Oliver Sacks

The Man Who Mistook His Wife for a Hat

“I am equally drawn to the scientific and the romantic and continually see both in the human condition.”

How does one have an identity without memory?1 Where is the root of the soul of being? What is a person?

Of all the questions that neurologist Oliver Sacks (1933 – 2015) faced in his five decades of treating neurological disorders, the question of person and personhood carried significance for its paradox, for its thwarting of reality, and for how it stretched Sacks’ ability as a scientist and a human.

Sacks’ The Man Who Mistook His Wife for a Hat is so much more than clinical cases of patients with brain abnormalities (although the man who literally thinks his wife is a hat holds some voyeuristic appeal).

It is a book about person and personhood.2

I feel myself a naturalist and a physician both; and that I am equally interested in diseases and people; perhaps, too, that I am equally, if inadequately, a theorist and dramatist, am equally drawn to the scientific and the romantic and continually see both in the human condition, not least in that quintessential human condition of sickness—animals get diseases, but only man falls radically into sickness.

Drawings for Oliver Sacks' "The Man Who Mistook His Wife for a Hat" in the Examined Life Library.
Sacks gives us a portrait of a patient with aphasia: “He could not express himself too well in words, but expressed himself simply and clearly in drawings. […] When I asked him to copy a simply figure, he produced, a three-dimensional elaboration.” Illustration courtesy of the book.
“It is the fate of every human being to be a unique individual, to find his own path, to live his own life, to die his own death,” wrote Sacks in his last published work, Gratitude. Sacks’ drive for scientific discovery was matched by his desire to connect to the humans he treated and to learn, sometimes ease, their paths.

“Memoryless Jimmie G.” was a forty-nine year old man convinced that he was nineteen and that the world existed as it did when he was nineteen. Jimmie was, Sacks noted, “isolated in a single moment of being, with a moat or lacuna of forgetting all around him […] .”

‘What year is this?’ I asked, concealing my perplexity under a casual manner.

‘Forty-five, man. What do you mean?’ He went on, ‘We’ve won the war, FDR’s dead, Truman’s at the helm. There are great times ahead.’

‘And you, Jimmie, how old would you be?’

Oddly, uncertainly, he hesitated a moment, as if engaged in a calculation.

‘Why, I guess I’m nineteen, Doc. I’ll be twenty next birthday.’

Looking at the grey-haired man before me, I had an impulse for which I have never forgiven myself—it was, or would have been, the height of cruelty had there been any possibility of Jimmie’s remembering it.

‘Here,’ I said, and thrust a mirror toward him. ‘Look in the mirror and tell me what you see. Is that a nineteen-year-old looking out from the mirror?’

He turned ashen and gripped the sides of the chair, ‘Jesus Christ,’ he whispered. ‘Christ, what’s going on?’

Sacks walks Jimmie back to Jimmie’s concocted reality, soothing a mind troubled by conflict.

Dr. P. was a musician who suffered from a condition that led to regular misclassifications of common objects. Like his shoe. Or his hat. Or his wife.

To begin to understand what this might be like, ask someone else to read Pablo Neruda’s Odes to Common Things aloud without naming the object. Can you identify it? Imagine seeing it and still not knowing.

I bought myself an extravagant red rose for my buttonhole. Now I removed this and handed it to him. He took it like a botanist or morphologist given a speciman, not like a person given a flower.

‘About six inches in length,’ he commented. ‘A convoluted red form with a linear green attachment.’

‘Yes,’ I said encouragingly, ‘and what do you think it is, Dr. P.?’

‘Not easy to say.’ he seemed perplexed. ‘It lacks the simple symmetry of the Platonic solids, although it may have a higher symmetry of its own… I think this could be an inflorescence or flower.’3

Drawings for Oliver Sacks' "The Man Who Mistook His Wife for a Hat" in the Examined Life Library.
“A few days later I saw him again […]. I asked him again to draw the same figure. And now, impulsively, without pausing for a moment, he transformed the original to a sort of trapezoid […]. ‘Boy flying kite, kites flying!’ he exclaimed excitedly.” Illustration courtesy of the book.
Sacks balanced his clinical study of the neurological condition with treating the emotions of individuals unaware they had neurological disorders.

Like the patient who could not remember or identify individuals he met (but unlike Dr. P. did know they were people).

He remembered nothing for more than a few seconds. He was continually disoriented. Abysses of amnesia continually opened beneath him, but he would bridge them nimbly, by fluent confabulations and fictions of all kinds. For him they were not fictions, but how he suddenly saw, or interpreted, the world. Its radical flux and incoherence could not be tolerated, acknowledged, for an instant—there was, instead, this strange delirious, quasi-coherence […] continually improvising a world around him.4

When Sacks asks and tries to answer what life is like for this patient, as he does for all his patients, he gives us a glimpse of what it might be to be trapped in a condition, ceaselessly struggling to maintain what we take for granted.

For it is not memory which is the final, ‘existential’ casualty here (although his memory is wholly devastated, it is not memory only which has been so altered in him, but some ultimate capacity for feeling which is gone; and this is the sense in which he is ‘de-souled.’

Drawings for Oliver Sacks' "The Man Who Mistook His Wife for a Hat" in the Examined Life Library.
“I saw him for the third time a few days after this, and found him rather down (he had been given Haldol to quiet him) […] this time he copied it dully, correctly, and a little smaller than the original with none of the elaborations. ‘I don’t “see” things any more, ‘ he said. ‘It looked so real, it looked so alive before.” Illustration courtesy of the book.
Sacks gives his patients a voice and unearths their personhood.5 Something we all need and deserve.

Next to Sacks, at the intersection of science and humanity, sit Alan Lightman, a physicist on a continual quest for consciousness; farmer and poet Wendell Berry; Rachel Carson, the biologist who tirelessly worked to connect the human spirit to its environment; and Stephen Grosz, a therapist who, like Sacks, seeks to bring narrative and meaning to the struggles his patients encounter.

Illustration of Oliver Sacks.