The late neurologist Oliver Sacks dedicated his life to studying the mysteries and extraordinary powers of the human brain. In The Man Who Mistook His Wife for a Hat, Sacks presents the stories of his patients, all of whom were suffering from some form of neurological impairment. In sharing these stories, Sacks weaves a narrative that demonstrates the remarkable complexity of the human brain and its extraordinary capacity to adapt. As we’ll see, the brain is the source of our very humanity, giving us our identity and deepest sense of self.
As we study the lives of these patients, some key themes emerge:
Neurologists often speak of brain disorders in terms of deficits. A deficit is an impairment of some element of neurological functioning, usually linked to brain damage to a particular area.
But the brain is adept at turning deficits in one area into surpluses in another—enabling patients to navigate their world, make sense of what they see, and retain some sense of identity and self.
We can see a clear example of a neurological deficit in the case of Dr. P, who experienced strange problems with visual recognition. He was unable to recognize the faces of his students and was known to pat inanimate objects like parking meters and fire hydrants, thinking they were children. He even struggled to identify his own wife—whose head he often grabbed at, believing it was a hat. Dr. P was suffering from agnosia—an inability to recognize and interpret visual data.
Sacks found that Dr. P could only recognize pictures of family and friends in which the subjects had distinct features—he identified a photo of his brother Paul, for example, by noting Paul’s square jaw and big teeth. He could identify only the features and use them as a clue to guess the identity of the person, but he was not truly recognizing them.
Despite this, Dr. P’s mind seemed to compensate for this deficit by crediting his neurological “account” in other ways. He had exceptional powers of abstract description and excelled at schematic mental models involving abstract shapes—for example, he was a skillful player of blind chess, able to perfectly visualize the board and pieces in his mind. His intact abstract sensibility gave him some means of interpreting what he saw with his eyes, providing him with a tool to order, recognize, and make sense of his world.
Some people who’ve suffered brain damage are unable to understand language. They suffer from aphasia—the inability to process and understand spoken words.
In the 1980s, Sacks was at an aphasiac ward of a psychiatric hospital, where the patients were watching a televised speech by US President Ronald Reagan. Their aphasia inhibited them from processing and understanding the words the president was speaking. But they could still understand the non-verbal aspects of language, indeed, far better than most other people.
They only heard Reagan’s tone and inflection, and thus, saw the polished actor-turned-president as a dissembling phony, keenly picking up on the falseness of his tone and body language. And their reaction to his speech was not reverential respect—it was uproarious, hysterical laughter!
Throughout most of the history of neurology, practitioners have focused on these deficits and the problems that result from the loss of function. But what about the opposite phenomenon, of excesses and superabundances? What happens when neurological functions work on overdrive?
When neurological disorders manifest as excesses and superabundances, they heighten some of the most crucial aspects of our humanity—impulse, will, action, and passion—and remove our inhibitions. Patients who experience the rush of these highs often report feeling more alive and human than ever as a result of their disorder. The patient does not wish to be “cured,” because they do not believe themselves to be ill.
One of the most famous disorders of superabundance is Tourette’s syndrome. Associated with an excess of the hormone and neurotransmitter dopamine, Tourette’s is characterized by an excess of nervous energy, commonly finding expression in repetitive motor movements called tics, as well as verbal outbursts.
One man, who called himself “Witty Ticcy Ray,” had experienced severe tics since the age of four. And yet, Ray forged a meaningful life for himself despite his affliction—indeed, he claimed it gave him an entire identity. He was an accomplished jazz drummer and a masterful ping pong player, both fields in which the speedy reflexes and reactions caused by his syndrome appeared to give him an advantage.
When Sacks began treating him with Haldol, an antipsychotic medication that blocks dopamine receptors in the brain, Ray felt he’d lost some essential part of himself. Although his tics decreased, he became slow and deliberate, unable to engage in the witty spontaneity and flights of inspiration that had so defined him. Worse still, he’d lost his musical fluidity as a drummer.
Ray didn’t want to entirely shed the part of himself that was defined by Tourette’s. So he and Sacks decided on a dual strategy—he would take Haldol during the weekdays but would stop taking it on weekends. On Saturday and Sunday, he would fully embrace his “Witty Ticcy Ray ” persona.
As humans, we have a basic need to shape a narrative about ourselves and how we came to be who we are. Sacks saw the most profound embodiment of this elemental need in a patient named Mr. Thompson. Thompson suffered from Korsakov’s syndrome, an alcohol-related condition that impairs short-term memory and causes retrograde amnesia—the inability to recall short-term memories.
Thompson’s condition caused him to constantly adopt new personae for himself, refashioning his world in an ever-changing drama with a revolving cast of characters. All the while, Thompson would regale those he encountered with fantastic anecdotes. He gave the outward appearance of a funny, charming, and ebullient man.
But all the while, he was suffering from the devastation of his short-term memory, using his powerful imagination to reinvent the world around him. This provided him with what felt like stability and normalcy, when his true reality had actually gone to pieces.
Neurological abnormalities can also reshape the human experience through our dreams, revelations, and visions. These sublime moments are central to the human experience and have been the focus of art and spirituality throughout human history.
But they are actually caused by neurological phenomena. Specifically, experiments have shown that stimulation of the temporal lobes can conjure extraordinarily vivid auditory, visual, and even olfactory memories from one’s past.
One of Sacks’s patients was an 88-year-old deaf woman named Mrs. O’C, who lived in a retirement home. She had begun hearing old Irish folk songs playing, often quite loudly, sometimes waking her up in the middle of the night. She realized that the songs weren’t coming from a radio or any other external source—the music was playing entirely in her head.
When he ran an EEG test on her, Sacks saw that Mrs. O’C had suffered a stroke and was experiencing temporal lobe seizures during the moments when she indicated that a song was playing. The music brought Mrs. O’C back to her early childhood in Ireland, a period of her life of which she had no concrete memories at all. Her parents had both died before she turned five, after which she’d been sent to America to live with an aunt. The music brought back lost memories of Mrs. O’C’s loving mother. In these memories, it was her mother’s voice that was singing the beloved songs. This confirmed to Mrs. O’C that she had had someone in her life who’d loved and cared for her.
For Mrs. O’C, the seizures were a gift, an opportunity to regain a lost part of herself and open a door that had always been shut.
Bhagawhandi was a young woman of Indian origin who was suffering from a brain tumor that caused seizures in her temporal lobe. The seizures transported her to the scenes of her girlhood in India, an experience she found enjoyable.
These were rich and detailed journeys to the past—highly organized, presenting consistent and coherent landscapes and characters. She saw her childhood home, village, and the surrounding countryside in vibrant detail. She was not merely seeing these scenes—she was inhabiting and experiencing them.
Bhaghawandi retreated more and more into her dream world, before she came to live there exclusively right before her ultimate death. Her journey to the past was complete.
But the reactivation of lost memories can also be dark and disturbing. One patient named Donald had murdered his girlfriend while under the influence of the drug PCP. Although he had no memory of committing the act, he was sentenced to a hospital for the criminally insane.
Five years later, while out on parole, Donald became involved in a bicycle accident that caused damage to his frontal lobes. Soon after, he began having awful nightmares of the long-suppressed murder. The nightmares turned into waking visions, in which he could suddenly remember and see it in all its horror. The damage to his frontal lobes had reactivated the memory, which now haunted him. Donald was nearly driven to suicide by the suddenly unescapable scene of carnage playing out in his mind.
Thankfully, with therapy and anticonvulsant drugs, Donald’s temporal lobes returned to a normal state and he found peace in gardening and nature, away from people. He managed to get to a place where he could remember the murder but was no longer consumed by it.
Some of Sacks’s most meaningful work was with intellectually disabled patients—those with neurological impairments that left them unable to perform even the most basic functions. He noted that such patients often struggled with abstraction and, instead, inhabited a purely concrete world.
Broadly speaking, abstract thought deals with the world of ideas and concepts that don’t “exist” in the physical world—like humor, freedom, and irony. Concrete thought, meanwhile, concerns those things that do exist in the physical world. Sacks believed that intellectually disabled people, with minds devoid of abstraction, experienced a more intense and vivid world.
We cannot be complete beings without the concrete, and its powers of expression and feeling are just as poignant and powerful as those of abstraction. Sacks saw some of the essential elements of humanity through his work with the intellectually impaired.
Rebecca was a 19-year-old girl with severe intellectual disabilities. But she had an extraordinary capacity to understand stories and narrative and fully grasped the metaphors, symbols, and imagery contained within them—because symbols, after all, are concrete objects representing abstract ideas. She was liberated from her intellectual constraints when she entered the narrative-based worlds of literature and spirituality.
In working with Rebecca, Sacks found that treatment in traditional clinical settings did little for her. But when she enrolled in a special theatre group for the intellectually disabled, she thrived. Rebecca was able to make meaning and become complete by playing characters.
Rebecca’s limitations concealed the parts of her that were preserved—and indeed, thriving.
After his experience working with her, Sacks saw that neurology focused too much on deficits, with its diagnostic and treatment tools failing to properly account for the full powers of a human being.
Jose was a young man in his early 20s who was unable to communicate verbally—symptoms that doctors would later use to diagnose Jose with autism. His parents, fearful that he would suffer a seizure in public and become injured, began keeping him in the cellar of their home when he was a boy. For 15 years, Jose was deprived of nearly all links to the outside world.
After a particularly violent seizure, Jose’s parents finally took him to the hospital, where EEG scans confirmed that Jose was experiencing severe temporal lobe disorders on both his left and right sides.
The hospital staff discovered that Jose had a remarkable talent for drawing. Indeed, Jose’s sketches were his only mode of self-expression, deprived as he was of other means of communication. His excellent performance in visual and spatial tasks seemed to compensate for verbal skills deficits.
The first time Sacks met Jose, he was thoroughly impressed by the young man’s success in drawing a watch in great detail. At their next meeting, Jose was able to reproduce a landscape scene on a magazine cover. In fact, Jose’s copy surpassed the original in many ways—he imbued the scene with mood, feeling, and character that had been lacking in the original. Subsequent drawings from Jose hinted at an interior life rich with creativity, emotion, and a sophisticated appreciation for aesthetics.
Sacks saw that a talented artist like Jose had the potential to lead a rich and fulfilling life, perhaps as an illustrator. But he lamented the short-sightedness of the mental health system of which Jose was a part. Nurturing his prodigious talents would require a patience that the other doctors around him lacked. Sacks lamented that Jose’s talents were likely to be wasted by an outdated mental health framework that saw people like Jose as somehow less than human.
Sacks’s work with his patients shows the pitfalls of traditional thinking about neurological disorders. As we’ve seen, people suffering from these conditions can lead rich lives filled with joy and creativity. Studying disorders of the human brain, ironically, can give us insight into just how powerful it is and how it is the source of so much of our humanity.
It is incumbent on the neurological profession to expand its view of neurological disorders and of the people who are afflicted by them. There is enormous untapped potential and capacity for them to lead meaningful and productive lives. But first, we must abandon the idea that such individuals are irreparably damaged or abnormal. But perhaps their “normal” isn’t deviant or wrong, but merely different than our own. Rather than attempting to cure or alter it, we should open ourselves up to the possibilities that the study of their unique brains can reveal to us. In recognizing their humanity, we come to recognize our own.
Neurology is often seen as a purely cold and clinical science, dealing with the concrete wiring of the brain. Indeed, we often think of brain science as a field of study too esoteric and advanced for it to have anything deeper to say about the human condition.
But this view is false. The human brain is not a computer or purely rational processor of data. The brain is precisely what makes us human, giving us our identity and deepest sense of self. Neurology is that rare field that can bring the rational empiricism of science together with the deepest philosophical questions that mankind has always sought to answer. What makes us human? What is the true nature of the self, of memory, knowing, or action?
By studying the work of neurologists—specifically their work with people who have suffered brain damage—we rediscover their humanity, and our own. The late neurologist Oliver Sacks dedicated his life to studying the mysteries and extraordinary powers of the human brain. In The Man Who Mistook His Wife for a Hat, Sacks presents the stories of some of his patients, all of whom suffer from one neurological impairment or another.
The stories of the people demonstrate the remarkable complexity of the human brain and its extraordinary capacity to adapt. Every story we’ll explore is more than just a case history; it is a narrative that tells a profoundly human story of struggle, survival, and, in some cases, hope.
As we study the lives of these patients, some key themes emerge:
Neurologists often speak of brain disorders in terms of deficits. A deficit is some impairment of neurological function, usually linked to brain damage to some particular area. Damage to Broca’s area, for example, is known to cause aphasia—the inability to process and understand written or spoken language.
We now know that the right hemisphere of the brain is primarily responsible for recognizing and ordering our reality. Indeed the right hemisphere is the neurological base of our identity and sense of self. It is how we root ourselves in time, space, and relation to other people.
But when the right hemisphere is damaged and the individual begins to lose this grounding and sense of identity, the brain has a remarkable ability. It replaces or compensates for this loss, creating a new reality that keeps our identity and self intact. In other words, the brain is adept at turning deficits in one area into surpluses in another.
In this chapter, we’ll explore the stories of patients who suffered brain damage that compromised core functions like visual recognition, memory, body awareness, and language. All of these patients lost some crucial element of their humanity, but the power of the human brain simultaneously endowed them with some extraordinary abilities to navigate their world, make sense of what they saw, and retain some sense of identity and self.
We can see a clear example of a neurological deficit in the strange case of Dr. P, a distinguished professor of music. Author Oliver Sacks met with Dr. P after the man’s wife reported that her husband was having strange problems with visual recognition.
This manifested in bizarre ways. Dr. P seemed to be unable to recognize the faces of his students and only knew them when they spoke or played their instruments. He also had the opposite problem—seeing faces where there were none. To the bafflement of observers, Dr. P was known to pat inanimate objects like parking meters and fire hydrants, thinking they were children.
When Dr. P went to an ophthalmologist, he discovered that his eyes were not the problem. Dr. P suffered instead from agnosia—an inability to recognize and interpret visual data. He could observe the visual world around him but derive no holistic meaning from it.
Sacks’s initial examination revealed that Dr. P was having problems with the left side of his brain. Sacks identified a few symptoms of Dr. P’s condition immediately:
Sacks found that Dr. P could not identify the faces in photographs of friends and family. Those he could recognize were those with distinct features—he identified a photo of his brother by noting his brother’s square jaw and big teeth.
But even this was only further evidence of his condition. He was identifying only the features and using them as a clue to guess the identity of the person, but he was not truly recognizing them. He was missing the forest for the trees, using characteristics as clues to unlock the puzzle of the unrecognizable world in which he lived. This also explained why he could identify highly stylized cartoon drawings, abstract shapes, or playing cards, but struggled to identify his own wife—whose head he often grabbed at, believing it was a hat.
Similarly, Dr. P could identify the individual features of objects, but never define what the object was as a whole. To him, a rose was “a convoluted red form” with a strange green tube attached to it.
Although Dr. P had lost the power of visual narrative, his mind seemed to compensate for this deficit by crediting his neurological “account” in other ways. As we saw with his rich and detailed descriptions of the features of objects like flowers or gloves, it was clear that Dr. P had exceptional powers of abstract description. This was one of the ways in which Dr. P managed to service meaning from his world. A clear manifestation of this was how he excelled at schematic mental models involving abstract shapes—he was a skillful player of blind chess, able to perfectly visualize the board and pieces on his mind.
His already prodigious musical skills were another means by which Dr. P held his atomized world together. Dr. P was only able to perform the routine functions of daily life by means of music. His clothes had to be laid out in the same precise way every day and he had to maintain a musical rhythm while he dressed himself. Any change or interruption would render him unable to complete the task. Thus, his life was ordered like a carefully orchestrated opera, each note and beat guiding him through his days.
Sacks recommended that Dr. P commit to living a life entirely consisting of music. Music was one of the gifts Dr. P’s brain had given him to compensate for his devastating impairment, providing him a tool to order, recognize, and make sense of his world.
Brain damage can also affect another crucial component of the self—memory. How can someone be said to be truly existing as a human being if they have no sense of past, but instead live in a continuous present that is reinvented every few seconds? This takes us to the remarkable case of Jimmie G.
Jimmie G. was a patient whom Sacks first met in 1975. This man likely suffered from the neurological impairment known as Korsakov’s syndrome, a condition caused by alcohol-related damage to the mammillary bodies in the brain. Korsakov’s syndrome impairs short-term memory and causes retrograde amnesia—the inability to recall memories.
The most recent memories tend to be those most severely impacted, with patients forgetting people they met and events they witnessed mere minutes before. Sometimes, the memory loss extends backward in time, eating up memories further and further back until only the most distant remain. The worst sufferers of Korsakov’s syndrome paradoxically become trapped in the past, while at the same time living in an inescapable present. This was the tortured psychic state in which Sacks first encountered Jimmie G.
One of the first things that struck Sacks was Jimmie’s excellent long-term memory. He could recall his childhood in Connecticut; the homes he’d lived in (even their phone numbers); his interest in math and engineering as a high school student; and his time in the US Navy, where he’d worked as a radio operator during World War Two.
But something curious happened when Jimmie talked about his Navy days. He switched to the present tense and began talking about his plans for what he was going to do when he was discharged from service in the war. He spoke of the death of President Franklin Roosevelt and the Allied victory in the war as though they were current events. Sacks realized that Jimmie still thought it was 1945 and that he was still a 19-year-old sailor. In reality, it was 1975 and he was nearly fifty years old.
When Sacks presented Jimmie with a mirror and asked him if the face he saw looked like that of a 19-year-old, Jimmie recoiled in horror, unable to understand what he was looking at. It temporarily shook his sense of identity to the core.
Luckily for Jimmie, he forgot the entire matter of the mirror a few minutes later. For, in addition to being stuck in the past, Jimmie was also stuck in an eternal present, having almost no short-term memory. He was good at solving puzzles, but only those that could be done within seconds or minutes. He was unable to do anything that took longer because he would forget the task he was engaged in.
Further, anything said to him would be forgotten in a matter of seconds, although sometimes he could show faint echoes of short-term memory. After Sacks stopped doing memory exercises with Jimmie and resumed them a few minutes later, Jimmie reported vaguely remembering performing similar exercises with a doctor “a while back,” but did not remember that it had been Sacks and that “a while back” was mere minutes before. His condition had rendered every moment of his existence devoid of temporal meaning and context.
After looking into Jimmie’s case history further, Sacks discovered that he had actually been in the Navy until 1965 and had been mentally competent throughout the entire period of his service. Sacks made contact with Jimmie’s brother, who told him that around 1970, Jimmie had suffered some sort of break, began drinking heavily, and almost entirely blotted out his post-1945 memories. When the brother went to visit Jimmie, Jimmie was unable to recognize him.
An essential piece of Jimmie (or whoever he may once have been) was missing and probably gone forever. He told Sacks that he didn’t feel miserable but that he didn’t enjoy life either, and said, hauntingly, “I haven’t felt alive for a very long time.”
But after consulting with the great Russian neuropsychologist Alexander Luria, Sacks resolved to help Jimmie regain some semblance of his humanity. Luria reminded Sacks that the self consists of more than just the memories of past events. Even someone as severely impaired as Jimmie still possessed feeling, emotion, and a sense of the sublime.
Sacks moved Jimmie to a facility where he was cared for by a team of doctors and nurses. Jimmie never truly came to recognize anyone at this facility, though he did come to familiarize himself with the setting, managing to navigate the halls and find his way to and from his room. He was capable of having emotionally significant visits with his brother, whom he still loved, though Jimmie, thinking his brother was in his 20s, could not explain why he looked so old for his age. These meetings were deeply poignant—Jimmie’s brother was his only link between his disconnected present and the past in which he still imagined himself to be living.
But some indestructible element of Jimmie’s being managed to overcome his impairment and even thrive. When Jimmie went to church and participated in the Mass, he was clearly moved spiritually. His disorder was an advantage here, because he was able to connect to God and remain completely in the moment. He could also follow and enjoy the rhythms of music and drama. Apparently, there were parts of Jimmie—perhaps the soul or the spirit—that even Korsakov’s could not destroy. The mind may have been irreparably damaged, but the soul could still be uplifted by music, art, and communion.
So far, we’ve talked about neurological losses as they relate to “internal” functions like visual recognition and memory. But the physical body is, of course, also an essential part of the self. Control and awareness of one’s body are crucial to our sense of autonomy. They are so automatic that we scarcely think about them.
But what happens when we are no longer guaranteed the certainty of our physical selves? This brings us to the unusual and disturbing case of Christina and her loss of proprioception.
Christina was a healthy, 27-year-old woman and mother of two. The night before she was scheduled to have a routine surgery to remove gallstones, Christina had an awful nightmare in which she imagined she had no control over her body. She wasn’t paralyzed in this dream—she could still move, but she had no control over her movement or awareness of where her body was in relation to the physical world.
Although the nightmare was initially dismissed by the hospital psychiatrist as standard pre-surgery hysteria, it soon became Christina’s living reality. She came back to the hospital, claiming that she felt weirdly disembodied, disconnected from her physical self. She had lost any sense of balance; could not hold objects or reach for them; could not stand without looking at her feet; and had suffered a total loss of tone and muscle posture, with her hands wandering freely unless she made a conscious effort to hold them in place.
When Sacks was called in to examine her, he found that Christina wasn’t suffering from hysteria at all. From head to toe, she had completely lost proprioception—her sense of self-movement and body position. Proprioception is a sixth sense, the “eyes” of the body by which we orient and position ourselves in relation to the physical world. It is how we know where our bodies are in space.
For example, even if you close your eyes, you can still touch your finger to your nose, because proprioception tells you where parts of your body are in relation to one another—you don’t need to rely on your sense of sight to tell you where your finger or your nose is.
Without proprioception, we are disembodied, with no innate awareness of our physical selves. Christina found that she could not sense her own body anymore. Whereas she once intuitively knew where her arm was, she now had to rely on her sense of vision to locate it—painstakingly using her eyes to consciously will her body to do what it had once done automatically. Whereas she once knew how to modulate her voice because her sense of proprioception gave her an awareness of her vocal cords, she now had to use her powers of hearing to regulate its volume and tone.
Christina had become a third-party operator of her body, as though it was an object that was no longer part of herself. With great concentration, she could control it, but it was no longer “hers” in any way. She was driven to the deepest despair by her condition, likening it to a “dead veil” that had enveloped her being, telling Sacks, “I feel my body is blind and deaf to itself.”
But Christina managed to regain some mastery over her body, through making extraordinary efforts and compensating for her loss with her other five senses. She regained her balance by maintaining an overly formal and upright sitting pose. Likewise, she learned to modulate her voice by adopting a theatrical, stagy voice. She had to adopt a constant pose of artifice and performance to make up for the lost reality of her proprioception.
Eventually, these mechanisms became second nature to Christina. Life was possible once again—although it would always be disembodied, and never normal.
The ability to understand language is one of the defining traits of humanity. Other organisms communicate through sounds, but there is no parallel to the evocative power of human speech. Yet some people who’ve suffered brain damage are robbed of this ability. They suffer from aphasia—the inability to process and understand spoken words.
But, as we’ve seen, the brain has a remarkable ability to compensate for deficits in one area with neurological surpluses in another. Aphasiacs may possess an uncanny ability to look beyond the veil of words and derive true meaning more clearly than anyone.
In the 1980s, Sacks was at an aphasiac ward of a psychiatric hospital, where the patients were watching a televised speech being given by President Ronald Reagan. Their aphasia inhibited them from processing and understanding the words the president was speaking. But they could still understand the non-verbal aspects of language, indeed, far better than most other people. Sacks observed that they were highly attuned to the changing rhythms, intonations, and cadences of Reagan’s speech.
Looking past the words prepared by Reagan’s speechwriters, they heard only his tone and inflection. Based upon this, they saw the polished actor-turned-president as a dissembling phony, keenly picking up on the falseness of his tone and body language. And their reaction to his speech was not reverential respect—it was uproarious, hysterical laughter! Sacks learned that one cannot fool an aphasiac with slick rhetoric, because they have extra heightened sensitivity to tone and can never be misled with words.
Agnosia presents the exact opposite condition. Someone with agnosia can understand only words, but not tone or expression. Sacks asked an agnosia patient named Emily D. how she interpreted Reagan’s address. Because she could understand nothing but words, Emily needed people to use precise wording in order for her to derive meaning from speech. Slang, colloquialisms, metaphors, or any other imprecisions of language would render what she was hearing incomprehensible.
When she listened to Reagan’s speech, she focused on its imprecision with words. The president was not clear in what he meant, and, according to Emily, this meant he was either brain-damaged or being dishonest. Once again, it took patients with brain damage to look past Reagan’s slick speech and see it for what it really was.
In the last chapter, we focused on the impact of neurological deficits—disorders that produce some impairment or inhibition of crucial functions like speech and memory. Throughout most of the history of neurology, practitioners have focused on these deficits and the problems that result from the loss of function.
But what about the opposite phenomenon, of excesses and superabundances? What happens when neurological functions work on overdrive? That is what we’ll explore in this chapter.
Disorders of superabundance make it difficult to control crucial aspects of our humanity—impulse, will, action, and passion. Patients who experience these uninhibited rushes often don’t feel ill or lost at all, as did some of the patients like Jimmie G. and Christina whom we met in the previous chapter. Indeed, this other class of patients often reports feeling more alive and human than ever as a result of their disorder. The rich interior life of a person, once dormant and dull, can become truly activated by neurological illnesses.
But there is a dark side to this frenzy and mania. The excesses can subsume the individual. Illness can masquerade as wellness. The activation of pleasure centers in the brain caused by disorders like Tourette’s, syphilis, and even some forms of Korsakov’s syndrome (which we explored in the last chapter) can be powerfully addictive; the patient does not wish to be “cured,” because they do not believe themselves to be ill.
The first disorder of superabundance we’ll explore is Tourette’s syndrome. Tourette’s was first diagnosed in the late 19th century by the French physician Georges Albert Édouard Brutus Gilles de la Tourette (who gave the disorder its name). It was largely forgotten over the next century, thought to be a rare syndrome. It began to receive renewed interest within the neurological community, the media, and among the general public in the 1970s.
Associated with an excess of the hormone and neurotransmitter dopamine, Tourette’s is characterized by an excess of nervous energy, commonly finding expression in repetitive motor movements called tics, as well as in verbal outbursts like coprolalia, the compulsive utterance of obscenities and slurs in socially inappropriate situations (these are called verbal tics).
Tourette’s can sometimes give the appearance of exerting a demon-like control or possession over its sufferers. The syndrome becomes their identity, blocking out all other aspects of the personality that lies beneath. Unnerving and frightening for outsiders to witness, Tourette’s patients can suffer severe social stigma and isolation.
In the most severe cases, the tics can go beyond physical gestures and verbal outbursts. They become tics of the mind, jerking perception and personality itself back and forth. Unlike severe forms of amnesia, the Tourette’s sufferer is all too aware of their disorder and the impulses it causes, constantly battling it in an epic psychic tug-of-war, a struggle to form their own identity from under the weight of Tourette’s.
In the 1970s, Sacks met a Tourette’s patient named Ray, who called himself “Witty Ticcy Ray.” He was 24 years old and had experienced severe tics since the age of four. Ray had suffered severe social stigma as a result of his condition and had been fired many times for his outbursts (he was known to yell obscenities like “Fuck!” at inappropriate times).
And yet, Ray had found the strength to forge a meaningful life for himself despite his affliction—indeed, it seemed to give him an entire identity. He was an accomplished jazz drummer and a masterful ping pong player, both fields in which the speedy reflexes and reactions caused by his syndrome appeared to give him an advantage. He was sharp and witty in repartee, which he attributed to the superabundance of energy due to Tourette’s. As Ray put it, “I consist of tics and nothing else.” It was, in short, an essential part of himself—one that he did not wish to lose.
Sacks began treating Ray with Haldol, an antipsychotic medication that blocks dopamine receptors in the brain and is also used to treat schizophrenia. Ray’s initial treatment with Haldol seemed to be effective and the tics disappeared. But they soon reappeared with a strange twist: they were slower, with Ray even becoming stuck in catatonic mid-tic states. Moreover, he had lost some essential part of himself. Ray was now slow and deliberate, unable to engage in the witty spontaneity and flights of inspiration that had so defined him. Worse still, he’d lost his musical fluidity as a drummer.
Sacks realized that medication alone would not be sufficient to treat Ray. He couldn’t just suppress the neurological basis of his syndrome; he needed to break Ray of his addiction to the wild thrill of Tourette’s, show him how rich and full his life could be without it. Only then could pharmaceutical options be exploited.
Ray wanted to maintain what he saw as the benefits of his tics, but be able to function better in the world. Sacks and Ray decided on a dual strategy—he would take Haldol during the weekdays but would stop taking it on weekends. On Saturday and Sunday, he would fully embrace his “Witty Ticcy Ray ” persona.
If Ray presents us with a hopeful story, however, we should be reminded of the psychic prison that the manic energy of Tourette’s imposes on many of its sufferers.
One day on the streets of New York City, Sacks saw an older woman wildly convulsing on the sidewalk. On closer inspection, he saw that she was imitating the people who passed her by on the street, grotesquely caricaturing and exaggerating their faces and gestures—each only for a split second.
The spectacle created a dizzying feedback loop. As people passed by the woman and realized what she was doing, they expressed their anger, bewilderment, and disgust. The woman, in turn, imitated these reactions in her highly stylized and lurid way, further eliciting more cycles of reaction and counter-reaction.
Eventually, the woman could maintain the dizzying imitation game no longer and ran to a nearby alley. There, she made a gesture of “expurgating” the personalities she had “consumed,” as if she had taken in her fill and could take no more. This was the tragedy of her condition—she was powerless to stop drinking in the demeanors and expressions of strangers, even when it clearly caused her great distress to do so. There was no self, just the masks and personas she borrowed from others.
We see another example of a patient succumbing to the dizzying highs of their neurological excesses in the story of Natasha. Natasha was an 88-year-old woman when she came to see Sacks. She reported feeling more energized and young than she had in decades. She even said she felt sexually “frisky,” pursuing and flirting with younger men.
Curiously, she diagnosed herself with what she termed “Cupid’s Disease.” Sacks had never heard this term before, but Natasha explained that it referred to the sexually transmitted disease known as syphilis. Although easily treated with penicillin in the modern era, syphilis was once a devastating disease. In the 18th and 19th centuries, when it was left untreated, it could lead to devastating neurological impairment and sharp personality changes—with these symptoms sometimes not manifesting until decades after infection.
Natasha explained that she’d been a prostitute at a brothel in the Greek city of Thessaloniki over 70 years before and that this was where she likely had caught the disease. Sacks knew that syphilis had a long latent period, but a seven-decade lag between infection and the onset of symptoms was extraordinary. But tests confirmed that Natasha’s self-diagnosis was spot-on—the bacteria’s spirochetes were stimulating her cerebral cortex and inflicting the cerebral damage that was causing her change in personality.
But Natasha did not want to cure her disorder. For her, it had become a wonderful new reality, giving her a new lease on life and a vibrancy she had not experienced in decades. Just as he had with Ray, Sacks opted for a middle course. The medical team administered her penicillin to kill the spirochetes but leave intact the cerebral damage that was causing her freeing flights of inhibition. She would live the rest of her life voluntarily in thrall to her illness. She gave herself up to Cupid.
The last case we’ll explore in this chapter touches on the very nature of reality, our need to derive meaning from our world, and the demands of the human psyche to shape a narrative about ourselves and how we came to be who we are.
Sacks encountered a patient named Mr. Thompson, who, like Jimmie G. from the previous chapter, suffered from Korsakov’s syndrome. But the manifestation of his disorder was of an entirely different character than that of Jimmie’s. Although Jimmie was frozen at a moment in time, he retained a hold on the person he once was. Jimmie had a consistent life-narrative, albeit one that was totally at odds with the lived reality of his present.
In contrast, Mr. Thompson’s retrograde amnesia caused him to constantly adopt new personae for himself, refashioning his world in an ever-changing drama with a revolving cast of characters. One minute, he might believe that he was a deli owner, addressing Sacks as if he was one of his customers. Another time, he might be a reverend. All the while, Thompson would regale those he encountered with fantastic anecdotes. He gave the outward appearance of being a funny, charming, and ebullient man.
But Mr. Thompson was suffering from the devastation of his short-term memory, using his powerful imagination to reinvent the world around him. He displayed a superabundance of energy, gregariously spinning new yarns to anyone he encountered. In fact, he seemed to be constantly talking and narrating. He was weaving a dense web of fantasy and illusion around himself. As we’ve seen with other neurological disorders, this was the way Mr. Thompson’s mind imposed rationality on an entirely irrational state.
It kept his sense of self intact, even if it was constantly being torn down and rebuilt—for indeed, Thompson had no awareness of the condition he was in. The fantasy and reinvention helped him make sense of the world surrounding him, providing him with what felt like stability and normalcy, when his reality had gone utterly to pieces.
Mr. Thompson’s gregarious storytelling was a way of creating a new world to replace what was lost, a constant creation and re-creation of a new self. And the fantasies worked—Mr. Thompson could never be convinced that anything at all was wrong with him. Poignantly, his condition speaks to the human necessity for an inner narrative, a knowledge of who we are and how we got to be that way—even in a man who had no short-term memory or point of self-reference.
Mr. Thompson was in a state of perpetual bewilderment, needing to fix the gaps in his memory all the time through endless reimagination. It was an exhilarating, but terrible existence. His world and his being were consumed by unreality. Even when he could identify real figures, like his younger brother Bob, he could not extricate them from fantasy. Mr. Thompson merely incorporated Bob into the neverending confabulations, scarcely treating him as a real person, but instead relegating him to become just another character in the fantasy where he permanently resided.
Unlike his fellow Korsakov’s sufferer Jimmie, Thompson was unable to have genuine emotional relations or be moved by music or spirituality. The nuns at the home where he lived acknowledged that while he may have had an immortal soul in the eyes of God, he did not have a soul in the way that we might typically think of one—a capacity for feeling and experience. The thick veneer of fantasy prevented him from ever engaging with the real world.
Sacks and the other doctors believed that if they could get Mr. Thompson to quiet down, to tame his boundless energy for story and self-reinvention, he might find some inner safe harbor. The only way he could quiet the fantasies was when he was divorced from people altogether. In the garden, among the plants and flowers, Thompson had less need to invent new realities. There, he could be at peace, alone with whatever his thoughts may have been, free from the human pressure to weave a new self-narrative.
Explore why maintaining a self-narrative is so crucial to our existence.
Briefly explain how your memories of past experiences and events shape your identity and sense of self.
Would you “be yourself” if you lost some part of your memory? Explain why or why not.
In the first two chapters, we looked at how neurological disorders can manifest as either deficits or superabundances—the brain either underperforming or overperforming. In this chapter, we’ll explore another dimension of how neurological abnormalities reshape the human experience: through our dreams, revelations, and visions.
Many of us have entered such mystical and otherworldly states before—an old memory suddenly unearthed, seemingly from nowhere; déjà vu, the mysterious sense that one has lived through some present situation before; or spiritual experiences that seem to bring us face-to-face with the divine. These sublime moments are central to the human experience and have been the focus of art and spirituality throughout human history.
But what we think of as spiritual or mystical journeys have a foundation in neurology and the inner workings of our brains, specifically the temporal lobe. Indeed, there are organic determinants to our most transformative moments. Studying the cases of people who have suffered severe neurological trauma can give us insight into these phenomena and demonstrate how it is the complex interplay of transmitters, receptors, cortexes, and neurons within our brains that truly makes us human.
We should not, however, succumb to the belief that these transformative experiences are somehow cheapened or diminished by ascribing a physical, scientific explanation to them. Studying these brain functions, to the contrary, brings us closer to understanding the workings of our spirituality. For it is within our temporal lobes that we create the images and reminiscences that transport us to other dimensions and planes of being.
In the 1950s, the great neurosurgeon Wilder Penfield demonstrated that stimulation of the temporal lobes in his patients produced extraordinarily vivid auditory, visual, and even olfactory memories. They could be so powerful, in fact, as to blot out real events happening concurrently, a sort of “doubling of consciousness.”
It is important to note that these experiences were memories, not fantasies. And they triggered the same wave of emotions that the patient had experienced during the original experience. They seemed indeed to be perfect and authentic reproductions of reality. Penfield’s research suggested that the brain had a perfect record of one’s entire life experience, a way to travel back in time in one’s mind.
Many times, these memories were pleasantly evocative, allowing patients to revisit old friends, family, and scenes of their youth. But other times, the frontal lobe stimulation unearthed dreadful memories, long-suppressed, of the worst moments in patients’ lives. We'll explore some cases of each type in this chapter.
Music has a great power to evoke memories and touch the soul. And in some cases, it can be the neurological link to a lost world of childhood memories and experiences. One of Sacks’s patients was an 88-year-old deaf woman named Mrs. O’C, who lived in a retirement home. She had begun hearing old Irish folk songs playing, often quite loudly, sometimes waking her up in the middle of the night.
But she could not find the radio or external source for the mysterious music. Even more curiously, she only seemed to be hearing one very particular set of Irish songs that she’d heard long ago when she was a girl in Ireland. It became clear to her that the music was playing entirely in her head.
What was Mrs. O’C experiencing? How could such a vivid musical episode come to her mind, more than 80 years after she’d heard these songs—of which she had no active memory? When he ran an EEG test on her, Sacks saw that Mrs. O’C had suffered a stroke and was experiencing temporal lobe seizures during the moments when she indicated that a song was playing. The stroke had activated long-dormant musical memories in Mrs. O’C’s cortex that transported her back to back to her early childhood in Ireland, a period of her life of which she had no concrete memories at all.
Her parents had both died before she turned five, after which she’d been sent to America to live with an aunt. Although she knew that this had been part of her life, she could never access it in her mind and had always yearned to rediscover the lost memories of her mother and her life in Ireland. As we’ve seen with other patients with neurological disorders, Mrs. O’C did not see the temporal lobe seizures as a curse—for her, they were a gift, an opportunity to regain a lost part of herself and open a door that had always been shut.
Three months later, the seizures stopped. The songs were gone and the door was closed once more. Mrs. O’C told Sacks that hearing the music in her head had been one of the greatest and most emotionally resonant experiences of her life, one for which she was deeply grateful. In her nearly ninety years, she’d lived a hard life, feeling alone, unloved, and abandoned. Now, she was comforted in the knowledge that she had been loved and cared for after all. It brought a profound sense of closure.
L-Dopa is an amino acid used to treat Parkinson’s disease. It can also trigger forced memories and a reactivation of older versions of the self. One of Sacks’s patients, a 63-year-old woman with Parkinson’s, found herself with a sharply resurgent sexual drive after being administered L-Dopa. But the renewed libido was really just one component of a broader transformation. This woman came to relive the life her younger self had lived during the 1920s. Like Mrs. O’C’s musical reminiscences, this woman found herself effortlessly remembering long-forgotten songs and jokes from the period. Even more remarkable, she began using the idioms and slang from that time. When the L-Dopa levels were brought down, the forced reminiscences ceased.
To some extent, we all experience these journeys to the past through the common experience of déjà vu, the mysterious sense that one has lived through some present situation already. Often, such rushes of reminiscence are triggered by sensory experiences like music or smell. In these moments, we are transported to another time and place. It suggests that these memories are permanently stamped in the brain, awaiting the right stimulus to reactivate them and make them “real” once more.
(Shortform note: The most famous work on involuntary memory may come from the world of literature. In Marcel Proust’s seven-volume novel A Remembrance of Things Past, the narrator takes a bite of a madeleine, a French tea cookie he’d eaten as a child. The smell, texture, and taste of that one bite of cookie cause a vast surge of long-forgotten memories and imagery of the past to come flooding back into his consciousness.)
Bhagawhandi was a young woman of Indian origin who was suffering from a brain tumor that caused seizures in her temporal lobe. The seizures transported her to the scenes of her girlhood in India, an experience she found enjoyable.
But her dreams were far more vivid and lucid than those often produced by temporal lobe seizures. They were no mere hallucinations or flights of fancy. They were rich and detailed, presenting consistent and coherent landscapes and characters. She saw her childhood home, village, and the surrounding countryside in vibrant detail. She was not merely seeing these scenes—she was inhabiting and experiencing them.
As we saw with Penfield's research, there was a “doubling of consciousness.” The visions occurred alongside and supplemented Bhagawhandi’s real experiences, enabling her to describe to Sacks and the other doctors what she was seeing and experiencing.
Bhaghawandi knew that she was dying from her tumor. She saw the visions as a homecoming that was getting closer and closer as her illness progressed. She retreated further and further into her dream world, before she came to live there exclusively right before her ultimate death. Her journey to the past was finally complete.
But the reactivation of lost memories can also be dark and disturbing. One Sacks patient named Donald tragically murdered his girlfriend while under the influence of PCP. Because of the drug, he had no memory of committing the act. He was sentenced to a hospital for the criminally insane (although staff seriously doubted whether he was criminal or insane—psychologically speaking, the murder had been committed by another person).
After five years, Donald was released on weekend parole, which allowed him to journey outside the prison campus before returning at the end of the week. One day while bicycling, he became involved in an accident that caused damage to his frontal lobes and even put him in a coma for two weeks. When he awoke, Donald began having awful nightmares of the long-suppressed murder. The nightmares turned into waking visions, in which he could remember and see it now in all its horror.
Interviews with police showed that the details of his nightmare-visions corresponded perfectly with the forensic evidence. It was impossible for Donald to have known some of the particularities that he described from outside sources—because the details were too gruesome to have been revealed in open court during his trial. The only explanation was that the damage to his frontal lobes had reactivated the memory, which he now could not escape.
We’ve seen other patients who experienced disinhibitions, like Ray with his tics and Natasha with her reactivated libido. But Donald’s disinhibition was not related to some aspect of his personality or behavior. What was being disinhibited, instead, was his capacity to repress this traumatic memory.
Thankfully, with therapy and anticonvulsant drugs, Donald’s temporal lobes returned to a normal state and he found peace in gardening and nature, away from people. He got to a place where he could remember the murder, but was no longer consumed by it.
One final example of the transformative power of the brain to open new avenues of consciousness and transport the individual to another plane of being can be seen in the case of a young medical student named Stephen. Stephen was a heavy user of cocaine and amphetamines. One night while he was high on these stimulants, he dreamed that he was a dog and could experience the world through the sense of smell.
When he awoke, he found that the dream had come true. His nose suddenly became a key that unlocked the door to a world he’d never known. It was like nothing he’d experienced before, as if he had been “blind” to the world of smell and was “seeing” it all for the first time. He was able to distinguish everything in the world by the sense of smell. Even people were identifiable purely by their smell (he claimed that everyone had a unique “smell-face”) and he was able to navigate New York City purely through smell.
After three weeks, Stephen’s dog-like state abated. He resumed normal functioning, but he missed the richness and immediacy of what he’d briefly experienced and, now, permanently lost. Like Mrs. O’C and Bhaghawandi, he had caught a fleeting glimpse of a world lying just beneath the surface.
In the previous three chapters, we explored the case histories of patients whose impairments either inhibited some core neurological function, super-charged these functions, or transported the individual to a world of forgotten memories. But we have not yet looked at those patients whose brain functioning, at first glance, seems to be the most compromised—those with severe intellectual disabilities.
(Shortform note: In this summary, we have eschewed a lot of the outdated—and, in modern times, insensitive—language that Sacks uses to describe some of his patients in this chapter. For instance, Sacks describes “retarded” patients who are “idiots” or “morons.”)
Sacks believed that there was something profoundly moving about working with intellectually disabled patients. Much of this had to do with the distinctions between abstract and concrete thought. Broadly speaking, abstract thought deals with the world of ideas and concepts that don’t “exist” in the physical world. Concrete thought, meanwhile, concerns those things that do exist in the physical world. The concrete world is that of the tactile, particular, and immediate.
Individuals with intellectual disabilities often struggle to grasp abstraction. Instead, they inhabit a purely concrete world. Because they were freed from the encumbrances of abstraction, they had a quiet sense of completeness and innocence that was rarely found in “normal” people. Moreover, their world was often more intense and vivid, freed as it was from the encumbrances of abstraction.
This view of intellectual disability, however, was at odds with much traditional neurology at the time he was writing. Classic neurology saw the ability to comprehend abstract ideas as one of the crowning achievements of the human brain, a trait that separated it from the brains of other, lower organisms. Meanwhile, this school of thought viewed concreteness as primitive and regressed.
But, as we will see with the case histories to follow, such a view is misinformed. Concrete thinking is a crucial part of what it means to be human. Its absence can wreak havoc—to see the consequences of this, we don’t need to look any further than the story of Dr. P from Chapter 1, an otherwise intelligent man who nevertheless had no ability to understand the concrete world right in front of him and could only make sense of it in terms of stylized abstractions.
As we’ve seen with all of our cases, poor functioning in one area of the brain seems to lead to enhanced functioning and ability in another. Without abstraction, intellectually disabled patients can fully immerse themselves in the world of the concrete, amassing a dazzling mental collection of details and particulars.
Concrete thought is capable of expressing emotion and feeling just as poignantly and powerfully as abstract thought. We see some of the essential elements of our own humanity in studying the intellectually disabled.
Rebecca was a 19-year-old girl with severe intellectual disabilities. She had an IQ of 60 (90-110 is considered to be normal or average intelligence) and was unable to dress herself, read, write, or count, to list just a few of her limitations. Overall, she struggled with tasks that required abstract thought and seeing the “big picture.”
But Rebecca had an extraordinary capacity to understand stories and narrative and fully grasped the metaphors, symbols, and imagery contained within them—because symbols, after all, are just concrete objects representing abstract ideas. Indeed, story and symbol were the keys that Rebecca used to unlock the abstract mysteries of her world.
She had a great appetite for story, frequently begging her grandparents to read to her. Sacks observed that it was not unlike how small children can understand ideas like empathy and love when they are represented in a story, but are unable to understand such abstract concepts when they are presented outside the context of a narrative.
Rebecca could even understand complex poetry and fully participate in the prayer services at her family’s Orthodox Jewish synagogue in New York—despite being otherwise unable to comprehend even the most basic verbal commands. She was liberated from her intellectual constraints when she entered the narrative-based world of literature and spirituality.
She had the soul and spirit of a poet; she was spiritually and emotionally complete, even if she was running an intellectual “deficit.” Rebecca could create narrative and meaning just as well as she could understand it, too. Sacks several times observed her conjure poetic imagery in wonderful, unexpected bursts when she was contemplatively looking at nature. Despite having no capacity to see abstract patterns or schema, she saw the real world with a clarity that few others could.
When her beloved grandmother died, Rebecca could only express her profound grief through allegory and metaphor—literary devices that are, of course, ways of linking the concrete world to the abstract world of ideas. She told Sacks, “It is winter, I feel dead”; “Part of me died with her”; “She’s gone to her Long Home.”
In working with Rebecca, Sacks found that treatment in traditional clinical settings did little for her. But when she enrolled in a special theatre group for the intellectually disabled, she thrived. Rebecca was able to make meaning and become complete by playing characters. Rebecca described her own condition in an apt simile: “I’m like a sort of living carpet...I come apart, I unravel, unless there’s a design...I must have meaning.”
Rebecca’s limitations concealed the parts of her that were preserved—and indeed, thriving. After his experience working with her, Sacks realized that neurology focused too much on deficits, with its diagnostic and treatment tools failing to properly account for the full powers of a human being.
Another intellectually disabled patient of Sacks’s was Martin, a 61-year-old who came to live at the facility Sacks operated. Martin suffered from Parkinson’s disease and had been severely brain damaged by meningitis as an infant. His disabilities prevented him from holding down a job or taking care of himself.
But Martin had a gift for music. Specifically, he possessed an exceptional musical memory and knew the music from over 2,000 operas, as well as all the other details of each production—the roles, who had sung the leads, and where they’d been performed anywhere in the world. This love of music was an inheritance from his late father, who had been a singer with New York’s Metropolitan Opera. Father and son had bonded over opera and it remained Martin’s passion and guiding light.
When he first came to live at the facility, Martin could often be irritable and unsociable, given to childlike fits of temper that made him unpopular with staff and patients alike. He later confided to Sacks that he missed being able to sing. He had sung in a choir every Sunday with his beloved father, he explained, until the latter passed away. Music was what sustained him.
Seeing that Martin was being denied his crucial creative outlet, Sacks arranged to have him resume his singing at churches and cathedrals across New York City, where he soon became valued for his encyclopedic musical knowledge.
Martin was utterly transformed when he sang. Gone was the childish and often spiteful person Sacks had come to know at the facility—in these moments, Martin was a complete person, fully at peace. In working with him, Sacks saw that Martin’s musical knowledge was no mere knack or trick of rote memory. Instead, he had a deep and sincere musical intelligence, one that could grasp the rich subtleties of a composer like Bach and appreciate the complexity and structure of the music.
One of Sacks’s most interesting windows into the concrete world of the intellectually disabled was his work with a pair of autistic twins named Michael and John. The twins had earned some level of national fame for their television appearances, in which they demonstrated their ability to immediately tell the day of the week for any date, no matter how far into the past or into the future. They also were able to perfectly recite 300-figure long number strings.
When asked to retrieve a date or a number sequence, their eyes would appear to “scan,” as if they were seeing and retrieving data. It dawned on Sacks—the twins were not human calculators; instead, they “saw” the dates and events, as if they were splashed across a vast canvas in their minds. Numerical concepts were completely concrete for them, as real and physical as anything in the outside world.
Michael and John, however, were unable to perform simple operations like addition and subtraction and had absolutely no comprehension of multiplication or division. These concepts were too abstract for them to process.
While visiting the twins one day, Sacks accidentally knocked a pack of matches on the floor, causing its contents to spill out. The twins immediately declared, “111.” When Sacks picked up the matches, he saw that there had been precisely 111 matches on the floor. Moreover, they murmured “37, 37, 37” after they identified the 111 matches—the prime factors of 111.
In speaking with Michael and John, Sacks realized that they hadn’t done any sort of counting or calculation. They simply “saw” 111, as if that number had certain unique qualities or properties (Sacks labeled it “111-ness”) that made it instantly recognizable. It was akin to someone who has perfect pitch, the ability to identify and reproduce any musical note without using a reference.
This provided an important insight into how the twins’ minds worked. On another occasion, Sacks observed the pair sitting quietly and contemplatively as they recited six-figure numbers to each other. They would name seemingly random numbers like “100,153” or “999,773,” to one another and smile contentedly as they “savored” the numbers, appearing to appreciate each for its own unique qualities—almost as if they were appreciating some piece of visual art or a nature scene. They found serenity and harmony in this ritual, an almost religious reverence for the beauty of numbers.
While trying to discover the significance of the numbers the twins were savoring, Sacks consulted a mathematical book and discovered that all of the six-figure numbers they were passing back and forth were prime numbers (divisible only by one and themselves).
This was remarkable—the twins had no understanding of division or multiplication, so it was impossible for them to do the calculations necessary to determine what a prime was (and there is no simple method or formula for calculating primes). They just “saw” primes in their minds and recognized them intuitively. It also explained why they said “37, 37, 37” when they saw the 111 matches on the floor—37, of course, being a prime number.
Sacks decided to join their prime number game and (cheating by using a book as reference) ventured his own eight-figure prime number. The twins contemplated it and, after some time, smiled in satisfaction. By some unknown process, they evaluated it as a prime number. Over the course of the session, the twins expanded their game, reaching new prime numbers going up to twenty figures.
It was impossible to discern the true workings of their ritual, but it seemed to Sacks as if the twins inhabited a rich and detailed universe of numbers, and could identify and retrieve primes on sight—as if they were walking through an endless meadow and plucking only a particular kind of flower.
Sadly, the hospital where Michael and John lived decided to separate them from one another, in the hopes of breaking them out of their isolated world and making them “socially acceptable.” To be sure, there were some positive results—they could perform menial jobs, take the bus, and maintain a decent outward appearance.
But the separation robbed them of their numerical communion and ritual, which was clearly the main joy and purpose of their lives. Their skills at identifying and appreciating prime numbers rapidly deteriorated. Sacks wondered if they really needed to be “cured.” If they were able to appreciate beauty in numbers and derive meaning and purpose from this pursuit, were they really damaged or defective? Sacks lamented their situation, which left the twins with all their deficits and none of their gifts.
The last Sacks patient whose story we’ll explore is Jose. Jose was a young man in his early 20s who, at age eight, had suffered a severe case of encephalitis. The illness wreaked havoc on Jose’s neurological functioning. He became prone to frequent and violent seizures and was no longer able to communicate verbally—symptoms that doctors would later use to diagnose Jose with autism.
His parents, fearful that he would suffer a seizure in public and become injured, began keeping him in the cellar of their home. For 15 years, Jose was deprived of nearly all links to the outside world. After a particularly violent seizure, Jose’s parents finally took him to the hospital, where he was able to get the treatment he needed. EEG scans confirmed that Jose was experiencing severe temporal lobe disorders on both his left and right sides.
The hospital staff discovered that Jose had a remarkable talent for drawing. Indeed, Jose’s sketches were his only mode of self-expression, deprived as he was of other means of communication. His excellent performance in visual and spatial tasks seemed to compensate for verbal skills deficits.
The first time Sacks met Jose, he was thoroughly impressed by the young man’s success in drawing a watch in great detail. At their next meeting, Jose was able to reproduce a landscape scene on a magazine cover. In fact, Jose’s copy surpassed the original in many ways—he imbued the scene with mood, feeling, and character that had been lacking in the original. Subsequent drawings from Jose hinted at an interior life filled with creativity, emotion, and a sophisticated appreciation for aesthetics.
Jose’s artistic works demonstrated his entirely concrete and particular mind. They evinced no understanding of general categories or fixed forms and were free of ambiguity. Sacks saw that a talented artist like Jose had the potential to lead a rich and fulfilling life, perhaps as an illustrator. But he lamented the short-sightedness of the mental health system of which Jose was a part. Nurturing his prodigious talents would require a patience that the other doctors around him lacked.
His gifts were too often written off by the hospital staff as being merely tricks of a human Xerox machine, rather than the artistic fruits of a sensitive and delicate soul. Sacks lamented that Jose’s talents were likely to be wasted, his potential remaining forever untapped.
Sacks’s work with his patients shows the pitfalls of traditional thinking about neurological disorders. As we’ve seen, people suffering from these conditions can lead purposeful lives filled with joy and creativity. Studying disorders of the human brain, ironically, can give us insight into just how powerful it is and how it is the source of so much of our humanity.
It is incumbent on the neurological profession to expand its view of neurological disorders and of the people who are afflicted by them. There is enormous untapped potential and capacity for them to lead meaningful and productive lives. But first, we must abandon the idea that such individuals are irreparably damaged or abnormal. But perhaps their “normal” isn’t deviant or wrong, but merely different than our own. Rather than attempting to cure or alter it, we should open ourselves up to the possibilities that the study of their unique brains can reveal to us. In recognizing their humanity, we come to recognize our own.
Explore the main takeaways from The Man Who Mistook His Wife for a Hat.
In what ways does the brain compensate for neurological deficits in one area with neurological advantages in another? Use two examples from the summary to support your answer.
Briefly explain the distinction between concrete and abstract thinking.
How has reading this summary changed your views of neurological disorders? Are there any ways in which you think some illnesses can actually be gifts?