A man who mistook his wife for a hat. Oliver Sachs. The Man Who Mistook His Wife for a Hat and Other Medical Stories
Oliver Wolf Sachs
The Man Who Mistook His Wife for a Hat and Other Medical Stories
From translators
We would like to express our deep gratitude to all those who helped in the preparation of this book, in particular to Alexei Altaev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeny Chislenko, and Elena Kalyuzhny. Translation editor Natalya Silantieva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been impossible at all.
Science editor's preface
When I received an offer to edit the translation of the famous neurologist, psychologist and writer Oliver Sacks' book The Man Who Mistook His Wife for a Hat, I accepted without a second's thought. This book, a gift from an American colleague, has been on the shelf of my closet for fifteen years next to the works of A. R. Luria. I have returned to it many times over the years. When teaching a course in neuropsychology, it is simply impossible not to quote Sachs. But The Man Who Mistook His Wife for a Hat is much more than a special monograph or manual for teachers and doctors.
Oliver Sachs is one of the most famous names in his field in the West. And his popularity goes far beyond the narrow professional environment.
He was born and educated in London and continued in the USA. Since 1970, his books - "Migraine", "Awakenings", "A Leg to Stand" - have been gaining readers. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs. It cannot be said that Saks is not known at all in Russia. Several of his essays entitled "Case Studies" were published in the journal "Foreign Literature". Russian authors refer to his works - both neuropsychologists and writers (for example, Tatyana Tolstaya). But the real acquaintance with the work of Oliver Sachs is yet to come for the Russian reader. How to determine the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a rather narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of the material in a textbook and monograph. What matters is not what Oliver Sacks writes about, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome "tourette"?), nor an abundance of special terms, nor a list of chemicals, the existence of which most simply do not know.
Is it possible to imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, intensity of passions. And her hero should be a man, not his illness. This is precisely the most important feature of Sax's work. And it is not surprising that his book The Awakenings became the basis for the play by Harold Pinter, and was later filmed. It is absolutely difficult to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with this book. The opera was written by Michael Nyman, a popular contemporary composer, the author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. The music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise in the street, catches in it a certain symphony. Music makes up the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. The music transforms the clumsy, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force organizing the life of Professor P., who "has his own melody for every action."
It seems that every reader can find something different in the book. Someone will be interested in the "Kunstkamera" - amazing neuropsychological stories. For another reader, the book of Oliver Sachs is a small tragedy, where in the foreground is not illness, ugliness, but the experience, fate, the tension of a person's struggle with the disease. Tragic is the misunderstanding of one's position, even more tragic is awareness - for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, it is an attempt to comprehend the human soul: a fracture reveals the hidden. Where can one find a reader as universal as the author?
I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, marveling at the persistence of the author, who, defending the main thesis, each time discovers something new. For us. But above all, for yourself.
It is amazing that Oliver Sacks, a man of vast clinical experience, manages to retain his ability to be surprised. Each of his descriptions is imbued with this feeling.
In Oliver Sachs's book, the reader will find a certain duality. The author is a doctor, and he has all the stereotypes of traditional clinical thinking. He dreams of understanding the human soul through the physiology of brain structures. He believes in miraculous substances that "wake up" patients. He has the optimism of a scientist who professes the principles of positive science. The brain is seen by him as a magnificent machine, extremely complex and well-coordinated. A machine whose failures are as extraordinary as its normal operation. However, a person begins to think about the structure of the mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, enters into an argument with the traditional thinking of the physician. He speaks not only about brain structures and neurotransmitters.
He talks about archetypes, symbols, myths. He speaks emotionally, excitedly. It is clear to the reader which side is winning. Romantic worldview triumphs. It is no coincidence that A. R. Luria dreamed of a romantic neuroscience, and Sachs picks up this idea. The heterogeneity of the material of the book, the variety of problems raised in it requires a synthesis. This synthesis is almost impossible on an intellectual level. And this is where passion comes in.
The book also covers philosophical questions. What is the nature of the disease as such? What is health? What does mental illness do? Does it always take away – or does it sometimes bring something new and even positive into the human soul? The very structure of the book answers this question. Its main sections are called "Losses" and "Excesses". But even in the Loss section, Sachs agrees that, at some level, illness can enhance the creative potential of the individual. Professor P., losing the ability to visual perception, moves from realism in painting to cubist and abstract canvases. And although in the end the artistic abilities of the hero come to naught, but “halfway through” he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient - a man who has lost his memory, Oliver Sacks sees a creative beginning.
To a psychiatrist who is accustomed to dividing symptoms into "productive" and "negative" ones, adding and taking away, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, and at there is a patient, then, therefore, we are talking about production, albeit pathological. And again, if the consciousness is deeply clouded, then we are talking about loss. But if bizarre images invade consciousness, filling the inner space along with the impressions of the real world, then we are talking about qualitative, productive disorders. However, Sacks' understanding of loss and surplus is more complex and, in my opinion, closer to the truth.
Yes, full, is there an excess? If it happens, it is only as a result of the lack of some other factor that upsets the balance. The easiest way to illustrate this thesis is by the example of a complete loss of the ability to memorize (Korsakov's syndrome). Confabulations (fictions, fantasies), as a rule, occurring with memory loss, are a productive symptom. But after all, confabulations only fill a huge lack - the emptiness formed in the psyche of a person who is not able to save true impressions in his memory. Yes, crazy ideas are products. But Freud once showed that the delusional worldview of the paranoid is just a flawed attempt to recreate some semblance of harmony in the place of the psyche destroyed by the disease. Any disease includes not only changes, but also reactions to these changes: on the part of the brain structures - on the physiological level, on the part of the patient's psyche - on the psychological level, and also on the part of relatives and society ...
Current page: 1 (total book has 19 pages) [accessible reading excerpt: 5 pages]
Oliver Wolf Sachs
From translators
We would like to express our deep gratitude to all those who helped in the preparation of this book, in particular to Alexei Altaev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeny Chislenko, and Elena Kalyuzhny. Translation editor Natalya Silantieva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been impossible at all.
Science editor's preface
When I received an offer to edit the translation of the famous neurologist, psychologist and writer Oliver Sacks' book The Man Who Mistook His Wife for a Hat, I accepted without a second's thought. This book, a gift from an American colleague, has been on the shelf of my closet for fifteen years next to the works of A. R. Luria. I have returned to it many times over the years. When teaching a course in neuropsychology, it is simply impossible not to quote Sachs. But The Man Who Mistook His Wife for a Hat is much more than a special monograph or manual for teachers and doctors.
Oliver Sachs is one of the most famous names in his field in the West. And his popularity goes far beyond the narrow professional environment.
He was born and educated in London and continued in the USA. Since 1970, his books - "Migraine", "Awakenings", "A Leg to Stand" - have been gaining readers. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs. It cannot be said that Saks is not known at all in Russia. Several of his essays entitled "Case Studies" were published in the journal "Foreign Literature". Russian authors refer to his works - both neuropsychologists and writers (for example, Tatyana Tolstaya). But the real acquaintance with the work of Oliver Sachs is yet to come for the Russian reader. How to determine the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a rather narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of the material in a textbook and monograph. What matters is not what Oliver Sacks writes about, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome "tourette"?), nor an abundance of special terms, nor a list of chemicals, the existence of which most simply do not know.
Is it possible to imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, intensity of passions. And her hero should be a man, not his illness. This is precisely the most important feature of Sax's work. And it is not surprising that his book The Awakenings became the basis for the play by Harold Pinter, and was later filmed. It is absolutely difficult to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with this book. The opera was written by Michael Nyman, a popular contemporary composer, the author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. The music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise in the street, catches in it a certain symphony. Music makes up the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. The music transforms the clumsy, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force organizing the life of Professor P., who "has his own melody for every action."
It seems that every reader can find something different in the book. Someone will be interested in the "Kunstkamera" - amazing neuropsychological stories. For another reader, the book of Oliver Sachs is a small tragedy, where in the foreground is not illness, ugliness, but the experience, fate, the tension of a person's struggle with the disease. Tragic is the misunderstanding of one's position, even more tragic is awareness - for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, it is an attempt to comprehend the human soul: a fracture reveals the hidden. Where can one find a reader as universal as the author?
I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, marveling at the persistence of the author, who, defending the main thesis, each time discovers something new. For us. But above all, for yourself.
It is amazing that Oliver Sacks, a man of vast clinical experience, manages to retain his ability to be surprised. Each of his descriptions is imbued with this feeling.
In Oliver Sachs's book, the reader will find a certain duality. The author is a doctor, and he has all the stereotypes of traditional clinical thinking. He dreams of understanding the human soul through the physiology of brain structures. He believes in miraculous substances that "wake up" patients. He has the optimism of a scientist who professes the principles of positive science. The brain is seen by him as a magnificent machine, extremely complex and well-coordinated. A machine whose failures are as extraordinary as its normal operation. However, a person begins to think about the structure of the mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, enters into an argument with the traditional thinking of the physician. He speaks not only about brain structures and neurotransmitters.
He talks about archetypes, symbols, myths. He speaks emotionally, excitedly. It is clear to the reader which side is winning. Romantic worldview triumphs. It is no coincidence that A. R. Luria dreamed of a romantic neuroscience, and Sachs picks up this idea. The heterogeneity of the material of the book, the variety of problems raised in it requires a synthesis. This synthesis is almost impossible on an intellectual level. And this is where passion comes in.
The book also covers philosophical questions. What is the nature of the disease as such? What is health? What does mental illness do? Does it always take away – or does it sometimes bring something new and even positive into the human soul? The very structure of the book answers this question. Its main sections are called "Losses" and "Excesses". But even in the Loss section, Sachs agrees that, at some level, illness can enhance the creative potential of the individual. Professor P., losing the ability to visual perception, moves from realism in painting to cubist and abstract canvases. And although in the end the artistic abilities of the hero come to naught, but “halfway through” he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient - a man who has lost his memory, Oliver Sacks sees a creative beginning.
To a psychiatrist who is accustomed to dividing symptoms into "productive" and "negative" ones, adding and taking away, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, and at there is a patient, then, therefore, we are talking about production, albeit pathological. And again, if the consciousness is deeply clouded, then we are talking about loss. But if bizarre images invade consciousness, filling the inner space along with the impressions of the real world, then we are talking about qualitative, productive disorders. However, Sacks' understanding of loss and surplus is more complex and, in my opinion, closer to the truth.
Yes, full, is there an excess? If it happens, it is only as a result of the lack of some other factor that upsets the balance. The easiest way to illustrate this thesis is by the example of a complete loss of the ability to memorize (Korsakov's syndrome). Confabulations (fictions, fantasies), as a rule, occurring with memory loss, are a productive symptom. But after all, confabulations only fill a huge lack - the emptiness formed in the psyche of a person who is not able to save true impressions in his memory. Yes, crazy ideas are products. But Freud once showed that the delusional worldview of the paranoid is just a flawed attempt to recreate some semblance of harmony in the place of the psyche destroyed by the disease. Any disease includes not only changes, but also reactions to these changes: on the part of the brain structures - on the physiological level, on the part of the patient's psyche - on the psychological level, and also on the part of relatives and society ...
We see how the patient learns to use nervous tics in order to individualize the manner of playing percussion instruments. And the improvement in his condition deprives his game of a unique brilliance. The patient can not only compensate or overcompensate pathological symptoms - he can utilize them, can productively integrate them into his "I".
According to Freud, awareness brings healing. In Sacks' patients, due to the grossly organic nature of the disease, full awareness is impossible. Temporary awareness is tragic. The “lost sailor”, who has lost his memory and lives in the past, considers himself a nineteen-year-old youth. Sachs shows him his face in the mirror: the patient is able to see the face of a gray-haired person and understand that this person is him. The patient's emotional reaction to a startling discovery is terrible. But interrupting the rhythm stops the tragedy. The doctor exits and re-enters. The patient forgot both the doctor and the traumatic experiment that had just been performed.
By reading Oliver Sachs, the specialist will recognize the signs of diseases that he has encountered in his practice or that he has only read about. Memory prompts tricky, mostly Greek names of symptoms and syndromes. Professor P. doesn't recognize people's faces? Yes, this is prosopagnosia, the inability to recognize faces, a symptom of damage to the occipital lobes. Not oriented in space on the left hand, ignoring the left side? Optical-spatial agnosia. Again, the occipital lobes. Can't recognize the glove? subject agnosia. Unaware of your illness? Anosognosia, more often occurs with damage to the right, subdominant hemisphere ... By the way, P. has higher reflexes when examined from the left side. But the fact that P. could not distinguish the hat from the head by touch ... Or the fact that he did not recognize the glove, even taking it in his hands ... It seems that the parietal lobes, their lower sections, are affected. Looks like we're starting to figure out what's going on.
However, by reasoning like this, we deceive ourselves. For ordinary medical thinking, naming is equivalent to understanding. Determine the symptom, group the symptoms into a syndrome, correlate it with a certain brain localization. Consider a treatment program. Well, for practical purposes, this is enough. But naming and understanding are two different things. We fall into the trap of terms. Moreover, we specialists take pleasure in pronouncing these unusual words, related to magic spells. Sachs also seems to be sorting through them - apraxia, agnosia, ataxia ... But let's translate these terms into Russian. The person does not recognize faces. We say he has prosopagnosia. Translated from Greek - the inability to recognize faces. The man says: I can't be in open, crowded spaces, I'm afraid. We say he has agoraphobia. Translated from Greek - fear of open crowded spaces. In other words, we simply return what we learned about the patient, but in a language that is incomprehensible to the uninitiated ... Most doctors, turning information about the patient into bricks of scientific terms, sort of build a wall between themselves and the patient - and consider their creation. Behind this wall is a living person, a unique personality. The scientist needs to make a considerable effort in order to break through the barrier that he himself has built. This is what Oliver Sachs does.
Psychiatry prefers to study pathology "with kings and poets." The more complex and beautiful the building, the more majestic and attractive the ruins. The most famous patients of psychoanalysis, for example, were exceptional personalities. Anna O. (pseudonym of Bertha Poppenheim), the first patient of J. Breuer and 3. Freud, later became famous as a pioneer of social work in Germany. She was called the "healer of mankind." The symptoms of this woman's illness were also unique and exceptional.
The patients of A. R. Luria were also unusual: one had an unprecedented will to live and courage, the other had a phenomenal memory. The same goes for Oliver Sacks' patients. On the pages of his book, exclusivity and everyday life meet. The music professor P. and the “ticky wit” are wonderfully gifted individuals. And the manifestations of their diseases look much more interesting, more complicated. There are more lessons to be learned from these stories, and they invite genuine philosophical reflection.
But the tragedies of ordinary people are no less impressive. We see a personality both in patients who have lost their memory and in "simpletons" - people with profound intellectual disabilities. How can we understand such patients who do not know how to understand themselves? Here's an autistic artist who can't speak a word - and who has made painting the only way to communicate with the world. Here are two twins with phenomenal numerical abilities. But here, too, Sachs is interested not so much in the “trainedness” of the twins (he even uses an old clinical term, far from politically correct, “scientific idiots”), but in the tragedy of these people, who were separated by doctors to “improve their social adaptation”.
In my opinion, to show the reader the way to himself through understanding the altered (but indestructible) personality of the patient is the main mission of Oliver Sacks.
Boris Khersonsky.
Author's preface to the Russian edition
It is impossible to write a preface to the Russian edition of this book without paying tribute to the man whose work was the main source of inspiration for its creation. This, of course, is about Alexander Romanovich Luria, an outstanding Russian scientist, the founder of neuropsychology. Although we never met in person, I had a lengthy correspondence with him that began in 1973 and lasted four years until his death in 1977. Luria's great systematic works - "Higher Cortical Functions of Man", "The Human Brain and Mental Processes" and others - were my reference books in my student years, but his work "A Little Book on Great Memory (Mind of a Mnemonist)" was a real revelation for me, published in English in 1968. Luria describes in it his thirty years of observation of a uniquely gifted, but in a certain sense flawed and suffering person, with whom he struck up a personal friendship. Deep scientific studies of memory, imaginative thinking and other cerebral functions side by side in this book with a vivid description of the personality and fate of the mnemonist, with a subtle empathy for his inner life. Luria himself called this combination of human contact and neuropsychology "romantic science", and later he brilliantly demonstrated this approach again in the book The Lost and Regained World. If Luria had lived longer, he would have written another similar work, as planned, a study of a patient with profound amnesia.
These two books played an important role in my life: working with patients and describing their fates and diseases, under the influence of Luriev's ideas, I gradually came to my own romantic science. That is why my book Awakenings, written in 1973, is dedicated to Luria. The present book is also closely related to him, especially the story of The Lost Sailor, where his letters are quoted - I think Luria himself could write such a study, although he would probably devote a separate book to the hero of this story, Jimmy.
I am very glad that The Man Who Mistook His Wife for a Hat is finally being released in Russian. I hope that by reading the stories of my patients, the reader will see that neurology is not just an impersonal science, relying mainly on technology, that it has a deeply human, dramatic and spiritual potential.
Oliver Sacks
New York, October 2003
The Man Who Mistook His Wife for a Hat and Other Medical Stories
Dr. Leonard Shengold
Talking about illness is like telling the stories of the Thousand and One Nights.
William Osler
Unlike the naturalist, the doctor deals with a single organism, a human subject struggling for self-preservation in a threatening situation.
Ivy Mackenzie
Foreword
“Only when you finish a book,” Pascal remarks somewhere, “you usually understand where to start.” So, I wrote, collected and edited these strange stories, chose a title and two epigraphs, and now I need to understand what was done - and why.
First of all, let's look at the epigraphs. There is a certain contrast between them - just what Ivy Mackenzie emphasizes, opposing the doctor and the naturalist. This contrast corresponds to the dual nature of my own character: I feel myself to be both a doctor and a naturalist, diseases occupy me as much as people do. Being equally (and to the best of my ability) theorist and storyteller, scientist and romantic, I simultaneously explore and personality, and organism and I clearly see both of these beginnings in the complex picture of the conditions of human existence, one of the central elements of which is disease. Animals also suffer from various disorders, but only in humans can a disease turn into a way of being.
My life and work is dedicated to the sick, and I owe some key thoughts to close association with them. Together with Nietzsche, I ask: “As for the disease, I would like to know if we can do without it?” This is a fundamental question; working with patients forces me to ask it all the time, and in trying to find the answer, I again and again return to the patients. In the stories offered to the reader, there is always this continuous movement, this circle.
Research - understandable; but why stories, stories? Hippocrates introduced the idea of the development of a disease in time - from the first symptoms to a climax and crisis, and then to a successful or fatal outcome. Thus was born the genre of the history of the disease - a description of its natural course. Such descriptions fit well with the meaning of the old word "pathology" and are quite appropriate as a kind of natural science, but they have one serious drawback: they do not tell anything about a person and his stories about the inner experience of a person faced with a disease and struggling for survival.
There is no subject in the narrowly defined case history. Modern anamnesis mentions a person only briefly, in a service phrase (albino trisomic, female, 21 years old), which could just as well refer to a rat. In order to address a person and place the suffering, straining human being in the center of attention, it is necessary to take the history of the disease to a deeper level, giving it a dramatic-narrative form. Only in this case, against the background of natural processes, a subject will appear - a real person in a confrontation with an ailment; only in this way can we see the individual and the spiritual in relation to the physical.
The life and feelings of the patient are directly related to the deepest problems of neurology and psychology, because where the personality is involved, the study of illness is inseparable from the study of personality and character. Some disorders and methods of their analysis, generally speaking, require the creation of a special scientific discipline, "personality neurology", whose task should be to study the physiological foundations of the human "I", the ancient problem of the connection between the brain and consciousness.
Perhaps between mental and physical Indeed, there is a conceptual and logical gap, but studies and plots devoted to both the organism and the personality are able to bring these areas together, bring us to the point of intersection of the mechanical process and life, and thus clarify the connection between physiology and biography. This approach especially interests me, and in this book I generally adhere to it.
The tradition of clinical stories centered around man and his destiny flourished in the nineteenth century, but later, with the development of impersonal neurology, began to fade away. A. R. Luria 1
A.R. Luria (1902-1977) - Russian neurologist, founder of neuropsychology. ( Hereinafter, except where otherwise noted, the notes of the translators).
Wrote: “The ability to describe, so widespread among the great neurologists and psychiatrists of the 19th century, has now almost disappeared. It needs to be restored." In his later works, such as A Little Book of Great Memory (Mind of a Mnemonist) and A World Lost and Regained, he attempts to revive this lost form. The stories of clinical practice that emerged from Luria's pen are connected with the past, with the traditions of the nineteenth century, with the descriptions of Hippocrates, the first medical historian, with the old custom of patients telling doctors about themselves and their illnesses.
Classical narrative plots revolve around archetype characters – heroes, victims, martyrs, warriors. The patients of the neurologist embody all these characters, but in the strange stories told below, they appear as something more. Are the images of the “lost sailor” and other amazing characters in this book reduced to familiar myths and metaphors? They can be called wanderers - but in unimaginably distant lands, in places that without them it would be difficult to even imagine. I see in their wanderings a reflection of a miracle and a fairy tale, and that is why I chose Osler's metaphor - the image of "A Thousand and One Nights" as one of the epigraphs. There is an element of parable and adventure in the case histories of my patients. The scientific and the romantic merge here into one - Luria liked to talk about "romantic science" - and in each of the cases described (as in my previous book Awakenings), in each fate we find ourselves at the crossroads of fact and myth.
But what amazing facts! What exciting myths! With what to compare them? We do not seem to have models or metaphors to make sense of such cases. Looks like it's time for new symbols and new myths.
Eight chapters of this book have already been published: "The Lost Sailor", "Hands", "Gemini" and "Autistic Artist" - in the New York Book Review (1984 and 1985), "Teak Wit", "The Man Who Accepted Wife for a Hat" and "Reminiscence" (in an abbreviated version called "Ear of Music") in the London Book Review (1981,1983 and 1984), and "The Eye of the Spirit Level" in The Sciences (1985) . The chapter "Nostalgia Influx" (originally published in the spring of 1970 in The Lancet under the title "L-dopa and nostalgic states") contains a long-written account of the patient who later became the prototype for Rose R. from Awakenings and Deborah from Harold's play Pinter's Something Like Alaska. Of the four fragments collected in the Phantoms chapter, the first two were published in the Clinical Cabinet of Curiosities section of the British Medical Journal (1984). Two more short stories are taken from my previous books: "The Man Who Fell Out of Bed" from "A Leg to Stand" and "Visions of Hildegard" from "Migraine". The remaining twelve chapters are published for the first time; they were all written in the autumn and winter of 1984.
I would like to express my deep gratitude to my editors, first of all to Robert Silvers of the New York Book Review and Mary-Kay Wilmers of the London Book Review; Keith Edgar and Jim Silberman of New York's Summit Books, and finally Colin Haycraft of London's Duckworth. Together, they were invaluable in helping shape the book into its final form.
I would also like to express my special gratitude to my neurologist colleagues:
– to the late James P. Martin, to whom I showed the videos of Christina and Mr. McGregor. The chapters "Disembodied Christie" and "Eye-Waterlevel" were born in the course of detailed discussions of these patients;
“To Michael Kremer, my former head physician from London. After reading my book A Leg to Stand (1984), he related a very similar case from his own practice, and I included it in the chapter "The Man Who Fell Out of Bed";
—To Donald Macrae, who observed an amazing case of visual agnosia similar to that of Professor P. I accidentally discovered his report two years after the publication of my story. Extracts from his article are included in a postscript to the story of "the man who mistook his wife for a hat";
– Isabella Rapin, colleague and close friend from New York. I discussed many of my cases with her; she asked me to look at the "disembodied" Christina and for many years, since his childhood, she observed José, an autistic artist.
I am eternally grateful to all the patients (and sometimes their loved ones) whose stories are told in the pages of this book. I thank them for their disinterested help and generosity, I thank them for the fact that, even knowing that my scientific interest would not help them in any way, they encouraged me and allowed me to describe what happened to them, hoping to help others understand and, perhaps, learn to cure diseases, from whom they suffer. As in The Awakenings, in the interest of medical secrecy, I changed the names and some of the circumstances, but in each case I tried to keep the basic feeling.
Finally, I want to express my gratitude - more than thanks - to Leonard Shengold, my teacher and physician, to whom this book is dedicated.
Oliver Sacks
Reviews (31)
Evgeny Kazachkov
I strongly recommend to everyone the amazing (this is not just a grandiloquent word) book by Oliver Sacks "The Man Who Mistook His Wife for a Hat". A collection of documentary stories from the practice of the author - a neurologist. Sachs considers all cases in depth, breadth and height, thereby creating a new understanding of the psyche, consciousness, soul, if you like, as well as the thin watersheds between them. This is a truly fascinating, informative and, in a sense, uplifting read. Each chapter is a story about how a person copes with mental illness. Or it doesn't work. Or adapt to the disease. Or enjoy it. Or it is used by it for its own purposes and makes it a trait of character (although sometimes the character itself becomes just a trait of the disease). And sometimes treatment and "social adaptation" are only to the detriment and destroy the remnants of the personality ... The last section is devoted to how the only ability that the disease leaves a person sometimes allows the human Self to "stay afloat" and not feel spiritually flawed .
The book is largely philosophical and simply artistically valuable, not medical and not even just "humanistic" topics constantly pop up. Sachs, as a researcher, cannot turn a blind eye to them when he encounters, for example, autistic adults who contemplate sixth and seventh order prime numbers, communicate with them, and enjoy them like musical harmonies.
People looking for inspiration and new topics: Harold Pinter wrote plays based on Sachs, Peter Brook staged something, a movie was made with De Niro in the title role. So be aware. This is a powerful source.
Renowned neuropsychologist Oliver Sacks describes interesting cases from his clinical practice. The book "The Man Who Mistook His Wife for a Hat" is primarily of scientific interest, but in the United States for seventeen years it has gone through five editions, which would not happen with an ordinary scientific monograph. The fact is that this book is not only accessible to a wide range of readers - it is extremely exciting.
“There is no subject in the narrowly defined case history,” Sachs writes. - Modern anamnesis mentions a person only briefly, in a service phrase (albino trisomic, female, 21 years old), which could just as well refer to a rat. In order to appeal to a person and place the suffering, straining human being in the center of attention, it is necessary to take the history of the disease to a deeper level, giving it a dramatic-narrative form.
The very title of the book suggests that we are not dealing with dry medical research, but with living literature. Possessing a great talent for storytelling, Oliver Sachs describes the strange world of neurological patients, reveals the personal drama of each of his patients. Here is a young man who is trying to kick his own leg out of bed. Here is a blind woman who, at the age of sixty, first learned to use her hands. In the description of stories, we feel the professional interest of a physician and, to no lesser extent, the surprise and participation of an ordinary person. An in-depth approach to illness prompts Sachs to refer not only to neurological sources, but also to the judgments of philosophers, psychologists, artists and poets. A follower of the Russian neuropsychologist A. R. Luria, Oliver Sachs shares his ideas about the “romantic science”, in which deep scientific research is combined with the study of the life and feelings of patients, “because where the personality is affected, the study of the disease is inseparable from the study of individuality and character” .
Scientific objectivity, soft irony of language and deep philosophical overtones attract to the book all those who are interested in the quirks and distortions in the work of the human brain.
EugeneAzarenko
The book by Oliver Sachs, the famous American neuropsychologist, rightfully became a bestseller and received many positive reviews both in the professional environment and from ordinary readers. Being a manifesto of a new - humanistic - attitude towards patients, the book invites us to consider the problem of mentally ill people in a different way, to see it not from the point of view of science, but from the point of view of morality and ethics. The chosen material itself also helps in this: a description of particularly interesting cases of the author's medical practice. The severity of the disease and the struggle of patients with it turns the book into a set of parables designed to bring an emotional aspect to reading, to enhance the process of empathy and empathy. In part, he himself mentions this
“There is an element of parable and adventure in the case histories of my patients. The scientific and the romantic merge here into one... and in each of the cases described, in each fate, we find ourselves at the crossroads of fact and myth. But what amazing facts! What exciting myths! With what to compare them? We do not seem to have models or metaphors to make sense of such cases. Looks like it's time for new symbols and new myths."
A similar mythological (“parable”) attitude to the material can also be found in S. Grof in his book “A Man in the Face of Death”. And if Sachs deals with people with mental illness, then Grof deals with patients on the verge of death. Apparently, only such stories are able to stir up the soul of the modern man in the street, accustomed to everything.
Be that as it may, we have before us the work of not a scientist, but a romantic. On the pages of his book, the author calls on the scientific community to change the prevailing attitude towards patients. Based on the developments of the Soviet neuropsychologist A.R. Luria, or rather, developing the thoughts expressed in his books, the author advocates a human attitude towards patients, for treating them as individuals: with their own characteristics, positive and negative sides. A proposal that is banal in modern times, but revolutionary at the time of the first publication of the book. And if it has become banal and self-evident today, is this not the merit of the author of this work?
The book consists of several sections ("Loss", "Excess", "Influx" and "The World of Naive Consciousness"), each of which contains stories, the heroes of which are real people suffering from various neurological disorders. Although why necessarily suffering? To the best of their strength and abilities, patients either completely succumb to the destructive effect of the disease, or actively fight it, or enjoy it (and this happens!).
Among the patients of the famous neuropsychologist you will meet a man who throws his leg out of bed every night (and falls out after it) because it is "someone's cut off, dead leg", and an old woman who constantly plays a concert of Irish music in her head, and twins mentally calculating prime numbers of the sixth or seventh order, and many others. And how others will treat them, how they will be treated and perceived, will affect their future fate, because improper treatment and an attempt at incorrect “social adaptation” can cause significant harm and destroy the remnants of personality.
Concluding the review, I would like to note that the book turned out to be very warm, kind and bright. The ideas expressed by the author are humanistic and correct in their essence, and his expressed personal approach is the only true one. And even though the ideal is still far away, the main thing is that this ideal is known, which means that there is a goal to strive for.
P.S. The huge potential of the book was appreciated not only by the professional community, but also by people of art. So, based on the books of Sachs, the film "Awakening" was shot with Robert de Niro and Robin Williams in the lead roles. The doctor also took part in the development of scripts for the films At First Sight, Remember, and, of course, the play The Man Who Mistook His Wife for a Hat.
Quite an exciting book, especially considering that it is similar to a scientific one. Also, a lot of facts about the structure of the brain are explained with live examples, which makes the book interesting to read.
5 more reviews
The work of the famous neurologist Oliver Sachs "The Man Who Mistook His Wife for a Hat, and Other Stories from Medical Practice" became a bestseller and has been translated into many languages. In it, the author talks about his medical experience, about people who become incomprehensible to many and cause conflicting feelings.
Despite the fact that the author is a doctor, his work is read quite easily. Of course, there is a description of some diseases and their features, but the writer tried to avoid complex terms. It is noteworthy that Oliver Sacks writes about people not as if he were taking notes in the anamnesis of the patient. His narrative does not look dry and concise, on the contrary, it is filled with feelings, empathy, reflections, humanity.
The book contains the stories of many people who have some deviations in mental development, in the work of the brain. For example, the author brings to attention the stories of people who suffer from the now known autism, but he also talks about very unusual cases.
It is interesting how complex the human brain is, how all the processes take place in it. If the slightest failure occurs somewhere, then this can already radically change the perception of a person. The book deals with both congenital and acquired deviations.
The author of the book not only observes people, but also reflects on them. Most people perceive such people as eccentrics, fools, even as abnormal and inferior. But if you think about it, perhaps their thinking is just a feature, not an aberration. Sometimes unusual perception allows people to create masterpieces of music, painting, literature. Or maybe those people who live in their own world are not so unhappy? Sometimes, watching such people, one gets the feeling that they can live happier and more fully than we, normal and ordinary, loaded with work and endless problems. The book will be of great interest to anyone who wants to learn more about people with an unusual psyche and worldview.
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Science editor's preface
When I received an offer to edit the translation of the book by the famous neurologist, psychologist and writer Oliver Sachs, The Man Who Mistook His Wife for a Hat, I agreed without a moment's hesitation. This book, a gift from an American colleague, has been on the shelf of my closet for fifteen years next to the works of A. R. Luria. I have returned to it many times over the years. When teaching a course in neuropsychology, it is simply impossible not to quote Sachs. But "The Man Who Mistook His Wife for a Hat" is much more than a special monograph or manual for a teacher and doctor.
Oliver Sachs is one of the most famous names in his field in the West. And his popularity goes far beyond the narrow professional environment.
He was born and educated in London and continued in the USA. Since 1970, his books - "Migraine", "Awakenings", "A Leg to Stand" - have been gaining readers. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs. It cannot be said that Saks is not known at all in Russia. Several of his essays entitled "Case Studies" were published in the journal "Foreign Literature". Russian authors refer to his works - both neuropsychologists and writers (for example, Tatyana Tolstaya). But the real acquaintance with the work of Oliver Sachs is yet to come for the Russian reader.
How to define the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a rather narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of the material in a textbook and monograph. What matters is not what Oliver Sacks writes about, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome "tourette"?), nor an abundance of special terms, nor an enumeration of chemicals, the existence of which most simply do not know.
Is it possible to imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, intensity of passions. And her hero should be a man, not his illness. This is precisely the most important feature of Sax's work. And it is not surprising that his book "Awakenings" became the basis for the play by Harold Pinter, and was later filmed. It is absolutely difficult to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with this book. The opera was written by Michael Nyman, a popular contemporary composer, the author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. The music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise in the street, catches in it a certain symphony. Music makes up the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. The music transforms the clumsy, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force that organizes the life of Professor P., who "has its own melody for every action."
It seems that every reader can find something different in the book. Someone will be interested in the "Kunstkamera" - amazing neuropsychological stories. For another reader, the book of Oliver Sachs is a small tragedy, where in the foreground is not illness, ugliness, but the experience, fate, the tension of a person's struggle with the disease.