Book Summary: The Man Who Mistook His Wife for a Hat by Oliver Sacks

In this book Oliver Sacks describes the stories of some of his patients who have neurological disorders and how these disorders affect their lives, both negatively and positively. Often the patients have severely lost their memories so they no longer remember how to do basic tasks such as lifting limbs or recognising familiar faces. However, the patients described are also blessed with musical, artistic and mathematical gifts, highlighting the talents these exceptional people have.

Sacks begins with a tale of a man who cannot distinguish objects, including differentiating his wife from a hat, in the presence of Sacks. The patient, Dr P, could read a book, understand it and remember parts of it but struggled to recall the sections containing visual imagery, highlighting a difference between Dr P and other people. Despite this, Dr P was extremely passionate about music and taught the subject at a school for the rest of his life. Sacks knew the condition was due to ‘lack of visual information’ or ‘faulty processing’, or both, as Dr P had a lack of connection between feeling and cognitive science, leading to confusing inanimate objects with people.

The second patient described fails to remember information within minutes which led to the patient being severely frustrated, lonely and irritated as he did not understand why people around him would be confused by what he was saying. For example, he told Sacks that he is nineteen years old when truthfully he is far older. The speed at which information was lost and forgotten was hastened when there were ‘distracting or competing stimuli’ – each competing for attention from Jimmie, the confused patient. Sacks described this case as ‘heartbreaking’ as Jimmie was ‘isolated in a single moment of being’. The diagnosis was Korsakov’s syndrome, potentially caused by excessive alcohol drinking.

Sacks goes on to talk about a patient whose body does not do what it is instructed to do by the brain, ‘disembodied’, perhaps caused by intaking too much pyridoxine found in Vitamin B6 supplements. This condition is particularly difficult socially as the patient is not visibly disabled so is treated normally by the public, when in fact they may require a little extra help. There are many different types of disembodiment including the one described above, or feeling like a particular body part does not belong to your own body, feeling that arms, fingers or legs are stumps rather than full-size body parts, or feeling that you have a limb that does not actually exist. There have been cases of this ‘phantom’ limb where patients have complained of pain in a body part that does not physically exist.

Other cases in the first section of the book called Losses includes cases of severe leaning all the time without falling over, extremely short attention span leading to only ever finishing half of an action, and understanding words without understanding the tone of the words being spoken.

The second section of the book focusses on Excesses – the tics leading to ‘morbidly heightened senses’, starting with sever Tourette’s syndrome. Sacks’ description of behaviour associated with Tourette’s is ‘wild excitements, violent impulses, often combined with a weird, antic humour’. It is the disturbance of the hypothalamus and amygdala that leads to ‘excitement of emotions and passions’ in patients with Tourette’s, rather than disturbance of the ‘midbrain and its connections’ leading to the involuntary and repetitive movements associated with Parkinson’s disease. Tourettic patients have too much dopamine released so this must be controlled by using medicine, such as ‘haloperidol’ – more commonly known as ‘haldol’. However, some patients refuse to take drugs to minimise their traits associated with Tourette’s as it restricts their ‘creative surges’. I was fascinated when reading this book that when asked to draw a particular object, those with Parkinson’s tend to draw it small and as they receive more L-Dopa in medication, their drawings enlarge and are more ornate.

The Man Who Mistook His Wife for a Hat’s third section is called Transports and focusses on seizures and nostalgia. The particular cases described by Sacks include seizures from musical stimulation, and nostalgia making patients feel that they are children, and in their childhood town. An ethical question raised in this section is whether it is right to punish and imprison those with neurological disorders that commit crimes, for example murder. It is possible for a person to have a temporal-lobe seizure and honestly forget committing the murder. The trial in court is therefore extremely traumatic for the individual with the neurological disorder as they may be proven guilty and never truly understand why.

The World of the Simple – the fourth and final section of the book focusses on the positives of living within neurological disorders. Sacks writes about his patients being intellectually extremely bright. These cases include patients’ fascination and extremely strong talents with poetry, singing, prime numbers, and drawing, proving that whilst these people with severe neurological disorders may struggle with basic speech or memory, their creative skills outcompete those of the population who do not have neurological disorders.

This book shows the power of the human mind and gives severe examples of when the human body’s intricate mechanisms go extremely wrong.


Emily Buchanan

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