The Man Who Mistook His Wife for a Hat

Aphasia is a neurological condition that affects a person’s ability to communicate. It often prevents a person from reading and writing or being able to understand written and spoken language. It can be caused suddenly by a stroke or brain injury, or it can be caused more gradually by a tumor. Some people with aphasia can relearn how to use, read, write, and understand language. In Chapter 9, Sacks discusses ways those with aphasia can learn to understand communication based on body language and tone of voice.

Autism is classified as a developmental disorder. Although it can be diagnosed at any age, symptoms of autism usually appear before the age of two. It is characterized by difficulty in communicating with others, having selective interests, engaging in repetitive behaviors, and other symptoms. Sacks discusses autism in the case of José, who has lost his ability to understand speech and to speak. It is not clear if he has autism or if he is unable to communicate because of a high fever that resulted in brain damage.

Encephalitis lethargica, also known as the “sleeping sickness,” is an uncommon form of encephalitis. It attacks the brain, causing Parkinson’s-like symptoms, including a high fever, sore throat, headache, double-vision, muscular weakness, loss of speech and movement, and a coma-like state. The exact causes of encephalitis lethargica are unknown. Some believe it is linked to an autoimmune response, while others believe it is connected to influenza. Encephalitis lethargica became a pandemic in the early 1900s and killed over one million people over the course of 11 years. Sacks speaks of treating patients with this disease with L-Dopa. His book, Awakenings, documents a case of treating a man with this disease.

Epilepsy is a term for a condition that causes seizures. There are many kinds of epilepsy and different types of seizures, such as grand mal seizures, which affect both sides of the brain, or partial seizures, which only affect one side. Sacks discusses epilepsy in several instances throughout the book, specifically in the section on transports. Mrs. O’C. experiences seizures deep in her brain that incite aural hallucinations.

Korsakoff’s syndrome (spelled Korsakov’s syndrome in the text) is a neurological disorder characterized by memory conditions, confusion, etc. It can be caused by alcohol use, complications related to AIDS, or a severe loss of B1 vitamins and thiamin. The syndrome encompasses both anterograde and retrograde amnesia, or the inability to create new memories or recall memories prior to injury or illness, respectively. Luria documented a case of Korsakoff’s syndrome in The Man with a Shattered World: The History of a Brain Wound (1971). The book is about a man who had Korsakoff’s due to brain damage he sustained during the war. Korsakoff’s is often associated with Wernicke encephalopathy, a degenerative brain disorder also caused by a lack of vitamin B1, known as Wernicke-Korsakoff syndrome (WKS). Sacks first discusses this syndrome in relation to Jimmie G. of Chapter 2, who he believes has a form of the syndrome brought on by Jimmie’s heavy alcohol use.

Patients can experience phantom limbs after an amputation. It is a sensation wherein amputees still feel the missing appendage, sometimes with or without accompanying pain. This sensation is reportedly felt by 80 to 100% of amputees. Phantom limb can sometimes be treated by operating on the spinal column rather than the remaining portion of the limb itself. However, Sacks notes that a phantom limb can be useful in helping patients adapt to a new prosthetic limb. Patients report being able to transfer the sensation of their phantom into their prosthesis, making it easier to use, provided the phantom is not painful.

Proprioception, or kinesthesia, is the body’s general awareness of itself via movement, action, and location. This is the “sixth sense” that allows a person to know where their body is in relation to what is around them. To conduct simple movements, the body’s proprioception must work in tandem with two other systems—vision and the vestibular system (the balance organs). Proprioception relies on receptors in the muscles, joints, and tendons receiving and sending signals to the brain. Without proprioception, a person must depend on their visual cues to know where they are and to guide their motor functions, as in the case of “The Disembodied Lady” in Chapter 3.

Amnesia is a condition in which a person loses or cannot recall information from their past. Retrograde amnesia comes from the Latin word “retro,” meaning “backward.” Retrograde amnesia refers to the condition of not being able to make new memories moving forward. In the case of Jimmie G., he could remember his past from before 1945, but couldn’t make or recall new memories. He believed that he was still a 19-year-old living in 1945.

The temporal lobes are located in the front of the brain, sitting just behind and above the ears. Temporal lobes are responsible for processes that are unique to humans, such as using language, remembering verbal information, and expressing emotions. The left side is the dominant lobe in most people and is responsible for processing and storing verbal information. The right side is typically nondominant and responsible for remembering information that is nonverbal, like images and music. Sacks points out that most neurology has been concerned with understanding damage to the left side of the brain, which controls schemas and functions. The right side of the brain, and results of damage to that side, remain more mysterious and unstudied. Those who experience damage to the right side of the brain often express symptoms that are more unique to the individual, hence part of why Sacks chooses to organize his book as stories about individual patients.