The Sixth Sense

The Man Who Mistook His Wife For a Hat and Other Clinical Tales

by Oliver Sacks
Summit, 233 pp., $15.95

Dr. Oliver Sacks is a British-trained neurologist who now practices in New York, where he is professor of clinical neurology at the Albert Einstein College of Medicine. With his earlier book, Awakenings (1973), which described the remarkable effect of a new drug, LDopa, on cases of postencephalitic parkinsonism, Dr. Sacks established himself as a writer who could describe physical illnesses clearly to lay readers, who could both imagine and communicate what it is like to suffer neurological diseases that undermine the bodily ground of our being, and who felt no inhibitions about reporting his own amazement, fascination, compassion, and optimism when confronted by patients with rare, extraordinary, and tragic disorders.

Then came A Leg To Stand On (1984), in which Dr. Sacks described how he himself had suffered damage to the nerves of one of his legs, as a result of which he lost all idea that that leg was any part of himself and experienced it (temporarily) as an external encumbrance of which he had no subjective awareness. Both these books—as well as Migraine (1973, revised 1985), which was apparently written primarily for migraine sufferers—are inspired by a specific philosophy of medicine, the idea that “it is insufficient to consider disease in purely mechanical or chemical terms,” as contemporary medicine mostly does, but “that it must be considered equally in biological or metaphysical terms, i.e., in terms of organization and design.” In other words, it is not enough to regard the body as a machine which can go wrong and be repaired or tinkered with by medical mechanics, but it must also be regarded as the residence, the ground, indeed part of the person, the soul.

It follows from this philosophy that case histories, and perhaps particularly neurological case histories, cannot just be objective accounts of the signs, symptoms, and lesions observed and inferred by the physician, but must also include accounts of the patient’s subjective experience of his illness, including his experiences of changes in his perception of his self-perceiving self. As Dr. Sacks puts it in his preface to his present volume of clinical tales:

There is no “subject” in a narrow case history; modern case histories allude to the subject in a cursory phrase (“a trisomic albino female of 21”), which could as well apply to a rat as a human being. To restore the human subject at the centre—the suffering, afflicted, fighting, human subject—we must deepen a case history to a narrative or tale; only then do we have a “who” as well as a “what,” a real person, a patient, in relation to disease—in relation to the physical.

The patient’s essential being is very relevant in the higher reaches of neurology, and in psychology; for here the patient’s personhood is essentially involved, and the study of disease and identity cannot be disjoined. Such disorders, and their depiction and study, indeed entail a new discipline, which we may call the “neurology of identity,” for it deals with the neural foundations of the self,…

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