The Man Who Mistook His Wife for a Hat: Book Review

Dr. Oliver Sacks in, The Man Who Mistook His Wife for a Hat, approaches the field of neurobiology from a reflective, intelligent, and caring learner perspective. He uses a non-authoritative story-telling style to introduce the process of science to the non-medical reader. Each case is systematically presented through the window of his own selective observations, mingled with relevant conversations with his patient. Most notable in his exploration of neurobiology is the primary importance Sacks places on the personhood of his patients. His emphasis on developing a relationship in order to recognize the patient’s individualism resonated strongly with me for two reasons. First, as a patient, it is nice to know that my opinions and uniqueness are valued. Second, as a neurobiology student, I know that the translation between the brain and behavior is essential in attempting to understand medical problems. At one level, The Man Who Mistook His Wife for a Hat represented an intriguing inquiry of bizarre neurobiological disorders. At another level, I found myself yearning for a more in-depth analysis of specific neurobiological disorders. In this book review, I employ the tools and language gained this semester in Neurobiology and Behavior to analyze and interpret three of Sacks’ critical case studies.

In the first case study – and also the study after which the book was named – Dr. Sacks met Dr. P, a well-respected musician who lacked the ability to form accurate judgments, “lost in a world of lifeless abstractions” (15). As Sacks investigated the situation, I found myself wondering whether this disorder resulted from a problem on the input or the output side of the brain. Were the patient’s eyes sending the correct messages to his brain? Was his brain misinterpreting those signals and creating an altered reality? One of the passages I found particularly revealing was Sacks’ examination of Dr. P’s paintings:

“He had indeed moved from realism to nonrepresentation to the abstract, yet this was not the artist, but the pathology, advancing – advancing towards a profound visual agnosia, in which all powers of representation and imagery, all sense of the concrete, all sense of reality, were being destroyed. This wall of paintings was a tragic pathological exhibit, which belonged to neurology, not art” (17).

This case was obviously more complicated than a simple problem with visual perception. Yet, Sacks did not know the exact cause of the disease. He hypothesized it to be either a massive tumor or the beginning of a degenerative process affecting the visual components of the patient’s brain. From the output side, it could be hypothesized that the pattern or central pattern generator set up to interpret visual information was having difficulty translating information and creating a consistent story. Near the end of the description of this case study, Sacks mentioned that he never saw Dr. P after that last visit. I was surprised and felt a little bit cheated, feeling that Sacks should have provided a more detailed and complete conclusion to compliment his detailed introduction to the case.

In another case study, Dr. Sacks examined Mr. MacGregor, who had difficulty walking upright and tended to lean to one side. As discussed in class, humans have access to many senses other than the classic five, and it was likely one of these secret senses that served as the source of the problem in this case. As observed in our examination of the disembodied lady, “If proprioception is completely knocked out, the body becomes, so to speak, blind and deaf to itself – and ceases to ‘own’ itself, to feel itself as itself” (72). This vestibular problem was likely affecting Mr. MacGregor’s sense of balance, and the loss of proprioception was likely a result of his Parkinson’s disease. I chose to highlight this case study, not because of its direct relevance to our class discussion, but because of the notable quality of the patient-doctor interaction. Mr. MacGregor came up with a brilliant idea, “I can’t use the spirit levels inside my head, but why couldn’t I use levels outside my head.” In an effort to resolve this challenge, Dr. Sacks experimented with the patient, ultimately creating an appropriate tool for the job, spectacles that included a built-in spirit stick (75). Identifying the problem is always the first step, and that step requires careful attention. Dr. Sacks recognized that the brain has the potential to make necessary adjustments and although the first few weeks required
continuous, exhausting exercise…it got easier and easier; keeping an eye on his ‘instruments’ became unconscious, like keeping an eye on the instrument panel of one’s car while being free to think, chat, and do other things (76). From that detailed observation, I think it is safe to conclude that Mr. MacGregor experienced a shift from feeling compelled to always rely on his conscious I-function to eventually being able to allow the rest of his nervous system to take responsibility for basic tasks.

The last case I will mention here, involved a nineteen-year-old girl named, “Rebecca.” Sacks admitted to the reader that he first perceived Rebecca as, “a casualty, a broken creature, whose neurological impairments I could pick out and dissect with precision” (180). Unlike many doctors, however, Sacks appeared willing to admit that, as he continued to observe Rebecca, he realized that his initial assessment was flawed. He went on to contemplate that not only were his initial assessments flawed, but in fact, the clinical evaluations upon which he based his assessments were also inadequate. “We paid far too much attention to the defects of our patients, as Rebecca was the first to tell me, and far too little to what was intact or preserved” (183). These observations are particularly useful because they remind us that cases are rarely black and white, and that resolution of most complex issues requires a detailed summary of observations paired with a systematic pattern of negotiations until the appropriate outcome is deduced. Highlighting one of the major themes of our class, Sacks reflected, “we were far too concerned with ‘defectology’, and far too little with ‘narratology’” (183). Expanding upon this concept, Sacks seemed to be arguing that the process of diagnosis is often conducted in far too concrete a manner and that the addition of a more observatory and thoughtful approach might yield more accurate answers. Science should be thought of as the narrative that it is, and the patient, Rebecca, provides an example of how the patient can provide useful input to the doctor, who is trying to solve the mystery.

Overall, Dr. Sacks’ greatest strength, in The Man Who Mistook His Wife for a Hat seemed to be his skill at making knowledge about neurobiological disorders accessible to a wider audience. This book allows the common person to gain understanding, sympathy, and appreciation for individuals who have faced extreme challenges. Due largely to Sacks’ open and honest writing style, readers are invited to interpret the given observations, summarize them, and draw their own conclusions. As discussed in class, we are all scientists to some extent. Many people may not have the privilege of earning a degree in neurobiology, but that does not mean that their ideas and their interpretations are necessarily flawed. Especially if they are the patient, their interpretations can be just as helpful, if not more helpful than those of people who hold Ph.D.’s. Through Sacks’ in-depth interactions with his patients (none of whom held degrees in neurobiology) this message became resoundingly clear. I very much enjoyed this book. I was intrigued with the cases and the ways in which they were presented. I also found the content of this book to be very applicable to class discussions, and I will definitely use it as a launching board for future investigations into the worlds of neurobiology and neuro-psychology.