The Man Who Mistook His Wife for a Hat

"When I was embarking on my medical career, this was a very influential book for me. I have fond and warm memories of lying on a beach in Thailand reading it, thinking wow, maybe I’ll be doing this sometime. I didn’t choose neurology because of it but the way Oliver Sacks writes about neurology is very compelling. He’s such a beautiful writer, and the way he presents the cases reminds you what an astonishing organ the brain is. What astonishing things it can do and what astonishing things happen when it goes wrong. I think that’s a very important point. He doesn’t write about neurological diseases, he writes about people. In the case of the man who mistook his wife for a hat, he paints a picture of an interesting person and an interesting family, with the disease in the background and the person in the foreground. It makes the book extremely readable and it makes him a humane, caring kind of doctor. “I had assumed Sacks was going around collecting these very special, rare cases. But now I realize that what he’s really doing is drawing your attention to things that are not that unusual after all. ” It’s about a musician and artist who developed facial agnosia, so he was unable to recognize objects and faces. When he looked at his wife’s head he mistook her for a hat. Sacks followed the progression of the man’s illness through his art. His paintings gradually changed through his life, becoming more abstract as his disease developed. When I first read this book as a student, before I had done any neurology, I wondered if Sacks was cherry-picking bizarre cases that hardly ever happened. But looking again as a qualified neurologist, I realise that these things aren’t so unusual. Another example would be the case of the man who fell out of bed. It’s about a man who had neglect of one leg. He ceased to be able to recognize his leg as his own. He would wake at night and think there was a severed leg in his bed and he would try and throw that leg out of the bed. This is a manifestation of something neurologists see all the time. If you have a stroke involving a particular part of your brain in the parietal lobe, particularly on the right side, you can get neglect of the other side. So you can have a plate of dinner and only eat the dinner on the left. Although you can see, you fail to recognize something about the dinner on the other side of your plate. This man had this neglect with one side of his body, so when he woke up he believed that the leg in his bed didn’t even belong to him. I had assumed Sacks was going around collecting these very special, rare cases. But now I realize that what he’s really doing is drawing your attention to things that are not that unusual after all. He makes the stories wonderful and beautiful through the personal way in which he tells them. I wouldn’t say he influenced me at all. I’d long to be able to write like him but I don’t feel that I do! He’s a wonderful writer and I wouldn’t in a million years compare myself to him."

"I agree. Let me just say that all five of these books were personally important to me in my intellectual development. Each of them transformed my thinking. When I first read Sacks, I was just stunned at the variety of ways the mind could go a little bit loopy and how people could put together meaningful, sometimes even beautiful, lives despite what you might think would be staggering disabilities. Sacks describes all this so beautifully and he conveys such love for the people he describes. It’s a series of portraits or case studies of people with neurological damage. Oliver Sacks was a neurologist, and he met fascinating people over the course of his career, many who found value and meaning amid quite disconcerting disabilities. Yes. This is a guy who has basically no new long-term memories since World War II. Sacks is interviewing him in the 1970s, I think. Sacks walks into the room and says, “hi” and the guy’s cheerful and he’s able to have superficial conversations, keeping hold of things for maybe 30 seconds, and then it’s gone. He’s living in this superficial world of friendliness. He has no clue how old he is. He looks in the mirror and is shocked and mortified at what he sees and to be told that it’s not 1945. What would that be like? What would it be like to be unable to lay down any new memories, to think it’s 1945 all the time and everybody you meet is new? It’s fascinating to imagine, and I feel a lot of sympathy for the Mariner even though he doesn’t know how bad he has it. “What would it be like to be unable to lay down any new memories, to think it’s 1945 all the time and everybody you meet is new?” A couple of twists add more depth to the story. One is that World War II was clearly the highlight of the Lost Mariner’s life. After the war he fell into alcoholism and had a terrible life. He developed Korsakoff’s Syndrome, due to severe alcohol abuse damaging his brain. His disability, in some sense, erased that terrible life and put him back permanently into this world that worked better for him. So, he lost what he needed to lose in some sense. Sacks is a little critical of him and says, “Look, he’s so superficial. It seems like an empty life in a way.” But then he describes the Lost Mariner going to Catholic church and engaging in the rituals there. Of course, these rituals are timeless and it doesn’t matter if it’s 1945 or 1975. He’s able to participate in the ritual and understand the meaning of the ritual. He has a powerful religious sense. That isn’t lost. He’s able to participate in religion because of its constancy. He knows what to do when the sacrament comes. So how do you evaluate a life like that? There’s no easy answer. You could write the exact same story as fiction."

"That was another really transformative book for me. Oliver Sacks is a beautiful storyteller, but he’s also a neurologist and these are real patients that he saw, with real symptoms. And with some of these patients the mind boggles — those that can’t see faces, or think their loved ones have been replaced by robots. We don’t know how this happens in the brain, all these different maladies and disorders, but we know quite a number of them. We know generally how and why they come about and it’s just wild to me that this can happen. I can’t imagine one day waking up and not knowing who my wife is, or seeing my wife and thinking that she was replaced by some sort of clone or robot. But it could happen to any of us… That’s something we look at in our book a lot. Our preface is an attempt to pay homage to the idea that a lot of what we know about how the brain works first came about by looking at injury: when someone has a specific brain malady, or trauma, or wakes up after a stroke and are unable to speak, or they can talk but they can’t understand language, or they suddenly can’t see one part of their visual world. For me, one of the most interesting ones is a disorder called hemineglect, where you lose the ability to pay attention to the left side of space. You just forget that the left side of the world exists. If you ask someone with hemineglect to draw a clock, they will cluster all of the numbers 1 through 12 on the right side of the clock face. And these things tell us something very fundamental about how we pay attention to things in our visual world, how we speak, how we understand. Engineers will tell you that they’ll take something apart and try to put it together again. We obviously can’t do this with brains and minds, but when something breaks it does tell you something about how it works. For me, Sack’s book is more interesting because it’s real. There is no buy – going back to the idea of believability – it seems like the author is asking too much of you, he’s pushing your credulity to the limits, but it’s all real."

"This is a bit of an obvious one, but it is such a genius book. It is a seminal book that anyone who wants to work in mental health should read. It is a charming and gentle (and also honest) exposé of what can happen to us when our mental health is compromised for whatever reason. The title is great, and, because the case studies are very bizarre, it does fly right into that stigma which exists around the whole issue of mental health, which is the differentiation between normal and abnormal. (Either you are on one side or the other, and, if you are on the wrong side of normal, then basically, according to society, that is it, pack your bags and leave.) But actually, what the book does is to blur that line – and he talks about some very, what we would call pathological behaviour. But actually, it is completely sane in the context of how it is presenting itself. For me, the book is a really lovely challenge in the whole debate around normality and abnormality and the constraints we put on our understanding of mental health because we are so label-conscious. I think it would be helpful if we could accept that mental illness and physical illness all lie on a continuum, and sometimes bits of our physical body don’t work very well, and sometimes bits of our mental body don’t work very well – and that that’s OK, and it’s actually not an indication of failure. If you break your leg, you are not going to suddenly be seen as less successful than you were before you had broken your leg. So why do we have this stigma around mental health? I have written about my postnatal depression and also how depressed I was when my father died, and I am not concerned that people know that and that I was treated for it. I think people do need to be more open, so that there is less of a stigma attached to this issue. We are scared of people seeing us as somehow not the person they thought we were, as if life is a competition and the only way that you win it is by being completely invincible and robust and never being fragile or vulnerable. That is just ludicrous. That is why I like kids: because they remind us that life really isn’t like that."