50 Psychology Classics (50 page)

As neurologist Oliver Sacks notes at the beginning of
The Man Who Mistook His Wife for a Hat: And Other Clinical Tales
, which was a massive bestseller around the world and made him famous, he has always been equally interested in diseases and people. A lifetime's work convinced him that it is often less a matter of “what disease does this person have” than “what person has the disease.” You can't examine a patient as if they are an insect—you are talking about a
self
.

This is all the more important in neurology, which involves a physical dysfunction of the brain that often affects a person's sense of who they are. Sacks' book aims to show that even when people's normal faculties desert them, they retain an unmistakable uniqueness. For Sacks, who has seen many strange cases, how people adapt or reinvent themselves in the face of mental or physical setbacks is amazing.

The book's 24 chapters detail a myriad of strange and interesting cases that give it the page-turning quality of a novel. Part One is titled “Losses” and it relates to people who have battled to return to a sense of normal self after suffering some debilitating loss of mental faculty.

Without memories, is it possible to have a self? Sacks tells us about Jimmie G, a 49 year old admitted to the old people's home where Sacks was working in 1975.

Jimmie was a handsome, healthy man and very genial. He had been drafted into the US Navy on his graduation from school, and became a radio operator on a submarine. But while talking about his personal history and family life, Sacks noticed that Jimmie was talking in the present tense. He asked Jimmie what year it was, and received a reply to the effect of “1945 of course!” For Jimmie, the war was won, Truman was President, and he was looking forward to going to college on the GI Bill. He believed he was 19.

Sacks went out of the consulting room, and when he returned two minutes later Jimmie seemed to have no idea who he was. It was as if their session had never happened. Jimmie was apparently living in a permanent present, his longer-term memory stopping dead in 1945. With his ability in science he had
no trouble solving complex problems in tests, but was disturbed by what seemed like major changes in the world around him. He could not deny that the man in the mirror was in his late 40s, but was not able to explain it. Sacks wrote in his notes that his patient was “without a past (or future), stuck in a constantly changing, meaningless moment.” He diagnosed the condition as Korsakov's syndrome, damage to the mamillary bodies in the brain caused by alcohol. This affects memory, although the rest of the brain experiences no change.

Sacks located Jimmie's brother, who noted that Jimmy had left the navy in 1965 and without the structure it provided began drinking heavily. For some reason he had experienced retrograde amnesia, going back to 1945.

Sacks asked Jimmie to keep a diary so that he knew what he had done the day before, but this did nothing to give him a sense of continuity as it was as if the events he read about had happened to someone else. Jimmie seemed to have been “de-souled,” something was missing in terms of a self.

Sacks asked the religious Sisters in the old people's home whether they thought Jimmie had indeed lost his “soul.” Somewhat affronted, they responded by telling him to watch Jimmie when he was in chapel. When Sacks went to observe him there, it was a different Jimmie. He seemed lost in the act of worship and the ritual of the mass, somehow more “together” than before. The level of spiritual meaning was obviously enough to overcome his normal mental chaos. Sacks writes: “Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.” The same was true if Jimmie was in the garden or looking at art or listening to music.

Thus, although Jimmie was dead to the normal experience of memory that we feel gives us a sense of self, at other times he was evidently a fully alive person, gaining meaning from experience. Through a careful regimen of like activity he was able to maintain a sense of calm; there was still some part of him, whether a “soul” or a “self,” that had found a way to exist despite the disease.

Part Two of
The Man Who Mistook His Wife for a Hat
is titled “Excesses.” The cases looked at involve not a loss but a
superabundance
of certain functions: flights of fancy, exaggerated perception, irrational exuberance, manias. These “hyper-states” actually give the people involved a heightened sense of life that normality does not. While they are technically ill, such conditions give subjects a feeling of great wellbeing and zest for life (although in the back of their mind there is the feeling that it cannot last). The functions meld with the person's identity, so that some may not want to be cured.

One example of neurological excess is a syndrome first described in 1885. Gilles de la Tourette was a pupil of the pioneering neurologist Charcot (as was
Freud) and recorded a condition of tics, extravagant motions, cursing, funny noises, mad humor, and strange compulsions. There were varying degrees of the syndrome and it was manifested differently in each sufferer, from benign to violent. Because of its inexplicable strangeness and relative rarity, Tourette's was largely forgotten about by the medical world.

However, the condition never went away, and by the 1970s there was a Tourette's Syndrome Association that grew to have thousands of members. Research confirmed Gilles de la Tourette's initial belief that it was a brain disorder, centered in the “old brain” (the most primitive part of the human brain) involving the thalamus, hypothalamus, limbic system, and amygdala, the instinctual areas that together form the basic personality. Touretters were found to have more than the usual amount of excitor transmitters in their brains, particularly the transmitter dopamine (people with Parkinson's have a lack of dopamine). They can be treated with the drug haldol, which counteracts the excess.

But Tourette's is not simply a matter of brain chemistry, for there are times—such as when singing, dancing, or acting—that Touretters lose their normal tics and behaviors. In such cases, Sacks observes, the “I” of the person seems to overcome the “It” of their condition. Normal people assume that they
own
their perceptions, reactions, and movements, so it is easy to have a strong sense of self. Touretters are so constantly bombarded with uncontrollable impulses that it is amazing if their ego can manage to keep a sense of self. Some people, Sacks notes, are able to “take” Tourette's and incorporate it into their personality, even making use of the way it increases their rate of thinking; others are simply possessed by it.

Ray, 24, came to Sacks with a rather extreme version of Tourette's. Every few seconds he went into a convulsive tic, which frightened everyone except those who knew him well. With high intelligence, wit, humor, and sound character, Ray had got through school and college, and even married. He had obtained jobs but had been fired from each for his behavior, which was pugnacious and included blurting out swear words. His Tourette's was a “sudden intruder” that he did his best to incorporate into his weekend role as a jazz drummer, producing sometimes wild drum solos. The only time he was free of his condition was while asleep, just after sex, or when deeply engaged in some task.

Ray was willing to try haldol, but was worried what would be left of him if his tics went away. He had, after all, been like this since he was 4. When the drug began to work, Ray had to deal with himself as a different person. During the week, when at work, the drug made him a sober, tic-free—even dull—individual, but as he missed his old intense, convulsive, wise-cracking self (the only self he had ever known), he chose not to take the drug at the weekend so he could be “witty, ticcy Ray,” as he called himself.

In this case, which was Ray's real self? Sacks does not offer an answer, but points to the story as an example of “resilience of spirit”—there is always some “I” inside us that seeks to assert itself, even in the face of an extreme “It” that can take us over.

Sacks notes that our current model for understanding the brain is based on the computer. But he asks: Could algorithms and programs account for the rich way we experience reality, in terms of the dramatic, the artistic, the musical? How do we reconcile the idea of memories being held in the back of the brain's computer, and
reminiscence
of the type expressed by Proust and other great writers in works of literature? Surely a human is not just a “thinking machine” but a being who lives through the meaningfulness of experience, having an “iconic” representation of reality that takes account of the vivid sense of things, their wholeness.

English physiologist Charles Sherrington imagined the brain as an “enchanted loom,” constantly weaving patterns of meaning. This analogy, Sacks suggests, is surely better than the computer in explaining the very personal nature of experience and the way meaning is gained over time. His own analogy for understanding the brain is in terms of “scripts and scores.” Our lives are akin to a script that makes sense of them as we go along, or perhaps a musical score that does the same. Ultimately, then, the prism through we which we grasp our lives should not be scientific or mathematical—this would do for the left brain's functioning, perhaps—but artistic. For the right brain, which is so deeply involved with the creation of this thing we feel to be the “self,” meaning must be gained from “the artful scenery and melody of experience and action.”

From one angle humans may look like advanced robots responding to their environment via a neurological computer, but to form a “self” requires something more. Sacks notes, “empirical science… takes no account of the soul, no account of what constitutes and determines personal being.” It is this something that his patients were striving to get back or retain in the face of an invader.

It is only when something goes neurologically wrong that we realize how much we take for granted the effort that goes into keeping up the feeling of being an autonomous being, always in control. We are a “miracle of integration,” Sacks says, and often underestimate just how strong the will of the self is to assert itself in the face of the forces of disintegration such as neurological damage or disease.

Were the brain merely like a computer it could not bring itself back from the edge of chaos to reestablish a sense of meaning and independence. Rather
than simply efficient operation, the human mind strives for wholeness; it seeks to create meaning out of random sensation and experience.

A painting or a symphony is not just oil paint or musical sounds—it is meaning. In the same way, over a lifetime human beings become something greater than the sum of their parts. When people die we mourn them not because they were “good bodies” but because they represented a certain meaning. This is what Sacks writes about: the undefined, meaningful, precious self.

Born in London in 1933 to physician parents, Sacks gained his medical degree at Oxford University. Moving to the United States in the 1960s, he did an internship in San Francisco and a residency at the University of California, Los Angeles
.

He settled in New York in 1965, and his work in the 1960s dealing with victims of “sleepy sickness” at the Beth Abraham Hospital in the Bronx is well known. He treated them with a then-experimental drug, L-dopa, which enabled many to come back to normal life. The experiments became the subject of his book
Awakenings
(1973), which inspired the Harold Pinter play
A Kind of Alaska
and the Hollywood movie
Awakenings
starring Robert De Niro and Robin Williams
.

In addition to having a private practice, Sacks is a clinical professor of neurology at the Albert Einstein College of Medicine and an adjunct professor of neurology at the New York University School of Medicine. He is also a consultant neurologist to the Little Sisters of the Poor religious order. He has received many honorary doctorates
.

Other books include
Seeing Voices: A Journey into the World of the Deaf
(1990),
An Anthropologist on Mars
(1995),
The Island of the Colorblind
(1996), and
Uncle Tungsten: Memories of a Chemical Boyhood
(2001)
.

“Unlike other negative emotions—anger, sadness, disappointment, even grief—what is so difficult about regret is the feeling that the regrettable state of affairs could have been avoided and that it could have been avoided by you, if only you had chosen differently.”

“After millions of years of survival based on simple distinctions, it may simply be that we are biologically unprepared for the number of choices we face in the modern world.”

In a nutshell

Paradoxically, happiness may lie in limiting our choices rather than increasing them.

In a similar vein
Daniel Gilbert
Stumbling on Happiness
(p 120)
Martin Seligman
Authentic Happiness
(p 254)

Is it good or bad to have choice? Based on the findings of psychologists, economists, market researchers, and experts working in the field of decision making,
The Paradox of Choice: Why More Is Less
begins with psychologist Barry Schwartz reeling off facts and figures on how many brands of cereal he can buy in his local supermarket, how many types of television set there are to choose from, and how the sales assistant doesn't know what he means when he asks for “regular” jeans in a clothing store, because with today's infinite variety there is no such thing as regular.