Review of "The Man Who Mistook His Wife For A Hat and Other Clinical Tales" by Oliver Sacks

Dr. Oliver Sacks

Dr. Oliver Sacks was a physician, author, and neurology professor who published several books about people with neurological problems. In this book Dr. Sacks discusses patients whose brain malfunctions cause a variety of 'maladies' including: a musician who lost the ability to see faces or recognize familiar objects; a former sailor who believed the year was permanently 1945; a man who thought his leg belonged to someone else; and other unusual afflictions. To provide a feel for the book I'll just give a capsule description of the most interesting cases.

THE MAN WHO MISTOOK HIS WIFE FOR A HATDr. P was a talented musician and music teacher whose problems began when he lost the ability to see people's faces - though he could recognize them by their voices and movements. The problem worsened to the point where Dr. P mistakenly thought inanimate objects - like fire hydrants, parking meters, and furniture knobs - were humans.



In time Dr. P could no longer identify everybody objects. For example, he thought his shoe was his foot and vice versa. Though Dr. P was not diagnosed, physicians speculate that he had a brain tumor or brain damage that caused 'agnosia' - "the loss of ability to recognize objects, persons, sounds, shapes, or smells."

The title of the story refers to the fact that - when looking for his hat one day - Dr. P mistook his wife for a hatrack, took hold of her head and tried to put it on. Luckily, Dr. P retained the ability to play and teach music, and was able to continue with his fulfilling career.

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THE LOST MARINER

In 1975, Dr. Sacks saw Jimmie G - a 49-year-old man who left the Navy in 1965 after serving for more than two decades. Jimmie seemed confused about his current situation but was able to describe his school days and his experiences during and after WWII - which he talked about in the present tense.



Dr. Sacks learned that - in Jimmie's mind - the year was perpetually 1945 and he was 19-years-old. Jimmie couldn't recall anything that post-dated 1945 and was unable to form ANY new memories. In fact, if Dr. Sacks walked out of the room and returned, Jimmie thought they were meeting for the first time.

When shown a mirror, Jimmie was shocked at his 'old' appearance, and - though his brother was long-married with grandchildren - thought his sibling was a single man in accounting school.

Apparently Jimmie was competent until he left the Navy, but by 1971 was totally disoriented - probably from alcohol abuse. It was determined that Jimmie suffered from amnesia due to 'Korsakov's Syndrome' - "an amnestic disorder usually associated with prolonged ingestion of alcohol."

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THE DISEMBODIED LADY

Christina was a bright, athletic 27-year-old computer programmer who worked from home. When health problems required the removal of her gall bladder, Christina was treated with prophylactic antibiotics prior to the operation. This was a common precaution, not expected to have any deleterious effects.

Shortly before the surgery Christina had a dream in which she lost sensation in her hands and feet. A couple of days later Christina REALLY lost sensation in her entire body. Christina couldn't feel her arms, hands, legs, feet, etc. She couldn't walk, was unable to pick things up, and so on. Christina felt like her body was 'dead, not real, not hers.'



Christina was diagnosed with inflammation of the nerves in her limbs. As a result, Christina lost her sense of 'proprioception' - "the ability to sense the relative positions of body parts without looking at them or thinking about it." It's unknown whether the prophylactic antibiotics caused this or not.

Eventually, Christina learned to use her other senses - especially vision - to compensate for her loss of propioception. Christina had to consciously monitor and regulate every motion, making her movements difficult and clumsy. Nevertheless, Christina persevered and tried to live as normal a life as possible.

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THE MAN WHO FELL OUT OF BED

Dr. Sacks was called in to see a man who had been admitted to the hospital because of a problem with his leg. After falling asleep in the hospital, the patient woke up to find 'someone's leg in the bed', a severed human limb.



The man was horrified, and concluded that a nurse had perpetrated a bizarre joke. The patient threw the leg out of bed, but he went with it, because the limb was attached to him.

While Dr. Sacks was in the room, the patient began punching and tearing at his left leg. Dr. Sacks advised the man to stop, as he was injuring his own limb, but the patient refused to accept this.The man apparently had hemiplegia - "paralysis on one side of the body", probably caused by brain damage.

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PHANTOM

A 'phantom' is the sensation that a lost body part (usually an amputated limb) is still there.

Dr. Sacks tells the story of a sailor who accidently cut off his right index finger, but couldn't dislodge the notion that the digit was still sticking out of his hand. For the next 40 years, the sailor was wary of bringing his damaged hand near his face - to eat or scratch his nose - because the finger might poke his eye out. The sailor knew this couldn't really happen, but was unable to make the feeling go away.



The sailor was finally 'cured' when he lost sensation in ALL of his fingers due to diabetic neuropathy (nerve damage). The phantom finger 'disappeared' with the rest of his digits.

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TILT

Mr. Dunston, a 93-year-old man with Parkinson's disease, tilted to the side when walking - to the point he was in danger of falling over. However Mr. Dunston was unaware of the slant, and refused to believe he wasn't upright until Dr. Sacks filmed him in motion.



Mr. Dunston, who had been a carpenter, attributed the problem to the loss of his inner 'spirit level' (an instrument used to determine whether a surface is perfectly horizontal or vertical).

Mr. Dunston, being a clever fellow, rigged up a 'level' that could be attached to his eyeglasses - called 'spirit spectacles' - which he could use to correct his posture. The spirit spectacles became very popular with patients afflicted with Parkinson's disease.

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EYES RIGHT

After a massive stroke, Mrs. S - a woman in her sixties - lost the ability to see anything on the left side. If Mrs. S's dessert was on the left side of her tray, she couldn't see it; in fact Mrs. S couldn't even see the food on the left side of her plate. This 'left blindness' extended to everything, so that Mrs. S. would only make up the right side of her face, etc.



To compensate, Mrs. S got a rotating wheelchair and swiveled in a circle until things came into view - a crafty solution to (some of) her problems.

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CUPID'S DISEASE

Natasha, a 90-year-old woman, had begun feeling unusually 'frisky' at the age of 88 - giggling, telling jokes, and flirting with men.



Natasha realized this was 'inappropriate', and - surmising she was physically ill - consulted a doctor. Natasha reported that, at age twenty, she had contracted 'Cupid's Disease' (syphilis) - which was treated, but apparently not eradicated.

In fact Natasha WAS suffering from neurosyphilis - an infection of the brain and/or spinal cord caused by the bacteria Treponema pallidum. The bacteria were stimulating her cerebral cortex and affecting her behavior.


Natasha didn't want to get end-stage syphilis, but didn't want to be cured either since she was enjoying her girlish feelings. So doctors gave Natasha penicillin to kill the microbes, but did nothing to repair her cerebral cortex - allowing the elderly woman to remain playful. (At 90 years old, why not. LOL)

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REMINISCENCE
Mrs. O'C - an 88-year-old Irishwoman living in an old age home in NY - was a little deaf but otherwise in good health. One night Mrs. O'C dreamed of her childhood in Ireland, complete with a woman singing Irish songs. When Mrs. O'C awoke, she still heard the Irish songs - very loud - and went to turn off the radio broadcasting the music. But there was no radio. Mrs. O'C then thought her dental fillings were picking up a broadcast, but this wasn't the case either. Finally, Mrs. O'C concluded something was wrong with her ears - and consulted a doctor.



Mrs. O'C was eventually sent to a neurologist - Dr. Sacks - but had trouble hearing him through the music. Dr. Sacks determined that the songs were neurological, probably due to a stroke that caused seizures in Mrs. O'C's temporal lobe (a part of the brain that processes music). As Mrs. O'C recovered, the music faded away.

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THE DOG BENEATH THE SKIN

Stephen D. was a 22-year-old medical student who regularly used amphetamines, cocaine, and PCP. One night Stephen dreamed he was a dog, and woke up with a greatly heightened sense of smell.



Stephen was able to distinguish all kinds of things by their 'aroma' including: friends, patients, streets, stores, sexual activity, foods, and so on. Unfortunately, unpleasant odors were stronger as well. Moreover, Stephen felt COMPELLED to sniff everything (like a pooch)....and had to be careful to avoid being inappropriate.

After three weeks the enhanced sense of smell disappeared, and Stephen returned to normal. Years later, Dr. Sacks revealed that HE was Stephen D. (Naughty naughty)

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THE WORLD OF THE SIMPLE

**I have to insert a note here. To modern ears, some of the language used in this section is very disturbing. Talking about people who are mentally challenged, Dr. Sacks uses terms like: simple, simpleton, retardate, mental cripple, idiot, moron, and dullard. Granted, these essays were written before such terms became 'forbidden.' Still, the book has been re-released several times over the years, and these words could have been changed (IMO).**

JOHN AND MICHAEL

John and Michael were 26-year-old twins who had been institutionalized since the age of seven. They had an IQ under 60, and were variously diagnosed as autistic, psychotic, or severely retarded.

As happens with some autistic people, the twins were 'idiot savants' - "mentally handicapped persons who display brilliance in a specific area, especially involving memory."

The twins had clear memories of ALL their experiences and had a 'calendar program' in their heads so that - given any date, past or future - they could instantly pair it with a day of the week. The twins were also able to recall and repeat a long string of numbers (over 300 digits), explaining that they 'could see it.'



Perhaps most remarkable of all, the twins made up a game in which they recited increasingly large prime numbers to each other, a feat that's almost impossible without a computer. In fact, Dr. Sacks - wanting to join the game - got a 'cheat book' of prime numbers. (Ha ha ha)

Dr. Sacks waxes poetic about the twins, saying: "The twins, though morons, hear the world's symphony, but hear it entirely in the form of numbers."

Eventually the twins were separated - 'for their own good' - which seems very sad to me.

THE AUTIST ARTIST

José was a mentally handicapped man whose epileptic seizures and (possible) autism became obvious when he was eight. At that time José's family confined him to the cellar, where he was isolated and deprived of stimulation for 15 years. Finally, at the age of 22, José 'blew up in a rage' and was hospitalized.

In the hospital, José - now properly medicated - showed a remarkable talent for drawing.



This was when Dr. Sacks met the patient. Dr. Sacks showed José his pocket watch and asked him to draw it. José studied the timepiece, then quickly and confidently drew a faithful facsimile, with creative flourishes. Dr. Sacks was impressed, thinking José had more mental agility than people thought.

During a later visit, Dr. Sacks showed José an issue of 'Arizona Highways' magazine, which had a scene of people canoeing. José swiftly copied the canoe and canoers - making the people seem even more intense and alive than the original. To Dr. Sacks, this demonstrated José's powers of imagination and creativity.

Then, when Dr. Sacks showed José an image of a rainbow trout, the patient drew a fish of his own - with an amusing roguish look, like a 'fish-person.' This showed not only imagination, but a sense of humor.

Eventually, surrounded by caring doctors and staff, José began to blossom. He no longer accepted his deprived state, strived to recover speech and understanding, and began to draw for self-expression.

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Dr. Sacks' case studies are interesting and informative, and - when originally published - shed light on afflictions that were not well understood at the time. Dr. Sacks' stories are still fascinating and I enjoyed reading them.

I also applaud the fact that Dr. Sacks showed that mentally challenged individuals can have talents and abilities that rival those of mainstream society - which usually marginalizes these people. And I admire Dr. Sacks attempts to help his patients find happiness and meaning in their lives.

That said, Dr. Sacks includes a LOT of philosophical musing in his stories, in an attempt to imbue neurological afflictions with some deeper meaning. In my opinion, illnesses (even brain malfunctions) are biological phenomena. Thus they have no abstract significance, and I found the 'philosophical' sections of the book boring and sometimes incomprehensible.

I'd recommend the book to readers interested in neurology and brain function.

Rating: 3 stars