This is a 1985 work by Dr. Oliver Sacks (1933-2015), who was a British-American neurologist turned writer.

This was his fourth book, and the one that really put him on the international stage, following on from Migraine (1970) and Awakenings (1973, also turned into a 1990 film).

The Man Who Mistook His Wife for a Hat made the good doctor famous. Not least with its leading story, a fascinating case study of a musician with visual agnosia.

Since its launch it’s featured in a lot of pop culture across the world and is referenced often, but the fact is it remains a brilliant and empathetic work. And an important insight for laypeople into the inner works of the human mind.

Making Neurology Cool and Fascinating in The Man Who Mistook His Wife for a Hat

“If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.”

He split this, his fourth book, into four parts:

1. Losses.
2. Excesses.
3. Transports.
4. The World of the Simple.

In this lot we come across individuals who have been afflicted by some of the most confounding neurological disorders you can imagine.

These case studies range from terrifying, to fascinating, and even rather amusing.

There is Christina from 1977 who becomes “disembodied”—ultimately she relearns how to use her body by directing limbs with her eyes.

Elsewhere readers are introduced to an ageing gentleman who doesn’t realise he’s walking at a bizarre angle. We also come across individuals stricken with memory loss, long dormant illnesses, and phantom limbs.

Then there’s the eponymous case study, the one arguably most famous from this work. As for many readers it was a memorable introduction to the bizarre world of neurological conditions.

For the layperson, the medical world is one we rarely enter. Usually not until we, or someone we know, gets ill. Then we demand answers from busy, stressed professionals.

If you refer to Roy Porter’s Blood & Guts: A Short History of Medicine (2002) you can get a sense of the level of advances in medicine over the last 150 years.

Certainly, the understanding of the human brain is still in its relative infancy. It was actually the Phineas Gage brain injury of 1848 that spurred on a lot of new understanding of the human mind.

And that’s what Dr. Sacks’ book encapsulates.

It is, unfortunately for those impacted by the condition, random patients dealing with issues that teach us more about how we function. Their debilitating conditions can, at the very least, provide others with reason for hope.

And it’s hope, and certainly empathy, that we think makes up a great deal of Dr. Sacks’ prose across his most famous book.

Dr. P’s Dilemma in The Man Who Mistook His Wife for a Hat

The reader’s introduction to the confusing, complicated world of neurology begins with chapter one’s iconic case study.

A composer with a faltering vision, it seems, who’s getting confused with day-to-day occurrences in a weird way.

After a brief introduction to the man and his accomplished abilities, that leads to arguably the most famous section of the work. A brilliant bit of writing and one we’ve remembered, and poured over, since we first read the book.

“I had taken off his left show and scratched the sole of his foot with a key – a frivolous-seeming but essential test of a reflex – and then, excusing myself to screw my ophthalmoscope together, left him to put on the shoe himself. To my surprise, a minute later, he had not done this.

‘Can I help?’ I asked.

‘Help what? Help whom?’

‘Help you put on your shoe.’

‘Ach,’ he said, ‘I had forgotten the shoe,’ adding, sotto voce, ‘The shoe? The shoe?’ He seemed baffled.

‘Your shoe,’ I repeated. ‘Perhaps you’d put it on.’

He continued to look downwards, though not at the shoe, with an intense but misplaced concentration. Finally his gaze settled on his foot: ‘This is my shoe, yes?’

‘No, it is not. That is your foot. There is your shoe.’

‘Ah! I thought that was my foot.’

Was he joking? Was he mad? Was he blind? If this was one of his ‘strange mistakes’, it was the strangest mistake I had ever come across.”

Dr. P. as a”musician of distinction” suffered from visual agnosia, which led to an inability to comprehend objects.

Dr. Sacks, in one section, shows him an image of the Sahara Desert and asks the composer to describe what he sees. That leads to this.

“A little guest-house with its terrace on the water. People are dining out on the terrace. I see coloured parasols here and there.”

Despite this, the man somehow maintained his possession as a lecturer of music. And there are some similarities to the story of British musician Clive Wearing (his story told here in Answers With Joe’s documentary series).

Wearing is now heading into his late 80s. He developed chronic anterograde and retrograde amnesia in 1985. He lives in a constant cycle of short-term memory.

His situation does play in with other studies in Sacks’ work, such as one gentleman with the same issue due to Korsakoff syndrome (brough about due to alcoholism). That’s chapter two from Losses in The Lost Mariner.

“It was not, apparently, that he failed to register in memory, but that the memory traces were fugitive in the extreme, and were apt to be effaced within a minute, often less, especially if there were distraction or competing stimuli, while his intellectual and perceptual powers were preserved, and highly superior.”

Returning to Dr. P, this first story does end on the sad note of the composer’s eventual demise. A brain tumour responsible for sending his vision elsewhere.

Dr. Sacks couldn’t find a cure for this ailment (naturally).

What he did do was encourage the composer to focus in on his musical talent, which remained completely unaffected by his condition. Remarkably. Another consistent theme of the book—patients devastated in some areas of their functioning, yet thriving brilliant in others.

The Twins and the Autist Artist

There are two brief autism related case studies at the end of part four. The Twins were autistic savants with severe mental handicaps.

But they did have a capacity for a remarkable documentarian memory, able to pick up on the most remarkable details and recall them.

“A box of matches on their table fell and discharged its contents on the floor: ‘111,’ they both cried simultaneously; and then, in a murmur, John said, ’37.’ Michael repeated this, John said it a third time and stopped. I counted the matches – it took me some time – and there were 111.”

Upon asking them how they could count so quickly, they respond by explaining they “saw” the 111.

Dr. Temple Grandin’s book The Autistic Brain (2013) sheds more light on ASD workings, Grandin having become a celebrity thanks to her efforts dealing with her condition. As did the twins in the ’60s, briefly appearing on talk shows to show off their memory skills.

The Autist Artist is a little different, highlighting instead the extreme creativity that can come with being ASD.

Dr. Sacks met with a mentally disabled young man in his early 20s, one gifted with high artistic abilities. We can point to Kenzaburō Ōe’s A Personal Matter (1963) here, as the writer’s son was born with a brain hernia, is autistic, and doesn’t speak

Yet Hikari Ōe is a very gifted composer and musician, highly skilled with chamber music and the works are remarkable to listen to.

These chapters from Dr. Sacks again highlight what people can bring to the world, even in the face of disability and difficulties. There is within a creativity urge or productive skill, one that can be put to use to provide self-worth throughout their lives.

The Man Who Mistook His Wife for a Hat as an Opera (Michael Nyman’s Work)

Legendary composer Michael Nyman adapted Dr. Sacks’ book into a full opera in October 1986. There are still performances of it to this day.

Nyman styled it as a one-act piece of chamber music.

The opera enjoyed its debut at the Institute of Contemporary Arts in London, with its narrative remaining faithful to Dr. Sack’s case study. The tenor, baritone, and soprano sing of his struggles—given he was a composer, it seems a fitting adaptation.

However, Nyman did have to reassure Dr. P’s wife the opera wasn’t intended to trivialise her husband’s situation.

To note, this opera was filmed in 1987, but there are various other recordings available online. There was also a CD album released in 1988. A quick search of YouTube and you’ll find plenty more.

The Hope Within Dr. Sacks’ Case Studies

“Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov’s, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.”

Reading through The Man Who Mistook His Wife for a Hat is poignant, but we do think Sacks’ work is defiant.

The case studies he tells showcase humanity dealing with adversity.

Almost every individual in the work battles on. We think of the poor disembodied lady, who somehow learns to exist despite her predicament. Or Dr. P who amiably continues on with his life. Or the memory less patients who put on a brave face amongst the confusion.

Where Dr. Sacks’ book works so well is it removes the complexities of medical language, making it accessible for everyone.

It makes us think of Carlo Rovelli’s Seven Brief Lessons on Physics (2014).

With esoteric scientific/medical interests, particularly ones demanding such a high level of intellect to truly understand, it does cut a lot of people off from that world. Our brains are just incapable of comprehending physics, for example, but we do find it fascinating.

Yet here we have, in bitesize form, works that explain them to us with clarity.

The marvel of reading! And Dr. Sacks’ various works are a must for anyone wanting to delve into the brilliant, mystifying, and frightening world of neurology.