The Man Who Mistook His Wife For a Hat is a collection of twenty-four clinical “tales” about a wide variety of strange and remarkable neurological disorders. The book is narrated in first-person by Dr. Sacks, a practicing clinical neurologist. Each essay tells the story of a real patient Sacks once encountered. He alters the names and certain details about his patients to both protect their privacy, and enhance the narrative quality of their experiences. The essays are organized into four sections: “Losses,” “Excesses,” “Transports,” and “The World of the Simple.”
“Losses” begins with a short introduction that provides some historical context on the evolution of neuroscience. Modern neuropsychology came into being after World War II, due to the joint efforts of Soviet physiologists. Many of the emerging field’s early discoveries had one thing in common: they were the result of studies conducted on damaged left hemispheres. As the hemisphere with more distinct, schematic and quantitative functions, the left side of the brain has easily lent itself to scientific research. The right hemisphere, on the other hand, has always been considered the more primitive side of the brain, even though its functions form the bedrock of how we construct reality.
This is certainly the case with Dr. P, the subject of Sacks’ titular story: “The Man Who Mistook His Wife for a Hat.” Dr. P is a distinguished musician who teaches at a school of music in New York. Dr. P comes to Sacks after a series of incidents wherein he had confused seemingly unmistakable things. For example, he would sometimes pat the top of a fire hydrant or parking meter, thinking that it was a child. Most famously, he grabs his wife’s head thinking that it is a hat. Not able to reach a diagnosis, Sacks advises Dr. P to fill his life with as much music as possible. True enough, despite the gradual advancement of his condition, Dr. P is able to continue teaching music until the end of his life.
The subject of “The Lost Mariner,” Jimmie G. is admitted into hospice care at the age of 49. Although he is charming and intelligent, he perpetually thinks that the year is 1945. Jimmie has Korsakoff’s, a degenerative illness caused by years of heavy drinking that causes both amnesia and short-term memory loss. Sacks worries that Jimmie is a lost soul with no hope for improvement. However, things rapidly change for Jimmie once he starts going to church. Jimmie’s total focus and awareness during Sunday services open Sacks’ eyes to “other realms where the soul is called upon” (38). He takes to gardening too, and over the years Jimmie gains an astonishing presence of mind, becoming deeply grounded in the beauty of each passing moment.
In “The Disembodied Lady,” Christina is a twenty-seven-year-old woman with two children, who in her previous life worked from home as a computer programmer. Just before going into surgery to have her gallbladder removed, Christina suddenly finds it impossible to feel the ground beneath her. A spinal tap reveals that she has a rare form of acute polyneuritis which has affected the sensory roots of her spinal and cranial nerves. She has lost all proprioception, the brain’s innate sense of the position and orientation of the body. Over eight years, Christina gradually replaces her proprioception by looking at each part of her body as it moves and listening to her voice as she talks in order to operate her jaw. The process is slow and mentally arduous at first, but eventually, this visual monitoring becomes second-nature.
In “The Man Who Fell Out of Bed” the author describes an encounter he had with an unnamed patient many years ago, back when Sacks was a medical student. The patient tells Sacks that he had woken up from a nap and, to his surprise and horror, found “someone’s leg” with him in his bed. Although the leg was attached to him, he was convinced that, as a prank, somebody left the leg in the bed for him to find. Disgusted, he’d thrown the leg out of bed, which brought the rest of his body to the floor. Sacks asks the man where his leg is, if this isn’t it. He shakes his head and says “I have no idea. It’s disappeared. It’s gone. It’s nowhere to be found…” (57).
Madeleine J., the subject of “Hands,” is a congenitally blind 60-year-old woman with cerebral palsy. Her family had supported her in every way since infancy. Although she is exceptionally intelligent and well-read, Madeleine tells Sacks that she can’t do anything with her hands at all. “[u]seless godforsaken lumps of dough–they don’t even feel part of me” (59). Sacks wonders if she doesn’t feel any connection with her hands simply because, over sixty years, she has never had the need to use them. This proves to be true, and within a year Madeleine takes to sculpting, creating simple but remarkably expressive three-dimensional figures. Sacks praises her astonishing and unexpected artistic sensibility, marveling at how one’s basic powers of perception can be developed so many decades after infancy.
“Phantoms” is, for the most part, an explanatory essay, using a series of anecdotal stories to illustrate what neurological phantoms are and how they are experienced by amputees. An unnamed man is plagued for forty years by the sense that his amputated index finger is rigidly extended at all times. A second patient under Sacks’ care has to slap his thigh-stump every morning several times in order to “wake up” his phantom leg. Another man tells Sacks that on occasion his phantom-foot “hurts like hell -- and the toes curl up, or go into spasm” (69). These pains only occur when the man has taken his prosthetic leg off for the night.
In “On The Level,” Mr. MacGregor sees Dr. Sacks because others have been telling him that he leans to one side. Although Mr. MacGregor is convinced that his posture is normal, indeed when he walks, his body tilts at a twenty-degree angle. Sacks tells Mr. MacGregor that he has lost part of his proprioception due to a faulty inner-ear. Mr. MacGregor, a former carpenter, rationalizes this diagnosis by way of making an analogy to a faulty spirit level, the device used to measure the levelness of a surface. Inspired, Mr. MacGregor rigs up a pair of glasses with a horizontal spirit level set about five inches out from the bridge of the nose. This way, he can use the leveler to monitor his balance visually instead of proprioceptively.
Mrs. S, the subject of “Eyes Right!” is a humorous and intelligent woman in her sixties who, after suffering a stroke in the deeper portions of her right cerebral hemisphere, completely loses touch with the left field of her vision. She is not simply blind in her left eye; she cannot conceptualize the notion of a “leftward” reality. Eventually, Mrs. S. finds a solution to this problem: instead of turning to the left, she swivels around to the right in a circle until what she’s looking for comes into view.
In “The President’s Speech,” an entire ward of patients are found laughing at a televised speech from the president. These patients all suffer from severe global aphasia, meaning that they have lost the ability to understand the meaning of words. However, with no damage to their right hemispheres, most aphasiacs still receive and understand all of the minute visual and tonal cues of speech, and hence they are often able to piece together what is said to them. Due to this unique impairment, “one cannot lie to an aphasiac,” Sacks writes. “He cannot grasp your words, and so cannot be deceived by them” (82). This is ostensibly why the ward finds the president’s speech so amusing.
The introduction to “Excesses” opens with a discussion on where neurological disorders of excess stand in the field of neuroscience. As mentioned in the introduction to “Losses,” neurology loves to study deficits, especially in the left hemisphere of the brain. For this reason, disorders that cause over-excitement or excessive ebullience in the brain have not received the attention they deserve.
Ray, the subject of “Witty Ticcy Ray,” is one of the few Tourette’s patients Sacks agrees to see after a sudden upsurge of interest in Tourette’s and “ticcing” brought on by a Washington Post article from early 1971. Sacks prescribes Ray a drug called Haldol, which proves within a matter of hours to completely cease his tics. After nine years of being tic-free, Ray returns to the clinic. He says that he’s tired of being “sober,” and that without his Tourette’s he no longer experiences the wild, creative surges that he used to. He’d lost his interest in his former hobbies and reports feeling far less competitive or playful. Finally, Ray decides to compromise: on weekdays he will dutifully take his Haldol, and on the weekends he will let fly, becoming Witty Ticcy Ray once again.
In “Cupid’s Disease,” Natasha K. comes into Sacks’ clinic worried that she feels “too well.” A historically shy woman, Natasha reports that soon after her 80th birthday she “felt young once again. I took an interest in the young men. I started to feel, you might say, ‘frisky’ ” (102). She is treated with penicillin, which eradicates the harmful spirochetes bacteria in her brain, but as the damage had been irreversible, Natasha’s feelings of friskiness and euphoria, to her relief, don’t subside.
William Thompson, the subject of “A Matter of Identity,” is a patient with Korsakoff’s syndrome who reaches a frenzied state of “confabulatory delirium” (110) after suffering a high fever. Like Jimmie G. in “The Lost Mariner,” Mr. Thompson has almost no short-term memory; however, he is also stuck in a continually excited state of narrative invention. Tragically, his sense of personhood has been lost in a kaleidoscopic array of illusions and inventions. Sacks describes his stream of narration to be both excited and indifferent, “as if it didn’t really matter what he said, or what anyone else did or said; as if nothing really mattered anymore” (112).
Mrs. B., the feature of “Yes, Father-Sister,” is a former research chemist whose personality changes suddenly after a large tumor develops in her frontal cortex. When she meets with Sacks, Mrs. B interchangeably calls him “Father,” “Sister” and “Doctor,” respectively because of his beard, his white uniform and his stethoscope. She reports that reality has become completely meaningless to her, which shocks and troubles Dr. Sacks. Mrs. B, however, is not perturbed at all.
“The Possessed,” the last essay of Excesses, is a short vignette about a grey-haired woman in her sixties who Sacks encounters on the streets of New York City. Sacks classifies her as a super-touretter: one whose tics are so constant and forceful that they have entirely subsumed her being. Standing in the middle of the sidewalk, the woman is doing ludicrous, exaggerated impressions of each person who walks past. After “a build-up of pressures,” the woman turns into an alley and, with the appearance of being violently ill, expels a furious string of abbreviated and accelerated versions of every gesture, posture, expression, and demeanor of the forty-to-fifty people who had passed. Sacks writes that after spending hundreds of hours talking to Tourette's patients, nothing taught him as much about the condition than this two-minute display on the sidewalk.
"Transports," what the 19th-century neurologist Hughlings Jackson calls “reminiscence,” are the portals created by the brain that take us to vividly realized memories, dreams, and other worlds. Neurologists usually don’t see patients because of transports, in part because there is a sense that using neuroscience to account for brilliant visions and memories would cheapen their experience. Sacks argues, on the contrary, that medicine is not in the business of valuing or devaluing. Mystic dreams and otherworldly visions are no less spiritually or psychologically significant because they can be explained by science; there is no reason for magic not to coexist with science.
The section’s first story “Reminiscence” follows two women who both begin to experience vivid, uncontrollable musical hallucinations. 88 years old, Mrs. O’C wakes from a dream about her childhood in Ireland and finds that the music she heard in the dream is still playing loud and clear in her ears, almost deafeningly loud. Mrs. O’M is a partially deaf woman in her eighties who comes to Dr. Sacks because of the music in her head. Just as in the case of Mrs. O’C, EGG scans of Mrs. O’M’s temporal lobes registered “strikingly high voltage and excitability” (136). Her hallucinations go away as soon as Dr. Sacks puts Mrs. O’M on anticonvulsants. Unlike Mrs. O’C, she is nothing but glad to be rid of the music.
In “Incontinent Nostalgia,” Sacks shares a letter to the editor he sent to the Lancet, a medical journal, about his experience administering L-DOPA to patients. He rehashes the case of Rose R., a 63-year-old woman who had spent most of her life in a hospital ward -- conscious, but barely able to move or express herself. After taking L-DOPA, Rose experiences “a dramatic release from her Parkinsonism” (151) and for the first time in her adult life finds herself able to move and speak freely. L-DOPA not only excites Rose’s motor functions; it also transports her to the world that existed before her condition set in. She is suddenly able to recall memories and sing songs from the 1920s, many of which she hadn’t thought of for over forty years. Sacks surmises based on this account that Rose “(like everybody) is stacked with an almost infinite number of ‘dormant’ memory-traces, some of which can be reactivated under special conditions, especially conditions of overwhelming excitement” (152).
“A Passage to India” is a brief vignette about Bhagawhandi P., a 19-year-old young woman with a malignant brain tumor. She comes to the hospital knowing that she has only a few weeks more to live. As the tumor continues to expand, her seizures become more frequent. However, instead of fully losing consciousness during her seizures, Bhagawhandi becomes “dreamy,” experiencing vivid, sweeping visions of landscapes, gardens, and homes from her childhood. Gradually, her visions occur more often and grow deeper, until they occupy most of Bhagawhandi’s day. “Three days later she died,” Sacks writes, “or should we say she ‘arrived’, having completed her passage to India?” (155.)
In “The Dog Beneath the Skin,” Stephen D., a 22-year-old medical student on cocaine and amphetamines, has a vivid dream that he is a dog. When he awakes, he suddenly has an acute and powerful sense of smell, a condition termed hyperosmia. Years later, now a young colleague of Dr. Sacks, Dr. D. says that he is nostalgic for the “smell-world.” “So vivid, so real!” he remarks. “It was like a visit to another world, a world of pure perception, rich, alive, self-sufficient, and full” (158). Stephen’s hyperosmia likely came from a period of reduced inhibition brought on by his use of excitants.
In “Murder,” a man named Donald suffers a drug-induced seizure and kills his daughter while unconscious. The State concludes after multiple tests that Donald genuinely has no memory of the incident, and they commit him to a psychiatric hospital for the criminally insane. During the fifth year of his sentence, he is given weekend parole, and he buys a bicycle so that he can go on weekend rides. Soon after, he falls off of his bike while riding down a steep hill and sustains a major head injury. After waking from a two-week coma, Donald tells doctors that he is experiencing repeated, hallucinatory visions of his daughter’s murder. Sure enough, EEG scans reveal “incessant, seething” epilepsies in both of his temporal lobes, extending deep into the emotional circuitry of his brain. Through medication and years of psychotherapy, Donald returns to gardening -- a hobby he developed as a prisoner in the psych ward. Although he does not forget the murder, years later he no longer experiences traumatic visions of it.
“The Visions of Hildegard” presents Sacks’ neurological perspective on Saint Hildegard of Bingen, a German nun from the 12th century who is known for experiencing visions of divine power throughout her life. Historians have determined based on these accounts that Hildegarde was experiencing severe migraines, causing visual auras and fortifications (shimmering jagged lines that cross the visual field). With admiration, Sacks notes that Hildegard’s migraines–a mental event that most people fear and hate–are what lead her toward a life of holiness.
In the introduction to “The World of the Simple,” Sacks confesses that when he first began “working with retardates,” (173) he thought the experience would be miserable. He feared that mentally handicapped patients, lacking refined emotional and intellectual sensibilities, would be difficult if not impossible to relate to. However, aided by some written encouragement from A.R Luria, Sacks finds that although the intellectually disabled are “defective” in some ways, they are also mentally complex and, in a sense, whole. Their innate grasp on concrete reality intrigues Sacks, compelling him to study and write about them.
The section’s first essay “Rebecca” features a young woman of the same name who comes to Sacks’ clinic at the age of 19. Due to a congenital condition, she has severe cognitive defects, and, according to her grandmother, she is still much like a young child. In November her grandmother dies, and, afterwards, Rebecca is enrolled in a variety of workshops and classes with the hopes that she might overcome her developmental limitations. These classes prove to be ineffective and frustrating. Instead, she joins an acting class, which Sacks says she loves and excels in. “[N]ow if one sees Rebecca on stage, for theater and the theatre group soon became her life, one would never even guess that she was mentally defective” (185).
In “A Walking Grove,” a 61-year-old man named Martin is admitted into hospice care. As an infant, Martin suffered a near-fatal bout of meningitis that for the rest of his life caused mental deficits and impulsive behavior. The son of a famous opera singer, he had lived at home with his parents until their deaths. Martin tells Sacks that despite not being able to read music, he knows over 2,000 operas. Martin doesn’t fare well in hospice, misbehaving often and showing signs of developmental regression. He tells Sacks that he needs to go back to church to sing. This turns out to be a miracle remedy. With a renewed sense of purpose and belonging, all that had been defective about Martin appears to fall away: “... the stigmatised retardate, the snotty, spitting boy -- disappeared; as did the irritating, emotionless, impersonal eidetic. The real person reappeared, a dignified, decent man, respected and valued now by the other residents” (192).
In “The Twins,” Sacks describes meeting an extraordinary set of twins, John and Michael, who live in a state hospital and have been variously diagnosed with autism, psychoticism, and severe retardation. One day a box of matches falls to the floor in front of the twins, and John and Michael simultaneously cry out “111.” This proves to be the exact number of matches on the floor. Sacks speculates that John and Michael share a preternatural “sense” for indivisible quantities. To pass the time, the twins sometimes have entirely numerical conversations -- calling up enormous prime numbers (verified later by Sacks) of six figures or more. In 1977 it is decided that the twins should be separated for the sake of their individual development. They move into separate homes and are placed in menial jobs. Although this does help them eventually learn how to care for themselves, Sacks reports that after years, they lose their numerical powers.
Finally, “The Autist Artist” opens with an interaction in the clinic between Sacks and José, a young man of about 21 who suffers from violent seizures. During testing, Sacks finds that José is quite compelled by drawing. When asked to draw Sacks’ pocket watch, José focuses on it intently and produces a copy that, while proportionally a bit off, is strikingly detailed. José proves to be a naturally gifted artist, reproducing photographs from a magazine with subtle twists and enhancements. His drawings are not simple carbon-copies; they have a life and a character that the original pictures do not possess. After years of living in the ward, José becomes the hospital’s artist-in-residence, creating mosaic altarpieces for churches, carving the lettering on tombstones, and hand-printing sundry notices. Sacks laments the fact that despite José’s enormous creative potential, he will likely spend the rest of his life overlooked and unappreciated by the outside world.
