The Man Who Mistook His Wife for a Hat

Rebecca is referred to the clinic at age 19. Rebecca’s parents died when she was three, so her grandmother has raised her. Her grandmother describes her as child-like. Rebecca sometimes puts on her clothes the wrong way, confuses left and right, and seems to have “no sense of space.” Rebecca has physical, cerebral, and mental conditions as the result of her congenital condition. Although Rebecca is painfully shy and withdrawn, she is capable of deep attachments and a love of nature and stories. As she doesn’t know how to read, her grandmother reads stories and poetry to her. Sacks describes Rebecca as a “‘primitive’, natural poet” (87). She understands the imagery and symbolism of even challenging poems but “need[s] the world re-presented to her in verbal images, in language” (87). When her grandmother takes her to the synagogue, where Rebecca loves lighting the candles, she exhibits a peace of soul that is perhaps more calm, complete, and deep than that of any other person.

When Sacks first sees Rebecca, he thinks of her as a “casualty” (88) who he can diagnose easily. She is a “poor thing” (88) who lacks motor functions, experiences various kinds of agnosia, and has a gift of speech that is merely a “fluke.” He sees Rebecca sitting in the garden, looking at the April day with utter delight. She does not look “clumsy.” Rebecca says some fragmented poetic words: “‘spring’, ‘birth’, ‘growing’, ‘stirring’, ‘coming to life’, ‘seasons’, ‘everything in its time’” (88). Sacks reconsiders his previous evaluation of her. Although she became “decomposed” during testing, she now appears wholly “re-composed.” Sacks notes that the tests supplied no insight into Rebecca’s inner world or her capabilities: “[T]he tests had given no inkling of anything but the deficits, of anything, so to speak, beyond her deficits” (88).

Sacks now recognizes the limitations and inadequacies of classic tests, which only evaluate a person’s ability to recognize patterns and problem-solve; they do not highlight a person’s natural artistic or otherwise extraordinary abilities. Sacks begins to see all his patients more like Rebecca. Rebecca has many depths. When her grandmother dies, Rebecca is full of grief, but she still comports herself with dignity. She speaks in a fragmented way, saying, “I’m crying for me, not for her. […] Grannie’s all right. She’s gone to her Long Home” (89). Sacks doesn’t know whether this is an allusion to Ecclesiastes or Rebecca’s own poetic sense of understanding. When Rebecca says that “spring will come again” (89), Sacks regards her ability to complete the cycle of grief as beyond the confines of a “mental defective.” Rebecca sits shiva with her great aunt. In the Kaddish, she finds “the right and only words for her comfort and lamentation” (89).

Rebecca takes classes at the home, which Sacks notes is not always an effective course for most patients. The challenges of the classes can drive patients fully toward their deficits, not their strengths. Rebecca makes it clear that she needs the concrete and the narrative; young children need stories and symbolism to gain a sense of the world. Rebecca realizes this and shows Sacks how she becomes composed when listening to music or looking at a natural scene. Rebecca has the wherewithal to recognize that the classes are not serving her: “They do nothing for me. They do nothing to bring me together” (90). Instead, Rebecca opts to be a part of a theater group, where she excels. Sacks witnesses Rebecca in her true element and notes how on stage she is graceful and appears without disabilities.

Postscript

Sacks emphasizes that neurologists should not underestimate the use of theater, drama, and music. Patients with intellectual disabilities, severe frontal lobe damage, and even apraxia may be able to do otherwise impossible tasks while listening to music because music can organize the mind. Apraxia is characterized by the inability to complete simple physical sequences and tasks. For those with limited cognitive and physical functionality, schooling and therapy must be centered on music. Sacks also maintains that the capacity to “be” does not hinge on intellectual capabilities.

Martin A. is a 61-year-old man who had meningitis as a child. The disease caused delayed intellectual development, impulsiveness, seizures, and spasticity on one side. Martin lived with his parents until they died, at which time he had to support himself with menial work. However, due to his disabilities, he is unable to hold a job. As Sacks discovers, Martin has an amazing musical ability and an extraordinary memory; he can remember an opera after hearing it only once. Sacks believes Martin’s musical abilities bring color to the man’s life. Sacks does not know if Martin’s musical ability is innate and survived the meningitis or if it emerged to compensate Martin’s disabilities. When he engages in music, he forgets about his limitations.

Martin has an eidetic memory and can instantly record anything he sees—an encyclopedia entry, a map of New York Subways—but does not have any emotion connected with information he records. The exception is that he knows by heart Grove’s Dictionary of Music and Musicians, which includes more than 6,000 pages. Martin and his father would read the dictionary together, and his father sang. When Martin recalls Grove’s after his father’s death, he remembers his father’s voice with great emotion.

Martin’s world outside of music is “small, petty, nasty, and dark” (92). He has been teased, left out, and fired by those in the wider world. Martin is having trouble adjusting to the home. Martin expresses that he can’t live or pray without song. Those at the home arrange for Martin to go back to church to sing with the choir. Sacks notes that Bach seems so intellectual, and it is strange to him that Martin, a “simpleton,” can understand his music so well. Sacks realizes that Martin lives for and in Bach. After Martin returns to singing, he regains his dignity and becomes respected by the other patients. When Martin is singing, others who observe him see only animation, passion, wholeness, and health.

Postscript

When Sacks wrote the above chapter, he did not realize there was much literature on this subject. A 1970 case study by David Viscott details Harriet G., who presents similar advanced capabilities as Martin. Harriet could remember every number on the first three pages of the phone book for years, and she could also “compose, and improvise, music in the style of any composer” (94). When Sacks asks her to play, she performs on the piano with all the feeling and creative intelligence of a concert performer. Otherwise, she has the mental faculties of a young child.

Sacks directs the reader to the article “Sensitivity to Tonal Structure in a Developmentally Disabled Musical Savant” by L. K. Miller (presented at the Psychonomics Society, Boston, November 1985). Many think of “idiot savants” as having only mechanical, rote knowledge of music, etc. However, Sacks observed with Martin and Harriet that these unique patients seem to have a genuine, innate intelligence and understanding, if only in a single narrow area.

When Sacks met John and Michael, they were already well known. Doctors had diagnosed the identical twins with multiple disorders, including autism, psychosis, and delayed intellectual development. They have disproportionate heads and hands, high-pitched voices, arched palettes, and degenerative myopia. They are famous because they can remember minute visual detail and know exactly what day of the week a date will fall on. The twins feature in Steven Smith’s book The Great Mental Calculators (1983).

Other doctors reduced the twins to one factor of their lives. They looked at the testable, obvious surface traits, but Sacks realizes that the twins are far more complex. The twins, with amazing abilities to remember numbers, cannot do basic arithmetic. They are “‘calculators’ who cannot calculate” (96). Smith comments that something mysterious but simple is happening here. The twins have a human ability to unconsciously compute algorithms, an ability that emerged at age four. Give them a date, and they will tell you the weather and what happened on that day—delivered in a flat, emotionless tone. When asked how they remember so much, they claim they simply “see” it.

When a box of matches falls and the matches come out, the twins shout “111.” When asked how they could count the matches so quickly, they say they didn’t count—they just see it. They also repeatedly say “37” because they see three groupings of 37 matches. They have spontaneously trisected the number.

One day in 1966, Sacks observes the twins speaking back and forth with one another, one listing a six-figure number to the other, and the other responding with a different six-figure number. Sacks has no idea what the conversation means at first but checks a book of numbers. He realizes that the twins are speaking in prime numbers. The next day, Sacks uses the book to join their “game” of six-figure primes. He adds in an eight-figure example, and the twins, after a half-minute pause, simultaneously break into a smile. Sacks understands their game and has given them a new toy. The twins continue until they are up to twenty-digit numbers, a feat which Sacks observes: “There is no simple method, for primes of this order—and yet the twins were doing it” (99).

Sacks ruminates on numbers as iconic entities and as a metaphor for music. He speculates that the twins don’t calculate numbers. They feel them, almost as tones, and treat them as “friends.” The twins see numbers, not mere numerals. Sacks infers that the twins must have a kind of sense in their numbers the way a jazz musician must have harmony.

Sacks asserts that everything intellectual is also “sensible,” as in, related to the five senses and to the personal. Martin associated Bach with his father. The twins have a harmonic sensibility, allied to music. They see directly a “heaven of numbers” (102). This association provides a kind of serenity and self-sufficiency to their lives.

Ten years later, doctors separated the twins so that they could better integrate themselves within “normal” society. Their means of communication was regarded as “unhealthy.” After separation, they can keep themselves relatively clean, do menial tasks, and take the bus if directed. Without their shared “communion,” the twins lose their numerical abilities. The doctors consider the twins’ ability as a “faculty,” but the results reveal that their numerical language was actually a core part of themselves. Without it, they also lose their “center."

This reminds Sacks of Nadia, a child with autism. Doctors wanted to “maximize” Nadia’s potential through various therapies. As a result, she unwittingly sacrificed her “phenomenal” drawing abilities for the ability to talk. English writer Nigel Dennis wrote of Nadia and criticized her treatment: “We are left with a genius who had her genius removed, leaving nothing behind but a general defectiveness, What are we supposed to think about such a curious cure?” (103). Like Dennis, Sacks does not believe that being “socially acceptable” is worth the price these patients will pay in sacrificing their innate, extraordinary abilities.

Postscript

Author Dr. Israel Rosenfield reviews Sacks’s case study and suggests that the twins’ abilities stem from cyclical pattern recognition. He posits that they are able to pinpoint exact dates by calculating simple algorithms. Sacks considers that the twins’ otherwise unexplainable abilities are actually connected to their ability to spatially organize and visualize information. In this way, Rosenfield’s observations—in conjunction with British mathematician Ian Stewart’s work—help Sacks to demystify the twins’ “inexplicable powers.”

Sacks observes a 21-year-old man named José who is nonverbal. An attendant degrades José, telling Sacks that the boy is an “idiot” and unable to understand anything. Sacks notes that José seems to wince at the attendant’s harsh tone. Sacks gives José a watch to draw, and what José produces, while not technically correct, captures the watch’s essence and reproduces a surprising amount of detail accurately. Sacks asks José to draw more pictures, this time from pictures in a magazine. Again, he creates images that show creativity and perception, adapting the imagery more as an interpretation than mere copying. José brings out dramatic elements that the original photos lack.

When José was eight, he had a high fever, which doctors believed led to psychomotor and other seizures. After the seizures, doctors determined that José presented as “autistic.” Sacks does not accept that José is simply an “idiot” or “autistic.” He surmises that José may have had encephalitis, which in severe cases is associated with temporal lobe damage. Temporal lobe disorders can also interfere with the ability to speak or to understand speech.

For 15 years, José remained at home. His mother wouldn’t take him out because she feared he would have more seizures, which were happening daily. She kept him in a cellar, where he continued to look at pictures and draw. After a violent episode, José is brought to a state hospital. Sacks notes that state hospitals can sometimes be a refuge for patients like José. Unlike his family members, José finds the doctors to be accepting and nonjudgmental. Sacks comes to visit José in the state hospital and sees he is in a regressed condition, rocking himself in a corner. Sacks takes him to the art room and asks him to draw the same fish from three weeks earlier. This time the trout has human nostrils and lips. José chooses to round out the scene and draws a smaller fish in play, a waterline, and a large wave, after which he gives a cry.

Eventually, José is moved to a “home for the heart” (113), a place where patients with autism are given more support than they would normally get in a ward. When Sacks visits, José brings him on a walk outdoors. He seems to recognize different types of plants and is particularly attracted to a dandelion. José gets out his clipboard and draws it. Sacks observes that José does not have abstract thought, but an affinity for the particular, or the concrete. Sacks considers José to be a “natural artist.”

Most people believe that people with autism cannot express themselves in a unique way or have a sense of humor or originality. Sacks has met several people with autism who prove the opposite. José is one of them. He ends this chapter and the book asking what is to become of José and people like him. José is capable of doing illustrations for any number of organizations or purposes, but only if someone very understanding employs him to do so. Otherwise, he is likely to go overlooked.

Postscript

As in the case of “The Twins,” Sacks receives many letters from other doctors after the publication of “The Autist Artist.” Sacks notes that it is impossible to test for “artistic potential,” citing that there must be the “spontaneous production” of art in order for extraordinary abilities to become recognized. Sacks conveys that for artists with autism to blossom, they must have some kind of “intimate, empathetic relationship” and not formal training alone.