Oliver Sacks – The Man Who Mistook His Wife for a Hat


This book was everywhere in the 80s. It became an opera (punctuated with an on-screen brain-dissection lecture, although not in this clip), inspired an album by Travis and the film Memento and made Sacks recognisable enough to be parodied. It’s twenty-four inspiring and intriguing case-studies of patients whose brains were telling them things that other people didn’t perceive. One of the patients is Sacks himself, but he only admitted this much later.

What made this book so popular was a combination of Sacks’ obvious compassion and interest in these patients as people and the recurrent point that the tiny changes to their brains had an enormous impact on their perceptions but not on who they were. The distress they experienced when they were unable, looking from inside, to make that distinction did affect some of them. It allowed anyone who thought that personality was somehow separate from brain-state to continue with that thought, whether they were religious or hard-line social constructivists, whilst removing the discredited Cartesian Dualist idea that the self was somehow disconnected from the body. It also allowed people to dignify small differences in ability with long words, so that anyone who’d hitherto been a bit crap at remembering faces now could say ‘I have prosopagnesia’.

Sacks’ concern went a bit deeper in this book. What he is emphatically not doing here is drawing a straightforward linear correlation between a small defect in a specific part of the brain and a peculiar set of perceptual differences between the afflicted individual. That’s ‘peculiar’ as in ‘unique to’, but the accounts usually start with an extreme manifestation. What comes across time and again in his work is that the mind is a set of processes as much as a cluster of neurons and peptides. A disruption in that process has knock-on effects that aren’t pedictable in advance and the personality of the individual will tend to try to overcome those disruptions or work them into the previously routine activities as though nothing had changed. This book predates the huge strides in imaging techniques and the wholly new realisation that, far from being set in stone at around 19 and just decaying slowly thereafter, the brain rewires itself and can, in some circumstances, expand some portions. Neural plasticity, as a concept, was laughable in the 80s.

Paradoxically, that makes Sacks’ diligent observations more interesting. He’s witnessing changes that he can’t measure the way someone with an fMRI scanner can now. Whilst he’s a long way from the largely-discredited work of Freud his anecdotal reports (‘anecdotal’ in the sense of ‘not deliberately engineering a situation with a control-group, non-experimental’) have the same potency as those of a century earlier, as a sort of folklore of odd behaviour indicating an obscure inward cause. In all such cases the message is the same: the part of me I call ‘me’ is only part of the story and is a work-in-progress, not a fixed, knowable object. Everything we think we are depends on thousands of interlinked systems all not-going-wrong simultaneously and continuously for decades. Miraculously, for most of us, we get away with it and take this to be normal (which it is) and thus unremarkable (which it isn’t).

By Tat Wood