The Man Who Mistook His Wife for a Hat

May 16, 2011

Not all neurological conditions are deficits; some heighten their bearers' brain function in ways beyond our capacity to easily recognize.

But it must be said from the outset that a disease is never a mere loss or excess–that there is always a reaction, on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be. (6)

It is easy to understand how someone who loses his or her dominant hand may come to rely on, and in reliance augment, the use of the other. Or how someone stricken blind may develop a heightened sense of hearing to compensate. But what about a man who loses the ability to form memories, or a woman who loses the possibility of words meaning anything? It seems impossible to imagine the conditions themselves, let alone how the brain1 might seek to adjust. And yet, fascinatingly, it does. The Man Who Mistook his Wife for a Hat is full of stories like this, which illuminate both the tragedy and the virtuosity of which the human mind is capable.

A Matter of Identity

The most haunting case study is of a Mr. Thompson. When the Dr. Sacks enters the room, Mr. Thompson, who used to be a grocer, treats him as a customer, asking “What’ll it be today?” When the doctor reminds him that, no, this isn’t the deli counter, Mr. Thompson then identifies him as an old friend, and begins to recount the history of their friendship. When the doctor corrects him once more, Mr. Thompson replies, “of course you’re not my old friend Tom, look at your white coat!” and settles on the notion that he is the kosher butcher next door and that business must be bad because his coat is without bloodstains. This episode proceeds though a series of identities, assigned on-the-spot, and this happens every time Sacks sees him. Mr. Thompson, it turns out, cannot remember anything for more than a few seconds. Every moment of his life vanishes into oblivion almost as soon as it happens. And yet, that isn’t even the most tragic thing about his condition. Alas, the most tragic thing is how he must deal with it, poignantly rendered by Sacks. Mr. Thompson engages in a

frenzied confabulatory delirium…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…and this narrative is us, our identities… A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self. [But Mr. Thompson,] deprived of continuity, of a quiet, continuous inner narrative, he is driven to a sort of narrational frenzy–hence his ceaseless tales, his confabulations, his mythomania. Unable to maintain a genuine narrative or continuity, unable to maintain a genuine inner world, he is driven to the proliferation of pseudo narratives, in a pseudo continuity, pseudo-worlds peopled by pseudo-people, phantoms. (110-11)

Mythomania. It sounds Borgesian, or I think of Scheherazade in Arabian Nights, who remains alive only so long as she can continue telling stories.

The President’s Speech

Not all the cases are so gut-wrenching. Sacks has one about an evening when the orderlies turn on the television in the aphasiac’s ward while then-president Reagan is giving a speech. Aphasiacs suffer from damaged speech centers in the brain and are incapable of processing the words they hear. But despite their inability to understand words, Sacks notes that his aphasiacs are largely unhindered at understanding communication, since they are hyper-attuned to the gestures, cadences, and tones with which we imbue our speech. (How fascinating, that the literal meanings of words are only a small part of what we rely on to communicate.)

So the orderlies turn on the television, and before long the aphasiacs are cracking up with laughter at the president’s speech. And I found myself chucking as Sacks explains why:

In this, then, lies (the aphasiacs’) power of understanding–understanding, without words, what it authentic or inauthentic. Thus it was the grimaces, the histrionisms, the false gestures and, above all, the false tones and cadences of the voice, which rang false for these wordless but immensely sensitive patients. It was to these (for them) most glaring, even grotesque, incongruities and improprieties that my aphasiac patients responded, undeceived and undeceivable by words. This is why they laughed at the President’s speech. (82)

It’s as if those of us with normal language capacities get so taken in, so distracted by the carefully-chosen and symbolically-laden words of politicians that we’re blind to the bullshit permeating the non-verbal aspects of communication.

There are many other moving and memorable stories contained herein. One is of a woman with what Sacks dubs “super-Tourette’s,” whose disorder compels her to imitate everyone she passes on the street in gross caricatures (123). It is so bad that on busy streets, when it gets to be too much, she must duck into an alley and “play back” the mimicries that possess her before she can face more people. And yet, despite all this, she chooses to go out and carry on her life.

There is another case of a woman who is practically transported back in time, who recalls old memories with lifelike vividness:

I know you’re there, Dr. Sacks, I know I’m an old woman with a stroke in an old people’s home, but I feel I’m a child in Ireland again–I feel my mother’s arms, I see her, I hear her voice singing (137)

This prompts the question, what are these things, memories, in our heads? If the brain-damaged can recall with absolute clarity experiences from their pasts, are such experiences buried beneath the surface of us all?

And then there is the case of The Twins, Michael and John, whom Sacks encounters playing a game in which they take turns naming prime numbers of steadily-increasing orders of magnitude. (With Sacks around they go as high as 13 digits, and this is in 1966, when the only intelligences capable of calculating primes that large were room-sized computers.) When a box of matchsticks spills out all over the floor, the twins immediately shout in unison: “111! 37! 37! 37!” (37 x 3 = 111). And yet when tested they struggled with addition and subtraction, and as far as doctors could tell has no concept of multiplication or division! They just somehow see the numbers.

Early and often in the book, Sacks makes the point in the epigraph above, that neurological conditions are never merely deficits. Some people affected may lose functionality but compensate in other areas, while many conditions involve excess functionality, super-functionality which we assume is a deficiency because we can’t understand it.

  1. Sacks, a brilliant scientist no doubt, slips between the use of “brain”, “mind”, and “soul” with a nonchalance that surprised me at first. But this is soon revealed as a professional necessity–that the neurological conditions within these pages aren’t amenable to a purely biological or psychological understanding.