Oliver Sacks differentiates his vignettes from conventional medical case histories by their engagement with ‘the person, and the experience of the person, as he faces, and struggles to survive, his disease’. This collection of portraits is therefore included in these ‘illness narratives’ for their insights into the personal experience of different conditions. It is for the reader to judge how well Sacks fulfils his undertaking to engage with the individual and enter his experience. When I read these today, I am very aware of Sacks the neurologist, determined to classify exactly, using exactly the correct medical terminology. But perhaps his writings need to be seen in their time (mainly the early 1980s), for although The Man Who Mistook His Wife For a Hat became a best-seller, this type of narrative writing was then uncommon. Sacks himself was worried that his medical peers would not view them as serious pieces of work (as is clear in his autobiography On The Move (2016)). Today’s readers of illness narratives should perhaps feel free to omit the more technical formal introductions to each section and the postscript to each case.
There are some wonderfully vivid portraits here of patients who were examined and observed closely by the neurologist Sacks. There is a professor of music who can recognise his individual pupils by their playing, and who knows everyone by their voice, but who has such a profound visual agnosia that he cannot recognise everyday objects like gloves. He even attempts, when he gets up to leave Sacks’ office, to pick up his wife’s head as though it were his hat. ‘The Disembodied Lady’ exhibits in an acute form the loss of proprioception examined in much more detail by Jonathan Cole (Pride and a Daily Marathon) over a longer period of time, and which Ian Waterman talks about in the documentary The Man who Lost His Body.
There are examples here of very strange perceptual effects. ‘The man who fell out of bed’ relates how a patient keeps on throwing his strange lifeless leg out of his hospital bed convinced that it is not part of him (an example of anosagnosia). Individuals with losses of memory (Korsakov’s Syndrome) or language (aphasia) are vividly and movingly described, some with insight into their condition, and others who exhibit instinctive strategies to get around the losses that they are hardly aware of.
Although Sacks tries to group these vignettes in four thematic groups – Losses, Excesses, Transports and The World of the Simple – he cannot disguise the essentially eclectic nature of the collection. But when I reread them in one sitting I am aware of a sense of wonder at the brain and how it manages our interactions with the world. Small losses or changes in brain chemistry can fundamentally alter how we execute those interactions and how we perceive ourselves and those around us. It is striking that these vignettes repeatedly show how individuals can and do adapt to their situation, heightening certain sensibilities even as they lose others. Very often the person is able to live a rewarding life despite some neurological deficit, using other faculties, even in the face of our society’s demands to fit the ‘normal’ pattern. The portraits of people with Tourette’s are sympathetic and understanding, showing how the ticking and other behaviours can severely affect how those people are treated by ‘normals’, but also how the individuals concerned may value the additions that the syndrome brings to their personality. The portrait of Ray tells how he has come to medicate during the working week, but to allow his true personality free without medication at the weekends. Fascinating.
This is a classic collection of short vignettes that gives an insight into how people behave when their brain is not ‘normal’. Highly recommended.
Sacks, O (1985) The Man Who Mistook His Wife for a Hat, London, Gerald Duckworth
Sources for the original essays:
New York Review of Books 1984, 1985: The Lost Mariner. Hands. The twins. The autistic artist.
London Review of Books 1981, 83, 84: Witty Ticcy Ray. The man who mistook his wife for a Hat. Reminiscence (originally ‘Musical ears’).
The Sciences 1985: On the level
The Lancet Spring 1970: Incontinent nostalgia