On The Man Who Mistook His Wife For A Hat

I recently finished reading The Man Who Mistook His Wife For A Hat And Other Clinical Tales by Oliver Sacks.

Below are key excerpts from the book that I found particularly insightful:

1- “In this first section, ‘Losses’, the most important case, to my mind, is that of a special form of visual agnosia: The Man Who Mistook His Wife for a Hat’. I believe it to be of fundamental importance. Such cases constitute a radical challenge to one of importance. Such cases constitute a radical challenge to one of the most entrenched axioms or assumptions of classical neurology—in particular, the notion that brain damage, any brain damage, reduces or removes the ‘abstract and categorical attitude’ (in Kurt Goldstein’s term), reducing the individual to the emotional and concrete. (A very similar thesis was made by Hughlings Jack son in the 1860s.) Here, in the case of Dr P., we see the very opposite of this—a man who has (albeit only in the sphere of the visual) wholly lost the emotional, the concrete, the personal, the visual) wholly lost the emotional, the concrete, the personal, the ‘real’ . . . and been reduced, as it were, to the abstract and the categorical, with consequences of a particularly preposterous kind.”

2- “It wasn’t merely that he displayed the same indifference to the visual world as a computer but—even more strikingly—he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified—in an ‘identi-kit’ way—^without the reality being grasped at all.”

3- “You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all . . , Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing … (I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s . . .) -Luis Bunuel”

4- “The blind, at least, are treated with solicitude—we can imagine their state, and we treat them accordingly. But when Christina, painfully, clumsily, mounts a bus, she receives nothing but uncomprehending and angry snarls: ‘What’s wrong with you. lady? Are you blind—or blind-drunk?’ What can she answer—’I have no proprioception’? The lack of social support and sympathy is an additional trial: disabled, but with the nature of her disability not clear—she is not, after all, manifestly blind or paralysed, manifestly anything—she tends to be treated as a phoney or a fool. This is what happens to those with disorders of the hidden senses (it happens also to patients who have vestibular impairment, or who have been labyrinthectomised).”

5- “We have five senses in which we glory and which we recognise and celebrate, senses that constitute the sensible world for us. Bu there are other senses—secret senses, sixth senses, if you will— equally vital, but unrecognised, and unlauded. These senses, unequally vital, but unrecognised, and unlauded. These senses, unconscious, automatic, had to be discovered. Historically, indeed their discovery came late: what the Victorians vaguely called ‘muscle sense’—the awareness of the relative position of trunk and limbs, derived from receptors in the joints and tendons—was only limbs, derived from receptors in the joints and tendons—was oi really defined (and named ‘proprioception’) in the 1890s. And the complex mechanisms and controls by which our bodies are properly aligned and balanced in space—these have only been defined in our own century, and still hold many mysteries. Perhaps it will only be in this space age, with the paradoxical license and hazards of gravity-free life, that we will truly appreciate our inner ears, our vestibules and all the other obscure receptors and reflexes that govern our body orientation. For normal man, in normal situations, they simply do not exist.”

6- “When the neglect is severe, the patient may behave almost as if one half of the universe had abruptly ceased to exist in any meaningful form. . . . Patients with unilateral neglect behave not only as if nothing were actually happening in the left hemispace, but also as if nothing of any importance could be expected to occur there.”

7- “To be ourselves we must have ourselves—possess, if need be re-possess, our life-stories. We must ‘recollect’ ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.”

8- “Because speech—natural speech—does not consist of words alone, nor (as Hughlings Jackson thought) ‘propositions’ alone. It consists of utterance—an uttering-forth of one’s whole meaning with one’s whole being—the understanding of which involves infinitely more than mere word-recognition. And this was the clue to aphasiacs’ understanding, even when they might be wholly uncomprehending of words as such. For though the words. the verbal constructions, per se, might convey nothing, spoken language is normally suffused with ‘tone’, embedded in an expressiveness which transcends the verbal—and it is precisely this expressiveness, so deep, so various, so complex, so subtle, which is perfectly preserved in aphasia, though understanding of words be destroyed. Preserved—and often more: preternaturally enhanced.”

9- “All the transports described in this section do have more or less clear organic determinants (though it was not evident too begin with, but required careful investigation to bring out). This does not detract in the least from their psychological or spiritual significance. If God, or the eternal order, was revealed to Dostoievski in seizures, why should not other organic conditions serve as ‘portals’ to the beyond or the unknown? In a sense, this section is a Study of such portals.”

10- “Experience is not possible until it is organised iconicalilly; action is not possible unless it is organised iconically. ‘The brain’s record’ of everything—everything alive—must be iconic. This is the final form of the brain’s record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, ‘art’—the artful scenery^ and melody of experience and action.”

11- “By a sort of inversion, or subversion, of the natural order of things, concreteness is often seen by neurologists as a v wretched thing, beneath consideration, incoherent, regressed. Thus for Kurt Goldstein, the greatest systematiser of his generation, the mind, man’s glory, lies wholly in the abstract and categoricical, and the effect of brain damage, any and all brain damage, is to cast him out from this high realm into the almost subhuman swamplands of the concrete. If a man loses the ‘abstract-categorical attitude’ (Goldstein), or ‘propositional thought’ (Hughlings Jackson), what remains is subhuman, of no moment or interest. I call this an inversion because the concrete is elemental—it is what makes reality ‘real’, alive, personal and meaningful.”


Omar Halabieh

The Man Who Mistook His Wife for a Hat


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