The Man Who Mistook His Wife for a Hat: And Other Clinical Tales – a perspective

The Man Who Mistook his Wife for a Hat, the first book of Dr. Oliver Sacks that I read, had a profound effect on me. The book has 24 chapters, with each chapter being a standalone clinical tale from his career as a neurologist. Divided into four parts, the book delves into ‘Losses’, ‘Excesses’, ‘Transports’, and ‘The World of the Simple’. The first part, ‘Losses’, describes numerous clinical cases of people who have lost some aspects of neurological function. The protagonist in the title chapter has trouble identifying things around him, and once mistook his wife’s head for a hat which he tried to wear! There were also a few poignant tales of those who had lost their sense of self or identity. The second part, ‘Excesses’, has many stories of neurological ‘excessive’ disorders such as Tourette’s syndrome. These stories describe people whose lives have become either energetic or impulsive because of their disorders. Although the ‘Losses’ part showed how neurological defects can have a detrimental effect on quality of life, the ‘Excesses’ part showed how some neurological disorders can bring more color and ‘life’ to someone’s daily existence. And sometimes treating these symptoms can make the patients feel as if they have lost an important part of themselves.

The last two parts were quite special to me. ‘Transports’ has clinical tales about patients who have ‘transported’ to a different conscious state – imaginations, spiritualism/religiosity, dreaminess, and reminiscence. There were two touching clinical tales about ladies whose illnesses made them dream or hear sounds from forgotten parts of their childhood. This section also delves into epilepsies of the temporal lobe, which has been implicated in deep spiritualism, religiosity, seizures, and having ‘visions’. Finally, the fourth and last part of the books presents clinical tales about mentally handicapped people – a group that used to be shunned and misunderstood by society, yet whose unique gifts and talents were presented with empathy in this book.  This section showed Dr. Sacks’ empathy and talents in presenting mentally handicapped people as normal human beings. He gave a sense of normality to those with autism and various other traits that might be considered oddities or mental disorders. This book also led me to question what exactly is normality? What neurological or physiological disorder is ‘abnormal’, or just a different kind of normal?

One of the thoughts that occurred to me after reading this book was whether we should accept what nature has given us, or whether we should try to overcome nature’s limitations with biotechnology. It also got me thinking about many people’s fears about new technologies that tinker with nature’s status quo. Many people use the phrases “everything happens for a reason”, or “there is a meaning behind everything”. Even though it is said with good intentions, I want to give a differing perspective on why it isn’t necessarily empathetic or helpful. Many of us say it from our experiences, privilege, and by rationalizing outcomes after they have occurred. Yet many people might not appreciate these statements when it relates to tragedies like war crimes, suffering of the innocent, or a parent burying a child. How can we tell a mother that there is a meaning or reason behind the death of her child? I have personally found these statements to be unhelpful, and in contrast have appreciated the honesty that something bad happened because I made a mistake or because I didn’t have the foresight to make a wise decision. That honest appraisal has led me to make changes, rather than rationalizing or normalizing a mistake as if the outcome was part of a divine plan. If we say everything happens for a reason, it might not motivate us to try and change the status quo for a better outcome.

When I see people with mental and physical disability, what is the reason or meaning behind their situation? Many of them have made the most of their disabilities. But wouldn’t it be better if they had their full neurological and physiological capabilities? Why should we accept or rationalize pain or physiological handicaps, instead of trying to create a world without such suffering? I have read articles written by parents that they wouldn’t use gene therapy to treat their children’s physical disabilities before they were born, because those handicaps made their kids who they are today. I find such thinking selfish because the child doesn’t get to decide if it wants to be born with neurological or physical disabilities if potential preventive treatments are available. I find it incomprehensible that those of us healthy would rather choose and rationalize nature’s random mutations causing severe disabilities in others over biotechnology that can prevent or treat disabilities.

There are those who have lost their sense of self and identity, or are physically disabled to the point where their quality of life has diminished. We can empathize with their pain without telling them that there is a reason for their disability. It doesn’t mean that we should despair at finding no ‘meaning’ to our circumstances. We can accept that life isn’t always fair, or that bad things happen to good people without any supernatural machinations. And that unpleasant truth should be the impetus that drives us towards eliminating unfair situations in life, towards fighting for a better and just world, and towards eliminating pain and suffering. This should prompt us to invest more in biomedical research where disabilities and illnesses can not only be treated, but also prevented through gene therapy. Such therapy, whether for embryos or adults, requires society to reach a consensus as to what treatment is acceptable or not, especially when someone is incapable of giving consent. How should we treat those who have lost their sense of self and are incapable of informed consent? And should it be mandatory to use gene therapy on an embryo that has all the markers for severe disorders? And how should we distinguish between the ‘excesses’ and ‘losses’ disorders. If the ‘excesses’, as shown in the book, can enhance someone’s life, should they be treated in unborn fetuses? These are questions with no objective answers, but questions society must ponder with the increasing advances of biotechnology.

The other topic from this book that piqued my interest had to be with the section ‘Transports’. As a scientist and supporter of rationalism, I strive for knowledge and understanding of our natural world. Religion has affected me in numerous ways, both good and bad. Understanding religiosity also increases my understanding of human behavior. Our advanced brain has made us ponder existential questions, and spiritual and theological doctrines have helped answering many of those questions. But what makes some people more spiritual or religious than others? What is behind the visions, voices, and other types of religious experiences? For many years, I had read of temporal lobe epilepsy being implicated in extreme religiosity. Therefore, it was a pleasant surprise to read the neurological reasons behind such ‘visions’, hallucinations, or seizures. Specific doctrines and beliefs will always evolve or go extinct, but if we have unanswerable questions then some sort of supernatural beliefs will remain a part of our species. But the changes I would like to see relates to understanding doctrines and personal interpretations of doctrines as immutable facts.  Too often such ‘facts’ have been used for violence, prejudice, and discrimination. We can be spiritual and/or religious, yet be humble enough to accept that no one has the right answers to our existential questions. Our brains might revolt against uncertainty and grey answers, yet uncertainty should be the preferred outcome over false truths.

Finally, if religious doctrines are considered as subjective understandings of our world rather than as objective truths, it might give people courage to go against doctrines when they wish and explore more personal freedom. Too many of us, myself included in the distant past, have wanted to eat something, wear something, and explore other personal freedoms but felt guilty that we are committing a sin or going against immutable truths. I have seen people cry because they mistakenly didn’t follow some doctrine or rule. I have had people ask me wistfully “when will doctrines change”, or “why are doctrines the way they are”. No one should feel guilty if they go against doctrines for their freedom or happiness. I don’t want to see people cry or commit suicide if they cannot follow some of these doctrines. I don’t want to see judgment and nonacceptance on parts of those who take doctrines as literal truths. I think a world where religion isn’t absolute, but where religiosity can be explained as products of our brains’ quest for meaning, a world where people can be spiritual or religious for personal peace and happiness, will be a better and happier world. I want people to see the beauty that comes from our own brains, be it spiritualism or the ability to overcome nature’s deficiencies with scientific breakthroughs. I want people to be confident about themselves, their strengths, and their abilities to change the world.

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