The Man Who Mistook His Wife for a Hat

Mrs. O’C. is 90 years old and partially deaf. One night, the sounds of Irish songs awaken her. She checks to see if her radio is playing, but it is not. She thinks that she must be picking up a radio station in one of her fillings and goes back to sleep. However, in the morning, she still hears the Irish music, the kind she sang and danced to as a child. Until the age of five, she lived in a small town in Ireland. Mrs. O’C. goes to see an ENT (ear, nose, and throat) doctor who tells her there is nothing physically wrong with her ears. The doctor recommends that she see a neurologist, so Mrs. O’C. goes to Sacks.

Sacks discloses that Mrs. O’C. was removed from Ireland as a child and taken to live with relatives in America. She has longed for her past, for her connection with her forgotten home and deceased family. Although the aural (auditory) hallucinations are brought on by a mini-stroke and a neurological phenomenon, they reconnect her with that past. They restore a feeling of wholeness. Sacks describes Mrs. O’C.’s “epileptic transports” as “healing.” He also relates the paradox of Mrs. O’C.’s circumstance: At the end of her life, a “cerebral mishap” provides her with comforting memories of her long-forgotten childhood. As a result of her neurological condition, Mrs. O’C. feels happier and healthier. Once the “epileptic reminiscence” cease, she misses them. Sacks calls this “Incontinent Nostalgia” (66) and alludes to author H.G. Wells’s short story “The Door in the Wall.”

Sacks recounts a similar instance of Mrs. O’M, who, like Mrs. O’C., is elderly, bright, and partially deaf. However, the music Mrs. O’M. hears—in addition to the occasional voice or hissing sound—becomes increasingly annoying. She eventually hears the same three hymns repeatedly. She believes her aural hallucinations are indicative of mental illness and is relieved to learn otherwise. Unlike Mrs. O’C., she does not like the songs or find them meaningful. Over the course of a year, she begins to hear more complex music, with the songs sometimes overlapping. Her condition worsens, and she develops “amusia” (67), in which tones and tunes become homogeneous. She was a fine singer, but now Mrs. O’M. is unable to distinguish tone in the songs she hears. An EEG finds damage in the temporal lobes, the place that controls music. She is having what Sacks calls “musical epilepsy” (68).

Sacks turns to the studies of American Canadian neurosurgeon Wilder Penfield. Penfield was able to locate the seizure-prone points of the cerebral cortex in patients who were still conscious as he performed experiments on them. He discovered that two states happen at once: One part of the brain experiences a “dreamy state” (68) of hallucinating music, while the intellectual mind experiences more normal conscious states. This is called “double consciousness” (68). Penfield shows that these are not fantasies but memories, which are accompanied by the feeling that the memory evokes.

Penfield deduced that the brain records our lifetime of memories and experiences, which electrical or epileptic stimulations can recall. Penfield believes that there is no reason why people experience a particular musical hallucination over another, i.e., why they hear one song instead of another. He surmises that the selection of songs, while random, is actually fixed. That is, patients will hear the same songs. Sacks wonders if there is something more significant behind the selection, but Penfield has not conducted a deeper analysis of his findings in this regard.

Mrs. O’M. remembers that she used to unconsciously hum her three songs before the seizures began. Although Sacks offers that there were, in fact, reasons why her brain selected these hymns for her aural hallucinations, he is not firm in this assertion.

Sacks relates the story of Russian composer Dmitri Shostakovich, a man with a fragment lodged in his brain. Shostakovich claimed that the injury to his temporal lobe helped him to compose music. Mrs. O’M. says she is not Shostakovich and wants her hallucinations to go away. Sacks puts her on an anticonvulsant, which resolves the issue.

Postscript

Sacks connects the case of Mrs. O’C. to the findings of English neurologist John Hughlings Jackson and Austrian neurologist Sigmund Freud: “She suffered from a Jacksonian ‘reminiscence,’ but this served to moor and heal her, as a Freudian ‘anamnesis’” (69). “Reminiscence” refers to the recollection of joyful past events, whereas “anamnesis” refers to the act of recalling. Sacks questions the nature of memory and identifies a gap, or “chasm,” between what neurologists learn from their patients’ experiences and what neurologists know about the physiology of the brain. Sacks maintains that “experience and action” are a type of art that should be considered when determining patients’ course of treatment.

Sacks uses this chapter to discuss the influence of L-Dopa. He explores the difference between “reminiscence,” as depicted in the previous chapter, and “stoppage.” With Rose R., he describes a 63-year-old patient who has not moved past 1926. (As an aside, Sacks notes that British playwright Harold Pinter portrays a character, Deborah, with a similar problem in his 1982 play A Kind of Alaska).

L-Dopa can sometimes cause patients to reactivate physical problems or moral attitudes they had at an earlier stage of their illness. In the case of Rose R., she was suspended in a Parkinson-induced “trance,” or coma, for 24 years. Once given L-Dopa, Rose experiences identification with a youthful self. She asks for a tape recorder and records smutty jokes, songs, and other things she remembers from a bygone “flapper’s era.” She is amazed that she remembers these things. She explains that they continue to run through her mind unbidden, until the doctors reduce her dosage of L-Dopa. After that, the memories are gone.

Sacks writes that this is a typical reaction to L-Dopa, but he does not know why certain memories and not others are lost and then found again. He wonders if the patients’ illnesses repress the “dormant” memories, to which the introduction of L-Dopa counters. Sacks refers to the work of neurosurgeons Wilder Penfield and Phanor Perot. Penfield and Perot determined that it was possible to trigger “fossilized memory sequences” in patients by stimulating specific parts of the cortex. Sacks regards the sudden flood of memories as “forced reminiscence” and categorizes them as “excitations.”

Sacks meets Bhagawhandi P. in 1978. She is a vibrant, 19-year-old Indian woman with a brain tumor. Her diagnosis occurred at age seven, but the tumor went into remission, allowing her to live a happy, full life until she was about 18 years old. Bhagawhandi P. lived in India as a young girl. As her brain tumor grows, encroaching on the frontal lobe, she experiences vivid memories from her childhood. She exists in a “dreamy” state that Hughlings Jackson calls “double consciousness.” She remembers India in great tactile detail and often mentally visits family and neighbors from her past. In speaking with nurses and doctors, she is able to answer questions and understand what they are saying, but the impression is that she is elsewhere. Soon, her dreamlike state accounts for most of her days. Bhagawhandi P. tells Sacks that she is “going home” and is at peace. Three days later, she dies. As Sacks puts it, she “arrives” home (77).

Stephen D. wakes from a dream in which he was a dog. Upon waking, he retains the acute, heightened sense of color and smell he had in the dream. Stephen is a bright, 22-year-old university student who uses addictive stimulants like cocaine, PCP, and amphetamines. For approximately three months, Stephen D. experiences the world with his new sense of smell, recognizing people by their scent and experiencing both extreme pleasure and disgust based on the smells of food or waste around him. As an aside, Sacks describes olfactory hallucinations that can result in a heightened sense of smell, called hyperosmia.

After those three months, Stephen’s heightened sense fades. Sacks attributes the unusual occurrence to Stephen’s previous use of amphetamines. Although he is glad to return to his “normal state,” Stephen also misses his animal consciousness. Freud believes that humans have suppressed many of their animal urges as they learn to stand upright and become more “civilized.” Sacks comments that while humans may need a more distinct consciousness to differentiate themselves from the animals, they also need our “dog” consciousness in order to be happy. He alludes to G. K. Chesterton’s poem “The Song of Quoodle” to emphasize his view.

Postscript

Sacks recounts the story of a man with a similar experience. One morning, the man discovered he could not smell anything, neither his coffee nor his pipe. Life lost its flavor because so much of life’s richness is based on smell. After several months in this state, he could taste his coffee and pipe again, yet the doctors told him his anosmia (loss of smell) had not been cured. The man was recollecting the smell of coffee and tobacco instead of actually physically smelling them. His desire to smell and his memory of the smells were so strong that he felt them to be real. Sacks describes these as controlled olfactory hallucinations.

While on PCP, Donald kills his girlfriend but has no memory of the incident. The courts rule that Donald is not culpable because he was under the influence of drugs. Donald is sentenced to four years in a psychiatric hospital. At the facility, Donald tends to plants and recovers a sense of calm. Sacks speculates that Donald felt he deserved to be incarcerated and was comforted by the security of being locked away. Donald’s gardening helps him heal, and after five years, Donald is released on probation.

Donald takes up cycling. One day, he swerves to avoid hitting a car and sustains severe head injuries to both of his frontal lobes. After two weeks in a coma, Donald wakes up plagued with the memory of killing his girlfriend. What’s more, he continues to relive the experience, seeing it play out in front of him over and over. The physical evidence of his girlfriend’s autopsy report validates his memories; Donald is not hallucinating or imagining the events. EEG reports show that Donald is having grand mal seizures and continuous activity deep in the frontal lobes where the emotional centers of the brain are located.

Sacks cannot explain why the seizures trigger Donald’s memory of his girlfriend’s death. It takes years of therapy, support from mental health practitioners, and Luria’s treatment of the frontal lobes for Donald to stop experiencing involuntary memories of the murder. With all this help, plus the health attributed to his youth, Donald begins to recover. Although he still remembers what he did, he is able to stop obsessing over the scene and return to a calmer life where he continues to garden. Donald notes that he likes being with plants because, unlike people, they don’t judge him. Sacks is mystified by the brain’s ability to repress and then liberate traumatic memories.

Sacks explains that there are many stories of religious visions, and it is hard to know if any of these are caused by epilepsy or other reasons. In the case of Saint Hildegard of Bingen (1098-1180), the mystic nun left two manuscripts, Scivias and Liber divinorum operum (“Book of divine works”), detailing her experiences. Sacks determines that her visions were “indisputably migrainous” (84).

In 1928, British historian Charles Singer wrote From Magic to Science: Essays on the Scientific Twilight. In the book, he describes Hildegard’s visions as points of light and shimmering lights that looked like eyes. They often appeared to be “working, boiling, or fermenting” (84). She claims she experienced her visions with “eyes of the spirit and the inward ears” (84). One vision she records as a sky of falling stars, which she interprets as the fall of the angels. Sacks understands this as “a shower of phosphenes across the visual field” (84).

Hildegard says that in addition to seeing light, and light inside of light, she loses any sadness and becomes like a child again when having her visions. Sacks attributes this to an ability to take physical phenomena and attach to them deeper significance. Russian novelist Fyodor Dostoyevsky, who had epilepsy, describes a similar experience in having a great religious revelation in five-second-long increments.