- The man who mistook his wife for a hat by Oliver Sacks
Duckworth, 233 pp, £9.95, October 1985, ISBN 0 7156 2067 3
It could be said that Oliver Sacks put neuropathology on the literary map. His first book Awakenings, about the stunning effects of the drug L-Dopa on patients afflicted with a form of Parkinsonism, attracted considerable critical acclaim from the literary world, and ‘inspired’ Harold Pinter’s rather ponderous play A Kind of Alaska. Sack’s second book A Leg to Stand On was similarly well-received. He has published a number of short pieces in this journal, as well as in its elder American sibling, several of which are reprinted in the present collection, along with 12 previously unpublished pieces. (His book Migraine seems to have excited rather less popular interest, no doubt because it is a less popular kind of book.) Yet the scientists of the nervous system do not seem to have been similarly impressed. When I asked a colleague in neuro-anatomy what he thought of Sack’s work he said he had never heard of him, and the neuroscientists I consulted who had heard of him were not inclined to attach any scientific importance to his writings. Unanimity between the two cultures is not perhaps to be expected, but in the present case the reason for this asymmetry of esteem lies deeper than mere difference of interest. The problem is that it is quite unclear what Sacks is doing. For whom is he writing? What kind of writing is it? Is it intended as sober science or fanciful fiction? What is its relation to an orthodox text of neuropathology? Can it really be taken seriously? Literary people seem tolerant of such uncertainties, but those concerned to discover the literal truth will want them clarified.
Sacks’s pocedure is to describe as winningly as possible the case-histories (or segments thereof) of various patents with whom he has had personal contact. These are, as it were, recreated before our eyes, like entries in a doctor’s diary, rather than being set down once all the data are in. They have tension, surprise, realistic dialogue, resolution, tragic dénouements, touches of humour, epiphanies. The cases are divided into four categories: ‘Losses’, ‘Excesses’, ‘Transports’, ‘The World of the Simple’. Here are some samples from each category. The man who mistook his wife for a hat was a distinguished musician, learned and charming, who had, through damage to his visual cortex, lost the ability to recognise familiar things despite being quite capable of seeing them; he couldn’t associate the visual appearance of things with their proper function or identity. Thus he mistook his foot for his shoe, his wife’s head for his hat (he tried to put her head on his), and he would Puzzle verbosely over ordinary things like gloves (‘a continuous surface, infolded on itself. It appears to have five outpouchings, if this is the word’). These failures of recognition may have stemmed from a total loss of the concepts in question or from an inability to apply them to what is seen – it is unclear. Sacks characteristically throws no light on the question, though his data seem to suggest the latter alternative. Instead of approaching the matter in a coolly analytical frame of mind, he prefers to burble on about the ‘intuitive, personal, comprehensive and concrete’ nature of judgment, suggesting that the patient has lost this capacity and then observing (inconsistently) that his judgment was ‘in all other spheres ... prompt and normal’.
Vol. 8 No. 3 · 20 February 1986
SIR: It was sad and maybe inevitable that Colin McGinn would find Oliver Sacks’s The man who mistook his wife for a hat to be a ‘coffee-table book for the scientifically shy to dip into and amaze themselves and their friends’ (LRB, 23 January). The inevitability was a result of the frustration, for a philosopher of the mind, of a book alluding to and yet circumnavigating the major issues of the mind-brain relationship. In his demolition of Sacks’s work McGinn fails to perceive the sympathy of a neurologist who observes with wonder the mysteries of the mind being revealed to him by his patients. To worry about the philosophical consequences of these cases is at a tangent to the real issue, which is how to understand a patient’s illness and so make life more comfortable for him. Sacks shows, with sensitivity and respect for his patients, how in treating them his understanding of neurology was broadened.
Vol. 8 No. 4 · 6 March 1986
SIR: I liked Colin McGinn’s review of Oliver Sacks’s The Man who mistook his wife for a hat (LRB, 23 January), but I wonder if he was not a bit swift in saying goodbye to the soul. If the ‘soul’ turns out to be a description of some facet of the neural tissue itself, then piecemeal degeneration of that tissue does indeed see the piecemeal degeneration of the soul, and death sees its end, because the soul is dependent on the neural tissue for its existence. But the question still remains: is it or isn’t it? And the neurological cases he cites do nothing to clear the matter up. If I switch on the Nine o’Clock news and find the top of Mrs Thatcher’s head missing, it may be that a terrible accident has happened to the Prime Minister, but the chances are that it is just my set that’s on the blink. Similarly, it is still open to those who do not believe that the soul is in the neural tissue any more than Mrs Thatcher is in my television set (though she spends a lot of time on it) to argue that it is the instrument of the soul’s expression, not the soul itself, that has been impaired when the functioning of the brain is disturbed. They may, of course, be wrong, but the argument is not advanced one way or the other by the sort of evidence Sacks’s patients provide. Indeed, the fact that nervous tissue will, given the opportunity, reorganise itself so that neurones that have performed one sort of function come to perform the task of some quite other neural tissue that has been irretrievably destroyed suggests that the ordinary machine model needs adapting. It is not, of course, in itself an argument for the existence of the soul, but it suggests to me that all is not quite as simple as McGinn appears to believe. The question of the soul’s survival may itself prove long-lived.
All Souls College, Oxford
Vol. 8 No. 5 · 20 March 1986
SIR: In his review of Oliver Sacks’s essays (LRB, 23 January), Colin McGinn implies that someone who just gives ‘new descriptions of old data – more dramatic descriptions’ is not thereby doing science. I wish to point out that Einstein’s celebrated ‘Explanation of the Perihelion Motion of Mercury by the General Theory of Relativity’ (Prussian Academy Sitzungsberichte, 18 November 1915) rested squarely on and essentially amounted to a novel description of the known trajectory of this planet as a geodesic (a ‘straightest line’) in a spherically symmetric curved spacetime. I do not claim that the new description is more dramatic than Newton’s in a literal sense, for it deprives the ‘system of the world’ of the theatrical machinery of instantaneous action at a distance. Yet by enabling us, at long last, to visualise in detail how the ‘wandering stars’ are held to their predestinate grooves, Einstein’s redescription achieved an effect we may well call dramatic, in the reviewer’s figurative sense.
I must also take exception to McGinn’s alleged proof of the mortality of the soul ‘by philosophical neuropathology’. He argues that, as diverse ‘parts of the mind’ are lost upon various kinds of partial brain damage, we ought to expect the rest of it to go out of existence when brain damage becomes total. But all that a neuropathologist can show is how many – and, ultimately, all – brain-controlled patterns of behaviour are disorganised and destroyed by brain damage. We do not need his assistance – or that of the ‘mental philosopher’ – to learn that all behaviour stops at death.
University of Puerto Rico