Summary
"Losses," the book’s first of four sections, 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 Alexander Luria, Pyotr Anokhin, and Nikolai Bernstein. Many of the emerging field’s early discoveries had one thing in common: they were the result of studies conducted on damaged left hemispheres. Luria’s The Man with a Shattered World, for example, is an account of a young Russian soldier in World War II who survives a catastrophic gunshot through the left side of his head and loses his short-term memory.
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. Hence, patients with right-hemisphere disorders have long gone overlooked. They are in the unique position of living with an inner reality that is impossible to rationalize or even describe. Sacks writes that he is less interested in the traditional left-hemisphere deficits studied by neurology than he is by the questions of self that emerge from right-hemisphere deficits. He emphasizes that a disease is never a simple loss of function; it is also how the patient reacts and compensates as he tries to preserve his identity.
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. He had lost the ability to distinguish faces and is only able to recognize his colleagues and students by their voices.
Dr. P is a genial, good-humored man, and an excellent communicator. When they first meet in Sacks’ office, Dr. P reaches down to put his shoes back on and freezes, thinking that his foot is his shoe. He also finds it impossible to correctly describe the objects in a landscape photograph, inventing details and images that aren’t there.
Sacks arranges for them to meet a second time, this time in Dr. P’s home. Although Dr. P can no longer read music, Sacks confirms that he still has a fine-tuned ear for it. He can easily judge and identify abstract shapes and even cartoon drawings of faces, and he quickly beats Sacks in a game of mental chess. However, when Sacks gives Dr. P a rose, he doesn’t realize that he is holding a rose until he smells it. He is totally perplexed by what the function might be of a leather glove, saying that its five distinct pouches might be a good way to store coins. After Sacks finishes his round of tests, Dr. P stands and reaches for his wife’s head, mistaking it for 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 functioning with the help of his wife. He teaches music until the very end of his life.
Analysis
Fittingly, the author uses the two hemispheres of the brain in order to symbolize the differences between Sacks’ interests and the interests of neuroscience in general. In so doing, he creates a two-sided symbolic framework where neuroscience is ostensibly a “left-brained” practice, and the work of Sacks is “right-brained.” The author, of course, knows that the brain is not polarized as rigidly or simply as he puts it here; rather, the right-versus-left-hemisphere duality is evoked for the sake of the story he wants to tell. While the goal of neuroscience is to map out the detailed schematics of the brain, ascribing words to various conditions and defects, and using quantitative testing to reach diagnoses, Sacks’ narrative goal is to describe and make sense of the reality that his patients live in, to understand the “right hemisphere” of neurological disorder.
Sacks is surprisingly inactive as a character in his first essay. Despite the fact that Dr. and Mrs. P come to Sacks’ clinic for help, Sacks proves not to be able to provide any concrete help for them at all. As the author, he may be intentionally playing down his medical knowledge in order to highlight the disarray between neuroscience and Dr. P.’s condition. In the story’s postscript, Sacks writes that “[n]eurology and psychology, curiously, though they talk of everything else, almost never talk of ‘judgment’–and yet it is precisely the downfall of judgment… which constitutes the essence of so many neuropsychological disorders” (19). Just as he said he would do in the introduction, Sacks is, at least in part, using the story of Dr. P to take science to task.
This tale of Dr. P serves in many ways as a template for this book as a whole. Each story Sacks tells rests on a broken triangular relationship between the story’s subject, the subject’s observer, and reality. When Dr. P (the subject) mistakes his wife (the observer) for a hat, the break in reality between Dr. P and his wife creates conflict, turning an otherwise uninteresting scenario (“A man recognizes his wife”) into an interesting and meaningful story. Panning back, we can also see this broken triangulation between neuroscience (the subject), Sacks (the observer), and the core goals and values of scientific case studies (reality), which, as Sacks establishes in the preface, he is seeking to reorient.
