Home > Books, Neuroscience and Psychology > Oliver Sacks – The Man Who Mistook His Wife for a Hat

Oliver Sacks – The Man Who Mistook His Wife for a Hat

[Public Service Warning: These posts on books are generally too long to be good reviews or blog posts, and too scattered. I put them here mostly as reading notes for myself, in the absence of a good system of keeping track of things read and thoughts had. But I figure they might as well be public–no harm in it, anyhow.]

I’m very sympathetic to Oliver Sacks: as a writer, I have a soft spot for narratives in science. And I’d always like to think that science can help us speculate on the Big Questions, so I’m intrigued when Sacks muses on issues of identity and the soul in the midst of these case studies. And even though his philosophy is lacking much of the time, I tend to enjoy that he tried, and take his speculations for what they are: wishful, though earnest, musings; philosophy lite meant to point out a direction more than travel a rabbit hole.

So, I deeply enjoyed these vivid case studies, and I found them instructive too–even when I groaned a little at the misinterpretation of Hume, the use of Wittgenstein as a glossy epigraph only, or the grandiosity of adding a page-long postscript on the nature of the soul to a simple neurological case study. And even though Sacks’ love of smart people grated (If I hear “there didn’t seem to be anything wrong: he was a man of great cultivation and charm” or any variant, ever again…), I suspect that there would be no Sacks as we know him without it–that same love drives him to explore the subtleties and varieties of how intelligence and the creative, remembering mind present.

Some studies that stood out:

*The recurring musings on time and memory occasioned by patients with various kind of aphasia. From Luis Bunuel:

“You have to begin to lose your memory, if only in bits and pieces, to realize that memory is what makes our lives…Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing…(I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s…)”

—Jimmy, who remembers his early life vividly, and speaks of it like the present: uses “not just the formal or fictitious present tense of recall, but the actual present tense of immediate experience.” (24) Sacks’ examination of him is illuminating: he tests what memory loss there is by asking him to write down the names of three objects Sacks has just hidden, and thereby pinpoints exactly how many seconds the memory loss entails. He asks about how many elements there are and how many planets to locate Jimmy in memory-time. He can tell that there are faint echoes of recent memories in Jimmy from how Jimmy remembers “some doc” tested him, though not what he was just asked to do in the test. Chess is too slow of a game for him to play it; checkers is fine.

“My note was a strange mixture of facts and observations, carefully noted and itemissed, wit irrepressible meditations on what such problems might ‘mean,’…I kept wondering, in these and later notes–unscientifically–about a ‘lost soul,’ and how one might establish some continuity, some roots.” (29) He brings in Luria’s account of Korsakov’s and Studs Turkel’s account of The Good War to make sense–unscientifically–of Jimmy’s experience. He reconstructs Jimmy’s life from hospital admission records and his brother’s reports. He makes the crushing bedside mistake of asking Jimmy how it can be himself, who looks so old, in the mirror.

Luria and Sacks write–they always write each other–and Luria advises, “There are no prsecriptions in a case like this. Do whatever your ingenuity and your heart suggest…But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being–matters of which neuropsychology cannot speak And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him. And the circumstances of your work especially allow this, for you work in a Home, which is like a little world, quite different from the clinics and institutions where I work.”

What to do for Jimmy? Sacks asked the Sisters if he had a soul still–they said, “watch him in chapel and see.” He saw intensity, steadiness of attention.  “Seeing Jim in the chapel [he calls him Jim now, more dignified, not kiddie] opened my eyes to other realms where the soul is called on, and held, and stilled, in attention and communion.” “He was perfectly organized in Bergsonian ‘intentional’ time; what was fugitive, unsustainable, as a formal structure, was perfectly stable, perfectly held, as art or will.” (38)

**The eponymous man, who sees features of an image but not the whole, the abstract–and seemingly makes up features that aren’t there, when questioned, without knowing he’s doing so. He can also process schematic, abstract things (playing cards, Platonic solids, cartoons once he’s picked an identifying feature–but not the faces of people he knows, unless they have a memorable outstanding feature. He calls a rose: About six inches in length; a convoluted red form with a linear green attachment.” (12) He has no trouble with auditory or olfactory stimulus identification, and he can recognize objects that he’s using.

**Christina, who has a dream about losing proprioception and then does, after the surgery. She compensates with learning physiology and LOOKING at every body part as she moves it: so she slowly learns to move again, but only when she can give it her undivided attention. She feels “her body is blind and deaf to itself”–she still feels disembodied, not-her. Sacks found hundreds like her later: all taking an overdose of vitamin B6.

**A woman with CP who hasn’t used her hands in 60 years: the sensations are all there, but no perception–she feels pain, heat, movement, but can’t recognize any object put in her hands. She’s highly verbal and literate – people have been talking to her for 60 years. The “dead” feeling is paralleled by electrical silence in the relevant nerves. When she’s pushed a little, though, by impulse she was induced to use her hands–food kept just a little bit out of reach. She starts out recognizing forks as a flat thing with tines–then suddenly intuits its organic objecthood and use. Then she became highly animated with her hands, and known locally as “The Blind Sculptress of St. Benedict’s.” The idea of “developmental agnosia,” and the ability to learn at 60 what most learn at 2.

**Mr. MacGregor, who diagnoses himself after seeing a video of him walking “on the tilt”: “is there a kind of spirit level in the brian, Doc? Can it be knocked out by Parkinson’s” – Sacks: “the picture I love to see: a patient in the actual moment of discovery–half-appalld, half-amused–seeing for the first time exactly what is wrong, and, in the same moment, exactly what there is to be done.” (72) The work of Purdon Martin on Parkinson’s patients in The Basal Ganglia and Posture, Martin “endlessly thoughtful and ingenious in designing a variety of mechanisms and methods…to achieve an artificial normality of gait and posture: lines painted on the floor, counterweights in the belt, loudly ticking pacemakers–to set the cadence for walking. In this he always learned from his patients…” They together design a literal level protruding from the bridge of his glasses, and he learns to use it.

**Patients who just seem to stop knowing the left side of the world exists: the image of a patient spinning around in her chair, always to the right, bisecting her portion each time so she can get most of it even though she can see but half at a time. Zeno’s patient.

**Agnosias and people who can detect what Head calls “feeling tone,” and thus, one feels, can’t be lied to. (Note: I first heard this term from Studs Terkel’s Division Street…)


**”Witty Ticcy Ray,” about Tourette’s. Sacks locates the disappearance of talk about Tourette’s in “the turn of the century, a split had occurred, into a soulless neurology and a bodiless psychology”–some doctors thought of Tourette’s as mythical. The integral role of the Tourette’s Syndrome Association, formed by patients, in driving research into Tourette’s: genetic and developmental factors, the associations and reactions that characterize it, evolutionary basis, the body-language, grammar and linguistic structure of tics, the role of cursing and joking in various neuropathologies. The disturbance is in the highest parts of the “old brain,” whereas in Parkinson’s–which leads to excesses of motion but not action–it’s in the midbrain. Many Tourette’s sufferers are also great improv musicians. Luria saw Tourette’s as the most interesting disease for a window into human nature. Being free from tics when engaged in some other “kinetic melody.” He could only take Haldol well after being “prepared” for life without Tourette’s in therapy–after coming to believe there was a self to him beyond the disease. And now he only takes it on weekdays: he needs the Tourette’s self for his music on weekends, needs to “let fly.”

—Doing “street neurology” to see the severest forms of Tourette’s, the imitator’s. Naturalistic studies: Meige and Feindel’s Tics, Rilke’s portrait in the Notebook of Malte Laurids Brigge. A woman who mimics and caricatures all passers-by, each for a few milliseconds, doing a kind of frenzied dance that draws crowds around her (which only makes the ticcing worse, giving her more to imitate).

**The Korsakov’s patient, with amnesia, who is always chattering and “making up” stories–his brother walks by, and he says “and there’s my brother” in the same easy tone–it takes the docs a while to realize that this part is true. Only finds peace in the garden, away from people with whom he feels pressure to be the comedian and tell stories. Doesn’t exhibit a sense of being “lost” or realization of the lack of inner feeling.

**Mrs. O’C, who heard Irish songs in her head constantly, clearly, when none were playing. She was having temporal lobe seizures–that got less intense after a few days: in the beginning, she couldn’t “hear” over the music. Another, Mrs. O’M, who had 3 songs she didn’t like on repeat in her brain, and who was developing amusia too–all the hymns in church started to sound the same. Hughlings Jackson on the strange phenomenon of a musical epilepsy: “It is not very uncommon for epileptics to have vague and yet exceedingly elaborate mental states at the onset of epileptic seizures…The elaborate mental state, or so-called intellectual aura, is always the same, or essentially the same, in each case.” Experiential hallucinations. A duality of perception–“I know you’re there, Dr. Sacks. I know I’m an old woman with a stroke in an old people’s home, but I feel I’m a child in Ireland again.” Always memories, these, never fantasies, according to Wilder Penfield’s studies. Why the preponderance of MUSICAL memories? Penfield calls them random–but “we know from the stud of ‘free associations’ tha the most seemingly trivial or random thoughts may turn out to have an unexpected depth and resonance, but that this only becomes evident given an analysis in depth.” Mrs. O’C’s seizures gave her back memories of a lost childhood: though she doesn’t remember the details now, she feels a sense of completeness and groundedness now that she didn’t before. [See Esther Salaman, A Collection of Moments, and Dostoyevsky on his seizures. Also see Penfield and Perot, “The Brain’s Record of Visual and Auditory Experience.” See also reviews of vision studies, older–David Marr 1982–and recent–Ramachandran.]


“Let us note…that the removal of the minute, convulsing point of cortex…can remove in toto the iterating scene, and replace an absolutely specific reminiscence..by an equally specific oblivion or amnesia. There is something extremely important, and frightening here: the possibility of a real psycho-surgery, a neurosurgery of identity (infinitely finer and more specific than our gross amputations and lobotomies, which may damp or deform the whole character, but cannot touch individual experiences.” (148)

Central question for Sacks here: “Thus a gulf appears, indeed a chasm, between what we learn from our patients and what physiologists tell us. Is there any way of bridging this chasm? Or, if that is (as it may be) categorically impossible, are there any concepts beyond those of cybernetics by which we may better understand the essentially personal, Proustian nature of reminiscence of the mind, of life? Can we, in short, have a personal or Proustian physiology, over and above the mechanical, Sherringtonian one?” Sherrington calls the mind “an enchanted loom,” weaving patterns of meaning.

In high school, I was fascinated by the brain and neuroscience. But I realized at some point that I had lots of questions and no idea of how I wanted them answered–I didn’t think “memories originate in the hippocampus” would be sufficient, nor is the more refined geography of the brain we now have a map to. Sacks points towards the types of answers I realized I’m interested in–must follow up on more recent science and see what’s going on in this vein of Hughlings Jackson, Luria and Sacks, and how much of this is real speculation.


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