The Case Studies of Oliver Sachs: How Neurologic Disorders Help Us Understand the Complexity of Personality and Identity

As a neurologist, Oliver Sacks writes about the riddle of human identity from a medical perspective, but with great compassion and understanding for the patients he has known throughout his years of practice.  In The Man Who Mistook His Wife for a Hat and Other Clinical Tales, he presents selected case histories of his patients to investigate what he calls the ‘neurology of identity.' What is unique about Sachs, and what I found personally motivating, is his approach to the patient as a total person, not just as someone who has a disease, as well as his ability to clearly relate this complex interrelationship in story form.  Although some of the cases can be technically challenging for the non-medical reader, Sachs' humanist perspective maintains his focus on using disease states to highlight what makes us uniquely individual and human.  These stories show how much we have to learn about how the brain works, and how simple our brain makes our daily lives appear to us.

The case reports in this book are divided into four groups, based on the patients' neurologic presentation: "Losses," dealing with the loss of speech, language, memory, vision, dexterity, identity; "Excesses," with Tourette's Syndrome and other superabundances of function; "Transports," with epilepsy and other altered perceptions, and "The World of the Simple," with the mentally disabled.

The respect Sacks has for his patients is apparent throughout the book, but particularly in "The World of the Simple." He writes touchingly that "'though mentally defective' in some ways, they may be mentally interesting, even mentally complete, in other[s]" (173).  In the chapter, "The Twins," he relates the lives of John and Michael, two "idiot savants," autists who have incredible mathematical abilities, which he describes as "nature's compensation" for deficiencies of emotion and personal relationships.  His sympathy for them is evident in his description of an interview with them: "they tell you of...the contempt, the jeers, the mortifications they endured, but all delivered in an even and unvarying tone, without the least hint of any personal inflection or emotion."  In writing about John and Michael, as in other patients, Sachs shows that even those with significant neurologic afflictions, such as autism, can have character and individuality that makes them human.  To me, this is one of the important messages of his writings.  Many people disregard those with neurologic disorders as "defectives," but Sachs shows that these people are more similar to us than we might suspect.

In this way, Sachs is able to break down the barrier most of us have in dealing with people with illness, especially mental illness. In 2001, BBC news published an article about the frequency of verbal abuse against the mentally ill. Of the 500 people questioned, aged 16-24 years old, 60% admitted to verbally abusing the mentally ill, using expressions such as "psycho, schizo, nutter or loony." Only one-third felt that the terms "psycho and schizo" were unacceptable. Significantly, one-half of the respondents said they would conceal knowledge of their own mental disorder from others because of the stigma.  Such a widespread negative attitude prompted Britain's Health Minister John Hutton to begin the "Mind out for Mental Health" campaign to educate young people on mental health issues.

Sachs makes his points easily because he is such a fine storyteller.  Science as story was the format of The Man Who Mistook His Wife For a Hat, as well as one of the themes of this course at Bryn Mawr.  Sacks' case studies are "human clinical tales" that intersect fact and fable, presented in a "loopy," non-linear scientific method. His point for doing so is that lesions of the right brain have much more complicated presentations than those of the left brain, since they involve issues of identity and personality rather than the more easily studied left brain lesions causing motor and sensory deficits.  He believes that right brain lesions instead require this kind of openness and dialogue between physicians and patient to understand the full spectrum of these disorders, since they affect a patient's "personhood." Because of their complexity, presenting them in story form more clearly illustrates the social manifestations of these disorders, including their emotional impact on the patient, something that would be difficult to depict in a purely scientific report.  

These case studies, as stories of science, demonstrate in a very effective way the complexity of the human brain by showing how devastating its malfunction can be when those traits that make us uniquely human are missing.






"Mentally ill abused by young." 12 March 2001. BBC. http://news.bbc.co.uk/2/hi/health/1211814.stm

Sacks, Oliver. The Man Who Mistook His Wife for a Hat. New York: Touchstone, 1998.