Mistakenly took the wife for a hat

Author: (USA) Oliver Sacks / Zhu Jianping
Publisher:
Publish Date: 2003-08-01
Features: Oliver Sacks is hailed as "the greatest clinic writer of the 20th century," pioneering a unique genre that combines character legends with medical popularization. All of his works have been wildly popular in Europe and America, and this book is one of the most outstanding among them. These clinic stories are bizarre and shocking: the patients described are all lost in absurd and fantastical worlds, some losing their memory or most of their past; some unable to distinguish people from ordinary objects; some experiencing severe convulsions, constantly making grotesque faces; some uttering obscene words but unable to control themselves; some with limbs acting against their will, as if their souls have left their bodies; some with intellectual disabilities yet displaying extraordinary artistic talent and mathematical abilities. With Sacks' empathetic and vivid pen, these stories are filled with a rich human touch.
[Preface]
Pascal said, "The most important problem to solve after writing a book is what to place at the beginning." Therefore, when I finished writing these strange stories, compiled them, organized them, and chose a title, quoted two epigraphs, now I need to review what I have done—and why. The dual nature of the epigraphs, as well as the stark contrast between them—actually, this is the true reflection of a certain duality within me: I feel myself to be both a naturalist and a doctor; I am interested in both disease and people; and I may be both a theorist and a playwright (though neither qualification is particularly strong); I enjoy both the precision of science and the romance of legendary tales, and I find both in the human environment, especially in the environment of typical human diseases. Animals can get sick, but only humans can be completely consumed by disease. My work, my life, are all closely tied to patients—but it is precisely the patients and their diseases that drive me to think. Without patients, without diseases, perhaps there would be no thoughts at all. The relationship between them is so close that I cannot help but ask, as Nietzsche did, "When it comes to disease, are we not always asking: Could we live without it?"—therefore, I am again moved to try to understand the fundamental questions raised by disease. Patients constantly prompt me to ask questions, and questions constantly lead me closer to patients—therefore, in the stories or studies in this book, I am always jumping from one story to another, from one study to another. Study? Yes, study. Why stories or cases? Hippocrates introduced the concept of the case history, believing that disease has a developmental process—from initial symptoms to climax or crisis, and then to a pleasant or fatal resolution. Thus, Hippocrates proposed the concept of the case history, which is a description of the natural history of disease—accurately expressed by the old term "pathology." These case histories are a form of natural history—but they cannot tell us anything about the individual or their history, nor can they convey any information about people or their experiences of struggling to survive in the face of disease. In those rigid case histories, there is no "subject"; modern case histories often use an imprecise term when referring to the subject (e.g., "21-year-old female trisomy albino patient"), which can refer to both humans and mice. To restore the central position of the "human subject"—the suffering, courageous human subject—we must further deepen the case history, writing it as a narrative or story; only then will we have both an "animal what" and a "human who," and truly possess a human patient related to disease—and to the body. The fundamental existence of the patient is of great significance in advanced neurology and psychology, because here the personality of the patient is closely tied to the study of disease, and the study of disease is inseparable from the study of identity. These diseases and their descriptions and studies indeed require a new discipline, which we call "identity neurology," because it deals with the neural basis of the self—a question as old as the study of thought and the brain. There is undoubtedly an insurmountable gap between the spiritual and the physical, a gap of categories; however, research and stories coexist, inseparable, and are closely tied to both the spiritual and the physical—what fascinates me most is precisely this, and what I am describing here is precisely this. Therefore, research and stories can bridge the distance between the spiritual and the physical, leading us to the intersection of mechanism and life, making us see more clearly the relationship between physiological processes and biography.
The clinic stories, rich in human touch, once reached their peak in the 19th century but declined with the emergence of objective neurology. Luria once wrote, "Descriptive ability was so common among outstanding neurologists and psychiatrists in the 19th century that it has almost vanished today. This ability must be revived." His own recent works, such as The Mind of a Memory Artist and The Man Who Mistook His Wife for a Hat, are attempts to revive this tradition. Therefore, the case histories in this book draw on an ancient tradition: both the tradition mentioned by Luria in the 19th century and the tradition left by Hippocrates, as well as the tradition that prehistoric patients always told their doctors about their experiences. Classical fables often feature archetypal characters—heroes, warriors, victims, and martyrs. Neurological patients embody these characteristics—and in the strange stories told here, their characteristics go far beyond these. If we apply these fictional or metaphorical terms, how can we classify "Marina Lost" or some other strange characters in this book? We could say they are travelers who have come to unimaginable lands—if not for them, we would never have known or even conceived of these lands. Why do their lives and journeys seem to have an allegorical quality to me? Why did I use the metaphor from The Arabian Nights in Oliver Sacks' The Man Who Mistook His Wife for a Hat as my epigraph? Why do I still feel compelled to mention stories and fables when discussing cases? The reason is this. In such a field, the precision of science and the romance of legendary tales demand to come together—they converge at the intersection of fact and fable (as in my book The Awakened), and this intersection becomes the fundamental characteristic of the patients' lives that I describe here. But what facts! What fables! What are we comparing them to? Perhaps we have no existing models, metaphors, or myths. Has an age of new symbols and new myths already arrived? Eight chapters in this book have already been published: "Marina Lost," "The Hand," "The Twin Brothers," and "The Artist with Autism" were published in The New Yorker (1984, 1985); "Viti Tacey Lee," "The Man Who Mistook His Wife for a Hat," and "Memory Reappeared" were published in The London Review of Books (1981, 1983, 1984)—among them, "Memory Reappeared" was abridged as "Music Ear." "The Leveler" was published in Science (1985). In "Nostalgia That Cannot Be Escaped," you can see the earliest description of one of my patients—he is the "prototype" of Rose R. in The Awakened and also the "prototype" of Deborah in Harold Pinter's A Kind of Alaska, which was inspired by The Awakened (the original article was titled "Nostalgia Induced by Levodopa" and published in the Spring 1970 issue of The Lancet). In my four "Illusions," the first two were published under the title "Clinic Freaks" in The British Medical Journal (1984). Two short stories are excerpted from previously published works: "He Fell Off the Bed" is from One Leg Stands; "Hildegaard's Hallucinations" is from Headache. The remaining twelve were written in the autumn and winter of 1984 and are entirely new and have not been published before. Here, I would like to express my special thanks to my editors: first, Robert Silvers of The New Yorker and Mary-Kay Wilmers of The London Review of Books; then, I also want to thank Kate Edgar, Jim Silberman of SummitBooks in New York, and Colin Heycraft of Duckworth in London, who have devoted hard work to the final publication of this book. Among my neurologist colleagues, I would like to express my special thanks to the late Dr. James P. Martin, who I showed the videos of "Christina" and "Mr. McGreggor" to and discussed these patients with in depth—"The Woman Who Had the Spirit of a Man" and "The Leveler" benefited greatly from his insights. I would like to thank Dr. Michael Kremer, my "boss" in London, who described a very similar case of his own after reading One Leg Stands (1984)—this is now included in "He Fell Off the Bed"; I would like to thank Donald Mac, whose unique case of visual agnosia bore a comical resemblance to the case I described, and which I stumbled upon two years after finishing my article—the excerpt is included in the postscript to "The Man Who Mistook His Wife for a Hat"; and I would like to express my special thanks to my close friend and colleague, Isabel Rapin in New York, with whom I have discussed many cases; she introduced me to Christina ("The Woman Who Had the Spirit of a Man") and knew the "Autistic Artist," José, for many years when he was a child. I hope to thank the patients (and the relatives of some patients in certain cases) mentioned in my stories for their help and generous dedication—they knew (as they usually did) that they could not directly benefit from it but still allowed me to describe their lives and encouraged me to do so, hoping that others would understand it, comprehend it, and one day be able to cure it. Like The Awakened, to protect privacy and professional confidentiality, the real names of the patients and certain specific details of their environments have been altered, but my true purpose has always been to preserve their basic "feelings" for life.
Finally, I would like to thank—not just thank—but my mentor and doctor, to whom I dedicate this book.
Oliver Sacks
February 10, 1985, New York