The Man Who Mistook His Wife for a Hat

The Man Who Mistook His Wife for a Hat and Other Clinical Tales (1973) is British neurologist Dr. Oliver Sacks’s fourth book. Sacks is a renowned physician, professor, and writer whom the New York Times calls “the poet laureate of medicine.” Sacks is best known for his 1973 memoir Awakenings, in which he explores the history of the encephalitis lethargica epidemic. In 1990, the story was adapted into a critically acclaimed movie starring Robin Williams as Sacks and Robert De Niro as his patient. As a writer, Sacks displays incredible knowledge of neurology, the history of the field, and the medical theories and practices of neurologists. In his numerous case histories and memoirs, Sacks seeks to make complex material accessible through the use of storytelling, attention to the human beings he studies, and probing existential questions about what it is to be a human.

Although the book is written using complex neurological terminology, it is designed to be overall accessible. Especially in the cases where Sacks does not have easy answers, he raises philosophical questions about what it means to be a whole human being. Sacks often quotes philosophers like Ludwig Wittgenstein and Friedrich Nietzsche. He also refers to the works of fiction writers like Jorge Luis Borges to help readers understand how a neurological condition might affect a person’s lived experience. This makes the book applicable and engaging, asking readers to imagine alternate states of being and question how their own brains work, what they are for, and how those functions help make any person “whole.”

Content Warning: This book was published in 1985 and does not reflect respectful, inclusive language when discussing people with disabilities. The author uses outdated, offensive terms for people with intellectual disabilities throughout, which may be replicated in this study guide only in direct quotes of the source material.

Summary

In the Preface to The Man Who Mistook His Wife for a Hat, Sacks pinpoints the core of his work: “Neurology’s favorite word is ‘deficit’” (5). Most neurological studies are conducted on the left hemisphere of the brain because that is the area that processes language and schema. However, injuries to the right hemisphere are just as common, though they often present as more “bizarre.” In this collection, Sacks relays 24 stories of his patients who experienced unusual brain injuries or neurological conditions. Sacks groups his stories into four parts: “Losses,” “Excesses,” “Transports,” and “The World of the Simple.” Sacks structures each case history as individual chapters to convey his patients’ unique qualities and stories, thus making them fully human to the reader. Sacks compares neurological patients to archetypal figures in classical fables, explaining that he alludes to both case studies and literary tales throughout the book to emphasize the fantastical nature of his patients’ experiences.

Sacks frequently refers to his colleague and predecessor, A. R. Luria, a Russian neuropsychologist whose theories about neurology emerged from treating patients during the Russian Civil War. Luria influenced Sacks’s medical understanding of neurology and taught that a patient is more than just a mind. Luria empathetically viewed patients as a spirit—one with an imagination, sense of morality, and desire for human connection and relationships. Sacks adopts Luria’s “romantic” approach to neurology and views his case studies at what he calls an “intersection of fact and fable” (v). It is at this intersection that Sacks considers the way brain damage and other neurological conditions interfere with his patients’ “souls.” As a neurologist, he seeks ways to help patients rehabilitate all parts of themselves.

In Part 1, “Losses,” Sacks explores both clear and complex cases. At times, the “strange” problems patients experience are easy to diagnose, and patients sometimes find solutions to compensate for their losses. In Chapter 3, Christina loses her sense of proprioception—the sense of the position and use of one’s own body. She eventually learns to rely on her eyes and ears to tell her where things are and how to interact with them. In Chapter 7, Mr. MacGregor loses his ability to walk straight until he attaches a leveler to his glasses, which allows him to hold his posture erect. Other stories present more complex challenges for which Sacks cannot find causes or cures. Sacks cannot determine what caused Jimmie G., “The Lost Mariner,” to develop retrograde amnesia, or Korsakoff’s syndrome. The syndrome prevents Jimmie G. from developing new memories, and Sacks is unable to find a cure. The same is true for the titular case in Chapter 1, in which a patient has developed visual agnosia, or “face blindness.” In Chapter 4, Sacks treats a young man who thought his leg wasn’t his and tried to push it out of bed. The man fell along with the “fake” leg. There are some neurological conditions for which Sacks does not have an easy explanation.

In Part 2, “Excesses,” Sacks likewise encounters patients whose neurological symptoms confound him. In Chapter 12, Mr. Thompson cannot remember his past or recognize anyone in his environment. To compensate for his knowledge gaps, he concocts wild stories about who he is and who everyone around him might be. In Chapter 13, a woman develops the “joking disease” (61) and cannot take anything seriously. In Chapter 14, Sacks sees an elderly woman on the street who demonstrates “super-Tourette’s” (62). Her condition makes it impossible for her to find her own center. Still, in these intractable cases, Sacks attempts to help patients learn to live as fully as possible with their conditions, finding alternative ways to help them work, relate to others, and restore their souls.

In Part 3, “Transports,” Sacks discusses the case of ordinary people who experience temporary neurological problems brought on by stroke or seizure. These are stories of patients who return to “normal” with time and care, and sometimes the episode can have a positive effect. The individuals in Chapters 16 and 17 recall unbidden memories and sensations from their past, allowing them to process previously forgotten experiences. The epileptic seizures of Fyodor Dostoyevsky and Saint Hildegard give them rapturous spiritual visions.

In Part 4, “The World of the Simple,” Sacks relates cases of permanent intellectual conditions since birth or early childhood. When the brain is unable to perform certain tasks, it sometimes compensates or develops other abilities that are almost extraordinary. Rebecca in Chapter 21 seems “clumsy” in her movements, but she can compose herself gracefully when listening to music or performing a narrative drama. Martin in Chapter 22 has detailed recall of material he read or saw years earlier. The twins in Chapter 23 have a mysterious ability to understand numbers, though they cannot do basic math. José in Chapter 24 cannot communicate with words but expresses himself through drawing.

Through relating these stories, Sacks advocates for use of what Luria calls “romantic science,” a holistic approach to neurology that focuses on the entire person: body, mind, and soul. This approach uses the terminology of poetry and painting as much as medical jargon and seeks to understand a patient’s subjective world in addition to their technical brain function. As a neurologist, Sacks recognizes the often-hidden value of what otherwise might be considered “malfunctions,” reframing them as differences that may bring compensational and unusual gifts.