This book contains a number of case studies from the career of the neurologist Oliver Sacks. The people described have a number of unusual conditions that affect how they perceive and interact with the world. The introduction in my copy by Will Self was quite hard to understand as he takes the opportunity to show off how many obscure words he knows. But the gist is that Sacks was aiming to revive a tradition of case studies that had fallen out of fashion, in order to bring medicine back into the personal realm, rather than dehumanising patients by treating them only as another data point. Fortunately the rest of the book is a lot easier to read than Self’s introduction, even though Sacks uses a few specialist words I didn’t know.
The case studies describe several patients with interesting and unusual neurological conditions. We find out how Sacks examines them and the tasks he gives them in order to determine the nature of their conditions. Many of the conditions result in the absence or diminution of those characteristics that we think of as making us human, or greatly affect the patients ways of perceiving and interacting with the world. In some cases other abilities have been enhanced in place of those faculties that have been lost. Sacks speculates about what the inner life of these people is like, and naturally I found myself as the reader speculating about my own humanity, and the faculties I rely on. Sacks’ aim with these patients, if they cannot be cured of their conditions, is to give them an environment and activities that engage those parts of them that are functioning well. Sacks is compassionate throughout, and clearly cares deeply about his patients, so I think this book manages to avoid the risk of being a “freak show” of people with strange mental deficiencies and abilities.
There is very little time in this book for the view of the brain as a computer, or for describing any of the information processing capabilities of the brain in terms of physical structures. Although parts of the brain are occasionally named and mentioned as being damaged or responsible for certain abilities, you won’t learn much about the brain from this book. Sacks deliberately takes a less scientific tone, and even expresses a belief in a person’s soul. I wondered whether this unscientific tone would limit the usefulness of this book for helping future patients with similar conditions. In terms of finding cures for their conditions, perhaps it wouldn’t be very helpful. But in terms of finding ways to engage and interact with them, based on the approaches that have worked with similar patients, these types of case studies might be useful. While one or two of the patients’ conditions are temporary and clear up of their own accord, and others are more or less successfully treated with medication or other methods, most of the patients are stuck with their conditions. However, there are hopeful stories for those patients for whom Sacks encourages engagement, such as one patient who finds meaning through gardening.
For me, the most fascinating case from a scientific perspective was that of ‘The Twins’. They have some amazing mathematical abilities without appearing to use conventional arithmetic or logic to achieve them. They can name the day of the week for any date within 40,000 years of the present. They play games with each other that involve naming prime numbers. When Sacks joins in (using a book listing the primes) the twins were able to tell that the 8 digit number he quotes is prime. Interestingly, it takes them longer to determine primality for larger numbers, just as a computer algorithm would. But they are not capable of describing how they are doing this, so we are left to speculate.
I enjoyed the stories in the book, finding them both disconcerting and warm-hearted. This book will make you think, and it may make you more appreciative of your own mental faculties.