Outpouchings

Colin McGinn

  • 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as in its elder American sibling, several of which are reprinted in the present collection, along with 12 previously unpublished pieces.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’.

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