjà vu, the mysterious sense that one has lived through some present situation before; or spiritual experiences that seem to bring us face-to-face with the divine. These sublime moments are central to the human experience and have been the focus of art and spirituality throughout human history.

But what we think of as spiritual or mystical journeys have a foundation in neurology and the inner workings of our brains, specifically the temporal lobe. Indeed, there are organic determinants to our most transformative moments. Studying the cases of people who have suffered severe neurological trauma can give us insight into these phenomena and demonstrate how it is the complex interplay of transmitters, receptors, cortexes, and...

The Man Who Mistook His Wife for a Hat Summary Chapter 4: Intellectual Disability

In the previous three chapters, we explored the case histories of patients whose impairments either inhibited some core neurological function, super-charged these functions, or transported the individual to a world of forgotten memories. But we have not yet looked at those patients whose brain functioning, at first glance, seems to be the most compromised—those with severe intellectual disabilities.

(Shortform note: In this summary, we have eschewed a lot of the outdated—and, in modern times, insensitive—language that Sacks uses to describe some of his patients in this chapter. For instance, Sacks describes “retarded” patients who are “idiots” or “morons.”)

Concrete Vs. Abstract Thought

Sacks believed that there was something profoundly moving about working with intellectually disabled patients. Much of this had to do with the distinctions between abstract and concrete thought. Broadly speaking, abstract thought deals with the world of ideas and concepts that don’t “exist” in the physical world. Concrete thought, meanwhile, concerns those things that do exist in the physical world. The concrete world is that of the tactile, particular, and immediate.

**Individuals...

Shortform Exercise: Reflect on the Book

Explore the main takeaways from The Man Who Mistook His Wife for a Hat.

In what ways does the brain compensate for neurological deficits in one area with neurological advantages in another? Use two examples from the summary to support your answer.