The Man Who Mistook His Wife for a Hat

Oliver Sacks

He was understandably discouraged by this experience--and this thought--and also by another thought which he now expressed. 'Suppose you could take away the tics,' he said. 'What would be left? I consist of tics--there is nothing else.' He seemed, at least jokingly, to have little sense of his identity except as a ticqueur: he called himself 'the ticcer of President's Broadway' and spoke of himself, in the third person, as 'witty ticcy Ray', adding that he was so prone to 'ticcy witticisms and witty ticcicisms' that he scarcely knew whether it was a gift or a curse. He said  he could not imagine life without Tourette's, nor was he sure he would care for it.

Superficially she was a mass of handicaps and incapacities, with the intense frustrations and anxieties attendant on these; at this level she was, and felt herself to be, a mental cripple--beneath the effortless skills, the happy capacities, of others; but at some deeper level there was no sense of handicap or incapacity, but a feeling of calm and completeness, of being fully alive, of being a soul, deep and high, and equal to all others. Intellectually, then, Rebecca felt a cripple; spiritually she felt herself a full and complete being.

'She is an idiot Ecclesiastes, I said to myself. And in this phrase, my two visions of her--as idiot adn as symbolist--met, collided and fused. She had done appallingly in the testing--which, in a sense, was designed, like all neurological and psychological testing, not merely to uncover, to bring out deficits, but to decompose her into functions and deficits. She had come apart, horribly, in formal testing, but now she was mysteriously 'together' and composed.
Why was she so decomposed before, how could she be so recomposed now? I had the strongest feeling of two wholly different modes of thought, or of organisation, or of being. The first schematic--pattern-seeing, problem-solving--this is what had been tested, and where she had been found so defective, so disastrously wanting. But the tests had given no inkling of anything but the deficits, of anything so to speak, beyond her deficits.

This was my human, as opposed to my neurological vision.

Is it possible, I wondered, that this being before me--at once a charming girl, and a moron, a cognitive mishap--can use a narrative (or dramatic) mode to compose and integrate a coherent world, in place of the schematic mode, which, in her, is so defective that it simply doesn't work?

It didn't work with Rebecca, it didn't work with most of them. It was not, I came to think, the right thing to do, because what we did was to drive them full-tilt upon their limitations, as had already been done, futilely, and often to the point of cruelty, throughout their lives.

The power of music, narrative and drama is of the greatest practical and theoretical importance. One may see this even in the case of idiots, with IQs below 20 and the extremest motor incompetence and bewilderment.

This is the positive side--but there is a negative side too (not mentioned in their charts, because it was never recognised in the first place). Deprived of their numerical 'communion' with each other, and of time and opportunity for any 'contemplation' or 'communion' at all--they are always being hurried and jostled from one job to another--they seem to have lost their strange numerical power, and with this the chief joy and sense of their lives. But this is considered a small price to pay, no doubt, for their having become quasi-independent and 'socially acceptable'.

Written before 1985, The Man Who Mistook His Wife for a Hat continually uses a terminology of idiot, moron, retard to refer to mental conditions. Reading the book now you get a strangely shocked sense as though Sacks were insulting his patients, yet loves the people he serves. So you find yourself cornered: he clearly does not mean to demean but it cannot be denied that he is speaking for society when he speaks here.

This barbaric way of speaking of those with mental health conditions and the revolution in sensistivity that occured and is occuring within it, is something that should and will begin in the homelessness world. Now we speak of and see homelessness and poverty with the insensitive and uncaring and unrecognizing eye that was so characteristic of how the people with mental conditions were seen in the '80s. Of course, you can err on the side of too much sensitivity, but what is called for is an eye that sees as God sees and recognizes the humanity, which is to say usefulness of each person.

But this leads me to ask, where is Mark useful? Or, where is Alvin useful? I really don't know, at all really. See, Mark is a difficult case: he's violent and has been drunk for so many years you think his brain is fried. So is Alvin: he's a hoarder and a health hazard to himself and doesn't seem to understand the realities of society. So is Michael, so is Mike so is and now I'm just filling in these names without thinking. There were so many instances in Sacks where what we took to be a problem, what was seen as a flaw actually became something entirely else as he began to see it with different eyes. In a way his book is almost a step by step walking you out of the one and into the other.

What I see in Sacks is the beginning of a desire to move from problem-centered therapy to gift-centered therapy. What happens in the case of many people with severe mental conditions is that in our attempt to discover what is 'wrong' so that we can fix it, we end up 'driving them full-tilt upon their limitations' like sailing a boat onto a reef in order to see where it is leaking. And so you get this sense that medicine is more concerned with what's wrong than what's right. But what if the best way to bring about a good (the best?) equilibrium is to focus on what's right in Sacks' case histories? Seeing the artist in the autism and the music in the 'mental retard'. So then what would this look like for homelessness?

Right now we ask, 'What do you need?' but waht if the more important question is 'What don't you need?' Because if we can figure that out, then we know what they are good at and we know what we can start with, what can be the basis of 're-entry into society'.What if the most important thing for us to be asking is what is good here? What is good about who this person is, what is good about their situation?

Now, all this is a load, a bunch of crap because, frankly, I haven't done anything yet to see if good things happen. I ahven't helped anyone yet. But time isn't up yet and we will see.

Problems: medical, mental, societal, emotional, attitudinal, economical, whatever, are only ever part of the whole, and if you give them a veto over the things that are going better than perfect, the gifts, the goods, then you'll never really get anywhere. It's like a black and white drawing: to see only one color is really to see a distortion or a half, no matter how much color there is. The shape of the other color is just as much a shape as the first. So the good is just as much a reality as the bad.