Man Who Mistook His Wife for a Hat

¶ … Man Who Mistook His Wife for a Hat and Other Clinical Tales is a collection of case studies compiled by Oliver Sacks, a physician and professor of neurology who often writes about the interesting cases he comes across in his profession. This volume of twenty case studies reads more like a book of short stories. The people he describes are remarkable, unique examples of the strange and fascinating workings of the neurological mind. The case studies themselves are written in a fluid, engaging style that is accessible to all levels of readers, including not just other neurologists and medical professionals, but also the average layperson.

The book gets its unusual title from one of Sacks' cases. A man, a music teacher described only as Dr. P., has received a recommendation from his ophthalmologist to visit Dr. Sacks for problems ostensibly related to vision. Since the eye specialist is unable to determine the nature of Dr. P.'s problem, he refers him to Sacks for further examination. The man attends the first visit with Sacks with his wife. During the initial interview, Sacks notices that the man does not respond in a normal way to stimuli; for example, he seems to lean into Sacks with his ear instead of facing him directly with his eyes, as most patients normally do. This is an indication that Dr. P. tends to respond to things through listening, rather than through visual methods. When the first visit is just about to end, Dr. P. reaches towards his wife's head, an action that seems rather peculiar to Sacks. To the patient's wife, however, this action seems perfectly normal. Sacks, after observing this, concluded that the patient's attempts to grab his wife's head indicate that he has mistaken her for a hat. This is a pivotal moment for Sacks, who decides to use this particular case study as the title for his book.

Further interactions with P. lead Sacks to conclude that P.'s way of interacting with the world is different from that of other people. He learns from Dr. P.'s wife that her husband often sings when he completes normal daily activities; to Dr. P. And to his wife, this is something that has become perfectly normal to them. The second visit with Dr. P. occurs at the patient's home. Here Sacks notices that Dr. P. has trouble visually identifying a rose that is attached to his lapel. He doesn't actually recognize it until he smells it. The olfactory sensation sparks P.'s recognition, and the association finally clicks. Based on these observations and on information given to him by Dr. P.'s wife, Sacks concludes that P. has compensated for his "visual" problem by relating to the world in other ways, primarily through music. Instead of seeing this as a deficiency to be cured, however, Sacks assesses the man as unusually creative in his adaptation to the real world. It is Sacks' ability to take on these unusual cases and to determine the roots of strange, apparently unexplainable neurological problems through musical and artistic "diagnoses" that inspired him to write this book.

Other stories include patients who have been assessed by other professionals as "retarded," but who are in fact gifted in other ways. Some of his patients have memory problems that make it difficult for them to function in daily life. Sacks describes -- and treats -- these patients as multi-faceted individuals, seeing beyond their diseases. His insights into them reflect not only a concern for the affliction or condition that plagues the individual, but also a deep respect for the ingenuity with which they have adapted to their lives despite limitations. "Witty Ticcy Ray" is one such individual. He is a patient afflicted with Tourette's Syndrome who had lived with the illness for many years by the time Sacks comes to know him. After starting Ray on a course of Haldol, Ray expresses a feeling that Sacks finds particularly significant: if Sacks were to remove all of Ray's tick completely, Ray asks, "What would be left? I consist of tics -- there is nothing else."

Sacks is very moved by the way Ray's identity as a sufferer of Tourette's has totally consumed his sense of identity; the thought of being "cured" through medication is both exhilarating and frightening to him. Ray also feels that the Haldol saps a part of who he is; it removes the tics that make him socially ostracized, but in exchange, he feels that his "self" is compromised. Sacks acknowledges this and he works with Ray to fashion a treatment plan that allows him to function at both ends of the spectrum. Sacks' respect for Ray's wishes and his accommodation of his needs are what separate Sacks from many traditional physicians for whom a return to a state of "normalcy" is really the only cure. Sacks understands that for Ray, the importance of living a meaningful life is the primary goal of treatment, and he honors this.