The husband who mistook his wife for a hat. Oliver Sacks. The man who mistook his wife for a hat. The man who mistook his wife for a hat and other stories from medical practice

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Oliver Wolf Sachs

From translators

We would like to express our deep gratitude to everyone who helped in the work on this book, especially Alexey Altaev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeniy Chislenko and Elena Kalyuzhny. Translation editor Natalya Silantyeva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been completely impossible.

Foreword by the scientific editor

Having received an offer to edit the translation of the book by the famous neurologist, psychologist and writer Oliver Sacks, “The Man Who Mistook His Wife for a Hat,” I agreed without thinking for a minute. This book, a gift from an American colleague, has been on the shelf of my closet for fifteen years next to the works of A. R. Luria. I have returned to it many times over the years. When teaching a course in neuropsychology, it is simply impossible to resist quoting Sachs. But “The Man Who Mistook His Wife for a Hat” is much more than a special monograph or a manual for teachers and doctors.

Oliver Sacks is one of the best known names in his field in the West. And his popularity goes far beyond the boundaries of a narrow professional environment.

He was born and educated in London and continued his education in the USA. Since 1970, his books - Migraines, Awakenings, A Leg to Stand - have won over readers. The book that the reader picks up is the fourth and one of Sachs’s most significant works. It cannot be said that Sachs is completely unknown in Russia. Several of his essays entitled “Cases from Practice” were published in the journal “Foreign Literature”. His works are referenced by Russian authors - both neuropsychologists and writers (for example, Tatyana Tolstaya). But the real acquaintance with the work of Oliver Sacks is yet to come for the Russian reader. How to determine the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a fairly narrow circle of readers. This is not to say that Oliver Sacks resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than a schematic presentation of the material in a textbook and monograph. It is not what Oliver Sacks writes about that decides the matter, but how he writes. The book's language is lively, engaging, with a penchant for word games and literary associations. Perception is not hampered by medical slang (who else can call a patient with Gilles de la Tourette syndrome a “Tourette”?), nor by the abundance of special terms, nor by the listing of chemicals, the existence of which most people simply do not know.

Is it possible to imagine a “neurological play” or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, intensity of passions. And its hero should be a person, and not his illness. This is precisely the most important feature of Sachs’s work. It is not surprising that his book “Awakenings” became the basis for a play by Harold Pinter, and was later filmed. It is very difficult to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with the book offered to you. The opera based on it was written by Michael Nyman, a popular contemporary composer who has composed music for most of Peter Greenaway's films. I think the composer was attracted to the plot not so much by the fact that the main character is a famous musician. Music is present in the book itself - rhythm and, if you like, melody. The reader will catch it just as the hero, listening to the noise on the street, caught a certain symphony in it. Music constitutes the inner world of a deeply inferior person in other respects, filling not only his memory, but also his soul. The music transforms the clumsy, dysplastic Rebecca, and her dance movements acquire grace. Music remains the only force organizing the life of Professor P., who “has his own melody for every action.”

There seems to be something for every reader in the book. Some may be interested in the “Kunstkamera” – amazing neuropsychological stories. For another reader, Oliver Sacks's book is about small tragedies, where in the foreground is not illness or deformity, but experience, fate, and the intensity of a person's struggle with illness. It is tragic to not understand one’s position, and even more tragic to realize it – for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, it is an attempt to comprehend the human soul: a breakdown reveals the hidden. Where can you find a reader as versatile as the author?

I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, marveling at the persistence of the author, who, while defending the main thesis, each time discovers something new. For us. But first of all, for myself.

It's amazing that Oliver Sacks, a man with vast clinical experience, manages to retain his ability to be surprised. Every description of him is imbued with this feeling.

In Oliver Sacks's book the reader will find a certain duality. The author is a doctor, and he has all the stereotypes of traditional clinical thinking. He dreams of understanding the human soul through the physiology of brain structures. He believes in miracle substances that "awaken" patients. He has the optimism of a scientist who professes the principles of positive science. He sees the brain as a magnificent machine, extremely complex and harmonious. A machine whose breakdowns are as extraordinary as its normal operation. However, a person begins to think about the structure of a mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, enters into an argument with the traditional thinking of a physician. He's not just talking about brain structures and neurotransmitters.

He talks about archetypes, symbols, myths. He speaks emotionally, excitedly. It is clear to the reader which side is winning. The romantic worldview triumphs. It is no coincidence that A. R. Luria dreamed of a romantic neurology, and Sachs picks up this idea. The heterogeneity of the book's material and the variety of problems raised in it require synthesis. This synthesis is almost impossible on an intellectual level. And this is where passion comes to the rescue.

The book also covers philosophical issues. What is the nature of the disease itself? What is health? What does illness do to the psyche? Does it always take away – or sometimes does it bring something new and even positive into the human soul? The very structure of the book answers this question. Its main sections are called “Losses” and “Excesses”. But even in the “Losses” section, Sachs agrees that at some level illness can enhance the creative potential of an individual. Professor P., losing the ability to visually perceive, moves from realism in painting to cubist and abstract paintings. And although in the end the hero’s artistic abilities come to naught, “halfway” he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient, a man who has lost his memory, Oliver Sacks sees creativity.

For a psychiatrist who is accustomed to dividing symptoms into “productive” and “negative”, adding and subtracting, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, but at there is a patient, then, consequently, we are talking about production, albeit pathological. And again, if the consciousness is deeply darkened, then we are talking about loss. But if bizarre images invade the consciousness, filling the internal space along with impressions of the real world, then we are talking about qualitative, productive disorders. However, Sachs's understanding of loss and excess is more complex and, it seems to me, closer to the truth.

Yes, it’s full, is there an excess? If it happens, it is only as a result of a lack of some other factor that disturbs the balance. The easiest way to illustrate this thesis is with the example of a complete loss of the ability to remember (Korsakov's syndrome). Confabulations (fictions, fantasies), usually found with memory loss, are a productive symptom. But confabulations only fill a huge deficiency - the void formed in the psyche of a person who is unable to preserve true impressions in his memory. Yes, delusional ideas are products. But Freud at one time showed that the delusional worldview of a paranoid person is only a flawed attempt to recreate some semblance of harmony in the place of a psyche destroyed by illness. Any disease includes not only changes, but also reactions to these changes: from the structures of the brain - on a physiological level, from the patient’s psyche - on a psychological level, and also from loved ones and society...

We see the patient learn to use nervous tics to personalize his percussion playing style. And improving his condition deprives his game of its unique shine. The patient can not only compensate or overcompensate for pathological symptoms - he can utilize them, can productively integrate them into his “I”.

According to Freud, awareness brings healing. In Sachs's patients, due to the grossly organic nature of the diseases, full awareness is impossible. Temporary awareness is tragic. The “Lost Sailor,” who has lost his memory and lives in the past, considers himself a nineteen-year-old boy. Sachs shows him his face in the mirror: the patient is able to see the face of a gray-haired man and understand that this man is him. The patient's emotional reaction to the stunning discovery is terrible. But interruption of the rhythm stops the tragedy. The doctor leaves and enters again. The patient forgot both the doctor and the traumatic experiment that had just been carried out.

By reading Oliver Sacks, a specialist will learn the signs of diseases that he has encountered in his practice or that he has only read about. Memory suggests sophisticated, mostly Greek names for symptoms and syndromes. Professor P. doesn't recognize people's faces? Yes, this is prosopagnosia, the inability to recognize faces, a symptom of damage to the occipital lobes. Doesn't orientate in space to the left, ignores the left side? Optical-spatial agnosia. Again, the occipital lobes. Can't recognize the glove? Subject agnosia. Doesn't realize his illness? Anosognosia, more often occurs with damage to the right, subdominant hemisphere... By the way, P., when examined on the left side, has higher reflexes. But the fact that P. could not distinguish the hat from the head by touch... Or the fact that he did not recognize the glove, even when he picked it up... It seems that the parietal lobes and their lower sections are affected. It looks like we're starting to understand what's going on.

However, by reasoning this way, we deceive ourselves. For ordinary medical thinking, naming is equivalent to understanding. Define a symptom, group symptoms into a syndrome, correlate it with a specific brain location. Consider a treatment program. Well, for practical purposes this is enough. But naming and understanding are two different things. We fall into the trap of terms. Moreover, we, specialists, enjoy pronouncing these unusual words, akin to magic spells. Sachs also seems to go through them - apraxia, agnosia, ataxia... But let's translate these terms into Russian. The person does not recognize faces. We say: he has prosopagnosia. Translated from Greek - the inability to recognize faces. The man says: I can’t be in open, crowded spaces, I’m overcome with fear. We say he has agoraphobia. Translated from Greek - fear of open, crowded spaces. In other words, we simply return what we have learned about the patient, but in a language incomprehensible to the uninitiated... Most doctors, turning information about the patient into bricks of scientific terms, seem to build a wall between themselves and the patient - and examine their creation. Behind this wall is a living person, a unique personality. A scientist needs to make a considerable effort in order to break through the barrier that he himself has built. This is what Oliver Sacks does.

Psychiatry prefers to study pathology “from kings and poets.” The more complex and beautiful the building, the more magnificent and attractive the ruins. The most famous patients of psychoanalysis, for example, were exceptional individuals. Anna O. (pseudonym of Bertha Poppenheim), the first patient of J. Breuer and Z. Freud, subsequently became famous as a pioneer of social work in Germany. She was called the “healer of humanity.” The symptoms of this woman’s illness were also unique and exceptional.

A. R. Luria’s patients were also unusual: one had an unprecedented will to live and courage, the other had a phenomenal memory. The same goes for Oliver Sacks' patients. On the pages of his book, exclusivity and everyday life meet. Professor of Music P. and the “ticky wit” are remarkably gifted individuals. And the manifestations of their diseases look much more interesting and complex. There are more lessons to be learned from these stories, and they inspire truly philosophical reflection.

But the tragedies of ordinary people are no less impressive. We see personality both in patients who have lost their memory and in “simps” - people with profound intellectual disabilities. How can we understand such patients who cannot understand ourselves? Here is an autistic artist who cannot say a word - and has turned drawing into the only way to communicate with the world. Here are two twins with phenomenal numerical abilities. But here, too, Sachs is interested not so much in the “training” of the twins (he even uses an old clinical term, far from political correctness, “scientific idiots”), but in the tragedy of these people, whom doctors separated to “improve their social adaptation.”

In my opinion, showing the reader the path to himself through understanding the changed (but indestructible) personality of the patient is the main mission of Oliver Sacks.

Boris Khersonsky.

Author's preface to the Russian edition

It is impossible to write a preface to the Russian edition of this book without paying tribute to the man whose work served as the main source of inspiration for its creation. We are, of course, talking about Alexander Romanovich Luria, an outstanding Russian scientist, the founder of neuropsychology. Although we never had the chance to meet in person, I had a long correspondence with him that began in 1973 and continued for four years until his death in 1977. Luria’s large systematic works - “Higher Cortical Functions of Man”, “The Human Brain and Mental Processes” and others - were my reference books in my student years, but his work “A Little Book of Great Memory (The Mind of a Mnemonist)” was a real revelation for me. published in English in 1968. Luria describes in it his thirty years of observation of a uniquely gifted, but in a certain sense flawed and suffering man with whom he began a personal friendship. In-depth scientific studies of memory, imaginative thinking and other cerebral functions coexist in this book with a vivid description of the personality and fate of the mnemonist, with a subtle feeling for his inner life. Luria himself called this combination of human contact and neuropsychology “romantic science,” and later he once again brilliantly demonstrated this approach in the book “The Lost and Returned World.” Had Luria lived longer, he, as planned, would have written another similar work - a study of a patient with profound amnesia.

These two books played an important role in my life: working with patients and describing their fates and illnesses, under the influence of Lurie's ideas, I gradually came to my own romantic science. That is why my book Awakenings, written in 1973, is dedicated to Luria. This book is also closely related to him, especially the story “The Lost Sailor”, which quotes his letters - I think Luria himself could write such a study, although perhaps he would devote a separate book to the hero of this story, Jimmy.

I am very glad that “The Man Who Mistook His Wife for a Hat” is finally being published in Russian. I hope that by reading the stories of my patients, the reader will see that neuroscience is not an impersonal, technologically driven science, but that it has profoundly human, dramatic, and spiritual potential.

Oliver SACKS

New York, October 2003

The man who mistook his wife for a hat and other stories from medical practice

Dr. Leonard Shengold

Talking about diseases is like telling the stories of the Arabian Nights.

William Osler

Unlike the naturalist, the doctor deals with an individual organism, a human subject struggling for self-preservation in a threatening situation.

Ivy Mackenzie

Preface

“Only when you finish a book,” Pascal notes somewhere, “usually do you understand where to start.” So, I wrote, put together and edited these strange stories, chose a title and two epigraphs, and now I need to understand what was done - and why.

First of all, let's look at the epigraphs. There is a certain contrast between them - this is precisely what Ivy Mackenzie emphasizes, contrasting the doctor and the naturalist. This contrast corresponds to the dual nature of my own character: I feel like both a doctor and a naturalist, diseases occupy me as much as people. Equally (and to the best of my ability) theorist and storyteller, scientist and romantic, I am simultaneously an explorer and personality, And organism and I clearly see both of these principles in the complex picture of the human condition, one of the central elements of which is disease. Animals also suffer from various disorders, but only in humans can illness turn into a way of being.

My life and work are dedicated to patients, and close communication with them gives me some key insights. Together with Nietzsche, I ask: “As for illness, I would very much like to know whether we can do without it?” This is a fundamental question; Working with patients forces me to ask it all the time, and trying to find the answer, I return again and again to patients. In the stories offered to the reader, this continuous movement, this circle, is constantly present.

Research – understandable; but why stories, stories? Hippocrates introduced the idea of ​​the development of a disease over time - from the first symptoms to a climax and crisis, and then to a successful or fatal outcome. This is how the genre of medical history was born - a description of its natural course. Such descriptions fit well into the meaning of the old word “pathology” and are quite appropriate as a type of natural science, but they have one serious drawback: they do not tell anything about a person and his stories about the internal experience of a person faced with an illness and fighting for survival.

In a narrowly conceived medical history there is no subject. Modern anamnesis mentions the person only briefly, in a service phrase (albino trisomic, female, 21 years old), which could just as easily refer to a rat. In order to address the individual and place the suffering, straining human being at the center of attention, it is necessary to take the medical history to a deeper level, giving it a dramatic-narrative form. Only in this case, against the background of natural processes, a subject will appear - a real person in the confrontation with the disease; only in this way can we see the individual and spiritual in relation to the physical.

The life and feelings of the patient are directly related to the deepest problems of neurology and psychology, for where personality is involved, the study of disease is inseparable from the study of personality and character. Some disorders and methods of their analysis, generally speaking, require the creation of a special scientific discipline, “personal neurology”, the task of which should be to study the physiological foundations of the human “I”, the ancient problem of the connection between the brain and consciousness.

Perhaps between the psychic and physical Indeed, there is a conceptual and logical gap, however, studies and stories devoted simultaneously to both the body and the individual can bring these areas closer together, bring us to the point of intersection of the mechanical process and life, and thus clarify the connection between physiology and biography. This approach is of particular interest to me, and in this book I generally adhere to it.

The tradition of clinical stories, built around a person and his fate, flourished in the nineteenth century, but later, with the development of impersonal neuroscience, began to gradually fade away. A. R. Luria 1
A.R. Luria (1902-1977) – Russian neurologist, founder of neuropsychology. ( Hereinafter, except where otherwise indicated, translators' notes).

Wrote: “The ability to describe, so widespread among the great neurologists and psychiatrists of the 19th century, has now almost disappeared. It needs to be restored." In his later works, such as "The Little Book of Big Memory (The Mnemonist's Mind)" and "The Lost and Returned World", he attempts to revive this lost form. The stories from the pen of Luria from clinical practice are connected with the past, with the traditions of the nineteenth century, with the descriptions of Hippocrates, the first medical historian, with the long-standing custom of patients telling doctors about themselves and their illnesses.

Classic narrative plots revolve around archetypal characters—heroes, victims, martyrs, warriors. The neurologist's patients embody all these characters, but in the strange stories told below, they also appear as something more. Are the images of the “lost sailor” and other amazing heroes of this book reduced to the usual myths and metaphors? They can be called wanderers - but in unimaginably distant lands, in places that would be difficult to even imagine without them. I see a glimpse of miracle and fairy tale in their wanderings, and that is why I chose Osler’s metaphor as one of the epigraphs - the image of “A Thousand and One Nights”. My patients' case histories contain an element of parable and adventure. The scientific and the romantic merge here into one - Luria liked to talk about “romantic science” - and in each of the cases described (as in my previous book “Awakenings”), in each destiny we find ourselves at the crossroads of fact and myth.

But what amazing facts! What fascinating myths! What to compare them with? Apparently, we have neither models nor metaphors for understanding such cases. It seems the time has come for new symbols and new myths.

Eight chapters of this book have already been published: "The Lost Sailor", "Hands", "Twins" and "The Autistic Artist" - in the New York Review of Books (1984 and 1985), "Ticotic Wit", "The Man Who Adopted wife for a hat" and "Reminiscence" (in an abridged version called "Ear for Music") - in the London Review of Books (1981, 1983 and 1984), and "The Spirit Level Eye" - in The Sciences (1985) . The chapter "The Flood of Nostalgia" (originally published in the spring of 1970 in The Lancet under the title "L-Dopa and Nostalgic States") contains a long-written account of a patient who later became the inspiration for Rose R. in Awakenings and Deborah in Harold's play Pinter "Something Like Alaska" Of the four fragments collected in the chapter "Phantoms", the first two were published in the Clinical Cabinet of Curiosities section of the British Medical Journal (1984). Two more short stories are taken from my previous books: “The Man Who Fell Out of Bed” is from A Leg to Stand, and “Visions of Hildegard” is from Migraine. The remaining twelve chapters are being published for the first time; all of them were written in the fall and winter of 1984.

I would like to express my deep gratitude to my editors—especially Robert Silvers of the New York Review of Books and Mary Kay Wilmers of the London Review of Books; Kate Edgar and Jim Silberman of Summit Books in New York, and finally Colin Haycraft of Duckworth in London. Together, they provided invaluable assistance in giving the book its final form.

I would also like to express special gratitude to my neurologist colleagues:

– to the late James P. Martin, to whom I showed videos of Christina and Mr. McGregor. The chapters “Disembodied Christie” and “The Spirit Level Eye” were born out of detailed discussions of these patients;

– Michael Cramer, my former chief physician in London. After reading my book A Leg to Stand (1984), he told of a very similar case from his own practice, and I included it in the chapter “The Man Who Fell Out of Bed”;

—To Donald Macrae, who observed a remarkable case of visual agnosia similar to that of Professor P. I accidentally discovered his report two years after the publication of my story. Excerpts from his article are included in the postscript to the story of "the man who mistook his wife for a hat";

– Isabella Rapin, colleague and close friend from New York. I discussed many of my cases with her; she asked me to look at the “disembodied” Cristina and for many years, since his childhood, she observed José, an autistic artist.

I am eternally grateful to all the patients (and sometimes their loved ones) whose stories are told on the pages of this book. I thank them for their selfless help and generosity, I thank them for the fact that, even knowing that my scientific interest would not help them in any way, they encouraged me and allowed me to describe what happened to them, hoping to help others understand and, perhaps, learn to treat the diseases from which they suffer. As in "Awakenings", maintaining medical confidentiality, I changed the names and some circumstances, but in each case I tried to preserve the basic feeling.

Finally, I want to express my gratitude—more than gratitude—to Leonard Shengold, my teacher and physician, to whom this book is dedicated.

Oliver SACKS

The work of the famous neurologist Oliver Sacks, “The Man Who Mistook His Wife for a Hat and Other Stories from Medical Practice,” became a bestseller and was translated into many languages. In it, the author talks about his medical experience, about people who become incomprehensible to many and cause conflicting feelings.

Despite the fact that the author is a doctor, his work is quite easy to read. Of course, there is a description of some diseases and their characteristics, but the writer tried to avoid complex terms. It is noteworthy that Oliver Sacks does not write about people as if he were taking notes on a patient’s medical history. His narrative does not look dry and compressed; on the contrary, it is filled with feelings, empathy, reflection, and humanity.

The book describes the stories of many people who have some deviations in mental development and brain function. For example, the author brings to attention the stories of people who suffer from the now known autism, but he also talks about very unusual cases.

It’s interesting how complex the human brain is, how all the processes occur in it. If the slightest glitch occurs somewhere, it can radically change a person’s perception. The book discusses both congenital and acquired abnormalities.

The author of the book not only observes people, but also thinks about them. Most people perceive such people as eccentrics, fools, even as abnormal and inferior. But if you think about it, perhaps their thinking is just a quirk and not an aberration. Sometimes unusual perception allows people to create masterpieces of music, painting, and literature. Or maybe those people who live in their own world are not so unhappy? Sometimes, watching such people, you get the feeling that they can live happier and more fulfilling lives than us, normal and ordinary, loaded with work and endless problems. The book will be very interesting to anyone who wants to learn more about people with an unusual psyche and worldview.

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