Book Summary : Doctor Oliver Sacks

Within, The Man Who Mistook His Wife for a Hat, doctor Oliver Sacks tells his experiences conducting a series of case studies and producing critiques for the medical community. Sacks states, “Neurology’s favorite word is ‘deficit’, denoting an impairment or incapacity of neurological function: loss of speech, loss of language, loss of memory, loss of vision, loss of dexterity, loss of identity and myriad other lacks and losses of specific functions (or faculties)” (3). Sacks feels that the medical community, focusing on neuroscience, lacks humanization; this stems off the idea that current studies looking at mental illness as a deficit have proven to be too narrow. The book revolves around Sacks’ alternative approach within his case studies in terms of his interaction with those who are mentally ill. However, such an alternative approach opens the door for Sacks to become the subject of criticism and levels of controversy. Is Sacks’ approach irrational and should he truly be labeled as, “the man who mistook his patients for a literary career?” (Lamboll 1). Throughout history, new discoveries and findings have been uncovered within the medical community, especially involving the brain. These narratives show Sacks continuing studies of the brain/mind relationship that started back in 1861; the mapping of the human brain continues to evolve to this day. Narrative medicine clearly has a longer history than we might realize and Sacks is simply a proponent of an ongoing project. Sacks uses these narratives to show his efforts to find a more effective and accurate analysis of patients, in terms of neuroscience, by trying an alternative approach. Sacks is not only interested in what is wrong with the patient, but to get to know the person and bring humanization to neuroscience. This can be done through narrative medicine, an approach that is continuously being applied within modern medicine.

The Journal of the American Medical Association published Dr. Rita Charon’s article, “Narrative Medicine: A Model for Empathy, Reflection, Profession and Trust,” back in 2001 to enlighten readers on the effectiveness of narrative medicine. According to Charon, narrative medicine, “enables the physician to practice medicine with empathy, reflection, professionalism, and trustworthiness” (Charon 1897). In this sense, the implication of narrative medicine combines both conceptual and practical medical skills to form a diagnosis (1897). These methods can be seen within Sacks’ case studies that he presents. In terms of neurological disorders, Sacks presents stories of patients who have become completely impaired physically, lack the ability to remember, comprehend, and even speak and hear. With that, comes another one of Sacks critiques; the medical community underestimates patients with deficits being able to compensate for their mental illness. This is exhibited in Sacks’ case study of Dr. P. Dr. P suffers from face blindness which becomes apparent from his inability to distinguish between his wife’s face and a hat. However, Sacks states, in terms of neurology in relation to Dr. P’s condition, the testing, “told me nothing about Dr. P’s inner world” (15). From this, Sacks tries an alternative approach; he attempts to not only understand what’s wrong with Dr. P but to understand his personality.

Although, Dr. P lacks the visualization skills in certain areas such as faces, scenes, of visual narrative and drama. Sacks finds that, “the visualization of schemata was preserved, perhaps enhanced. This, when I engaged him in a game of mental chess, he had no difficulty visualizing the chessboard or the moves- indeed, no difficulty in beating me soundly” (16). This supports Sacks one critique that the medical community underestimates patients ability to compensate for their deficits and mental illness. The key to narrative medicine, according to Sacks, is to have the complete picture. He notes, “I could make no sense of what had occured in terms of conventional neurology (or neuropsychology). In some ways he seemed perfectly preserved, and in others absolutely, incomprehensibly a hat and, on the other, function, as apparently he still did, as a teacher at the Music School? I had to think, to see him again - and to see him in his own familiar habitat, at home” (11). Sacks new objective was to test Dr. P’s visual memory and imagination. Sacks tests Dr. P’s ability by asking him to, “imagine entering one of our local squares from the north side, to walk through it , in imagination or memory, and tell me the buildings he might pass as he walked. He listed the building on his right side, but none of those on his left. I then asked him to imagine entering the square from the south . Again he mentioned only those buildings that were on the right side, although these buildings were the very buildings he omitted before” (13). It is evident that Dr. P had, “difficulties with leftness, his visual field deficits, were as much internal as external, bisecting his visual memory and imagination” (Sacks, 15). This brings light to another one of Sacks critiques of the medical community. He believes that the medical community marginalizes disorders of the brain, specifically the right hemisphere; this cannot be easily understood in terms of being a deficit within a brain function that is so specific.

Sacks concludes that Dr. P lacks cognitive judgement. He states, “a judgement is intuitive, personal, comprehensive, and concrete” (19). Now dissecting neurology, Sacks informs the reader that neurology and psychology never address ‘judgement’- and yet is precisely the downfall of judgement (19). In this sense, Dr. P’s abstract attitude would be missed in terms of neurological diagnosis. “Judgement must be the first faculty of higher life or mind- yet is ignored, or misinterpreted, by classical (computation) neurology” (Sacks, 20). It’s not that Sacks feels that classical neurology is wrong. In fact he states, “Of course, the brain is a machine and a computer- everything in classical neurology is correct. But our mental processes which constitute our being and life, are not just abstract and mechanical, but personal, as well- and, as such, involve not just classifying and categorizing, but continual judging and delete feelings also” (20). Furthermore, the lack of humanization within the medical community, could possibly hinder an accurate diagnosis of a patient.

The Man Who Mistook His Wife for a Hat, was first published back in 1985. As said in Charon’s article on narrative medicine, “the effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others” (1897). Despite the support he has behind his claims, Sacks is still accused to be, “nothing more than an intellectual freak show host” (Lamboll 1). But it's important that Sacks is establishing a sense of comfortability between him and his patients. The fact of the matter is, every patient is different. Narrative medicine takes the singularity of a patient into account allow a more immediate and accurate diagnosis. Sacks’ approach is simply building upon and improving previous claims from Broca back in 1861, as is Charon.

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