The Man Who Mistook His Wife for a Hat
-our basic concept or vision of the nervous system as a sort of machine or computer is radically
inadequate and needs to be be supplemented by concepts more dynamic, more alive
Part One: Losses
Case One: Dr. P (The Man Who Mistook his Wife for a Hat)
-unable to translate the visual reality to abstract in his brain, he lost the world of representation
-could try to make guesses as to what things were by the visual clues but was very often absurdly
wrong
-he had an 'abstract attitude' and nothing else, no ability to perceive identity or particulars
-a downfall of judgement: "Whether in a philosophic sense (Kant's sense), or an empirical and
evolutionary sense, judgement is the most important faculty we have. An animal, or a man, may get
along well without 'abstract attitude' but will speedily perish if deprived of judgement."
-our mental processes are far more than the computational, we have a personal that does more than
just add up the factors before us
Case 2: Jimmie (The Lost Mariner)
-had complete memory loss of events for the last 40 years and had continuous short term memory
loss so he remembered nothing of his current life, no sense of his present
-living in a bottomless world
-he was a 'lost soul' with no connection to a self, a sense of who he was and what he was doing, a
'Humean being' as nothing more than bundle of different sensations in perpetual flux and movement
(what Hume said all humans were)
-he had no sense of time or continuity, attempt at diary entries showed no sense of reflection
-since he had lost his self, he was unaware of having lost anything
-the only time that he found a continuity of reality was through music and spirituality: "Perhaps there is
a philosophical as well as a clinical lesson here: that in Korsakov's, or dementia, or other such
catastrophes, however great the organic damage and Humean dissolution, there remains the
undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this
can be preserved in what seems at first a hopeless state of neurological devastation."
Case 3: Christina (The Disembodied Lady)
-lost the mental awareness of her body, had to control and move it only through vision
-with "bodilessness" came a loss of sense of self, a "deficiency in the egoistic sentiment of
individuality"
Case 4: The Man Who Fell out of Bed
-about a man who viewed his own left leg as a “counterfeit” limb cut off from a cadaver and attached
to him, unable to say where his real left leg was
Case 5: Hands (Madeleine)
-a 60-year-old who had both cerebral palsy and blindness, who missed developing the ability to use
her sense of touch to figure out what things were and the use of her hands was quite alienated from
her with no power to integrate the sensations and perceptions that they gave her into her mind to
understand what they meant
-this is called developmental agnosia, one can also have acquired agnosia due to brain disease or
injury
Case 6: Phantoms
-about the phenomenon of feeling a limb or digit of the body that had been amputated
-says that the phantom limb is essential if an artificial limb is going to be successful and the loss of
the phantom can mean the loss of the ability to use the artificial
Case 7: On the Level (Mr. MacGregor)
-man who leaned when he walked, his centre of gravity being 20 degree to the left
-“We have five sense in which we glory and which we recognize and celebrate, sense that constitute
the sensible world for us. But there are other senses -secret senses, sixth senses, if you will -equally
vital, but unrecognised, and unlauded. These senses, unconscious, automatic, had to be discovered."
-in the Victorian era the awareness of the relative position of the trunk and limbs, derived from
receptors in the joints and tendons, was labelled proprioception
-the complex mechanisms and controls by which our bodies are properly aligned and balanced in
space are still being defined in our time
-“If there is a defective (or distorted) sensation in our overlooked secret senses, what we then
experience is profoundly strange, an almost incommunicable equivalent to being blind or being deaf.
If proprioception is completely knocked out, the body becomes, so to speak, blind and deaf to itself and (as the meaning of the Latin root proprius hints) ceases to ‘own’ itself, to feel itself as itself."
-this patient had three secret senses impaired: the labyrinthine (ear canals responsible for balance),
proprioceptive and visual: a synthesis that is impaired in Parkinsons disease: the repeating of this
exact synthesis has led researcher to conclude that there must be some “higher authority” in the brain
that controls these functions to allow for the state of stability for our bodies
Case 8: Eyes Right! (Mrs. S)
-a woman who suffered a massive stroke and lost the ability to see anything on the left side of her
vision, or to even recognize that there is a left side to anything (only eats things on the right side of
her plate, will only put on make up on the right side of her face)
Case 9: The President’s Speech
-aphasiacs are people who lose their understanding of words, but they develop a greatly heightened
understanding of tone and expression, so much so that one would rarely be able to tell their affliction
-tonal agnosia is the opposite, people who can understand words but not tones or expression
-it is extremely hard to successfully lie to the first but quite easy to the second
-this chapter looks at these patients’ reaction to a speech by Ronald Reagan -the first group finding it
funny because of the falsehoods they perceived and the second group saying that it made no sense
because of the jumble of word choice, thinking he must be either brain damaged or trying to mislead
-“Here then was the paradox of the President’s speech. We normals -aided, doubtless, by our wish to
be fooled, were indeed well and truly fooled. And so cunningly was deceptive word-use combined
with deceptive tone, that only the brain-damaged remained intact, undeceived."
Part Two: Excesses
-there is a problem when talking about illnesses which result in too much of an ability in some area to
see it as a gift rather than the problem that it presents to the brain and to normal living (usually is tied
to manias)
-“This is the simultaneous gift and affliction, the delight, the anguish, conferred by excess.” -it is a
“morbid brilliance"
Case 10: Witty Ticcy Ray
-starts off describing Tourette's syndrome, an excess of nervous energy which displays in tics, jerks,
mannerisms, grimaces, noises, curses, involuntary imitations and an odd elfin humour with a
tendency to antic and outlandish kinds of play
-moves to discussion of the 1920s epidemic of sleepy-sickness, which starts off with something that
looks very much like Tourette's and then the patients fall into a trance like 'sleep'
-when these patients were given L-Dopa, a precursor transmitter dopamine, they were 'awakened' to
health but they were then driven to the excess with the tics and frenzy
-in Tourette's there seems to be a similar disorder in the subcortex of the brain, the primate part that
governs drive, which is also the area of Parkinson's and chorea
-in Tourette's there is an excitement of the emotions and passions, a disorder of the primal, instinctual
bases of behaviour
-while there existed an excess of dopamine in these patients, it is much more than that, there are
many more subtler and widespread changes in the pathways of their brains, which means that a
simple drug to suppress dopamine is not the single answer
-"Complementary to any purely medicinal, or medical, approach there must also be an 'existential'
approach: in particular, a sensitive understanding of action, art and play as being in essence healthy
and free, and thus antagonistic to crude drives and impulsions, to 'the blind force of the subcortex'
from which these patients suffer. The motionless Parkinsonian can sing and dance, and when he
does so is completely free from his Parksonianism; and when the galvanized Touretter sings, plays or
acts, he in turn is completely liberated from his Tourette's. Here the 'I' vanquishes and reigns over the
'It'."
-in treating Tourette's, in the case of Ray, fixing it meant losing something he sometimes saw as an
advantage, a quickness and competitive edge
Case 11: Cupid's Disease (Natasha K.)
-about an elderly woman who developed neurosyphilis in her 90s, causing her to feel alive, very
healthy, and release of inhibitions
-her choice was to halt the continuation of the disease but did not want to reverse and lose the
rejuvenation she had gained
-another case of neurosyphilis that Sacks encountered saw the disease give a man great artistic
imaginings and treatment took his zest for art away
Case 12: A Matter of Identity (William Thompson)
-about a man with excited Korsakov's syndrome, the same thing we saw in Jimmie in a previous
chapter, but this man was constantly filling the gaps of his lack of memory existence with fabrications,
continually creating a world and a self
-"To be ourselves we must have ourselves -possess, if we'd 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. This narrative need, perhaps
is the clue to Mr. Thompson's deperate tale-telling, his verbosity. Deprived of continuity, of a quiet,
continuous, inner narrative, he is driven to a sort of narrative frenzy - hence his ceaseless tales, his
confabulations, his mythomania. Unable to maintain a genuine narrative or continuity, unable to
maintain a genuine inner world, he is driven to the proliferation of pseudo-narratives, in a pseudocontinuity, pseudo-worlds peopled by pseudo-people, phantoms."
-"Here is a man who, in some sense, is desperate, in a frenzy. The world keeps disappearing, losing
meaning, vanishing -and he must seek meaning, make meaning, in a desperate way, continually
inventing, throwing bridges of meaning over the abysses of meaninglessness, the chaos that yawns
continually beneath him."
-discusses the fact that William, unlike Jimmie, never stops trying to create the fabrications, he never
sits in silence and allows reality to creep in: it is not memory he has most lost but some ultimate
capacity for feeling
-Sacks says this is the very loss of his soul
Case 13: Yes, Father-Sister (Mrs. B.)
-case of a woman who had a cerebral tumour and who was given to wise-cracks, impulsivity and
superficiality, like she doesn't care about anything at all
-examination showed that she didn't care about the title she gave things or people, the difference
between left and right, nothing had any meaning for her
-her world was void of feeling and meaning, there was no sense of real and unreal, everything was
equal and the whole world was reduced to facetious insignificance
-another example of a desouled person
-the Germans call this the 'joking disease' and it is seen as a fundamental form of nervous
'dissolution' where some sort of centre to the mind is lost and there is only an abyss of superficiality
Case 14: The Possessed
-about cases of 'super-Tourette's' which result in a form of psychosis or frenzy
-discusses the need to view these disorders not in a clinical setting where the people know they are
being observed, but in the street where many of the population have obvious mental illness and feel
the freedom to express it
-the difference between the Korsakovian (Jimmie, et al) and the Touretter is that the former is driven
by amnesia whereas the latter is driven by inner impulses of which he is fully aware and unable to
control
-it is a bombardment on the Touretter: how can identity develop or survive in such a life?
-for Hume, personal identity doesn't exist but we are just a consecution of sensations, or perceptions:
this is clearly not the case for the normal human being because he owns his perceptions, but it can
be said to be partially true for Touretters
-"The super-Touretter, then, is compelled to fight, as no one else is, simply to survive - to become an
individual, and survive as one, in face of constant impulse."
Part Three: Transports
-this section about reminiscence, altered perception, imagination, 'dream'
-these things often miss the attention of the medical field because they seem more to the realm of the
spiritual and they have an intense dramatic, or narrative, or personal 'sense'
-"The theme of this section is the power of imagery and memory to 'transport' a person as a result of
abnormal stimulation of the temporal lobes and limbic system of the brain. This may even teach us
something of the cerebral basis of certain visions and dreams, and of how the brain may weave a
magic carpet to transport us."
Case 15: Reminiscence (Mrs. O'C)
-about a patient who reported great mental health except she was hearing old songs from her
childhood loudly and repeatedly in her head
-discovered she had suffered a temporal-lobe seizure, which is the area of the brain that is the basis
for 'reminiscence' and experiential hallucinations
-describes another similar case and defines it as "Musical epilepsy"
-one scientist was able to tap into that part of the brain and cause vivid reminiscences on the
operating table, which can be described in great detail: this has been called "double consciousness"
in which a person is hallucinating at the same time they have normal consciousness
-in the case of Mrs. O'C she was able to use the seizures to unlock happy memories of her parents
she had lost, being orphaned at the age of 5
-these 'experiential' seizures tell us a lot about how the brain records and saves experiences and
what memory is: it is interesting that sings and scenes are remembered like movies or scores
-if the inner working of our brains were merely like schemata, programmes, algorithms, etc then how
could it account for the rich visionary, dramatic and musical quality of memory of experience?
-there seems to be a gulf between what one learns from a patient and what is taught by physiologists,
there seems to be something over and above the mechanical: "above the level of cerebral
programmes, we must conceive a level of cerebral scripts and scores" that connect to the personal,
the emotional
-"Experience is not possible until it is organized iconically; action is not possible unless it is organized
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."
-therefore, art and music must be central to an attempt to recreate memory for those who have lost it
Case 16: Incontinent Nostalgia
-on the Awakenings patients, on the fact that increased excitement on the L-Dopa led to being able to
force the patients into a flood of reminiscence in the same manner cortical probes do
-interesting how memories are held and seemed to be released and then can be lost again
Case 17: A Passage to India (Bhagawhandi P.)
-about a young lady who had a tumour in the same region of the brain that the reminiscing patients
were having their seizures in
-interesting case that her reminiscing was very vivid, of full landscapes and scenes, and she was
happy there, slowly slipping into this world until she died
Case 18: The Dog Beneath the Skin (Stephen D.)
-about a young man, who had the habit of taking stimulants, who had a few weeks of having what he
described as the senses of a dog, particularly greatly increased sense of smell
-calling on the words of Freud, Sacks suggests that we repress many of our sensory skills and a loss
of inhibition in the brain, seen in drug use as well as in Tourette's syndrome and patients given LDopa, can release these abilities
-points out that there are scent memories on the brain as much as visual or auditory
Case 19: Murder (Donald)
-about a man who had committed a murder when under the influence of PCB and had no memory of
it until years later when he suffered brain injury due to a cycling accident, and then the memory is
very vivid and overwhelming
Case 20: The Visions of Hildegard
-about the visions had by those suffering from migraines or epilepsy and the feeling of ecstasy or
harmony that sometimes accompanies this fairly base physiological event
Part Four: The World of the Simple
-the value of studying those with mental retardation lies in "the qualities of mind which are preserved,
even enhanced, so that, though 'mentally defective' in some ways, they may be mentally interesting,
even mentally complete, in others"
-their world is concrete: vivid, intense, detailed, yet simple precisely because it is concrete: neither
complicated, diluted, nor unified, by abstraction
-many have seen this concrete existence as a loss of humanity, saying that it is our abstract or
categorical thought that makes us human but as we saw with the case of the Man Who Mistook,
lossing the concrete is more damaging than the opposite
-having a super focus on the concrete can lead to enhanced powers of concrete imagery and
memory, to obsessive preoccupation with particulars, and the development of eidetic imagery and
memory
-most interesting, is the proper use and development of the concrete in these individuals
Case 21: Rebecca
-about a girl who failed miserably at every cognitive and motor skills test but was highly intelligent
when it came to understanding narrative, poetry and church liturgy; she was at peace when
contemplating nature and had no clumsiness when dancing
-this showed that her intelligence, her composing factor, was something other than schematics on
which most of us rely, but it is rather of narrative
-to work with these patients on developing their cognitive skills is only to drive them full-tilt upon their
limitations and ignore what was intact or preserved
Case 22: A Walking Grove (Martin A.)
-about a man whose childhood meningitis had caused retardation, impulsiveness, seizures, and some
spasticity on one side
-despite his mental limitations, he was able to memorize thousands of operas, often retaining an
oratorio after a single hearing
-since his father was a gifted singer, one wonders if this would have been an even greater gift if the
disease hadn't hampered it or if it was compensation for brain damage in other areas
-he knew not only the songs but also all the singers who had played the roles, details of scenery,
staging, dress and decor in different productions; he also knew all of the streets and transit routes of
Nee York City; he also knew by heart the nine-volume Grove's Dictionary of Music and Musicians (he
was illiterate, it was read aloud to him by his father)
-without music he took on personas of a rebellious child or stigmatized retard but with music he was a
quiet, dignified man who could become wholly absorbed by even some of the most complicated
pieces
Case 23: The Twins (John and Michael)
-about two brothers who had been hailed as being human calculators because of their skills with
remembering digits and thei ability to almost instantly say what day any date has or would fall on
-it was thought that they were using calculating skills, when in reality their actual calculating abilities
were very low; instead they were using some sort of landscape of pattern inside their heads, a sort of
unconscious algorithm
-they could also recount the weather, significant news and memories of any day of their lives from
about the age of four on
-by their own account, they "see" these numbers, dates and events
-they could do the flash count of dropped match sticks, saying that they didn't count them but they
saw the number (and more, they saw 111 but then broke it down to see 37 three times)
-describes the boys' ability and pleasure in discovering prime numbers or a greater and greater size,
levels not usually possible without the aid of a computer
-Sacks concludes that the twins had a sense of numbers the same way a musician has of harmony, a
harmony that is lost to most of us
Case 24: The Autist Artist (Jose)
-about a severely autistic man who was able to express himself through art, regaining some access to
language as he drew
-"The abstract, the categorical, has no interest for the autistic person -the concrete, the particular, the
singular, is all. Whether this is a question of capacity or disposition, it is strikingly the case. Lacking,
or indisposed to it, the general, the autistic seem to compose their world picture entirely of particulars.
Thus they live, not in a universe, but in what William James called a 'multiverse', of innumerable,
exact, and passionately intense particulars."