* The Man Who Mistook his Wife for a Hat, Oliver Sacks. 1984
The 20th volume in the Essays Project (co-reading with CT) gets us back to essays. Here we are continuing our side quest to read all of OS’s work. This is Sack’s fourth book, and its excellence is consistent with my belief that Sack’s somehow found his muse — at least for writing for general audiences — while writing A Leg to Stand On, his previous book. Hat, so far, seems to be about various forms of agnosia — the loss of knowledge or awareness of things. So far this includes face and object recognition, awareness of limbs (or the entire body), and portions of the visual field. Looking ahead, I now see that only the first section is on “Losses,” so there will clearly be a much wider variety of ‘neurographies.’
The Book
Preface to the Original Edition (1985)
There is also a 2013 Preface, but I find little of note, though if you are reading the book it is worth a quick perusal.
Sacks begins the 1985 Preface by reflecting on his epigraphs, which has to do with his practicing medicine as a physician also involving getting a view of the larger context of his patients’ troubles — he sees himself as as much as naturalist as a physician. He also says, interestingly, that: “animals get diseases; only man falls radically into illness.” In my view, this reflects his view that some (all?, almost all?) diseases have an ontological component. I love the comment in one of his letters: “What is so instructive about disease, like disaster, is that it shakes the foundations of everything.” He also discusses the value of broad accounts, even stories, and laments the modern tendency to eliminate or minimize the subject of ‘case histories:’ “To restore the human subject at its center — the suffering, afflicted, fighting human subject — we must deepen a case history to a narrative or tale….” (p. xviii) He also brings in myths and fables with their hero’s and archetypes — “travelers to unimaginable lands, lands of which we should otherwise have no idea or conception.“
PART ONE: Losses
Introduction
“Neurology’s favorite word is deficit…” So Sacks begins, and while there is no denying the Sacks’ patients suffer impairment, he is quick to note that the individual always reacts “to restore, to replace, to compensate for and preserve its identity.” Again, we see Sacks’ view that neurological disorders have ontological components. A possible exception is those patients with certain right hemisphere deficits who are unaware of their difficulties — anosognosia is the term for this.
Sacks also refers to his neurographies as studies of organized chaos, which he views as characteristics of many diseases.
The Man Who Mistook His Wife for a Hat
This eponymous essay is about Dr. P, a musician and music teacher who began to have strange visual problems. He would fail to recognize students faces (but would recognize their voices); he would also, “Magoo like,” as Sacks says, amiably address inanimate objects like fire hydrants, parking meters and carved knobs on furniture, and would be puzzled when they did not reply.
As it turns out, he had difficulty recognizing visual objects (like faces) as wholes. He could see individual features, but could not synthesize them into a whole. It was not just faces, though. He had difficulty recognizing pictures, common objects and even his own foot. This agnosia extended to his imagination as well: asked to relate what he would see while walking a familiar route, he would only report the objects on his right; if told to imagine he was walking in the other direction, he would report the objects he had missed before (now on his right).
Examining in his home, and in the company of his wife, Sacks learned that Dr. P. sang constantly, and that he had songs for eating, drinking, bathing. “He can’t do anything unless he makes it a song,” his wife said. Sacks concluded that he had lost the ability to see images, and to construct them internally, but that he used songs instead to knit the fragmented world into a whole.
The Lost Mariner
This is the story of Jimmy G, a sailor who appears to have lost the ability to transfer short term memory into long term memory. His memories of the world, and of his personal history, stopped in 1945. Whatever was shown to him, or said to him, was forgotten within a few seconds. He did sometimes retain faint memories for a few minutes — for example, remarking that some doctor had played tic-tac-toe with him, though not remembering that it was Sacks or how long ago it was. After some time in the hospital where Sacks saw him, Jimmy developed some familiarity with the spaces and layout of the institution, and recognized some people, though he made up stories that connected them to his 1945 life.
The Disembodied Lady
This tale is about a woman who lost her sense of proprioception. She was given an antibiotic as a prophylactic prelude to surgery and apparently had some sort of bizarre reaction to it. The problems she would face first surfaced in a dream (something that will be encountered number of times in Awakenings) where she felt herself swaying and had difficulty picking things up and holding them with her hands. Later that day, after she awoke, the difficulties in her dream became reality. She was unsteady on her feet and kept dropping things from her hands. As time went on things became worse — she could not grasp things, track her hands, or even sit up reliably. She said she could no longer feel her body… A subsequent examination showed that she had lost all proprioceptive sensation.
She adapted, learning to substitute — after a fashion — vision for her proprioception. Clumsy at first, after a while she developed a sort of automatic visual feedback that enabled her walk and move. Over time she developed other forms of feedback that enable her to sit up and speak, albeit both in a sort of staged or performative way. Although she has compensated, her deficit has never improved.
… reading break …
The Man Who Fell Out of Bed
This is a very brief fictionalized account of Sacks’ own experience with losing the portion of his body-image that had to do with his leg, and the profound alienation and terror that accompanied that loss: the feeling that there is this alien ‘thing’ attached to him. At the end of this account, a similar case is reported by another physician.
Hands
This is the story of Madeleine J, a blind-from-birth woman with cerebral palsy who, in addition, does not feel that her hands work. While she has normal sensory capacities in her hands, she has an impairment of perception: she cannot identify objects in her hands, nor does she use them to ‘explore’ her environment. She describes her hands as ‘lumps of putty.’
Sacks wonders if the problem is that she has been helped too much from birth, and so she has never needed to use her hands. Sacks decides that she must be ‘tricked’ into using her hands, automatically as it were. He suggests to the nurses that they not be so accommodating and place her food slightly out of reach. This worked — hungry, she succeeded in grasping and snagging a bagel. After this she progressed rapidly, initially with food and the recognition of ‘components’ of the item, but subsequently her recognition became more wholistic and within a month expanded to all sorts of objects including faces. After a while she began to mold faces in clay, and became famous as the blind sculptress of St. Benedicts.
The chapter concludes with a brief account of Simon K, another visually-impaired person with cerebral palsy. Given the success with Madeleine J, they decided to see whether Simon had a treatable “developmental agnosia.” They tried to get Simon K to use his hands, and succeeded, and within a year he was doing carpentry and other manual activities after five decades of no use of his hands.
Phantoms
- Phantom limbs are of all types: realistic, distorted, painful, painless. Phantom limbs can gets cramps and spasms; one patient even reported the phantom pain of an ingrown toenail that had not been taken care of before amputation. .
- Neurologists believe that no user of a prosthetic can use if effectively without a phantom analog of the limb.
- One patient described how he had to ‘wake up’ his phantom limb in the morning by slapping his stump a few times until the limb “suddenly shoots forth, rekindled, fulgurated, by the peripheral stimulus.” — ibid. p 79.
- Charles D suffered from a flickering delirium of sensory positional illusions — sometimes the floor seemed closer, then farther way, as well as pitching and tilting like a ship’s deck in a heavy sea. He could sometimes maintain his balance by looking at his feet, but this was not always effective
On the Level
This is the account of Mr. MacGregor, a man who walked at a 20-degree tilt without realizing it. In meeting with Sacks, Sacks videotaped him, and let him watch the tape, which amazed him. After that, MacGregor thought about his problem, and came up with an analogy to a ‘spirit level’ — he was a former carpenter. Sacks helped him understand that his internal spirit level had been knocked out by Parkinsons, and then MacGregor proposed a solution == having a small ‘spirit level’ that projected from his glasses to give him external information on his tilting. By watching this he was able to stay on the level — initially it was hard work, but over the course of a few weeks it came to be automatic.
A nice example of how involving patients can lead to innovative accommodations to their own problems.
Eyes Right!
Ms S. lost her left visual field. Not only could she not see things on the left, but as appears to be common in such cases, she was not aware that she was missing anything. She could not imagine anything to her left. She developed an ingenious compensation involving turning right, in a complete circle, when she could not see something that she knew ought to be present. A fascinating example is that she would eat the right half of her meal, and then when it was gone make a rightward rotation that would bring the remaining food into sight. She would eat the right half of that, and then would make another rightward rotation to find the remainder. “It’s absurd,’ she said, “I feel like Zeno’s arrow — I never get there.”
A similar problem involving putting makeup only on the right half of her face was less tractable: they gave her a ‘video mirror’ which did not show a mirror image so she could see the other side of her face. But she found it extremely upsetting because although she could now see the other side of her face, it was something that she did not feel existed.
The President’s Speech
A brief account of a bunch of aphasics watching a TV speech by Ronald Regan, who burst into laughter because – although they could not understand the words — the could tell from the expressions, the tones, the cadences, that it was ‘false.’
… reading break …
II: Excesses
Introduction
A very interesting introduction where Sacks critiques classical neurolgy which, he says, has focused only of deficits of thought and behavior. It was only as recently as Luria that attention began to be paid to excesses or exaggerations, as with The Mind of a Mnemonist. The generative aspects of mind, Sacks suggest, are as susceptible to excess or burgeoning as they are to deficit.
Growth can become over-growth, life “hyper-life.” All the “hyper” states can become monstrous, perverse aberra-tions, “para” states: hyperkinesia tends towards parakinesia – abnormal movements, chorea, tics; hypergnosia readily becomes paragnosia – perversions, apparitions, of the morbidly heightened senses; the ardors of “hyper” states can become violent passions.
The paradox of an illness which can present as wellness-as a wonderful feeling of health and well-being, and only later reveal its malignant potentials-is one of the chimaeras, tricks and ironies of nature.
ibid., p 104
and
In disorders of excess there may be a sort of collusion in which the self is more and more aligned and identified with its sickness, so that finally it seems to lose all independent existence and be nothing but a product of sickness.
—ibid., p. 106
Witty Ticcy Ray
Tourette’s syndrome was described in 1885, and Tourette’s paper was well received and was followed by extensive reporting of cases. But as the century turned, a split occurred between souless neurology and bodiless psychology, and reports of Tourette’s syndrome disappeared.
Sack’s observed ticcing in his ‘awakened’ patients, and, upon a comment on this to a NYT reporter led to the publication of a NYT article on it. [Was this article by Sacks?] This led to a flurry of letters, most of which Sacks passed on to colleagues, but one was from a patient he consented to see: Witty Ticcy Ray. The day after seeing Ray, Sacks noticed three Touretters on a walk down town, and began noticing a lot of people with tic-ish behaviors.
Sack’s comments on Tourette’s as a sort of pathological “missing link” between the body and mind.
Sack’s observes that Touretters, like Parkinsonians, can become temporarily free of their symptoms when they sing, dance or act. “Here, the ‘I’ vanquishes and completely reigns over the ‘It’.”
He goes on to describe Witty Ticcy Ray, who, though almost incapacitated by volleys of tics that come every few seconds, has managed through strength of character and intelligence to get through college, and develop a circle of friends and get married. He was also able to leverage his Tourette’s to become a locally famous jazz drummer and a superb ping pong players. When given drugs that controlled his Tourette’s he lost his abilities — or at least his edge. The only time he was free from tics was “when he swam, sang, or worked, evenly and rhythmically and found a ‘kinetic melody,’ a play which was tension-free, tic-free, and free. “
This is a case where Sacks was able to really help his patient. They spent three months verbally exploring his potentials and what he could do were he to be free of Tourette’s symptoms. After this, he went on Haldol during the week – the Haldol enabled him to perform in a responsible position at work, become an important member of his community, and to function as a father. But on the weekends he stopped it and reverted to his ticcy self.
Cupid’s Disease
A 90 year old woman came to Sacks. Shortly after her 88th birthday, she noticed a change: she became euphoric and began to flirt and giggle and tell jokes and feel “frisky.” She suggested that she had “Cupid’s disease,” another name for syphilis, that was manifesting as neurosyphilis 70 years later. However, she liked how she felt, and didn’t want to be ‘cured;’ on the other hand, she was concerned about how it would effect her if it continued progressing. They discussed this, and the resolution was to give her penicillin, which killed the microorganism and stopped progression, but it left her as she was.
Sack’s relates the story of another patient, who was neurosyphilitic. While they were waiting for the results of his spinal fluid test to come back, he was put on Haldol to calm him down. Sacks documents the differences in his drawings, and general mood, due to the euphoria of neurosyphilis versus the dopamine-reduction produced by Haldol.
A Matter of Identity
This is a case with a man who has difficulty with memory and recognizing people. But he fluently confabulates, attempting to create and re-create a narrative of what is happening to him. “He would whirl fluently from one guess, one hypothesis, one belief, to the next, without any appearance of uncertainty at any point – he never knew who I was, or what and where he was, an ex-grocer with severe Korsakof’s syndrome in a neurological institution.” (ibid., p. 128)
Although Mr. Thompson gives no sign that he knows something is wrong, “there is a tense, taut look on his face all the while, as a man under ceaseless inner pressure – and occasionally … a look of open, naked, pathetic bewilderment.” (ibid., p. 132)
[He is in] in an almost frenzied confabulatory delirium (of the sort sometimes called “Korsakov’s psychosis,” though it is not really a psychosis at all), continually creating a world and self to replace what was continually being forgotten and lost.
Such a frenzy may call forth quite brilliant powers of invention and fancy — a veritable confabulatory genius — for such a patient must literally make himself (and his world) up every moment. We have, each of us, a life-story, an inner narrative whose continuity, whose sense, is our lives. It might be said that each of us constructs and lives a “narrative,” and that this narrative is us, our identities.
ibid., p 130
Yes, Father-Sister
Mrs. B has undergone a rapid personality change, becoming funny, impulsive and superficial. Her friend said, ‘she doesn’t seem to care about anything at all.’ She refers to Sacks as doctor, Sister [nun], and Father [priest], depending on what particular aspect of his appearance (stethoscope, white ‘gown,’ beard. She knows the difference, but doesn’t see that it matters how she refers to him. Sacks refers to the as an “unsoiled” state, and writes:
The end point of such states is an unfathomable “silliness,” an abyss of superficiality, in which all is ungrounded and afloat and comes apart. Luria once spoke of the mind as reduced, in such states, to “mere Brownian movement.”
—ibid., p 140
The Possessed
This chapter is on super-Tourettes, where the syndrome is so severe that it may “disintegrate the personality and lead to a bizzsare, phantasmagoric, pantomimic, and often impersonatory form of ‘psychosis’ or frenzy.” Sacks observes that hospitals, clinics and asylums are very controlled environments and that a syndrome like Tourette’s, whose manifestations are influenced by the physical and social environment may manifest very differently elsewhere. He speaks of “street neurology,” and comments that James Parkinson was an inveterate walker and observer.
Sacks relates the example of a Tourette’s person who imitated fragments of behavior from every person she saw in a fraction of a second, producing a sort of convulsive sequence of caricatures. More generally, Sacks writes:
Lacking the normal protective barriers of inhibition, the normal organically determined boundaries of self, the Touretter’s ego is subject to a lifelong bombardment. He is beguiled, assailed, by impulses from within and without, impulses which are organic and convulsive but also personal (or rather pseudo-personal) and seductive. How will, how can, the ego survive this bombardment. Will identity survive? Can it develop in the face of such shattering, such pressures…
—ibid., 145-146
III: Transports
Introduction
This section discusses altered reminiscence (often meaning uncontrollable — forced or paroxysmal — eruptions of memory), altered perceptions, and/or imagination. There is often a “doubling” of perception, with a dreamy or imagined state existing simultaneously with normal experience. And sometimes the reminiscences are so vivid as to be difficult to distinguish from reality (e.g., as with music).
I think I’d tend to classify these “transports” as examples of “excess,” although Sacks seems to want to call it out as distinct.
The phenomena described in these accounts all have to do with strokes, seizures or other disruptions of temporal lobe function and the limbic system.
Reminiscence
Provides an account of Mrs. OC, an elderly somewhat deaf woman who dreamt vividly of her childhood in Ireland, and awoke hearing (very loud) Irish music that she recalled from her childhood. It was so realistic that she went around checking radios to see if they were the source; at some point, she realized that unlikelihood of a radio station that only played music she recognized.
Sacks (and she) suspected a stroke, and eventually an EEG confirmed that episodes of music were correlated with the sharp spikes of activity (seizures) in her temporal lobe. Over time the music faded, and Mrs OC reported she even had trouble remembering it; she professed to be glad it was over — the loudness and constant music was annoying and disruptive — but also to have a ] bit of regret about losing the songs that reminded her of her childhood. It turns out that Mrs. OC was orphaned, and previously had remembered nothing about her first five years of life in Ireland, before she was sent to live with a forbidding maiden Aunt who lived in America. She was happy that her stroke had left her with memories of a time that she had previously had no awareness of.
Later Sacks encountered another slightly deaf elderly woman, Mrs. O’M, who had begun hearing music (and distant voices). The music was not constant, but could be triggered either by hearing songs or by her thinking of them (or trying not to think of them). Her inner music was most vivid when she woke up, and then faded as the day went on, particularly when she was intellectually occupied with other things. As with Mrs. OC, an EEG showed temporal lobe seizures to be correlated with the episodes of music.
She found the songs very annoying and disruptive. It is the case that these are songs she used to hum unconsciously to herself. Sacks put Mrs. O’M on anticonvulsants, and the music ceased. Mrs. O’M did not miss the music at all.
Sacks, in his discussion of these cases, takes at face value Penfield’s assertion that the evoked memories represent veridical traces of experience. I am less sure. Then Sacks ventures into speculation — though speaking as though he is certain — about the implications of the existence of such traces for the mechanisms through which memory works. He suggests that the detailed nature of the memories shows that they can not be a product of schemata or algorithms — that seems wrong to me, and clearly contra-indicated by the detailed imagery, etc., that generative AI can now produce. He also talks about how experience and action is not possible unless it is organized iconically — I have no idea what he means by that (and I am not sure he does either).
Incontinent Nostalgia
This brief chapter revisits the idea of the forced reminiscence Sacks observed in many of his L-Dopa (Awakenings) patients. I am not sure of the point he is trying to make in this chapter.
A Passage to India
Here Sacks recounts the case of a young woman from India with a malignant tumor that was growing into her temporal lobe (or perhaps putting pressure on it). Although initially she had grand mal seizures, they soon became stranger: she would become dreamy, and had visions of landscapes, villages, homes, gardens from her childhood in India. These were different from temporal lobe seizures (where the visions tend to have a fixed format that is invariably repeated); her visions were ever-changing panoramas. This may have been due to steroid psychosis, though such psychoses are often excited and disorganized, unlike her visions. These visions became deeper and more continuous — though she continued to be normally conscious at the same time — until she died.
The Dog Beneath the Skin
Account of a medical student, Stephen D, who was high a lot on cocaine, PCP and amphetamines. He recounted dreaming he was a dog, in a world of intense smells, and then awakening with an enhanced sense of color and smell. “And with all this went a strange sort of trembling, eager emotion, and a strange nostalgia, as of a lost world, half-forgotten, half-recalled.” He claimed to be able to recognize individuals by their distinctive odors, as well as detecting their emotional states. Similarly, he claimed he could recognize streets and shops by their smells.
Maybe. But this chapter cries out for some verification. How does one distinguish between a genuine sensory enhancement, and the ability to make use of it, and an imagined state due to amphetamine psychosis?
Murder
Describes the case of a committed person who had murdered someone under the influence of PCP though he had no memory of it whatsoever. After years in a psychiatric hospital, he progressed to a point where he could leave on weekends, and while on leave we in a bicycle accident that produced massive head injuries. These injuries seem to have reawakened or disinhibited his memory of the murder, and he was horrified by the recall. What he recalled matched the details of the murder, which had never been publicized, so it seems likely his memory was veridical. Sacks suggested that the injury somehow resulted in his losing the ability to repress the memory. Moreover, he lost the characteristic impulsiveness, etc., of frontal lobe syndrome, and overtime, aided by psychiatry and anticonvulsants, became able to return to his ‘normal’ life in the psychiatric hospital.
The Visions of Hildegard
Not much here, particularly given the appendix on Hildegard that was part of the Migraine book.
IV: The World of the Simple
Introduction
Rebecca
A Walking Grove
The Twins
The Autist Artist
Annotated Bibliography
Views: 108