The Man Who Mistook His Wife For A Hat: And Other Clinical Tales,   ISBN:9780684853949

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Oliver Sacks spent his career as a clinical neurologist. Somber, comical, encouraging, dispiriting, outlandish, but always fascinating. These could all describe the patient case histories presented by Sacks in his book, The Man Who Mistook His Wife for a Hat. The author is at the top of his game in medical expertise, yet manages to go far beyond the mere mechanics of neurology and embrace the mysterious humanity of his patients.

Sacks divides his book into four different sections. The first, entitled Losses, deals with neurological deficits. An example of this would be one woman's terrifying loss of proprioception, detailed in the chapter called The Disembodied Lady. Part two of his book explores the opposite spectrum of neurology, Excesses. He starts this section of the book with an interesting look at the pathophysiology of Tourette's Syndrome manifested in one of his patients, nicknamed Witty Ticcy Ray. The third part of the book delves into the strange world of Transports. Transports refers to massive alterations in one's perceptions and inner experiences. One chapter chronicles the experiences of a woman who couldn't escape hearing loud radio-quality Irish music in her head. Many would be tempted to simply write her off as crazy, but Sacks patiently and diligently discovers the neurological culprit behind the unwanted musical renditions. Another fascinating case history in this section of the book is the amphetamine-induced hyperosmia of a young medical student. His weeks-long experience with a "dog's nose" truly makes one wonder about the vibrant everyday realities that often escape our physical senses. The fourth and final part of this book, The World of the Simple, contains four chapters describing the experiences of the mentally retarded. After reading through his interactions with these patients, I'm fairly convinced he dubbed this section The World of the Simple with tongue in cheek. The mentally retarded are far too often dismissed as being bound to a mundane existence. Sacks shatters this misconception as he takes a personal interest in his patients and shows them to be both capable and rich in deep inner experiences. This section focuses primarily on autism.

I believe that one of the biggest catalysts to compassion is knowledge. Without a proper medical diagnosis these patients could have been carelessly relegated to the ranks of the crazy, the inferior, the hopeless, as if such ranks even existed. Point being, dedicated and caring neurologists such as Oliver Sacks are working hard through their writings and their clinical practice to bring us to an understanding of the delicate underpinnings behind our human existence. A humble appreciation of human frailty is key in treating these cases with compassion and understanding. Anyone who reads this work by Oliver sacks will grow leaps and bounds in such understanding.

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I didn't want this book to end. I started slowing down even as I wanted to keep going. I'd sit in the New York City subway trains and think about reading but not. And I know I'm going to reread it sooner rather than later.

Dr. Sacks goes through a multitude of clinical case studies, within four different categories of right brain disorders (those that disrupt our sense/perception of reality): losses, excesses, transports, and the world of the simple. Throughout the book, he is constantly engaging with the human condition, overwhelmingly compassionate, curious, lyrical. He invokes stories, elevates them, shows how neurology, and medicine in general, have forgotten about people and why it's imperative for the profession, for the world. It's also striking to note how complex and tenuous our grasp of reality is, how many ways there are to lose it.

Because I've been obsessing recently about memory and memory loss, this passage in particular, from a letter from Dr. Sacks' mentor, A.R. Luria, struck me as being so nuanced and smart and ultimately, comforting:

"A man does not consist of memory alone. He has feeling, will, sensibilities, moral being, matters of which neuropsychology cannot speak."

Would that we all know this. And read this book. It's one of the best I've ever read.

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Great book. The mechanics and word usage in the book are a bit dated, though.

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an interesting book. make u think about the human nature, see deep through whatever was hidden there.

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Seldom is a book intended for a narrow discipline and capable of reaching general audiences with limited field knowledge. Clinical neurologist, Oliver Sacks, however, skillfully authors The Man who Mistook his Wife for a Hat for students of neuroscience without repressing less familiar audiences. The power of the brain is witnessed here through examination of clinical cases where normal function of the brain is lost and neurological disorders result.

Provocative accounts from Sacks's actual patients mark his book and illustrate the dissocializing nature of neurological disorders. "Dr. G" of Chapter 1 exemplifies this notion as his visual memory is lost after sustaining brain damage. As a result, Dr. G errantly recognizes objects, i.e. his wife for a hat, as titled. Social implications are associated with his disorder and are observed at home as well as at work. Additional case histories are discussed subsequently, all converging to support a common effect of neurological disorders: social unrest and continuous dependence on others. Twenty-two patient histories are examined in total. Sacks classifies patient disorders into two broad-ranging categories that conveniently serve as a division in the book: losses and excesses. Losses are explained to "denote an impairment or incapacity of neurological function" (p. 3). Alternatively, "excesses" are also hallmarks of neurological disorders, however, less common and characterized through a "superabundance of function," seemingly the opposite function of losses (p. 88).

Sacks begins his description of aberrant neurology through examining patients with loss of function. Justification can be derived for this decision with the observation that abnormalities display characteristics otherwise concealed by normal function. As described above, "Dr. G" portrayed in Chapter 1 begins to illustrate the consequences of a debilitating neurological disorder. To further expand this, "Christina" (Chapter 3: The Disembodied Lady), once very active and healthy, sustained an unfortunate accident that left her completely without sensation of her body. This left her trapped in the hospital and separated from her children and loved ones. Normal work was no longer possible and once able to return to the public scene, completing common tasks were a continuous struggle.

When further studying neurological disorders, Sacks reasons that in addition to examining loss of function, abnormal gain of function is equally possible to result in neurological disorders. In fact, Sacks intuitively recognizes that disorders "may not be apparent when we consider only loss" (p. 87). However, he additionally recognizes that (at the time of publishment - 1970) "neurology never considers such disorders of excess", therefore, such studies would be unprecedented (p. 88). Regardless, Sacks unyieldingly attempts to examine cases of excess function to gain a more comprehensive understanding of how neurological disorders affect one socially. "Ray" (Chapter 10: Witty Ticcy Ray) demonstrates an example of a patient not affected from a loss of function, but rather a gain of function. Ray experienced a condition that lead him to be hyperactive in nature, twitchy, nervous, and unsettled. Sachs utilizes Ray to demonstrate that the social implications experienced by those with abnormal gains of function are equally troubling.

Arguably, Sacks's case by case examination functions more than a technique to survey neurological disease and disorder. A more profound implication for such case studies is reached by the conclusion. Sacks seemingly describes patient case studies to demonstrate daily challenges encountered by his patients. Such challenges are apparent by observation, but their significance is otherwise unrecognized and unappreciated by the outside world. For example, the students of "Dr. G" are perplexed at his inability to distinguish among themselves in class and are unsure of how to address him. Similarly, "the lack of social support and sympathy is an additional trial" for Christina to overcome before being accepted once again into society (p. 51). Demonstrating these unique challenges enlightens the reader as how to begin to interact and respond to individuals with debilitating neurological disorders. Thus, Sacks's focus benefits individuals at two levels; those with the disorder and the interacting population. In this regard, the book distinguishes itself from similar accounts by its inherent humanistic nature.

Sachs comprehensively examines a broad-range of neurological disorders with an ultimate goal of exposing the reader to large range of techniques used by patients to manage their disorders. This goal is achieved while accommodating the needs of both the students of neurology and the more general audiences. Completing the book allows one to understand the significance of The Man Mistaking his Wife for a Hat.