The Man Who Mistook His Wife for a Hat by Oliver Sacks

Rating: 10/10

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This is the first in a (hopefully long) series of book recommendations aimed at medical students (and anyone else) looking for a bit more life outside of thrilling canonical classics like Lippincotts Biochemistry. Best to be enjoyed during a prolonged period of peristalsis, when insomnia comes knocking or perhaps after an acute dose of poison.

Recommendations. It’s hard to hold my vomit in at the mere thought of being subjected to someone’s highly conjectured opinion. But here I go anyway, joining the fray.

The subject of my first recommendation? Oliver Sacks. Everyone’s own personal weightlifting motorbike-riding super-doc. Who, back in the late 70’s, finally sat down after several years spent in the company of psychotics to pen ‘The Man Who Mistook His Wife for a Hat (and Other Clinical Tales)’ subsequently blowing open patient-doctor confidentiality to give husbands everywhere an awesome excuse to toss their wives under the sofa and never speak to them again.

Context: What to Expect

The book, comprised of twenty-four essays split into four sections, might be a bit of a slog for today’s medical school cohort (busy doing those pointless quizzes on Facebook), but it’s a worthwhile one nonetheless.

Inside you’ll see a neurologist (Sacks) ruminate whimsically, tragically and sometimes horrifically at the manifest symptoms of conditions like visual agnosia (suffered by the patient referred to in the book’s title), somatoparaphrenia (the feeling of missing a limb) and anterograde amnesia (you forget things — like I do these book notes).

So captivating were Sacks’ collection of essays that the book itself inspired a Michael Nyman opera, a theatrical production, an episode of Parks and Recreation and the title of Scottish band Travis’ second studio album (music that subsequently propagated several cases of self-inflicted amnesia).

Proof enough that people bloody love neurological derangement then, it’s safe to say that this book has had a fair impact since it was first published back in 1985. Which is surprising given the little amount of traction it gets now. Especially among future specialists in psychiatry, general practice, neurosurgery and the like.

Why You Should Read This

So rarely do I see this book mentioned on the recommended reading lists of medical-school forums that I begin to wonder if it’s only ever me that’s actually enjoyed it.

Couple that with the fact that not once have I ever heard any other student mention the mere name ‘Oliver Sacks’ to me and I’m beginning to question even my own mental faculties.

What if I myself am one of the cases in the book? Some desperate, helpless guy trapped in a world where all the media he’s ever consumed has only ever been done so by him. Waterboarded by my own library.

Like Sacks’ patient Jimmie — who “found himself, found continuity and reality, in the absoluteness of spiritual attention and act” — perhaps this review series is my own divine attempt to reaffirm my existence in a world that really couldn’t care less.

Introspection aside (for now at least), it seems the young medical community has thrown poor old Oliver out. Abandoned his teachings. Tossed him out of the classroom like a pissed-soaked stethoscope.

Would-be-disciples now seem to worship at the altar of Goldacre, Gawande and Grant’s Dissector. Titillated by conspiracy, spiritual warbling, political intrigue and a probe shoved into someone’s retroperitoneal sac.

The heroes with violent tics and alien limbs that you see in this book? No longer seen as sexy in comparison to some silky-worded surgeon suturing yet another ruptured labia.

Which is a great shame. Because there’s a lot to glean from Sacks’ writing that I’ve never really come across in any other book (and I’ve read — a bit). Not the least of which is his own insight.

Offering a deeply human treatise that’s immune from the dilution you usually see involved in shifting a crapload of copies, Sacks’ voice here is a bit different from your run-of-the-mill doctor turned publishing mega-bastard. Devoid of exaggeration or ego, it’s odd to even consider he ever once took the Hippocratic oath given his earnestness.

What I Like About It

The thing I like about the tone of The Man Who Mistook His Wife for a Hat? though (especially for med students), is the fact that it’s poetic rather than clinical.

It’s 200-plus pages of somewhat smooth reading. A breath of fresh air from the usual force-my-tired-eyeballs-over-this-chapter-on-ketone-body-synthesis-and-pray-I-understand it type fare.

As for laying bare the tragedy of having an ill-functioning brain that can make you do and say very weird and comical things? That’s something I’d argue we all could learn more from.

Sack’s examination of Dr P. — a patient coming to him in the late chapters of the book — is an interrogation not just into the psyche of a once-lucid clinician. It’s also an illustration of the fine line we all tread between madness and sanity.

The books’ encapsulation of treatments like these (of which there are a ton) ask deeper, philosophical questions of our roles as future caregivers and practitioners.

Perhaps most intriguingly, as is the case with Dr.P, they also have us asking whether the ‘patient’ is ever really a patient at all.

And so that’s ultimately why I chose this book as my first recommendation. Because I want medical students to spend more time considering the question of ‘what’ and ‘who’. And less time attempting to cheat on exams.

Quotations

My favourite: “Empirical science, empiricism, takes no account of the soul, no account of what constitutes and determines personal being.” p.42

“Dr P. was not fighting, did not know what was lost, did not indeed know that anything was lost. But who was more tragic, or who was more damned – the man who knew it, or the man who did not?” p.17

“You are a wonderful musician, and music is your life. What I would prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the centre, now make it the whole, of your life.” p.19

“If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self – himself – he cannot know it, because he is no longer there to know it.” p.38

“Jimmie found himself, found continuity and reality, in the absoluteness of spiritual attention and act.” p.40

“We have five senses in which we glory and which we recognise and celebrate, senses 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.” p.76

“Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us – through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives – we are each of us unique.” p.117

“Donald has now returned to gardening. ‘I feel at peace gardening,’ he says to me. ‘No conflicts arise. Plants don’t have egos. They can’t hurt your feelings.’ The final therapy, as Freud said, is work and love.” p.172

“Is being an island, being cut off, necessarily a death? It may be a death, but it is not necessarily so. For though ‘horizontal’ connections with others, with society and culture, are lost, yet there may be vital and intensified ‘vertical’ connections, direct connections with nature, with reality, uninfluenced, unmediated, untouchable, by any others.” p.243

“For, as the stars stand, he will probably do nothing, and spend a useless, fruitless life, as so many other autistic people do, overlooked, unconsidered, in the back ward of a state hospital.” p.244