Case studies

The DO Book Club, January 2021: The Man Who Mistook his Wife for a Hat and Other Clinical Tales

Oliver Sacks, MD, who was a prominent neurologist and historian, argues for a paradigm shift regarding what he calls neurology’s favorite word: “deficit.”

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Welcome back to The DO Book Club!

For January, Lydia Duvall, OMS IV, of the Marian University College of Osteopathic Medicine, read The Man Who Mistook his Wife for a Hat and Other Clinical Tales by Oliver Sacks, MD. Duvall is pursuing a career in pediatric anesthesiology and hopes to contribute to global health initiatives for vulnerable children.

If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email Andy Brown at abrown@osteopathic.org.

Plot Summary

In this book of case studies from 1985, Dr. Sacks, who was a prominent neurologist and historian, takes readers on a journey through the complexity of the brain, and argues for a paradigm shift regarding what he calls neurology’s favorite word: “deficit.”

At the beginning of the book, we meet Dr. P, the patient after whom this book is named. A music teacher and singer, he had a peculiar case of visual agnosia, meaning he lost the ability to recognize concrete objects in front of him but was able to maintain his sense of abstract thought (the ability to understand concepts not tied to physical objects, such as music) and memory.

Dr. Sacks says his predecessors once believed this to be impossible, and that they considered patients with these inabilities to be “subhuman.” He takes a different approach, encouraging Dr. P to focus on his strength, abstract thoughts, by continuing to teach music.

Dr. Sacks then discusses neurological excesses, otherwise known as a superabundance of neurological function. One 88-year-old patient named Natasha K. was suddenly described as becoming “radiant,” “flirtatious,” and “frisky,” more so than she did in her twenties.

She realized after one year of this euphoric state that something was wrong, and correctly diagnosed herself with latent neurosyphilis, something she had caught seventy years prior. Dr. Sacks believed her story revealed a strange irony: “what a cruelty … that inner life … may lie dormant unless … awakened by disease” (p. 107).

Another recurring idea addressed is that of transports or dreamlike portals to the beyond or unknown. One patient was orphaned and adopted from Ireland at five and had no memory of her homeland or mother. However, when she began having frontal lobe seizures, she had sudden nostalgia, hearing Irish songs and vividly remembering her mother’s embrace.

The seizures brought a sense of relief, because she knew from these unlocked memories that she had been loved.

Notable quotes

Another chapter details the case of a 49-year-old man named Jimmie G., who had Korsakoff syndrome due to alcoholism. He had no memories after his teenage years and no short-term memory and no longer recognized his reflection, believing himself to be 19.

Dr. Sacks though nothing could hold Jimmie’s attention until he observed him attending Mass. Dr. Sacks came to a realization while witnessing what he thought was impossible for Jimmie: concentration and attention.

“A man does not consist of memory alone. He has feeling, will, sensibility, moral being … It is here … you may touch him and see a profound change. Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely” (p. 38).

As Dr. Sacks introduces the section of the book on neurological excesses, he states that to understand the true “life of the mind,” neurologists (and all physicians) must think beyond the narrowing and limited scope of standard medicine. Failing to do so, he writes, may explain why patients struggling with common disorders sometimes do not receive the understanding they deserve.

“Traditional neurology, by its mechanicalness, its emphasis on deficits, conceals from us the actual life which is instinct in all cerebral functions—at least higher functions such as those of imagination, memory and perception. It conceals from us the very life of the mind” (p. 89).

Takeaways

Although the stories shared in this novel could be viewed as tragic, Dr. Sacks’s tone of empathy, compassion, and innovation shed new light on cases that may otherwise have been viewed as dismal prognoses.

The cases presented echo a theme, which is that physicians can sometimes focus too much on dysfunctions and deficits, and focus too little on what is preserved in patients who have those deficits. In other words, as medical students like me prepare to embark on the journey of residency, we should remember that people are more than their disease. And, if we are willing to take the time to be truly present with our patients, we will be astonished by how much they can teach us.

February’s book

For February, The DO Book Club will be reading Womb With a View: Tales from the Delivery, Emergency and Operating Rooms by Rebecca Levy-Gantt, DO. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore due to COVID-19, we recommend checking out eBook options for rent or purchase.

As a reminder, if you read “The Man Who Mistook His Wife for a Hat” or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email abrown@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, December 2020: The Spirit Catches You and You Fall Down

The DO Book Club, November 2020: On Immunity: An Inoculation

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