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

Due to Oliver Sacks’ presence in the consciousness of the general population, largely because his book, Awakenings, and the film that followed, I expected The Man Who Mistook His Wife for a Hat to be written for the layman. I was mistaken.

To get the most from this book, the reader needs a grounding, or at least rudimentary exposure, to neurology and psychiatry. Sacks relays case histories of twenty of his patients largely deep in the weeds medical jargon, its practices, theories, and hypotheses, which had me running to the internet far too often for comfort. (Though I did learn some new terminology). For about three quarters of the book I felt as though I was reading a foreign language. Yet I soldiered on and am glad that I did. Some of the pathologies that Sacks discusses are familiar (Tourette’s syndrome, amnesia) while others are less well-known to the average reader (agnosia, mnemonist). Many of the references made my head spin: A. R. Luria’s Higher Cortical Functions of Man, S. E. Jelliffe’s Psychopathology of Forced Movements and Oculogyric Crises of Lethargic Encephalitis, D. Bear’s “Temporal-lobe epilepsy: a syndrome of sensory-limbic hyperconnection.”

The saving grace of this book is Sacks deep compassion and empathy for his patients. Recognizing that studying them in a clinical setting, where they are examined and tested in unnatural and uncomfortable circumstances, does not give the clinician a full picture, he visits them in their homes. Observing his patients function as normally as their maladies allow, he is better able to treat them. He believes that clinical case histories

tell us nothing about the individual and his history; they convey nothing of the person, and the experience of the person, as he faces, and struggles to survive, his disease. There is no ‘subject’ in a narrow case history; modern case histories allude to the subject in a cursory phrase (‘a trisomic albino female of 21’), which could as well apply to a rat…To restore the human subject at the centre – – the suffering, afflicted, fighting, human subject – – we must deepen a case history to a narrative tale; only then do we have a ‘who’ as well as a ‘what…’

Sacks possesses the humility to accept the advice and counsel of the Sister who works closely with his hospital patients, and to admit that he and his fellow physicians make mistakes. He says that “[they] paid far too much attention to the defects of our patients…and far too little to what was intact or preserved.”

Sacks is at his best when he tells the patients’ story, acknowledges their full humanity, and how he adjusts his perceptions and changes course. Just one example of many: “Rebecca,” who is mentally challenged with a very low IQ, flounders in workshops and classes, (“…what we did was to drive [patients] full-tilt upon their limitations…”) and instead enrolled her in a special theater group, in which she flourished. “She loved this – – it composed her; she did amazingly well: she became a complete person, poised, fluent, with style, in each role.”

Is it worth reading such a difficult book for these sporadic understandable passages?
Absolutely.

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