The man who mistook his wife for a hat

Oliver Sacks

The scientific study of the relationship between brain and mind began in 1861, when Broca, in France, found that specific difficulties in the expressive use of speech (aphasia) consistently followed damage to a particular portion of the left hemisphere of the brain. This opened the way to a cerebral neurology, which made it possible, over the decades, to ‘map’ the human brain, ascribing specific powers to equally specific ‘centres’ in the brain.

Towards the end of the century it became evident to more acute observers – above all, Freud, in his book on Aphasia (1891) – that this sort of mapping was too simplistic, that all mental performances had an intricate internal structure, and must have an equally complex physiological basis. He felt this, especially, in regard to certain disorders of recognition and perception, for which he coined the term ‘agnosia’. An adequate understanding of aphasia or agnosia would, he believed, require a new, more sophisticated science.

The new science of brain/mind which Freud envisaged came into being in the Second World War, in Russia, as the joint creation of A.R. Luria (and his father R.A. Luria), Leontev, Anokhin, Bernstein and others, and was called by them ‘neuropsychology’. The development of this immensely fruitful science was the life-work of A.R. Luria, and considering its revolutionary importance, was somewhat slow in reaching the West. It was set out, systematically, in a monumental book, Higher Cortical Functions in Man (translated into English in 1966), and, in a wholly different way, in a biography or ‘pathography’ – The Man with a Shattered World (which appeared in English in 1973). Although these books were almost perfect in their way, there was a whole realm which Luria had not touched. Higher Cortical Functions in Man treated only those functions which appertained to the left hemisphere of the brain; similarly, Zazetsky, the man with the shattered world, had a huge lesion in the left hemisphere – the right was intact. Indeed, the entire history of neurology and neuropsychology can be seen as a history of the investigation of the left hemisphere.

One important reason for the neglect of the right hemisphere, the ‘minor’ hemisphere, as it has always been called, is that while it is easy to demonstrate the effects of variously-located lesions on the left side, the corresponding syndromes of the right hemisphere are much less distinct. Anatomically, too, the right hemisphere is less differentiated than the left: it does not have hundreds of clearly-demarcated regions like the left, but instead has a relatively homogeneous appearance. It was presumed, usually contemptuously, to be more primitive than the left, the latter being seen as the unique flower of human evolution. And in a sense this is correct: the left hemisphere is more sophisticated and specialised, a very late outgrowth of the primate, and especially hominid, brain. On the other hand, it is the right hemisphere which, controls the crucial powers of recognising reality which every living creature must have in order to survive. The left hemisphere, like a computer tacked onto the basic creatural brain, is designed for programs and schematics; and classical neurology was more concerned with schematics than with reality, so that when, at last, some of the right-hemisphere syndromes emerged, they were considered bizarre.

There had been attempts in the past – for example, by Anton in the 1890s and Pötzl in the 1930s – to explore right-hemisphere syndromes, but these attempts themselves had been bizarrely ignored. In The Working Brain, one of his last books, Luria devoted a short but tantalising section to right-hemisphere syndromes, ending: ‘These still completely unstudied defects lead us to one of the most fundamental problems – to the role of the right hemisphere in direct consciousness ... The study of this highly important field has been so far neglected ... It will receive a detailed analysis in a special series of papers ... in preparation for publication.’ Luria did, finally, write some of these papers, in the last months of his life, when mortally ill. He never saw their publication, nor were they published in Russia: he sent them to Richard Gregory in England. They will appear in Gregory’s Oxford Companion to the Mind.

Inner difficulties and outer difficulties match each other here. It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems. Moreover, this peculiar anosognosia is observed only in such patients, and it is singularly difficult for the observer, however sensitive, to understand what it must be like to be in this situation. Left-hemisphere syndromes, by contrast, are relatively easily imagined. Although right-hemisphere syndromes are as common as left-hemisphere syndromes – why should they not be? – one will find a thousand descriptions of left-hemisphere syndromes in the neurological and neuropsychological literature for every description of a right-hemisphere syndrome. It is as if such syndromes were somehow alien to the whole temper of neurology and yet, as Luria says, they are of the most fundamental importance, so much so that they may demand a new sort of neurology, a ‘romantic science’, as he liked to call it. Luria thought a science of this kind would be best introduced by a story – a detailed case-history of man with a profound right-hemisphere disturbance, a case-history which would at once be the complement and opposite of The Man with a Shattered World. In one of his last letters he wrote: ‘Publish such histories, even if they are just sketches. It is a realm of great wonder.’

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