Oliver Sacks - The Man Who Mistook His Wife For A Hat and Other Clinical Tales

Their patient was a young man of 32, who, following a severe automobile accident, with unconsciousness for three weeks, . . . complained, exclusively, of an inability to recognise faces, even those of his wife and children. Not a single face was ‘familiar’ to him, but there were three he could identify; these were workmates: one with an eye-blinking tic, one with a large mole on his cheek, and a third ‘because he was so tall and thin that no one else was like him’. Each of these, Macrae and Trolle bring out, was ‘recognised solely by the single prominent feature mentioned’. In general (like Dr P.) he recognised familiars only by their voices.

He had difficulty even recognising himself in a mirror, as Macrae and Trolle describe in detail: ‘In the early convalescent phase he frequently, especially when shaving, questioned whether the face gazing at him was really his own, and even though he knew it could physically be none other, on several occasions grimaced or stuck out his tongue “just to make sure.” By carefully studying his face in the mirror he slowly began to recognise it, but “not in a flash” as in the past—he relied on the hair and facial outline, and on two small moles on his left cheek.’

In general he could not recognise objects ‘at a glance’, but would have to seek out, and guess from, one or two features— occasionally his guesses were absurdly wrong. In particular, the authors note, there was difficulty with the animate .

On the other hand, simple schematic objects—scissors, watch, key, etc.—presented no difficulties. Macrae and Trolle also note that: ‘His topographical memory was strange: the seeming paradox existed that he could find his way from home to hospital and around the hospital, but yet could not name streets en route [unlike Dr P., he also had some aphasia] or appear to visualize the topography.’

It was also evident that visual memories of people, even from long before the accident, were severely impaired—there was memory of conduct, or perhaps a mannerism, but not of visual appearance or face. Similarly, it appeared, when he was questioned closely, that he no longer had visual images in his dreams . Thus, as with Dr P., it was not just visual perception, but visual imagination and memory, the fundamental powers of visual representation, which were essentially damaged in this patient—at least those powers insofar as they pertained to the personal, the familiar, the concrete.

A final, humorous point. Where Dr P. might mistake his wife for a hat, Macrae’s patient, also unable to recognise his wife, needed her to identify herself by a visual marker , by . . . a conspicuous article of clothing, such as a large hat.

You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all . . . Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing ... (I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s . . .)

This moving and frightening segment in Bunuel’s recently translated memoirs raises fundamental questions—clinical, practical, existential, philosophical: what sort of a life (if any), what sort of a world, what sort of a self, can be preserved in a man who has lost the greater part of his memory and, with this, his past, and his moorings in time?

It immediately made me think of a patient of mine in whom these questions are precisely exemplified: charming, intelligent, memoryless Jimmie G., who was admitted to our Home for the Aged near New York City early in 1975, with a cryptic transfer note saying, ‘Helpless, demented, confused and disoriented.’

Jimmie was a fine-looking man, with a curly bush of grey hair, a healthy and handsome forty-nine-year-old. He was cheerful, friendly, and warm.

‘Hiya, Doc!’ he said. ‘Nice morning! Do I take this chair here?’ He was a genial soul, very ready to talk and to answer any questions I asked him. He told me his name and birth date, and the name of the little town in Connecticut where he was born. He described it in affectionate detail, even drew me a map. He spoke of the houses where his family had lived—he remembered their phone numbers still. He spoke of school and school days, the friends he’d had, and his special fondness for mathematics and science. He talked with enthusiasm of his days in the navy—he was seventeen, had just graduated from high school when he was drafted in 1943. With his good engineering mind he was a ‘natural’ for radio and electronics, and after a crash course in Texas found himself assistant radio operator on a submarine. He remembered the names of various submarines on which he had served, their missions, where they were stationed, the names of his shipmates. He remembered Morse code, and was still fluent in Morse tapping and touch-typing.

A full and interesting early life, remembered vividly, in detail, with affection. But there, for some reason, his reminiscences stopped. He recalled, and almost relived, his war days and service, the end of the war, and his thoughts for the future. He had come to love the navy, thought he might stay in it. But with the GI Bill, and support, he felt he might do best to go to college. His older brother was in accountancy school and engaged to a girl, a ‘real beauty’, from Oregon.

With recalling, reliving, Jimmie was full of animation; he did not seem to be speaking of the past but of the present, and I was very struck by the change of tense in his recollections as he passed from his school days to his days in the navy. He had been using the past tense, but now used the present—and (it seemed to me) not just the formal or fictitious present tense of recall, but the actual present tense of immediate experience.

A sudden, improbable suspicion seized me.

‘What year is this, Mr G.?’ I asked, concealing my perplexity under a casual manner.

‘Forty-five, man. What do you mean?’ He went on, ‘We’ve won the war, FDR’s dead, Truman’s at the helm. There are great times ahead.’

‘And you, Jimmie, how old would you be?’

Oddly, uncertainly, he hesitated a moment, as if engaged in calculation.

‘Why, I guess I’m nineteen, Doc. I’ll be twenty next birthday.’

Looking at the grey-haired man before me, I had an impulse for which I have never forgiven myself—it was, or would have been, the height of cruelty had there been any possibility of Jim-mie’s remembering it.

‘Here,’ I said, and thrust a mirror toward him. ‘Look in the mirror and tell me what you see. Is thata nineteen-year-old looking out from the mirror?’

He suddenly turned ashen and gripped the sides of the chair. ‘Jesus Christ,’ he whispered. ‘Christ, what’s going on? What’s happened to me? Is this a nightmare? Am I crazy? Is this a joke?’— and he became frantic, panicked.

‘It’s okay, Jimmie,’ I said soothingly. ‘It’s just a mistake. Nothing to worry about. Hey!’ I took him to the window. ‘Isn’t this a lovely spring day. See the kids there playing baseball?’ He regained his colour and started to smile, and I stole away, taking the hateful mirror with me.

Two minutes later I re-entered the room. Jimmie was still standing by the window, gazing with pleasure at the kids playing baseball below. He wheeled around as I opened the door, and his face assumed a cheery expression.