Took his wife for a hat to read. Oliver Sachs. The man who mistook his wife for a hat. The man who mistook his wife for a hat and other medical stories

In "The Man Who Mistook His Wife for a Hat" there is actually only one interesting moment - the one to which I originally found the link - how the twins get information from nowhere (from the unconscious). That is, the infa, which they saw before, corresponds to the objective reality. The rest - the description of obvious hallucinations of different origin and interest is not of interest.

Original: Oliver Sacks, “The man who mistook his wife for a hat and other clinical tales”
Translation: Julia Chislenko, Grigory Khasin

annotation

The author of this book, a neuropsychologist and writer, is well known in the United States. The Man Who Mistook His Wife for a Hat (1985) became a bestseller there and went through five editions. Oliver Sachs comes to a Russian reader for the first time.

This is a deep and wise book in which everyone will find something of their own. Here is a description of complex and rare cases from the practice of Dr. Sachs, and the dramatic vicissitudes of a person's struggle with illness, and philosophical attempts to comprehend the human soul. What is the nature of the disease? What does she do with her psyche? Does it always take away - or does it sometimes bring something new and even positive?

Oliver Sachs' amazing stories paradoxically contribute to mental health.

From translators

We would like to express our deep gratitude to everyone who helped in the work on this book, especially Aleksey Altayev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeny Chislenko and Elena Kalyuzhny. Translation editor Natalya Silantyeva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been impossible at all.

Foreword by the Science Editor

Having received an offer to edit the translation of the book of the famous neurologist, psychologist and writer Oliver Sachs "The Man Who Mistook His Wife for a Hat," I agreed without a moment's thought. This book, a gift from an American colleague, has been standing on the shelf of my closet next to the works of A.R. Luria for fifteen years. Over the years, I have come back to it many times. When teaching a course in neuropsychology, it is simply impossible to refrain from quoting Sachs. But "The Man Who Mistook His Wife for a Hat" is much more than a special monograph or manual for a teacher and a doctor.

Oliver Sachs is one of the most famous names in his area in the West. And his popularity goes far beyond the boundaries of a narrow professional environment.

He was born and educated in London and continued in the United States. Since 1970, his books - "Migraine", "Awakenings", "Leg to Stand" - have won readers over. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs.

This is not to say that Sachs is not known at all in Russia. Several of his essays entitled "Cases from Practice" were published in the journal "Foreign Literature". His works are cited by Russian authors - both neuropsychologists and writers (for example, Tatiana Tolstaya). But the real acquaintance with the work of Oliver Sachs for the Russian reader is still ahead.

How to define the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a fairly narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of material in a textbook and monograph.

It is not what Oliver Sachs writes about that decides the matter, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome a “tourette?”), Nor the abundance of special terms, nor the listing of chemicals, the existence of which most simply do not know.

Can you imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, the intensity of passions. And its hero should be a person, not his disease. This is precisely the most important feature of Sachs's work.

And it is not surprising that his book "Awakenings" became the basis for the play by Harold Pinter, and was later filmed. It's hard to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with the book I am offering you. An opera based on it was written by Michael Nyman, a popular contemporary composer, author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. Music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise on the street, caught a certain symphony in it. Music constitutes the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. Music transforms the awkward, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force organizing the life of Professor P., who "has his own melody for every action."

It seems that every reader can find something of their own in the book. Someone will be interested in "Kunstkamera" - amazing neuropsychological stories. For another reader, Oliver Sachs's book is a small tragedy, where in the foreground is not illness, ugliness, but experience, fate, the intensity of a person's struggle with illness. Tragic is the misunderstanding of one's position, even more tragic is the realization - for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, this is an attempt to comprehend the human soul: a breakdown reveals the hidden. Where can we find a reader who is as versatile as the author?

I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, amazed at the persistence of the author, who, defending the main thesis, each time discovers something new. For us. But above all for himself.

It is amazing that Oliver Sachs, a man of great clinical experience, manages not to lose the ability to wonder. Each of his descriptions is imbued with this feeling.

In Oliver Sachs's book, the reader will find a certain duality. The author is a doctor, and all the stereotypes of traditional clinical thinking are inherent in him. He dreams of understanding the human soul through the physiology of brain structures. He believes in miraculous substances that "wake up" patients. He is characterized by the optimism of a scientist professing the principles of positive science. He sees the brain as a magnificent machine, extremely complex and well-coordinated. A machine whose breakdowns are as extraordinary as its normal operation.

However, a person begins to think about the structure of the mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, gets into an argument with traditional medical thinking. He's not just talking about brain structures and neurotransmitters.

He talks about archetypes, symbols, myths. Speaks emotionally, excitedly. It is clear to the reader which side the victory is on. The romantic worldview triumphs. It is no coincidence that A.R. Luria dreamed of romantic neurology, and Sachs picks up this idea. The heterogeneity of the book's material, the variety of the problems touched upon in it requires synthesis. This synthesis is almost impossible intellectually. And this is where passion comes to the rescue.

The book also covers philosophical issues. What is the nature of the disease as such? What is health? What does illness do to the psyche? Does it always take away - or does it sometimes bring something new and even positive into the human soul? The structure of the book itself answers this question. Its main sections are called "Loss" and "Excess". But even in the “Loss” section, Sachs agrees that at some level, illness can enhance the creative potential of an individual. Professor P., losing the ability to visual perception, goes from realism in painting to cubist and abstract canvases. And although in the end the hero's artistic abilities come to naught, but "halfway through" he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient - a person who has lost his memory, Oliver Sachs sees creativity.

For a psychiatrist who is used to separating symptoms into “productive” and “negative,” add and subtract, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, but the patient does, then, therefore, we are talking about products, albeit pathological. And again, if the consciousness is deeply clouded, then we are talking about a loss. But if bizarre images invade consciousness, filling the inner space along with the impressions of the real world, then we are talking about qualitative, productive disorders. However, Sachs' understanding of loss and excess is more complex and, it seems to me, closer to the truth.

Yes, full, is there an excess? If it happens, it is only as a result of a lack of some other factor that disturbs the balance. The easiest way to illustrate this thesis is on the example of a complete loss of the ability to memorize (Korsakov syndrome).

Confabulations (fictions, fantasies), as a rule, occurring with memory loss, are a productive symptom. But after all, confabulations only fill a huge flaw - the void that has formed in the psyche of a person who is unable to preserve true impressions in his memory. Yes, crazy ideas are products. But Freud at one time showed that the delusional worldview of the paranoid is just a flawed attempt to recreate some semblance of harmony in the place of the destroyed psyche disease.

Any disease includes not only changes, but also reactions to these changes: on the part of the structures of the brain - at the physiological level, on the part of the patient's psyche - on the psychological, and also on the part of loved ones and society ...

We see how the patient learns to use nervous tics in order to personalize the manner of playing the percussion instruments. And an improvement in his condition deprives him of the game of a unique brilliance. The patient can not only compensate or overcompensate for pathological symptoms - he can utilize them, can productively integrate them into his “I”.

According to Freud, awareness brings healing. In Sachs' patients, due to the grossly organic nature of the diseases, full awareness is impossible. Temporary awareness is tragic. The "lost sailor", who has lost his memory and lives in the past, considers himself a nineteen-year-old boy. Sachs shows him his face in the mirror: the patient is able to see the face of a gray-haired person and understand that this person is him. The patient's emotional response to the overwhelming discovery is appalling. But the interruption of the rhythm ends the tragedy. The doctor exits and enters again. The patient forgot both the doctor and the traumatic experiment that had just been performed.

By reading Oliver Sachs, a specialist recognizes the signs of diseases that he has encountered in his practice or which he has only read about. Memory prompts tricky, mostly Greek names for symptoms and syndromes.

Professor P. does not recognize the faces of people? Yes, this is prosopagnosia, the inability to recognize faces, a symptom of damage to the occipital lobes. Can't orientate in space on the left hand, ignore the left side? Optical spatial agnosia. Again, the occipital lobes. Can't recognize the glove? Object agnosia. Not aware of your illness? Anosognosia, more often occurs when the right, subdominant hemisphere is affected ... By the way, P.'s reflexes are higher when examined on the left side. But the fact that P. could not distinguish the hat from the head by touch ... Or the fact that he did not recognize the glove, even taking it in his hands ... It seems that the parietal lobes and their lower sections are affected. It seems that we are beginning to understand what is the matter.

However, by reasoning in this way, we are deceiving ourselves. For ordinary medical thinking, naming is equivalent to understanding. Define a symptom, group symptoms into a syndrome, relate it to a specific brain localization. Think over a treatment program. Well, for practical purposes, that's enough. But naming and understanding are different things. We fall into the trap of terms. Moreover, we, specialists, enjoy pronouncing these unusual words, akin to magic spells. Sachs, too, seems to be sorting through them - apraxia, agnosia, ataxia ...

But let's translate these terms into Russian. A person does not recognize faces. We say he has prosopagnosia. Translated from Greek - the inability to recognize faces.

The man says: I cannot be in open, crowded spaces, I am overwhelmed by fear. We say he has agoraphobia. Translated from Greek - the fear of open public spaces.

In other words, we simply return what we learned about the patient, but in a language incomprehensible to the uninitiated ... Most doctors, turning information about the patient into bricks scientific terms, as if building a wall between himself and the patient - and examines his creation. Behind this wall is a living person, a unique personality. A scientist needs to make a considerable effort in order to break through the barrier that he himself built. This is what Oliver Sachs does.

Psychiatry prefers to study pathology "with kings and poets." The more complex and beautiful the building, the more magnificent and attractive the ruins are. The most famous patients in psychoanalysis, for example, were exceptional personalities. Anna O. (pseudonym of Bertha Poppenheim), the first patient of J. Breuer and Z. Freud, later became famous as a pioneer of social work in Germany. She was called "the healer of humanity." The symptoms of this woman's illness were also unique, exceptional.

The patients of A.R. Luria were also unusual: one had an unprecedented will to live and courage, the other had a phenomenal memory. The same goes for Oliver Sachs' patients. On the pages of his book, one can find exclusivity and everyday life. Professor of music P. and "tic witty" are remarkably gifted individuals. And the manifestations of their diseases look much more interesting and complex. From these stories one can learn more lessons, they lead to truly philosophical reflections.

But no less impressive are the tragedies ordinary people... We see personality both in patients who have lost their memory and in "simpletons" - people with profound intellectual disabilities. How can we understand such patients, who cannot understand ourselves? Here is an autistic artist who does not know how to say a word - and who has turned drawing into the only way to communicate with the world. Here are two twins with phenomenal numerical abilities. But here, too, Sachs is interested not so much in the "trained" twins (he even uses the old clinical term, far from political correctness - "scientists idiots"), as in the tragedy of these people, whom doctors separated to "improve their social adaptation."

In my opinion, showing the reader the path to himself through understanding the altered (but indestructible) personality of the patient is the main mission of Oliver Sachs.

Boris Kherson.

It is impossible to write a preface to the Russian edition of this book without paying tribute to the person whose work served as the main source of inspiration for its creation. Of course, we are talking about Alexander Romanovich Luria, an outstanding Russian scientist, the founder of neuropsychology. Despite the fact that we never had a chance to meet in person, I was in a long correspondence with him, which began in 1973 and lasted four years, until his death in 1977.

Luria's large systematic works - "Higher cortical functions of man", "Human brain and mental processes" and others - were my reference books in my student years, but his work "A little book about great memory (Mnemonist's mind)" was a real revelation for me. published in English in 1968. Luria describes in it his thirty years of observation of a uniquely gifted, but in a certain sense flawed and suffering person, with whom he developed a personal friendship. In this book, deep scientific studies of memory, imaginative thinking and other cerebral functions are combined with a vivid description of the personality and fate of the mnemonist, with a subtle feeling into his inner life. Luria himself called this combination of human contact and neuropsychology a "romantic science", and later he once again brilliantly demonstrated this approach in the book "The World Lost and Returned". If Luria had lived longer, he, as planned, would have written another similar work - a study of a patient with deep amnesia.

These two books played an important role in my life: working with patients and describing their fates and diseases, under the influence of Luria's ideas, I gradually came to my own romantic science. That is why my book Awakenings, written in 1973, is about Luria. This book is also closely related to him, especially the story "The Lost Sailor", where his letters are quoted - I think that such a study could have been written by Luria himself, although perhaps he would have devoted a separate book to the hero of this story, Jimmy.

I am very glad that "The Man Who Mistook His Wife for a Hat" is finally being published in Russian. I hope, after reading the stories of my patients, the reader will see that neuroscience is not limited to an impersonal science that relies mainly on technology, that it has deeply human, dramatic and spiritual potential.

Oliver SAX
New York, October 2003

The man who mistook his wife for a hat and other medical stories

To Dr. Leonard Shengold

Talking about disease is like telling the stories of The Thousand and One Nights.
William Osler

Unlike a naturalist,<…>the doctor deals with a single organism, a human subject, struggling for self-preservation in a threatening situation.
Ivy Mackenzie

"Only when you finish a book," Pascal remarks somewhere, "you usually understand where to start." So, I wrote, put together and edited these strange stories, chose a title and two epigraphs, and now I need to understand what has been done - and why.

Let us first turn to the epigraphs. There is a certain contrast between them - this is exactly what Ivy Mackenzie emphasizes, contrasting the doctor and the naturalist. This contrast is in keeping with the dual nature of my own character: I feel like both a doctor and a naturalist, illnesses are as much a concern to me as people. Equally (and to the best of my ability) theorist and storyteller, scientist and romantic, I simultaneously explore and personality, and organism and I clearly see both of these principles in a complex picture of the conditions of human existence, one of the central elements of which is disease. Animals also suffer from various disorders, but only in humans can the disease turn into a way of being.

My life and work are dedicated to the sick, and I owe some key thoughts to close communication with them. Together with Nietzsche, I ask: "As for the disease, I would very much like to know, can we do without it?" This is a fundamental question; working with patients forces me to ask it all the time, and trying to find the answer, I come back to patients again and again. In the stories offered to the reader, this continuous movement, this circle, is constantly present.

Research is understandable; but why stories, stories? Hippocrates introduced the idea of ​​the development of a disease in time - from the first symptoms to a climax and a crisis, and then to a successful or fatal outcome. This is how the genre of medical history was born - describing its natural course. Such descriptions fit well into the meaning of the old word "pathology" and are quite appropriate as a kind of natural science, but they have one serious drawback: they do not report anything about a person and his stories about the inner experience of a person who is faced with a disease and struggling to survive.

There is no subject in a narrowly understood case history. Modern anamnesis mention a person only in passing, in an official phrase (trisomic albino, female sex, 21 years old), which may just as well refer to a rat. In order to address a person and place in the center of attention a suffering, straining human being, it is necessary to take the history of the disease to a deeper level, giving it a dramatic narrative form. Only in this case, against the background of natural processes, a subject will appear - a real person in a confrontation with an illness; only in this way will we be able to see the individual and the spiritual in connection with the physical.

The patient's life and feelings are directly related to the deepest problems of neurology and psychology, since where personality is affected, the study of the disease is inseparable from the study of personality and character. Some disorders and methods of their analysis, generally speaking, require the creation of a special scientific discipline, "personality neurology", whose task should be to study the physiological foundations of the human "I", the ancient problem of the connection between the brain and consciousness.

Perhaps, there really is a conceptually logical gap between the mental and the physical, but studies and plots devoted to both the body and the individual are able to bring these areas closer together, bring us to the point of intersection of the mechanical process and life, and thus clarify the connection between physiology and biography. This approach is especially interesting to me, and in this book I generally adhere to it.

The tradition of clinical stories built around a person and his or her destiny flourished in the nineteenth century, but later, with the development of impersonal neurology, began to gradually fade away. A.R. Luria (A.R. Luria (1902 1977) - Russian neurologist, founder of neuropsychology. XIX century, has now almost disappeared.<…>It needs to be restored. " In his later works, such as The Little Book of Great Memory (Mnemonic Mind) and The Lost and Returned World, he tries to revive this lost form. The stories from clinical practice drawn from Luria's pen are connected with the past, with the traditions of the nineteenth century, with the descriptions of Hippocrates, the first medical historian, with the long-standing custom of patients telling doctors about themselves and their diseases.

Classic narrative plots unfold around archetype characters - heroes, victims, martyrs, warriors. The neuropathologist's patients embody all these characters, but in the strange stories told below, they appear to be something more. Are the images of the "lost sailor" and other amazing characters in this book reduced to the usual myths and metaphors? They can be called wanderers - but in unimaginably distant lands, in places that would be difficult even to imagine without them. I see in their wanderings a reflection of a miracle and a fairy tale, and that is why I chose Osler's metaphor as one of the epigraphs - the image of “A Thousand and One Nights”. There is an element of parable and adventure in my patients' medical records. Scientific and romantic merge here - Luria liked to talk about "romantic science" - and in each of the cases described (as in my previous book "Awakenings"), in every destiny we find ourselves at the crossroads of fact and myth.

But what amazing facts! What fascinating myths! How do you compare them? We do not seem to have models or metaphors for making sense of such cases. It looks like the time has come for new symbols and new myths.

Eight chapters of this book have already been published: "The Lost Sailor", "Hands", "Gemini" and "The Autistic Artist" - in the "New York Book Review" (1984 and 1985), "The Ticky Wit", "The Man Who Mistook His Wife for hat and Reminiscence (abbreviated as Ear for Music) in London Book Review (1981, 1983 and 1984), and Eye Level in The Sciences (1985). In chapter

Rush of Nostalgia (originally published in the spring of 1970 in The Lancet as L Dopa and Nostalgic States) contains a long-written account of a patient who later became the prototype for Rose R. from Awakenings and Deborah from Harold Pinter's play What something like Alaska. " Of the four fragments collected in the Phantoms chapter, the first two were published in the Clinical Cabinet of Curiosities, British Medical Journal (1984). Two more short stories are borrowed from my previous books: "The Man Who Fell Out of Bed" from The Foot to Stand, and Visions of Hildegarda from the book "Migraine". The remaining twelve chapters are being published for the first time; they were all written in the fall and winter of 1984.

I would like to acknowledge my deep gratitude to my editors - most notably Robert Silvers of New York Book Review and Mary Kay Wilmers of London Book Review; Keith Edgar and Jim Silberman of Summit Books in New York and finally Colin Haycraft of Duckworth in London. Together, they were invaluable in helping to get the book into its final shape.

I would also like to express special gratitude to my fellow neurologists:
- to the late James P. Martin, to whom I showed the videos of Christina and Mr. McGregor. The Chapters "Disembodied Christie" and "The Eye of Spirit Level" were born out of detailed discussions of these patients;
- Michael Kremer, my former chief physician from London. After reading my book A Foot to Stand (1984), he related a very similar case from his own practice, and I included it in the chapter “The Man Who Fell Out of Bed”;
- To Donald Macrae, who witnessed an amazing case of visual agnosia, similar to that of Professor P. I accidentally discovered his report two years after the publication of my story. Excerpts from his article are included in the postscript to the story of "the man who mistook his wife for a hat";
- Isabella Rapin, colleague and close friend from New York. I discussed many of my cases with her; she asked me to look at the "disembodied" Christina and for many years, from his very childhood, she watched Jose, an autistic artist.

I am infinitely grateful to all the patients (and sometimes their loved ones), whose stories are told in the pages of this book. I thank them for their disinterested help and generosity, I thank them for the fact that, even knowing that my scientific interest would not help them in any way, they encouraged me and allowed me to describe what happened to them, hoping to help others understand and, possibly, learn to cure diseases from which they suffer. As in The Awakenings, in keeping with medical confidentiality, I changed the names and some circumstances, but in each case I tried to preserve the basic feeling.

Finally, I want to express my gratitude - more than gratitude - to Leonard Shengold, my teacher and physician to whom this book is dedicated.

Current page: 1 (total of the book has 19 pages) [available passage for reading: 5 pages]

Oliver Wolf Sachs

From translators

We would like to express our deep gratitude to everyone who helped in the work on this book, especially Aleksey Altayev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeny Chislenko and Elena Kalyuzhny. Translation editor Natalya Silantyeva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been impossible at all.

Foreword by the Science Editor

Having received an offer to edit the translation of the book of the famous neurologist, psychologist and writer Oliver Sachs "The Man Who Mistook His Wife for a Hat," I agreed without a moment's thought. This book, a gift from an American colleague, has been standing on the shelf of my closet next to the works of A.R. Luria for fifteen years. Over the years, I have come back to it many times. When teaching a course in neuropsychology, it is simply impossible to refrain from quoting Sachs. But "The Man Who Mistook His Wife for a Hat" is much more than a special monograph or manual for a teacher and a doctor.

Oliver Sachs is one of the most famous names in his field in the West. And his popularity goes far beyond the boundaries of a narrow professional environment.

He was born and educated in London and continued in the United States. Since 1970, his books - "Migraine", "Awakenings", "Leg to Stand" - have won readers over. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs. This is not to say that Sachs is not known at all in Russia. Several of his essays entitled "Cases from Practice" were published in the journal "Foreign Literature". His works are cited by Russian authors - both neuropsychologists and writers (for example, Tatiana Tolstaya). But the real acquaintance with the work of Oliver Sachs for the Russian reader is still ahead. How to define the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a fairly narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of material in a textbook and monograph. It is not what Oliver Sachs writes about that decides the matter, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome a “turette?”), Nor the abundance of special terms, nor the listing of chemicals, the existence of which is simply not known to most.

Can you imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, the intensity of passions. And its hero should be a person, not his illness. This is precisely the most important feature of Sachs's work. And it is not surprising that his book "Awakenings" became the basis for the play by Harold Pinter, and was later filmed. It's hard to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with the book I am offering you. An opera based on it was written by Michael Nyman, a popular contemporary composer, author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. Music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise in the street, caught a certain symphony in it. Music constitutes the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. Music transforms the awkward, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force organizing the life of Professor P., who "has his own melody for every action."

It seems that every reader can find something of their own in the book. Someone will be interested in the "Kunstkamera" - amazing neuropsychological stories. For another reader, Oliver Sachs's book is a small tragedy, where in the foreground is not illness, ugliness, but experience, fate, the intensity of a person's struggle with illness. Tragic is the misunderstanding of one's position, even more tragic is the realization - for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, this is an attempt to comprehend the human soul: a breakdown reveals the hidden. Where can we find a reader who is as versatile as the author?

I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, amazed at the persistence of the author, who, defending the main thesis, each time discovers something new. For us. But above all for himself.

It is amazing that Oliver Sachs, a man of great clinical experience, manages not to lose the ability to wonder. Each of his descriptions is imbued with this feeling.

In Oliver Sachs's book, the reader will find a certain duality. The author is a doctor, and all the stereotypes of traditional clinical thinking are inherent in him. He dreams of understanding the human soul through the physiology of brain structures. He believes in miraculous substances that "wake up" patients. He is characterized by the optimism of a scientist professing the principles of positive science. He sees the brain as a magnificent machine, extremely complex and well-coordinated. A machine whose breakdowns are as extraordinary as its normal operation. However, a person begins to think about the structure of the mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, gets into an argument with traditional medical thinking. He's not just talking about brain structures and neurotransmitters.

He talks about archetypes, symbols, myths. Speaks emotionally, excitedly. It is clear to the reader which side the victory is on. The romantic worldview triumphs. It is no coincidence that A.R. Luria dreamed of romantic neurology, and Sachs picks up this idea. The heterogeneity of the book's material, the variety of the problems touched upon in it requires synthesis. This synthesis is almost impossible intellectually. And this is where passion comes to the rescue.

The book also covers philosophical issues. What is the nature of the disease as such? What is health? What does illness do to the psyche? Does it always take away - or does it sometimes bring something new and even positive into the human soul? The structure of the book itself answers this question. Its main sections are called “Loss” and “Surplus”. But even in the “Loss” section, Sachs agrees that at some level, illness can enhance the creative potential of an individual. Professor P., losing the ability to visual perception, goes from realism in painting to cubist and abstract canvases. And although in the end the hero's artistic abilities come to naught, but "halfway through" he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient - a person who has lost his memory, Oliver Sachs sees creativity.

For a psychiatrist who is used to separating symptoms into “productive” and “negative,” add and subtract, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, and at there is a patient, then, therefore, we are talking about products, albeit pathological. And again, if the consciousness is deeply clouded, then we are talking about a loss. But if bizarre images invade consciousness, filling the inner space along with the impressions of the real world, then we are talking about qualitative, productive disorders. However, Sachs' understanding of loss and excess is more complex and, it seems to me, closer to the truth.

Yes, full, is there an excess? If it does, it is only as a result of a lack of some other factor that disturbs the balance. The easiest way to illustrate this thesis is on the example of a complete loss of the ability to memorize (Korsakov syndrome). Confabulations (fictions, fantasies), as a rule, occurring with memory loss, are a productive symptom. But after all, confabulations only fill a huge flaw - the void that has formed in the psyche of a person who is unable to preserve true impressions in his memory. Yes, crazy ideas are products. But Freud at one time showed that the delusional worldview of the paranoid is just a flawed attempt to recreate some semblance of harmony in the place of the destroyed psyche disease. Any disease includes not only changes, but also reactions to these changes: on the part of the structures of the brain - at the physiological level, on the part of the patient's psyche - on the psychological level, and also on the part of loved ones and society ...

We see how the patient learns to use nervous tics in order to personalize the manner of playing the percussion instruments. And an improvement in his condition deprives him of the game of a unique brilliance. The patient can not only compensate or overcompensate for pathological symptoms - he can utilize them, can productively integrate them into his “I”.

According to Freud, awareness brings healing. In Sachs' patients, due to the grossly organic nature of the diseases, full awareness is impossible. Temporary awareness is tragic. The "lost sailor", who has lost his memory and lives in the past, considers himself a nineteen-year-old boy. Sachs shows him his face in the mirror: the patient is able to see the face of a gray-haired person and understand that this person is him. The patient's emotional response to the overwhelming discovery is appalling. But the interruption of the rhythm ends the tragedy. The doctor exits and enters again. The patient forgot both the doctor and the traumatic experiment that had just been performed.

By reading Oliver Sachs, a specialist recognizes the signs of diseases that he has encountered in his practice or which he has only read about. Memory prompts tricky, mostly Greek names for symptoms and syndromes. Professor P. does not recognize the faces of people? Yes, this is prosopagnosia, the inability to recognize faces, a symptom of damage to the occipital lobes. Can't orientate in space on the left hand, ignore the left side? Optical-spatial agnosia. Again, the occipital lobes. Can't recognize the glove? Object agnosia. Not aware of your illness? Anosognosia, more often occurs when the right, subdominant hemisphere is affected ... By the way, P.'s reflexes are higher when examined on the left side. But the fact that P. could not distinguish the hat from the head by touch ... Or the fact that he did not recognize the glove, even taking it in his hands ... It looks like the parietal lobes and their lower parts are affected. It seems that we are beginning to understand what is the matter.

However, by reasoning in this way, we are deceiving ourselves. For ordinary medical thinking, naming is equivalent to understanding. Determine the symptom, group the symptoms into a syndrome, relate it to a specific cerebral localization. Think over a treatment program. Well, for practical purposes, that's enough. But naming and understanding are different things. We fall into the trap of terms. Moreover, we, specialists, enjoy pronouncing these unusual words, akin to magic spells. Sachs also seems to be sorting through them - apraxia, agnosia, ataxia ... But let's translate these terms into Russian. A person does not recognize faces. We say he has prosopagnosia. Translated from Greek - the inability to recognize faces. The man says: I cannot be in open, crowded spaces, I am overwhelmed by fear. We say he has agoraphobia. Translated from Greek - the fear of open public spaces. In other words, we simply return what we have learned about the patient, but in a language incomprehensible to the uninitiated ... Most physicians, turning information about the patient into bricks of scientific terms, seem to build a wall between themselves and the patient - and consider their creation. Behind this wall is a living person, a unique personality. A scientist needs to make a considerable effort in order to break through the barrier that he himself has built. This is what Oliver Sachs does.

Psychiatry prefers to study pathology "with kings and poets." The more complex and beautiful the building, the more magnificent and attractive the ruins are. The most famous patients in psychoanalysis, for example, were exceptional personalities. Anna O. (pseudonym of Bertha Poppenheim), the first patient of J. Breuer and Z. Freud, later became famous as a pioneer of social work in Germany. She was called "the healer of humanity." The symptoms of this woman's illness were also unique, exceptional.

The patients of A.R. Luria were also unusual: one had an unprecedented will to live and courage, the other had a phenomenal memory. The same goes for Oliver Sachs' patients. On the pages of his book, one can find exclusivity and everyday life. Professor of music P. and "tic witty" are remarkably gifted individuals. And the manifestations of their diseases look much more interesting and complex. There are more lessons to be learned from these stories, and they lead to truly philosophical reflections.

But the tragedies of ordinary people are no less impressive. We see personality both in patients who have lost their memory and in "simpletons" - people with profound intellectual disabilities. How can we understand such patients, who cannot understand ourselves? Here is an autistic artist who cannot say a word - and who has turned drawing into the only way to communicate with the world. Here are two twins with phenomenal numerical abilities. But here, too, Sachs is interested not so much in the "trained" twins (he even uses an old clinical term far from political correctness - "scientists idiots"), as in the tragedy of these people, who were separated by doctors to "improve their social adaptation."

In my opinion, showing the reader the path to himself through understanding the patient's altered (but indestructible) personality is the main mission of Oliver Sachs.

Boris Kherson.

Preface by the author to the Russian edition

It is impossible to write a preface to the Russian edition of this book without paying tribute to the person whose work served as the main source of inspiration for its creation. Of course, we are talking about Alexander Romanovich Luria, an outstanding Russian scientist, the founder of neuropsychology. Despite the fact that we never had a chance to meet in person, I was in a long correspondence with him, which began in 1973 and lasted four years, until his death in 1977. Luria's large systematic works - "Higher cortical functions of man", "Human brain and mental processes" and others - were my reference books in my student years, but his work "A little book about great memory (Mnemonist's mind)" was a real revelation for me. published in English in 1968. Luria describes in it his thirty years of observation of a uniquely gifted, but in a certain sense flawed and suffering person, with whom he developed a personal friendship. In this book, deep scientific studies of memory, imaginative thinking and other cerebral functions are combined with a vivid description of the personality and fate of the mnemonist, with a subtle feeling into his inner life. Luria himself called this combination of human contact and neuropsychology a "romantic science," and he later brilliantly demonstrated this approach once again in his book The World Lost and Returned. If Luria had lived longer, he, as planned, would have written another similar work - a study of a patient with deep amnesia.

These two books played an important role in my life: working with patients and describing their fates and diseases, under the influence of Luria's ideas, I gradually came to my own romantic science. That is why my book Awakenings, written in 1973, is about Luria. This book is also closely related to him, especially the story "The Lost Sailor", where his letters are quoted - I think that such a study could have been written by Luria himself, although perhaps he would have devoted a separate book to the hero of this story, Jimmy.

I am very glad that "The Man Who Mistook His Wife for a Hat" is finally being published in Russian. I hope, after reading the stories of my patients, the reader will see that neuroscience is not limited to an impersonal science that relies mainly on technology, that it has deeply human, dramatic and spiritual potential.

Oliver SAX

New York, October 2003

The man who mistook his wife for a hat and other medical stories

To Dr. Leonard Shengold

Talking about disease is like telling the stories of The Thousand and One Nights.

William Osler

Unlike a naturalist, a doctor deals with a single organism, a human subject, struggling for self-preservation in a threatening situation.

Ivy Mackenzie

Foreword

"Only when you finish a book," Pascal remarks somewhere, "usually you understand where to start." So, I wrote, put together and edited these strange stories, chose a title and two epigraphs, and now I need to understand what has been done - and why.

Let us first turn to the epigraphs. There is a certain contrast between them - this is exactly what Ivy Mackenzie emphasizes, contrasting the doctor and the naturalist. This contrast is in keeping with the dual nature of my own character: I feel like both a doctor and a naturalist, illnesses are as much a concern to me as people. As equally (and to the best of my ability) theorist and storyteller, scientist and romantic, I simultaneously explore and personality, and organism and I clearly see both of these principles in a complex picture of the conditions of human existence, one of the central elements of which is disease. Animals also suffer from various disorders, but only in humans can the disease turn into a way of being.

My life and work are dedicated to the sick, and I owe some key thoughts to close communication with them. Together with Nietzsche, I ask: "As for the disease, I would very much like to know if we can do without it?" This is a fundamental question; working with patients forces me to ask it all the time, and trying to find the answer, I come back to patients again and again. In the stories offered to the reader, this continuous movement, this circle, is constantly present.

Research is understandable; but why stories, stories? Hippocrates introduced the idea of ​​the development of a disease in time - from the first symptoms to a climax and a crisis, and then to a successful or fatal outcome. This is how the genre of medical history was born - describing its natural course. Such descriptions fit well into the meaning of the old word "pathology" and are quite appropriate as a kind of natural science, but they have one serious drawback: they do not report anything about a person and his stories about the inner experience of a person who is faced with a disease and struggling to survive.

There is no subject in a narrowly understood case history. Modern anamnesis mention a person only in passing, in an official phrase (trisomic albino, female, 21 years old), which may just as well refer to a rat. In order to address a person and place in the center of attention a suffering, straining human being, it is necessary to take the history of the disease to a deeper level, giving it a dramatic narrative form. Only in this case, against the background of natural processes, a subject will appear - a real person in a confrontation with an illness; only in this way will we be able to see the individual and the spiritual in connection with the physical.

The patient's life and feelings are directly related to the deepest problems of neurology and psychology, since where personality is affected, the study of the disease is inseparable from the study of personality and character. Some disorders and methods of their analysis, generally speaking, require the creation of a special scientific discipline, "personality neurology", whose task should be to study the physiological foundations of the human "I", the ancient problem of the connection between the brain and consciousness.

Perhaps between the mental and physical indeed, there is a conceptual-logical gap, but studies and plots devoted to both the organism and the personality are able to bring these areas closer together, bring us to the point of intersection of the mechanical process and life, and thus clarify the connection between physiology and biography. This approach is especially interesting to me, and in this book I generally adhere to it.

The tradition of clinical stories built around a person and his or her destiny flourished in the nineteenth century, but later, with the development of impersonal neurology, began to gradually fade away. A.R. Luria 1
A.R. Luria (1902-1977) - Russian neurologist, founder of neuropsychology. ( Hereinafter, except for specially stipulated cases, translators' notes).

Wrote: “The ability to describe, which was so widespread among the great neurologists and psychiatrists of the nineteenth century, has now almost disappeared. It needs to be restored. " In his later works, such as The Little Book of Great Memory (Mnemonic Mind) and The Lost and Returned World, he tries to revive this lost form. The stories from clinical practice that came from Luria's pen are connected with the past, with the traditions of the nineteenth century, with the descriptions of Hippocrates, the first medical historian, with the long-standing custom of patients telling doctors about themselves and their diseases.

Classic narrative plots revolve around archetypal characters - heroes, victims, martyrs, warriors. The neuropathologist's patients embody all these characters, but in the strange stories told below, they appear to be something more. Are the images of the "lost sailor" and other amazing characters in this book reduced to the usual myths and metaphors? They can be called wanderers - but in unimaginably distant lands, in places that would be difficult even to imagine without them. I see in their wanderings a reflection of a miracle and a fairy tale, and that is why I chose Osler's metaphor as one of the epigraphs - the image of “A Thousand and One Nights”. There is an element of parable and adventure in my patients' medical records. Scientific and romantic merge here - Luria liked to talk about "romantic science" - and in each of the cases described (as in my previous book "Awakenings"), in every destiny we find ourselves at the crossroads of fact and myth.

But what amazing facts! What fascinating myths! How do you compare them? We do not seem to have models or metaphors for making sense of such cases. It looks like the time has come for new symbols and new myths.

Eight chapters of this book have already been published: "The Lost Sailor", "Hands", "Gemini" and "The Autistic Artist" - in the New York Book Review (1984 and 1985), "The Tic Wit", "The Man Who Accepted wife for a hat "and" Reminiscence "(in an abbreviated version called" Ear for Music ") - in the" London Book Review "(1981, 1983 and 1984), and" Eye-Spirit Level "- in the journal" The Sciences "(1985) ... The chapter "Rush of Nostalgia" (originally published in the spring of 1970 in The Lancet magazine under the title "L-Dopa and Nostalgic States") contains a long-written account of a patient who later became the prototype of Rose R. from Awakenings and Deborah from Harold's play. Pinter's "Something Like Alaska." Of the four fragments collected in the Phantoms chapter, the first two were published in the Clinical Cabinet of Curiosities, British Medical Journal (1984). Two more short stories are borrowed from my previous books: The Man Who Fell Out of Bed from The Foot to Stand, and The Visions of Hildegarda from Migraine. The remaining twelve chapters are being published for the first time; they were all written in the fall and winter of 1984.

I would like to acknowledge my deep gratitude to my editors — most notably Robert Silvers of New York Book Review and Mary-Kay Wilmers of London Book Review; Keith Edgar and Jim Silberman of Summit Books in New York and finally Colin Haycraft of Duckworth in London. Together, they were invaluable in helping to get the book into its final shape.

I would also like to express special gratitude to my fellow neurologists:

- to the late James P. Martin, to whom I showed the videos of Christina and Mr. McGregor. The Chapters "Disembodied Christy" and "The Eye-Spirit Level" were born out of detailed discussions of these patients;

- Michael Kremer, my former chief physician from London. After reading my book A Foot to Stand (1984), he related a very similar case from his own practice, and I included it in the chapter “The Man Who Fell Out of Bed”;

- To Donald Macrae, who witnessed an amazing case of visual agnosia, similar to that of Professor P. I accidentally discovered his report two years after the publication of my story. Excerpts from his article are included in the postscript to the story of "the man who mistook his wife for a hat";

- Isabella Rapin, colleague and close friend from New York. I discussed many of my cases with her; she asked me to look at the "disembodied" Christina and for many years, from his very childhood, she watched Jose, an autistic artist.

I am infinitely grateful to all the patients (and sometimes their loved ones), whose stories are told in the pages of this book. I thank them for their disinterested help and generosity, I thank them for the fact that, even knowing that my scientific interest would not help them in any way, they encouraged me and allowed me to describe what happened to them, hoping to help others understand and, possibly, learn to cure diseases from which they suffer. As in The Awakenings, in keeping with medical confidentiality, I changed the names and some circumstances, but in each case I tried to preserve the basic feeling.

Finally, I want to express my gratitude - more than gratitude - to Leonard Shengold, my teacher and physician to whom this book is dedicated.

Oliver SAX

Oliver Wolf Sachs

The man who mistook his wife for a hat and other medical stories

From translators

We would like to express our deep gratitude to everyone who helped in the work on this book, especially Aleksey Altayev, Alena Davydova, Irina Rokhman, Radiy Kushnerovich, Evgeny Chislenko and Elena Kalyuzhny. Translation editor Natalya Silantyeva, literary editor Sofya Kobrinskaya and scientific editor Boris Khersonsky can rightfully be considered co-authors of the translation. Finally, without the participation of Nika Dubrovskaya, the appearance of this book would have been impossible at all.

Foreword by the Science Editor

Having received an offer to edit the translation of the book of the famous neurologist, psychologist and writer Oliver Sachs "The Man Who Mistook His Wife for a Hat," I agreed without a moment's thought. This book, a gift from an American colleague, has been standing on the shelf of my closet next to the works of A.R. Luria for fifteen years. Over the years, I have come back to it many times. When teaching a course in neuropsychology, it is simply impossible to refrain from quoting Sachs. But "The Man Who Mistook His Wife for a Hat" is much more than a special monograph or manual for a teacher and a doctor.

Oliver Sachs is one of the most famous names in his field in the West. And his popularity goes far beyond the boundaries of a narrow professional environment.

He was born and educated in London and continued in the United States. Since 1970, his books - "Migraine", "Awakenings", "Leg to Stand" - have won readers over. The book that the reader picks up is the fourth in a row and one of the most significant works of Sachs. This is not to say that Sachs is not known at all in Russia. Several of his essays entitled "Cases from Practice" were published in the journal "Foreign Literature". His works are cited by Russian authors - both neuropsychologists and writers (for example, Tatiana Tolstaya). But the real acquaintance with the work of Oliver Sachs for the Russian reader is still ahead. How to define the genre of this wonderful book - popular, scientific? Or is there something else here? On the one hand, the book is devoted to the problems of neurology and neuropsychology. The topic assumes a fairly narrow circle of readers. This is not to say that Oliver Sachs resorts to simplifications to attract the attention of the uninitiated. On the contrary, his approach is more complex than the schematized presentation of material in a textbook and monograph. It is not what Oliver Sachs writes about that decides the matter, but how he writes. The language of the book is lively, captivating, with a penchant for word games and literary associations. Neither medical slang interferes with perception (well, who else can call a patient with Gilles de la Tourette's syndrome a “turette?”), Nor the abundance of special terms, nor the listing of chemicals, the existence of which is simply not known to most.

Can you imagine a "neurological play" or a film based on a special monograph? Probably, in this case, the monograph should carry something special - drama, internal dynamics, the intensity of passions. And its hero should be a person, not his illness. This is precisely the most important feature of Sachs's work. And it is not surprising that his book "Awakenings" became the basis for the play by Harold Pinter, and was later filmed. It's hard to imagine a chapter from a monograph or a popular science book on the opera stage. But this is exactly what happened with the book I am offering you. An opera based on it was written by Michael Nyman, a popular contemporary composer, author of music for most of Peter Greenaway's films. I think the plot attracted the composer not so much because the main character is a famous musician. Music is present in the book itself - the rhythm and, if you like, the melody. The reader will catch it in the same way that the hero, listening to the noise in the street, caught a certain symphony in it. Music constitutes the inner world of a person who is deeply inferior in other respects, filling not only his memory, but also his soul. Music transforms the awkward, dysplastic Rebecca, in the dance her movements acquire grace. Music remains the only force organizing the life of Professor P., who "has his own melody for every action."

It seems that every reader can find something of their own in the book. Someone will be interested in the "Kunstkamera" - amazing neuropsychological stories. For another reader, Oliver Sachs's book is a small tragedy, where in the foreground is not illness, ugliness, but experience, fate, the intensity of a person's struggle with illness. Tragic is the misunderstanding of one's position, even more tragic is the realization - for a moment. For a physician, here is an in-depth description of complex and rare clinical cases. For a psychologist, this is an attempt to comprehend the human soul: a breakdown reveals the hidden. Where can we find a reader who is as versatile as the author?

I am convinced that such a reader exists. And his meeting with this book will be the beginning of a long friendship. He will read all the other books of Sachs, amazed at the persistence of the author, who, defending the main thesis, each time discovers something new. For us. But above all for himself.

It is amazing that Oliver Sachs, a man of great clinical experience, manages not to lose the ability to wonder. Each of his descriptions is imbued with this feeling.

In Oliver Sachs's book, the reader will find a certain duality. The author is a doctor, and all the stereotypes of traditional clinical thinking are inherent in him. He dreams of understanding the human soul through the physiology of brain structures. He believes in miraculous substances that "wake up" patients. He is characterized by the optimism of a scientist professing the principles of positive science. He sees the brain as a magnificent machine, extremely complex and well-coordinated. A machine whose breakdowns are as extraordinary as its normal operation. However, a person begins to think about the structure of the mechanism mainly when this mechanism fails. Sachs never verbalizes this approach. On the contrary, his entire consciousness protests against mechanism. Sachs, a philosopher and writer, gets into an argument with traditional medical thinking. He's not just talking about brain structures and neurotransmitters.

He talks about archetypes, symbols, myths. Speaks emotionally, excitedly. It is clear to the reader which side the victory is on. The romantic worldview triumphs. It is no coincidence that A.R. Luria dreamed of romantic neurology, and Sachs picks up this idea. The heterogeneity of the book's material, the variety of the problems touched upon in it requires synthesis. This synthesis is almost impossible intellectually. And this is where passion comes to the rescue.

The book also covers philosophical issues. What is the nature of the disease as such? What is health? What does illness do to the psyche? Does it always take away - or does it sometimes bring something new and even positive into the human soul? The structure of the book itself answers this question. Its main sections are called “Loss” and “Surplus”. But even in the “Loss” section, Sachs agrees that at some level, illness can enhance the creative potential of an individual. Professor P., losing the ability to visual perception, goes from realism in painting to cubist and abstract canvases. And although in the end the hero's artistic abilities come to naught, but "halfway through" he clearly acquires new qualities of style. Even in the inexhaustible inventions of another patient - a person who has lost his memory, Oliver Sachs sees creativity.

For a psychiatrist who is used to separating symptoms into “productive” and “negative,” add and subtract, this problem seems obvious. After all, if an ordinary person does not have hallucinations and delusions, and at there is a patient, then, therefore, we are talking about products, albeit pathological. And again, if the consciousness is deeply clouded, then we are talking about a loss. But if bizarre images invade consciousness, filling the inner space along with the impressions of the real world, then we are talking about qualitative, productive disorders. However, Sachs' understanding of loss and excess is more complex and, it seems to me, closer to the truth.

Yes, full, is there an excess? If it does, it is only as a result of a lack of some other factor that disturbs the balance. The easiest way to illustrate this thesis is on the example of a complete loss of the ability to memorize (Korsakov syndrome). Confabulations (fictions, fantasies), as a rule, occurring with memory loss, are a productive symptom. But after all, confabulations only fill a huge flaw - the void that has formed in the psyche of a person who is unable to preserve true impressions in his memory. Yes, crazy ideas are products. But Freud at one time showed that the delusional worldview of the paranoid is just a flawed attempt to recreate some semblance of harmony in the place of the destroyed psyche disease. Any disease includes not only changes, but also reactions to these changes: on the part of the structures of the brain - at the physiological level, on the part of the patient's psyche - on the psychological level, and also on the part of loved ones and society ...