The Man Who Mistook His Wife for a Hat and other Clinical Tales by Oliver Sacks

Every once in a while I would be relating some of the unique behavior of my daughter to an often bewildered interlocutor when suddenly he or she would ask, “Have you ever read, The Man Who Mistook His Wife for a Hat, by Oliver Sacks?” No. I would reply. You should, would come back as a faint echo, and then nothing more would be said as if nothing more had to be said.

Admittedly, the title is intriguing. I had no idea who Oliver Sacks was, although, I did see Awakenings, but never realized Oliver Sacks was the doctor who wrote the book (I believe Robin Williams portrayed him in the movie). I did not run out to get the book. It stayed tucked away in my brain for a long time. I finally took the book out from the library when I was told again to read Dr. Oliver Sacks. I gave his name a search and found he was a neuropsychiatrist who wrote on many neuro-impairments, including Tourettes, Autism and Schizophrenia. I thought I might find something to help me understand my daughter, and I also thought about some other adoptive moms I knew, who were trying to manage their children’s neurological challenges. Perhaps, I could suggest Dr. Sacks to others. Perhaps, I could even say why.

The Man Who Mistook His Wife for a Hat is the title of the book, which takes its name from an essay within it. The emphasis really is, and other Clinical Tales.  So why were people telling me to go read this book? As I began reading I realized I could see my daughter in almost every essay. Sadly, I could not see her in the essays at the end of the book devoted to autism.  I was also hoping I might see her in the excesses section. The chapter on Tourettes was striking, but I did not find my daughter there. I suppose I was hoping to see something other than deficits. Maybe she did fall under autism. Since Dr. Sacks, Autism has become a major focus of concern and attention. I did not see her there either, though. She is not singular in focus with a highly identifiable, even enviable, talent for science or art. At least, this is the way in which autism is presented to us.

Dr. Sacks would not be politically correct today as he divides his book into four parts:  Losses, Excesses, Transports, and The World of the Simples. This terminology seems cold and heavy, but Dr. Sacks is in no way a cold clinician. Rather, it is the opposite. Oliver Sacks looks way beyond the neurological impairment and seeks to understand the individual who has an identity and a soul. He asks himself and the reader to think about life and what it is that we demand of everyone. He clearly worries that simplifying the brain as a computer will miss the point entirely of being human. In effect, he is a philosopher and theologian too.

“Of course, the brain is a machine and a computer — everything in classical neurology is correct. But our mental processes, which constitute our being and life, are not just abstract and mechanical, but personal, as well– and, as such, involve not just classifying and categorizing, but continual judging and feeling also (18-19).”

In each “clinical tale” Dr. Sacks is asking what is it that makes us conscious human beings. What happens when you can no longer feel yourself as yourself? What happens when you lose important pieces of yourself? When your brain cannot function the way it used to? These questions are hard to answer; mostly they remain unanswerable or only answerable on a personal level. But, they are part of our real life, and need to be thought, even if it is not happening to us directly.

Sacks’s clinical work is amazing, and his insights deepen our awareness of how we construct our identities and find ourselves. In his essay, “The Disembodied Lady,” he works with a young woman who was quite healthy, and then lost all her proprioceptive sense. This young woman had lost one of her senses that helps give one a sense of the body. She could not stand up if she had her eyes closed. She could not feel herself in space.

My child, like many others, has the need for OT. When she was younger we needed to give her deep pressure, and wrap her in a blanket like a hotdog. Many children with boundary issues and who seem clumsy are simply struggling with their sense perception being off — just like someone who needs glasses, but the stakes are higher and the fixes not so clear. Dr. Sacks, of course, was dealing with an extreme case. But the extreme is vital for learning. We learn that our identity is tied to our bodies, and if our bodies do not feel as if they belong to us then we become dispersed, and unable to function. This is why Sacks goes beyond the actual processes and looks deeply into how we feel and judge. For the young woman who lost her proprioception, her body was gone and she had felt like someone “scooped” out her center. She described herself as  “pithed, like a frog” (50), whose anatomy was being studied.

What happens to a person who suffers a loss of memory that brings him back to 1945? Dr. Sacks wonders if he has a soul. I do not imagine there are many doctors willing to ask that question. The answer, though, comes as a surprise. The nuns who take care of the amnesiac assure Dr. Sacks that he can follow the church mass and he seems to experience great pleasure from the order and symbolism. Not all are so fortunate to maintain such a connection.

What Sacks neatly shows through careful and artful examination of losses is how the abstract is tightly connected to the concrete. One cannot function in a world made entirely of abstraction or in a world that is only concrete. The man who did mistake his wife for a hat was a musician who was losing his ability to understand the concrete world. Dr. Sacks draws forth from his patients the delicate interplay between a computerlike brain and artful abstraction:

“Experience is not possible unless it is organized iconically; action is not possible unless it is organized iconically. The brain’s record of everything — everything alive — must be iconic. This is the final form of the brain’s record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, ‘art’ — the artful scenery and melody of experience and action” (141).

Towards the end of the book, Dr. Sacks continues with his questioning, but it becomes more profound because he is dealing with people who did not lose, but who were born with losses. In his last section he works with young adults with low IQs, who could not do simple arithmetic and probably would never be able to care fully for themselves. This leads him to note a rigidity in all the measuring and testing.

He speaks of one young woman:

“Superficially she was a mass of handicaps and incapacities, with the intense frustrations and anxieties attendant on these; at this level she was , and felt herself to be, a mental cripple — beneath the effortless skills, the happy capacities, of others; but at some deeper level there was no sense of handicap or incapacity, but a feeling of calm and completeness, of being fully alive, of being a soul, deep and high, and equal to all others” (17o).

Dr. Sacks begins to see a young woman who could love deeply and could compose herself when dancing or participating in theatre.

“She had done appallingly in the testing — which, in a sense, was designed, like all neurological and psychological testing, not merely to uncover, to bring out deficits, but to decompose her into functions and deficits.” (172)

What testing lacks is its inability to discover the strengths of an individual. As Sacks writes:

“They had given me no hint of her positive powers, her ability to perceive the real world- the world of nature, and perhaps of the imagination — as a coherent, intelligible, poetic whole… ” (172).

He begins to think it is quite possible that this young girl sees the world differently; not using a “schematic mode,” but rather a “narrative (or dramatic) mode” to create a cohesive world (172).

Throughout each clinical tale we see a person struggling to create an organized world. Some have the capacity to love deeply and find meaning in music and theater. Others are so concrete that they can pick up on details in their environment and draw it with a touch of playfulness coming from their own internal world. Still others communicate through numbers. Their worlds are coherent, but limited. They would fail miserably at purchasing basic necessities and would not be able to get around town.

The brain works to organize itself and form a cohesive world. It does this on its own. For many, it takes its computational and programmatic abilities and somehow creates. For others, the “schematic” mode will never function. The brain, then, uses other forms of seeing, according to Dr. Sacks, more artful or melody forms, and creates. It is here, in creation where we find the conscious or the soul or the fully alive. In the end, the deficits do not matter as much as the discovery of how a person organizes and then creates out of that organization.

One can read Dr. Sacks and walk away thinking the world of neuropsychology/psychiatry does not offer much hope. In a way, there are no cures. We are still bogged down in testing. I could tell you all of my daughter’s deficits. I still worry over the skills she needs in order to survive. And yet, my daughter survived before I came into her life. She survived neglect and an orphanage.  So it is not just survival here. Dr. Sacks’s work seeks to explore the depths of being, and comes out with a general idea of what one must feel in order to feel fully alive: one must feel composed, feel whole and feel as a participant in creation. He leaves the door open as to how one gets there.

In the end, the worries remain (a grace of parenting, my preacher tells me): how will our children continue through school, maintain a job and live each day without executive functioning skills? These questions ought to be easy to answer; they are concrete enough, and very much rest on community responsibility. Discovering how our children can create a cohesive world for themselves without getting crushed by the demands of daily living, however, is the constant challenge.

 

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