The Man Who Mistook His Wife for a Hat (Oliver Sacks, 1985), presented by Marco on 07.11.2023, 23 members present.
In our first meeting at a new venue, Marco took on the task of distilling this classic work of neurological case studies into one hour of presentation and discussion. The audience, sufficiently lubricated with wine, was immediately engaged by a colorful biography of Oliver Sacks—including such eccentric details as his record-breaking 600-pound squat at Muscle Beach.
The book consists of 24 vignettes or “stories”, falling into one of four categories: Losses, Excesses, Transports, and The World of the Simple. Marco chose to present four stories from the first three categories, each followed by a group discussion and exchange of ideas.
Losses are understood to be neurological deficits, frequently linked to conditions involving the left hemisphere of the brain. (By contrast, the right hemisphere is associated with more primitive functions, including perception of self and reality.) Sacks stresses the need for personalized science in such cases, and attention to the dynamic reactions of patients. The first Losses story selected by Marco features Dr. P., music teacher and title character of the book, a sufferer of visual agnosia—due, as we later learn, to a malignant brain tumor. The second, The President’s Speech, revolves around two types of patients subjected to the political orations of an unnamed American president, probably Ronald Reagan. Aphasiacs understand perfectly the tone of the speech, but not necessarily the words; by contrast, a patient with agnosia understands the words, but not the tone. In both cases, the President’s speech falls flat, being perceived as odd, disingenuous, or even (in the aphasia ward) downright hilarious. Blogger comment: these sound like normal responses of healthy people to presidential speeches in the 2020s.
In particular, the story of Dr. P. elicited lively audience engagement. Some participants questioned the ethicality of such a case study, in which the patient is effectively placed on stage for the entertainment or amusement of others, without himself having received meaningful medical help. Others took a more positive view, stressing new opportunities that may arise for such patients as they adapt to their challenging conditions. Dr. P., whose temporal lobes were unaffected, devoted himself even more fully to music for the remainder of his life.
Excesses are essentially the opposite of losses, epitomized by the story of Witty Ticcy Ray, a sufferer of Tourette syndrome. Sacks describes Tourette’s as a relic of the “old brain”, where primal instincts are lodged; the disorder is associated with an overproduction of dopamine. Although Ray’s violent tics threaten his career and marriage, they have also shaped his character and inform his jazz drumming. After beginning Haldol treatments, Ray struggles to strike a balance between two extremes: the lethargic state induced by the drug, and his familiar vibrant but erratic state. During discussion, we considered this personality/treatment paradox, and also learned about the surprising pandemic phenomenon of “TikTok tics”.
The final story, in the Transports category—dealing with alterations of perception and imagination—was a local one familiar to many residents of the Rhine Valley. Hildegard von Bingen, the influential medieval nun and polymath, was known for her religious visions, which are now attributed to migraine hallucinations. (Conventional wisdom in Germany seems to be that the weather patterns around Mainz are particularly unfortunate for migraine sufferers—can anyone comment on this?) Incidentally, Hildegard’s abbey near Rüdesheim is still active (some of the nuns even have PhDs), known for its production of wine and books. As I write this blog entry, I’ve been listening to Hildegard’s music.
In our concluding discussion, we considered the utility of Sacks’ so-called “19-century approach”, with its relative lack of focus on understanding the underlying causes of neurological illness, and agreed that qualitative and quantitative data may complement each other. While the amount of attention that Sacks paid to individual patients would be unlikely in today’s medical settings (precluding the home visits which enabled Sacks to discover, for example, the evolution of Dr. P’s painting from figurative to abstract as his visual agnosia progressed), care is now commonly delivered by medical teams covering a wider range of specializations. There was also a debate about issues of consent as regards publishing patient stories, and how medical ethics may have changed since the 1980s.
What do you think about the book and the topics discussed? Did I omit or misrepresent anything in this summary? Please post your comments below! And feel free to share general suggestions about this blog using our Contact Form.
Leave a Reply